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Lead tests not done
Federal guidelines call for them for toddlers at ages 1, 2
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Published: April 13, 2009
Doctor's offices in Forsyth County are missing some children who are supposed to be tested for lead poisoning under federal guidelines, according to report cards issued by state health officials.
The reports found that no doctor's office in Forsyth County is fully in line with federal requirements that all children enrolled in Medicaid have their lead levels tested.
The state recently sent the lead-testing report cards to all the doctor's offices that see at least 15 enrolled children in Medicaid. The reports show how many of those children were tested for lead poisoning at each clinic in 2007, and what the overall rate was for testing those children.
The children were supposed to be tested at ages 1 and 2.
Doctor's offices had overall testing rates that ranged from a low of 20.8 percent to a high of 90.9 percent.
Local health officials are responding by stepping up efforts to make sure all children -- not just those on Medicaid -- are tested for lead.
"Our plan is to get out into all the practices and talk about the Medicaid requirements and the recommendations in the new lead rules to check all children's' blood at 1 and 2 years old," said Bob Whitwam, the director of environmental-health services in the Forsyth County Health Department.
Those visits will start soon and will begin with the medical practices that see the most Medicaid children, Whitwam said. All the practices that received report cards will get a visit. But Whitwam also hopes to encourage lead-level testing for all children, not just those who are enrolled in Medicaid.
The report cards cover the 2007 calendar year. For each doctor's office, it shows the number of children covered by Medicaid who were seen and the number tested at ages 9 to 17 months and ages 18 to 29 months.
The report gives an overall testing rate for children 9 to 35 months.
The best overall rate was logged by Cornerstone Pediatric Associates in Kernersville, which tested 90.9 percent of Medicaid-enrolled children. The lowest rate was at Walkertown Family Practice, which had an overall testing rate of 20.8 percent.
State officials compiling the reports cautioned that the reports are not completely accurate because of the difficulties in matching names in different computer databases. They said that if a match was not found the child was assumed to be untested, and that actual testing rates for clinics could be higher than reported.
Ed Norman, the state program manager for the lead-poisoning program, said he thinks that name matches and other database problems account for only a small number of discrepancies in the reports. When the state gave the statewide program a test-run in Guilford County, it found that the biggest reason Medicaid children were not getting tested was that the doctor's office had referred the child elsewhere for the test.
"There are clinics that are referring patients to labs and to the health department for lead testing, and if so that is a very inappropriate referral," Norman said. Forsyth County doesn't have a child health department and doesn't do lead testing, Norman noted.
The state can provide doctors' offices with lists of potentially untested children so they can check their records.
In Forsyth County, the doctor's offices showing the lowest percentages tended to be those that saw only a limited number of Medicaid patients.
"If you don't see that many of them you are just not that used to the process," Whitwam said. "That is one of the reasons we plan to get out into the practices and elevate the awareness of lead poisoning."
Scott Tolley, the practice administrator at Winston-Salem Pediatrics and Kernersville Pediatrics, said that the procedure is to collect blood for lead-level tests for 1- and 2-year-olds during their wellness checkups.
"Although we are not clear on how the data was collected, we strive to provide the best care for our patients," Tolley said. "If there are opportunities to improve upon our protocols we will do that."
Most of the doctor's offices on the list are part of the Novant or Wake Forest University Baptist Medical Center systems.
Nan Holland, the senior director of clinical excellence with Novant Medical Group, said she takes the state's report card seriously because it's a way to find out if patients are receiving the best care possible. "I am not able to comment specifically on this data because we need to receive more information from the state in order to review it against our own medical records," Holland said in an email. "As the state has indicated, there are challenges in collecting this type of data and then developing an accurate indicator to measure provider performance."
Holland said that Novant would review the data and see if all the patients included are being seen at Novant's practices. Then Novant can review the actual records to see how that compares with the state report card.
Bonnie Davis, a spokeswoman for Wake Forest University Baptist Medical Center, said that some children are not being brought in when they are supposed to for their "well child" visits at one and two years. Also, lead testing is done at the medical center lab, and some simply aren't taken there. Then too, Davis said, many of the children eligible for Medicaid are in families that frequently move.
"We're doing a pretty good job based on our numbers," Davis said.
Local lead regulations call it a level of concern if a child under the age of 6 is found with a lead level of five to seven micrograms of lead per deciliter of blood. In those cases, Whitwam said, the health departments consults with the parents and offers to do an investigation. At levels of eight and above an investigation is mandatory.
People who have lead levels of 20 micrograms are considered to have lead poisoning, state officials said.
Lead can cause impaired growth, behavioral problems and learning disabilities, state officials said. It can even cause seizures and death.
Children under the age of 6 are at the greatest risk because their brains are still developing, and because of more hand-to-mouth contact.
Whitwam said he thinks doctors' offices will welcome the chance to hear more about testing for lead.
"We have a pretty good relationship with the practices," he said.
■ Wesley Young can be reached at 727-7369 or at wyoung@wsjournal.com.
Lead testing
Practice Percent tested
Ardmore Family Practice 53.4
Cedar Creek Family Medical 68.8
Dr. Lorie Coe 37.8
Downtown Health Plaza 86.4
Cornerstone Pediatric Associates 90.9
Family Medical Associates -- Lewisville 63.6
Forsyth Pediatric Associates 82.3
Kernersville Pediatric 87.6
Maplewood Family Practice 65.2
North Point Medical Associates 76.9
Peace Haven Pediatrics 72.1
Pine Ridge Family Practice 81.2
Rice Pediatrics 89.8
Salem Family Practice 32.4
Wake Forest University Health 82.6
Walkertown Family Practice 20.8
Westgate Pediatrics 63.6
Winston East Pediatrics 79.3
Winston-Salem Health Care 87.4
Winston-Salem Pediatrics 87
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