In September 2015, Cayuga County health officials made a horrific discovery — a 2 1/2-year-old child poisoned by lead.
The health effects of lead poisoning are irreversible and often devastating: a lowered IQ, decreased learning and memory, decreased verbal ability, impaired speech and hearing, and early signs of attention deficit hyperactivity disorder. Children are at greater risk than adults because their bodies are still growing, absorbing more of the toxic substance when exposed to it.
Lead paint that's peeling, chipping or flaking is usually the cause. Children may chew on a windowsill, breathe in the dust or put their fingers in their mouths when they have paint residue on them, said Deanna Ryan, senior public health educator with the Cayuga County Health Department.
Levels in this Auburn child's blood were so high that she was immediately admitted to Golisano Children's Hospital in Syracuse, where she required one, then two rounds of chelation, a painful and expensive intravenous procedure that helps the patient excrete lead and other heavy metals through the kidneys.
In order to be discharged from the hospital, the child needed to have a lead-safe environment to go home to, Ryan said. At first, she did.
But her family moved without notifying the health department, and for a while, Ryan said, they lost touch with the family. In 2017, they found her living across the street from the original residence. They tested the child's blood and her levels had jumped back up 10 points.
"The neighborhoods play into this," Ryan told Cayuga County legislators at a Feb. 27 meeting.
While this little girl's case has been a sorry lesson for families and state and local officials, her circumstances spurred the creation of the Cayuga County Lead Poisoning Prevention Task Force.
In its approximately two years of existence, much has been done to decrease lead poisoning in children across the county, but the health department is considering a new measure to reach even more families: declaring areas of high risk. It's an option under state Public Health Law, said Cayuga County Health Director Kathleen Cuddy, and it allows officials to enter homes in those areas and test for lead paint sooner rather than later.
"It provides us as a health department a mechanism to go in and lead test residences without the trigger of having a lead-poisoned child already in the home," Cuddy said in a phone interview after Ryan's presentation to lawmakers. "Depending on how we move forward with that, there are quite a few neighborhoods and/or properties that could be designated as such, and if we do that, it is our responsibility to continue to follow up on these residences and that takes human power, that takes people to follow up, who have the skill set and have been trained."
The federal government banned lead paint in 1978, but about 95 percent of housing in the city of Auburn was built before 1975, Ryan said. Since January 2010, 30 children in the county have had concerning lead levels in their blood and were monitored by health department staff. Of those, 22 lived in the city, and 16 lived in rental units.
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Three children between 2013 and 2015 have required chelation therapy, one round of which costs nearly $33,000 at Upstate Hospital in Syracuse, Ryan said. No children required the medical procedure in 2016 or 2017.
Certificates of occupancy are required for rental properties, which has been one way the task force relies on code enforcement to make sure housing conditions are safe for children. Jennifer Haines, director of Auburn's Office of Planning and Economic Development, told legislators that there are about 12,000 housing units in the city, about half of which are rented. While the city added another code enforcement officer recently to help keep up with inspections, she said it's still "really overwhelming."
Another stem to the problem involves public assistance from the county. The task force discovered that the Department of Social Services does not require an inspection in order to issue a subsidy to a family. Through the Cayuga County Healthy Neighborhoods Program, officials have discovered instances where families were housed in unsafe lead-filled environments.
Legislator Andrew Dennison asked Feb. 27 if the county should have a policy to make sure housing is livable if its giving county assistance.
"Those are some of the conversations that we're having with Department of Health and other programs that provide housing," said Cayuga County Administrator J. Justin Woods. "That's something we have to look at very, very seriously. We're subsidizing where people live — is it adequate and safe, especially a place with small children."
Besides using public health law to inspect more homes, the health department it also looking into options to legally require a landowner or homeowner to correct hazards when they're identified. Cuddy said it is getting attorney input on this. The department also hopes to have certificate of occupancy inspections available to the public online, similar to how real property records are on the county's website. Along with this, it hopes the Department of Social Services will only provide subsidies for properties with a valid certificate.
All of these provisions will take time, Cuddy said, and she hopes legislators will think about the information that was presented and make some decisions on moving forward. The department will be making a similar presentation before the Auburn City Council in April, too.
As for the toddler who helped spur this movement, Cuddy said the health department is still monitoring her condition, about two years later. It takes time to bring blood lead levels down, she said, calling the irreversible effects of lead poisoning "heart-wrenching."
Legislator Keith Batman, who is on the task force, spoke up after the Feb. 27 presentation.
"This girl, this child, at the age of 2 1/2's life is ruined," he said. "This child went from a normal, healthy kid with a future, to a child who has no future. The doctors on the Board of Health, when those (blood lead) numbers were mentioned, each and every one of them went (gasps). Literally, there was an intake of breath. This child will be lucky if she can function at all. That's the significance of this. Of course it's expensive, but these are lives that are ruined because paint was not taken care of. I mean, it's terrible. It breaks my heart, as I'm sure it breaks all of your hearts."