LEAD - Lead Poisoning Prevention Overview

Lead Poisoning Prevention Overview Department of Legislative Services Office of Policy Analysis Annapolis, Maryland January/February 2001 For further information contact: Dawn G. Myers, Robyn S. Elliott, and Christine M. Anderson 1 Phone: (410) 946-5530 Lead Poisoning Prevention Overview 2 Lead Poisoning Prevention Overview Overview Introduction Lead paint poisoning impacts the cognitive and physical development of young children. Children are exposed to lead through breathing lead paint dust, eating lead paint chips, or absorbing lead while in-vitro. Most of the exposures to lead can be eliminated by removing lead paint from the homes of children and pregnant women. Despite the efforts of State and local agencies and their private partners, lead paint remains a severe health issue, as indicated by the 772 documented cases of lead poisoning in 1998. Although the fiscal 2001 base budget had $4.9 million to address lead poisoning, State agencies had not made a significant impact on lead poisoning rates. To expand the agencies’ efforts, the Governor, through a supplemental budget, added $5 million to the fiscal 2001 budget for the Maryland Department of the Environment (MDE), the Department of Housing and Community Development (DHCD), and the Department of Health and Mental Hygiene (DHMH). These funds were withheld by the budget committees due to concerns over the agencies’ strategic plan for the initiative. After the agencies adequately addressed these concerns, the committees released the funding. The fiscal 2002 budget includes an additional $673,000 to expand the initiative, as shown in Exhibit 1. Exhibit 1 Spending on Lead Poisoning Prevention* MDE Baseline Funding for Lead Fiscal 2001 Funding -- Phase 1 Fiscal 2002 Additional Funding -- Phase 2 Total Funding in Fiscal 2002 Allowance $3,400,000 1,000,000 0 $4,400,000 DHCD $642,000 3,500,000 316,000 $4,458,000 DHMH** $900,000 500,000 357,000 $1,757,000 *Only includes initial funding increases. The actual amount is slightly higher because of annualization and inflation in salary expenses. **Does not include Medical Assistance Program (Medicaid) dollars. Source: Department of Legislative Services This analysis divides the initiative into the following two phases: Phase One: The $5 million increase above the fiscal 2001 base budget is primarily directed toward prevention efforts in Baltimore City. The Governor indicated that this phase will be funded for three years. ! 3 Lead Poisoning Prevention Overview Phase Two: Additional funding of $673,000 in fiscal 2002 is available to focus on areas outside of Baltimore City, in accordance with last session’s HB 1221 that mandated the testing of children in high-risk areas. Baltimore City will continue to receive the same level of resources awarded in fiscal 2001 under Phase 1 of the Governor's initiative. Some resources that existed prior to Phase 1 may be shifted to areas other than high-risk neighborhoods in Baltimore City. ! Overview of the Initiative for Phase 1 and Phase 2 The Agencies’ Role in Lead Poisoning Prevention Lead paint poisoning is a complex problem that requires a multi-agency approach. As shown in Exhibit 2, each agency has clearly defined roles. MDE is the lead agency because it identifies and monitors rental properties that are contaminated with lead paint. MDE identifies these properties by inspecting and registering pre-1950's rental properties as well as other homes on an as-needed basis. Through MDE’s enforcement program, rental property owners that are not compliant with lead paint laws may be prosecuted. To increase the number of lead-free homes, DHCD offers State Lead Hazard Reduction grants to owners of rental properties or private homes. These grants are used to perform statutorily required risk reduction and could potentially be offered to owners of properties that are identified by MDE as being problematic. DHCD may also provide temporary housing to residents of contaminated properties while abatement activities are being conducted. The Governor’s initiative in Baltimore City will also offer window replacement grants in housing units where that is the most effective lead abatement strategy. DHMH provides testing services to determine if a home is contaminated or if an individual has a high lead level. When DHMH or a private laboratory identifies an individual with an elevated lead level, the information is forwarded to MDE. In turn, MDE notifies the local health department in the appropriate jurisdiction. Through a case manager funded by MDE, the local health department coordinates medical and social services for the affected individual. Additional case management services are funded by DHMH in Baltimore City and Prince George’s County. Monitoring Lead Test Results By law, all laboratories are required to report lead test results to MDE. If there is a high level of lead, MDE contacts the local health department so that case managers can provide adequate follow-up. This system has been reinforced in Baltimore City with the recent passage of a local ordinance. Laboratories are now also required to report lead test results for Baltimore City residents directly to Baltimore City’s Health Department. 4 Lead Poisoning Prevention Overview Exhibit 2 The Agencies’ Role in Lead Poisoning Prevention MDE DHCD DHMH Environment Testing: Tests envir onmental s a mp les collected by MDE during inspections. Blood Testing: Provides blood tests for eligible individuals without insurance coverage for lead testing. Case Management: At the local health department, coordinates medical and social services for lead poisoned individuals. Funding is provided by both MDE and DHMH. Medicaid: Funds testing and related medical services. Inspections: Conducts initial and follow-up inspections of atrisk properties. Enforcement: Coordinates with the Office of Attorney General on enforcement of compliance with rental laws. Accreditation: Accredits anyone who provides a lead abatement service. Source: Department of Legislative Services DHMH and MDE report that laboratory results sometimes do not include complete addresses, making follow-up difficult. Much of the problem can be traced to regulations that do not clearly indicate that complete patient information is required. MDE is trying to address this problem by issuing more specific regulations. These regulations could be adopted as early as this spring, but industry opposition could delay the process. The Department of Legislative Services (DLS) recommends that MDE be prepared to comment on the problem of incomplete patient data recording. DLS also recommends that future Managing for Results plans include a performance measure that demonstrates progress in obtaining more complete data from laboratories. 5 ! ! ! ! Identification of At-Risk Individuals: Tracks reports by DHMH and pr iva t e laboratories of individuals with elevated blood levels. Temporary Housing: Provides temporary housing for residents displaced because of leadcontaminated homes. ! ! Identification of At-Risk Properties: Tracks rental properties through the pre-1950 registry. Total Lead Paint Abatement: Provides grants up to $8,500 to qualified property owners for total lead paint abatement. ! ! ! ! ! Lead Poisoning Prevention Overview 6 Lead Poisoning Prevention Overview Medicaid Reports -- Low Testing Rates of Children DHMH is working to improve compliance with the Medicaid requirement that children be tested for lead poisoning at 12 and 24 months. Encounter data provided by the managed care organizations (MCOs) for calendar 1998 indicates that only 15% of one-year-olds and 13% of two-year-olds were actually tested. Data from the Maryland Department of Environment Childhood Lead Registry indicates that actual testing rates may be slightly higher at 22.4% and 19.5% respectively for one- and two-year-olds. Updated information will be available when Medicaid completes an analysis of fiscal 2000 encounter data and calendar 1999 registry data in March. Explanations for the low testing rates include: difficulties in administering the test in physician offices; parents not taking their children for a lab test; confusing national and local protocols which call for less than universal testing; and physicians in neighborhoods where lead paint is not an issue choosing not to order a test. Baltimore City, where awareness of the lead paint problem is high, has the second highest testing rate (over 24% for one-year-olds) in the State. Howard County, in contrast, has a testing rate below 10%. ! ! ! ! To address the low test rate, DHMH will monitor the testing data; develop an accountability plan for MCOs, which includes goals; provide training to providers and MCO staff on the best technique for drawing blood in a provider’s office; and enhance lead paint testing awareness efforts targeting patients and providers. DLS recommends that DHMH report on the success of its efforts to expand the number of children screened under Medicaid. Shortage of Lead Abatement Contractors Could Impact Progress A strong economy has caused a shortage of skilled contractors trained to conduct lead abatement activities, and the shortage may become problematic over the course of this initiative. The strategic plan indicates that 750 abatements will be accomplished given the available funding. However, regardless of the amount of funds available to support abatement, if no one is certified to conduct these activities, goals to increase the number of lead-safe housing units will not be realized. The agencies should submit information on how they intend to deal with the potential shortage of contractors who are certified to conduct lead abatement activities. 7 Lead Poisoning Prevention Overview Phase One in Fiscal 2001 -- Update on Activities in Baltimore City Baltimore City’s Financial Contribution In January 2000, Baltimore City pledged financial support of $18 million over a period of three years for the lead poisoning prevention initiative. Baltimore City provided the budget committees with information, included as Appendix 1, indicating that the city would contribute $6.1 million for fiscal 2001. The city included ongoing State and federal grants and funds for demolition activities in calculating its contribution. In addition, a Memorandum of Understanding (MOU) between DHCD and Baltimore City will govern the grant of the Governor’s Initiative funds from DHCD to the city. The MOU stipulates that the city should “contribute no less than $4,557,612 in city funds for fiscal 2001.” No specific information on Baltimore City’s financial contribution has been provided for fiscal 2002 or 2003. DHCD should brief the committee’s on how they have defined what will constitute city funds within the context of the MOU. In addition, DHCD should explain the consequences for Baltimore City if they are unable or unwilling to participate as outlined in the MOU with DHCD. DLS is concerned that without the expected Baltimore City contribution of $6 million each year in local funds for three years, the full expectations of the initiative cannot be realized. The lead poisoning initiative is intended to provide additional resources above and beyond the current level of spending on lead poisoning prevention. Progress against lead poisoning can only be made using the combined financial resources of the State and city over the course of this three-year initiative. This progress is jeopardized when the city does not contribute a reasonable share toward the initiative and instead relies on using existing federal and State funds as evidence of financial support. DLS is also concerned about the source of the funds that Baltimore City is offering as evidence of support for the initiative. As Appendix 1 depicts, only about $235,000 of the city’s proposed fiscal 2001 $6.1 million contribution represents new city resources. The balance includes $1.3 million in existing federal and State funds already committed to lead paint abatement, $1.5 million in State and local funds to demolish structures, and a one-time $3 million grant from the federally designated Empowerment Zone. DLS questions: (1) whether it is appropriate to credit existing State and federal grants as city funds; (2) whether demolition funds should be applied toward this effort; and (3) whether Empowerment Zone funds will be available in subsequent years. DLS is concerned that the city is simply recycling other federal and State grants as evidence of financial support. This is against the intent of the initiative which was to maximize the combined resources of the State and the city to combat lead poisoning. Rather than include activities and resources that the city is already employing, effective implementation of the initiative requires financial resources above and beyond current efforts. DLS recommends budget bill language that expresses the General Assembly’s intent that the city contribute a reasonable share so as to maximize the impact of the initiative on eliminating lead poisoning in children. DLS also recommends budget bill language requiring that the city provide its own funds as evidence of a financial contribution to the lead poisoning prevention initiative. 8 Lead Poisoning Prevention Overview Use of Demolition Funds as Evidence of City Contribution The city’s intention to attribute State and city demolition funds totaling $1.5 million to its contribution to the lead poisoning initiative was not included as part of the strategic plan. In a letter dated October 23, 2000, advising the committees of this change, the city states that “demolition of certain unsalvageable properties is the only veritable solution for blocks of housing containing lead and other housing-based hazards.” However, DLS notes that demolition does not contribute much towards fighting lead paint poisoning. No children are lead tested or treated; no lead-free housing is created when demolition occurs; and no enforcement actions are taken against recalcitrant property owners. The demolition funds are more related to the city’s community and economic rehabilitation efforts as opposed to the lead poisoning prevention initiative. Simply because some of the units that will be destroyed may contain lead is not a particularly compelling reason to include demolition funds as a contribution towards the lead paint initiative. DLS recommends budget bill language restricting the application of demolition funds toward the lead poisoning prevention program. Baltimore City’s Lead Enforcement Grant During the 2000 session, the General Assembly attached restrictive language to a $500,000 grant to aid Baltimore City in its lead paint enforcement activities. The language specifically provided that “the $500,000 grant to Baltimore City... may only be expended for lead inspectors, x-ray fluorescence (XRF) machines for lead inspectors, and city solicitors dedicated to prosecuting lead cases.” The language was designed to ensure that Baltimore City used the funds to increase the resources dedicated to eliminating the scourge of lead paint instead of being the sole source of funding for the city’s enforcement activities. Baltimore City agreed to abide by this budget language, and MDE will audit the funds to check Baltimore City’s compliance with the language. Since the initial plan for fiscal 2002 did not include performance measures for Baltimore City’s enforcement efforts, MDE and Baltimore City were asked to provide this information. Additionally, MDE was asked to include in its fiscal audit a performance audit to determine whether the objectives agreed upon were met. MDE has included performance measures in its MOU for the enforcement grant. The performance measures for fiscal 2001 are as follows: perform 200 inspections to determine or verify compliance with Baltimore City lead poisoning prevention laws; initiate 75 civil or administrative actions against owners of residential property in Baltimore City to obtain compliance with Baltimore City lead poisoning prevention laws; identify 200 residential dwelling units that require abatement actions; and complete 50 abatements resulting from enforcement actions. ! ! ! ! 9 Lead Poisoning Prevention Overview DLS recommends budget bill language again that requires an audit of the city’s expenditure of the funds and restricts the use of the $500,000 grant for lead inspectors, x-ray fluorescence (XRF) machines for lead inspectors, and city solicitors dedicated to prosecuting lead cases. Coordinated Outreach in Baltimore City The initial plan submitted by MDE, DHMH, and DHCD showed little evidence of coordination among State and local agencies. Such coordination is critical in planning successful outreach efforts. These efforts can target both general audiences as well as families that are at risk. In targeting general audiences, the agencies and Baltimore City have discussed lead poisoning prevention with parents, health care providers, community groups, property owners, and Empowerment Zone village centers. They have also marketed the initiative through informational inserts in water bills. Since some of these outreach efforts may work better than others, DLS recommends that the agencies report how they will evaluate the effectiveness of their general outreach efforts. The agencies plan to provide more direct outreach services to at-risk families. When MDE or DHCD identifies properties that may be hazardous, they plan to refer the families to case managers at the Baltimore City Health Department. The case managers are supposed to provide follow-up care to ensure that the individuals are tested and receive appropriate medical services. DLS recommends that the agencies report on the implementation of the new referral and follow-up system. Transitional Housing and Relocation of Residents in Baltimore City The strategic plan indicates that with $640,500 in State funds, ten new apartments will be leased each year to allow 14 days on average stays for residents displaced while abatement work is conducted in their homes. In some cases where the resident must find either housing for periods longer than a few days or a new home, the strategic plan indicates that the city, in conjunction with DHCD, intends to provide transitional housing. DHCD has pledged an additional $200,000, outside of this initiative, to provide a loan to a nonprofit developer to acquire or renovate a transitional housing facility for lead-affected households. The transitional housing facility will provide a central location for relocating residents while the leased units allow the city the flexibility to move from neighborhood to neighborhood as abatement activities are completed. The agencies and the city should report on the status of leasing the apartments for displaced residents and the status of providing a transitional housing facility. In addition, the status report should include estimates of the number of residents who will need or who have taken advantage of temporary housing while abatement work is conducted. 10 Lead Poisoning Prevention Overview Demolition Activities Pose Environmental Hazard There is some concern about the hazard posed by demolishing houses with lead paint. The process can release lead into the environment because lead paint is not removed prior to demolition. While the level of danger is not clear, it is possible that individuals can be negatively affected. More information will be known after the Kennedy Krieger Institute completes a study sponsored by the National Institutes of Health. In the meantime, efforts should be made to keep children from playing near or on demolition sites. DLS recommends that the agencies report on how the potential environmental hazard from demolition of structures containing lead paint can be addressed. Phase Two in Fiscal 2002 -- Expanding Efforts in Other Jurisdictions In fiscal 2001, the agencies focused on 11 high-risk zip codes in Baltimore City because the city has the most severe lead paint problems. In fiscal 2002 the agencies plan to make additional efforts to address lead poisoning in other parts of Maryland. While other jurisdictions already receive funding that existed prior to fiscal 2001, it has not been sufficient. In fiscal 2002 the additional funding of $637,000 will focus on high-risk areas outside of the targeted Baltimore neighborhoods. The agencies’ new efforts are summarized below: MDE: As in fiscal 2001, MDE plans to increase enforcement efforts in areas outside of Baltimore City’s high-risk neighborhoods. DHCD: The fiscal 2002 allowance provides $3.5 million for lead abatement activities for use solely in the 11 high-risk neighborhoods in Baltimore City. An additional $200,000 for transitional housing in Baltimore City will be funded through DHCD’s Group Home Financing Program. DHCD plans to use the fiscal 2002 funding of $642,000 in the existing Lead Hazard Reduction program to focus on abatement activities statewide and in other Baltimore City neighborhoods not part of the Governor’s initiative. DHCD has requested an additional $116,000 in general funds for three contractual positions to monitor the lead abatement program, to provide technical assistance, and to coordinate the activities. DHCD expects to see approximately 350 additional applications for abatement grants in fiscal 2002. DHMH: DHMH will use $107,000 in general funds to support five new positions in the Laboratories Administration. These positions will allow the agency to increase lead testing for areas outside of Baltimore City. However, the agency cannot fill most of the positions until at least December 2001 because the allowance includes a 41% turnover rate. DHMH will use another $250,000 in general funds to support local health department grants made by CPHA. These grants will fund case management activities in other jurisdictions that have been identified as high-risk. CPHA will study the impact of these grants to determine if the methodology used to define a high-risk area is correct. ! ! ! 11 Lead Poisoning Prevention Overview There has been great focus on improving coordination among State and local agencies in Baltimore City due to the new funding in fiscal 2001. Some of this focus should shift to other jurisdictions in fiscal 2002. Just like in Baltimore City, these jurisdictions need coordinated plans to address the lead poisoning problem. In other jurisdictions, local health departments take the primary responsibility for preventing lead poisoning. Through a $30,000 grant from MDE and possibly another grant from CPHA, local health departments conduct outreach activities to parents, health care providers, and property owners. If resources are sufficient, they may also provide case management services for individuals with high levels of lead. With new fiscal 2002 funding in CPHA, some jurisdictions will receive additional funds for case management services. This funding should allow local health departments to improve coordination of services offered by MDE, DHCD, and DHMH. These services include transitional housing, abatement grants, enforcement, and case management. Since a coordinated approach is important in all jurisdictions, DLS recommends that the agencies discuss how local health departments will coordinate services with State and local agencies. 12 Lead Poisoning Prevention Overview Recommendations 1. Add the following budget bill language: Section XX. AND BE IT FURTHER ENACTED, That it is the intent of the General Assembly that the fight against childhood lead poisoning in Baltimore City be a joint effort between the State and Baltimore City. In the past year, State agencies and Baltimore City have made tremendous strides to create a cohesive and cooperative effort to combat childhood lead poisoning. However, to have a measurable impact on the problem of lead in the environment, Baltimore City must make a reasonable financial contribution to the initiative. Baltimore City should contribute funds that consist solely of city funds and should not include: (1) funds that the city received from State or federal sources; or (2) city funds that will be used for demolition. Furthermore, the Maryland Department of the Environment, the Department of Housing and Community Development, the Department of Health and Mental Hygiene, and Baltimore City shall jointly submit reports to the General Assembly on the overall progress of the lead poisoning prevention initiative by December 1, 2001, and August 1, 2002. The reports should include information on the following: (1) The overall progress of the lead poisoning prevention initiative; (2) An accounting of all funds expended for lead poisoning prevention in fiscal 2001 and fiscal 2002; (3) A breakdown of Baltimore City’s fiscal 2002 contribution by fund source and program; and (4) Updates on: (a) the results of efforts to expand the number of children screened for lead under Medicaid in Baltimore City and statewide; (b) the number of contractors available to perform lead risk reductions in Baltimore City and statewide; (c) the effectiveness of the agencies' general outreach efforts in Baltimore City and statewide; (d) the progress of implementing a lead poisoning referral and follow-up system in Baltimore City and statewide; (e) the status of leasing apartments for displaced residents and the status of providing a transitional housing facility, including estimates on the number of people who will be using temporary housing while abatement work is conducted in Baltimore City and statewide; 13 Lead Poisoning Prevention Overview (f) the methods that local health departments in Baltimore City and in other jurisdictions will use to coordinate services; (g) the number of abatement grants and the amount of funds awarded by zipcode; and (h) the Managing for Results data previously submitted to the General Assembly and new performance measures that demonstrate progress in obtaining more complete data from laboratories. Explanation: The language clearly relates that the intent of the General Assembly is to encourage Baltimore City to provide new city funds to the lead poisoning initiative and not to count city demolition funds as part of the city's contribution. The language also requires the Maryland Department of the Environment, the Department of Housing and Community Development, the Department of Health and Mental Hygiene, and Baltimore City to jointly submit to the General Assembly two reports on the progress of the lead paint poisoning initiative. One report is an update of the progress of the fiscal 2001 portion of the initiative due December 1, 2001. The other report, due August 1, 2002, is intended to replace a report that was previously requested by the budget committees in a letter dated November 12, 2000. Additionally, the language provides that certain information included in the report should be separated by jurisdiction. Baltimore City information should be provided separately from other statewide information. However, when available, the statewide information should be provided at a county level. Information Request Reports on efforts and activities targeted to childhood lead poisoning prevention Authors MDE DHMH DHCD Baltimore City Due Dates December 1, 2001 August 1, 2002 2. Add the following budget bill language to the general fund appropriation in UA06.07 Technical and Regulatory Service -- Waste Management Administration: , provided that the $500,000 grant to Baltimore City in this appropriation shall only be expended for lead inspectors, x-ray fluorescence (XRF) machines for lead inspectors, and city solicitors dedicated to prosecuting lead cases. The funds may not be used to pay for Baltimore City’s administrative expenses. Further provided that the Maryland Department of the Environment shall audit Baltimore City’s expenditure of the funds and enforcement performance and report the results to the General Assembly by September 1, 2002. Explanation: The language requires Baltimore City to spend the $500,000 lead enforcement and inspection grant only on lead inspectors, machines that are required to conduct lead inspections, and city 14 Lead Poisoning Prevention Overview solicitors dedicated to prosecuting lead cases. Funds may not be expended for any other purpose, especially administrative expenses. Also, the language requires the Maryland Department of the Environment to audit Baltimore City's grant expenditures and performance and report the results to the General Assembly by September 1, 2002. 15 Lead Poisoning Prevention Overview Updates 1. MDE’s Performance Targets in Baltimore City While MDE’s goals for Phase 1 of the initiative were generally realistic in the strategic plan, there were still some outstanding issues with MDE’s MFR plan. The enforcement part of the MFR plan was a major area of concern for DLS and this section will update the resolutions to DLS’s concerns. As shown in Exhibit 3, between fiscal 2001 to 2002 MDE expects to register 5,000 rental units as required by State law; however, between fiscal 2002 and 2003, only 2,000 rental units are expected to be registered. The budget committees asked MDE to explain why so few rental units are expected to be registered in fiscal 2003. MDE responded that the agency expects the initial publicity to generate a strong and early response from property owners. Thus, the number of rental units registered would “peak” early. Exhibit 3 Summary of Goal 3 -- Increase Residential Property Owner Compliance with Both State and Baltimore City Lead Poisoning Prevention Laws Fiscal 2001 through 2003 FY 2001 Objective 1: Increase Rental Unit Registration for rental units built before 1950 in at-risk areas of the State, particularly in Baltimore City. Objective 2: Enforce risk reduction standards in t a r get ed a r ea s o f Baltimore City. 278,000 total registered units 174,000 total risk reductions FY 2002 283,000 total registered units 186,000 total risk reductions FY 2003 285,000 total registered units 200,000 total risk reductions 500 annual inspections 250 annual enforcement actions 1,300 annual inspections 300 annual enforcement actions 1,700 annual inspections 300 annual enforcement actions Source: Department of Legislative Services Objective 1 also lists a performance measure of 174,000 risk reductions to be performed in 2001. The committees asked MDE to define what constitutes a “risk reduction” under Goal 3. MDE has indicated to DLS that “risk reductions” are the actual number of rental units that undertake the efforts required by law to lower the amount of lead in the unit. While this indicator is not really a performance measure of the agency per se, it can be indicative of the progress of the lead initiative as a whole. 16 Lead Poisoning Prevention Overview Objective 2 states that by fiscal 2003, MDE will be able to perform 1,700 inspections a year. Assuming 52 weeks in a year and five inspectors, that nets to 6.5 inspections a week per inspector, or approximately 33 inspections total a week. In previous conversations and in testimony to the legislature, the department was adamant that the most MDE was capable of performing was a total of ten inspections per week. In fact, the original estimate MDE submitted stated that the department could only perform two inspections a week total. The committees asked that MDE provide a more substantial answer as to why there are such large variations in the number of inspections projected with each version of the agencies’ strategic plan and in agency testimony. The committees also asked MDE to fully explain why 1,700 inspections is a realistic inspection number for fiscal 2003. MDE never explained the wide variations in the number of inspections projected with each version of the strategic plan and in agency testimony. Instead, MDE responded that the agency revised its estimates based on newly increased staff capacity and a reorganization of the inspection process. The agency has chosen to stick with its numbers and expects 1,200 to 1,700 inspections to be completed each year. Objective 2 also states that the number of enforcement actions will be level between fiscal 2002 and 2003 at 300 enforcement actions. As the number of inspections is expected to increase by 400 inspections during the same time period, MDE was asked to explain why the number of enforcement actions remains stagnant between fiscal 2002 and 2003. MDE explained that an increase in the number of inspections does not necessarily result in a proportional increase in the number of enforcement actions because many inspections are follow-ups to previous inspections or are used to assist property owners to come into compliance with the law. MDE has adequately addressed committee and DLS concerns regarding the agency’s MFR data for the lead initiative. 17 Lead Poisoning Prevention Overview Appendix 1 Baltimore City Financial Contributions to the Lead Paint Initiative Fiscal 2001 Source of Funds Existing State and Federal Lead Poisoning Grants -- Staff Time Empowerment Zone -- One-Time Grant New City Demolition Funds State Demolition Funds New City Funds -- Staff Time Total Source: Baltimore City Health Department Fiscal 2001 $1,321,662 3,000,000 1,000,000 500,000 235,950 $6,057,612 18