- - Sunday, January 31, 2016

During my childhood my father had a phrase that meant “get busy and get it done!” That phrase was “Get the lead out!” In the light of the recent catastrophe in Flint, Michigan, the analogy is pertinent on many levels.

What happened? In 2015, doctors began finding elevated levels of lead in the children in Flint, with local tap water considered to be the likely cause. The safety of the discolored and foul-smelling water flowing through the municipal water system had already been a source of concern for a full year.

Flint, which switched its water supply about two years ago, was unable to come to an agreement on a contract with Detroit to buy water. Local authorities agreed to an alternate system that will draw water from Lake Huron. However, that system was not complete and will not be available until sometime in the future.

Meanwhile, the city decided to pump water from the Flint River. Complaints about foul-smelling, discolored water began soon after the city started drawing water from the Flint River. Within a few weeks, the GM plant in Flint recognized that the water was causing rust and corrosion and found other sources of water for manufacturing.

In the summer of 2014, the city issued a notice for residents to boil their water because of E. coli contamination detected in the drinking water. The city was then found to be in violation of the Safe Drinking Water Act because of high levels of a disinfectant byproduct called total trihalomethanes — an unintended consequence from all the chlorine the city had to use to kill the E. coli.

Over the past summer, researchers from Virginia Tech found that Flint River water is highly corrosive and when it comes into contact with lead from service lines, household pipes or solder, it releases the lead from the pipes and out the faucets. City officials and state regulators say they’re now putting together a corrosion control plan to reduce lead exposure.

What is the problem with lead? For forty years we as pediatricians have worried about lead. Lead is neurotoxic or poisonous to the brain, especially a child’s developing brain. High lead levels in the blood have been associated with developmental delays, learning disabilities, autistic behaviors and psychosis. Increased awareness of the risks to children triggered changes in paint formulations and requirements for cleaning urban areas that had decades of lead-based paint or manufacturing contamination in the environment.

Lead is associated with health problems in adults including hypertension, abdominal distress, headaches and muscle discomfort. Lead toxicity is not new. The citizens of Pompeii and Rome suffered from lead exposure through their lead pipes, cooking utensils and wine-making techniques. Two thousand years ago, Romans knew fresh rain water was healthier for drinking.

The adverse outcomes seen in children, especially lead-exposed infants, can be difficult or impossible to reverse. Consequently, prevention of exposure is optimal. As noted for centuries past, “An ounce of prevention is worth a pound of cure.” Few statements better summarize a sound public health plan.

Many antiquated municipal and residential water systems continue to use lead pipes. Sometimes the lead delivered from those pipes is relatively low, but if the water passing through the pipes is already corrosive, lead is leached out of the old pipes and discharged through the faucet. Flint is not the only town faced with lead dangers. Lead contamination in Washington, D.C., has been identified as higher, and the exposure period is much longer than that found in Flint.

For decades public health experts have recommended levels of fewer than 15 parts per billion for lead in drinking water. The lack of response to extraordinary multiples of that level in Flint is difficult to explain, but easy to recognize.

Who is responsible and who is accountable? Most Democrats and many Republicans believe that multiple layers of bureaucracy are needed to provide protection for citizens. Flint, Michigan, is a case study of that failed concept. The overlapping jurisdictions, authorities and agencies created cover for each mayor, manager and official to defer action to someone or something else. None of the bureaucrats felt their personal and professional well-being was on the line as long as they could point to another governmental entity as being the one responsible. And, since unions and career government workers are difficult to fire, employees were justified in their sense of security, regardless of the astronomical lead levels flowing into Flint homes.

Now that genuine health risks are obvious, a circular firing squad has formed. A few bureaucrats have taken a bullet and acknowledged at least partial responsibility. However, the consequences of lead exposure in the coming days, months and years will be difficult to assess and manage. Infants whose formula was mixed with contaminated water may pay the highest price. While state and federal governments quibble about how many millions of dollars will be necessary, lawyers gather like vultures over Flint.

So, what should happen? It is time to acknowledge what most Americans have watched for several decades: government does not work well. Rather than responding quickly, efficiently and accountably when things go wrong, the bureaucratic reaction is to deny, diffuse and direct blame to others.

In a developed society with complex technical capabilities, we do not ask government workers to build our computers. We do not have police units that build patrol cruisers. We use experts to provide equipment, monitoring and services. When the contracted experts fail to provide the service and quality needed, they lose the contract and are accountable for the failures.

The current chorus of complaints should not be wasted. The issue is much bigger than whether an Environmental Protection Agency director should resign, or if the emergency manager is inept, or why the pediatricians were ignored, or what the motives of the mayor or governor may be. The issue is really the health and well-being of our children and communities. Flint, Michigan, has just shown us that it is time to create a responsible and accountable system to monitor and correct health threats.

Communities and individuals need fewer governmental layers, clear lines of authority, expert entities that employ state of the art technology and guidelines, and excellent methods for citizens to get accurate information and share concerns. Private corporations whose continued employment is dependent on client satisfaction will be more responsive and accountable than seasoned government employees whose job is secure regardless of negligence or malfeasance. We now know that convoluted bureaucracies can’t get the lead out.

Dr. Alma Golden is a retired pediatrician who served as deputy assistant secretary of Health and Human Services under former President George W. Bush. She lives in in Temple, Texas.

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