After 4 rounds of proposed regulations and 2 public hearings since the signing of HB 222 on June 30, 2021, DHSS Regulations 4459A Governing the Childhood Lead Poisoning Prevention Act were finally published in the Delaware Register of Regulations on August 1, 2023.
While these regulations are over a year overdue (the full implementation of the regulations was due by June 30, 2022), we remain pleased that the majority of problems and inconsistencies between the four drafts and state and federal laws have been corrected.
We are pleased that the final regulations include the following:
Differentiates between blood lead screening and testing.
Establishes clear language about the blood lead level that triggers a mandatory confirmatory test following screening that is consistent with CDC guidelines.
Requires reporting of results of all screening and testing for all children, regardless of age.
Recognizes school nurses as healthcare providers.
Defines the specific months of age that are counted as a 12-month and 24-month screening or test.
Clarifies the information that must be submitted with the blood lead screening or test, including demographic information.
Describes the information that must be submitted by parents about their child’s lead screening during enrollment in Childcare or Kindergarten.
Where the regulations fall short:
Does not require FDA-approved methods for screening, which has unfortunately become a problem with the use of “filter paper” methodology, which is known to result in false-negatives and has therefore been prohibited in other states, including California.
Does not include any enforcement mechanisms, including for healthcare providers who refuse to screen, who neglect to confirm venous testing was performed, or who fail to order a confirmatory test when a screening result exceeds the Blood Lead Reference Value.
Does not establish a process where school nurses can directly access information to verify screening through an electronic database.
Limit the reporting of screening when enrolling in childcare or Kindergarten for those children who had repeated screenings or tests, such as for those children with active case management due to lead poisoning.
Excludes DHSS’s role in managing, maintaining, and reporting the results of the universal reporting system for childhood blood lead levels.
The extended process of this regulatory update was tedious, frustrating, and added unnecessary delays to implementation that in many ways that likely prevented children with lead poisoning from being identified and receiving the services to which they are entitled.
The regulatory process has a lot of flaws which limit the ability of the public to participate in rule-making. We demand that for all future changes to DHSS Regulations 4459A, that DHSS include the following:
Workshops that integrate stakeholder input early in the process so that four rounds of public comment are not needed.
Schedule a public hearing with the original publication of the draft in the Delaware Register; the actions of DHSS staff to prevent public hearings were disrespectful to the public and not in the spirit of good government.
Include a presentation that describes the proposed changes at the public hearing, as is typical for regulatory updates in other state agencies.
Include input from the Childhood Lead Poisoning Prevention Advisory Committee; there was no input requested from the CLPPAC at any point during this process.
With all these in mind, we are still very glad that this process is complete and we can move forward on other lead poisoning prevention efforts.
Sarah Bucic, MSN, RN
Amy Roe, Ph.D.
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