One in 10 of Milwaukee’s young children have some form of lead poisoning. What should be done about it?
The network of Sixteenth Street Community Health Centers operates like something of a mini health department on the city’s South Side, and it’s feverishly fighting a public health crisis that the public, by and large, believes is over: lead poisoning. Sixteenth Street’s five clinics test every newborn and toddler they can, as most live in houses and duplexes built during the first half of the 20th century, when leaded paint was as commonplace in American cities and towns as the white picket fences it covered. The Milwaukee Health Department estimates that to this day, about 10 percent of Milwaukee children under age 6 have too much of the heavy metal in their bloodstream, per the latest standards of concern set by the Centers for Disease Control and Prevention (CDC). These elevated “blood-lead” levels, classically caused by toddlers inhaling old paint dust or sucking it off their fingers, can inflict withering neurological damage on adults and children, but especially the latter. Element Pb, as lead is denoted on the periodic table, can permanently slow their mental development, lower their IQ, and raise their penchant for impulsive and disruptive behavior.
No wonder doctors at Sixteenth Street were alarmed a couple of years ago when confronted with two months-old babies with near-astronomical blood-lead levels. The first, daughter to a young mother who was herself poisoned as a child, underwent three grueling “chelation” treatments – a somewhat dangerous procedure that forces lead out of the body – before the age of 6 months. “We had never seen anything like this before,” says Carmen Reinmund, an outreach worker in Sixteenth Street’s Department of Environmental Health. “There were paint chips in this little girl’s intestines,” she says, a puzzling discovery, as the youngster couldn’t yet walk or crawl and was exhibiting no outward signs of poisoning (infants sometimes don’t).
As is standard practice in such cases, Carmen and other specialists completed what they call “interim measures” at the South Side apartment where the baby and mother were staying. This amounted to vacuuming up paint chips and dust, and taping over window frames that were peeling badly. But the mother kept moving. “We kept chasing them,” Carmen says, vacuuming and chelating until the baby’s lead levels eventually went down.
How they’d risen so high in the first place remained something of a mystery. Some of the invading metal in the girl’s bloodstream, if not the paint chips in her intestines, could have crossed over from the mother’s blood and bones during gestation. One of the cruelties of lead poisoning is that the body mistakes the rather large Pb atoms for calcium, and stores them in the dental enamel and skeletons of young children, where they have a half-life of 20 to 30 years.
At the extreme end of the spectrum, lead poisoning can cause catastrophic brain damage, exploding blood vessels and reducing the victim to a comatose state, if he or she survives. Perhaps more troubling, however, is the fact that researchers have not yet found the opposite end of the spectrum – a concentration of blood-lead that is effectively nontoxic. Modern techniques can measure down to about 2 micrograms per deciliter of blood, and even this level has been found to inhibit the “synaptic pruning” that the brain must carry out as it matures into adulthood.
At 25 micrograms per deciliter of blood, the second lead-poisoned baby wasn’t testing high enough for chelation, which is normally performed at 45 micrograms or higher. But like the other young baby’s case, finding so much of the toxin inside a “non-ambulatory” infant opened up a mystery. Where did it come from? A home visit turned up lead paint, but nothing dramatic, and nothing close to the baby’s crib. “We just couldn’t figure out what was going on,” says Dr. Marcos De La Cruz, a pediatrician and clinical director of Sixteenth Street’s lead program. Finally, on a subsequent home visit, the mother revealed that while pregnant, she had suffered from the mental condition known as pica – which compels people to eat inedible things – and had swallowed up to a pound of dirt a day. In most American cities, the first few inches of topsoil remain contaminated with lead from decades of leaded exterior paint and gasoline exhaust, and so De La Cruz had a tentative conclusion: in-utero transmission.
The boyish young doctor, who grew up on the South Side, says he later heard that the child was doing “OK” for the time being. “Maybe with this 6-month-old who is now 2 years old, you don’t see it yet,” he says, but delays and deficiencies often turn up later in childhood, when a previously poisoned toddler first goes to school. In a third and more commonplace case, a lead-poisoned boy who struggled with speech delays at ages 3 and 4 benefited from speech therapy, but at age 9, began to founder in reading, even though his unpoisoned siblings were doing fine. “I’m looking back and saying this is probably due to the lead exposure,” says De La Cruz.
A study of about 2,600 lead-poisoned Milwaukee Public Schools students found that even after controlling for socioeconomic factors, the previously poisoned kids scored markedly lower on standardized tests than those without blood-lead histories. A related study found that lead-poisoned kids at MPS were three times more likely to be suspended, and such exposure accounted for about 23 percent of the discipline gap with white students in the district.
“Whenever I’ve done a lead project, lead has always turned out to be bad,” says Marty Kanarek, an epidemiologist at the University of Wisconsin School of Medicine and Public Health, and one of the MPS researchers. “It’s one of the most powerful neurotoxins we deal with. Our country was dumb in that we put lead in as a gasoline additive, so it was spread throughout the dust of our nation. And we put it all over our houses.” Kanarek has also studied the effects of asbestos insulation, PCBs, nitrous oxide and radon, all common environmental hazards that come with their own cautionary tales.
But there’s something inevitable about lead, a simple element that mining has delivered from deep underground. Because of old housing stock and blistering winters that erode exterior and window paint, states in the Northeast and Midwest have the highest rates of childhood poisoning. Wisconsin consistently ranks in the top 10, with by far the greatest concentration of cases reported in Milwaukee. Rates were once much higher. Under an older, looser CDC standard, some 32 percent of the Milwaukee children tested in 1997 up to age 6 came back as too high. That’s 3,456 kids. And while the numbers have declined, “There are still hundreds of kids each year who need not to have been poisoned,” says Paul Biedrzycki, the Milwaukee Health Department’s director of disease control.
Between 2010 and 2014, routine testing found dangerous levels of lead in the bloodstreams of about 3,300 children living in the city of Milwaukee, all of them under age 6. About 770 of these were residents of the South Side, as compared to almost 2,000 from the North Side. The state Department of Health Services tracks lead poisoning across the state and found that of the 88,000 Wisconsin kids tested in 2014, about 4,000 surpassed the CDC’s most recent limit of 5 micrograms. More than 50,000 childhood poisonings have occurred in the state since 1996, according to Marjorie Coons, the department’s lead program manager, and about 12,000 of those happened in cities with fewer than 50,000 people. “We have a lot of old housing,” she says. “You can have that old farmhouse anywhere.”
Old housing is inevitably the culprit, along with aging windows, where friction has slowly pulverized once-durable paint. Biedrzycki carts around an old, unopened pail of Dutch Boy, and its label advertises a strong-as-iron concentration of 88 percent white lead. He says that although the problem of deadly paint has refused to go away, the “funding is shrinking” for needed abatements and prevention, including that from the CDC. At the moment, the Health Department is spending down a $3.9 million grant from the U.S. Department of Housing and Urban Development to replace lead-contaminated windows in six ZIP codes on the North Side, with no money for the South Side. In the 1990s, Milwaukee helped to innovate the now-standard practice of focusing on window replacement instead of complete removal of all leaded paint from a house, which costs several times more.
This leaves the South Side with no access to the department’s signature windows program, which (after a lengthy qualifying process) pays for about 80 percent of the replacement costs. The department says that as grant funding for lead removal has declined, the city has begun to channel what dollars remain into the North Side’s most at-risk areas, which account for some 75 percent of Milwaukee poisonings. “We’re putting as much money into primary prevention as we can,” says Geoffrey Swain, the department’s medical director. “Primary” prevention means removing lead before it can poison someone, but the city still struggles to find enough property owners interested in using the program.
“I thought people would be coming out of the woodwork for windows,” says Biedrzycki. “Some [landlords] just don’t want to pay the 20 percent,” and others don’t want to invite in city inspectors. Secondary prevention, sometimes called the “canary in the coal mine” approach, involves waiting for a child to be poisoned and then removing the lead hazard. In official terms, this is the city’s elevated blood-lead program, and it often results in an inspector’s orders to abate.
Before the federal government banned lead paint for residential use in 1978, house painters would mix white and yellow lead pigments with oils (often linseed) and various chemicals to improve drying. The old cans often contained admonitions to “cleanse hands thoroughly” after use. The greater irony was that the Dutch Boy himself was a child, sometimes seen in ads painting a toy wagon with the highly opaque leaded paint. (“One coat!” the ads boasted.)
Kanarek, the epidemiologist, traces the first modern research on lead poisoning to the 1890s, although societies dating back to the Romans have born witness to the most visible of the mined metal’s effects, such as comas, convulsions and death. Kanarek worked for the EPA during its push to ban leaded gasoline, which persisted, in small quantities, until about 1995.
“It was a great battle,” he says.
In a sense, the campaign against poisonous paint in Milwaukee is just starting. The Health Department estimates that, so far, it’s made some 16,000 housing units lead-safe, but department spokeswoman Sarah DeRoo says that leaves another 130,000 “that pose a risk to young children visiting or living on the premises.”
“The public health resources are not there to handle that many kids,” says Kanarek. “This is a billion-dollar problem.”
The referral came to Carmen Reinmund on a blue sheet of paper, the “Interim Controls Referral Form.” A child in an apartment on South 28th Street had tested high for lead. Another outreach worker had visited the duplex over the winter and found the windows sealed-in with plastic sheeting to lower the heating bill. Even through the makeshift insulation, the worker could see the hallmark alligator-scaling of lead paint, just waiting for the 20-odd windows to blow open again and lightly dust the house with a contaminated snow. The child’s blood-lead levels had “come down” over a number of months, and now it was Carmen’s job to ensure they stayed that way while also expending little-to-no money, a few cleaning supplies and only a couple hours of her time.
She carried in her tools: a portable vacuum shaped like a silver egg and a duffel bag filled with industrial wipes and asthma-friendly cleaning supplies. “Hola,” she said, and consulted with the mother in Spanish, next to a framed picture of the Virgin Mary. Around them hung the photographs of four children, ages 3 through 19, the youngest three of which were home on summer break, watching TV and playing on an iPad. As Carmen pulled back some nearby drapes, she saw that the plastic was long gone and most of the windows stood propped open with pieces of wood.
The kitchen smelled like vanilla and sugar, and a handful of cilantro rested in a glass of water atop a narrow table. Paint dozens of layers deep covered two wide-open windows facing the table, and somewhere in the strata, she could detect the jigsaw lines that indicated lead. “It breaks in little pieces, like it’s a puzzle,” she said.
The day was clear-skied and springlike. “It’s so windy through these windows that the dust is blowing across the table where the kids are eating,” she said. In the apartment’s other rooms, she found children’s beds made with military precision and many more windows, low to the floor, the kind designed to facilitate airflow in an era long before air conditioning.
To the minds of children, lead can camouflage itself in a home environment filled with love, mouth-watering smells and an otherwise healthy upbringing. “You know the candy Sweet Tarts?” Carmen said. “It tastes just like that.” In the apartment’s central room, a dining table was piled high with a bowl of raw potatoes, deflating Father’s Day balloons, and a half-eaten cake. Carmen picked up her metallic egg, which was taped over with warnings and directions, and set to suctioning away whatever loose paint she could from the nearby windows. Scales and scraps skittered up the nozzle.
She wasn’t wearing a mask and said she only does for the most dramatically contaminated houses. Otherwise, she said, “After I leave the property, I could get a headache.” Although not studied as intensively as childhood poisoning, adult lead exposure carries its own risks, including gastrointestinal disturbances, anemia, and peripheral neuropathy, a neurological condition that causes weakness and numbness in one’s extremities.
Carmen’s work makes her something of the South Side’s lead fairy: She visits several homes a week, suctioning up and taping over lead hazards before they can poison children further. Pregnant women at Sixteenth Street tend to avoid such work for fear of the associated lead exposure, but Carmen doesn’t appear to have ever shied away. At the time of this visit in July, she was the only Sixteenth Street employee performing interim measures, and after vacuuming all 20 windows, she pulled down some blinds to point to an area of gray spotting. It indicated where lead paint – applied during manufacturing in a foreign country – had melted in the sun.
Carmen finished the interim measures by scrubbing the window wells with industrial tissues, sopping up a blackish layer of dirt and old paint. Sixteenth Street had been tracking this family for some time: Its lead case number, written on the blue referral sheet, fell in the 4,200s. The program’s latest numbers had risen to almost 7,000 families.
“I see a lot of behavioral problems and delinquency,” Carmen said. “Some [kids] are doing OK. Some are living day to day. The worst part is, parents don’t see the effects right away. You fall, you get a bump, you see it. With lead, you’re not going to see the effects until later.”
David Rosner had just completed an undergraduate degree in psychology at the City College of New York when he signed up for a research project at the imposing Kings Park Psychiatric Center, a dozen-story state-run mental hospital on Long Island. Part of his duties included steering young patients through intake examinations, which included drawing a straight line on a piece of paper or tracing a circle – failure to come close enough could signal a major error in mental functioning. Some of these children, he found, “couldn’t keep near the line. They were going in huge, oblong circles. They had real perceptual problems. I realized that these kids were suffering from real physiological damage.” It was 1968, and many had lead poisoning in their history, along with nutritional deficits, which can heighten the body’s absorption of lead.
Now a professor of public health and history at Columbia University, Rosner published a book called Lead Wars in 2013 – along with Gerald Markowitz of CUNY – that lays much of the blame for “the longest-lasting pediatric epidemic in American history” (Rosner’s words) on a handful of paint manufacturers. The big boys of lead, including Sherwin-Williams and National Lead (Dutch Boy), owned their own vertically integrated lead mines, and for as long as such mines have existed, so has “acute” poisoning resulting in comas and death. Science didn’t nail down Pb’s more subtle long-term effects until a series of Harvard studies in the 1950s, partly because blood testing methods remained primitive through the 1940s. Modern methods allowed testing to spread across cities and states in the 1970s, ’80s and ’90s, when Milwaukee began to track its lead levels.
Lead Wars drew on a roomful of industry documents obtained in a lawsuit by the New York City Law Department – which had sued the industry after the city itself was sued by public housing residents poisoned by lead paint. The records showed how the major lead-paint companies were more concerned about bad press than preventing poisonings, which they wrote off as a pox on uneducable black and Puerto Rican slums. This, of course, obscures how all socioeconomic strata used lead during its heyday, and in today’s Wisconsin, about a quarter of poisonings occur in cities with less than 50,000 people.
One of the country’s leading lead toxicologists, Paul Mushak, who helped to confirm the in-utero link between lead-poisoned mothers and their babies, works out of a small office in Durham, N.C. Other dangerous metals, such as thallium and arsenic, can inflict similar damage on the nervous system, he says, but not at such low doses. “Lead is almost in a class by itself,” he says. Rosner says that “the best researchers are so frustrated by this issue after 100 years,” and Mushak seems to be one of them. “It started out with, ‘If the kid didn’t die, lead poisoning was not a problem,’” Mushak says. “Then it went to, ‘If the kid wasn’t mentally retarded, then lead poisoning was not a problem,’ and then, ‘If there wasn’t any effect that the [family] physician could measure in his little office, then lead poisoning was not a problem.’”
Mushak also points to an enduring legacy of adult exposure. Road builders and governments still stripe driving lanes with lead paint and use it to cover infrastructure, such as bridges. To this day, many metal foundries remain hot spots for adult lead poisoning. “We’ve been sort of remiss in not paying attention to adult problems,” he says. Employers used to recommend drinking loads of calcium-rich milk as a way to inoculate against the element, he says, but “that was self-serving nonsense.”
Peter Earle didn’t go to law school until age 35, and like many who do so at a later age, he went in with something of an agenda. He’d previously worked as a community organizer in the Humboldt Park and West Town neighborhoods of Chicago, establishing new tenant unions and interviewing new residents as they joined up. From these conversations, he drew a picture of lead poisoning as an invisible plague. “It struck me as a horrible, faceless thing,” he says. “It seemed insane.”
Further investigation sometimes produced a slum lord to pester for repairs, and yet other property owners were genuinely appalled, he says. “I couldn’t ignore the fact that some of them were not negligent and were trying to do the best they could. I realized there was a greater evil here.”
Still bouncy and charismatic at age 65, Earle falls into the brawler category of lawyers and pecks at his MacBook with stiff pointer fingers. He’s also part of a group of trial lawyers that has shepherded a crowded docket of lead poisoning cases in Rhode Island, Wisconsin and California in recent years, directly suing the former makers of lead paint, or what’s left of them. Earle was part of the legal team that won a $1.15 billion jury award in California, now tied up on appeal, to remove leaded paint from all houses in the state built before 1978.
In Wisconsin, the lead fight is just beginning. After a number of rulings, the door is now open for cases encompassing 173 plaintiffs to be tried in federal court in Milwaukee. “We intend to litigate these cases vigorously,” says Earle, who filed many of the cases on short notice, before the state Legislature passed a law intended to nullify the “risk contribution theory” established by the Wisconsin Supreme Court in a 2005 opinion, Thomas v. Mallett. Written by Justice Louis Butler, it affirmed that one of Earle’s clients, Steven Thomas, had the right to sue a panoply of lead paint companies, even though he had no way of telling which one had manufactured the paint that poisoned him as a child.
Between ages 1 and 6, Thomas’ blood-lead levels had fluctuated widely while living in houses on Milwaukee’s North Side. Experts testified that this years-long exposure seemed to be the cause of the severe “cognitive deficits” that he’d developed. His lowest-ever IQ result was a 56, which, in the terminology of the time, would have classified him as “mentally retarded.”
While he struggled with reading and math in school, Thomas also exhibited bizarre and sometimes threatening behaviors. Once, when a librarian caught him “hiding under the stairs,” he followed her out to the school’s parking lot and shouted, “Now you’re scared, aren’t you bitch … I know your car now.”
Thomas lost a jury trial after Butler’s opinion in his case, and also an appeal in 2007. Lawyers for the former lead paint companies have described risk contribution theory as an affront on basic legal principles, which would normally require a plaintiff to prove a direct link between a company’s product and his or her injury.
According to an attorney for Sherwin-Williams, Charles Moellenberg, the company “is not responsible for today’s risks from decades-old lead-based paint caused by neglected maintenance of properties by delinquent landlords.”
Dutch Boy’s maker, NL Industries (formerly National Lead), has already reached an out-of-court settlement with a large number of the 173, and court records say NL will pay to create “special needs trusts” proportional to each child’s level of exposure. The largest sums will go to those who once tested at 45 micrograms or beyond.
In Wisconsin, lead-paint lawsuits targeting landlords often run up against a 1999 state Supreme Court opinion, Peace v. Northwestern National Insurance Company, that classified lead paint as a “pollutant.” Most landlords’ insurance policies specifically exclude paying for injuries caused by random pollutants, meaning their insurance companies wouldn’t be on the hook for a lead-related settlement, just like they wouldn’t have to pay for one related to air pollution. Unless the landlord has deep pockets, there’d be little money to recover for a lead victim.
“We have children with profound cognitive impairments, children who will never be able to take care of themselves,” Earle says. “Who is going to pay for this problem? Are the kids going to pay with their cognition and ability to succeed in school?”
When business is good, and it almost always is, Jean Schultz inspects a housing unit a day for leaded paint. As a full-time lead inspector for the Milwaukee Health Department, she carries an X-ray fluorescence (XRF) machine to press against suspected wall paint and windowsills. For her purposes, anything above 0.7 milligrams per square centimeter is considered a positive test, and anything north of 20 is considered high. On a July afternoon, the XRF registered a 33.8. “That’s a lot of lead,” she said and stepped back from a stairwell window, part of a duplex built in 1902. At least two children lived in the rooms upstairs.
Like Carmen Reinmund, Schultz doesn’t wear a mask, and she said the Health Department advises lead inspectors to have a yearly blood test if they worry about their levels. Schultz, who just started eight months ago, hadn’t done so yet.
She pulled out a couple of white plastic frames and used them to guide her baby-wiping of paint dust. Each mottled tissue went into a plastic test tube. With enough positive results, HUD money could be used to replace all of the windows. So far, the Health Department had no record of a child being poisoned at this address. The aim was to keep it that way.
Matt Hrodey is a senior editor at Milwaukee Magazine. Write to him at firstname.lastname@example.org.
Tune in to WUWM’s “Lake Effect” Sept. 23 at 10 a.m. to hear more about this story.