I'M CALLING TO ORDER THE.
OVERSIGHT HEARING OF THE
ASSEMBLY COMMITTEE ON
ENVIRONMENTAL SAFETY AND TOXIC
MATERIALS.
WE'RE GONNA TALK ABOUT A
CHILDHOOD BLOOD LEAD TESTING.
AND HOW DO AND. THIS IS JUST A
THIS IS A REAL SERIOUS QUESTION
THAT.
THE COMMITTEE THE COMMITTEE
MEMBERS JUST DON'T KNOW THE
ANSWER TO WHICH IS.
HOW CAN WE INSURE?
THAT LOW INCOME CHILDREN ARE
RECEIVING THE TESTING THAT'S.
REQUIRED AND IS PAID FOR BY THE
STATE FOR LEAD EXPOSURE.
SO.
.
WE'RE TRYING TO UNDERSTAND.
IN MORE DETAIL HOW THE STATE
HEALTH DEPARTMENTS TRACK
CHILDREN ON THESE PROGRAMS
SUCH AS MEDI CAL.
TO ENSURE THEY RECEIVING THEIR
BLOOD TEST.
AS THEY ARE ARE REQUIRED TO DO.
AND TO ENSURE THEY ARE RECEIVING
THESE BLOOD LEAD TO HAVE TESTS
IS THEY SHOULD.
WE CAN'T SOLVE THE PROBLEM.
WE CAN'T HELP THE KIDS.
UNLESS THEY'RE TESTED.
AND.
BOB THAT PANELS CAN ADDRESS THIS
ISSUE THE PUBLIC DATA WE SEEM
SHOWS THAT ONLY ABOUT TWENTY
EIGHT PERCENT OF THE CHILDREN ON
MEDI CAL.
I HAVE BEEN TESTED ANNUALLY FOR
THE PAST FIVE YEARS.
SO IS THAT DATA CORRECT AND IS
THERE ANYTHING WE CAN DO TO MAKE
IT BETTER.
WE HAVE LONG KNOWN THAT LED IS
HIGHLY TOXIC ESPECIALLY FOR KIDS
AND THERE'S JUST NO SAFE LEVEL
OF LEAD.
CAUSES REAL.
PERSONALITY DISORDERS THERE IS
SOME SPECULATION THAT THE
DECREASE IN CRIME.
STARTED NINETIES I WAS DUE TO
THE FACT THAT SO MUCH LEAD WAS
TAKEN OUT OF THE ENVIRONMENT.
NO ONE KNOWS IF THAT'S TRUE OR
NOT. BUT THE FACT THAT YOU CAN
EVEN MAKE THAT HYPOTHESIS.
SHOWS THE DANGERS OF LAND IN
BLOOD.
A LETTER COURSE IS LISTED UNDER
PROP SIXTY FIVE IS SUBSTANCE
THAT CAN CAUSE REPRODUCTIVE
DAMAGE.
BIRTH DEFECTS.
ARMED.
LEAD EXPOSURE IN LEAD POISONING
ARE ALSO ASSOCIATED WITH
COGNITIVE ANOTHER HEALTH IMPACTS.
ESPECIALLY TO CHILDREN AND THEY
CAN BE A REVERSIBLE.
MILLIONS OF CHILDREN ARE
EXPOSED TO LEAD IN THEIR HOMES
THROUGH LEAD PAINT.
BUT THERE ARE OTHER SOURCES WELL
YOU CAN JUST BE IN AN OLDER
NEIGHBORHOOD AND WHILE YOUR
HOUSE DOESN'T HAVE LEAD PAINT
EDUCATION HOMES CAN.
YOU CAN BE NEAR A HIGHWAY WHERE
THERE WAS LOTS OF EXHAUST FROM
CARS THAT HAD LEAD IN IT.
ARM AND WE KNOW THAT IT CAN
CAUSE PROBLEMS TO THE BRAIN SLOW
GROWTH AND DEVELOPMENT.
LEARNING AND BEHAVIOR PROBLEMS
HEARING AND SPEECH YOU PARAMOUNT.
AND ALTHOUGH ALL KIDS ARE AT
RISK PARTICULARLY THE KIDS ON
MEDICARE HOW OF POOR AND
MINORITY CHILDREN ARE
DISPROPORTIONATELY AFFECTED NET
HIGHEST RISK.
AND IF ANY CHILD AT HIGH RISK
GOES UNTESTED THAT CHILD WILL
NOT RECEIVE THE.
THE.
SERVICES THAT THEY NEED SO
THAT'S.
BUT ONE OF THE REASONS THAT WERE
WERE HOLDING THIS HEARING TODAY.
WE'D LIKE TO BELIEVE THE STATE
IS DOING EVERYTHING IT CAN TO
ENSURE THOSE GOALS.
SO AGAIN WE'RE GONNA BE LOOKING
AT.
.
HOW THE STATE IS ARE TRIED
MAKING EFFORTS TO GET ALL
CHILDREN TESTED?
OUR I UNDERSTAND HOW THE
CHILDREN ARE TRACKED FOR
RECEIVING THOSE TASKS.
AND UNDERSTAND WHAT IF ANY
OBSTACLES MAY LIE IN THE WAY OF
ACHIEVING STRUGGLE COMPLIANCE
WITH THE MANDATE TO BLOOD LAST
HIT. BLOOD LEAD TEST ALL LOW
INCOME CHILDREN.
SO I'D LIKE TO THANK THE
WITNESSES WE HAVE TODAY.
AND ALL THOSE WHO'VE TRAVELED
TO OUR.
HERE AS WELL.
OUR I WOULD LIKE TO RECOGNIZE MY
FIRST MY VICE CHAIR ASSEMBLY
MEMBER CHEN.
ART DO YOU HAVE ANYTHING THAT
YOU'D LIKE TO SAY.
ASSEMBLY MEMBER CHEN.
IF YOU WANNA PRESSURE BUT NOT.
I HAD THANK YOU FOR THE
INFORMATION HEREIN LA QUARTZ
SOON LEARN MORE ABOUT.
LOOK WASN'T.
ME TOO. AND THEN.
ASSEMBLY MEMBER ELOISE GOMEZ
REYES.
CLEARLY THIS IS A TOPIC THAT IS
SO IMPORTANT TO SOMEBODY IN THE
COMMUNITY I COME FROM A
COMMUNITY WHERE. THE POVERTY
LEVEL IS VERY HIGH MANY OF MY
CHILDREN ARE.
MEDICAID RECIPIENTS
WE KNOW THAT THE RULES REQUIRE
TESTING AND I'M REALLY LOOKING
FORWARD TO FINDING OUT.
IF THEY ARE BEING TESTED AND IF
THEY'RE NOT WHAT CAN WE DO TO
FIX THAT.
GREAT.
ALRIGHT.
SO IN PANEL LINE.
I'D LIKE TO INVITE DOCTOR KAREN
SMITH DIRECTOR OF PUBLIC HEALTH.
A DOCTOR VICTORIA.
CHARLTON CHIEF FOR THE.
CHILDHOOD LEAD POISONING
PREVENTION BRANCH.
TO COME UP.
ED TO THE STAND AND TO PROVIDE
US WITH AN OVERVIEW OF HOW THAT
DEPARTMENT TRACKS.
THE BLOOD LEAD TESTING OF
CHILDREN ENROLLED IN GOVERNMENT
ASSISTANCE PROGRAMS.
ARE SO PLEASED TO HAVE YOU BOTH
THANK YOU VERY MUCH FOR COMING.
AND YOU CAN CERTAINLY HAVE UP
TO THIRTY MINUTES FOR YOUR
PRESENTATION. AND I HOPE THAT.
.
WE CAN REALLY LEARN FROM YOU.
WHAT THE EFFORTS ARE AND WHAT'S
HAPPENING?
I'D LIKE TO RECOGNIZE ONE OTHER
ASSEMBLY MEMBER THAT HAS COME
MAN. ASSEMBLY MEMBER AL
MURATSUCHI.
HE IS FROM TORRANCE AND IS THERE
ANYTHING YOU PARTICULARLY WANTED
TO. BRING UP TODAY.
ALRIGHT AND.
I MISS RAY S. IS THE THAT IS
FROM SAN BERNADINE NOW I'M FROM
HAYWARD.
SO.
WHICH REVIEW WOULD LIKE TO
START FIRST.
GOOD AFTERNOON CHAIR MEMBERS I'M
DOCTOR KAREN SMITH I'M THE
DIRECTOR OF THE CALIFORNIA
DEPARTMENT OF PUBLIC HEALTH IN
THE CALIFORNIA STATE PUBLIC
HEALTH OFFICER. AND I'M GOING TO.
PROVIDE A STATEMENT DR CHARLTON
WHO'S A LITTLE UNDER THE WEATHER
AND I ARE BOTH HERE TO ANSWER
YOUR QUESTIONS BUT SHE WILL BE
PROVIDING YOU READ A STATEMENT.
SO I AM.
START AT THE CALIFORNIA
CHILDHOOD LEAD POISONING
PREVENTION PROGRAM IN THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH'S
INTENDED TO WORK TO REDUCE THE
INCIDENCE OF CHILDHOOD LEAD
EXPOSURE IN CALIFORNIA. AND AS
ESTABLISHED IN THE CALIFORNIA
CHILDHOOD LEAD POISONING
PREVENTION ACTS.
PROGRAM.
HAS WORKED WITH THE H. SEE US
DEPARTMENT HEALTH CARE SERVICES
TO PROMULGATE REGULATIONS THAT
SPECIFY A STANDARD OF CARE FOR
HEALTH CARE PROVIDERS REGARDING
THE SCREENING AND ASSESSING FOR
CHILDHOOD LEAD POISONING.
THIS STANDARD OF CARE REQUIRES
THAT CHILDREN WHO RECEIVE
ASSISTANCE FROM PUBLICLY FUNDED
PROGRAMS.
FOR LOW INCOME CHILDREN SUCH AS
MEDI CAL AND THE WOMEN INFANTS
AND CHILDREN'S PROGRAM. OUR
BLOOD TESTED FOR.
AT BOTH AGE ONE AND TWO YEARS.
THE DEPARTMENT GOES TO GREAT
EFFORT TO ACHIEVE THIS LEVEL OF
TESTING INCLUDING EXTENSIVE
OUTREACH AND EDUCATION TO
FAMILIES COMMUNITIES.
CHILD CARE PROVIDERS AND HEALTH
CARE PROVIDERS THROUGH MEDIA
CAMPAIGNS THROUGH WORKING WITH
LOCAL COMMUNITY GROUPS DIRECT
MAILINGS OF MATERIALS
CONFERENCES IN NUMEROUS
PRECIPITATIONS.
IN ADDITION TO WORKING TO
ACHIEVE THIS UNIVERSAL TESTING
REQUIRED BY STATUTE.
THE PROGRAM ALSO PROVIDES CASE
MANAGEMENT SERVICES TO CHILDREN
WITH HIGH LEAD LEVELS.
UNDER THE THE PROGRAM DEVELOPED
REGULATIONS HEALTH CARE
PROVIDERS MUST PROVIDE GUIDANCE
ABOUT PREVENTING LEAD EXPOSURE
TO ALL FAMILIES OF YOUNG
CHILDREN DURING THEIR PRETEEN
HEALTH CARE VISITS. BETWEEN THE
AGES OF SIX AND SEVENTY TWO
MONTHS OR SIX MONTHS IN SIX
YEARS. THIS REQUIREMENT IS NOT
LIMITED TO THE PUBLICLY FUNDED
TO CHILDREN WHO ARE IN PUBLICLY
FUNDED PROGRAMS FOR LOW INCOME
CHILDREN.
CHILDREN WHO DO RESEARCH THAT
SERVICES FROM PUBLICLY FUNDED
PROGRAM ARE REQUIRED TO BE BLOOD
LEAD TESTED AT AGE TWELVE AND
TWENTY FOUR MONTHS.
CHILDREN WHOSE HEALTH CARE
PROVIDERS DETERMINE THAT THOUGHT
MANDATORY TESTING WAS NOT DONE
AT THOSE AGES ARE REQUIRED TO
TEST AT SOME POINT DURING UP TO
SEVENTY TWO MONTHS.
THE CITY PITCH CHILDHOOD LEAD
PROGRAM FOCUSES OUR OUT REACH IN
PRIORITIZING CHILDREN WHO ARE AT
INCREASED RISK FOR LEAD EXPOSURE.
AND THOSE INCLUDE CHILDREN WHO
ARE PRIMARILY FROM LOW INCOME
FAMILIES INCLUDING THOSE WHO
RECEIVE ASSISTANCE FROM PUBLICLY
FUNDED PROGRAMS. BUT ALSO THOSE
WHO LIVE IN DETERIORATED
DETERIORATED OR RECENTLY
RENOVATED OLDER HOUSING BECAUSE
OF THE LIKELIHOOD OF LEAD BASED
PAINT OR LED TO CONTAMINATED
DUST AND SOIL BEING PRESENT.
HOWEVER CHILDREN OF ANY
BACKGROUND IN AGE MAY BE BLOOD
BLOOD TESTED AND IF THE HEALTH
CARE PROVIDER OR FAMILY BELIEVES
THAT CIRCUMSTANCES PUT THEM AT
RISK.
ALL CHILDREN IDENTIFIED TO HAVE
AS HAVING INCREASED BLOOD LEAD
LEVELS ARE ELIGIBLE FOR SERVICES.
FROM THE CALIFORNIA LED PROGRAM.
REGARDLESS OF THEIR
DOCUMENTATION STATUS AND
REGARDLESS OF FAMILY INCOME.
TO ENCOURAGE COMPLIANCE WITH THE
STANDARD OF CARE FOR SCREENING
FOR CHILDHOOD LEAD POISONING
CITY PH CARRIES OUT EXTENSIVE
OUTREACH TO HEALTH CARE
PROVIDERS AND HEALTH PROGRAMS.
THIS OUT REACHES CONDUCTED BY
BIG BY OUR CALIFORNIA DEPARTMENT
OF PUBLIC HEALTH.
CHILDHOOD LEAD PREVENTION
PROGRAM BRANCH WHICH WE LIKE TO
CALL CLIP FIRST FOR A SHORT MRS
SAKE. AND ALSO BY STATE
SUPPORTED LOCAL CLIP PROGRAMS
THROUGHOUT THE STATE.
TO INCREASE COMPLIANCE BY
MEDICAL PROVIDERS WITH MANDATED
SCREENING. A CLIP PUBLIC HEALTH
MEDICAL OFFICER PROVIDES IN
PERSON PRESENTATIONS TO
PHYSICIANS AND MIDDLE THE MID
LEVEL PROVIDERS THROUGHOUT
CALIFORNIA.
THESE PRESENTATIONS PROVIDE
INFORMATION ON THE AFFECTS OF
BLOOD LED SCREENING IN
MANAGEMENT OF LEAD EXPOSED
CHILDREN AND INFORM PROVIDERS
ABOUT THE STATE REGULATIONS
REGARDING CHILDHOOD LEAD TESTING.
PRESENTATIONS ARE GIVEN OUT
MEETINGS CONFERENCES ONE TWO ONE
IN MEDICAL OFFICES MEDICAL
RESIDENCY PROGRAMS AS WELL AS AT
HOSPITALS. AND A TO CLINIC STAFF
DEPARTMENT AND HOSPITAL WIDE
PRISON TITIAN'S.
WE ALSO HAVE A FREE CONTINUING
MEDICAL EDUCATION OR SEE A ME.
PROGRAM THAT IS SIMILAR TO THE
IN PERSON PRESENTATIONS
CONTINUOUSLY AVAILABLE ON OUR
WEBSITE.
AS WELL AS BEING UP ON THE CME
THAT CALIFORNIA WEBSITE.
FROM THE MEDICAL BOARD.
IN ADDITION PUBLIC OF NURSES IN
THE LOCAL CLICK PROGRAMS PROVIDE
DIRECT OUTREACH MEDICAL
PROVIDERS IN THEIR COMMUNITIES.
DURING THE FIRST HALF OF TWENTY
SEVENTEEN FIVE HUNDRED AND
SEVENTY SIX OUTREACH AND
EDUCATION EVENTS OCCURRED AND
REACHING ALMOST TEN THOUSAND
PROVIDERS ACROSS THE STATE OF
CALIFORNIA.
WE ALSO HAVE OUTREACH MATERIALS
THAT ARE MADE AVAILABLE TO
HEALTH CARE PROVIDERS ALWAYS IN
SPANISH AND ENGLISH AND MANY OF
THE MATERIALS ARE ALSO PRODUCED.
IN EIGHTEEN OTHER LANGUAGES.
IN ADDITION TO KEY DOCUMENTS THE
CALIFORNIA MANAGEMENT GUIDELINES
ON CHILDHOOD LEAD POISONING FOR
HEALTH CARE PROVIDERS AND THE
STANDARD OF CARE GUIDELINES ON
CHILDHOOD LEAD POISONING FOR
CALIFORNIA HEALTHCARE PROVIDERS.
ARE SENT TO HEALTH CARE
PROVIDERS THROUGHOUT THE STATE.
PUBLICATIONS AND ARTICLES
REGARDING CHILDHOOD LEAD
POISONING PREVENTION AND BLOOD
LEAD TESTING REQUIREMENTS ARE
PUBLISHED IN THE CALIFORNIA
MEDICAL BOARD NEWSLETTER AND
OTHER PUBLICATIONS FOR MEDICAL
PROVIDERS.
ANY CHILD IDENTIFIED AS A
CONFIRMED CASE OF LEAD POISONING
WILL RECEIVE PUBLIC HEALTH
NURSING AND ENVIRONMENTAL FOLLOW
UP AND CASE MANAGEMENT.
PUBLIC HEALTH NURSES AND
ENVIRONMENTAL PROFESSIONALS MAKE
HOME VISITS TO EDUCATE THE
FAMILY ABOUT HOW TO REDUCE THE
LEAD EXPOSURE. AND CARRY OUT
INTER INTERVIEWS REGARDING
PRODUCTS IN USE AT THE HOME A
HOW TO AND REDUCING LEAD
EXPOSURE. AND FAMILY BEHAVIORS
AND THEY ALSO CONDUCT
INSPECTIONS OF THE PHYSICAL
ENVIRONMENT INCLUDING THE HOUSE
AND SURROUNDINGS.
HOME INVESTIGATIONS INCLUDE
TESTING PAINT DUST SOIL AND
WATER FOR LED AND OFTEN INCLUDE
ACTUALLY FLUORESCENT EVALUATIONS
OF LEAD IN AND AROUND THE HOUSE
HOME. TIM WITH A HAND HELD
DEVICE THAT PROVIDES IMMEDIATE
FEEDBACK TO THE FAMILY.
THE CHILD RECEIVE SPECIAL HEALTH
CARE REFERRALS AS NEEDED AN
ONGOING COLLABORATION BETWEEN
PUBLIC HEALTH AND THE CHILD'S
HEALTH CARE PROVIDERS DIRECTLY.
FOLLOW UP IS CARRIED OUT TO
ASSURE THAT THE SOURCES OF LEAD
IN THE HOME ARE IDENTIFIED AND
REMOVED AND TO ENSURE THAT THE
BLOOD LEAD LEVELS IN THE
CHILDREN DECLINE AND REMAIN LOW.
CITY PITCHES CLIP BRANCH WORKS
IN PARTNERSHIP WITH THE
CHILDHOOD HEALTH AND
DISABILITIES PROGRAM IN THE
DEPARTMENT HEALTH CARE SERVICES.
TO PROMOTE BLOOD LEAD TESTING
THROUGHOUT REACHED A HEALTH CARE
PROVIDERS.
CLIP NCH DP JOINTLY ISSUE THE
HEALTH ASSESSMENT GUIDELINES FOR
MEDICAL PROVIDERS AND SCREENING
FOR LEAD EXPOSURE AND MANAGING
CHILDREN IDENTIFIED WITH
INCREASED BLOOD LEVELS THESE
GUIDELINES ARE SENT TO HEALTH
CARE PROVIDERS THROUGHOUT
CALIFORNIA AND WERE UPDATED BY
CH DP AND CLIP. AND REISSUED IN
SEPTEMBER OF TWENTY SEVENTEEN.
GUIDELINES ARE ALSO AVAILABLE ON
THE C. HTP WEBSITE AS WELL AS
OUR WEBSITE AT CTP AGE AND ARE
ALSO AVAILABLE AND HARD COPY TWO
PAGE HANDOUT.
SO THAT CONCLUDES MY STATEMENT
WE'RE HAPPY TO ANSWER ANY
QUESTIONS THAT YOU HAVE.
SO I THINK YOU A DOCTOR SMITH
AND I'M SORRY YOUR VOICES NAM
CHALLENGE TODAY DOCTOR.
A CHARLATAN.
.
SO YOU'RE CLEARLY DOING A LOT OF
WORK.
IS FIRST FALL IS THE NUMBER
TWENTY EIGHT PERCENT.
WHICH IS THE ONLY PUBLIC NUMBER
WE HAD FOR THE NUMBER OF
CHILDREN WHO ARE ELIGIBLE FOR.
REIMBURSEMENT UNDER MEDI CAL
AND BLACK
TWENTY EIGHT PERCENT OF THEM
BEING TESTED IS THAT DO YOU
THINK A GOOD NUMBER.
SO I DON'T WE DON'T HAVE GOOD
MEANING AT ACCURATE IDEA BECAUSE
TO THINK NOW WE ALL AGREE IT
WOULDN'T BE GOOD IF ONLY TWENTY
EIGHT PERCENT AT HOW ACCURATE IS
THAT NUMBER SO I'M GOING TO
DEFER QUESTIONS AT THAT THAT
RELY ON MEDI CAL DATA TO.
MY COLLEAGUE JENNIFER CAN'T
BECAUSE I DON'T REALLY WE DON'T
HAVE ACCESS TO THE MEDICAL DATA
WHAT I CAN TELL YOU IS THAT.
WHAT VOTE CALIFORNIA LED
PREVENTION PROGRAM POISONING
PREVENTION PROGRAM HAS DONE IN
THE PAST?
IS A MANUAL ASSESSMENT OF.
ARE OUR BEST ESTIMATE OF THE
PERCENTAGE OF LOW INCOME
CHILDREN IN CALIFORNIA THAT HAVE
BEEN TESTED.
WE'VE DONE THIS BY.
USING U. S. CENSUS DATA TO
ESTIMATE THAT THERE
APPROXIMATELY A MILLION CHILDREN
IN CALIFORNIA BETWEEN THE AGES
OF ONE AND TWO SO THAT'S THE
POPULATION. OVER ALL WITH WHO
ARE I'M AT OR BELOW TWO HUNDRED
FIFTY PERCENT OF THE FEDERAL
POVERTY LEVEL TO THAT'S THE
NUMBER OF CHILDREN THAT WE WOULD
EXPECT TO HAVE TESTED.
IF AT THE SAME TIME WE IF WE
LOOK AT THE NUMBER OF CHILDREN
WHO WERE LED TESTED IN
CALIFORNIA WHAT WE SEE IS
APPROXIMATELY SEVENTY TWO
PERCENT.
OF THE CHILDREN THAT WE HAVE
THAT NUMBER THAT WE EXPECT TO BE
HAVE ACTUALLY BEEN TESTED AT
LEAST ONCE.
AND.
DR CHARLTON WLL CORRECT ME IF I
MAKE ANY MISSTATEMENTS ABOUT
THOSE
SO THAT WE DON'T BE BECAUSE.
LEVEL OF INCOME IS NOT AN IT
BAG COLLECTED WITH FOR THE
CHILDHOOD LEAD POISONING
PREVENTION DATA WE GOT.
WITH ELECTRONIC LAB REPORTING
OF ALL LEAD TESTING DONE IN
CALIFORNIA ALL AGES INCLUDING
ALL CHILDREN.
HOWEVER THE INCOME THE FAMILY
INCOME LEVEL IS NOT ONE OF THE
PIECES OF DATA THAT'S COLLECTED.
SO WE'VE USED THIS.
SURROGATE METHOD FOR ESTIMATING
THAT THE PERCENTAGE OF TESTING
THAT'S HOW BOOK OKAY BUT HOW
MANY TOTAL CHILDREN ARE THERE.
ARE.
BETWEEN THE AGES OF ARE SIX
MONTHS AND SIX YEARS.
THERE WERE ABOUT FIVE HUNDRED
THOUSAND CHILDREN BORN IN
CALIFORNIA EVERY YEAR.
IT'S DROPPED A LITTLE OVER THE
OKAY RETAILERS THAT WOULD BE
ABOUT A MILLION TOTAL CHILDREN.
AGE TWO AND THREE.
AND I'M WE HAD ESTIMATED AT
TWENTY FIFTY PERCENT OF POVERTY
LEVEL THAT THERE'S ABOUT FIVE
HUNDRED SEVENTY THOUSAND SUCH
CHILDREN.
AND WE GET OUR.
BLOOD LEAD TEST RESULTS
ELECTRONICALLY FROM THE LABS SO
WE GET INDIVIDUAL REPORTS AND
THE CHILDREN WERE TESTED.
OKAY SO THIS FIVE HUNDRED
SEVENTY THOUSAND CHILDREN AND
THEN HOW MANY ACTUAL TESTS ARE
DONE ABOUT FOUR HUNDRED AND NINE
THOUSAND WOULD INCLUDE. CHILDREN
AGE NINE MONTHS TO TWELVE MONTHS
BECAUSE SOME CHILDREN GET THEIR
ONE YEAR VISIT IN A FEW MONTHS
BEFORE. AND THEN ABOUT THREE
HUNDRED SEVENTY THOUSAND
CHILDREN AGED TWO AND THREE.
SHOW WHEN WE COMPARE THOSE WE'RE
ENDING UP WITH A. AS WAS SAID
AYE AYE NUMBER IN THE MID
SEVENTIES FOR CHILDREN WHAT WE
BELIEVE ARE GETTING TEST. BUT.
THAT'S ASSUMING THAT ALL THE
CHILDREN GETTING TESTED ARE LOW
INCOME.
SO AND THAT'S OUR TARGETED GROUP
AS WITH EXPLAIN WHY AND WHEN WE
LOOK AT CASES CHILDREN WHO HAVE
VERY HIGH BLOOD LEAD LEVEL TO
GET THE. CASE SERVICES THAT
DOCTOR SMITH EXPLAINED
ABOUT EIGHTY FIVE PERCENT OF
THEM ARE MEDI CAL.
SHOW YOU COULD NOT BELIEVE THAT
AND AND MOVE IT DOWN. AND THEN
ALSO SOME CHILDREN GET A TEST
AFTER TO THAT MAKE UP TEST SO
THEY MAY BE.
THREE AND A HALF OR SOMETHING
LIKE THAT.
TOGETHER TO WE BELIEVE A
CONSIDERABLY MORE CHILDREN ARE
BEING TESTED THEM THAT TWENTY
EIGHT PERCENT WOULD INDICATE.
OKAY ARM.
I.
CERTAINLY.
AND PREPS I CAN ASK MY STAFF
JUST TO QUESTION
.
THIRD DOWN RIGHT I'LL GET SO I'M
JUST NOT SURE I BELIEVE YOUR
NUMBERS. AYE BUT I'D ONE WILL
WILL HAVE WILL TRY AND GO TO IT.
.
THOSE EXTRAPOLATIONS ARE REALLY
DEPENDING UPON.
THE FACT THAT.
WELL FOR EXAMPLE I COULD BELIEVE
THAT.
THERE IS A LESS OF A CHANCE OF
HIGHER INCOME PEOPLE.
LIVING IN HOMES THAT HAVE LED
PROBLEMS AND IF FOR SOME REASON
THEY WERE GETTING TESTED AT A
HIGH RATE YOU CAN. UNDERESTIMATE
THE NUMBER WHERE IS THE NUMBER
WE'RE GETTING FROM MEDICAL DATA
IS I THINK MORE HARD DATA BUT.
I WILL ADMIT TO BEING CONFUSED.
AND I MENTIONED
WE DID IT WAS A FEW YEARS BACK.
TO AN ACTUAL MATCH
I'M GETS CHILDREN WHO AND MEDI
CAL
TALK COULD FIND AND LOOK.
AT WHETHER WE COULD FIND THEM
BETWEEN AGE NINE MONTHS AND
TWENTY SEVEN MONTHS IN OUR
DATABASE. OF CHILDREN SHOWING UP
FOR SERVICES AT MEDICO.
WE GOT ABOUT THE SAME ABOUT
SEVENTY FIVE SEVENTY SEVEN
PERCENT OF CHILDREN WERE GETTING
AT LEAST ONE BUT LET TEST.
AND FOR CHILDREN THAT WE
COULDN'T DOCUMENT ANY OTHER
MEDICAL SERVICES
WE WERE GETTING SIXTY.
THREE PERCENT CHAU SO CLEARLY WE
ALL NEED TO TO TRY AND FIGURE
OUT WHAT'S THE DIFFERENCE MARIN.
WELL EVEN IF IT'S SEVENTY SOME
PERCENT THEN THERE'S TWENTY FIVE
PERCENT WHO AREN'T. UP.
WHAT OTHER THINGS FOR THE
SOMEWHERE BETWEEN TWENTY FIVE
PERCENT AND SEVENTY PERCENT THAT
AREN'T BEING TESTED?
UP WHERE WHERE WE LOSING PEOPLE.
SO.
WE DON'T KNOW WHAT WE DON'T KNOW
BUT I'M NOT SAID I THINK THAT
THE MOST LIKELY IT LIKELY IS THE
THE SAME POPULATION THAT WE ARE
NOT REACHING IN OTHER WAYS TO
THOSE WHO ARE NOT ACTIVELY
ENGAGING IN ANY SERVICE SO
WHETHER IT'S.
A WOMEN IT'S FOR INFANTS AND
CHILDREN BUT THEY'RE ALSO NOT
ACCESSING HEALTHCARE PROVIDERS
* WHO WHO BILL THEY MAY BE
GETTING SERVICES IN FREE CLINICS
ETCETERA SO THERE'S A LARGE
POPULATION OF PEOPLE
PARTICULARLY. OF RECENT
IMMIGRANTS WHO DON'T ACTUALLY.
ENGAGE IN THE PUBLIC SECTOR
VERY MUCH AT ALL AND IT MAY BE
THAT A PORTION OF THOSE CHILDREN.
ARE THERE I'M NOT SURE AS FAR AS.
THE THE MEDI CAL POPULATION PER
SE.
I'M NOT REALLY FAMILIAR WITH
THE MEDICAL DATA AND SO I THINK
I WOULD I ONCE AGAIN REFER TO
MISS KENT ON THAT.
OKAY.
.
WHAT WOULD YOU SUGGEST A BE DONE
TO GET?
THE KIDS WHO ARE BEING TESTED
DOES THAT MEAN WE NEED TO DO
MORE WITH FREE CLINICS OR.
I THINK THAT M. INNER SPIRIT
I'VE WORKED AT THE LOCAL LEVEL
FOR TEN YEARS BEFORE COMING TO
THE STATE AND I WILL SAY THAT
THE. YOU SPEAKING ON BEHALF OF
THE CHILDHOOD LEAD PREVENTION
PROGRAM AND AND I I DO ACTUALLY
HAVE SOME EXPERIENCE WITH THE
CHILD HEALTH AND DISABILITY
PROGRAM.
THEY WORK VERY CLOSELY WITH WITH
CLINICS PARTICULARLY FQHCS AND
OTHER.
CLINICS IN COMMUNITIES THAT
REALLY REACH THESE MOST
VULNERABLE POPULATIONS AND THEY
DO A VERY GOOD JOB OF MAKING THE
CLINICIANS AWARE OF LEAD TESTING.
THERE ARE SOME BARRIERS BUT
THERE ARE BARRIERS WITHIN THE
SYSTEM SO FOR EXAMPLE.
IN MANY CLINICS POINT OF CARE
LEAD TESTING SO THE KIND OF
TESTING OR MUNICIPALITY. A SMALL
TEST AT WHAT SITES ARE NOT
AVAILABLE AND WHAT THAT MEANS IS
THAT THAT FAMILY THEN HAS TO GO
TO A BLOOD COLLECTION SITE
ACTUALLY STAY GET THE TOSSED
THEY MAY HAVE TO PAY A CO PAY.
AND THE EACH STEP REMOVED THAT
YOU ARE IS A STEP THAT CREATES A
BARRIER AND THAT'S TRUE FOR ANY
KIND OF.
TESTING THAT REQUIRES A BLOOD
DRAW AND THAT MAY BE ONE OF THE
AREAS WERE RELEASING SOME
CHILDREN AS WELL.
SO ARM WOULD YOU SUGGEST IT
WOULD BE A GOOD IDEA IF WE COULD
DO AT LEAST A SCREENING TEST
WHEN THE CHILDREN ARE GETTING
THEIR CHECKUPS.
I YOU KNOW IT TO PI DON'T KNOW
ENOUGH ABOUT THE STATE OF THE
ART OF POINT OF CARE LEAD
TESTING THERE HAVE BEEN THERE
ARE TECHNOLOGIES AVAILABLE MY
UNDERSTANDING IS THAT THEY ARE
IN FACT.
SOME ARE DEVELOPING IN THAT.
RECENTLY THAT WAS OF SOME OF THE
TECHNOLOGY THAT'S AVAILABLE HAS
ACTUALLY BEEN CALLED INTO
QUESTION AS FAR OF ITS AS FAR AS
ITS ACCURACY GOES IN AND SO
WITHOUT MORE INFORMATION ABOUT
THE TECHNOLOGY THAT'S AVAILABLE
I WOULD HESITATE. HESITATE TO
CALL FOR A BROAD ADOPTION OF
POINT OF CARE TESTING COULD YOU
GIVE US MORE INFORMATION AND.
AND PERHAPS WEEK WE KEEP THE
RECORD OPEN FOR A MONTH.
IF SOMEONE IN YOUR DEPARTMENT
COULD GET THIS INFORMATION.
ABOUT HOW THE ACCURACY OF THESE
TASKS AND THE COST
ARE PERHAPS WE COULD LOOK AT
MAKING IT AVAILABLE PARTICULARLY
TO.
TO LEARN COMMUNITIES IN
PROVIDERS WHO GET A LOT OF MEDI
CAL AND WAKES CHILDREN.
WE CAN PROVIDE THAT WE TO HAPPY
TO PROVIDE BUT I MIGHT JUST WANT
TO MENTION. THE POINT OF SOME OF
CARE.
SYSTEM THAT EXISTS NOW WHICH WAS
BUILT WITH THE CDC WAS MEANT TO
BE ACCURATE AROUND TEN.
WHICH WE ALL KNOW NOW IS NOT.
THE IDEAL LEVEL TO LOOK AT LED
WE'RE ALL GOING MUCH LOWER I'M
IT IS ACCURATE ABOUT THREE POINT
THREE.
IT'S REALLY PUSHING UP AGAIN.
LEVELS OF ACCURACY THAT JUST WAS
A BIG RECALL.
I'M OF THE SYSTEM BECAUSE WITH
VENOUS BLOOD TEST.
PEOPLE USING* TELL
SUPPOSED TO CAPILLARY
THEY WERE UNDER READING. ROOM SO
THERE'S A LOT GOING ON AROUND
THAT BUT WE HAVE BE HAPPY TO GET
YOU OUT AND.
CAN BE WONDERFUL THANK YOU.
ALRIGHT AYE AYE YEAH YES ARE SO.
OF MR CHEN IS VICE CHAIR YOU CAN
GO NEXT I KNOW MISS.
REYES HAS A QUESTION.
AND THEN IF MR SCHUMER'S SUCI AS
A QUESTION GO RIGHT AHEAD.
THANK YOU MISTER CHAIR PRECIADO
TIME. MY QUESTIONS IN THE AREA
OF LEAD PAINT SPECIFICALLY
INCREASE IN TERMS OF WHAT HAVE
WE DONE THE STATE LEVEL TO WORK
WITH A FIFTY EIGHT COUNTIES.
UNDERSTAND THAT EVERY COUNTY
DEPARTMENT OF PUBLIC HEALTH
THROUGHOUT OUR STATE HAS THROWN
INDIVIDUAL PUBLIC HEALTH PROGRAM.
THAT COMMENTS IS AREA A WHAT
HAVE WE DONE TO CLAPPER WOULD
COLLABORATE WITH THEM. MY SECOND
QUESTION IS.
HAVE WE SEEN.
.
IT INFLUX OF MORE OF THESE LEAD
PAINT ISSUES IN AREAS IN WHICH
OR FROM LOWER SOCIO ECONOMIC
LEVELS AND HOW MUCH OF THAT IS
THE RESPONSIBILITY IN THE ONUS
ON. THE RESIDENT.
NATURAL WEAR AND TEAR ON THEM
BREATHING THEN BREATHING IN A
LEAD PAINT BY EATING LEAD PAINT
CHIPS.
AND WHAT HAVE WE DONE TO TRY TO
COMBAT THESE ISSUES.
SO I'M.
THE. THE DEPARTMENT PROVIDES
FUNDING TO.
FIFTY CONTRACT IT WELL WERE
FORTY EIGHT COUNTIES CONTRACT
WITH US CURRENTLY TWO WERE IN
THE PROCESS OF COMPLETING THE
CONTRACTS.
TO ACTUALLY DO BOTH THE CASE
MANAGEMENT OF THE INDIVIDUAL
CHILDREN HERE.
ARE DETECTED IS HAVING HIGH
LEAD LEVELS BUT THEN ALSO TO DO
ENVIRONMENTAL SURVEY FOUND WE
SEND ENVIRONMENTAL HEALTH
PROFESSIONALS IN TWO TO SURVEY
AND THEN. DIRECT REMEDIATION AS
FAR AS.
WHOSE RESPONSIBILITY IT IS
WHETHER IT IF IT'S AN OWNER IT'S
CLEAR THAT THE RESPONSIBILITY IS.
ON THE OWNER.
I I WOULD NOT I AM NOT AN
EXPERT IN THE LAW AND I KNOW
THAT THESE ISSUES WITH BETWEEN
TENANTS AND OWNERS IN RENTAL
SITUATIONS CAN BECOME EXTREMELY
CAN.
YES AND I DON'T REALLY HAVE.
THE EXPERTISE TO ANSWER THAT
QUESTION. ON WELL BUT WE AND WE
WORK VERY CLOSELY WITH THE LOCAL
I JURISDICTIONS AND ALL THE AND
IN THOSE COUNTIES WHERE WE DO
NOT DIRECTLY CONTRACT WITH THE
COUNTY. THEY THE DEPARTMENT
PROVIDES THOSE SERVICES IN SOME
COUNTIES TO PROVIDE THEM IN
COLLABORATION WITH THE WITH THE.
COUNTY BUT WE IN OTHER COUNTIES
ARE NURSES AND OUR ENVIRONMENTAL
HEALTH PROFESSIONALS DO THE WORK
DIRECTLY.
OKAY. ANYTHING ELSE.
ASSEMBLYMEMBER REYES.
THANK YOU MISTER CHAIRMAN.
BUT I'D LIKE TO GO BACK TO THE
STATISTICS BECAUSE IT'S CLEAR
FROM YOUR PRESENTATION THAT ONCE
THE CHILD HAS BEEN TESTED HAS
BEEN FOUND TO HAVE LED.
THEN CLEARLY THERE ARE NUMBER
SERVICES ARE PROVIDED TO THE
CHILD TO THE FAMILY.
AND.
SERVICES TO MAKE SURE THAT
THEY'RE NO LONGER EXPOSE AND
THAT OF THE CHILDREN NOT EXPOSED
TO THE LAND.
BUT I AM VERY CONCERNED ABOUT
THE NUMBER OF CHILDREN WHO ARE
ACTUALLY TESTED.
AND I DO KNOW THAT THAT THE
NUMBERS THAT WERE REFERRED TO.
COME FROM THE DEPARTMENT OF
HEALTH CARE SERVICES.
AND THEY DID TALK ABOUT THE IF
IT IN HERE.
FIT FEDERAL FISCAL YEAR TWO
THOUSAND TWELVE THROUGH THROUGH
TWO THOUSAND SIX
TEAM.
THE NUMBER OF CHILDREN AGES ONE.
TO.
WHO HAD BEEN CONTINUOUSLY IN A
CONTINUOUSLY ENROLLED IN
MEDICARE EL? WHO WERE TESTED
VERSUS THOSE WHO ARE
CONTINUOUSLY ENROLLED IN
MEDICARE WILL?
THE NUMBERS ARE VERY DIFFERENT.
FOR TWO THOUSAND SIXTEEN THE
NUMBER TESTED WERE TWO HUNDRED
TWENTY ONE THOUSAND.
THE NUMBER AND ROLLED WERE SEVEN
HUNDRED EIGHTY SEVEN GIVING US A
TWENTY EIGHT POINT ONE PERCENT.
THAT WERE ACTUALLY TESTED.
.
SO AGAIN I AM WHERE WERE WE.
I'M GONNA DEFER TO.
JEN CAN'T WE DEAL WITH I'M THE
ACTUAL LABORATORY TESTS SO WE
HAVE THE END OF THE PROCESS
I'M RATHER THAN WHAT WE'RE WHICH.
HEALTH INSURER THE CHILD IS IS
SADDAM IS INSURED BY.
WHAT EVERY SINGLE LABORATORY
TEST DONE FOR LOUD FOR EVERYONE
IN CALIFORNIA COMES THROUGH OUR?
SYSTEM AND SO WHEN WE MET WHEN
WE MAKE ESTIMATES AND THEY ARE
ESTIMATES AGAIN WE DON'T GOT
FAMILY INCOME LEVEL.
WE USE WHAT WE HAVE FROM CENSUS
DATA AND THE NUMBER OF SO WE
MAKE AN ESTIMATE OF WHAT THE
TOTAL POPULATION IS USING U. S.
CENSUS DATA. AND WE KNOW HOW
MANY.
SAMPLES WE RECEIVE FROM KIDS IN
THE APPROPRIATE AGE RANGE AND
THAT'S HOW WE MAKE OUR ESTIMATES
OF THE NUMBER OF ANTICIPATED
CHILDREN IN POVERTY IN
CALIFORNIA UNDER TWO HUNDRED
FIFTY PERCENT OF PART OF. THE
FEDERAL POVERTY LEVEL ARE BEING
TESTED AND IT'S BASED ON LEAD
TEST RESULTS. I DON'T I DON'T.
REALLY HAVE I NEITHER HAVE
ACCESS TO NOR UNDERSTAND THE
MEDICAL DATA.
SO I WILL I KNOW THAT.
THIS KENSHIN TENDS TO TALK
ABOUT IT AND IF I COULD CLARIFY.
OUR NUMBERS ARE INDIVIDUAL
CHILDREN TESTED.
SO IF A CHILD GETS TO BLOOD
BLOOD TESTS THAT WERE ONLY
COUNTING THEM ONCE.
SO IT'S A D. DUPLICATED
INFORMATION.
THE PROCESS THAT WE DO MANUALLY.
SO THE QUESTION IS THEN SHOULD
BE REFERRED TO NEXT HANNAFORD
CAN'T CONCERT.
ULTIMATELY I THINK THAT.
IF IF WE HAD DATA SYSTEMS THAT
WOULD ALLOW US TO TO ACTUALLY
DIRECTLY.
OUT COMPARED THE MEDICAL DATA
AND YOU KNOW SORT OF. REALLY.
RUN ANALYSES ON THE TWO SYSTEMS
TOGETHER WE WOULD BE ABLE TO
PROVIDE MUCH MORE.
ACCURATE DATA RATHER THAN
ESTIMATING BUT AT THIS TIME WE
JUST DON'T HAVE THAT TECHNOLOGY.
WOULD YOU AGREE THAT.
THAT IT IS EXTREMELY IMPORTANT
TEST
CHILDREN.
FOR LED ABSOLUTELY AND WOULD YOU
AGREE THAT THE CHILDREN FROM LOW
INCOME THAT THE COME FROM LOW
INCOME FAMILIES. ARE AT A HIGHER
RISK
OF LEAD POISONING YES THAT'S
EXACTLY WHAT WE PRIORITIZE THAT
POPULATION AND I THINK THAT IT
EL ALONG THOSE LINES THEM TO THE
CHILDREN THAT ARE LOW INCOME.
ARE USUALLY ON MEDI CAL AND
THAT'S WHY WE HAVE THE
REQUIREMENT THEM THAT THEY BE
TESTED.
WE AGREE YES SHOULD THEY BE
TESTED ONCE OR SHOULD THINK THEY
BE TESTED MORE THAN ONCE
WELL THE REQUIREMENT IS FORTY.
FOR TESTING BOTH A AT SIX MONTHS
AND AT TWELVE MONTHS AND SO DOT
DOT IS WHAT OUR RECOMMENDATION
WOULD BE.
VERY GOOD.
PART OF THE REASON THAT THAT OF
A FOR MY GREAT INTEREST AS.
CHAIRMAN KNOWS I I DID INTRODUCE
AB TWENTY ONE TWENTY TWO
SPECIFICALLY BECAUSE WE WERE
FINDING THAT MANY OF OUR
CHILDREN. WERE NOT BEING TESTED.
EVEN THOUGH THEY WERE IT WAS
REQUIRED THAT THE THAT THEY BE
TESTED WE'RE FINDING BECAUSE OF
THE STATISTICS THAT WAS NOT
HAPPENING.
AND IF I COULD MAKE ONE MORE
COMMENT.
OUR NUMBER IS PROBABLY A LOW
NUMBER.
BECAUSE WHAT OUR NUMBERS ARE AS
THE BLOOD LEAD TESTS THAT ARE
REPORTED TO US.
SO IF THERE'S ANY ABSENCE OF
REPORTING OR ANY PATCHES THAT'S
NOT REPORTED ARE ARE NUMBERS
WOULD BE YOU KNOW SO IN OTHER
WORDS A RATHER THAN IT BEING
OVERESTIMATE. I WOULD THINK IT
TENDS TO BE A LITTLE BIT OF LOVE.
WELL WE ALL AGREE THEIR CHILDREN
YOU SHOULD BE TESTED WHO ARE NOT
SELL THAT THAT WE CAN AGREE ON.
.
I AND THE. OTHER ANY OTHER
QUESTIONS
BEFORE I STE AYE I HAVE I ALWAYS
HAVE MORE QUESTIONS.
.
IT DEPICTED GEOGRAPHICAL DATA
WHEN YOU GET THE RESULTS OF THE
TEST AND YES WE DO.
BUT I WATCHED CHICAGO DATA WHOM
WE HAVE ADDRESS DATA WE HAVE TO
FOLLOW THESE CHILDREN SO WE WE
AND CHECK IT OUT TRUST INTO FARM
IT DOESN'T ALLOW YOU TO FIND.
NEIGHBORHOODS THAT ARE
PARTICULARLY.
IN DANGER OF HAVING THAT
CHILDREN WITH HIGH LEFT.
.
IN A WITH THE APPROPRIATE DATA
SYSTEMS WE DO DO GEO MAPPING WE
COULD DO JAIL MAPPING I DON'T
KNOW JUST THE SYSTEM A LOT. AND
WE DO HAVE DONE ZIP CODE.
AREAS IT'S ACTUALLY POSTED ON
OUR WEBSITE TO SHOW THE ZIP
CODES THAT HAVE A HIGHER
PERCENTAGE OF VERY GOOD CHILDREN
THAT THAT WOULD HAVE BEEN. I'M
INCREASED.
.
BUT.
WITH ABOUT SEVEN HUNDRED
THOUSAND BLOOD LEAD TEST COMING
IN EACH YEAR.
AND.
SOME OF THESE TESTS ABOUT
FIFTEEN PERCENT OR SO LACK
COMPLETE ADDRESSES SO WE HAVE TO
WORK WITH THE LAB TO GET IT.
SOME OF THE MAPPING IT IS NOT SO
ACCURATE FOR THE DENOMINATOR SO
WITHIN MY BLOOD LEAD LEVEL WE
WORK REALLY HARD TO FIND THAT
CHILD TO GET SERVICES.
BUT IT'S A VERY LOW BLOOD LEAD
LEVEL THAT WOULD JUST BE THE
DENOMINATOR CHILDREN TESTED IN
THAT AREA. IT THEY THEY MAY NOT
QUITE GET THE. THE THE RESEARCH
ATTENTION BUT WE'RE WORKING ON
IT AND.
A GEOGRAPHIC INFORMATION SYSTEM
IS PART OF WHAT WE'RE DEVELOPING
WITH OUR DATABASE NOW. SO THAT'S
EXCELLENT BECAUSE WHO WOULD BE
VERY GOOD IF WE COULD LET
PEDIATRICIANS NO.
ARE WHAT AREAS THEY SHOULD
PARTICULARLY LOOK OUT FOR.
ALRIGHT ALAMEDA COUNTY HAVE ONE
MORE QUESTION.
SO ARM YOU HAVE THIS THEIR BLOOD
LEVEL TRACKING SYSTEM ARE RASCAL.
AND THAT HOW WAS THAT.
PROGRAM COMING ALONG WENDY
THINK KILL HAVE.
.
OF IMPROVE DATABASE SO CHAU
RASCAL WHICH STANDS FOR THE
RESPONSE AND SURVEILLANCE SYSTEM
FOR CHILD AND LEAD EXPOSURE.
MAYBE MORE THAN YOU WANTED TO
KNOW. WAS THAT A DATA SYSTEM
THAT WAS DEVELOPED ALMOST TWENTY
YEARS AGO.
AND RECEIVES ALL THE BLOOD THE
TEST WE'VE TALKED ABOUT GETS
INFORMATION ABOUT CASES DETECTOR.
SO WE ARE LOOKING NOW AT IT
UPGRADING IT TO MODERN
TECHNOLOGY AND TO DO THESE
THINGS WE TALKED ABOUT. THE NEW
SYSTEMS CAN BE CALLED SHIELD.
I'M JUST TO DISTINGUISH AT ITS
SERVE SURVEILLANCE HEALTH
ENVIRONMENTAL INVESTIGATION AND
LEAD DATABASE JUST THE SEC. AND
THEN I'M AS AN ASIDE I WILL ALSO
SAY THAT THE CDC.
TOOK RASCAL AND USED IT FOR WHAT
IT DISSEMINATED AROUND THE THE
NATION I'M YEARS AGO AFTER WE
DEVELOPED IT. AND SO IT SERVED
US IN GOOD STEAD BUT IT CAN
CERTAINLY BE IMPROVE NOW.
.
S. TO SECOND
.
THE RIGHT THING IF THERE ARE NO
FURTHER QUESTIONS.
AYE WELL LA THANK YOU VERY MUCH
FOR BEING HERE. FOR ALL TRYING
TO IMPROVE AND ANYTHING YOU CAN
THAT GET TO S. BESIDES THE
ACCURACY OF PHAM.
AND FEASIBILITY OF HAVING.
TESTS AFTER PEDIATRICIAN'S
OFFICE WOULD BE VERY MUCH
APPRECIATED AND THANK YOU AGAIN
VERY MUCH FOR BEING HERE.
UP NEXT I WOULD LIKE TO INVITE
JENNIFER CAN'T DIRECTOR AND JC
COOPER ASSISTANT DEPUTY DIRECTOR.
OF HEALTH CARE DELIVERY SYSTEMS
FROM THE DEPARTMENT OF HEALTH
CARE SERVICES. COME TO THE STAND
TO PROVIDE US WITH AN OVERVIEW
OF HOW THAT DEPARTMENT.
OVERSEAS IN MEDICAID AND MANAGES
MEDI CAL DATA AND TRACKS THE
MANDATED BLOOD TESTING LUDLOW
LEAD TESTING.
DATA CHILDREN ON MEDI CAL ARE
REQUIRED TO RECEIVE I'D LIKE TO
KNOW WHAT YOUR DEPARTMENT
PROVIDED THE COMMITTEE WITH
UPDATED STATISTICS ON COMPLIANCE.
SHE INCLUDED IN AND THE DAMN
THEM TO OUR HEARING MEMO.
PLEASE FEEL WELCOME TO REFER TO
THESE UPDATED.
DATING YOUR TESTIMONY. CAN
WORSHIP PLACED AB BOTH OF YOU
THAT I AM HERE TODAY AND
CERTAINLY TAKE UP TO THIRTY
MINUTES FOR YOUR PRESENTATION.
GREAT.
SO GOOD AFTERNOON JENNIFER
KENT'S.
DIRECTOR FOR THE DEPARTMENT
HEALTH CARE SERVICES I WILL.
IMMEDIATELY TELL YOU THAT I DID
NOT HAVE THIRTY MINUTES WORTH OF
PRESENTATIONS SO.
.
IN PREPARING FOR THIS.
COMMITTEE TESTIMONY IN AND
WORKING WITH YOUR STAFF AND WITH
THE DEPARTMENT OF PUBLIC HEALTH
AND. IT'S
A IT WAS CLEAR TO US THAT AND.
WE'RE NOT AS FAMILIAR WITH THIS
COMMITTEE AND NOR IS THIS
COMMITTEE ALL THAT FAMILIAR WITH.
HEALTH CARE DELIVERY SERVICES
AND SO I WANTED TO KIND OF JUST
STEP BACK JUST A SECOND AND
EXPLAIN. KIND OF SOME VERY HIGH
LEVEL AND COMPLIMENTS OF OUR
PROGRAM AND HOW WE WORK WHICH IS
VERY DIFFERENT THAN HOW THE
DEPARTMENT OF PUBLIC HEALTH
WORKS AND SO I THINK WE ARE JUST
AS INTERESTED IN WORKING. WITH
YOU ON TO EXPLAIN THERE'S
DIFFERENCES BETWEEN PUBLIC
HEALTH DATA AND OURS IN THERE
SOME CRITICAL WAYS IN WHICH WE
COLLECT THE DATA THAT'S
DIFFERENT SO. I JUST WANTED TO
YOU FIRST OFF.
SAY WE HAVE A PROGRAM OF
APPROXIMATELY THIRTEEN AND A
HALF MILLION.
BENEFICIARIES TODAY THERE'S
ABOUT FIVE AND A HOUSE TO ALMOST
SIX MILLION CHILDREN AGES ZERO
TO TWENTY IN THE PROGRAM.
WE HAVE.
.
SEVEN MAIN DELIVERY SYSTEMS THAT
WE OVERSEE WITHIN THE DEPARTMENT
OF HEALTH CARE SERVICES A LOT OF
TIMES PEOPLE THINK OF FEE FOR
SERVICE AS THE MEDICAL PROGRAM
THAT'S ONE. OF THE SYSTEMS BUT
NOT THE ONLY ONE BY ANY STRETCH
OF THE IMAGINATION.
BETWEEN EIGHTY FIVE AND NINETY
PERCENT OF OUR THIRTEEN AND A
HALF MILLION MEMBERS ARE
ENROLLED IN A MANAGED CARE PLAN.
IN THE STATE OF CALIFORNIA
THROUGHOUT THE FIFTY EIGHT
COUNTIES WE HAVE TWENTY FOUR
CONTRACTING HEALTH PLANS THAT WE
WORK WITH.
TODAY TO DELIVER CARE TO THOSE
AND APPROXIMATE TEN AND A HALF
TO ELEVEN MILLION BENEFICIARIES.
.
OUR OTHER MEAN DELIVERY SYSTEMS
THAT WE OVERSEE OUR DENTAL
DOUBLE FEE FOR SERVICE SYSTEM
DENTAL MANAGED CARE SYSTEM.
CALIFORNIA CHILDREN'S SERVICES
SYSTEM WHICH IS OUR OLDEST
PROGRAM STARTED IN NINETEEN
TWENTY SEVEN.
WHICH.
HANDLES CHILDREN WITH RARE.
AN UNUSUAL OR.
CHRONICLE ATRA MATIC.
CHILDHOOD INJURIES WERE IRATE
INDICAN DISORDERS CANCER
CEREBRAL PALSY HEMOPHILIA.
AND THEN LASTLY WE HAVE A
MENTAL HEALTH DELIVERY SYSTEM
THROUGH OUR COUNTIES FOR
SPECIALTY MENTAL HEALTH. AS WELL
AS SUBSTANCE USE DISORDER AND.
AND VARIOUS COUNTIES DEPENDING
ON THE COUNTY THAT WE'RE WORKING
WITH.
SO YOU TAKE ALL OF THOSE BIG.
DELIVERY SYSTEMS WITH A LOT OF
DIFFERENT.
MOVING PARTS AND INDIVIDUALS
THAT ARE AND MEDI CAL CAN BE AND
ONE OF THE SYSTEMS THAT CAN BE
AND ALMOST ALL OF THOSE SYSTEMS.
INCLUDING DEVELOPMENTAL SERVICES
SO IF WE HAVE A CHILD WITH AN
INTELLECTUAL DISABILITY THEY MAY
BE IN OUR DDS.
SISTER DEPARTMENT FOR LETTERMAN
ACT SERVICES AND SO.
WHEN WE STARTED I'M COMING
THROUGH THE DATA ON THIS I'M
REQUEST WITH THE COMMITTEE IT
BECAME QUICKLY APPARENT TO US
THAT.
HOW WE CAPTURE DATA AS OPPOSED
TO HOW AND THE DEPARTMENT OF
HEALTH CAPTURE STATE IS VERY
VERY DIFFERENT? SO IN MEDI CAL
TODAY WITH OUR.
CONTRACTING HEALTH PLANS WE
HAVE TWENTY FOUR PLANS
WE HAVE CONTRACTS THAT WE HAVE
WITH THEM THAT ARE TWO THREE
HUNDRED PAGES LONG. THERE ARE
PROVISIONS IN THE CONTRACT
BETWEEN US IN THE PLAN THAT SAYS
THESE ARE THE REQUIREMENTS THAT
YOU HAVE TO DO. TO PROVIDE
APPROPRIATE BLOOD LEAD SCREENING
TESTS FOR CHILDREN.
.
IDEALLY AT AGES BETWEEN TWELVE
MONTHS AND TWENTY FOUR MONTHS SO
THAT'S OUR CONTRACTUAL
REQUIREMENT BETWEEN OUR PLANS
AND US.
WE HAVE GUIDANCE OUT TO THE
PLANS. DATING ALL THE WAY BACK
TO TWO THOUSAND AND TWO.
WE USUALLY ISSUE GUIDANCE TO
OUR PLANS FOR WHAT IS KNOWN AS
AN ALL PLANNED LETTER SO THAT'S
KIND OF OUR.
REGULATORY DOCUMENT THAT WE
CLEANER QUE OUR EXPECTATIONS AND
REQUIREMENTS OF THE PLANS ON AND
SO WE HAVE LETTERS AND TO THE
PLAN STATING ALL THE WAY BACK TO
TWO THOUSAND TWO BECAUSE WE HAVE
OBVIOUSLY.
UNDERSTAND THE IMPORTANCE I
HAVE A LEAD SCREENING ESPECIALLY
IN LOW INCOME POPULATIONS AND
WHAT IT MEANS AROUND
DEVELOPMENTAL MILESTONES. AND SO
OUR PLANS ARE UNDER INSTRUCTION
BY US TO BOTH PAY FOR AND
FACILITATE.
THE DELIVERY OF THE SERVICES
FOR CHILDREN AT THESE PARTICULAR.
POINTS IN TIME.
PLANS
HAVE.
CONTRACTED NETWORKS OF
PROVIDERS SO IF YOU ARE IN LOS
ANGELES.
YOU ARE IN LA CARE HEALTH PLAN
LA CARE HEALTH PLAN HAS AND
THREE. PLANS THAT THEY DO WORK
WITH AS WELL AS MEDICAL GROUPS
AND SO LA CARE GOES TO ITS
CONTRACTING PROVIDERS AND SAYS
IF YOU HAVE A MEDICAL CHILD IN
YOUR PRACTICE WE EXPECT YOU TO
PROVIDE. BLOOD LEAD SCREENINGS
AT TWELVE MONTHS AND AT TWENTY
FOUR MONTHS IF THEY DON'T HAVE A
SCREENING AT TWELVE MONTHS
YOU'REINSTRUCTED TO MAKE SURE
THAT THEY HAVE ONE AT TWENTY
FOUR MONTHS.
AND WE'VE A VARIETY OF OTHER
INSTRUCTIONS.
FOR ALL POPULATIONS WE HAVE
VACCINATION REQUIREMENTS WE HAVE
IT CUT ABOUT DIABETES THERE'S A
LOT OF DIFFERENT CLINICAL.
MEASURES AND METRICS THAT WE USE.
AND COMMUNICATING WITH THE
PLANS AS WELL AS THE PROVIDERS
DOWN BELOW.
WHEN PROVIDER SEE A CHILD IN
MEDI CAL.
THEY WILL BILL AN ENCOUNTER TO
THE HEALTH PLAN SAID THIS IS A
PHYSICIAN THAT HAS A CHILD IN
THEIR OFFICE AND THEY'RE DOING A
WELL CHILD VISIT. AND THEY MAY
BE DOING A VARIETY OF THINGS.
FOR THAT CHILD AT THAT
PARTICULAR VISIT ONE OF WHICH
MAY BE A BLOOD LEAD SCREENING
AND ONE OF THE REASONS THAT WE
THINK PERHAPS SOME OF THE STATE
THAT IS AND SUCH.
.
IT AND IT'S A IT'S NOT MATCHING
UP WITH WHAT THE DEPARTMENT OF
PUBLIC HEALTH IS. THAT.
PROVIDER MADE DO THE SCREENING
BUT THEY SIMPLY MAY NOT REPORT
THAT TESTS
TO THE HEALTH PLAN WHICH IS ARE
MEAN AGGREGATOR OF SUCH DATA.
SO IF YOU'RE A PROVIDER AND YOU
ARE SEEN THOSE PATIENTS AND ALL
YOU'RE DOING IS SUBMITTING WHAT
WE CALL AN ENCOUNTER TO THE PLAN
IT BASICALLY TELLS THE PLAN I
SAW THIS CHILD FOR WELL CHILD
VISIT. AND SO THE PLAN REPORTS
THAT WELL CHILD VISIT TO US BUT
IT MAY NOT INCLUDE ALL THE SUB
COMPLIMENTS OF WHAT THAT
PROVIDER. GAVE ARE PERFORMED ON
THAT CHILD SO THAT'S ONE KIND OF
KEY AREA WHERE WE THINK THE DATA
IS PROBABLY NOT AS GOOD AS WE
WOULD LIKE IT TO BE.
THERE WERE.
CHANGES MADE.
TO A FORM THAT WE USE TO USE
THAT WAS A PAPER BASED AND.
CARBON TRIPLICATE FORM AND IT
WAS CALLED THE PM ONE SIXTY.
IT'S GONE AWAY IT WASN'T
COMPLIANT WITH A LOT OF
REQUIREMENTS THAT WE HAVE IN
TODAY'S WORLD AROUND HEALTH
INSURANCE PORTABILITY AND
PRIVACY AND IT DIDN'T ACTUALLY
FIT INTO ANY KIND OF.
I TEAR AUTOMATED SYSTEM AND SO
WE HAVE PHASED OUT THE PM ONE
SIXTY BUT WHAT THAT DOCUMENT AND
WITHOUT FORM USED TO DO FOR US
WAS THAT WAS KIND OF ONE OF THE
WAYS THAT PROVIDERS INDICATED
THAT THEY HAD DONE A CHILD LED.
SCREENING ON A CHILD SO THEY CAN
VOLUNTARILY PROVIDE THAT
INFORMATION BUT THEY'RE NOT
MANDATED TO PROVIDE IT AND SO
THERE'S NOT ALWAYS A FAIL SAFE
WAY TO CAPTURE AN ACCOUNT FOR
THAT.
PROVISION OF SERVICE AND SO WE
THINK THAT THAT IS PROBABLY ONE
AREA.
IN WHICH WERE NOT GETTING A LOT
OF COMPLIANCE AND WITH THE
PROVIDER COMMUNITY ESPECIALLY IF
THEY'RE NOT BEING. PAID TO
PROVIDE SOME OF THESE PIECES OF
DATA RIGHT THEY IF THEY'RE LIKE
I'M GETTING.
YOU KNOW FIFTY DOLLARS FOR THIS
EXAM BUT I'M NOT GOING TO BE
REIMBURSED FOR THE TIME SPENT
YOU KNOW FILLING OUT A
VACCINATION RECORD OR FILLING
OUT OF.
YOU KNOW A SPORTS CLEARANCE
AURA LED SCREENING OR SOMETHING
LIKE THAT WE MAY THEY MAY
PERFORM ALL THOSE THINGS BUT WE
MAY JUST NOT SEE THE APPROPRIATE
KIND OF DOCUMENTATION AND PAPER
WORK AROUND THAT.
AND THE LAST THING I WOULD SAY.
ON SOME OF THE DATA IS THAT WE
KNOW ON HOW MANY CHILDREN WE
HAVE AND MEDI CAL AND WHAT I
THINK WAS AND VERY TELLING WHEN
WE WERE WORKING WITH THE
DEPARTMENT OF PUBLIC HEALTH
WHICH WE WORK WITH I'M QUITE
CLOSELY AT IT. IN PARTICULAR
HISTORICALLY ON THIS PROGRAM IS
THEY.
ARE VERY ACCURATE WHEN THEY SAY
THEY SEE THE END OF THE PIPELINE
SO THEY KNOW HOW MANY CHILDREN
WERE TESTED BECAUSE THEY'RE SEEN
THE ACTUAL LAB TESTING DATA. WE
ARE SEEN.
SOME OF THE DATA ON THE FRONT
ENDS MEANING THE PROVIDER HAS.
SCREEN THE CHILD BUT THEN THE
MATCH UP BETWEEN WHAT WERE YOU
SEEN AS OUR DENOMINATOR IS OUR
AND ROLLED MEDICAID
BENEFICIARIES.
WITHIN OUR PROGRAM AND.
PUBLIC HEALTH IS USING.
BOTH CENSUS DATA AND OTHER
KINDS OF ESTIMATES FOR HOW MANY
CHILDREN THEY THINKER AND THE.
POPULATION OF LOW INCOME WHEREAS
WE ARE WORKING WITH LIKE HARD
NUMBERS AS IT PERTAINS TO OUR
ELIGIBILITY DATABASE.
SO I THINK.
.
I WILL CLOSE AND AND HAPPY TO
ANSWER QUESTIONS AND GC IF I'VE
MESSED UP ANYTHING FROM A
FACTUAL. PLACE WILL CERTAINLY.
HELP
CLARIFY MY.
THINKING.
BUT I WANT TO ALSO SAY IS THAT
I'M WE SEE VALUE ON BOTH AND
WHAT THE COMMITTEE WAS ASKING AS
WELL IT'S KIND OF MAKING US GO
BACK AND LOOK AT SOME OF OUR
POLICIES AND PROCEDURES THAT WE
HAVE WITH THE PLANS. WE
CERTAINLY ARE GOING TO BE I'M
LOOKING AT THIS I'M ALL PLAN
LETTER WHICH WE ISSUED BACK IN
TWO THOUSAND AND TWO.
TRYING TO MAKE SURE THAT THE
PLANS ARE AWARE THAT WE.
CAN MONITOR TO THAT FOR
COMPLIANCE PURPOSES WE ANNUALLY
AUDIT ALL OF OUR MANAGED CARE
PLANS.
OUR PLANS IN TURN ARE REQUIRED
TO SURVEY THEIR PROVIDERS
ON SITE EVERY THREE YEARS AND SO
IT'S JUST ONE OF THOSE.
GOOD REMINDERS FOR ALL OF US
I'M IN MY DEPARTMENT IS
CERTAINLY NOT LEFT OUT IN THIS
IS THAT WE ALWAYS NEED TO MAKE
SURE. THAT WE ARE.
DOUBLE BACK CHECKING WITH OUR
PLANS TO MAKE SURE THAT THERE
ENSURING COMPLIANCE WITH IN THE
PROVIDER COMMUNITY AND LIKEWISE
THAT THE PLANS ARE IN COMPLIANCE
WITH OUR EXISTING CONTRACTUAL
RESPONSIBILITIES WITH THEM AS
WELL AS OUR GUIDANCE TO THEM ON
THESE PARTICULAR ISSUES.
THERE WAS AND I DON'T KNOW THAT
THE COMMITTEE WAS AWARE OF THAT
THERE WAS.
SOME MEDICAID GUIDANCE ISSUED
BY THE FEDERAL GOVERNMENT.
CENTER FOR MEDICARE AND
MEDICAID SERVICES AWHILE BACK
THAT TALKED ABOUT UNIVERSAL
VERSUS TARGETED SCREENING AS IT
PERTAINS TO LEAD SCREENING. I'M
WE HAVE WE HAVE AND WE ARE A
STATE THAT DOES UNIVERSAL
SCREENING.
THE FEDERAL GOVERNMENT
ESSENTIALLY GAVE GUIDANCE TO
STATE MEDICAID PROGRAMS AND SAID
TO THE EXTENT THAT YOU FEEL
TARGETED SCREENING IS MORE
APPROPRIATE AYE EE.
YOU DON'T HAVE TO
SCREEN EVERY CHILD BUT YOU HAVE
TO JUST SCREEN CHILD CHILDREN IN
CERTAIN AREAS WHERE YOU BELIEVE
THAT THERE'S A HIGH
PREPONDERANCE OF FLAT OR IN
CERTAIN POPULATIONS. THEY LEFT
IT OPEN TO THE STATE'S.
AND WE AS A STATE HAVE NOT
CHANGED OUR UNIVERSAL SCREENING
APPROACH BUT WHAT I WILL SAY IS
THAT.
OTHER PAYERS MEANING PRIVATE
COMMERCIAL INSURANCE AND OTHER.
SYSTEMS HAVE GONE TO TARGETED
SCREENING AND SO WE ALL USE THE
SAME.
DOCTORS AND SO THERE IS
PROBABLY WE ASSUME SOME
CONFUSION IN THE PROVIDER
COMMUNITY WHICH IS DO WE DO
UNIVERSAL SCREENING OR DO WE DO
TARGETED SCREENING AND THEY'RE
GETTING CONFLICTING MESSAGES.
BOTH FROM US AS A PAYER.
AS WELL AS FROM OTHER PEER
GROUPS AND SO I WOULD JUST
STIPULATE THAT THAT ALSO IS KIND
OF OUT THERE IN THE. PROVIDER
COMMUNITY IN TERMS OF THEY'RE
NOT QUITE SURE WHETHER THEY
SHOULD BE SCREENING EVERYONE OR
IF THEY SHOULD ONLY BE.
SCREENING CHILDREN THAT HAVE
CERTAIN RISK FACTORS.
SO.
AB ANSWER QUESTIONS AND THANK
YOU FOR HAVING US.
ALRIGHT AND THEN THE
ADMINISTRATION COOPER ASSISTANT
DIRECTOR.
IT'S SO I I I I WILL BE HAPPY TO
ANSWER ANY QUESTIONS EYES
SUPPORT EVERYTHING THAT DATA
DIRECTOR CAN'T JUST SAID. OF
GREEN WITH YOUR BOSS YES.
GOOD IT WOULD BE EMBARRASSING
OPENING THING I'LL TURN.
MISTRESS DID YOU HAVE A
QUESTION.
YES THANK YOU.
WHEN YOU TALK ABOUT JUST THE
LAST THING YOU WERE TALKING
ABOUT TARGETING SCREENING VERSES
UNIVERSAL SCREENING.
EVEN IF WE TALK ABOUT TARGETING
SCREENING.
WOULD YOU AGREE THAT. THOSE ON
MEDI CAL SHOULD BE TARGETED FOR
THE SCREENING.
NO I THINK I MEAN THIS IS WHY WE
AS A STATE HAVE NOT CHANGED OUR
APPROACH FROM UNIVERSAL
SCREENING THE TARGETED SCREENING
IS I THINK THAT.
.
A QUICK AND TO BE HONEST IN A
STATE AS LARGE.
AND IS KIND OF COMPLICATED AS
OURS IS I'M NOT EVEN SURE AND WE
CERTAINLY DON'T POSSESS THE
CLINICAL.
EXPERTISE FROM AN ENVIRONMENTAL
STANDPOINT I DON'T KNOW HOW WE
AS A DEPARTMENT WOULD LOOK AT
CERTAIN EITHER GEOGRAPHIC AREAS
OF THE STATE AND SAY OH YES
THESE ARE DEFINITELY PLACES THAT.
SHOULD BE TARGETED OR THESE ARE
CERTAIN I'M HOUSING COMPLEXES
THAT SHOULD BE IDENTIFIED I
THINK WE FEEL THAT IS PROBABLY
JUST SAFER ON THE NATURAL TO
JUST ASSUME. THAT EVERYBODY
SHOULD BE SCREENED AND TO THE
EXTENT THAT UNIVERSAL SCREENING.
HELPS IDENTIFY CERTAIN AREAS
SUCH AS WHAT PUBLIC HEALTH WAS
SAYING WE CAN YOU KNOW DRIVE
DOWN TO ZIP CODES AND WE CAN
REALLY HONE IN ON. CHILDREN IN A
PARTICULAR AREA THAT ARE SHOWING
HIGH LEVELS OF LEAD IN THEIR
BLOOD TESTS.
THAT'S GREAT BUT I THINK OUR
ATTITUDE IS IS WE WOULD PREFER
PROBABLY JUST TO STAY AT A
UNIVERSAL SCREENING LEVEL AND
NOT ASSUME ANYTHING ESPECIALLY
BECAUSE WE DON'T POSSESS.
SCIENTIFIC EXPERTISE ON HOW TO
BETTER TARGET.
IT MAY THOUSAND EMPLOYEES.
IT IN THIS UNIVERSAL SCREENING
ABOUT.
I UNDERSTAND THAT THE THE THE
THE PEDIATRICIANS ARE REQUIRED
TO TEST BUT THEY ARE NOT
MANDATED TO PROVIDE THE
INFORMATION.
CONFIRMING THAT THEY TESTED.
AND YOU DON'T FIND THAT OUT
UNTIL YOU DO AUDITS OF THE OF
THE RECORDS IS SET IN MY HEARING
THAT CORRECTLY. SURE AND JC CAN
ALSO HELP TURN IN ON SOME OF%
THESE DETAILS SO AND.
PLANS ARE RECEIVE ENCOUNTER
CLAIMS FROM PROVIDERS SO A CHILD
COULD BE BROUGHT IN FOR THEIR
TWELVE MONTHS.
WELL CHILD EXAM AND THE PROVIDER
WILL.
ESSENTIALLY CLAIMED TO THE PLAN
I DID THE WELL CHILD EXAM IN THE
BILL A SINGLE CODE UNITS. NINE
THOUSAND.
ONE TWO ONE NO ONE CODING AND
MAKE IT UP BUT THAT'S THEY BILL
THAT. AND THEY MAY DO A VARIETY
OF OTHER PROCEDURES ARE OTHER
SERVICES DURING THAT WELL CHILD
EXAM BUT THEY SIMPLY JUST DON'T
IDENTIFY WITH THOSE WERE IN THE
CLAIM TO THE PLANETS OF THE PLAN
DOESN'T HAVE THAT DATA IT'S NOT.
MANDATED.
WHAT WE DO IS WE?
?
GO EN AND AUDIT THE PLANS TO
MAKE SURE THAT THEY'RE GOING TO
THE CONTRACT SO SOMETIMES WE DO
WHAT'S KNOWN AS.
.
HE DOSE.
HE DISCOURSE AND IN TRYING TO
KEEP MY HEALTH.
.
HEALTH.
ACRONYMS AS LIGHT AS POSSIBLE SO
I DON'T LOSE YOU AND THOSE ARE
ESSENTIALLY EMPIRICALLY
DETERMINES
PEER REVIEWED MEASUREMENTS THAT
WE GO AND TO THE PLANTS AND SAY
WE WANT TO ENSURE THAT YOU ARE
DOING CERTAIN. SERVICES FOR
CERTAIN POPULATIONS.
AT A LEVEL IN WHICH WE FEEL
THAT THAT IS A AND A LEVEL OF
PERFORMANCE EXPECTATION AND SO.
THAT HE TO SCORE FOR EXAMPLE IS
MAKING SURE THAT ANY OF YOUR
PICKED PATIENTS WITH DIABETES.
HAVE AN A. ONE C. BLOOD TESTS.
EVERY QUARTER.
AND YOU GO INTO A PLAN AND YOU
SAY YOU HAVE YOU KNOW EX NUMBER
OF.
INDIVIDUALS IDENTIFIED WITH
DIABETES ON AN X. PERCENTAGE
WHEN WE DID CHART POLLS AND DID
A KIND OF A STATISTICALLY THIS.
BALLOTS SAMPLING.
YOU HAD SEVENTY PERCENT OF THOSE
PATIENTS WITH DIABETES THAT HAD
NAY ONE C. TEST AND SO YOU HAVE
A CERTAIN HE TO SCORE ATTACHED
TO THAT.
WE GO IN AND WE DON'T HAVE A
SPECIFIC TIME HE'D A SCORE
AROUND LED SCREENING PER SE BUT
WE HAVE AND HOW MANY.
PLANS AND PROVIDERS ARE DOING
WELL CHILD EXAMPLE BUT WE GO IN
AND SURVEY THE PROVIDERS
THEMSELVES WE WILL DO RANDOM
SHARPLES AND SAY ARE YOU IN
COMPLIANCE WITH OUR CONTRACT TO
DO. BLOOD LEVEL SCREENS AND THEN
WHEN WE GO ON AND DO OR IF THE
PLANNED AS A PROVIDER SITE
REVIEW THEY WILL PULL CHARTS AND
SAY ARE YOU DOING BLOOD BLOOD
SCREENING ON YOUR KIDS AT TWELVE
MONTHS. SO WE DON'T.
DO A HUNDRED PERCENT COMPLIANCE
CHECKS BUT WE CERTAINLY. SAMPLE.
WITHIN KIND OF A STATISTICALLY
SIGNIFICANT.
POLL TO MAKE SURE THAT PLANS
ARE IN COMPLIANCE WITH A VARIETY
OF THINGS INCLUDING BLOOD
SCREENING BUT IT'S NOT A HE THIS
MEASURE PER SE.
BUT IT IS YOUR STATISTICS THAT
SHOWED ONLY TWENTY EIGHT PERCENT
ARE BEING TESTED IS THAT RIGHT.
MORE THERE WERE A COUPLE
DIFFERENT PIECES OF DATA THAT WE
PROVIDED THAT AND I BELIEVE YOU
SHOULD HAVE A COPY OF THE AN
ADDENDUM OF THE DATA BUT. I'M IN
TWO THOUSAND AND SIXTEEN WE ARE
REPORTING IN MANAGED CARE I'M
WHICH IS AS REPORTED ABOUT
EIGHTY NINE PERCENT ARE CHILDREN
ARE IN MANAGED CARE. OF THE
NUMBER IS FORTY TWO POINT SEVEN
PERCENT FOR AT THE TWELVE MONTHS
SCREENING UP THIRTY THREE
PERCENT OUT THE TWENTY FOUR
MONTHS SCREENING WITHIN PEEPER
SERVICES ABOUT THIRTY SEVEN
PERCENT AT THE TWELVE MONTHS
SCREENING. AND TWENTY SIX POINT
FOUR AT THAT TWENTY FOUR MUCH
MEANS WE DID PROVIDE REVISED
DATA TO SHOW A BOTH MANAGE CARE
AND FEE FOR SERVICE NUMBERS
SEPARATELY AT THE TWELVE MONTH
AND THE TWENTY FOURTH MONTH.
THE MY FINAL QUESTION PLEASE.
WHAT DO YOU RECOMMEND IT?
IT'S CLEAR AND IT.
ARE CHAIR WRIST GOD GAVE SOME
OF THE INFORMATION REGARDING HOW
SERIOUS THIS IS.
THE THE CHILDREN IF THEY'RE NOT
TESTED EARLY HOUSES REQUIRED.
AND WE DON'T FIND THIS WE DON'T
KNOW PROVIDE SERVICES TO THEM.
IT CAUSES IRREPARABLE HARM.
SO KNOWING THAT AND KNOWING THAT
THE STATISTICS.
WHETHER IT'S TWENTY EIGHT
PERCENT OR. OR THREE QUARTERS
THAT ARE TESTED OR AS WAS SAID
EARLIER. PERHAPS ONLY A QUARTER
WERE NOT TESTED.
THE FACT THAT THEIR CHILDREN
WERE NOT TESTED WHAT DO YOU
RECOMMEND THAT WE DO WHAT WHAT
SHOULD BE REQUIRED SO THAT WE
GET CLOSER TO THE ONE HUNDRED
PERCENT.
IF TESTING OUR CHILDREN WELL I
THINK YOU KNOW CERTAINLY WHAT WE.
DETERMINED AFTER WORKING.
WITH BOTH YOUR STAFF AS WELL AS
PUBLIC HEALTH IS THAT WE
OURSELVES ARE GONNA GO BACK TO
THE PLANTS THAT WE CONTRACT WITH.
AND.
DO A REVISION ON BOTH THE
POLICY AND PROCEDURE RIGHT WHICH
IS YOU KNOW MAKE SURE THAT THE
PLANS KNOW THAT THEY HAVE THIS
CONTRACTUAL REQUIREMENT. WE ARE
GOING TO REVIEW THE ALL PLAN
LETTER IN THE GUIDANCE THAT WE
GAVE TO THE PLANS.
SEVERAL YEARS AGO TO MAKE SURE
IT STILL BALLOT OBVIOUSLY A LOT
HAS CHANGED.
AND OUR PROGRAM UMB WITH THE
EXPANSION.
IN TWENTY FOURTEEN AND WE HAVE
A MUCH MORE SIGNIFICANT.
BENEFICIARY PARTICIPATION THAN
WE DID BACK IN TWO THOUSAND AND
TWO SO I THINK THIS WAS A GOOD.
BOTH REMINDER TO US TO GO BACK
AND.
RE REVIEWS SOME OF OUR BOTH
GUIDANCE AND REQUIREMENTS
I THINK IT WILL ALSO AND BE
SOMETHING THAT WE WANT TO WORK
WITH PUBLIC HEALTH AND I KNOW
THAT AND DIRECTOR SMITH. ALSO
REFERENCED IT IN TERMS OF MAKING
SURE THAT OUR DATA IS MAYBE
BETTER.
LINKS BECAUSE WE ARE WE ARE
CLEARLY NOT COMPARING.
THE SAME NUMERATORS AND
DENOMINATORS RIGHT THEY HAVE A
VERY DIFFERENT WAY OF HOW THEY.
HAVE A METHODOLOGY FOR HOW THEY
ASSUME THE LEVEL OF TESTING IN
CALIFORNIA AND I THINK YOU KNOW
YOUR YOU SHOULD DO BETTER AS TO
DEPARTMENTS TO SAY ALRIGHT LET'S
PUT. YOUR TESTS.
DATA TOGETHER WITH OUR IN
ELIGIBILITY DATA AND LET'S SEE
EITHER WHAT THE OVERLAP IS OR.
IS THERE A BETTER WAY THAT WE
CAN COMMUNICATE WITH.
PROVIDERS ARE CLINICS IN WHICH
THESE POPULATIONS ARE MOST
LIKELY TO BE SEEKING CARE TO
ENSURE THAT THEY KNOW WHAT
THEY'RE DOING I THINK THE OTHER
THING IS. THERE'S A VARIETY OF
ORGANIZATIONS THAT WE WORK WITH
AS WELL AS I'M WHAT THE
DEPARTMENT OF PUBLIC HEALTH HAS
IN TERMS OF OUTREACH WITH.
I'M LOCAL COMMUNITY BASED
ORGANIZATIONS.
THE LEAD PIPE PREVENTION
PROGRAMS FIRST FIVE THERE'S A
LOT OF DIFFERENT.
ENTITIES THAT WE CAN WORK WITH
TO.
BOTH HIGHLIGHT THE IMPORTANCE
ABOUT.
THE SCREENING AND TESTING AS
WELL AS ENSURING THAT OUR
PROVIDERS KNOW THAT THIS IS AN
EXPECTATION ON THEM WHEN THEY
SEE THESE CHILDREN AT THE
CERTAIN PERIODICITY SCHEDULES.
THANK YOU. PLANET A VICE CHAIR
CHEN.
THANK YOU MISTER CHAIR.
MY QUESTION IS SINCE THERE IS
YOU KNOW A FINITE AMOUNT OF
FINANCIAL RESOURCES.
AND THOUGH I THINK UNIVERSAL
TESTING IS
A GREAT WAY TO GO. IS IT MORE
EFFICIENT. AS A MORE SCIENTIFIC
IF WE HAD TESTING IN SPECIFIC
AREAS THAT YOU HAVE HOMES THAT
ARE.
PRE NINETEEN SEVENTY EIGHT THAT
DO HAVE AREAS IN WHICH THEY DO
NOT HAVE MUNICIPAL WATER LINES
ON THAT ARE A LOT MORE MUCH MORE
HIGHER ENTERS A LIKELIHOOD OF
HAVING. THAT LED A ISSUES IF YOU
WILL.
SUPPOSE OTHER NEWER COMMUNITIES
THROUGHOUT OUR STATE.
AND GIVEN THE FINANCIAL
CIRCUMSTANCES THAT WE'RE IN
RIGHT NOW.
SO COUPLE THOUGHTS I'M ONE IS
THAT WOULD AND LIKE I SAID
EARLIER. WE DON'T NECESSARILY
HAVE.
.
THE ENVIRONMENTAL.
FOR SCIENTIFIC EXPERTISE TO
KIND OF DETERMINE WHAT THOSE.
HIGHER. PERCENTAGES PART PARTS
OF CALIFORNIA ARE IN TERMS OF
HOUSING AND WE DO A LOT OF
THINGS BUT WE DON'T DO AS WELL
LEAD ASSESSMENTS VERY WELL
THAT'S NOT OUR OUR BODY OF.
EXPERTISE SO I WOULD.
WE WOULD DESPERATELY NEED TO
RELY ON SOMEONE ELSE TO BE ABLE
TO HELP US DETERMINE IF WE WERE
GOING TO TARGET WHAT WOULD THAT
LOOK LIKE AND HOW WOULD WE DO IT.
ON AS A MEDICAID PROGRAM IT'S AN
ENTITLEMENT PROGRAM WHICH MEANS
ANY BENEFICIARY THAT IS ENTITLED
TO MEDICAID SERVICES RECEIVE
THEM SO WE DON'T.
.
I DON'T THINK WE WOULD EVER
TARGET AND LIMIT SCREENINGS ONLY
TO A CERTAIN POPULATION WITHIN
MEDICAID BECAUSE THAT'S NOT HOW
WE OPERATE ANY OF THE SERVICES
THAT WE HAVE TODAY.
THE ONLY OTHER THING I WOULD
SAY IS THAT WE PAY THE PLANS.
AN ACTUARIAL.
APPROVED AND BASED RATE FOR
SERVICES THAT ENCOMPASSES.
ALL OF THE SERVICES AND SO PLANS
GET A PER MEMBER PER MONTH
CAPITATION RATE FOR EACH AND
EVERY AND ROLE WE.
ON THEIR IN THEIR EIGHT COULD
CODE SO FOR CHILDREN WE HAVE
DEVELOPED A RATE.
YOU KNOW SAY IT'S A HUNDRED
DOLLARS A MONTH FOR EASY MATH SO
FOR EVERY CHILD THAT THE PLAN
HAS BEEN ROLLED WE PAY THEM A
HUNDRED DOLLARS EVERY MONTH.
THAT COVERS INPATIENT PHARMACY
PHYSICIAN SERVICES DURABLE
MEDICAL EQUIPMENT YOU'RE
ANYTHING THAT THAT CHILD NEEDS
FOR MEDICAL NECESSITY AND SO I
WOULD ARGUE THAT. THE BLOOD
SCREENINGS HAVE BEEN FULLY
ENCAPSULATED INTO THAT CAPITATED
PAYMENT AND IT'S SUCH AS.
SMALL AMOUNT THAT IT WOULDN'T
MAKE ANY SENSE TO TRY TO PULL IT
OUT AND SO IT'S ALREADY
ESSENTIALLY BEING PAID FOR SO I
WOULD ARGUE THAT IT'S PROBABLY
JUST.
SAFER ON THE NATURAL TO JUST
ASSUME THAT WE SHOULD DO
UNIVERSAL SCREENING AND AND HAVE
IT BE COVERED.
YEAH.
THANK YOU EVAN NEITHER QUESTION
EITHER ONE OF THE BENEFITS OF
HAVING A MANAGED CARE PROGRAM IS
THAT IT'S A HOLISTIC PERSPECTIVE
IT FOLLOWS THE PATIENT. THERE'S
LESS LIKELY OF DUAL DIAGNOSES
ECCENTRICS ULTRA.
ON WHAT POLICIES IN PLACE TO WE
HAVE TO MAKE SURE DEPARTMENTS IF
YOU WILL THROUGHOUT THE COUNTY
SYSTEM DO NOT WORK IN SILOS WE
HAVE. COUNTY SYSTEMS ARE VAST
LIKE LA COUNTY. AND THEY PERHAPS
TO BE TREATED AS A PATIENT THEY
COULDN'T HAVE CO OCCURRING
DISORDERS MENTAL HEALTH ISSUES
SUCH AS ABUSE ISSUES.
PRIMERICA RICHES ECCENTRIC
SUCHER OTHER PAUSES POLICIES IN
PLACE RIGHT NOW WITHIN THE STATE
IN WHICH WE TRY TO ENCOURAGE.
FOR THE DEPARTMENTS
NOT TO WORK WITH ONE ANOTHER AT
THE FALL THE PATIENT IF YOU WILL.
THAT MANAGED CARE PROGRAM DATA.
YEAH YOU WORLD INVESTED IN YEAH
SO THAT'S A GREAT QUESTION.
SO OUR PLANS HAVE CONTRACTUAL
RESPONSIBILITIES FOR ALL THE
SERVICES THAT THEY'RE REQUIRED
TO GIVE ONTO THEIR PATIENTS.
ON A MONTHLY BASIS I'M WE SEND
THE PLANS.
AND ENROLLMENT FILE WHICH IS
ESSENTIALLY YOU KNOW HERE ARE
THE NUMBER OF ENROLLEES BY
IDENTIFIER THAT ARE ENROLLED IN
YOUR PLAN AS OF THAT MONTH.
SO EVERY MONTH THE PLANS KNOW
EXACTLY WHO THEY ARE RESPONSIBLE
FOR AND ALL OF THEIR DATA AND
INFORMATION.
SO DUPLICATION IS REALLY IS
ALMOST.
REALLY HARD TO DO BECAUSE I'M A
PROVIDER WILL.
RUN THAT BENEFICIARIES
IDENTIFICATION NUMBER AND IT
WOULD SHOW AS BELONGING TO LA
CARE OR TO HELP THAT I'M USING
MY LOS ANGELES EXAMPLE. AND SO
THE PROVIDER. AND IF THEY WANTED
TO BE PAID FOR THOSE SERVICES
WOULD NEED TO BE CONTRACTING
WITH THAT PLAN FIRST OF ALL
BECAUSE IF THEY'D PROVIDED
SERVICES AND THEY WEREN'T THEY
RUN THE RISK OF NOT BEING.
REIMBURSED SO THAT'S ONE WAY
THAT WE WOULD ENSURE THAT
THERE'S NOT DUPLICATION THERE
ARE.
SERVICES THAT THE PLANS ARE NOT
RESPONSIBLE FOR AND YOU ALLUDED
TO A COUPLE OF THEM MENTAL
HEALTH IS ONE. SO IF A CHILD OR
AN ADULT HAS A SERIOUS MENTAL
HEALTH CONDITION OR REQUIRES
SPECIAL TO MENTAL HEALTH
SERVICES. OUR PLANS ARE REQUIRED
TO HAVE.
A MEMORANDUM OF UNDERSTANDING
WITH THE COUNTY MENTAL HEALTH
PLAN WHICH IS I'M RESPONSIBLE
FOR THIS CARE. YOU'RE
RESPONSIBLE FOR THAT CARE AND
THEN THEY HAVE THEY AGREE ON HOW
THEY SHARE THAT INFORMATION TO
ENSURE. THAT BOTH SIDES KNOW
WHAT IS OCCURRING WITH THAT
PATIENT IN TERMS OF CLINICAL.
DIAGNOSES OR SERVICES THAT ARE
BEING PROVIDED SO THAT THEY CAN
TRY TO MINIMIZE.
DUPLICATION OF YOU KNOW MAYBE
I'M TESTING OR DIAGNOSE THE.
SO.
IT'S NOT PERFECT BY ANY STRETCH
OF THE IMAGINATION BUT WE DO
HAVE SOME KIND OF BIG THINGS IN
PLACE THAT HELP PREVENT ON
DUPLICATION ARE UNNECESSARY ON
TESTING ON ON PATIENTS.
REPUTABLE MISTER CHAIRMAN OF
COURSE. SURE THAT YOU DON'T HAVE
DEBTS.
THANK YOU. ARM THANK YOU THAT'S
A THAT'S A GREAT EXPLANATION
FROM MY UNDERSTANDING.
SO.
THE FURTHER COMMUNICATION LINES
ON.
HEALTH RECORDS OUR EMR EHR.
THERE'S DEPARTMENTS.
THAT DON'T MAKE IT WITH EACH
OTHER WITHIN THE SAME COUNTY.
ARE THE REQUIREMENTS ON THE
STATE LEVEL AND A CLOSE OF FORCE
PART OF IT PART PROBLEM IS IF WE
DO MAKE US REQUIREMENTS HOW. HOW
THE FUND?
THAT HEALTH RECORD AND SOME OF
THOSE.
ON INFORMATION THAT'S BEEN SURE
RIGHT NOW AS PHYSICALLY. A CHART.
GOING FROM ONE DEPARTMENT TO THE
OTHER AND THINGS GET.
FALLING THROUGH THE DEFAULT TO
THE CRACKS A WHAT HAVE YOU. ON
ITS ITS ONEROUS IS COMPLICATED
ON IS THERE.
REQUIREMENTS IN PLACE PAULSON
PLEASE ENCOURAGE.
ELECTRONIC HEALTH RECORD.
EDUCATION METHODOLOGIES ALSO
WOULD DEPARTMENTS WITHIN THE
COUNTY CAN TUNICATE WITH ONE
ANOTHER.
I'M I THINK THAT IF.
WE HAVE A POSITION AND OUR
CHIEF MEDICAL INFORMATION
OFFICERS DIVISION SHE'S PROBABLY.
DANCING FOR JOY THAT YOU'RE
ASKING THESE QUESTIONS RIGHT NOW
BECAUSE THAT'S WHAT SHE SPENT
HER LIFE DOING.
SO WE HAVE AN ENTIRE PORTION OF
OUR DEPARTMENT THAT WORKS WITH
HOSPITALS AND OTHER ON PROVIDERS
AT THE PHYSICIAN LEVEL MEDICAL
GROUP LEVEL.
TO HELP.
INCENTIVIZE THE USE OF
ELECTRONIC HEALTH RECORDS AND.
OPEN PLATFORM SO MEANING
THERE'S NOT PROPRIETARY SYSTEMS
THAT CAN'T TALK TO EACH OTHER
AND SO. STARTING BACK ON.
WITH THAT ARE A FUNDING WHICH IS
AMERICANS RECOVERY SOMETHING ACT
ON THERE WAS.
STRONG INCENTIVES PUT INTO
PLACE TO GIVE.
THOSE PROVIDERS
MANY USING A NINETY TEN FEDERAL
MATCH NINETIES NINETY CENTS
FEDERAL TEN CENTS US STATE. TO
HELP DEVELOP THOSE SYSTEMS TO
HELP DEVELOP THOSE PLATFORMS AND
SO WE HAVE A WHOLE. SECTION OF
OUR DEPARTMENT THAT HAS BEEN
WORKING ALMOST EXCLUSIVELY JUST
IN THAT AREA ALONE.
GC AND MANY OF HER COLLEAGUES
ARE ALSO WORKING ON A REALLY
INTERESTING PROJECT RIGHT NOW
WITH THE FEDERAL GOVERNMENT AND
SPECIFIC COUNTIES.
.
CALLED THE WHOLE PERSON CARE
PILOT THE IDEA ON THIS IS THAT
I'M THAT WAS STARTED IN SAN
DIEGO COUNTY CALLED PROJECT
TWENTY FIVE AND THAT THEY HAD
VERY VERY HIGH RISK.
VERY EXPENSIVE PEOPLE THAT
CALLED NINE ONE ONE.
A LOT AND THEY SAID YOU KNOW WHO
ARE THE TOP TWENTY FIVE USERS OF
THE NINE ONE ONE SYSTEM AND WHEN
THEY LOOKED AT WHO THOSE
INDIVIDUALS WHERE THEY HAD
SERIOUS MENTAL ILLNESS THEY HAD
SUBSTANCE USE PROBLEMS THEY WERE
HOMELESS. THEY MAY HAVE BEEN.
YOU KNOW IN JAIL MULTIPLE TIMES
THEY WERE HIGH USERS OF THE
EMERGENCY ROOM DEPARTMENT AND
ALL OF THESE COUNTY AND HEALTH
CARE SILOS. KNEW WHO THIS
INDIVIDUAL WAS BUT NONE OF THEM
KNEW THAT THE OTHER ONE KNEW WHO
THOSE PEOPLE WERE AND SO THEY SO
SAN DIEGO WAS THE FIRST KIND OF.
PUT PEOPLE TOGETHER PUT THE DATA
TOGETHER AND THEN.
GO AFTER THESE INDIVIDUALS AND
WRAP THEM WITH A LOT OF INTENSE
OF SOCIAL AND HEALTH CARE
SERVICES AND THEY WERE ABLE TO
REDUCE THEIR COSTS REDUCE
UTILIZATION IN THE EMERGENCY
ROOM WHERE THE JAIL.
AND SO WE HAVE TAKEN THAT
CONCEPT AND.
EXPANDED AND SHARED IT WITH
OTHER COUNTIES AND SO JC AND
OTHERS ARE WORKING WITH THOSE
COUNTIES AND ONE OF THE KEY.
STARTING BUILDING BLOCKS LOCAL
PERSON CARE IS THE DATA SHARING
SO WE ARE BREAKING AND IT HAS
BEEN PAINFUL AND LONG AND
EXTRAORDINARILY HARD. YOU'RE
BREAKING.
SILOS BETWEEN PUBLIC SAFETY.
YOU KNOW COUNTY CHILD WELFARE
SERVICES SOCIAL SERVICES.
HEALTH CARE SERVICES THE
MANAGED CARE PLAN AND YOUR AND
INTEGRATING THAT DATA AND THEN
TRYING TO LOOK AT WHO THOSE
INDIVIDUALS ARE AND VERY MUCH GO
AFTER AND TARGET THEM SO.
WE'RE.
KIND OF THAT IS THE NEW HORIZON
AND THE NEW.
PROBLEM THAT IS APPROACHING
HEALTH CARE IT'S NO LONGER KIND
OF EASY STUFF WE HAVE GOTTEN
INTO THESE POPULATIONS THAT ARE
EXTRAORDINARILY. ON DIFFICULT TO
EITHER MANAGE DUE TO THEIR YOU
KNOW.
EXTRAORDINARY LIFE CIRCUMSTANCES
ARE THEY HAVE MEDICAL COMPLEXITY
THAT IS SIMPLY.
OVERWHELMING FOR THEM TO HANDLE
ON THEIR OWN AND SO WE'RE
STEPPING IN AND TRYING TO
PROVIDE CARE COORDINATION. THIS
DISCUSSION ON CHILD LED.
SCREENING IS A PERFECT EXAMPLE
THAT IF YOU ARE. A PARENT OR A
FAMILY THAT HAS.
CHALLENGES AND THAT YOU'RE NOT
BY ENGLISH PROFICIENT YOU MAY OR
MAY NOT HAVE.
TRANSPORTATION TO GET TO AND
FROM MEDICAL APPOINTMENTS OR
OTHER TYPES OF APPOINTMENTS AND
IF YOU HAVE A CHILD THAT TESTS
POSITIVE FOR A HIGH LED SCREEN.
YOU ARE ASKING THAT THE VERY
GOOD QUESTION AND AND WE WILL
CERTAINLY SHARE AND THAT ANSWER
IS WHAT DO YOU DO WITH THAT
CHILD HOW DO YOU MAKE SURE THAT
THE FAMILY DOES THE APPROPRIATE
FOLLOW UP. AND THEN HOW DO WE
COLLECTIVELY AND SURE THAT
SUBSEQUENT TESTING AND OTHER
TYPES OF.
PROCEDURES ARE DONE AND SO IT'S
A PARTNERSHIP BETWEEN US AND
PUBLIC HEALTH AND THE LOCALS BUT
THESE ARE ALL.
THESE ARE THE QUESTIONS THAT ON
THAT MAKE OUR WORK YOU KNOW BOTH
VERY VALUABLE BUT ALSO
CHALLENGING SOMETIMES.
I. WOULD APPRECIATE ALL THAT
YOU'RE DOING A PRETTY THE CHAIRS
LEADERSHIP AND MAKING SURE WE
HAVE THIS INFORMATIONAL HEARING.
WELL KNOWING THAT'S A YEAR ON
THIS IN A PUBLIC POLICY
STANDPOINT IN THAT RELATES TO A
FIFTY EIGHT COUNTIES I THINK IS
CRITICALLY IMPORTANT. IN
ADDITION TO THAT I THINK THIS IS
A A NON PARTISAN ISSUE I THINK
THE INVESTMENT IN THIS IS. A
CRITICALLY IMPORTANT AND IS
GOING TO READ NOT WHEN TERMS OF.
PUBLIC POLICY REWARDS ON SOCIAL
REWARDS BUT ALSO FINANCE REWARDS
AND I DON'T THINK IT IT'S
REPUBLICAN DEMOCRAT OR
INDEPENDENT. SO I WAS REALLY
REALLY APPRECIATE WHAT YOU'RE
DOING BECAUSE I THINK IN LA
COUNTY. ON THE OLD SAYING WAS
TWENTY PERCENT OF OUR
CONSTITUENTS OR THE QUOTE
UNQUOTE FREQUENT FLYERS IF YOU
WON'T. REALIZE EIGHTY PERCENT OF
LA COUNTY'S RESOURCES
AND INSTEAD OF TREATING THE
SYMPTOMS WE CAN TREAT THE ROOT
OF THE PROBLEM AND PREVENT.
FOLKS FROM DUPLICATION.
TREATING THE INDIVIDUAL ITSELF I
THINK IT'S SO CRITICAL
IMPORTANCE WAS SO NICE TO HAVE
THAT LEADERSHIP ON YOUR LEVEL.
AND I REALLY APPRECIATE YOU
INFORMING US ON THESE
CONCERNS IN THESE ISSUES.
PERHAPS.
WELL.
SO I'M QUITE HAPPY THAT YOU SAID
YOU'RE GONNA CHECK WITH YOUR
CONTRACTORS YOU MAY GET CONFUSED
AS TO.
WHEN IT'S HAVE REQUIRED CHAIR
TESTIMONY DE ISN'T SO I THANK
YOU VERY MUCH FOR.
SOAP DO YOU KNOW THE TOTAL
NUMBER OF CHILDREN OF A
PARTICULAR AGE THAT ARE SAY
REQUIRED HAVE THIS TEST.
BETTER ON MEDI CAL OR WHERE X.
G. DO YOU KNOW THAT NUMBER.
YEAH
IT WOULD ITWOULD BE THE NUMBERS
THAT WE'VE PROVIDED ON YOU WITH
OF HEARTS AND SAID THAT NUMBER
YOU NOW. AND THOSE ARE JUST MEDI
CAL BENEFICIARIES JUST MEDICARE
AND NOT ALL CHILDREN IN
CALIFORNIA THEY'RE ONLY MEDICAL
BENEFITS.
NOW WHEN THE BUILDING IS DONE.
ARMED IS IT POSSIBLE THAT THE
HOME LABS COULD INCLUDING THE
INFORMATION THEY SEND TO THE
DEPARTMENT OF PUBLIC HEALTH.
THAT THIS WAS A MEDIC OUT
PATIENT AND THEN WE WOULD NO THE
FRACTION OF MEDI CAL PATIENTS
THAT WERE BEING TESTED.
BUT I THINK.
AND THIS IS WHERE I IT'S IT
IT'S ALSO BEEN A GOOD
OPPORTUNITY FOR US TO REVISIT
OUR RELATIONSHIP WITH A
DEPARTMENT OF PUBLIC HEALTH ON
THE DATA. IT'S NOT AND THAT
PARENTS INCOME LEVEL ARE STATUS
IS NOT NECESSARILY REPORTED TO
THE LAB BUT WE HAVE THE
MECHANICS IN PLACE WE THINK TO
DO THE DATA MATCH ON OUR SIDE
BETWEEN THE TWO DEPARTMENTS. AND
SAID THEY HAVE THE ON TESTING
DATA. WITH UNIQUE IDENTIFIERS
AND WE HAVE IDENTIFIERS IN THE
MEDICAL DATA BASE THAT WE CAN DO
A DATA LINKAGE ON THE BACK AND
AND SO WE CAN CERTAINLY WORK
WITH THE DEPARTMENT TO TRY TO.
GO THERE BECAUSE I GOT PUT THAT
BACK TOGETHER BECAUSE I DON'T
THINK.
ANYTIME THAT YOU GO BACK AND
ASK OTHER.
PEOPLE TO DO SOMETHING YOU MAY
NOT GET A HUNDRED PERCENT
COMPLIANCE AND SO I THINK WE
WOULD PUBLIC TRUST OUR DATA
LINKAGE FIVE. BETTER THAN
ANYTHING ELSE
YEAH DEBBIE GREAT YEAH WILL AND
CERTAINLY. PROVIDE YOU AN UPDATE
WILL TALK WILL HAVE OUR DATA
EIGHTEEN PEOPLE TALK TO EACH
OTHER AND THEN WE'LL SEE IF WE
CAN.
GIVE YOU AN ASSESSMENT OF HOW
LONG WE THINK THAT WOULD TAKE OR
WHAT WE THINK THAT THE NUMBERS
WOULD LOOK LIKE SO YOU MIGHT BE
ABLE TO GET BACK TO US IN A
MONTH OR SO. WE WILL DO OUR BEST
THANK YOU AND BE VERY NICE WELL
YOU'VE BEEN VERY HELPFUL AND WE
REALLY APPRECIATE IT. ARM AND
THEN ANY IDEAS YOU HAVE FUN HOW
WE CAN INCREASE THAT COMPLIANCE
YOU BROUGHT UP ONE ALREADY.
WE CERTAINLY GLAD TO HEAR AND
AS HE SAID THE RECORD WILL BE
OPEN FOR ANOTHER MONTH THAT LOVE
TO REPORT THAT YOU FIGURED OUT.
HOW YOU CAN?
DETERMINE WHAT THE ACTUAL
COMPLIANCE IS SO.
THAT WOULD THAT WOULD BE A
START SO THANK YOU SO VERY MUCH
THANK YOU FOR HAVING.
ROOM.
THE AYE NEXT OUR PANEL OF WE
HAVE.
DR COLIN ROBINSON WHO'S MEDICAL
DOCTOR AND HEALTH SERVICES
ASSISTANT AND CLINICAL PROFESSOR
OF MEDICINE AT UCLA INTERNAL
MEDICINE AND PEDIATRICS.
I HE'S COMING TO THE STAND NOW
TO PROVIDE US WITH PEDIATRICIANS
PERSPECTIVE ON COMPLIANCE WITH
THE LEGAL MANDATE THAT.
WHICH I UNDERSTAND IS A
CALIFORNIA MANDATE AS OPPOSED
FEDERAL.
THEY'RE ALL CHILDREN REVELED IN
GOVERNMENT ASSISTANCE PROGRAMS
BE TESTED FOR BLOOD VLAD AT AGES
ONE AND TWO.
BOB THANK YOU SO MUCH FOR COMING.
YOU'VE COME UP IN SOUTHERN
CALIFORNIA.
AND.
IF YOU COULD JUDT TAKE UP TO
ABOUT TWENTY MINUTES AFTER YOUR
PRESENTATION NOTHING ARE YOU.
OF COURSE THANK YOU VERY MUCH
FOR INVITING ME TO QUIRK AND AND
PAGE.
.
SO I WILL A DEFINITE COKE TWENTY
MINUTES I THINK A LOT OF STUFF
THAT YOU'LL HAVE ENOUGH
QUESTIONS WILL GO THAT LAW THAT.
MAYBE WELL JUST TO YOU KNOW.
NO BUT ONE OF HIS BROTHERS AND
FINANCING IS GOING REALLY WELL
SIDE BY SOME THE EXPERTS
OBVIOUSLY IN THE HEALTH PLAN AND
DEPARTMENT PUBLIC HEALTH LEVEL.
I'M MORE HERE.
HAS.
CAN REPRESENT THE AMERICAN
ACADEMY OF PEDIATRICS WHICH
REPRESENTS OBVIOUSLY.
ME WE HAVE A.
BRANCHER.
.
IN A REGION HERE IN CALIFORNIA
BUT IT'S OBVIOUS IN NATIONAL
ORGANIZATION THAT SUCH LOT OF
THE STANDARDS AND POLICIES FOR
WHAT WE LIKE TO FOLLOW.
SO.
JUST ABOUT TO BEGIN A LITTLE
BIT WITH WHAT.
.
THE AP KIND OF SUCH AS THE
GUIDELINES IT JUST SEEMS LIKE
MORE DISCUSSION CLEARLY THAT.
THE STATE EXCEEDS KIND OF THE
REGULATIONS WOULD AT A MINIMUM
REQUIRE A TERMS OF TESTING KIDS
WERE ON GOVERNMENT ASSISTANCE
PROGRAMS RIGHT SO.
THE AP USES WHAT'S CALLED
BRIGHT FUTURES IN CASE THAT
COMES UP AGAIN THIS KIND OF OUR
GUIDELINES FOR OUT OF GO THROUGH
WELL CHILD VISITS SO YOU KNOW
SIX MONTHS OR TWELVE MONTHS
HOLDS TWENTY FOUR MONTHS OLD.
AND THESE CORRELATE REALLY WELL
TO THE CDC'S US CENTERS FOR
DISEASE CONTROL AND PREVENTION.
MUCH AS YOU KNOW.
DECADES OF EXPERIENCE IN
STUDYING THIS TIME AND THEY'RE
THE PEOPLE ORIGINALLY CAME UP
WITH THE.
.
THE KNOWLEDGE THAT NO LEVEL OF
LATTICED ACCEPTABLE.
SO THEY SAY BASICALLY THEY USED
TO RECOMMEND A MORE UNIVERSAL
SCREEN A ROLL THAT BACK A LITTLE
BIT.
WITH A RECOMMENDATION TO DO A
RISK ASSESSMENT.
AT NO CERTAIN POINTS EARLY ON
THE AND CHILD'S LIFE UNDER THE
AGE OF TWENTY FOUR MONTHS.
AND THEN ONLY TO DO THE THE
BLOOD TEST OF A CAME BACK AS A
SUPPOSITORY SEEING THAT THAT FOR
THESE KIDS WERE ON MEDI CAL WERE.
KIND OF EXCEEDING THAT.
AS WELL AND OBVIOUSLY CERTAIN
HIGH RISK POPULATIONS MIGHT BE
MORE.
MORE VULNERABLE OR IT MIGHT BE.
MORE YOU KNOW WORTHWHILE
TESTING KIND OF UNIVERSALLY.
.
SO WE CAN PARTY COVERED SO WHAT
SOME OF THE RISK FACTORS WERE IN
TERMS OF THAT THE HOUSING.
GENERALLY SPEAKING SO IN OUR IN
OUR TRAINING AND AND.
.
AND THE GUIDANCE IS THERE PUT
OUT THROUGH OUR COMMUNICATIONS
BASED THEY GIVE US KIND OF
INFORMATION ABOUT WHAT DOES
CONSTITUTES.
MALE HIGH RISK PATIENT ARE HIGH
RISK PERSON.
SO.
.
YOU KNOW THIS IS SOMETHING THAT
HAPPENS MORE AT THE NATIONAL
LEVEL HAPPENS IN OUR TRAINING IF
YOU RECERTIFY FOR BOARDS EXAMS
THIS IS FOR SURE GOING TO BE ON
YOUR BOARD EXAM AT LEAST ONE OF
THOSE QUESTIONS.
.
BUT.
IN TERMS OF DIRECTLY
COMMUNICATING WITHIN THE STATE
OF CALIFORNIA THAT OFTEN DOES
COME DOWN TO FILL A LEVEL OF
WHICH FOR BEFORE THAT FARM
PUBLIC HEALTH AND.
AND THE.
AND META CALIPHATE WITH THEIR
SPECIFIC CONTRACTS AND PLANS IN
AND GROUPS THAT THEY WORK WITH
AT THAT TIME A MORE GRANULAR
LEVEL. TO COMMUNICATE WITH THE
PRACTITIONERS.
.
SO.
US ONE POINT ALSO TO TO THINK
ABOUT IS THAT YOU IN ADDITION TO.
PEDIATRICS PRACTITIONERS WHO
REDUCING THE LINE CHAIR OF KIDS
IN CALIFORNIA ARE NOT THE ONLY
ONE TO SEE KIDS IN CALIFORNIA.
WE HAVE IN A FAMILY
PRACTITIONERS AS WELL MY WIFE IS
ONE OF THEM ACTUALLY.
WHO SEE KIDS AND?
AND THAT'S ALSO PART OF THEIR
TRAINING US AS FOR.
YUPPIE DOCTOR SORRY PATRICK JOB
POSITION ASSISTANCE OR ON FAMILY
PRACTITIONER OUR SITE NURSE
PRACTITIONER
SO THAT'S KIND OF THE CADRE
PEOPLE THAT WE SEE. THAT TAKING
CARE OF OF KIDS SO YOU KNOW WE
WERE DEAD. TIRED AGAIN ADJUSTED
AT THE LEVEL OF OF ME AS OPPOSED
THE LEVEL OF.
THE DIRECTORS THOSE ARE KIND OF
THE GROUPS OF PEOPLE WHO ALSO
SEE
WHO ALSO SEE CHILDREN.
SO.
.
WE GOT KIND OF.
LISTA QUESTIONS I THINK FROM
PAGE BEFORE THE THINGS TO A TO A
JUST LOVE THEM AGAIN HAVE
ALREADY BEEN ADDRESSED ONE OF
THEM WAS I THINK PROBABLY MOST
IMPORTANT QUESTION THAT I CAN.
SPEAK TO IS IS WHY THESE TESTS
AREN'T HAPPENING AND HEARING THE
PRIOR.
TESTIMONY OR IN THE CAR THE
PRIOR STATEMENTS AND THEN ALSO
COMPANY TOGETHER MY KNOWLEDGE.
OF WHAT HAPPENS I THINK ONE OF
THE. THINGS I SEE ON THE GROUND
A LOT IS.
.
PHONE CALL NOT COMPLEXITY NOT
ADHERENCE TO A PARTICULAR
TREATMENT PLANTS.
SO ONE EXAMPLE MIGHT BE THE
FAMILY MISSES THE TWELVE MONTH
POINT BECOMING A FIFTEEN OR
FOURTEEN MONTHS AND YOU'RE
THINKING ABOUT THE FIFTEEN MONTH
WHERE IT'S.
YOU KNOW WHAT THE TWELVE MONTH
IS THAT NO STANDARD BREAD AND
BUTTER TEACHING TO. TO DO THAT
THE LEAD SCREENING AND THEN SAME
THING AGAIN AT HOW TWENTY FOUR
MONTHS THEY MISSED TWENTY FOUR
COMING AT THIRTY INSTEAD YOU
KNOW LIFE IS BUSY. THINGS ARE
CRAZY AND SO THEY THEY MISS THAT
AND YOU DON'T THINK BACK TO YOU
KNOW THE THE LEAD TESTING.
AT THE TWENTY FOUR MONTH KIND
OF APPOINTMENT.
.
I SETS SO THAT'S ONE PART OF IT
I'M NOT SURE IF MEDI CAL
ACTUALLY CAPTURES LIKE WHEN
PEOPLE ACTUALLY MISS THOSE
APPOINTMENTS YOU KNOW AT THE AT
THE SETS PERCENT TIMES. I'M AND
THEN OF COURSE NOT GETTING THE
TESTS THEMSELVES RIGHT SO I
CAN'T TELL YOU HOW MANY TIMES I.
GO BACK MY YOU KNOW ELECTRONIC
HEALTH RECORD BOX EXPECTING TO
SEE SOME LAB RESULTS AND THERE'S
NOTHING THERE NOTHING CONTINUES
TO COME BACK BECAUSE THE FAMILY
JUST.
MISUNDERSTOOD WHAT I WENT HOME
OR THE GYM WAS REALLY UPSETS OR
IN A ONE OF A MILLION THINGS
COULD HAVE HAPPENED AND AND THE
TEST OF SIMPLY. DIDN'T HAPPEN.
AND SO YOU KNOW IT'S KINDA
NATURE THE LIFE WE HAVE A SMALL
KID AND THAT THINGS LIKE THAT TO
COME UP.
.
AND SO I THINK THAT THAT
ACTUALLY MIGHT PLAY A LITTLE BIT
OF A ROLE AS WELL AS IT IS TOUGH
TO CAPTURE THAT RIGHT AT THE
LEVEL OF AGAINST ON THE FOLKS
WHO'VE BEEN SPEAKING.
BEFORE ME.
BUT THAT COULD BE SOMETHING
THAT'S WHAT'S HAPPENING UPS I'VE
SEEN IT HAPPEN ON A HOW MANY
TIMES EVEN IN THE LAST WEEK WITH
DIFFERENT TESTS FOR ALL
DIFFERENT AGES ACROSS THE THE
SPECTRUM THAT I SEE.
.
SO I THINK THOSE ARE KIND OF
SOME OF THE MAIN THINGS.
JUSTICE SPEAK REALLY QUICKLY TO
THE POINT OF CARE TESTING WHICH
HAVE COME UP UP AS WELL AS WAS
LOOKING THROUGH SOME OF THE
CALIFORNIA DEPARTMENT PUBLIC
HEALTH.
HIM BROCHURES THAT'S NEVER
REALLY GREAT SET OF OF.
INFORMATION PACKETS ONLINE AND
THERE IS YOU KNOW A AN
EXHORTATION TO REPORT THE POINT
OF CARE TESTING BUT AGAIN THOSE
ARE. NOT AS EASY TO GET IN THE
CLINIC SO IF YOU TO TRY TO
MITIGATE THAT'S KIND OF
NONCOMPLIANCE FROM THE THE BLOOD
DROP IN THE ARE WHICH CAN BE
LIVE THE MORE PAINFUL ARE MORE
DIFFICULT TO GET. BY GETTING THE
POINT OF CARE TESTING.
NEARLY AS THEY SOUGHT TO REPORT
BUT IT'S IT SOMETIMES IT'S A
LITTLE BIT MORE.
.
HAD DIFFICULTY MAINTAINER TO GET
THAT POINT AFTER TESTING IS NOT
ALWAYS NO CHEAP POOR ARE WORTH.
FINANCIALLY WORTH YOU KNOW
KEEPING IN THE CLINIC AS OPPOSED
TO JUST HAVING THE PERSON GO
OVER TO THE LABORATORY
LABORATORY DOES AS WE MENTIONED
BEFORE. NO REPORT OVER TO.
CALIFORNIA DEPARTMENT OF HEALTH
BUT.
DUBBED THE POINT OF TESTING YOU
KNOW THAT THAT GOES TO A
DIFFERENT SORT OF REPORTING FORM
RIGHT BECAUSE IT DOESN'T COME
FROM A LAB COMMISSION THE CLINIC
ITSELF.
SO THAT'S ONE ONE AREA THAT
MIGHT BE KIND OF A CAP IN THEIR
IN THAT WEEK BMB LACKEY MISSING
SOME PEOPLE WHO. COULD GET
CLINICAL TESTING BUT THE ICONS
ARE ABLE TO DO IT AND THEN THEY
KINDA MISS OUT ON THE. ON THE
VENOUS BLOOD DRAWS ARE THE KINDA
MORE PAINFUL BUT JOHNSON THE
ARMS THAT.
YOU KNOW I WAS TALKING ABOUT
BEFORE.
.
SO I THINK.
A LEAVE A COUNTY THAT THERE AND.
AND CAN OPEN UP TO ADDITIONAL
QUESTIONS I THINK JUST FROM THE
AP'S PERSPECTIVE. IN OUR OUR
MAIN GOAL HERE IS TO BE YOU KNOW
HERE FOR INFORMATION HERE'S A
RESOURCES WHILE WE HAVE ABOUT A
HALF A DOZEN. DOCTORS IN
CALIFORNIA THAT WE DO REPRESENTS
AND COMMUNICATE WITH.
.
SO IF THERE ARE WAYS THAT WE CAN
BE OF SERVICE CAN BE IT CAN BE
OF USE.
AND PLEASE LET US NOW AND I'M
HAPPY TO KIND OF TALK ABOUT THAT
A LITTLE BIT MORE.
YA AS WE AS WE GO FORWARD.
WELL THANK THANK YOU VERY MUCH
FIRST BILL FOR COMING AND THEN
FOR BEING AYE I THINK VERY
STRAIGHTFORWARD IN DESCRIBING.
BOB WHAT SOME OF THE PROBLEMS
ARE AND THAT I REALLY APPRECIATE
THAT.
BOB YOU WERE DISCUSSING THAT
SOMEONE WHO WAS SUPPOSED
COMMENDED TWELVE MONTHS COMES IN
AT FIFTEEN THIS MAY CREATE SOME
CONFUSION IN THE DOCTOR'S MIND.
AS TO WHETHER OR NOT I SHOULD BE
ASKING FOR THAT LEAD TEST AT
THAT TIME.
I KNOW AND WE'VE HAD KIDS OF MY
OWN ALTHOUGH A LONG TIME AGO.
DATA YES.
LIFE CAN BE VERY HECTIC FOR
PEDIATRICIANS.
AND THEY DON'T GET PAID ENOUGH
AND. THEY END UP HAVING MORE
PATIENCE THAN THAN NAM.
THEN PERHAPS IS OPTIMAL AND.
SO IT'S IT IS A DIFFICULT LIFE.
A CAN YOU THINK OF PROCEDURES
THAT WOULD HELP.
I TO REMIND THE PEDIATRICIAN.
OUR DAD TO.
THIS PERSON HASN'T HAD THE LEAD
TESTIS THERE SOME. SOMETHING
ANY OF THEIR MEDICAL RECORDS
THAT COULD BE ADDED THAT WOULD
TURN ON.
YOU NOW.
NEXT ALLEY LOOKS AT THAT MEDICAL
RECORD IT SHOWS UP BRIGHT RED
GET IT WOULD GET LEAD TEST WE
HAVE BEEN DONE IT YET.
ARM.
JUST ANY SUGGESTIONS YOU COULD
MAKE WOULD BE HELPFUL YEAH
THAT'S A THAT'S A GOOD POINT SO.
ACTUALLY.
SEE BOTH ADULTS AND KIDS ACTION
OF TO BOARD CERTIFICATION
SERGEANTS IN WHAT'S FROM THE
ADULTS I BECAUSE I'M WHERE I
WORK WE ACTUALLY DO HAVE KINDA.
SCOTT HEALTH MAINTENANCE TAB.
AND I WOULD IMAGINE A LOT OF
PLACES DO THAT FOR KIDS WHO JUST
STARTED DEVELOPING AT FOR ADULTS
OF FOR EXAMPLE FIFTY TWO YEAR
OLD MALE COMES AND. SHOULD HAVE
A COLONOSCOPY BY THAT POINT
THERE'S A BIG RED DOT BY KIND OF
IN THAT PORTION OF THE TAB THAT
SAYS HEY.
S. PERSON ACTUALLY NEEDS A
COLONOSCOPY BECAUSE THEY'RE
PASSED THE POINT OF GETTING A
TEST. YOU CAN IMAGINE THE SAME
THING YOU KNOW GOES FOR SO
ACTUALLY DO HAVE A FOR VACCINES
FOR OUR CHILDREN AND SO ALSO YOU
KNOW THEY NEED TO.
THE NEXT IN AMMONIA VACCINE
IT'S IN READ WITH A DATE THAT IT
SHOULD HAVE BEEN DONE.
SO THAT ACTUALLY A GREAT
MECHANISM TO TO JUST REMIND
DOCTORS THAT THAT'S
BUT THAT'S THEIR.
ENDS NOT ALL OF THE DIFFERENT
HEALTH PLANS ARE ALL DIFFERENT
CLINICS ARE SINCE THEN THE HR
FOR THE MOST PART SOME OF THEM
THEM VERY DIFFERENT THAN OTHERS
BUT. YOU COULD HAVE YOU KNOW
THOSE KINDS REMINDERS PAPA. NAM.
DOES THAT MAKE YOU WOULD HAVE TO
HIGH SATISFY THAT TOOK ARE.
CLEAR.
.
NOT HAVE A A COMPLIANCE BAR OKAY
WELL PERHAPS WE COULD HAVE.
.
OUR DISCUSSIONS LATER RON.
WITH APPROPRIATE FOLKS TO SEE.
HOW WHETHER OR NOT?
THIS EXISTS PARTICULARLY IN THE
ONLINE MEDICAL RECORDS.
I DON'T KNOW WHAT FRACTION OF
PEDIATRICIANS HAVE THEM ONLINE
BUT SO THAT THERE IS THIS KIND
OF AUTOMATIC.
A WARNING THAT COULD PERHAPS
HELP.
WITH COMPLIANCE FROM THE
PEDIATRICIAN AND.
AGAIN.
AYE QUITE BELIEVE YOU THAT.
FOR WHATEVER REASON NOT EVERYONE
GETS A BLOOD TEST I'VE TALKED TO.
A FRIEND WHO WAS ON MEDICARE
ALLEN
S. TOLD GET A BLOOD TEST DIDN'T
AND DIDN'T AND THEN FINALLY WHEN
THE TRIALS AROUND FIVE.
SHE GOT THE CHILD A TEST AND IT
SHOWED HIGHER BLOOD LEVELS.
SHE WAS VERY UPSET AT HERSELF
I'VE EVEN HAD THINGS THAT I
HAVEN'T DONE HAT MY
PEDIATRICIAN ASKED ME TO DO SO.
.
I REMEMBER GETTING UPSET AT ME
TOO.
ANYWAY.
.
AGAIN I REALLY THINK AND WE'LL
FIND OUT FROM THE MEMBERS OF THE
FIRST PANEL WHETHER OR NOT
THERE'S AN ACCURATE.
IN OFFICE TEST.
THAT MIGHT BE USED FOR THAT AND
OTHERS.
ARM.
WE DON'T YET KNOW WHETHER OR NOT
THERE ARE ADEQUATE TESTS AND
THEY'VE EVEN SAID THAT.
THE BLOOD DRAW HAS TO BE.
FROM MA.
OWNER SHOULD NOT BE VENOUS BLOOD
DROP THAT HAS TO BE FROM THE.
HI.
TARTARY.
SO THAT JUST TO GET THE ACCURACY
THAT THEY NEEDS OF THAT TIME.
WELL WE'LL SEE IF THAT'S CLOSELY
WHICH REALLY NECESSARY IN TRYING
TO GET A BETTER IDEA THAT DO YOU
HAVE ANY COMMENTS ON.
ACCURACY OF IN OFFICE TASKS
VERSUS VENUS TASK VERSUS ARTERY
TEST
THERE ARE ALSO SMART TO MY
KNOWLEDGE THINK VENUS TESTING
STILL BAND CONCERTS. ADEQUATE
FOR FOR.
FOR BLOOD DRAWS I THINK THAT
THE PROBLEM HAS BEEN IN THE
LIMITS OF DETECTION IN THE
ACCURACY FOR THE POINT OF CARE
ONCE OR EVEN IN BUSY OFFICES
THAT ARE.
BIKE UP I TALKED ABOUT TO
PEDIATRICIANS KIND OF BEEN IN MY
AREA IN.
KIND OF IN PREPARATION FOR THIS
IS WHILE THEY'RE ALL PRETTY
RIGID ABOUT GETTING THE TESTING.
BUT A LOT OF ACTION BUT NOT
MADE THE POINT TO GET THAT THE
POINT COURTESY AGAIN BECAUSE OF
THE ACCURACY SO I THINK AS WE
SEE A LITTLE MORE DEVELOPMENT
AND THOSE TESTS. AND WE MIGHT
SEE MORE ADOPTION OF UP AND DOWN
AGAIN THROUGH YOU KNOW THAT THE
ADEQUATE REPORTING.
.
THAT WOULD PROBABLY BRING UP THE
LEVELS LITTLE BIT. IN TERMS OF
YOU KNOW HOW MANY KIDS ARE BOTH
TESTED AND REPORTED RIGHT TO
COME CLOSE THAT KIND OF GAP OF
WHO'S NOT WHO MIGHT BE TESTED
BUT NOT REPORTED IN THE FIRST
PLACE.
.
AND THEN.
AND I RECEIVED A COSTS
A FACTOR FOR SOME CLINICS IS IS
A BIG DEAL WITH THESE TESTS
POINT ACCORDIONS ARE. CHEAPER
JUST GOING THROUGH A FOR A BUNCH
OF OTHER DIFFERENT TESTS.
NOT ONLY LEAD BUT FOR YOU KNOW
KINDA LIVER TESTS AND THINGS
LIKE THAT IN A CLINIC AND
THEY'RE NOT THEY'RE NOT CHEAP
UNFORTUNATE FOR NOW AND
HOPEFULLY AS.
YOU KNOW.
EWING THINGS GO OF IT LESS
EXPENSIVE TECHNOLOGIES BASS IS A
LITTLE BIT THEN WE CAN MORE
RELIABLY USE THOSE ARE EXPECTED
TO BE A LITTLE BIT LESS MORE
COST EFFECTIVE LESS EXPENSIVE.
LEARN.
ARM.
THAT MEANS TAKE A LOOK AT TO SEE
ABOUT SOME OF THE OTHER
QUESTIONS I HAVE IN MY NOTES
HERE.
HOME.
DO YOU SEE HERE A DIFFERENCE IN
THAT TYPE OF PRACTICE PEOPLE
HAVE.
DEPENDING ON. WHERE THEY ARE
FOR EXAMPLE PEROT PRACTICES
VERSUS PRACTICES IN THE CITY'S
VERSUS PRACTICES AND CLINICS
PURSES?
OUR POSITIONS AND ARE AT AT TAKE
KAISER WHICH IS HALF THE STATE
THIS POINT BUT IT'S DIFFERENT
FROM PRIVATE PRACTICE.
I UNIVERSITIES.
.
DO YOU SEE DIFFERENT CHALLENGES
IN DIFFERENT AREAS.
YEAH I MEAN I THINK THERE ARE
DIFFERENT.
THE COULD EVER PRACTICES IN
DIFFERENT AREAS SO.
FOR EXAMPLE I SPOKE WITH
SOMEONE WHO IS IN PRIVATE
PRACTICE WHO WAS VERY VERY
DILIGENT AND CONSCIENTIOUS
PEDIATRICIAN.
SHE.
DOES THAT BASIN THAT RISK
ASSESSMENT RYAN WAS NEW RISK
ASSESSMENT. THEY'LL SAY OKAY IS
THE DOES THE CHILD MEETS COMIC.
CRITERIA TO GET TESTED AND ON
THE GO AHEAD AND TOSS THEM AND
ACTUALLY SHE'S ALL HAD ONE CHILD
TURNED POSITIVE BECAUSE. RISK
ASSESSMENT IS PRETTY GOOD ENOUGH
IF YOU ASK THEM REPORT AND HOUSE
THOSE MADE BEFORE YOU KNOW
NINETEEN SEVENTY EIGHT OR
WHATEVER.
AND SO YOU KNOW THAT'S THAT'S
THAT PRACTICE THEIR.
IN ME I LIKE A COUNTY CLINIC OR.
FQHC FEDERALLY QUALIFIED HEALTH
CENTER THEY TEND TO BE MUCH MORE.
ARE ON TOP OF THE INCOME OF
THAT'S JUST WHAT THEY DO
UNIVERSALLY RIGHT BECAUSE THEY
HAVE THE MEDI CAL. UP PATIENTS
ARE HEROES BECAUSE MOST OF THE
RURAL ENVIRONMENT HAS ALLIES.
QUITE THE OPPOSITE THAT BUT.
BUT IT DEPENDS YOU KNOW THAT.
.
IT DOES DEPEND EVEN WITHIN THE
CITY OF ALACHUA COUNTY OF LA
WHERE IT WHERE YOU'RE PRACTICING
WHAT THAT.
.
EXPECTATIONS ARE THAT YOU HAVE
FOR YOURSELF OR FOR YOUR
PATIENCE BUT.
SUFFICE TO SAY FOR THOSE WHO
ARE DOING COMPLETELY UNIVERSAL
GENERALLY SPEAKING THEY'RE EVEN
STILL DOING THAT RISK ASSESSMENT.
EVEN IF THEY HAVE LIKE A PARENTS EVER SAY I DON'T WANNA.
LED TASK.
MORE THAN LET'S SAY I'VE THEY
WILL SAY THAT I THINK PARTLY
IT'S JUST A LITTLE BIT OF.
SOME OF THE COULD NOT ARRESTED
ALL OF MY HOUSE IS BRAND NEW OR
THAT DOES NOT MEAN THAT I CAN'T
THINK.
SOME OF THEM DON'T KNOW THE
RISKS OF LETTER WHICH I THINK IS
NOT UNDERSTANDABLE BECAUSE THAT
ENHANCE. WHICH I GOT OUT THERE
EVERYONE TRIES TO GET OUT THERE
BUT IT'S HARD TO CRAP WITH ALL
THAT.
AS A PARENT AND SOMETIMES
THERE'S THEY JUST DON'T WANNA
HURT THE CHILD'S IN THE OTHER
ONE PROTECT THEM FROM THE BLOOD
DRAWN SO YOU KNOW I'LL TAKE MY
CHANCES BECAUSE I THINK.
YOU KNOW WE'RE NOT GONNA. NOT
WE'LL HAVE HIGH LEAD LEVELS IN
OUR WATER OR PAINT OR WHATEVER.
AND SO YOU KNOW FAIRLY CERTAIN I
KNOW WE TRY TO WORK WITH THEM
AND TRY TO CONVINCE THEM.
BUT SOME PEOPLE ARE JUST GONNA.
STUCK IN AND SAYING NOW SAYING
NOW AND WE.
NASA TO WATCH OUT FOR THEM FOR
SIGNS AND SYMPTOMS OF LEAD
BUTTON NEXT CITY FROM FROM THERE
ON OUT AND HOPE THAT.
THEY'RE CORRECT IN THE FIRST
PLACE BUT.
OKAY TO. ITS.
IT'S PROBABLY DIFFICULT FOR YOU
TO SAY WHAT PART OF THE NON
COMPLIANCE IS FROM.
PARENTS ARM JUST NOT THINKING
ABOUT DOING THE TESTING OR
PARENTS REFUSING TO DO THE
TESTING OR DOCTOR REFUSING TO
ASK.
DO WE HAVE ANY IDEA WHAT THE
BIGGEST PROBLEM MIGHT BE.
THE OTHER SLAYER PRIDE I
SHOULDN'T VENTURE INTO GUESSING
WHICH ONES THERE'S THAT.
NOW AVAILABILITY BY SUCCUMBS
AND SO WHATEVER STANDS OUT TO ME
I MIGHT I MIGHT OVER ESTIMATE
SURE.
THAT'S ONE AREA WHERE A P..
MAY BE USEFUL IN FIGURING OUT
YOU KNOW HEY YOU KNOW FOR ASK A
SWATH OF PEDIATRICIANS.
YOU KNOW WHERE DO YOU SEE THE
THINGS FALLING SHORT HUESO TESTS
FALLING SHORT. KNOWS THAT
BECAUSE PARENTS ARE NO IS
BECAUSE PARENTS.
.
TIPS PLANTED IT TOMORROW AND
THEN YELL DOESN'T HAVE BETWEEN
NOW AND THEN
WE COULD WE COULD ASK THEM AND
TRY TO FIGURE THAT PART OUT YOU
KNOW IT'S A RELATIVELY SIMPLE
SURVEY. IF YOU COULD DO THAT
THAT BE GREAT.
OKAY YET MY STAFF WILL FOLLOW UP
WITH YOU THEN BEAT THAT WOULD BE
VERY GOOD IT ALWAYS BEST TO
DEFINE A PROBLEM YET.
COULD HAVE DATA.
YEAH.
ALRIGHT.
THANK YOU VERY MUCH THANKS FOR
COMING ALL THE WAY UP AND.
FOR OFFERING THAT THE SURVEY
WHICH.
IN AND OF ITSELF MAY JUST YOU
KNOW POINT US IN THE RIGHT
BALLPARK I DON'T EXPECT THAT.
E. WE WITNESS.
AT YOU. IF I DON'T KNOW WHAT
KIND OF NUMBERS WE CAN GET BUT
AT LEAST WE WOULD GET A SAMPLE
OF VARIOUS DOCTORS AND.
WHAT THEIR IMPRESSIONS ARE SAID
THAT WOULD BE
FULL?
WE CAN GET NUMBERS THAT'S EVEN
BETTER FAT.
AGAIN THANK YOU VERY MUCH AND.
LET'S TRY AND FIGURE OUT WHAT
THE PROBLEM IS IN IF THERE'S
ANYTHING THE DATA YOU ALL CAN DO
WHERE. WE ALL CAN HELP HERE IN
THE CAPITAL RIGHT THANK YOU
INCLUDES.
ALRIGHT.
SO THE NEXT PANEL.
IS A UNIQUE ONE WE'RE GOING TO
TALK WITH.
.
JOHN BATTERS.
EV NIKA STEVENSON AND DAPHNE
MACKLIN.
AND THIS IS SORT OF A CITIZENS.
RESPONSE.
ARE.
YOU COME UP TO SHARE THEIR
PERSONAL STORIES I WITH
CHILDHOOD TARA.
BLOOD LEAD LEAD TESTING.
AND IN ADDITION WE'RE GOING TO
HAVE TESTIMONY FROM SEVERAL
INDIVIDUALS THAT ARE GOING TO
WHO COULD NOT ATTEND THE HEARING
THAT'LL BE READ.
I AND SUBMITTED TO OF HER
TESTIMONY.
I'M.
THANK YOU VERY MUCH IF YOU COULD
USE. ABOUT THREE OR FOUR MINUTES
EACH.
ARM FOR TOTAL OF TEN MINUTES FOR
THE THREE OF YOU SAU.
WHEN YOU OBVIOUSLY WE NOW KNOW
WHO JOHN IS.
.
AB NIKA COULD YOU RAISE YOUR
HAND ARE AYE AND.
DAPHNE.
YES DAPHNE'S ON MY RIGHT HAVE
NICK IN THE MIDDLE JOHN ON THE
LEFT OKAY.
WHO WOULD LIKE TO GO FIRST?
OKAY WE'RE GOING TO TO HEAR FROM
THE MAYOR.
AND FARM.
EMERYVILLE.
WHICH IS JUST A FEW MILES FROM
HAYWARD WHERE I LIVE.
THANK YOU THANK YOU FOR.
INVITING US HERE TODAY MISTER
CHAIR COMMITTEE MEMBERS AND
STAFF.
HOW MANY MISS JOHN POWDERS I
HAVE THE PLEASURE OF SERVING THE
PEOPLE OF EVERY VILLAGE THEIR
MER? AND I SERVICE THE CHAIR OF
THE ALAMEDA COUNTY LEAD
POISONING PREVENTION DISTRICT
AND DEPARTMENT JOINT POWERS
AUTHORITY.
WHICH IS THE NATION'S FIRST
MULTI DISCIPLINARY.
LEAD POISONING TASK FORCE
WAS FOUNDED IN NINETEEN NINETY
ONE AND WE PROVIDE.
SERIES OF INTERVENTIONS AND
AGREE TO BE HELPED BY HEALTH
CARE. ARE RELATED TO NURSING
ENVIRONMENTAL.
TOXIC REMEDIATION OF THE CASE
MANAGEMENT SERVICES TO THE
PEOPLE NAM IT ALAMEDA COUNTY.
I ALAMEDA COUNTY'S CHILD ISN'T
OF LEAD POISONING PREVENTION
RATE IS.
AVERAGES ABOUT SEVEN PERCENT.
TO GIVE SOME CONTEXT OF THAT IN
FLINT MICHIGAN WHICH MOST OF US
ARE FAMILIAR WITH.
THE CHILD LEAD POISONING RATE
IS FIVE PERCENT.
ON THE CITY OF EVERY BUILT SIX
AND A HALF AND IN THE FRUITVALE
IT IS ALMOST SEVEN AND A HALF.
SO ARM LET ME GET THE NUMBERS
STRAIGHT AGAIN SO FRUITVALE WAS
SEVEN AND A HALF.
EMERYVILLE WAS SIX.
MICHIGAN WAS FIVE MICHIGAN IS.
AND WHAT WAS THE FIRSTNUMBER IT
WAS FOR ALAMEDA COUNTIES ME TO
COUNTY ON THE WHOLE AVERAGES
ABOUT SEVEN PERCENT.
THAT'S SEVEN PERCENT YES
SO.
WE HAVE BIGGER PROBLEMS WE HAVE
A VERY BIG PROBLEM.
.
THE PROBLEM IS A LITTLE
DIFFERENT IN TERMS OF THE SOURCE
OF THE TOXICS.
IT'S NOT GENERALLY RELATED TO
WATER AS MOST PEOPLE ASSEMBLY
LEAD POISONING TO BE DUE TO THE
NEWS AROUND FLINT MICHIGAN. ON
MARS IS MORE SOIL BASED.
A BY PRODUCT OF PAST USES IN
THE WESTERN PART OF ALAMEDA
COUNTY NORTHERN ALAMEDA COUNTY.
AS WELL AS.
PAINT PAINT RELATED ISSUES.
.
HOMES IN.
UNDER INVESTED NEIGHBORHOODS
AND COMMUNITIES THAT HAVE GONE
IN DISREPAIR FOR A LONG PERIOD
OF TIME. ARE ALSO A SOURCE OF
LEAD.
OUR DEPARTMENT SEES ABOUT THREE
HUNDRED FIFTY CASES PER YEAR.
BLOOD LAB LEAD LEVEL READING OF
FIVE TO FIFTEEN MILLIGRAMS PER
DECILITER. AUTOMATICALLY RESULTS
IN A CASE MANAGEMENT FAMILY
SERVICES PROGRAM BEING INITIATED
WE HAVE ABOUT THIRTY FIVE TO
FORTY CASES PER YEAR WHERE.
THE CASE IS SO SEVERE CHILD HAS
OVER A READING OF OVER FIFTEEN
MILLIGRAMS PER DECILITER. IN
THOSE CASES I WE DISPATCHING
NURSE
TO ASSIST THE FAMILY IN THE
CHILD.
THROUGH THERAPY AND TREATMENT
FOR LEAD POISONING AND WE ALSO
BY DISPATCHING ENVIRONMENTAL
SPECIALIST TO THE HOME. TO
IDENTIFY THE SOURCE AND
REMEDIATE AS APPROPRIATE.
OUT RECENTLY WE WE'VE BEEN GOING
THROUGH A SITUATION WITH THE
OAKLAND UNIFIED SCHOOL DISTRICT.
AS PART OF REGULAR TESTING
OAKLAND IDENTIFIED FORTY FIVE OF
ITS SCHOOLS. ARE TESTED HIGHER
THAN THE ALLOW CDC ALLOWABLE
FIFTEEN PARTS PER BILLION FOR
LEAD IN WATER.
DOES NEIGHBORHOODS THAT I HAVE
ALREADY MENTIONED WHERE ON
THERE'S A HIGHER PREVALENCE OF
EAD POISONING ALAMEDA COUNTY
HAPPENED TO ALSO BE.
HAVE SOME SIX SIGNIFICANT
OVERLAP WITH PLACES WHERE THE
SCHOOLS ARE LOCATED NOW THAT IS
NOT TO SUGGEST THAT THE SCHOOLS
ARE THE SOURCE FOR THAT ALONE.
IT IS IT IS IT.
ABUNDANCE OF THE TOXIC IN THE
ENVIRONMENT.
BUT WHAT WE FIND IN THOSE
COMMUNITIES IS THAT MANY OF THE
CHILDREN IN THOSE SCHOOLS ARE ON
MEDI CAL.
ON THEIR LOWER INCOME
NEIGHBORHOODS AND COMMUNITIES
AND SO THE NEED TO DO SCREENING.
EARLIER REGULARLY.
AND ACTUALLY MEET THOSE
CHILDREN WHERE THEY'RE AT AND
INFORM THEIR PARENTS OF THE
IMPORTANCE OF BLOOD LEAD LEVEL
TESTING.
IS CRITICAL.
AND I I KNOW IT WAS A FAN
FAVORITE.
LAST YEAR TO PROVIDE A COUPLE
PIECES OF CONTEXT ABOUT HOW.
LITTLE LEAD IS NEEDED TO
ACTUALLY HARM A CHILD.
BUT IF YOU CUT A PENNY.
INTO A MILLION PIECES IT TAKES
JUST TWO OF THOSE MILLION PIECES
TO POISON A CHILD.
AND IF YOU TOOK A PACK OF SUGAR.
A LITTLE PICTURE YOU GET COFFEE
AND IF I WAS TO SPRINKLE IT
RANDOMLY ACROSS THIS ENTIRE ROOM
AND WE WERE TO HAVE A CHILD.
A TODDLER CRAWL ACROSS THIS ROOM
THAT'S ABOUT HOW.
DISPERSED IT NEEDS TO BE TO
ACTUALLY COME INTO CONTACT WITH
THE CHILD THAT'S HOW LITTLE YOU
NEED IN THE ENVIRONMENT.
TO BOTH BE IN A DANGEROUS
SITUATION AND TO POISON A CHILD.
AND SO ARE DEPARTMENT TAKES A
LEAD POISONING VERY SERIOUSLY WE
HAVE EXCELLENT STAFF.
AND.
EACH CITY IN THE JPA IS
REPRESENTED ON THE BOARD. AND.
WE WE'VE BEEN VERY ACTIVE IN.
SUPPORTING THE GOOD WORK YOU IN
THIS COMMITTEE HAVE DONE AND
TRYING TO REMEDIATE LED FROM THE
ENVIRONMENT WE SEE IT.
IN ABUNDANCE UNFORTUNATELY IN
OUR COUNTY AND SO.
WE'RE HERE TO BE SUPPORTIVE AND
JUST LET YOU KNOW THAT IT IS A
REAL PROBLEM FOR CHILDREN OUR
COMMUNITY.
I JUST ONE QUICK QUESTION YOU
SAID ABOVE FIFTEEN YOU SEND A
NURSE OUT.
WHAT DO YOU DO BETWEEN FIVE AND
FIFTEEN WE DO CASE MANAGEMENT
AND FAMILY SERVICES WHERE WE
GUIDE?
THE FAMILY THROUGH THE
APPROPRIATE REFERRAL PROCESS BUT
WE DO NOT PROVIDE THE DIRECT
HEALTHCARE CELLS.
OKAY.
THANK YOU YOU'RE WELCOME ARM.
GAFFNEY OR.
MAY NAME IS STEPHANIE MACKLIN
I'M.
INSULTED BUT IF IT'S.
ADVOCATE WITH.
CALIFORNIA COALITION OF.
A COALITION OF CALIFORNIA
WELFARE RIGHTS ORGANIZATIONS.
MANY YEARS I WAS AN ATTORNEY
WITH LEGAL SERVICES OF NORTHERN
CALIFORNIA SELLING MY SEMI
RETIREMENT CLAIM BACK DOING
ADVOCACY IS TO LOBBY HERE FOR
THE ACLU.
MY FAVORITE.
OF.
I.
WAS PART OF A GROUP WHO
IDENTIFIED SOME PEOPLE WHO WERE
NOT ABLE TO TESTIFY. IN I WOULD
SIMPLY LIKE TO READ THEIR
STATEMENTS AND MAKE A FEW SHORT
COMMENTS WITHOUT.
FOLLOW VERY GOOD THANK YOU KING
CATHERINE WHO LIVES IN EAST
OAKLAND IS SUBMITTING HER
WRITTEN TESTIMONY FOR THE RECORD.
CATHERINE'S THE MOM OF A THREE
YEAR OLD BOY NAMED ROBBIE. THEY
RECENTLY FOUND OUT THAT ROBBIE
HAS ELEVATED BLOOD LEAD LEVELS.
THEIR HOME A SINGLE FAMILY
RENTAL HOUSE IN EAST OAKLAND
TESTED POSITIVE FOR LEAD BASED
PAINT.
DURING THE RAINY SEASON THE ROOF
BEGAN LEAKING AND THE LANDLORD
DID NOT FIX IT.
THE WALLS BECAME SATURATED AND
THE PAINT PEELED ALL ALONG THE
BACK OF THE HOUSE. EVENTUALLY
THE LANDLORD DID FIX THE ROOF
LEAK
BUT THEN DID THAT WE PAINT THE
HOUSE.
CATHERINE AND HER HUSBAND HAVE
MADE MINOR REPAIRS THEMSELVES
BECAUSE THE HOMELESS STILL
AFFORDABLE BY OPEN STANDARDS
FOURTEEN HUNDRED DOLLARS OVER
THE FIVE YEARS THAT THEY LIVE
THERE.
AND READ FOURTEEN HUNDRED
DOLLARS A MONTH BUT THEY DID NOT
KNOW ABOUT THE DANGERS OF
POSSIBLE LEAD BASED PAINT.
ROBBIE DID NOT SPEAK OR HAVE ANY
EXPRESSION UNTIL HE WAS TWO
YEARS OLD. WHEN THEY TESTED HIM
FOR BLOOD BUT.
SINCE THEN HE'S BEGUN TO DEVELOP
BEHAVIORAL ISSUES SUCH AS
HYPERACTIVITY AND SHORT
ATTENTION SPAN.
CATHERINE OFTEN CANNOT LEAVE A
HOUSE ALONE WITH HIM BECAUSE HE
TRIES TO RUN INTO TRAFFIC.
DOCTORS WHO DIAGNOSED HIM WITH
AUTISM AS WELL.
CATHERINE SUFFERED DEPRESSION
FOR MONTHS AFTER HIS DIAGNOSIS
SAYING SHE BLAMED HERSELF AND
FELT THAT THEIR LIVING
CONDITIONS RUINED HIS LIFE.
MEANWHILE THE LANDLORD HAS BEGUN
TO HARASS THE FAMILY SHE TOLD
CATHERINE THEY COULD STAND
ANOTHER APARTMENT OF HERS RENT
FREE WHILE THE HOUSE WAS
REPAIRED. BUT ONLY IF CATHARINE
SIGNS A STATEMENT THAT SAYS THE
LAMB OR DISCLOSED INFORMATION TO
THEM ABOUT THE HOUSES LEAD BASED
PAINT BEFORE THEY MOVED IN WHICH
SHE DID NOT.
CATHERINE STRING TO FIGURE OUT
HER RIGHTS AS A RENTER AND
PROTECTOR FAMILY WHILE
NAVIGATING HER SENSE THEIR PEAK
AND STRUGGLING WITH FINANCIAL
DIFFICULTIES AS A RESULT OF HIS
DIAGNOSIS.
SHE HAD TO QUIT HER JOB TO CARE
FOR HIM.
THE.
FAMILIES ONLY RECOURSE
TRY TO HANG ON UNTIL THEY SAVE
ENOUGH TO AFFORD A PLACE OF
THEIR OWN ONE DAY.
THIS KNOCKS TESTIMONY IS I'M
JUST LET ME ASK A QUESTION YEAH.
CATHERINE AND HER FAMILY OF GINO
WHEN THEY STARTED TO GET LEAD
TESTING. I DO NOT KNOW SHE DID
NOT PUT THAT IN HER STATEMENT.
I.
WE APPARENTLY BAILEY FIGURE
RATHER THREE YEARS I'M WONDERING
IF IT ACTUALLY STARTED EARLIER
BUT THEY DIDN'T HAVE THE TESTING
DONE.
WHEN I WOULD SAY IN MY
EXPERIENCE AS A LEGAL SERVICES
ATTORNEY IS IT'S NOT UNUSUAL FOR.
OF FAMILY WITH YOUNG CHILDREN TO
BE LIVING IN A HOME THAT THEY
SEE IS AFFORDABLE BUT WHICH IS
FUNDAMENTALLY AND SAFE.
I'M HOME AND THAT AND IT WAS A
LEGAL SERVICES ATTORNEY FOR
LEGAL SERVICES OF NORTHERN
CALIFORNIA I COVERED THE SIX.
OVER NORTHERN COUNTIES SO WERE
LOOKING AT SIERRA PLASTER
ELDORADO NEVADA AMADOR IN
CALAVERAS I KNOW THAT AND THOSE
COMMUNITIES THERE IS A GREAT
DEAL OF OLDER HOUSING. PROBABLY
WITH LEAD BASED PAINT WHICH IS
NOT BEING REVIEWED ARE
CONSIDERED.
AND TOM WE REALLY STARTED THIS
PROJECT AT CCW R. O. WHEN WE
TOOK IT TOOK A LOOK AT
INFORMATION FROM. THE LOS OPEC
PACKARD FOUNDATION SPY KIDS
COUNT AND THEY WERE A GREAT MANY
RURAL COUNTIES THAT SIMPLY DID
NOT HAVE ENOUGH DATA COLLECTED.
SEVERAL OF THE STATISTICS AND
THE BASELINE EXISTENCE OF THE
PROBLEM IS.
WAIT GREATER THAN ANYONE COULD
HAVE IMAGINED
THANK YOU ALL RIGHT YOU MAKE A
HAD READ THE NEXT STATEMENT.
THIS STATEMENT IS FROM A WOMAN
NAMED DEBBIE WHO CONTACTED US.
.
I AM FROM PLACERVILLE AND
THEY'VE SUBMITTED MY WRITTEN
TESTIMONY FOR THE RECORD.
I RECENTLY RETIRED FROM
SACRAMENTO COUNTY'S CHILDHOOD
LEAD POISONING PREVENTION
PROGRAM WHERE I SERVED AS AN
ENVIRONMENTAL HEALTH OFFICER.
I AM CONCERNED ABOUT THE LOW
BLOOD TESTING AMONG MEDICAL
TODDLERS AND PERSONALLY BELIEVE
THAT ALL CHILDREN SHOULD BE
TESTED BETWEEN THE AGES OF ONE
AND TWO.
WE MISSED SO MANY BY PRIMARILY
TESTING THOSE ON PUBLIC
ASSISTANCE AND ONLY TWENTY EIGHT
PERCENT OF PEACE CHILDREN ARE
TESTED ACCORDING TO THE
COMMITTEE'S INFORMATION.
THE QUESTIONNAIRE GIVEN BY
DOCTORS TO ASSESS POTENTIAL LEAD
EXPOSURE IN CHILDREN. DO YOU
LIVE OR FREQUENTLY VISIT A PRE
NINETEEN SEVENTY EIGHT HOME IS
INADEQUATE.
PARENTS DON'T THINK TO ANSWER
YES TO REFLECT THE WEEKLY VISITS
TO GRANDMA'S OR EVEN DAILY
VISITS TO DAYCARE. NO ONE WANTS
TO THINK THAT THESE VISITS COULD
CAUSE A CHILD PROBLEMS.
FREQUENTLY HOME REMEDIES MAKEUP
SUMMER A COAL INC SACRAMENTO
SPICES TO MERRICK IN SACRAMENTO.
RITUAL ITEMS TWICE OTHER THINGS
BROUGHT IN FROM OVERSEAS HAVE
HIGH LEAD LEVELS.
THIS IS MISSED ON THE
QUESTIONNAIRE AND IN THE
DOCTOR'S OFFICE SINCE LEAD
POISONING OFTEN IS OFTEN SYMPTOM
FREE A DAMAGING LEVELS AND IT'S
NOT JUST PEOPLE ON PUBLIC
ASSISTANCE THAT USE THESE ITEMS.
HERE ARE A FEW EXAMPLES.
WHAT?
A SICK DOG BENNETT ASTUTE
VETERINARIAN DIAGNOSED WITH LEAD
POISONING. THE DOCKS FAMILY WAS
THEN FOUND TO HAVE VERY HIGH
BLOOD LEVEL.
BUT LET LEVELS
TO.
A FAMILY WITH THE
DEVELOPMENTALLY DELAYED CHILD TO
THE DOCTOR TESTED FOR LEAD
EXPOSURE ON A WHIM AND FOUND THE
CHILD TO HAVE ELEVATED BLOOD
LEAD LEVELS.
WE FOUND THAT HIS MOTHER WAS
GIVING HIM A HOME REMEDY THAT
CONTAINED BOTH LEAD AND MERCURY
MICA.
CLANDESTINELY TESTED THE SOIL
SOMEONE CLANDESTINELY TESTED THE
SOIL IN A GARDEN IN A DOWNTOWN
SACRAMENTO UPPER CLASS DAY CARE
WHICH CARED FOR OVER ONE HUNDRED
CHILDREN. AND FOUND THE SOIL TO
BE A FIVE HUNDRED PARTS PER
MILLION IN THE PLAY AREA HOWEVER
THOSE CHILDREN WOULDN'T HAVE
BEEN TESTED.
I HAVE MANY MORE EXAMPLES.
IN CONCLUSION I WOULD LIKE TO
SEE THIS IT'S VERY IMPORTANT FOR
THE COMMITTEE TO HASN'T IT TO
HAVE CALLED THIS HEARING.
ON LICENSES THAT THE STATE OF
CALIFORNIA WAS ONCE VERY
AGGRESSIVE AT LOOKING AT BLOOD
BLOOD ISSUES.
AND I THINK IT'S KIND OF FALLEN
OFF THE MAP.
ON A COUPLE OF WEEKS AGO I DID A
PRESENTATION TO THE STATE'S
FIRST FIVE COMMISSION BECAUSE
ONE OF THE THINGS THAT I WAS
CURIOUS ABOUT IS. WELL LET'S
IMPORTANT* UP ON THE FIRST
FIVE COMMISSION RIGHT.
NO ONLY ABOUT TEN OF THE
COMMISSION COUNTY COMMISSION
WEBSITE HAD ANY INFORMATION
ABOUT WHAT IT WAS OFTEN VERY
HARD TO GET TO. THE STATE WIDE
COMMISSION HAD NOTHING.
I THINK THAT AS OF NICOLE WILL
TESTIFY TO. THE MORE INFORMATION
THAT CAN BE GIVEN TO PARENTS AND
THE SOONER IN THEIR IN THEIR
CHILD'S LIFE. EVEN PRENATALLY A
SOME OF THE INFORMATION THAT I
RESEARCH FOUND ON THE BETTER. ON
THIS IS A VERY CRITICAL
CONDITION AND.
WE'VE JUST FORGOTTEN HOW
SERIOUS IT IS.
WELL FIRST OF ALL.
MISS MACKLIN THANK YOU VERY MUCH
FOR YOUR YEARS WORKING FOR AS AN
ADVOCATE THAT'S REALLY
APPRECIATED AND THANK YOU FOR
BRINGING THESE STORIES TO US.
AND YOUR OBSERVATIONS.
SO ARM TECHNIQUE AND.
STEVENSON.
PAYMENT OF MICAH STEVENSON I
LIVE IN SACRAMENTO COUNTY ZIP
CODE NINE FIVE EIGHT NINE FIVE
EIGHT FOUR TO. I'M A STUDENT AT
AMERICAN RIVER COLLEGE I HAVE
FOUR CHILDREN.
THREE OF MY CHILDREN ARE GIRLS
WHO ARE UNDER AGE FIVE.
MY CHILDREN I GET HEALTH CARE
COVERAGE TO MEDI CAL ARC
PROVIDERS KAISER.
THAT CHILDREN HAVE BEEN TO
MULTIPLE APPOINTMENTS WITH
PEDIATRICIANS AT KAISER. I DO
NOT RECALL WHAT TESTING BEING
DISCUSSED AS PART OF THEIR CARE
UNTIL EACH OF THE CHILDREN WERE
ABOUT ONE ONE YEARS OLD. EVEN
WHEN BLOOD LEAD TEST SCREENING
IS BROUGHT UP DURING A
CONVERSATION DURING THE TWELVE
MONTH OLD BABY APPOINTMENT THERE
WAS NO DETAILS GET BANNED Y. THE
BLOOD LET SCREENING AS
RECOMMENDED.
I WAS JUST TOLD THAT.
THE CHILD WAS NOW AT THE AGE TO
BE TESTED FOR LEAD AND THE
DOCTORS WHAT'S UNDER REQUEST TO
THE KAISER LAB FOR TESTING.
THERE WAS NO REAL FOLLOW UP I
GOT THE SAME INFORMATION.
FROM WAKE.
AS A PARENT I WAS TOLD THAT LAB.
THE LAB TESTS.
REQUIRED WAS PENDING BUT I WAS
NOT GIVEN ANY SPECIFIC
INFORMATION AND I WAS NOT REALLY
GIVEN ANY INFORMATION. THAT
WOULD HELP ME IDENTIFIED MY
CHILD AS AT RISK FOR LEAD
POISONING. I FEEL THAT AS A
PARENT I SHOULD BE PROVIDED WITH
BETTER DETAILED INFORMATION
ABOUT THE RISKS OF LEAD
POISONING AND THE IMPORTANCE OF
WHAT SCREENINGS.
FOR VERY YOUNG CHILDREN.
AND I DO ALSO HAVE AT. FROM.
BOB LET ME JUST ASK SO WHAT.
BECAUSE OF THE LACK OF
INFORMATION DID YOU DELAY
GETTING THE TEST DONE NOT OF MY
CHILD.
AND TESTED FOR LEAD.
.
IT WAS NEVER BROUGHT UP BACK IN
CONVERSATION EVEN UP TO THERE'D
TWO YEARS CHECKUPS WE'LL GET IT
NOW.
I WOULD BEING THAT I KNOW MORE.
MORE INFORMATION ABOUT LED
SCREENING BECAUSE I'VE LEARNED
THREE RESEARCH BUT I.
WHAT?
HOW THEY PRESENT MOST HOW KAISER
PRESENT SO I DON'T THINK A LOT
OF?
FAMILIES NO.
AS TO WHAT THE RISKS ARE AND WHY
WE'RE NEEDING TO THE KIDS TO BE
TESTED OKAY.
BUT YOU WILL GET IT NOW.
AND THE OTHER THING THAT I
PROVIDING AS IS WITH THE
DIFFERENT WAYS THAT CAN BE
TESTED WERE GIVEN AN OPTION TO
WHERE THEY SAY THE ONLY WAY THEY
CAN BE TESTED AS.
AS LIKE WITH A BANG PUNCTURE AND
WITH TODDLERS IT'S REALLY HARD
TO.
MOVEMENT SIT STILL THROUGH BATON
TO MY UNDERSTANDING THERE SHOULD
BE OTHER WAYS OF GETTING THAT
TESTING.
WELL WE HAD QUESTIONS ABOUT THE
ACCURACY OF OUR PIN* TESTS.
SO.
WELL GET MORE INFORMATION ON
THAT AS TIME GOES ON A GO AHEAD
AND AND RETURN NEXT CASE.
VICTORIA IS SOMEONE WHO LIVES
IN OAKLAND WHO SUMMONING HER
WRITTEN TESTIMONY FOR RECORD FOR
TODAY'S HEARING.
THE VICTORIA BE ISN'T OAKLAND
AREA RESIDENT WHO RESPONDED TO A
SOCIAL MEDIA INFORMATION REQUEST
SENT OUT BY THE COMMUNITY BASED
ORGANIZATIONS MARK OAKLAND.
VICTORIA IS THE MOTHER OF A TWO
YEAR OLD DAUGHTER WHO WAS BORN.
WITH SOME ORTHOPEDIC IMPOSSIBLE
DEVELOPMENTAL DISABILITIES THE
CHILD QUALIFIES.
FOR FEDERAL DISABILITY BENEFITS
AND HAS FOR TWENTY.
AND HAVE HER TWENTY FOUR MONTH
WELL BABY VISIT A FEW WEEKS AGO.
VICTORIA REPORTED THAT NO
DISCUSSION WAS HAD WITH HER
ABOUT BLOOD LEAD SCREENING FOR
HER DAUGHTER SHE RECALL THAT
THERE WAS NO SPECIFIC
INFORMATION GIVEN TO HER ABOUT
BLOOD LET'S SCREENING ISSUES. AT
HER DAUGHTER'S TWELVE MONTH WELL
BABY CHECK
VICTORIA ONE* EXPLAINED THAT
USES A CLINIC THAT ACCEPTS MEDI
CAL THAT IS LOCATED NEAR
CHILDREN'S HOSPITAL. AS IT IS
NEAR SOME OF THE OTHER MEDICAL
PROVIDERS THAT USES FOR HER
DAUGHTER.
TORIA B. WAS AWARE OF BLOOD LEAD
POISONING AS AN ISSUE AS ONE OF
HER NIECES WAS DIAGNOSED WITH
HIGH BLOOD LEAD AT EACH TO.
THIS CHILD IS NOW THIRTEEN AND
HER FAMILY NOW LIVES IN THE
FRESNO AREA WHERE VICTORIA BE
AND HER DAUGHTER LIVE FOR
SEVERAL MONTHS.
CONCERNING FRESNO VICTORIA BE
EXPRESSED CONCERN THAT WHILE
LIVING WITH HER MOTHER IN A
SECTION EIGHT RENTAL. SHE NOTED
THAT THE UNIT HAD.
PEELING PAINT THAT WAS A
POTENTIAL SOURCE OF LEAD
EXPOSURE TO HER DAUGHTER.
TORIA B. ONE ASK STATED SHE FELL
INFORMATION ABOUT THE IMPORTANCE
OF BLOOD LET'S KING SHOULD BE
PROVIDED BY MEDICAL PROVIDERS.
AS EARLY AS DURING PRENATAL CARE
SO THAT MOTHERS AND PARENTS ARE
ABLE TO HAVE GOOD QUALITY
INFORMATION ABOUT THE RISKS
POSTED BY LED EXPOSURES TO
INFANTS AND YOUNG.
YOUNG CHILDREN.
THANK YOU.
HARM.
DO THAT IS THERE ANY OTHER TH
TOP TOPICS YOU YOU WOULD LIKE TO
BRING UP.
UP MAYOR THANK YOU VERY MUCH FOR
COMING.
AND DAD.
ARE VEGAS STEVENSON DAPHNE.
MACKLIN YOU'VE PERFORMED A GREAT
SERVICE.
AND DAD.
I I REALLY APPRECIATE YOUR
COMING UP AND HELPING US OUT
TODAY THANK YOU.
OKAY SO.
NOW WE'RE GOING TO HAVE SOME
PUBLIC TESTIMONY.
ARM.
I'LL JUST SAY SOMETHING THAT I
WOULD CONCLUDE HAVING LISTENED
AND.
TO OPT PEDIATRICIAN LISTEN TO.
HAVE NIKA.
IF WE CAN GET AN ACCURATE PIN
* TEST IT WOULD BE VERY NICE
BECAUSE I DO UNDERSTAND THE
DIFFICULTY OF A BLOOD DRAW ON
THAT TODDLER.
.
TELL I'LL BE LOOKING FORWARD TO
THE DAY THAT WE GET TO FIND OUT
WHETHER OR NOT THERE IS SUCH A
SO OUR PUBLIC COMMENT ó YOU
HAVE TWO MINUTES EACH PLEASE
IDENTIFY YOURSELF AND ANY
AFFILIATION YOU HAVE.
WHERE YOU'RE FROM?
AND THAT WE ALSO WELL LA KEEP
THE RECORD OPEN FOR A MONTH.
ARE SO FEW HAVE SOME WRITTEN
TESTIMONY LIKE TO INCLUDE AS
WELL THAT A VERY HELPFUL. TO WE
HAVE.
SOMEONE YOU'D LIKE TO COME UP
AND SPEAK.
THANK YOU LINDA WAY WITH WESTERN
CENTER ON LAW AND POVERTY COULD
YOU SAY YOUR NAME AGAIN LINDA
WAY. WITH WESTERN CENTER ON LAW
AND POVERTY LINDA COULD YOU
SPELL YOUR LAST NAME N. G. U. Y..
ANGIE YOU WHY THANK YOU.
UP WE WE REPRESENT A LOW INCOME
CALIFORNIANS AND WE SHARED THE
CHAIRING COMMITTEES CONCERNED
THE CALIFORNIA CHILEAN CHILDREN
PARTICULARLY LOW INCOME CHILDREN
ON MEDI CAL ARE NOT RECEIVING.
THE.
BLOOD SKY TESTS THAT A.
BUT.
BETTER I AND SUBSEQUENT
REFERRALS AND FOR NEEDED EARLY
INTERVENTION SERVICES WE
APPRECIATE THAT DEPARTMENT OF
HEALTH CARE SERVICES WILL BE
WORKING WITH THE DEPARTMENT OF.
PUBLIC HEALTH TO IMPROVE DATA
COLLECTION AND BE REVIEWING
POLICIES AND PROCEDURES TO
HEALTH PLANS AND PROVIDERS AND
LOOK FORWARD TO WORKING WITH
BOTH DEPARTMENT AND THIS
COMMITTEE TO. TO ENSURE THAT WE
ARE MOVING FORWARD IN THE
DIRECTION OF IMPROVING OUR
PLEDGING A.
LET TESTING THANK YOU.
THANK YOU VERY MUCH
I SEE A FAMILIAR FACE
ABOVE THEIR GOOD AFTERNOON.
A FIRST I WANT TO THANK YOU
MISTER CHAIR FOR HOLDING THIS
HEARING THIS WAS A GREAT
ENDEAVOR. AND I KNOW TO A LOT OF
YOUR TIME AND RESOURCES TO DO SO
SO THANK YOU VERY MUCH I'M MY
NAME SUSAN LITTLE I'M WITH THE
ENVIRONMENTAL WORKING GROUP.
AND.
.
WE HAVE BEEN WORKING WITH THE.
THE COMMITTEE FOR QUITE AWHILE
ON THIS ISSUE AND I ALSO WANTED
JUSTICE HAD.
GIVE KUDOS TO THE COMMITTEE
STAFFER SPENDING SO MUCH TIME IN
TRYING TO IDENTIFY. THE ACCURATE
MET.
MEDICARE LEAD TESTING RATES.
IT TOOK QUITE A LOT OF WORK WITH
THE DIFFERENT AGENCIES OR REALLY
APPRECIATE YOUR TIME TO DO THIS
TO DO SO.
ON.
ONE THING THAT HAS COME TO MIND
IN ALL OF THIS DISCUSSION IS
JUST THAT THE NEED TO ENGAGE THE
PARENTS IN THE PUBLIC MORE IN.
THE SERVICES THAT THEY RECEIVE I
HEARD A LOT OF CONVERSATION OF
BETWEEN. THE AGENCIES ABOUT
COMMUNICATION BETWEEN THEMSELVES
AND THE PROVIDERS BUT NOT A LOT
OF DISCUSSION ABOUT
COMMUNICATION WITH THE ACTUAL
PARENTS.
WHO AND I THINK THAT THOSE FOLKS
ARE ACTUALLY THERE OF COURSE THE
ONES OF THE MOST INVESTED IN
THEIR CHILDREN'S WELFARE? SO.
WE WOULD LIKE TO SUGGEST THAT
IN AN ERA WHEN WE HAVE OUR UPS
AND COMPUTER PROGRAMS THAT TRACK.
OUR EVERY MOVE OUR FOOT STEPS
ARE CALORIE COUNTS.
ARE.
CREDIT SCORES ARE SPENDING
HABITS.
THAT WE COULD POSSIBLY AND
DEVELOP A PROGRAM OR IMPROVE THE
PROGRAMS THAT WE HAVE.
TO ALLOW THESE THE THE MEDICAL
CHILDREN SERVICES TO BE TRACKED
AND THEN PARENTS TO BE ALERTED
WHEN POSSIBLY THEY MISS.
ONE OF THEIR SERVICES THAT THAT
IT THAT IS REALLY NEEDED.
AND SO ON ANYWAY THAT'S
SOMETHING THAT WE WOULD LIKE
EVERYBODY TO KIND THINK ABOUT.
AND WE LOOK FORWARD TO WORKING
WITH THE COMMITTEE WITH YOU
MISTER CHAIR THANK YOU.
THANK YOU VERY MUCH.
ARM IS THERE ANYONE ELSE.
ALRIGHT SO I'VE LEARNED A LOT
AND I THINK SUSAN LITTLE JUST
MADE AN EXCELLENT POINT ABOUT
WHAT'S SAID TO THE PARENTS AND
OF MICAH STEVENSON DOT. TOLD US
WHY THAT'S SO IMPORTANT.
I WANT TO THANK A PAGE BROKAW
MARK OF MY STAFF WHO I BELIEVE
WAS THE LEAD ON THIS COMMITTEE
HEARING.
AND ALSO THEN THE ENEMY ANY OF
MY OTHER STAFF MEMBERS WHO
HELPED AMY GILSON MY SCIENCE
FELLOW.
PHD FROM HARVARD JUST SAN.
JOSH TO OCCUR. AND.
SHANNON MCKINNEY AND THANK YOU
ALL FOR YOUR HELP.
AND.
WE ALSO HAVE OUR OUR MINORITY
COUNSEL THANK YOU VERY MUCH.
SO I THANK YOU ALL FOR BEING
HERE THANKS PARTICULARLY TO
DIRECTOR CAN'T FOR VOLUNTEERING
TO DO SOME FOLLOW UP STATISTICS.
REALLY APPRECIATE IT.
AND I WILL THEN CALL THIS
HEARING TO CLOSE THANK YOU ARE