Correspondence from Lee to Van Wye

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1 AN S 

Nah J £y 

July 16, 1991 = { NV ee) Y 4 LT i 

Honorable Louis W. Sullivan 
Secretary 
United States Department 

of Health and Human Services 
200 Independence Avenue, SW 

Room 615F 

Washington, D.C. 20201 

Dear Secretary Sullivan: 

I am writing to you about lead poisoning, which you have aptly 
declared to be "entirely preventable, yet . . . the most common and 
societally devastating environmental disease of young children." 
The issue is of particular concern to the Legal Defense Fund, as 
it is to you, because studies show that fully 2/3 of African 
American inner city children suffer from lead poisoning. 

Last year, the Legal Defense Fund, along with several other 
organizations, filed a federal civil rights action on behalf of two 
black girls from Long Beach, California and an Oakland community 
group against the California Department of Health Services for its 
failure to administer blood lead tests to screen for lead poisoning 
in young, poor children pursuant to the Early Periodic Screening, 
Detection and Treatment component of its Medicaid health programs. 
Matthews v. Coye, N.D. Cal. Civ. Act. No. C-90-3620 EFL. In this 
case, LDF is seeking to enforce the crystal clear instruction in 
HHS' State Medicaid Manual requiring states participating in the 
Medicaid program to "[s]creen all Medicaid eligible children ages 
1-5 for lead poisoning." 

  

  

In order to save money, the California Department of Health 
Services has declined to follow HHS' instruction to test its 
poorest young children for lead poisoning, although it is precisely 
that group that is at the greatest risk. The Department of Health 
Services argues that the term "screen" in the HHS Manual does not 
refer to blood testing, but only to verbal history-taking even 
though lead poisoning, as we all know, is often asymptomatic, 
especially in young children. The result of this short-sighted 
stance, of course, is that virtually no blood testing of eligible 
children takes place in California. Last year, for example, less 
than .0002% of Medi-Cal eligible children below the age of six were 
administered blood tests. At the same time, the California 
Department has estimated that at least 50,000 children under age 
six suffer from lead poisoning and that all but a handful go 
undiagnosed and untreated. And notwithstanding the undisputed 
evidence regarding incidence of lead poisoning in African American 
children, only two black children in all of Los Angeles County were 
administered a blood test under the EPSDT program. 

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Letter to Secretary Louis W. Sullivan 
July 16, 1991 
Page Number 2 

The California Department's refusal to conduct blood lead 
testing for screening is inconsistent with the practice of several 
other states which follow the HHS Manual, including the state of 
Alabama. There is no reason the State of California cannot do what 
Alabama does for its poor, young children. 

My particular reason for writing to you is that the court in 
the Matthews case has requested that HHS file an amicus curiae 
brief, as a friend of the court, to apprise the court of its view 
of the issue in the case. LDF has sent to Grover Hankins, HHS' 
Principal Deputy General Counsel, the court's request for an HHS 
brief and the file. The legal arguments of the parties are fully 
set forth in the file. 

    

I wanted to bring the matter to your personal attention 
because the position LDF is asserting in the Matthews case for 
blood lead testing of young Medicaid eligible children would 
enforce, not only HHS' State Medicaid Manual, but also HHS' 
Strategic Plan for the Elimination of Childhood Lead Poisoning that 
you released last February. Without adequate screening, the 
Strategic Plan's recommendation for a nationwide surveillance 
system will never even remotely become a reality. 

  

  

  

  

I will not reiterate the legal arguments contained in the file 
given to Mr. Hankins. He is fully capable of assessing them. 
However, I enclose a copy of declarations from several doctors who 
have set forth their views fully in support of LDF's position, Drs. 
John F. Rosen, Herbert L. Needleman, and Philip J. Landrigan. As 
you know, Dr. Rosen is currently Chairman of HHS' Center for 
Disease Control's Advisory Committee on Childhood Lead Poisoning 
Prevention of which Dr. Needleman is also a member. Dr. Rosen was 
one of the peer reviewers of the Strategic Plan to which Dr. 

  

Needleman was a contributor. Dr. Landrigan was the Chairman of the 
Committee on Environmental Hazards of the American Academy of 
Pediatrics which drafted the Academy's current 1987 Statement on 
lead poisoning. With respect to young, poor and minority children, 
no expert in the subject area of lead and children concludes 
anything other than that a blood test be utilized to detect lead 
poisoning. No expert in this area endorses California's position. 

 



  

Letter to Secretary Louis W. Sullivan 
July 16, 1991 
Page Number 3 

I, therefore, request that HHS submit an amicus curiae brief 
in support of LDF's position that HHS' State Medicaid Manual means 
what it says: screen all Medicaid eligible children ages 1-5 for 
lead poisoning. 

  

  

Sincerely, 

aD. 

Jul us Le Lh bers 

iy ctor Counsel 

JLC:sm