HB 227 — AN ACT TO AMEND TITLES 16 AND 24 OF THE DELAWARE CODE RELATING TO LEAD POISONING PREVENTION.

and WHEREAS, according to the Mayo Clinic, "Lead poisoning can be hard to detect.

Even people who seem healthy can have high blood levels of lead.

Signs and symptoms usually don't appear until dangerous amounts have accumulated.

Signs and symptoms of lead poisoning in children include:

Developmental delay, Learning difficulties, Irritability, Loss of appetite, Weight loss, Sluggishness and fatigue, Abdominal pain, Vomiting, Constipation, Hearing loss, Seizures, Eating things, such as paint chips, that aren't food (pica).";

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06/14/2023 11:03 AM WHEREAS, according to the Mayo Clinic, "Although children are primarily at risk, lead poisoning is also dangerous for adults.

Signs and symptoms in adults might include:

High blood pressure, Joint and muscle pain, Difficulties with memory or concentration, Headache, Abdominal pain, Mood disorders, Reduced sperm count and abnormal sperm, Miscarriage, stillbirth or premature birth in pregnant women.";

and WHEREAS, lead can be found in paint, makeup, toys, apple juice and other juices, and spices, such as turmeric, chili powder, and red pepper;

and WHEREAS, IDEA Part C Early Intervention, administered at DHSS, does not collect data regarding how many children receiving early intervention services are eligible for those services due to lead exposure;

and WHEREAS, families of children referred for an early intervention or a special education evaluation in Delaware are not currently required to submit 12 or 24 month lead screening results prior to the determination of eligibility for services.

Currently, blood lead levels are not required to be documented in early intervention and special education eligibility repots;

and WHEREAS, currently, school nurses, special education coordinators, and early intervention case managers are not able to access information related to a child's blood lead level, even though lead poisoning is a critical factor in determining a child's needed education and mental health supports;

and WHEREAS, the following zip codes have been targeted by the Division of Public Health as having an elevated risk for lead poisoning due to the preponderance of homes constructed before 1978 that may contain lead paint:

19701, 19702, 19703, 19706, 19709, 19711, 19713, 19720, 19733, 19801, 19802, 19803, 19804, 19805, 19806, 19808, 19809, 19810, 19904, 19933, 19934, 19938, 19939, 19940, 19941, 19943, 19945, 19901, 19946, 19947, 19950, 19952, 19953, 19956, 19958, 19960, 19962, 19963, 9966, 19968, 19971, 19973, 19975, and 19977;

and WHEREAS, childhood lead poisoning can be prevented.

NOW, THEREFORE:

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:

Section 1.

Amend § 2602, Title 16 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:

§ 2602.

Physicians and health-care facilities to screen children.

(a) Every health-care provider who is the primary health-care provider for a child shall order lead poisoning screening of the child, under regulations adopted by the Division of Public Health, at or around 12 and 24 months of age.

(b) [Repealed.] HD :

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06/14/2023 11:03 AM 81 (c) (1) If screening under subsection (a) of this section determines that a child has an elevated blood lead level, the health-care provider shall order testing under regulations adopted by the Division of Public Health.

(2) A health-care provider is encouraged to use the health-care provider’s clinical judgement to determine when testing should be used in lieu of screening under subsection (a) of this section.

(d) All laboratories and health-care providers involved in blood lead level analysis, including screening and testing, shall participate in a universal reporting system as established by the Division of Public Health.

The universal reporting system shall include the lead screening and testing results of all children, regardless of age.

(e) Nothing in this section may be construed to require any child to undergo screening or testing if the child’s parent or guardian objects on the grounds that the screening or testing conflicts with the parent’s or guardian’s religious beliefs.

(f) [Repealed.] (g) Every health-care provider who is the primary health-care provider for a child shall report the results of lead poisoning screening on electronic forms to be developed by the Division of Public Health.

The forms shall be completed at well visits for children at or around 12 months of age and again at well visits for children at or around 24 months of age.

”.Section 2.

FURTHERAmend AMEND§ House2603, BillTitle No.16 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:

227§ by2603. deleting lines 109 through 111 in their entirety and inserting in lieu thereof the following:

“(d)Screening Theprior Division of Public Health shall ensure that all school nurses have access to datachild thatcare confirms or deniesschool whetherenrollment. each enrolled child has been screened for lead poisoning.

A(a) recordFor ofevery child who has reached the proofage of screening12 months, child care facilities and public and private nursery schools, preschools, and kindergartens shall berequire keptproof inof eachscreening student’sfor schoollead healthpoisoning record.”.for admission or continued enrollment.

FURTHER(b) AMENDExcept Housein Billthe No.case of enrollment in kindergarten, the screening under subsection (a) of this section may be done within 60 calendar days of the date of enrollment.

227(c) afterA linechild’s 111parent andor beforeguardian linemust 112provide by1 insertingof the following:

“(e)(1) ByA Novemberstatement 1from of each year, all school districts and charter schools must report to the Divisionchild’s ofprimary Publichealth-care Healthprovider thethat number of students enrolled in kindergarten who have not met the requirementschild underhas subsectionreceived (c)a ofscreening thisfor section.lead poisoning.

”.(2) A certificate signed by the parent or guardian stating that the screening is contrary to the parent’s or guardian’s religious beliefs.

FURTHER AMEND House Bill No.

227 by deleting lines 112 through 140 in their entirety.

SYNOPSIS To better identify those communities in which lead screening numbers are low and to increase community awareness and engagement, this Amendment clarifies that primary health-care providers must report results to the Division of Public Health for every instance of screening, in addition to the 12 and 24 months scheduled screenings.

Along with the results, the forms must contain the provider's information and the date of screening.

It further requires all school districts and charter schools to report the number of students enrolled in kindergarten who have not provided proof of screening, or a certificate signed by a parent stating that screening is contrary to the parent's religious beliefs.

Finally, this Amendment removes Sections 3 and 4 from the bill that requires health-care providers to complete a training program every 2 years on their obligations under Chapter 26, the Childhood Lead Poisoning Prevention Act.

This Amendment also clarifies that a record of proof of screening shall be kept in each student's school health record.

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06/22/202306/14/2023 02:1711:03 PMAM HD(d) :The Division of Public Health shall ensure that all school nurses have access to data that confirms or denies whether each enrolled child has been screened for lead poisoning.

NSWA :record of the proof of screening shall be kept in each student’s school file.

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06/22/2023Amend 02:17Chapter PM26, 3501520171Title 16 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:

§ 2607.

Training for healthcare providers.

The Division of Public Health shall create or approve of a training program for health-care providers certified under Chapter 17 of Title 24.

Health-care providers shall complete the training program every 2 years, which shall educate health-care providers of their obligations under this chapter.

The training program shall educate health-care providers on the following requirements:

(1) Screening all children for lead poisoning at or around 12 and 24 months of age.

(2) Ordering additional testing for all screening results above a certain threshold to be determined by the Division of Public Health.

(3) Implementing a plan of action for all children whose tests are above a certain threshold to be determined by the Division of Public Health.

Section 4.

Amend § 1723, Title 24 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:

§ 1723.

Issuance of certificate to practice;

registration and registration renewal;

reactivating inactive status.

(c) The registration of a certificate to practice medicine must be renewed biennially, through a procedure determined by the Division.

The procedure must include payment of an appropriate registration renewal fee;

submission of a renewal form provided by the Division;

submission of the materials required by § 1720(b)(4), (b)(5), and (g), of this title unless waived pursuant to § 1720(e) of this title;

proof that the certified person has met the continuing medical education requirements established by the Board;

and the period of time within which a person certified to practice medicine in this State may renew the certified person’s registration without penalty, notwithstanding the fact that the person failed to renew the person’s registration on or before the renewal date;

and the penalty for failure to renew registration in a timely manner.

The procedure must also include evidence of completion of training the following:

(1) Training on the recognition of child sexual and physical abuse, exploitation and domestic violence, and the reporting obligations under the Medical Practice Act and § 903 of Title 16, and any successors thereto, and any other mandatory reporting obligations required by the Board.

Such trainings shall be coordinated under §§ 911 and 931(b)(4) of Title 16 to ensure consistent trainings across disciplines.

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06/14/2023 11:03 AM (2) Training on the provisions of the Childhood Lead Poisoning Prevention Act in accordance with § 2607 of Title 16.

SYNOPSIS This Act makes various amendments to the Childhood Lead Poisoning Prevention Act to improve compliance with its testing and reporting requirements.

First, this Act requires physicians to take a training program every 2 years relating to the provisions of the Childhood Lead Poisoning Prevention Act.

Second, it requires the Division of Public Health to develop electronic forms to be used at a child’s 12 and 24 month well visit that record lead screening results and are shared with the Divison.

Third, it clarifies that laboratories and health care professionals involved in blood lead level analysis must report results to the the Division of Public Health.

Finally, it requires the Division of Public Health to share data with school nurses relating to whether an enrolled student has been screened for lead poisoning.

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