The Lead Menace

In its lawsuit, St. Louis is eager to blame the lead industry for making the area one of the most contaminated in the nation. But the city itself is guilty of doing little to prevent the poisoning of thousands of children like "Little Al" Evans.

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The location for the third annual National Lead-Safe Housing Conference and Exposition last May couldn't have been more fitting: St. Louis, with its aging and often dilapidated housing stock, is widely regarded as one of the worst cities in the nation in terms of the number of children poisoned by lead each year. St. Louis Mayor Clarence Harmon took to the podium in a banquet room of the Regal Riverfront Hotel to speak to the crowd of about 300: nurses at local clinics, state and federal health officials, workers at nonprofit agencies, lead inspectors and lead-abatement contractors. The mayor rattled off the city's dismal statistics: More than 20 percent of children tested each year have increased levels of lead in their blood, and in some neighborhoods the figure is 40 percent. He touched on the litany of problems that lead causes: Lead-poisoned children are five times more likely to have reading difficulties and seven times more likely to drop out of school.

"Our city has been struggling with this problem for a little over 20 years -- I've been in office for two years," the mayor said. "The clock has run out now. It is time to deal, I feel seriously, with the problem. And we are moving rather rapidly ahead to do that."

He announced that, within weeks, he would introduce a plan to eliminate the lead-paint problem in St. Louis: "We are looking to change ordinances, to step up inspections and do a whole host of things that relate to dealing with this very insidious and longstanding problem in our community." He read a proclamation declaring that week "Lead-Safe Housing Awareness Week," and when he finished, his speech was met with a rousing round of applause.

Two days later, Harmon signed an executive order mandating a 10-year initiative with a slew of measures. He vowed to have building inspectors look for lead while inspecting homes in the city's housing-conservation districts, which cover two-thirds of St. Louis. He called for an ordinance that would add $2 to the cost of building permits to raise money for cleaning up lead-contaminated housing. He ordered that $1 million in community-development funds be set aside for forgivable lead-abatement loans to property owners.

On the heels of Harmon's initiative, the Board of Aldermen in July passed three ordinances relating to lead: one updating and strengthening the city's lead ordinance, another increasing by $2 the building-permit fees and a third diverting Medicaid funds for lead testing and treatment from the city's general coffers to a special fund to provide temporary housing to families dealing with lead hazards in their homes.

In January, Harmon went after the lead-paint industry, filing a lawsuit against the Lead Industries Association and a host of paint manufacturers, accusing them of conspiring to hide the dangerous effects of lead for decades while actively marketing their products as safe, even beneficial, to human beings. The pending lawsuit seeks both punitive and compensatory damages, including the costs of treating lead-poisoned children and cleaning up lead hazards in homes.

But nearly a year after the mayor's dramatic speech at that national conference, much of his initiative exists only on paper. So far, it has had little, if any, meaningful impact on preventing childhood lead poisoning in St. Louis.

· About $1.3 million for the two loan programs exists in separate funds, but not a dollar has been spent. Inexplicably, the criteria for the largest of the loan programs are so restrictive that only families of children already poisoned may apply, leaving out families who want to prevent the problem.

· Although $50,000-$60,000 in Medicaid money is available in another fund to provide temporary housing, it remains in the "collecting stages," according to the St. Louis Health Department. No money has been spent.

· Although the city's building inspectors have conducted 5,000 inspections since September, they aren't certified to do lead inspections, as required by state law, so they've merely conducted "visual surveys" to look for peeling paint. Only 20 of the 5,000 inspected buildings have been referred to the Health Department for actual lead inspections.

· Even though the new lead ordinance enacted last July allows the Health Department to conduct lead abatement when landlords refuse to do so, and bill them for the work, in not a single instance has that has occurred.

· The same ordinance also called for the compilation of a list of "lead-safe" housing alternatives for families of poisoned children. No list exists.

· Meanwhile, St. Louis children continue to be poisoned at a rate nearly six times the national average.

Symbolic of the city's lethargy is the fact that even the walls of the stairwell outside the city's lead clinic on Grand Boulevard have large sections of peeling paint that contain lead at twice the level deemed acceptable by federal guidelines -- a condition that top city health officials have been aware of for at least two years but have yet to repair.

When interviewed recently about the progress of his initiative, the mayor seemed surprise at the lack of progress. He did not know that the number of lead-inspection referrals was so small. He did not know that no loans for lead cleanup had been extended. He says he was under the impression his initiatives were working "moderately well.... We have a process now where we didn't have one before. I have to think it's better than what we had before."

Confronted by the actual data, however, Harmon acknowledges that the initiative needs to be formally evaluated. He characterizes the 20 lead referrals in 5,000 total inspections as "minuscule."

"I'm not sure what to make of that," Harmon says. "It may say we have not been diligent enough in terms of our inspection process.... The basis for my concern now is why are these numbers this small and what are we doing or not doing, and let's take another look at how we are doing it."

As for the loan program, Harmon wonders whether the city needs to market the program better so that more people are aware that they may qualify. "If what we started out to do is have a massive impact on lead-paint contamination, this data would suggest we haven't," Harmon says. "It's like a lot of good intentions, public good intentions. You have to examine how successful you are in the real world, and I think that's what's called for."

The slow progress of the city's efforts doesn't surprise those who have followed the lead issue in St. Louis for decades. They say the city has a long history of neglecting to take meaningful action that could prevent thousands more children from being poisoned by lead each year. A "Get the Lead Out" conference was held at St. Louis University in 1971, and the keynote official, declaring that the city's children were being used as canaries in a coal mine, urged the crowd to take action.

Ann Harris attended the conference. She was a founding member of the Greater St. Louis Lead Poisoning Prevention Council and remained active until the mid-1990s. "It is incredible to me that this problem still exists," Harris says. "It's all about money.... Regardless of what this mayor says or what any other mayor says, you've got to put your money where your mouth is. The dollars have to be allocated, the people have to be hired and follow-up has to be done."

The history of lead's harmful effects on children dates back a century. The first documented studies began appearing in 1908 in Australia, where 262 children were treated for lead poisoning at one hospital over a 16-year-period. In 1910, the U.S. Congress considered a measure to require that lead paint be labeled with a skull and crossbones, but it failed. In the 1920s, insurance companies began to monitor the number of children who died from lead paint poisoning. By the mid-1930s, more than a dozen European countries had banned or restricted the use of interior white lead paint.

Meanwhile, the lead industry knew of these dangers and tried to downplay, or conceal, the harm while actively marketing its products. National Lead Co., for instance, claimed in 1923 that lead "helps to guard your health." A 1924 Sherwin-Williams ad claimed, "Cousin Susie says her health improved instantly" after her home was painted with lead paint. Glidden, in 1936, described an area painted with lead paint as "a good idea for giving tots a pleasurable place to play." All of this is alleged in lawsuits filed against the Lead Industries Association (LIA) and lead-paint manufacturers by New York City, the state of Rhode Island and the city of St. Louis.

A report from the 1954 annual meeting of the LIA says: "Childhood lead poisoning continues to be our major 'headache' and source of adverse publicity. Threats of poison labeling have come from authorities in New York, Chicago and some other cities. We are working with the Paint Association to combat these moves." The United States did not ban lead paint for interior use until 1978.

A surge in additional research in the 1970s and 1980s led the Centers for Disease Control and Prevention (CDC) to repeatedly lower the acceptable level of lead in blood. That level was 40 micrograms per deciliter in 1971, 30 micrograms per deciliter in 1974, 25 in 1985 and 10 micrograms per deciliter today.

Boston lawyer Neil Leifer filed the first-ever lawsuit against paint manufacturers in 1987 on behalf of a lead-poisoned child named Monica Santiago. During his research, he learned the lead industry had been sued for alleged price-fixing by the Federal Trade Commission in the 1940s. He began digging through records from the case on file in the National Archives and uncovered a treasure trove of information: "It was a voluminous record, and within that record I discovered hundreds of pages of minutes from the Lead Industries Association, correspondence to and from doctors, legislative strategy and overall proof they knew they had a serious public-health hazard on their hands and what they did to try and prevent legislation and regulation and to promote lead. The most damning records came from the 1930s and 1940s. It was very clear at that time they knew children were being lead-poisoned, that they knew safe product alternatives were available and that they also knew that to ban lead paint would be a crushing blow to the lead industry."

Despite the seemingly damning nature of this information, the Santiago case and a number of similar lawsuits failed when various courts held that it could not be proved which particular pigment was responsible for a child's poisoning. The tide of interest has recently changed, however, in the aftermath of the tobacco litigation, which relied on the theory of market-share liability. The theory makes it unnecessary to prove which specific product caused harm, instead assigning blame on the basis of a manufacturer's share of sales. "When the tobacco litigation settled, people having gone through that experience looked around and thought the lead companies had acted comparably," says Arthur Bryant of San Francisco, executive director of Trial Lawyers for Public Justice, which was involved in some of the earlier lawsuits. "If the only legal hurdle preventing them from being held accountable didn't stop recovery against tobacco manufacturers, that shouldn't stop recovery from the lead industry."

It may not stop the recovery, but the industry can certainly delay it. New York City sued the manufacturers more than a decade ago, and the case is still pending. "The defendants were very afraid of what the New York courts were going to do, so they tried to delay it," says John Low-Beer, the city's lawyer. "The case sat dormant for four years because the defendants made all kinds of motions. They lost those motions, but they delayed a lot. There's also been massive discovery on a slew of issues that, to my mind, are of scarce relevance to the matter at hand."

Nationwide, the number of children poisoned each year has dropped dramatically since the 1970s. From 1976-80, says the CDC, about 88 percent of children between the ages of 1 and 5 years had increased blood-lead levels. Today, only about 4.4 percent of children have increased lead levels, a reduction of 95 percent. The CDC attributes most of the decline to the federally mandated phase-out of lead as an additive in gasoline. In the city of St. Louis, nearly 25 percent of children continue to have increased blood-lead levels.

The problem continues to disproportionately affect poor children and minorities in central cities with older housing. About 20 percent of black children living in pre-1946 housing are estimated to have increased blood-lead levels; the rate for white children living in newer housing is just 2 percent.

In 1992, the nonprofit Washington D.C.-based Alliance to End Childhood Lead Poisoning successfully lobbied for stricter federal regulations, including a disclosure requirement for owners of properties built before 1978 who either rent or sell those properties. Don Ryan, executive director of the alliance, says requiring disclosure hasn't been as effective as he had hoped. "In low-income, high-risk rental housing, compliance is very low," he says. "Many landlords don't even go through the motions of disclosure. To the extent that they do, they basically check the 'don't know' box." The law requires disclosure of any known information about lead hazards and "sort of rewards ignorance," Ryan adds. "There is a perverse disincentive for finding out about lead hazards. We've also heard a lot of anecdotal reports of real estate agents pooh-poohing the problem, discouraging the buyers from investigating."

Recently the Environmental Protection Agency has become more aggressive about enforcing the regulations (which took effect in 1996), taking landlords to court. A case in St. Louis recently became the first ever to go to hearing before an administrative law judge. In a civil administrative complaint, the EPA alleged six violations of the Toxic Substances Control Act against landlord Billy Yee of Chesterfield, accusing him of failing to provide proper notification to a woman with six children who moved into a property on Cherokee Street in St. Louis. Five of the children later showed increased lead levels, including the two youngest -- ages 1 and 2 -- who had levels near 70 micrograms per deciliter -- a level so high it can result in death. The EPA's chief administrative law judge, Susan L. Biro, had previously found Yee liable on all six counts, and the only issue at the December hearing was the size of the penalty. The EPA is seeking a fine of $29,700. Biro has not yet issued a ruling in the case.

Angela Evans and her fiancé, Albert Bedford, are struggling with the aftermath of lead poisoning. Back in 1996, the couple moved into a three-bedroom rental apartment near Tower Grove Park with Evans' five children, including her then-3-year-old son, Albert "Little Al" Evans. Several months after moving in, Little Al was tested for lead as part of a routine clinic visit. His blood level was 18 micrograms per deciliter. Health officials visited the apartment, tested for lead and recommended that the child be retested three months later. He was. The level was 52 micrograms per deciliter, more than five times the acceptable level. Evans was told to take Little Al to Children's Hospital, where he was admitted and underwent the five-day treatment.

Bedford, 33, a coordinator at a food pantry, has raised Little Al since the boy was a baby. He remembers the difficulties of that treatment, which required the insertion of an intravenous line to flush out the high levels of lead. "Little Al is a very strong little boy," says Bedford. "It took me, his mom, the doctor and three nurses to hold him to get the IV in, and they still couldn't get it in. He was just fighting all the way -- I mean, he was actually raising himself up, moving his whole entire body up, arching his butt and his back. I started crying. I just couldn't see him going through this. It was just a horrible experience."

Little Al couldn't return home after the treatment because of the lead present in the apartment. Evans, a 28-year-old who processes tax payments for a temp service, lived with her sister for a while, then rented a different apartment -- until it, too, was discovered to have a lead problem. With a great deal of difficulty, Evans and Bedford found another home.

Today, they say, the 6-year-old isn't the same outgoing little boy he once was. Instead of kindergarten, Little Al is enrolled in a special Head Start class for children with developmental problems. He is withdrawn and prefers to play alone, and his vocabulary is limited to a handful of words. He has difficulty sitting still. He can't form simple sentences. He can point to specific colors but can't name them himself. Even reciting the alphabet is a difficult task. "He tries to say it," his mother says. "He'll count for you sometimes. He'll say certain letters and then get lost. He might say 'A, B, C,' and then jump to another letter. But he used to know his alphabet." Bedford adds: "If you say 'A,' he'll say 'A.' If you say 'B,' he'll say 'B.' He'll grin. He'll laugh. I'll say, 'You've got to concentrate.' And he'll start all over again." Bedford describes Little Al this way: "It's almost like he is trying to come out of a shell. But it's like the shell is kind of hard to crack."

The couple has filed a lawsuit against their former landlord, and the case is pending. The problems Little Al experiences are not an easy subject for the couple to talk about. "I'm still waiting for him to say 'Daddy,'" Bedford says, shaking his head. "I think about that and...." His voice trails off as he wipes a tear from his eye.

At high levels, lead can cause brain damage, mental retardation, even death. Children between 6 months and 6 years are most vulnerable to lead poisoning. Researchers now know that even low levels of lead can be harmful to a growing child, affecting growth and hearing, causing learning disabilities and lowering the IQ. Studies have shown that children with increased blood-lead levels tend to be somewhat smaller and shorter than children in comparison groups, says Dr. Tom Matte, a medical epidemiologist with the CDC. Children with lead levels greater than 10 micrograms per deciliter also tend to have decreased hearing acuity.

Lead is stored in the bone in much the same way as calcium, Matte says, and a pregnant woman with previous lead poisoning can pass lead on to her developing fetus.

A child with a lead level of 50 micrograms per deciliter, once identified, should be immediately hospitalized for a five-day treatment with intravenous medication that bonds with the lead and flushes it out in the child's urine. But even that doesn't completely purge lead from a child's body; the lead can take months, or years, to leave a child's system. Many people mistakenly believe that children are poisoned only by eating paint chips or gnawing on a lead-painted windowsill. The CDC says poisoning most commonly occurs when decaying lead paint sheds minute particles of lead dust or when dust is released through improper renovations, such as dry sanding. The dust is ingested when a child mouths a toy or pacifier contaminated by that dust or eats with hands contaminated by dust. Small amounts of dust, ingested over a month's time, can be enough to cause an increased blood-lead level.

Dr. Herbert Needleman, a professor of psychiatry and pediatrics at the University of Pittsburgh, has studied the effects of low-level lead in children. One study linked higher bone-lead levels with juvenile delinquency, aggression and attention problems. "We've estimated 11-38 percent of delinquency in Allegheny County is attributable to lead exposure," Dr. Needleman says. His studies also found children with higher levels of lead in their baby teeth measured four to six points lower on intelligence tests.

Needleman points to some reasons there haven't been more aggressive efforts to prevent lead poisoning in the United States. "The much higher incidence in poor and black children was assumed to mean only poor black children got the disease, so the country as a whole wasn't very interested," he says. "The mothers were blamed for it -- 'If the mother took care of the children, this wouldn't have happened.' Private pediatricians didn't believe this was a problem for their practices. Realtors and the lead industry fought to disguise the effect of lead on children, and, generally, academic pediatrics wasn't interested in it."

In the city of St. Louis, the lead problem may be as old as the city's housing. Documented cases of childhood lead poisoning first began appearing in the 1940s, when two children died as a result of exposure to lead fumes caused by a common practice of burning used battery casings in coal-fired stoves.

Gil Copley, who oversaw the St. Louis lead clinic from 1972-1995, discovered a host of facts when he traced the city's long history of lead problems. In the mid-1950s, a study published in the Southern Medical Journal focused on St. Louis to demonstrate the seasonal incidence of lead poisoning. In the study, 246 cases of childhood lead poisoning -- including 12 deaths -- that occurred here between 1950-1954 were reviewed. It was shown that poisoning was more likely to occur in the summer -- both because children were more likely to play outdoors on porches and verandas with peeling paint and because the increased sunlight causes the body to release lead stored in the bones.

In the 1960s, about one child a year died of lead poisoning, but interest in the issue didn't begin to build until the end of that decade. The city's health lab each year detected more than 120 cases of lead poisoning in children at levels greater than 50 micrograms per deciliter. The Metropolitan Tenants Association, in conjunction with the Legal Aid Society and Ald. Henry Stolar, pushed for a city lead ordinance in 1970 and succeeded, but it received no funding that first year. Then a little boy died of lead poisoning, and his highly publicized death increased public pressure, Copley says. By September, using unexpended funds, the city created the Lead Poisoning Control Service, with 10 full-time positions.

Free lead testing was offered by the city the next year, and the health commissioner ordered that all children be routinely tested during clinic visits. Interest in the problem continued to build, and in 1971, about 300 people attended the "Get the Lead Out" conference at St. Louis University. The keynote speaker, Dr. Barry Commoner, then director of Washington University's Center for the Biology of Natural Systems, gave an impassioned speech in which he likened children and lead poisoning to the use of canaries in a coal mine -- because only after children are poisoned do health officials find out whether an apartment or home has a lead hazard: "No matter what you believe about the huge frustrating enormously complicated political, social and economic problems of this country and despite the fact that the lead problem is tangled up in every one of them, I think it's a fact that this is one problem where kids' lives can be saved literally by working on it."

In December 1974, another child died of lead poisoning. Copley was quoted in the St. Louis Globe-Democrat as saying lead screenings were not enough. "We have to have a block-by-block preventative program to eliminate lead before a child is tested. I was afraid of something happening like this. If lead is not there, the children won't be poisoned."

But the city's efforts continued to be focused on the public-health aspects of the problem -- testing children, treating them, trying to make their homes lead-safe after they'd been poisoned -- with limited success. The city never addressed the crux of the problem: cleaning up lead hazards in the city's housing stock before children were poisoned. "The real problem in lead is the housing," Copley says. "Public-health practitioners can sit there and test kids and follow kids and case-manage kids and go out and identify lead hazards in the homes of children who are poisoned until they are blue in the face, but it's not going to get rid of the problem." Each year, when Copley drew up his annual report on the lead program, his message was always the same: "Our message consistently to city government and the city fathers was that if we really wanted to do something about lead, we needed to get rid of the housing stock causing this, either by cleaning it up or getting rid of it if it wasn't salvageable. That's what all the health commissioners preached ... but that's a different budget and a different department."

In St. Louis, more than 70 percent of the housing was built before 1950, when paint manufacturers began reducing the amount of lead in their product, and 90 percent before 1978 -- when lead paint was banned for interior use in residential homes. St. Louis is considered one of the worst cities in the nation in terms of the number of children poisoned each year -- though no one, including the CDC, compiles precise data comparing cities and states. In 1998, the most recent year for which data are available, about 41 percent -- 13,205 -- of the city's children under age 6 were screened for lead, and nearly 25 percent of them -- 3,269 -- had increased levels of lead in their blood, almost six times the national average.

Dr. Don Weiss, who was medical director of the city's Childhood Lead Poisoning Prevention Program from 1997 until December 1999, says the program has continued to rely on "secondary prevention" to deal with the lead problem, meaning that once children test positive for increased levels of lead, attempts are made to treat the child and deal with the problems in the home. Weiss says that approach simply doesn't work. "You have to find the kids -- test their blood -- and by the time you find them, they may have already suffered irreparable harm," he says. "Once it gets into a child's body, it affects their system, and we really can't reverse it. The responsibility of fixing it then falls on landlords, who probably don't have a lot of resources, or the burden is on the family: 'OK, your house had lead -- you do something about it.' And it just doesn't happen."

A review of children born in St. Louis between 1993 and 1997 demonstrates that the longer a child lives in St. Louis, the more likely he or she is to be lead-poisoned. A child born in 1997 who has lived in the city for one year has a 10.7 percent risk of being poisoned; a child born in 1993 has a 35.9 percent risk, because he has lived in the city for five years. The problem, says Weiss, is that there are few places for children to go after they've been poisoned. "There is no lead-safe temporary housing or long-term housing in St. Louis. So they either stay in the area or move to another house that has lead in it."

Once a child is found to have a lead level greater than 15 micrograms per deciliter, the case is referred to a Health Department lead inspector, who is then supposed to go to the child's home to test for the presence of lead. In 1998, the department received 2,311 referrals of children with lead poisoning, but it conducted just 1,227 inspections of the homes where the children lived. Weiss says a variety of factors are to blame for the lower number of inspections: Families sometimes report wrong addresses; inspectors may go when no one is home; or the owner or renter can refuse the inspector entrance into the house or apartment.

Of the 1,227 residences inspected in 1998, more than 1,000 were cited for lead hazards and the owners ordered to address the problems. When the owner fails, the case is referred to housing court. But that program has limited effectiveness. The inspectors cite only hazards existing at that time -- a peeling windowsill here, a hole in the wall there. Property owners are not required to make the entire unit lead-safe, which can result in repeat cases of lead poisoning in the same unit. Even cases referred to housing court can drag on for months or years, and the fines are generally small -- $100-$500 per case.

A four-family flat at 5046 Page Ave., built in 1901, is a classic example. Health-department records indicate that a toddler living there had a lead level of 49 micrograms per deciliter back in September 1981. The building was purchased in 1984 by St. Louis attorney Rick L. Nelson. Health Department records indicate that three different children living in the building tested with increased lead levels in 1995, 1996 and 1997. In February 1997, an inspector issued a notice of violation on the exterior windows and ledges of the building, the basement window frames, a coal chute and an exterior door unit. Those issues were addressed by September; Nelson was fined $250 plus $21 in costs.

Regarding 5046A Page Ave., the records indicate, a letter was issued in August 1998 after another child was found to have increased lead levels. The citation involved the front windows, a door frame, a window sash, the rear-stairwell wall, the bathroom window and a kitchen windowsill. An inspector paid seven more visits to the unit, but in every case either no one was home or the inspector was denied entry by the tenant. In March 1999, with no repairs verified, the unit was vacant and the case closed. Nelson was fined $100, plus $21 in costs.

Nelson says he didn't recognize the names of the tenants read to him from the Health Department records. "I rented to a lady who moved some people in, and when I noticed they were there I asked them to leave," he says. "I think it was all related to the upstairs unit. Anytime I was told to make some repairs, then I did it. I am very concerned about any kind of lead violation that may be in a home."

Unlike a number of municipalities in St. Louis County, the city of St. Louis historically did not perform routine building inspections when a building changed owners or occupants. Until 12 years ago, inspections were performed only if someone complained that living conditions in a house or apartment were unsafe or, as required by the federal government, for Section 8 subsidized housing.

That changed with the creation of the city's housing-conservation districts, which now cover two-thirds of St. Louis. Building Commissioner Ronald H. Smith says the effort was intended to use property-maintenance and building codes to "stabilize the neighborhoods." Now, whenever a unit is sold or rented, a city inspector is sent to review both interior and exterior conditions, with an eye toward citing any "life-safety" violations: Is the unit liveable; are the exterior doors unblocked and accessible; is there a smoke detector; are there bars on the windows that might prevent escape during a fire; are there sewage problems; is there running water? Lead was not something inspectors looked for, however -- at least, not until last year.

As a result of the mayor's initiative, building inspectors in September added lead to their checklist. But there was a problem. Missouri law requires that lead inspectors be certified -- by attending a training course, passing a state exam and paying a fee -- and city building inspectors have no such certification. So, Smith says, the inspectors were trained by the Health Department to do only "visual surveys" by looking for peeling paint. If an inspector suspects a lead hazard, the property owner is given a chance to fix the problem. If no work has been done by the time of reinspection, the case is referred to the Health Department for a lead inspection, a more detailed procedure that involves using a hand-held analyzer that detects the presence of lead in paint, as well as dust-wipe samples that are tested for lead dust.

This new program, however, only applies to conservation districts, and one-third of the city lacks such a designation, including some wards with the highest rates of childhood lead poisoning. More than 40 percent of the children in the 4th Ward, for example, had increased lead levels in 1998, but because it is not in a conservation district, no inspections occur unless a property owner or tenant requests one. Even in the conservation districts, of the 5,000 inspections conducted since September, only 20 were referred to the Health Department for actual lead inspections.

Smith considers the program a success, even though there is no assurance that the homes end up being lead-safe. "It's been a remarkable response from the homeowners and landlords," he says. "They are not waiting for the Health Department to be brought in, because if they do lead testing of the property, chances are it's going to be a lot more expensive at that point to fix it. They're going to have to hire a certified lead-abatement contractor, where when we go in, we are not officially saying there's lead here or a lead hazard here. We're saying there appears to be."

But others say a visual survey is ineffective. "A visual inspection is an easy way of identifying peeling paint, but if you're going to a property built before 1950, you almost know the answer ahead of time. Just about all of them have lead paint," says Ryan, of the Alliance to End Childhood Lead Poisoning. As for property owners' making their own repairs, that could worsen the problem, says Ryan. "It's not sufficient simply to fix the peeling paint -- doing that might aggravate the hazard and increase the lead-dust contamination," he says. "If the workers doing the paint repair don't know how to contain, control and clean up lead dust, you're missing the boat. And if there is not lead testing at the end of the job, you have no confidence the property is safe. In fact, it might be more dangerous."

Asked what can be determined from a visual survey, Mazzie Talley, regional lead coordinator with the EPA in Kansas City, says not much. "They could probably identify a lead pipe," she says. Talley pauses. "We're done."

Well-maintained intact surfaces, particularly flat walls, are not usually a hazard if they contain lead-based paint, according to the EPA, but deteriorating lead-based paint on any surface can be a hazard, particularly paint on surfaces subject to friction, such as windows or doors, or paint on surfaces accessible to children.

"Which would you rather take your child to?" Talley says. "Someone who thinks they know medicine or someone who has gone to school, learned to look for, identify and treat illnesses -- because you're basing this all on the health of our children. If somebody doesn't know where to look, how to test properly and how to treat it properly, you don't know if you do or do not have a hazard."

The Health Department's lead inspectors are certified in accordance with state law, and they are undergoing more rigorous training to be certified as lead-risk assessors -- but, as the numbers demonstrate, they are rarely called in by building inspectors.

St. Louis Health Commissioner Larry Fields, when asked about the progress of the mayor's initiative, acknowledges the problems with implementing it but says everything will work out sooner or later. The initiative, he says, has been brought to an "active level" and is "actually running in real time." Questioned about the actual numbers of referrals and inspections, he concedes that he was initially surprised by the few referrals. "Our expectation was that we would be getting a lot more referrals. I spoke to (Director of Public Safety) Martie Aboussie, and Martie did an internal look at that. He indicated he was satisfied."

Fields says he plans to evaluate the program this summer. And he notes that, thanks to a federal grant, his department now has a 10-member ClearCorps team, part of the AmeriCorps program, that is being trained in lead abatement. The additional staff should allow the department to double the number of cases in which a Health Department crew goes in and performs lead cleanup themselves. The department did 55 such "remediations" last year -- in owner-occupied homes of families with incomes at or below the federal poverty level.

His department now has the authority to clean up lead hazards and bill property owners for the work, but that has yet to happen. Fields says it could occur in the next several months -- or maybe later this summer. "Things are ramped up and geared up," he says, "but it takes a while to get things going in the city. The initiative has gone pretty well."

He acknowledges that even the Health Department's building on North Grand has peeling lead paint on the walls of its stairwells. He says that problem will be fixed. "In my view, a health department deserves a healthy building. The level of concern I have is not just for people that come in and out, because that's the short term -- that won't boost lead levels like an area where there is dust around windowsills." Still, he adds: "The issue of the facility needs to be addressed. We've made our request to get the painting done, and that is going forward."

Other aspects of the mayor's initiative -- and the subsequent ordinances approved by the Board of Aldermen -- are also moving at a snail's pace.

A special fund created with the $2 in additional building-permit fees now contains $300,000 to help clean up lead hazards in homes, but no money has been spent. Building Commissioner Ron Smith says the fund will pay lead-abatement contractors up to $10,000 per unit to rid homes of lead hazards, but his office has received no referrals from the city's Community Development Agency (CDA).

The $1 million in CDA block-grant funds that the mayor ordered set aside for a loan program is available, too, but not a single loan has been made. The restrictions are extensive: Landlords who live in the county but own property in the city are not eligible. Nor are families who may have lead hazards in their homes but whose children, as yet, haven't actually been lead-poisoned.

The program provides five-year loans to owner-occupied units for families earning up to 80 percent of the area median income, and the loan is forgiven if the family resides in the house the entire five years. Other residential properties may qualify for deferred-payment loans, which come due once the unit is sold or transferred. Owners of rental units can't earn more than the median income to qualify -- $56,500 for a family of four. The loans are only available for houses in which a child under 6 who has been lead-poisoned is living or spends a significant amount of time, and the child must have a blood-lead level of at least 20 micrograms per deciliter. A city resident must own the property, all taxes and property insurance must be current, and the owner can't have a history of unresolved code-enforcement issues.

Sandra Moushey, the CDA's director of housing programs, defends the criteria, saying they were developed with input from a mayoral task force and from Fields. But Fields says he was unaware the loans were available only to units in which lead-poisoned children live.

Other aspects of the new lead ordinance still exist only on paper. The lead-safe-housing list is still under development. Even if a list existed, it might be misleading. Charles Jackson, the Health Department's program manager for lead, food and beverage control, cautions that such a list might give families a false sense of security, because even the city's remediation teams don't make units lead-safe in the long term -- which can require the replacement of woodwork and windows. Instead, their work focuses mainly on the short term. "The list is only good for that moment. As soon as somebody knocks a hole in a wall, you've got a problem there," Jackson says. "The list is not going to be airtight. Yeah, it was lead-safe on March 30, 2000, but what about May 10, 2000? Half of the premises might not be safe."

Clearly a large part of the city's problems in dealing with lead poisoning have to do with a lack of money -- for testing, for inspections and for actually making homes lead-safe. And Mayor Harmon is looking to the lawsuit he initiated in January against the lead industry to provide that money.

But even that has become mired in politics -- and an unusual cast of characters have jumped into the fray, including former Mayor Freeman Bosley Jr. and Eric Banks, a former city counselor, who have been hired to assist the lead industry.

Bosley, who lost to Harmon in 1997 in a contentious and ugly battle, was hired to advise the lead industry, and he defends his involvement, boasting that a black law firm, Caldwell & Singleton, got the job. "Having been mayor of the city, I know these issues. I know these problems. I have contacts and relationships with people in St. Louis. I know people on both sides, plus our firm is probably one of the few African-American firms in the country to get this kind of business," he says. "It's even a first in terms of African-Americans' getting this type of opportunity to be at the table to deal with an issue at this level. If you flip the tables, you've got people in the African-American community clamoring they don't get a chance to participate in business. This is business. You have to take the emotion out of it."

Bosley won't say whether he will run for mayor next year but says he isn't worried that taking on this case will hurt his chances if he does run. "I think it may cause people to say, 'Why is Freeman doing that?'" Bosley says. "But I think I have history in this community...."

He disputes any comparison with the tobacco litigation -- and he notes that, as yet, not a single lawsuit has been won against the paint industry. And he disputes allegations in lawsuits that the industry was well aware of the dangers of lead as far back as the turn of the century. "They're totally different in that in tobacco, they knew that nicotine was addictive and as opposed to doing something about it, they kept manufacturing it and made it stronger," Bosley says. "The paint manufacturers themselves discovered 40 years ago that there were lead levels in the paint that, if ingested, caused kids to become sick. So the problems we are experiencing now are a result of lead applied 40 years ago getting into their system. How does it get into their systems? The owners of those homes are not maintaining those homes properly."

Bosley is critical of Harmon for moving too swiftly to file a lawsuit against the paint industry. "They were interested in a dialogue, and before we knew it the city ran out and filed a lawsuit. They wanted to talk about potential legislation -- Vermont and Massachusetts have passed legislation that has resulted in lead levels' being reduced 50 percent -- wanting to ostensibly join in with the city in the passage of legislation, just trying to see how they could work together on dealing with the issue.... When you file a lawsuit, it's like throwing a hand grenade on the table."

Harmon dismisses Bosley's criticisms. "I think the community will take him to task for what he's done," the mayor says. "I think what he did literally pulled the covers off him and exposed the real side of him that a lot of us knew he was all along."

The mayor says he isn't all that surprised that this lawsuit has drawn people "out of the woodwork.... The scent of money has drawn all sorts of interesting characters. These lawsuits remind me of water holes on the African savannah after a drought. Animals that would normally have nothing to do with each other -- that are prey or predator -- side by side, drinking from the water hole."

Among the first to line up was St. Louis lawyer John Frank. Last year, Frank approached Harmon's office, proposing that the city file a lawsuit against the lead industry. Last August, Frank and employees at his firm donated $10,000 to Harmon. In November, Harmon signed a contract with Frank's firm to file the lawsuit. The mayor says he realized awarding a potentially lucrative contract to a campaign contributor was a "sensitive area," and he said as much to the city counselor's office when they brought him the contract: "I said, "Why do you think we ought to use him?' They said, 'Cause he's got the background. He's done the work. He's probably the best local guy we could find.'"

Not long after he signed, the city's lawyers returned. They told Harmon that Comptroller Darlene Green refused to sign off on that contract -- saying it needed to go before a selection committee and the Board of Estimate and Apportionment, a three-member panel comprising Harmon, Green and Aldermanic President Francis Slay. So the city solicited bids and received two. One proposal came from Frank's team of three firms, which included Richard Banks of St. Louis and Fleming & Associates of Houston. They offered to handle the lawsuit for a 25 percent contingency fee. The other proposal came from a team of five law firms, among them the local firm Hopkins Goldenberg -- an llinois firm that had had a limited partnership with the Frank firm before the relationship was dissolved in October. The firm has handled more than 100 lead-paint lawsuits against landlords, including the case of "Little Al" Evans of St. Louis. Another firm in their team was Ness, Motley, Loadholt, Richardson & Poole of South Carolina. Ness Motley is handling the state of Rhode Island's suit against the lead industry and played a key role in the states' $246 billion tobacco settlement. They offered to do the work for an 18 percent contingency fee if the case went to trial, 15 percent if it was settled before trial.

A selection team -- comprising members of Green's, Slay's and Harmon's staffs, plus two members of the city counselor's office -- met. The vote was 3-2, with Green and Slay's representatives voting no. The fee for Frank's firm was reduced to 20 percent.

In February, the recommendation went before the Board of Estimate and Apportionment -- and that meeting offered a snapshot of city politics at work. Slay, himself a lawyer who is running against Harmon next year, had drawn up an amendment that slashed Frank's fee to the same level proposed by the legal team the selection committee had rejected. But before he could introduce that amendment, Harmon gave the floor to Frank -- who stood up and announced he was voluntarily cutting his fee to 18 percent. Slay, visibly irritated, said that that wasn't enough. He made a motion to send the matter back to the selection committee, adding that the "team selected had the least amount of experience and the price was higher than the other team." He pointed out that Frank's reduced 18 percent fee was still higher than the fee proposed by the Ness Motley team. Slay's motion failed.

Slay then proposed that Frank's fee be decreased to 15 percent if the case was settled before trial -- 18 if it proceeded to trial -- the same fee proposed by the Ness Motley team. Green agreed.

At one point in the meeting, Frank stood up and gave a speech about his life -- how he had been born in St. Louis and plans to die here, how he discovered fraud in a police pension fund while a member of the police board during the 1980s, how he was held hostage for two days by a police officer convicted in that scheme. He said it was his idea to sue the lead industry and that he had brought the idea to the mayor.

In a series of votes related to the amendment reducing Frank's fee further, the mayor repeatedly voted no. It passed anyway, with support from Green and Slay. The panel then voted on whether to award the amended contract to the Frank firm. It passed unanimously.

Later that day, Harmon's office issued an oddly worded press release: "Despite intense political posturing," it said, "Mayor Clarence Harmon took a major step forward today in his drive to hold the lead paint industry accountable for health problems associated with lead poisoning, a problem that disproportionately effects lower income children." The release quoted Harmon: "I am glad that we can finally move past the political games that have blocked our way and get on with the business of litigating a lawsuit intended to help children in the city of St. Louis."

Many of the advocates for lead cleanup have grown tired of the inaction and finger-pointing and want to focus on making St. Louis homes lead-safe. A group of local people who attended last May's national lead conference here later formed a coalition to address the region's lead problems. The coalition includes representatives of the city, the schools, real-estate agents, health clinicians, universities and hospitals, landlords, tenants and families with lead-poisoned children. Called the St. Louis Lead Prevention Coalition, it has hired a full-time executive director. Committees are focusing on four areas: prevention, community involvement, policy development, and legislative and legal action.

"We want this to be a catalyst for change. We want to make things happen, not just talk some more about it," says Fernando Serrano, co-chairman of the coalition and a public-health instructor at St. Louis University.

"It's not just the city's responsibility, it's all of ours," says executive director Jonathan VanderBrug. "There's a tendency in all of us to try to take it all on ourselves or point and say 'It's not my problem, and that group can take care of it.' So many players in the city with such diverse perspectives moving at crossroads to each other doesn't move us forward."

On a recent afternoon in the mayor's office, Harmon sat down to discuss his decisions on the lead issue, and he voiced some frustration with the limits of what he can do -- the building inspections in the city's Conservation Districts, for instance, have not been expanded throughout the city because he feels he lacks the support from the Board of Aldermen to do so. He continues to view the lawsuit as the most realistic way the city can get the funding it needs to deal with the lead-poisoning problem -- and hold the paint industry accountable.

"It's clear to me that, legislatively, you cannot effectively deal with some of these issues," Harmon says. "The tobacco industry is a case in point. The gun industry is another, because they can afford to withstand an effort to legislate against them because they can afford very large lobbying budgets. If you've seen it from my vantage point, if you've seen how that works in Jefferson City and here in the Board of Aldermen, how money moves opinion, you recognize that you have few choices in terms of trying to represent the interests of the citizens, and this was a choice we made."

The city has already spent about $10 million in the last decade on lead testing, treatment and inspections. Harmon says the city simply cannot afford to deal with the problem alone -- and suing the lead industry is the city's only hope of coming up with the millions needed to make the city's housing lead-safe for children.

"That's what I want to see happen as a result of litigation," he says.

For more informatin see sidebar, A Tale of Two States.

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