Anger and Frustration With Milwaukee’s Lead Program

No one is happy with Milwaukee’s childhood lead poisoning prevention program, including the people running it.

“Even before I stepped into the role, I realized the lead program is probably the most scrutinized in the city for very legitimate reasons,” said Milwaukee Health Department deputy commissioner of environmental health Tyler Weber on Thursday to members of the Common Council Public Safety & Health Committee.

The program’s struggles first became public in January 2018 when Mayor Tom Barrett announced the resignation of Health Commissioner Bevan K. Baker. But they haven’t gone away as a string of four commissioners has taken turns at the helm. Weber has been on the job for eight weeks after being hired by new commissioner Kirsten Johnson.

The department admitted in June, and again on Thursday, that a breakdown occurred with a Bay View family where a duplex that was home to children testing positive for elevated blood levels wasn’t properly abated.

“We recognize that there were some failures on the inspector and as a result we are going to be making some changes to our internal policies,” said home environmental health program director Marivel Montejano. She said follow-up inspections by different inspectors revealed bare soil and garage trim that were not abated and the abatement process wasn’t closed properly.

The impacted children, the first of which tested positive for an elevated blood lead level in 2018 at a different address, have not cleared the federal protocol of having blood tests spaced at least six months apart that reveal a lead concentration of fewer than 15 micrograms per deciliter. Montejano also said the department didn’t initially realize that the children lived in an environment where an extended family occupied both units in the duplex.

She indicated the department only became aware of the extent of the problem in June after a media request was made about the property and family.

When an inspector returned to the property, they found work a contractor performed had been damaged, with painted walls scratched to expose lead-based paint. She said she thought the department would be able to close the case by the end of the year.

Alderwoman Marina Dimitrijevic, who represents the family and chairs the Public Safety & Health Committee, called the matter disturbing. When the issue was first disclosed in June she called for an audit of all cases and believes similar issues will be found. She described the lead issue as “the pandemic before the pandemic.”

At the meeting Thursday, the issue kept snowballing. During a question about the temporary relocation practices of the department, no one from MHD offered knowledge of a council-funded program to use furnished, city-owned houses in partnership with Community Advocates in lieu of hotel stipends.

“This is balls dropping left and right,” said Ald. Chantia Lewis, the housing measure’s lead sponsor. She said the program was created for situations like this and was intended to encourage people to get the abatement work done when they might otherwise be hesitant about an extended hotel stay. “I am very irritated right now.”

Dimitrijevic shut down housing discussion on the issue in favor of a follow-up meeting. But that didn’t end the criticism of the health department.

“At what point in time are we going to get an honest answer and evaluation of where we are at and where we need to be?” asked Ald. Jose G. Perez. “We are still here today with kids slipping through the cracks.”

“Who is held responsible and at what point are we going to get some honest answers?” asked Perez.

“I understand the frustration. I feel that myself,” said Johnson.

“Who is responsible for this?” asked Perez.

“It’s the lead program director and that team. It ultimately falls on my shoulders,” the commissioner responded.

Perez said he wasn’t frustrated, he was angry. “We have got to find a better way to do this.” He suggested the city outsource the work if it couldn’t handle the job.

Weber said changes were coming.

“Transparency and data and accountability is critical. That has to happen and that has to happen soon,” he said. The deputy commissioner said he is working with the team, and mayor’s office, on a monthly report that would show the caseload, response time and other indicators. “This is an opportunity to build trust that has been broken for a very long time.”

Weber said database software from Quickbase is now being used to scale data collection. Officials in 2018 described a program that relied on paper records to administer cases. “There is now I think a solid year and a half we can start pulling from,” he said.

But plenty of issues remain, even with the report. Weber said he discovered that not all the recommendations of a Public Health Foundation audit of the program were implemented. The report, part of the fallout from 2018, was delivered to the department in March 2020. He said some of the top recommendations, including those involving data collection, remain.

“Yes, it is challenging and disturbing that not everything has been implemented,” said Weber. He said he has engaged the foundation in multiple meetings and looking forward to more. An already-planned, second audit from the national foundation will begin in the coming months. Weber said he was pushing to do more after that.

“What we really need to have from them is a process where we map out every single process and how it gets done,” said Johnson.

Weber said MHD also has a strained relationship with the Wisconsin Department of Health Services. He’s engaged the state department in weekly meetings to address issues.

The deputy commissioner described a situation where two things need to be addressed in tandem to improve the situation. The city needs to improve its own processes, including integrations with other departments on housing issues. It also needs to engage with community partners including the Social Development Commission, Sixteenth Street Community Health Centers and Coalition on Lead Emergency (COLE). “We have to clean up internally and be a champion of an integrated lead program.”

But Dimitrijevic suggested the city rethink its entire model, which implements interventions only after children are blood tested. “We have gone through many commissioners and can’t get it right,” he said. “We have to approach it differently.”

She said she is introducing legislation to push a model similar to one being advanced in Cleveland that pushes landlords to make their properties lead-safe. The alderwoman said she favored using American Rescue Plan Act funds to address paint and soil problems now and would wait for lead lateral replacement as part of a proposed federal infrastructure bill. Dimitrijevic said she fears what the city will find when parents resume getting their children tested after canceling appointments during the COVID-19 pandemic and spending so much time at home.

Perez also has a pending proposal to expand the city’s lead abatement programs.

Three community members spoke, including Clean Wisconsin program director, staff director and COLE member Pam Ritger and COLE organizer Shyquetta McElroy. The latter is a parent of a child who suffered substantial lead poisoning. McElroy said her son is now 14 and doesn’t want to go to high school because of mental challenges she attributes to lead poisoning. “The biggest fear as a parent is to have a child who is lead poisoned,” she said in a speech that multiple council members said moved them.

Get The Lead Out steering committee member Derek Beyer also testified. The organization is focused on the replacement of lead water service lines, while the city and other organizations have focused on paint and soil. “Given the testimony here I don’t think the city has a leg to stand on to even know,” he said without offering new evidence.

But Beyer did bring up at least one thing that drew the committee’s interest – a seemingly dormant criminal investigation by the Wisconsin Department of Justice into the health department. In November 2019 city officials and Public Health Foundation auditors said the investigation was delaying their work by blocking access to certain records. Perez, on Thursday, said he was also concerned. The alderman submitted to the record a July 7th letter he wrote to Attorney General Josh Kaul calling for an update on the investigation and details on what had been found.