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Our basic problem is being able to sell an ongoing screening program. This is what I think is very important at the local level.

As the mayor said, this should be just as an important thing as screening children for tuberculosis, PKU, which is a disease which causes mental retardation, just as we give all the kids immunization for rubella; this is just as important.

So we had some in-service training of nurses and sanitarians so they knew more about the disease. We implemented a screening program, which is conducted 1 day a week in the health department where the children can be referred in or can walk in if a family is so disposed to have the child examined.

The results are forwarded to the family's private physician or to the pediatric clinic at the hospital.

One hundred and forty-nine samples certain was not my goal. We encountered a number of problems. One of the big problems is that we find in a family where there is a potential of lead poisoning, the family may have two or three appointments before the child is finally seen. The reason for broken appointments can vary from transportation to the weather to conflicts with employment, or something of that nature.

We also find, Senator—and this is very important—that these families where the child that manifests pica have a multiplicity of problems within the family: low income, low level of education, large number of children, with a mother who is simply unable to observe and care for all the children.

Then this has its effect upon the family,

In addition, because of their income, they are forced into poor housing, which is deteriorating, often where there is peeling paint.

With regard to the enforcement, I was surprised at the statistics to see that we were that successful in abating as many leaded environments as we did without court action. We do have an ordinance, and we have yet to go to court.

But, as the testimony has indicated earlier, in some cases there is a delay of up to 100 days before a child can be placed back in the environment in which the normal family lives.

It normally takes 2 to 3 weeks before the child is deleaded in the hospital. But we need funds at the local level to be able to go into a dwelling unit and render it such that the child cannot ingest any more material, and we do not cause these family problems.

We simply do not have the money at the local level to be able to do this in the beginning, and I think funds should be made available through the Federal grant-in-aid program where we could use it either as a revolving fund or use it for certain specialized situations where the money has to be available.

I would hope that pretty much capsulizes. If you have any questions, I would be happy to answer them.

Senator KENNEDY. How many children are covered in the program?

Mr. BYRNES. We screened in the clinic 149. There are probably, I would say, another 50 percent of that number that are still broken appointments that we are trying to get back in.

Senator KENNEDY. These are the target areas?

Mr. Hart. No. Our city is a target area, Senator; and we have families deriving income in the ethnic backgrounds throughout the entire

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city, so it was not directed toward one central part of the city. The housing patterns are very diverse throughout the city.

We tried to direct it toward the child who had the potential symptoms of disease rather than just the mass screening.

Senator KENNEDY. Tell me, Mr. Mayor, have you an application now in HEW for any kind of help and assistance at all?

Mr. Hart. For lead poisoning? No, we do not.
Mr. BYRNEs. The forms are sitting on my desk.
Senator KENNEDY. You are in the process?
Mr. HART. We are in the process.

Senator KENNEDY. I am not sure it would have done very much good because they have not let any money out under that $7.5 million.

Mr. Hart. We are waiting.

Senator KENNEDY. What can you tell us? We are talking about $50 million here. What would it cost to do the job that needs to be done in terms of this problem in your community alone?

Mr. HART. $72,000 is the beginning. This is what we are estimating to screen 3,000 children in our community. That probably would not be maximum, but it would probably be the best we could do at the present time.

Mr. BYRNES. Health officers are very good, and he said they had some in-service training. They have been able to diagnose the cases much earlier than we have had others testify today.

We think with these types of money, anywhere from $75,000 to $100,000, we would really be able to work on the situation.

When you take a community such as ours where there has been a flight of whites from the larger and nicer apartment buildings within the community, and as black families move into the community, you are a great deal more involved in the walls being taken care of. The landlords seem to let down on the upkeep of the buildings. Then we get leakage from above. This is what starts the peeling of paint, and this is when you start the real problem.

Senator KENNEDY. How much of this request from HEW do you have in matching funds?

Mr. BYRNES. We would have no problem with in-client services. It is 75 to 25, so we could make it with no sweat.

Senator KENNEDY. That is not quite the answer I was looking for. Mr. BYRNES. I am sorry.

Senator KENNEDY. We have moved along in that nutrition program for our elderly, 90 to 10, which was just passed last year. Given, as I thought the mayor pointed out, something that really hits the inner city and the older communities that are heavily weighed down with the kind of tax burdens they do have—and this is something which I am sure exists in some of the rural communities as well—but certainly the highest incidence of lead-paint poisoning is in the older communities which I think would have a thinner tax base.

I think we ought to be considering moving to a 90 to 10 program contribution.

Mr. BYRNES. Certainly it would be very helpful to us. Mr. Hart. Especially with the tax base that we have in our town, which is higher than Newark.

Senator KENNEDY. We have made some progress in this to some extent in nutrition and a few of the health emergency manpower pro

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grams, and it certainly seems to me this would be the type of program for a target area, particularly since it is targeted for the most part into the under-served communities and older communities.

I think you have covered it pretty well. You have talked about the importance of reaching this ceiling in terms of the percent of lead. You have talked about the importance of screening programs, and the importance of the inadequacy of labeling in terms of really doing the job.

You refer somewhat to trying to provide some help and assistance to communities or landlords who had this problem, to help remedy the situation. That is also a feature of this program under title II.

We are not talking about a sort of giveaway to the inner-city landlords by any means, but I suppose it is a recognition that unless we are going to provide some sort of a carrot and stick, we are not going to get the job done.

Mr. Hart. I think Mr. Byrnes can answer that.

Mr. BYRNES. There are two things that I see that are important with the use of the moneys: No. 1, what we call summary abatement in code enforcement.

If we had a revolving fund of $50,000 to $80,000 we could immediately take action to free the environment from lead or accessibility of lead while the child is being deleaded in the hospital, so that we do not pose a problem on the family where the child is going to have to stay with an aunt in another part of town, et cetera. You are not going to disorganize the family. So we could make the arrangement to have paneling done, sanding done, whatever is needed in that unit, so that child could come home after his hospital stay.

In some cases, with our absentee landlords and with our resident landlords, they will not or simply cannot because of the tax structure of the community, and their own financial situation, go in and even in some cases put in $400 or $500 worth of work.

We would have to give some sort of support and arrange for some sort of tax lien, and try to recoup the money later.

. I cannot speak with too much authority about Newark, but I do know they have about 2,000 pieces of property up for tax sale; that most of it is being purchased for tax-sale purposes.

People live in these buildings; they have any number of code enforcement problems, and lead poisoning problems are included.

The other important point is—and I think we went over it just a little too lightly—we need to be able to provide medically indigent families with financial support or direct payment for the care of the child as he is seen as an outpatient or as he is seen in the hospital as an inpatient.

There are some families who fall in the gray area, who simply do not have the funds, and in some cases, this is an impediment to having a child admitted to the hospital, deleaded; and the problem goes on and on.

While it sort of departs from some of the traditional reimbursement programs that HEW has, we would like to see funds made available to provide for the direct care of the child that is staying in the hospital. The precedent is, I think, with your family training moneys it does provide for in-hospital care of patients and needs.

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Senator KENNEDY. Do you have a neighborhood health center in your community!

Mr. BYRNES. Yes.

Mr. Hart. We have one, and we are anticipating one in the model cities program.

Senator KENNEDY. Do you have any kind of program?

Mr. BYRNES. Actually, our neighborhood health center is, No. 1, in the basement of the health department, which has a clinical and laboratory facility. We do have a small neighborhood health center located in a public housing project for a limited degree of services.

Senator KENNEDY. I think you have been very helpful. My own impression from what you have told us here is that unlike 3 years ago when we introduced the legislation, I think the communities are prepared to develop these programs in a conscientious and comprehensive way.

Even the moneys we authorized at that time were woefully inadequate and were not administered, and I am going to offer amendments to increase significantly—we ought to at least double this authorization in any event, and we ought to certainly be able to insure that that is achieved.

Also, we are going to try to modify this percentage of community participation. I think it is useful to have some participation. I think it gives the program more standing generally within the community, and there is a greater interest to it; but that can be in service, and you are prepared to do this type of thing.

We ought to really begin to respond to this area. I think we know a good deal about it. I can remember last year we had some difficulty in terms-particularly in the House

of getting adequate kinds of authorization; but I think with this kind of record that we have had in the past few years, we are going to be able to try to do the job that ought to be done.

I want to thank you gentleman very much for your very helpful testimony.

Mr. Mayor, it is a pleasure to see you. We are glad to see that you have a good man in your health department.

Mr. Xart. Thank you very much.

Senator KENNEDY. The subcommittee adjourns until Thursday morning

(Whereupon, at 1:25 p.m., the subcommittee was recessed, to reconvene on Thursday, March 9, 1972, at 10 a.m.)

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