Pact seeks to aid lead-paint victims

May 28, 1994|By Patricia Meisol | Patricia Meisol,Sun Staff Writer

They're found, they're cured, they're returned home and, inevitably, the victims of lead poisoning are back -- for more medical help.

Now the No. 1 treatment center in Maryland for children with lead poisoning,the Kennedy Krieger Institute, says it is prepared to end this revolving-door syndrome -- in some cases by moving families to other homes -- under a new $1 million contract with the state.

It's all aimed at keeping children out of the hospital.

The in-and-out pattern of hospitalization of hundreds of inner-city children living in older housing permeated by lead-paint chips or dust costs at least $30,000 per child annually in medical costs, plus thousands more over a lifetime for special education if the poisoning results in learning disabilities.

The new contract between the state Department of Health and Mental Hygiene and Kennedy Krieger, a specialty pediatric hospital, essentially allows the hospital to take on the environmental causes of lead poisoning, all in a bid to reduce cost.

Under the contract, the institute will receive half of the average annual cost of treating each child referred to it who has lead levels of 40 micrograms per deciliter or greater -- which means the child must be cleansed of the lead. In return, the institute will guarantee during that year that the children will remain free of lead, and do everything necessary to keep them in a least-cost setting.

That could include hiring a contractor to install new window sills or paying the security deposit for a family to move to a lead-free apartment to prevent second or third hospitalizations in a year, said James M. Anders Jr., chief operating officer of Kennedy Krieger.

"We'll be working with the family -- do they own, rent their home? How many kids do they have? What are their options [for moving], their income, etc. What kind of housing can we help you find?" he said. "We'll spend a lot of time educating them, showing them how to clean the house -- things we couldn't do before because they were not part of [medical] treatment. Before, landlords had some responsibility, the city had some, it was factionalized."

Maryland has the fifth-highest number of reported cases of children with lead poisoning, and local health departments follow more than 4,000 children annually whose blood tests show lead levels of more than 25 micrograms per deciliter. Over the years, many solutions have been tried, from suing landlords to educating tenants on ways to eliminate lead dust from their apartments.

Mr. Anders said Kennedy Krieger hopes to copy the lead poisoning contract in other specialty treatment areas, including rehabilitation and pediatric mental health. The institute also is negotiating to provide the lead poisoning specialty care for two independent insurance companies, Prudential Health Care and Total Health Care.

The pilot for lead poisoning, a totally preventable disease, is the first of what Nelson Sabatini, secretary of the Maryland Department of Health and Mental Hygiene, says could be a series of experiments to parcel out specialty care to health care experts for a preset fee.

"If you take it to its logical conclusion, we will pay you to care for people with diabetes, and it would be to your advantage to go there every day and make sure they are taking their medicine," he said. "And to the extent you are successful in keeping these persons from being hospitalized or losing their eyesight, you earn a profit."

Mr. Sabbatini said he is not sure how much is spent on lead poisoning.

Chipped paint on window sills is the biggest source of lead. The institute's summer patients will be redirected to lead-free apartments and other environmentally safe housing. The institute will work with city inspectors, landlords and families to educate them on cleaning methods.

In the past, the state has reimbursed providers for each service the child required, from testing to hospitalization. Now, Kennedy will receive a flat fee and the responsibility of keeping the child lead-free for a year. If the child has to be rehospitalized, Kennedy would have to pay for it.

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