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Hidden dangers: Additional cases of lead exposure in Cairo public housing complexes revealed

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Cairo Elmwood Place

The windows and doors to some of the units at the Elmwood Place housing complex in Cairo are boarded up Saturday, Dec. 16.

CAIRO — Over the course of roughly a decade, from 2004 to 2015, when James Wilson and Martha Franklin were in leadership roles at the Alexander County Housing Authority, 13 children living in ACHA properties tested with elevated blood lead levels of at least double — and in some cases triple or almost quadruple — the Centers for Disease Control and Prevention’s recommended public health intervention level, according to data provided to the newspaper by Southern Seven Health Department.

Of those cases, each representing a unique child, 11 of the children were residing at the time at Elmwood or McBride, family public housing complexes in Cairo that Housing and Urban Development has slated for demolition. Two of the children were residing in the family public housing complex in Thebes known as Mary Alice Meadows.

The data obtained by The Southern Illinoisan only represent cases where the testing was conducted by Southern Seven Health Department, the local health department that provides services in the state’s lower seven counties, including Alexander. Other children may have been tested during that time frame by their family physician or in another health care setting. Duplicate cases, where a child’s blood lead levels were elevated on consecutive tests, are not included, according to the local health department.

As well, the data do not reflect cases of children that may have tested between 5 micrograms of lead per deciliter of blood — the CDC's recommended intervention level — and 10 micrograms per deciliter, the state's intervention level, which results in case management for the child, and potentially an environmental investigation of his or her environment.  

Lead exposure, particularly in very young children, can stunt development and lead to irreversible and lifelong health and social challenges. That's true even in low doses, particularly if the exposure occurs over a long period of time.

HUD claims former ACHA director falsified compliance with lead safety rules

HUD: Ex-director falsified compliance  

In a civil complaint filed late last month against Wilson and Franklin, in which the federal government is seeking hundreds of thousands of dollars in civil penalties and assessments under the Program Fraud Civil Remedies Act of 1986, HUD claimed, among other things, that Wilson and Franklin failed to follow the federal housing agency’s lead safe housing regulations, and that Wilson falsified compliance.

The complaint only cites one case, from 2003, of a child living at Elmwood and McBride testing with an elevated blood lead level. HUD spokesman Jereon Brown said the federal agency was unaware of the data obtained and reviewed by The Southern indicating there have been at least 14 additional cases since then (13 of the 14 cases were during the time Franklin and/or Wilson were associated with the ACHA, and one after) of children testing with elevated blood lead levels in ACHA properties.

In addition to the 2003 case, Brown said HUD was aware of only one other case, which was of a child testing with an elevated blood lead level earlier this year. According to Southern Seven Health Department's data, a child tested with an elevated blood lead level between 20 and 29 micrograms per deciliter some time in 2017.   

According to HUD officials and other experts on lead exposure in government assisted housing, the civil complaint against Wilson and Franklin marks the first time  in recent history that HUD has sought civil penalties against housing authority managers for alleged failure to comply with the agency’s Lead Safe Housing Rule and/or Lead Disclosure Rule, which both apply to federally owned or subsidized family housing constructed prior to 1978. Much of the ACHA’s housing stock was built pre-1978, the year the federal government phased out consumer uses of lead-containing paint.

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Cairo Elmwood Place

Some of the units at the Elmwood Place housing complex are boarded up, pictured here in December in Cairo.

The allegation is among many in the complaint that seeks hundreds of thousands of dollars in fines and assessments against the two, but is one of the most serious because it directly concerns the health and safety of children. It also raises a number of questions about HUD's ability to compel compliance with its lead safe housing rules and regulations.    

HUD’s civil complaint states that between 1991 and 1995, the ACHA conducted testing to identify lead-based paint, which concluded that it was present with in the ACHA units and common areas.

Although the ACHA conducted some abatement work on door frames, interior window frames, wood bathroom accessory rails and stairway rail caps in 1993 and 1994, lead-based paint remained on other sources within common areas and units, the complaint states. In September 2003, it was discovered that a child residing in an AHCA complex had an elevated blood lead level, which prompted the Illinois Department of Public Health to send a licensed lead inspector/risk assessor to conduct a lead investigation at the property.

In a letter dated Sept. 26, 2003, IDPH advised the ACHA that the risers, baseboard and tread at the complex (the name of the complex is redacted in the complaint) were “determined to be lead-bearing substances” that “must be monitored and maintained,” the complaint states.

In 2017, a year after placing the ACHA in administrative receivership, HUD conducted a lead-based paint inspection at Elmwood and McBride, both of which were built in the early 1940s. “The inspection confirmed that lead-based paint was present on stair risers and stair stringers throughout both properties,” the complaint states.

A labyrinth of lead safe housing laws, rules 

What the complaint doesn’t mention is that the IDPH note to the ACHA also stated there were “no lead hazards found” during the state health agency’s environmental investigation that year. According to IDPH spokeswoman Melaney Arnold, there have been five environmental investigations conducted at either Elmwood or McBride since 2000. Two were conducted between 2000 and 2005; one between 2006 and 2010; and two between 2011 and 2017, she said. 

Arnold said that during each of those five environmental investigations, lead-based paint was found, but did not pose an immediate health hazard to people. “Therefore, it needed to be monitored and have ongoing maintenance,” Arnold said, in an emailed response. “If it were considered an immediate health hazard, remediation would have been required."

Kert McAfee, lead program manager for IDPH, said that the health department was not able to trace the source of the lead exposure to the living environment of the children in any of the five cases. Water and soil also would have been tested for lead, he said. Generally speaking, where lead-containing paint is identified but intact, state laws and regulations do not demand immediate remediation action but direct the landlord to closely monitor those items for chipping and peeling paint, he said.

While lead-containing paint is among the most common sources of childhood lead exposure, other sources include water, soil and consumer products. Children could be exposed in their homes, or in another environment they frequent often, such as day care centers, schools or relatives' homes. 

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Lawsuit

In this photo taken in May 2016, peeling paint is seen on the ceiling of a bedroom in an ACHA Elmwood Place property in Cairo. Concerns have been raised about whether former ACHA directors neglected to test for lead-based paint.

Still, according to Southern Seven Health Department’s data reviewed by the newspaper, roughly one in three cases of tests revealing elevated blood lead levels in Alexander County between 2004 and Oct. 30, 2017, were of children living in the ACHA’s Elmwood and McBride properties. The state has designated the Cairo area a high-risk zip code for childhood lead exposure, based on a number of factors including poverty levels and the age of the housing stock. There has not been any new single-home residential construction in Cairo in at least 40 years.

Between 2004 and Oct. 30, 2017, there were 85 cases of cases of children testing with elevated blood lead levels in Alexander County — as defined by the state's intervention level of 10 micrograms per deciliter or greater — with 28 of those cases being found in children living in public housing in Cairo (26 cases) or Thebes (2 cases). Of note, these numbers are different and higher than the ones cited above because they include duplicate cases, where a child tested with an elevated blood lead level in one or more consecutive tests beyond the initial elevated case.  

Despite the test results showing at least a dozen individual children with elevated blood lead levels living at Elmwood and McBride over about a decade, this never prompted a complex-wide assessment of lead hazards at Elmwood or McBride. Though HUD now claims that Wilson and Franklin failed to follow lead safe housing rules and regulations, the federal oversight agency did not compel further lead testing until this year, as the developments were targeted for demolition and a transition plan finalized. The state also did not flag this as a potential development-wide concern.

Until recently, the complexes were home to more than 400 residents, about half of them children. The complexes have almost exclusively housed African-American families for years. On April 10, HUD officials announced they would begin relocating residents from Elmwood and McBride, and to date, about 95 of 185 families have moved, according to Brown.

According to Brown, only verified blood-lead levels, confirmed with a venous blood test versus a finger prick, are reported to HUD, and “HUD would not require lead hazard control if there was no finding of lead-based paint or lead-based paint hazards.” The Southern only cited cases provided by Southern Seven Health Department that were confirmed by a venous blood draw.

The data show that one or more unique cases of children tested with elevated blood lead levels (defined by Illinois's intervention level of 10 micrograms of lead per deciliter of blood or greater) in 2004 (two children), 2005 (two children), 2008 (one child), 2011 (two children), 2012 (3 children), 2014 (1 child) and 2017 (1 child) — according to the Southern Seven data provided to The Southern.

The reason why situations such as this fall through the cracks may be, at least in part, to blame on the hodgepodge of complex laws and regulations governing reporting of elevated blood lead levels, and what triggers intervention activities at the federal, state and local levels, and among different agencies at various governmental levels. There also have been numerous changes in recent years to these laws, rules and regulations.

At the state level, an environmental investigation, which is intended to identify the source of the lead exposure, is triggered if a child age 6 or younger has an elevated blood lead level at or above 20 micrograms per deciliter. (Prior to 2008, it was 25 micrograms per deciliter). As well, an environmental investigation is conducted if a child has three consecutive test results between 15 and 19 micrograms per deciliter. However, if any test result dips below 15, the process starts over — and three more consecutive tests of 15 to 19 micrograms per deciliter are needed to mandate an environmental investigation.

The rules are different if the child is between the ages of 0 and 2. In those cases, an environmental investigation is conducted for toddlers testing at 10 or greater micrograms per deciliter. Any child age 6 and younger with an elevated blood lead level of 10 micrograms per deciliter or greater is assigned a case manager from a local health department, but the environmental investigation is only prompted by any of the above scenarios, or by the special request of a physician. 

“It is convoluted. I will give you that, and we are attempting to simplify the regulations,” McAfee said.

HUD amends its Lead Safe Housing Rule 

It gets even more confusing when various federal regulations come in to play. While the state’s intervention level is 10 micrograms per deciliter for children age 6 and younger — or children through age 7 in places the state has designated high-risk zip codes — the CDC’s is 5 micrograms per deciliter for children under age 6.

For years, HUD’s intervention standard was a child living in a public housing complex with test results of 20 micrograms per deciliter or greater. That changed on Feb. 13, when HUD amended its Lead Safe Housing Rule to match the CDC’s intervention standards.

Under the old rule, public housing authority managers were supposed to report elevated blood lead level cases to their respective HUD regional office, but there was no time frame specified in the rule by which they must comply.

Public housing authority directors are also required to attest by signature that they followed all of HUD's lead safe rules and regulations as part of the agreement for receiving their annual capital funds. It's an agreement based largely on the honor system, and it's what HUD claims that Wilson falsified compliance with by signing forms that stated he had complied with lead safe housing rules and regulations, among numerous other unrelated HUD regulations. 

The amendments to the rule, which the agency began enforcing this summer, is an attempt to tighten HUD’s ability to provide effective oversight of its lead safe housing rules and regulations. It says housing authorities must notify both their respective HUD regional office and HUD Healthy Homes and Lead Hazard Control Office within five days of learning of a child testing with an elevated blood lead level of 5 micrograms per deciliter or greater, and also follow up with proof that required mitigation activities were undertaken in the short- and long-term. 

According to Brown, of HUD, the public agency’s reporting requirement timeline is triggered by its being notified of an elevated blood lead level case, not by when the medical health care professional determines that the child’s blood lead level is elevated. "In its rulemaking, HUD recognized that it does not control when medical health care professionals notify public housing agencies of case information," Brown said. 

And therein lies the rub, at least where it concerns housing authorities in Illinois.

Sharing health data an issue 

Except when a convoluted set of particular circumstances are met, as described above, or a specific request is made, property managers may never be notified by a respective local health department or the Illinois Department of Public Health. The state only notifies landlords of cases of elevated blood lead levels when an environmental investigation is prompted by one of the above scenarios.

That means landlords are not notified when a child tests with an elevated lead level of greater than 5 but less than 20 micrograms per deciliter, unless the child is ages 0 to 2. McAfee said that notification to landlords when an environmental investigation is not triggered could amount to a violation of health care privacy laws. It's a fine line to walk between ferreting out environmental sources of lead and patient privacy, he said. 

Therefore, HUD may never be notified either, at least where it concerns children in Illinois living in federally owned and subsidized housing, with the exception of the city of Chicago, which has adopted a more aggressive intervention standard. That makes it rather difficult for the federal agency to ensure local housing authorities are complying with lead safe housing rules and regulations, despite recent changes and the mass amount of effort that went into them.

Brown acknowledged that "challenges to adequate oversight" include a lack of reporting of cases of elevated blood lead levels to public housing authorities by parents, landlords, health departments and other sources. 

So does the confusing labyrinth of laws, rules and regulations; what’s described in this article is far from the unabridged version. That means while there’s little shortage of guidance on the state and federal books, targeted enforcement and intervention is a much more difficult task.

In Cairo, there’s also no definitive proof that the children testing with elevated blood lead levels were exposed through lead-containing paint.

HUD also tested the drinking water at Elmwood and McBride this March, and more than half of the 22 units from which water samples were taken tested at or above the Environmental Protection Agency’s action level of 15 parts per billion. Water filters were then installed throughout all of the ACHA’s properties. HUD did not take this action until a year after it took over the housing authority, only after announcing the relocation plan that includes giving vouchers to all residents of Elmwood and McBride, and requiring they move out. A move-out deadline has not been set. 

HUD also had the drinking water at Elmwood and McBride tested for lead the previous spring, not long after taking over the ACHA. HUD officials said that in the earlier test results, all came back favorable except one. HUD officials have said they cannot explain the reason for the change in results. The city’s water, which is supplied by American Water Co., did not test positive for lead, leading officials to believe the cause could be the joints of the copper water pipes. 

14 years later 

The civil complaint against Wilson and Franklin comes 14 years after the 2003 case HUD cites in that complaint of a child testing with an elevated blood lead level. 

The two were cited for allegedly failing to disclose to tenants all known lead-based paint and/or lead-based paint hazards at the property; failing to provide tenants with all records or reports available concerning lead paint hazards; failing to conduct risk assessments; failing to abate lead-based paint or conduct interim controls; failing to conduct visual assessments; and failing to conduct reevaluations of lead-based paint or lead-based paint hazards, all of which were required of housing authority managers administering public housing programs with federal dollars.

Wilson’s only comment in response to the civil complaint filed against him was that he wanted to “wish everybody a Merry Christmas.” The newspaper has never been successful in reaching Franklin.

HUD files fraud complaint against ex-ACHA officials; in response, former executive director wishes 'everybody a Merry Christmas'

The data and reporting concerns and the fact that there was not intervention sooner to determine the source of lead exposure for children living at the Alexander County Housing Authority, a relatively small housing authority compared to the roughly 3,800 nationwide, illustrates how difficult it is for HUD to get a handle on compelling compliance with its lead safety rules — and how easy it is for life-threatening hazards in federally owned or subsidized housing to potentially go unaddressed for years.

The data and reporting requirements are nuanced and painstaking to follow, gather and analyze. The consequences for not doing so — at the federal, state and local levels — are potentially dire and lifelong for the children whose hazardous environments go unaddressed. Emily Benfer, one of the nation’s leading legal experts on the prevalence of childhood lead poisoning in government-subsidized housing, said that HUD’s ability to compel compliance with its lead safety rules is a “major issue.”

Benfer, a distinguished visiting scholar and senior fellow at Yale Law School’s Solomon Center for Health Law & Policy, said the case in Cairo and others making headlines across the country in recent months and years are exposing these shortcomings on a broader scale.

HUD's Brown said the agency believes that its new rule on lead safety, which had a compliance date of July 13, will result in improvements in HUD’s ability to provide better monitoring and oversight of lead safety concerns at public housing authority and subsidized multifamily properties. Lead exposure in HUD-assisted housing is lower than in unsubsidized housing, Brown noted.

But Benfer questioned whether the new rule goes far enough to protect millions of vulnerable children living in government-supported housing in the United States. 

molly.parker@thesouthern.com

618-351-5079

On Twitter: @MollyParkerSI ​

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Molly Parker is general assignment and investigative projects reporter for The Southern Illinoisan.

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