Recommendations to Governor Frank O'Bannon by IKE's Lead Poisoning Prevention Task Force

Finalized April 26, 2000

Recommendation #3

Action: Direct Indiana State Department of Health to amend its proposed rule published in the January 1, 2000 Indiana Register to require mandatory reporting of all childhood capillary and venous blood tests for lead without regard to the level of lead detected.

Currently, only blood lead tests conducted by public labs, such as those run by Marion County and Vanderburgh County health departments and ISDH, are required to be reported to the State and included in its database. Private labs generally do not report their results. This gap has the following implications.

• The State and local health departments are unaware of the potential problem in a neighborhood or household. While the doctor should help the individual child, the doctor is unaware of a broader problem. The opportunity to identify clusters and prevent future poisonings is lost. Not all lead is from typical sources such as lead-based paint.
• The doctor may not be aware of the severe but subtle impacts of lead poisoning at low levels and address only those children with blood lead levels high enough to require medical intervention. The long-term prevention benefits that an in-home environmental investigation by a trained professional provides is lost. The health departments are able to provide these services only if they know of the problem.
• The ISDH’s assessment of the state’s progress in reducing lead poisoning is skewed. If only positive results are reported, the health department is unable to tell if increases are due to more testing or a worsening lead problem. And decreasing results may be due to reduced testing or successful programs. No one will have enough confidence in the results to revise priorities or, hopefully, expand on successes. While universal testing would be an unnecessary expense beyond at-risk neighborhoods, the burden of requiring labs to report all test results and not just elevated levels is nominal - and the gains are significant.

Mandatory reporting of all blood lead tests by the laboratories will bring Indiana up to par with most States. The information will provide Indiana with a more comprehensive view of the problem so it can more accurately develop effective strategies.

Despite informal requests to ISDH by both IKE and the Marion County Health Department to require mandatory reporting, it published in the January 1, 2000 Indiana Register a proposed rule that requires reporting only of venous blood lead levels more than 10 ug/dL.

The IKE Task Force believes ISDH needs to:

• Include mandatory reporting by laboratories of all blood lead tests, capillary and venous, in the final rule – a total number of tests will limit the health department’s ability to detect duplicates, connect the tests to Medicaid issues, and evaluate neighborhood data; and
• Make it clear in the rule that the parent/patient and the doctor receive a copy of the results as well.

See also IKE's April 2000 Newsletter on the topic of mandatory reporting.