Catholic Health World

Saint Francis Hospital gets the lead out in Hartford

Hospital teams with competitor, philanthropists and government to tackle public health problem

Herman and Terri Gwynn of East Hartford, Conn., were happy to buy their colonial-style home in 2003. It was room enough for their growing family.

"It's noisy, but it's a good house," said Herman Gwynn.

But 2009 was a bad year. Herman lost his job as a courier, and Terri was laid off by a bank. And they learned that Daniel, the second-youngest of their five children, had a dangerously high level of lead poisoning — 58 micrograms of lead per deciliter of blood, or almost six times the federal definition for poisoning.

The source was old lead paint in their home, built in 1925. Daniel has a form of autism that propels him to chew almost constantly, and he had been chewing on windowsills that were contaminated by old paint.

"The doctor said Daniel couldn't go back home," said Herman. "We didn't have jobs. Where were we supposed to go?"

The answer was the Lead Safe House in Hartford, a place where families can live until they can return home or find another dwelling. Saint Francis Hospital and Medical Center runs the seven-apartment program as part of a regional lead-poisoning treatment system that includes Connecticut Children's Medical Center and other local organizations.

Herman and Daniel, now 5, spent almost three months in the Safe House while the boy underwent outpatient treatment. Terri and their other four children, none of whom had lead poisoning, joined them while workers for an affiliated program installed new doors and windows, and removed vestiges of old paint.

The family returned home in October. Daniel's lead levels are decreasing. "Now it's safe for him to chew," Gwynn said of his son.

Low-income children at risk
Dr. Lisa Menillo, who runs the program for Saint Francis Hospital, said lead poisoning continues to be a serious medical issue, especially among lower-income children who live in older homes and apartments. In Hartford, a city with many older dwellings, 1.4 percent of the children two years and younger have blood lead levels that are higher than recommended by the Centers for Disease Control and Prevention.

Menillo said the number of cases has decreased since 1993, when she helped to create the Hartford Regional Lead Treatment Center. But, she said, there still are too many young patients like Daniel Gwynn.

"Our goal has always been to work ourselves out of a job," said Menillo. "We're not there yet."

Saint Francis manages the Hartford Regional Lead Treatment Center in cooperation with Connecticut Children's, where Dr. Hilda Slivka, who is Menillo's partner in the collaborative program, is treating Daniel. The regional program manages the Safe House, actually two buildings side by side that house the office and the seven apartments. The site is a few blocks away from Saint Francis.

The Safe House gives families a place away from their contaminated homes while their sick children are undergoing treatment. Menillo said the cost of placing a family in the Safe House is only about a fifth of keeping a child long-term in a hospital. In addition, she said, a family living in the Safe House has more time to get its own dwelling made safe, or find new housing.

She said about 600 children and their families have stayed in the Safe House since it was opened in 1994. Aetna, a national insurance company with its corporate headquarters in Hartford, made the buildings available and eventually deeded them to Saint Francis.

Reaction rather than prevention
Lead contamination is a stubborn public health issue, and it is one that preys on children. Public health experts maintain that even low levels of chronic lead poisoning can interfere with development of growing muscles and nerves and have a permanent impact on a child's attention span and cognitive development.

The federal government banned lead from residential paints in 1978, but many dwellings, especially those in lower-income neighborhoods, still are contaminated. Menillo said the most common source of lead poisoning for children is paint dust, which they ingest by chewing wood surfaces or putting their dust-covered fingers into their mouths.

"This remains a problem because we aren't yet truly doing primary prevention in the form of fixing the housing stock," Menillo said. "We're still using the child as the canary in the coal mine. Once the child is poisoned, then we get around to fixing the home."

The lead remediation of eligible homes in the Hartford area is done through an affiliated program that is funded by the U.S. Department of Housing and Urban Development. The Gwynn's home was fixed at no cost to them.

Saint Francis manages the Safe House annual budget of $380,000, about half of which is financed by a state grant. Among other expenses, the money pays the salaries of staff members who manage the building and help the families.

Treatment, plus respect
Herman Gwynn is full of praise for the Safe House staff. "Most times, a relationship between a landlord and a tenant is, at best, cordial," he said. "The people (at the Safe House) treated us with total respect. It was a good experience for us."

The Safe House employs three people, including an outreach worker who makes follow-up visits with families. Both hospitals operate pediatric clinics that test and treat children for lead poisoning. They screen almost 5,000 children annually.

Menillo said that she began the lead-treatment program at Saint Francis with little more than "a bunch of names on a legal pad of kids who had lead poisoning." The Hartford Foundation for Public Giving, a local charity, gave the grants that allowed the two hospitals to develop their joint lead poisoning program and renovate the Safe House buildings.

When either of the two hospital clinics find children whose lead levels are at least 10 ug/dl (micrograms of lead per deciliter), they begin treatment. At levels of 20 ug/dl, workers are sent to examine the family dwelling for contamination, and the family is eligible for Safe House residency. Children whose levels are at least 44 ug/dl are hospitalized for chelation therapy to remove lead from the blood.

Menillo said the program reduced its basic screening level to 10 ug/dl from 20 ug/dl in 2008. And she said recent research indicates developmental harm at levels as low as 3 ug/dl. The state of New York now considers 5 ug/dl to be toxic.

Measurable impact
The good news is that the number of serious pediatric lead poisoning cases has declined, Menillo said. In 1994-5, the hospitals treated 161 children who had levels of at least 20 ug/dl. In 2006-7, they had only 18 such cases, although the number jumped back to 35 in the following year. Forty children received chelation treatment in 1996-7, and 12 in 2008-9.

Those declining numbers are one reason why lead poisoning doesn't get the public attention it received in the 1970s, when paint formulations were changed.

Last September, a group of volunteers from UnitedHealthcare in Hartford repainted apartments in the Safe House. Menillo said some of the volunteers were surprised to learn that lead paint contamination remains a big problem.

Menillo looks forward to the day when lead poisoning in children can be spoken of in historic terms, but that day is not yet in sight.

Copyright © 2010 by the Catholic Health Association of the United States
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