District of Columbia's Drinking Water: Agencies Have Improved Coordination, but Key Challenges Remain in Protecting the Public from Elevated Lead Levels
Published: 2005-03-31T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Media reports on elevated lead in the District of Columbia's drinking water raised concern about how local and federal agencies are carrying out their responsibilities. The Lead and Copper Rule requires water systems to protect drinking water from lead. The U.S. Army Corps of Engineers' Washington Aqueduct treats and sells water to the District Water and Sewer Authority (WASA), which delivers it to District residents. The Environmental Protection Agency's (EPA) Region III Office oversees these agencies. GAO examined (1) what agencies implementing the rule in the District are doing to improve their coordination and reduce lead levels, (2) the extent to which WASA and other agencies are identifying populations at greatest risk of exposure to lead in drinking water and reducing their exposure, (3) how other drinking water systems that exceed EPA's action level for lead conduct public education, and (4) the state of research on lead exposure and how it applies to drinking water.
section_title: What GAO Found
paragraphs: WASA and other government agencies have improved their coordination, but significant challenges remain. According to EPA officials, WASA has thus far met the terms of a June 2004 consent order by enhancing its coordination with EPA and the D.C. Department of Health. For example, WASA developed a plan to improve its public education efforts and collaborated with the department to set priorities for replacing lead service lines. EPA expects the August 2004 addition of a corrosion inhibitor to eventually reduce lead in drinking water, though it may take more than one year for full improvements to be observed. Tap water test results reported in January 2005 show that D.C. drinking water still exceeds the standard for lead. WASA is identifying those customers most at risk from exposure to lead in drinking water and reducing their exposure. WASA is focusing on lead service lines as the primary source of lead in drinking water. It is updating its inventory of lead service lines, accelerating its rate of service line replacement, and providing priority replacement for customers most vulnerable to lead's health effects. However, questions remain about the success of the replacement program because, by law, WASA can only pay to replace the portion of the service line that it owns. Homeowners may pay to replace their portion of the service line, but few homeowners chose to do so in 2003 and 2004. Other water systems use innovative methods to educate their customers and to judge the effectiveness of their efforts. These practices include using a variety of media to inform the public, forming partnerships with government and nonprofit agencies, and targeting and adapting information to the audiences most susceptible to lead exposure through drinking water. Many of these practices go well beyond the requirements of the Lead and Copper Rule. In this connection, water industry representatives and others noted several shortcomings with the rule's public education provisions, including confusing language and the lack of a requirement to notify homeowners of the specific lead levels in their drinking water. Additionally, EPA has not evaluated water systems' public education efforts on lead in drinking water since the rule was established more than a decade ago. Much is known about the health effects of lead exposure, particularly its impact on brain development and functioning in young children. However, limited studies have been conducted on the health effects of exposure to low levels of lead in drinking water. EPA plans to prepare a health advisory document to help utilities explain the risks of lead exposure to the public, and a paper summarizing lead research conducted since the Lead and Copper Rule was published in 1991. However, the timetable for these projects is not clear, and it is also not clear how this work will fit into a broader research agenda, or if this effort needs to involve other key organizations, such as the Centers for Disease Control and Prevention.

section_title: Letter
paragraphs: In January 2004, local media reported that the District of Columbia Water  and Sewer Authority (WASA) had found elevated lead levels in the drinking  water of more than 4,000 homes in the city—the results of tests conducted  during the summer of 2003. The lack of timely disclosure of this problem  and the subsequent confused effort by government agencies to inform the  public on steps to protect itself resulted in numerous congressional  hearings and ongoing Environmental Protection Agency (EPA) efforts to  review the adequacy of federal regulations on lead in drinking water. In  July 2004 testimony before your subcommittee, we made preliminary  observations on issues surrounding the elevated levels of lead found in  Washington, D.C.’s drinking water and highlighted areas for further  examination. This letter discusses our findings and recommendations from  that further review.
Although rarely the sole cause of lead poisoning, lead in drinking water can  significantly increase a person’s total lead exposure. EPA estimates that  drinking water is the source of up to 20 percent of Americans’ lead  exposure, and recent research suggests that drinking water may provide as  much as 60 percent of total lead exposure for infants who drink baby  formula and concentrated juices that are mixed with water. Adults exposed  to high levels of lead could develop kidney problems or high blood  pressure. Developing fetuses, infants, and young children are more  vulnerable to lead from all sources, including drinking water. Their  exposure to lead may harm their physical or mental development.
Lead is unusual among drinking water contaminants because it generally  does not come from source water supplies like rivers and lakes. Rather,  lead enters drinking water primarily from the corrosion of materials  containing lead in the water distribution system and in household  plumbing. These materials include lead service lines that connect a house  to the water main, lead-based solder used in a house to join copper pipe,  and brass plumbing fixtures such as faucets. The 1986 Amendments to the  Safe Drinking Water Act limited the amount of lead used in solder, faucets,  pipes, and other plumbing components. However, older leaded  components are still present in many homes, and many new components  still contain some lead.
The Safe Drinking Water Act is the key federal law protecting public water  supplies from harmful contaminants. Its 1991 Lead and Copper Rule  requires water systems to protect consumers against exposure to elevated  levels of lead in drinking water by chemically treating water to reduce its  corrosiveness and by collecting water samples from consumer taps and  testing them for evidence of lead corrosion. Because lead contamination  generally occurs after water leaves the treatment plant, the Lead and  Copper Rule requires testing for lead at consumer taps. Large water  systems, like WASA’s, generally must take 100 samples in a 6-month period.  EPA considers lead to be over the “action level” when lead levels are higher  than 15 parts per billion in over 10 percent of tap water samples taken. If a  water system exceeds the action level, it must notify and educate the public  about ways to reduce exposure. If lead levels exceed the action level after  treatment to minimize water’s corrosiveness, the water system must  annually replace 7 percent of the lead service lines that it owns.
Implementation and enforcement of the Lead and Copper Rule in the  District of Columbia is complicated because of the number and nature of  the entities involved. The Washington Aqueduct, owned and operated by  the U.S. Army Corps of Engineers, treats the water (including controlling  for corrosion). WASA purchases water from the Washington Aqueduct and  delivers it to District residents, and is responsible for monitoring tap water  samples for lead. EPA Region III in Philadelphia has oversight and  enforcement authority for the District’s public water systems.
You asked us to determine (1) what the key government entities that  implement the Safe Drinking Water Act’s regulations for lead in the District  of Columbia are doing to increase their level of coordination and reduce  lead levels, (2) to what extent WASA and other agencies are determining  which adult and child populations in the District of Columbia are at  greatest risk of exposure to elevated lead levels in drinking water and how  the agencies are reducing the public’s lead exposure, (3) how other  drinking water systems that exceeded EPA’s action level for lead conducted  public notification and education, and (4) the state of research on lead  exposure and how this information could help inform other drinking water  utilities of potential problems in their systems.
To answer the first two questions, we interviewed officials responsible for  the delivery and regulation of drinking water in the District of Columbia,  including WASA, EPA, the Washington Aqueduct, and officials from  community advocacy groups. We also reviewed key documents, such as the  consent orders between WASA and EPA and testimony by the involved  entities. Additionally, we spoke to officials with the D.C. Department of  Health and the Centers for Disease Control and Prevention (CDC), and  reviewed a March 2004 CDC study on lead exposure from drinking water in  the District of Columbia. To answer the third question, we interviewed  officials responsible for the delivery and regulation of drinking water in  several cities around the country, reviewed documents these officials  produced, and observed aspects of their public education programs. We  also spoke with EPA, water industry groups, and public advocacy groups  and reviewed reports these entities produced. Finally, to answer the fourth  question, we interviewed experts on the health effects of lead exposure,  including officials at EPA and CDC, and reviewed public health studies and  medical literature describing the health effects of lead exposure. We also  interviewed EPA officials and reviewed program documentation to  understand EPA’s involvement in lead research.
We conducted our review from April 2004 through February 2005 in  accordance with generally accepted government auditing standards. For a  more detailed discussion of our scope and methodology, see appendix I.
subsections: section_title: Background
paragraphs: The Safe Drinking Water Act established a federal-state arrangement in  which states may be delegated primary implementation and enforcement  authority (“primacy”) for the drinking water program. Except for Wyoming  and the District of Columbia, all states and territories have received  primacy. For contaminants that are known or anticipated to occur in public  water systems and that the EPA Administrator determines may have an  adverse impact on health, the act requires EPA to set a nonenforceable  maximum contaminant level goal (MCLG) at which no known or  anticipated adverse health effects occur and that allows an adequate  margin of safety. Once the MCLG is established, EPA may set an  enforceable standard for water as it leaves the treatment plant, the  maximum contaminant level (MCL). The MCL generally must be set as  close to the MCLG as is feasible using the best technology or other means  available, taking costs into consideration. Alternatively, EPA can establish a  treatment technique, which requires a treatment procedure or level of  technological performance to reduce the level of the contaminant.
The fact that lead contamination occurs after water leaves the treatment  facility has complicated efforts to regulate lead in the same way as most  other drinking water contaminants. In 1975, EPA established an interim  MCL for lead of 50 parts per billion (ppb), but did not require sampling of  tap water to show compliance with the standard. Rather, the standard had  to be met at the water system before the water was distributed. The 1986  amendments to the act directed EPA to issue a new lead regulation, and in  1991, EPA adopted the Lead and Copper Rule.
Instead of an MCL, the rule established an “action level” of 15 ppb for lead  in drinking water. To reduce the amount of lead entering the water as it  flows through distribution lines and home plumbing to customers’ taps, the  rule required that water systems, if needed, treat the water to limit its  corrosiveness. Under the rule, the action level is exceeded if lead levels are  higher than 15 ppb in over 10 percent of tap water samples. Large systems,  including WASA’s, generally must take at least 100 tap water samples in a 6- month monitoring period, though reduced monitoring schedules are also  allowed for some systems. If a water system exceeds the action level, it has  60 days to deliver a public education program that meets EPA  requirements, including a notice in customers’ water bills; delivery of  public service announcements to television and radio stations; and the  distribution of information to locations likely to serve populations  vulnerable to lead exposure, including hospitals, clinics, and local welfare  agencies. In addition, if lead levels exceed the action level after treatment  to minimize water’s corrosiveness, the water system must annually replace  7 percent of the lead service lines under its ownership and offer to replace  the private portion of the lead service line (at the owner’s expense) until  the tap water 90th percentile lead levels drop below the action level for two  consecutive six month monitoring periods.
Drinking water is provided to District of Columbia residents under a unique  organizational structure:  The U.S. Army Corps of Engineers’ Washington Aqueduct draws water  from the Potomac River that it filters and chemically treats to meet EPA  specifications. The aqueduct produces drinking water and sells it to  utilities that serve approximately 1 million people living or working in or  visiting the District of Columbia; Arlington County, Virginia; and Falls  Church, Virginia. Managed by the Corps of Engineers’ Baltimore  District, the aqueduct is a federally owned and operated public water  supply agency that produces an average of 180 million gallons of water  per day at two treatment plants located in the District.
The District of Columbia Water and Sewer Authority buys its drinking  water from the Washington Aqueduct and distributes it through 1,300  miles of water mains to customers in the District and several federal  facilities in Virginia. From its inception in 1938 until 1996, WASA’s  predecessor, the District of Columbia Water and Sewer Utility  Administration, was a part of the District’s government. In 1996, WASA  was established by the District of Columbia as a semiautonomous  regional entity.
EPA’s Region III Office in Philadelphia has primary oversight and  enforcement responsibility for public water systems in the District of  Columbia. According to EPA, the regional office’s oversight and  enforcement responsibilities include providing technical assistance to  the water suppliers on how to comply with federal regulations; ensuring  the suppliers report monitoring results to EPA by the required deadlines;  taking enforcement actions if violations occur; and using those  enforcement actions to return the system to compliance in a timely  fashion.
The District’s Department of Health, while having no formal role under  the act, has as its mission identifying health risks and educating the  public on those risks.
In August 2002, WASA officially reported to EPA that drinking water in the  District of Columbia exceeded the action level for lead. This report  triggered the Lead and Copper Rule’s requirement to deliver a public  education program within 60 days and to replace lead service lines at a  minimum rate of 7 percent per year. Because WASA and property owners  in the District share ownership of the water service lines, the rule required  WASA to replace the portion of the lines that it owns, and to offer to  replace the portion of the lines controlled by the homeowners at the  homeowners’ expense.
Under the Lead and Copper Rule, water systems get credit for lead service  line replacement either by actually replacing lines or by finding homes with  lead service lines that test under the 15 ppb action level. For fiscal year  2003, WASA decided to physically replace and test lead service lines  concurrently. WASA reported that it tested 4,613 homes with lead service  lines in fiscal year 2003, and found 1,241 homes at or below the 15 ppb  action level but another 3,372 homes with water exceeding the action  level. Local media made these results public in January 2004.
EPA began a special audit of WASA’s compliance with the Lead and Copper  Rule in February 2004. This audit resulted in a consent order that EPA and  WASA signed on June 17, 2004. Congress held a number of hearings in 2004  to investigate drinking water problems in the District.
section_title: Agencies Have Improved Coordination, but Challenges Remain in Reducing Lead Levels
paragraphs: WASA and other government agencies implementing the act’s regulations  for lead have taken steps to improve their coordination. According to EPA  officials, WASA has thus far met the terms of the order the two agencies  signed that required WASA to take a number of corrective actions. WASA  has also agreed to implement most recommendations that the D.C.  Inspector General made in a January 2005 report to develop internal  policies and procedures at WASA that would improve the coordination  between EPA, WASA, and the D.C. Department of Health. Improved  coordination, however, has not resolved all problems, and EPA and WASA  officials remain concerned that drinking water WASA provides still exceeds  the action level for lead of 15 parts per billion.
subsections: section_title: WASA Has Improved Coordination with Other Agencies
paragraphs: Under the June 2004 Consent Order, WASA agreed to take several actions  to improve its compliance with the Lead and Copper Rule and, in so doing,  enhanced its coordination with EPA and the D.C. Department of Health.  The order required WASA to improve its selection of sampling locations  and reporting of water testing results to EPA, create a strategy to improve  its public education efforts, physically replace an additional 1,615 lead  service lines by the end of fiscal year 2006, develop a plan and a schedule to  identify additional lead service lines, and, in collaboration with the D.C.  Department of Health, develop a plan to set priorities for replacing lead  service lines. According to staff in EPA’s Region III, WASA appears to be on  track to meet the terms of the order. Table 1 identifies some principal  requirements of the order and notes the status of WASA’s compliance as of  January 18, 2005.
WASA also agreed to implement 11 of the 12 recommendations contained  in the D.C. Inspector General’s January 2005 report. The D.C. Inspector  General found that WASA had not developed or maintained internal  policies or procedures for implementing requirements set forth in the Lead  and Copper Rule, including those for selecting and reporting lead water  sample test results. However, the D.C. Inspector General concluded that  WASA’s current initiatives on lead concentrations in the District’s tap water  were noteworthy; he also made 12 recommendations to improve WASA’s  annual monitoring, lead service line replacement, and communication.
WASA agreed to all of the Inspector General’s recommendations except  one to develop a memorandum of understanding (MOU) with the D.C.  Department of Health that defines both agencies’ roles and responsibilities,  the expert advice each agency can provide in the areas of water quality  management, and the frequency and manner of transmission of information  between the agencies. WASA did not agree that an MOU was necessary to  ensure effective cooperation, and noted that its relationship with the D.C.  Department of Health has vastly improved and reflects a more creative and  flexible partnership and that the range of substantive issues around which  WASA and the D.C. Department of Health must communicate is wide,  diverse, and complex. While we agree that WASA’s relationship with the  D.C. Department of Health has improved, we nonetheless agree with the  Inspector General’s view that an MOU would serve to define the two  agencies’ roles and responsibilities and help improve their coordination  and partnership.
section_title: Lead Levels Remain Above the Action Level
paragraphs: Despite improved coordination, the central problem remains: lead in D.C.  drinking water is still over the EPA action level. In February 2004, EPA  formed a Technical Expert Working Group made up of representatives  from WASA; EPA; CDC; the Washington Aqueduct; Arlington and Falls  Church, Virginia; the D.C. Department of Health; and industry consultants.  Industry experts traced the likely cause for the increased lead levels to  November 2000. At that time, the Washington Aqueduct changed its  secondary disinfectant treatment from free chlorine to chloramines to  comply with a new EPA regulation that placed strict limits on disinfection  by-products. This change in water treatment may have had the unintended  consequence of making the corrosion control treatment that was in place  no longer adequately protective. Therefore, lead levels increased in water  exposed to lead-containing plumbing and fixtures.
The group recommended the introduction of orthophosphate to the  drinking water supply because it concluded that this chemical would form  a protective coating inside lead service lines and fixtures to prevent lead  from leaching into drinking water. In order to assess the effect of  orthophosphate on the water distribution system, in May 2004, EPA  approved the Washington Aqueduct’s request to apply the corrosion  inhibitor to a portion of the District of Columbia drinking water  distribution system, and the corrosion inhibitor was introduced June 2004.  This portion is called the 4th High Pressure Zone, and it is hydraulically  isolated from the remainder of the system.
In early August 2004, based on the results of the partial system test, EPA  approved the Washington Aqueduct’s request for broader use of the  corrosion inhibitor, and on August 23, 2004, the inhibitor was introduced  systemwide. On January 10, 2005, WASA submitted to EPA its latest tap  water sampling results, covering tap water samples taken from July  through December 2004. These results showed that the 90th percentile  sample reached 59 ppb, still substantially over the 15 ppb action level for  lead. However, EPA and WASA officials report that some reductions of lead  levels occurred in the latter half of the monitoring period. WASA data show  that 42 samples taken during July through September 2004 had a 90th  percentile reading of 82 ppb, while 88 samples taken during October  through December 2004 had a 90th percentile reading of 31 ppb. According  to EPA, experts have said that it can take 6 months or more to begin seeing  a drop in lead levels and a year or more for the orthophosphate treatment  to reduce lead levels below the EPA action level.
section_title: WASA and Other Agencies Are Taking Steps to Identify At- Risk Populations and Reduce Their Lead Exposure
paragraphs: WASA is identifying those most at risk for exposure to lead in drinking  water by updating its inventory of lead service lines. To reduce the  exposure of District residents to lead in drinking water, WASA is  accelerating its rate of lead service line replacement and providing priority  replacement of lead service lines for populations particularly vulnerable to  the health effects of lead. However, questions remain about the success of  the lead service line replacement program, because WASA is replacing only  part of the lead service line unless customers pay to have their portion  replaced.
subsections: section_title: WASA Is Updating Its Lead Service Line Inventory
paragraphs: WASA and EPA officials are focusing on lead service lines as the primary  source of lead in drinking water in the District of Columbia. Locating these  lines allows WASA to identify the people most likely to be exposed. The  June 2004 consent order that WASA signed with EPA Region III requires  WASA to update its baseline inventory of lead service lines each year.  WASA must use this baseline inventory to calculate the 7 percent of lines it  replaces each year. In September 2004, WASA revised its baseline inventory  to 23,637 lead service lines and reported this number to EPA. However, at  that time WASA did not know the composition of 31,380 service lines. The  order requires WASA to provide a strategy and timetable for identifying the  composition of these unknown lines. During fiscal year 2005, WASA plans  to determine the composition of 1,200 unknown lines by digging up or  testing a segment of each line. Figure 1 shows the inventory of WASA’s  service lines as of October 1, 2004.
To speed the process of identifying the composition of unknown lines,  WASA is attempting to develop a methodology to identify the composition  without physically digging up the line. WASA plans to statistically analyze  line composition data from test pits dug in 2003 through 2005 along with  known quantities about each excavated line: the date of service line  construction, water test result for lead, and size of service line. WASA  hopes that these known quantities can be used to determine the unknown  line composition. WASA plans to complete this analysis by August 1, 2005.
section_title: WASA Is Accelerating Lead Service Line Replacement and Targeting At-Risk Populations
paragraphs: To reduce residents’ exposure to lead in drinking water, WASA is  accelerating its schedule for replacing lead service lines. WASA’s Board of  Directors decided to replace all lead service lines in public space in the  District of Columbia by 2010. The total cost of this program is estimated at  $300 million. In fiscal years 2002 through 2004, WASA replaced 2,229 lead  service lines in public space, about 9 percent of the total known lead  service line inventory.
In its lead service line replacement program, WASA replaces the majority of  lines on a block-by-block basis. However, to reduce exposure to lead in  drinking water for those residents most vulnerable to lead’s health effects,  WASA agreed, as part of the consent order, to develop in consultation with  the D.C. Department of Health a system for setting priorities for lead  service line replacement and to replace 1,000 lead service lines by the end  of fiscal year 2006 on a priority basis. For fiscal year 2005, WASA’s first  priority for replacement is homes with children younger than 6 who have  elevated blood lead levels; its second priority is day-care centers; and its  third priority is homes that are occupied by children younger than 6, or  pregnant or nursing mothers. WASA identified members of this third group  by sending a letter to all customers in its database who have a lead service  line or a service line of unknown composition. Customers could return the  letter to identify themselves as members of these at risk groups, as  appropriate, and WASA sorted customer responses to remove those who  did not meet the criteria for priority replacement. WASA worked with the  D.C. Department of Health to establish criteria for priority replacement,  and EPA has approved the program. Table 2 shows the number of priority  replacements WASA completed in fiscal year 2004 and plans to complete in  fiscal year 2005.
section_title: Questions Remain about the Success of the Lead Service Line Replacement Program
paragraphs: WASA is replacing lead service lines in public space—from the water main  to the homeowners’ property line. In the District of Columbia, homeowners  own the portion of the service line that runs from the property line to the  home. Homeowners may replace this portion of the line if they choose, but  this replacement is not required. WASA can replace the private portion of  a lead service line when it replaces its portion of the line. Figure 2 shows  the configuration of a service line from the water main to a customer’s  home.
Experts disagree about the effectiveness of removing only part of a lead  service line. Studies that EPA cited in the Lead and Copper Rule suggest  that long-term exposure to lead from drinking water decreases when a  service line is partially replaced. However, after partial replacement of a  lead service line, exposure to lead in drinking water is likely to increase in  the short term because cutting or moving the pipe can dislodge lead  particles and disturb any protective coating on the inside of the pipe. Some  experts believe that lead exposure can increase after partial service line  replacement because of galvanic corrosion where the dissimilar metals of  the old and new pipes meet. A study at WASA showed that partial lead  service line replacement significantly reduced average lead levels, but that  flushing was necessary to remove lead immediately after replacement. At  an EPA conference on lead service line replacement in October 2004, water  industry officials and others stressed the importance of encouraging or  mandating full replacement of lead service lines.
As the consent order required, WASA has established a program to  encourage homeowners to replace their portion of lead service lines. This  program includes   a low-interest loan program for low-income residents, offered through a   grants of up to $5,000 for low-income residents, offered by the District  of Columbia Department of Housing and Community Development; and  a fixed-fee structure for line replacement of $100 per linear foot plus  $500 to connect through the wall of the home, to make pricing easier for  homeowners to understand.
WASA implemented this program in July 2004, and EPA approved the  program on August 10, 2004. Information about these programs is included  in the notice that homeowners receive at least 45 days before their lead  service line is scheduled to be replaced.
Thus far, few homeowners in the District of Columbia have replaced their  portion of lead service lines. In fiscal years 2003 through 2004, only 2  percent of homeowners (48 of 2,217) replaced the private portion of their  lead service line. WASA officials attribute the low rate of full line  replacement to customers’ cost concerns. An EPA Region III official told us  it is too early to determine if the District of Columbia’s program is  increasing the number of customers who replace their portion of the  service line, since the program went into place approximately 2 months  before the end of fiscal year 2004. However, WASA officials told us that the  number of full replacements is increasing since the program was  implemented—14 percent of customers (119 of 841) replaced the private  portion of their lead service line between October 1, 2004, and January 28,  2005. EPA has asked WASA to report on the number of customers taking  advantage of the various incentive programs in the 2005 annual lead service  line replacement report.
Madison, Wisconsin, provides an alternative example for maximizing full  lead service line replacement. A 1997 study showed that these lines were  the source of elevated lead levels in water, and that fully replacing them  could reduce lead levels to well below the action level. Madison cannot use  orthophosphate corrosion control treatment because this treatment would  degrade surface water quality in local lakes. In lieu of corrosion control  treatment, the water utility is replacing all lead service lines in the city over  10 years, a total of approximately 6,000 service lines. To ensure that lines  are completely replaced, Madison passed an ordinance in 2000 requiring  homeowners to replace their portion of the lead service line when the  utility replaces its portion. The city reimburses homeowners for half of the  cost they incur in replacing their portion of the line, up to a maximum of  $1,000. Assistance is available for customers who cannot afford the  replacement. A Madison Water Utility official told us that before the  ordinance was passed, less than 1 percent of customers paid to have their  portion of the lead service line replaced.
section_title: Experiences of Other Water Systems Highlight Ways to Better Educate the Public
paragraphs: Other water systems use innovative methods to educate their customers  about lead in drinking water. These practices include using a variety of  media to inform the public, forming partnerships with government  agencies and community groups, and targeting educational materials to the  audience most susceptible to lead exposure through drinking water. These  practices tend to go well beyond the provisions of the Lead and Copper  Rule, which require public notification language that is difficult to  understand and do not require utilities to notify individual homeowners of  the lead concentrations in their homes’ drinking water.
subsections: section_title: Other Water Systems Used Innovative Methods to Educate the Public about Lead in Drinking Water
paragraphs: WASA’s experience highlights the importance of conducting an effective  public education program. In its June 2004 consent order, EPA found that  WASA had committed only a few violations of the public education requirements of the Lead and Copper Rule. However, community groups  and others have criticized WASA for failing to adequately convey  information to its customers about lead in drinking water and for failing to  communicate a sense of urgency in the materials provided. As we testified  in July 2004, EPA acknowledges that it should have provided better  oversight of WASA’s public education program.
Other water systems we contacted have used innovative approaches to  educate the public about lead in drinking water. For example, some  systems used a variety of media to inform the public. Officials from the  Massachusetts Water Resources Authority (MWRA) appear for interviews  on local radio and television talk shows to spread information about lead in  drinking water. The Portland (Oregon) Water Bureau provides funding for  many lead education initiatives, including materials presented to new  parents in hospitals; billboard, movie, and bus advertisements targeted to  neighborhoods with older housing; and education materials produced by  the Community Alliance of Tenants to educate renters on potential lead  hazards. Each of these materials directs people to call a telephone hotline  to get information about all types of lead hazards. This hotline is operated  by the Multnomah County Health Department and funded by the Portland  Water Bureau.
Water industry experts at an EPA conference in September 2004 stressed  the importance of partnerships, particularly with health officials, in  educating the public about lead in drinking water. Some water systems  have already formed partnerships to better educate the public and provide  a unified message. Three examples follow:  MWRA provides training workshops on drinking water issues, including  lead in drinking water, for local health officials. These officials can then  educate the public about drinking water issues when they arise.
MWRA also sends the local health department the same drinking water  data that it sends to the state drinking water regulator, so local health  officials are well informed.
The Portland Water Bureau participates in an integrated program to  educate the public and reduce exposure to all sources of lead, including  drinking water. The water bureau’s partners in this program include the  Multnomah County Health Department, the State Lead Poisoning  Prevention Program, the Portland Bureau of Housing and Community  Development, and community nonprofit agencies.
The Lead and Copper Rule requires water systems that exceed the action  level to provide written education materials to facilities and organizations  that serve high-risk segments of the population, including people more  susceptible to the adverse effects of lead and people at greater risk of  exposure to lead in drinking water. Some water systems have gone beyond  this basic requirement to better reach high-risk populations. For example,  in January 2004, the Portland Water Bureau sent a targeted mailing of  approximately 2,600 postcards to the homes of an age most likely to  contain lead solder that it identified as having a child 6 years old or  younger. These postcards encouraged residents to get their water tested for  lead, learn about childhood blood lead screening, and reduce lead hazards  in their homes. Water bureau officials said that they obtained the  information needed to target the mailing from a commercial marketing  company and that the information was inexpensive and easy to obtain. The  rule specifies that educational materials be delivered to Women, Infants,  and Children (WIC) and Head Start programs, where available. Both  Portland and MWRA have cultivated relationships with these programs.  MWRA worked with local WIC officials to add information about lead in  drinking water to WIC’s postpartum program for new mothers, and to  prepare an easy-to-understand brochure explaining how to avoid exposure  to lead in drinking water. Portland funded efforts with Head Start to  provide free blood lead testing and to present puppet shows teaching  children how to avoid lead hazards. Table 3 shows how the Portland Water  Bureau targets its lead education program to community groups.
Some other water systems measure the impact of their public education  programs. MWRA has conducted focus groups to judge the effectiveness of  its public education program, and routinely refines the information  presented about lead in drinking water. The Portland Water Bureau tracks  calls received by its lead information hotline and surveys callers to  determine their satisfaction with the program and the extent to which it  changed their behavior. An official from St. Paul (Minnesota) Regional  Water Services told us that the utility surveys its customers about water  quality issues. During the time the utility was conducting public education  about lead in drinking water, it surveyed customers each year to ask if  customers believed they were receiving enough information about the  quality of their water.
section_title: Lead and Copper Rule Public Education Requirements Have Several Shortcomings
paragraphs: Responding to concerns about the Lead and Copper Rule’s public  education requirements, EPA conducted a workshop in September 2004 at  which representatives from the water industry and community groups  discussed their views of the rule’s requirements. Representatives from the  water industry also told us they went beyond the rule’s requirements to  ensure the success of their public education programs. At the EPA  workshop and in interviews, water industry officials, experts, and  community groups identified the following problems:  The public cannot easily understand the required public education  language. Representatives of several water utilities told us the required  language was too long and the reading level too advanced for many  customers to understand. One expert estimated that understanding the  EPA language required at least an 11th grade reading level, while  approximately half the adult population of the United States reads at an  8th grade level or lower. Water industry officials suggested customizing  education materials about lead in drinking water for those who have  limited reading ability.
The rule does not require utilities to send results to homeowners  whose water is sampled for lead compliance. EPA officials told us that  many water systems do provide this information to customers, but in the  past, WASA did not provide this information in a timely fashion. The  consent order requires WASA to provide lead results to homeowners  within 3 days of receiving the results from the laboratory, and  encourages WASA to provide this data within 30 days of collecting the  sample.
Public notification under the rule is less timely than that required for  other violations of the Safe Drinking Water Act. The rule requires a  water system to notify the public within 60 days if it exceeds the action  level for lead. Other violations of the Safe Drinking Water Act with the  potential to cause serious adverse effects on human health require  public notification within 30 days, including violations of MCLs and  treatment techniques.
EPA has not evaluated the effectiveness of the public education  requirements of the rule since it was implemented in 1991. Water  industry officials at the EPA workshop suggested several methods to  evaluate the effectiveness of public outreach, including surveying the  public to determine its knowledge of lead in drinking water issues and  comparing the level of knowledge in areas where public education has  and has not been conducted. These officials also suggested that EPA  identify public education activities conducted by utilities around the  country that are following EPA guidelines and doing additional  voluntary education work to identify good practices.
In response to elevated lead levels in the District of Columbia, EPA is  conducting a national review of compliance and implementation of the  Lead and Copper Rule, including its public education requirements.  Additionally, EPA conducted the public education expert workshop to gain  information to use in its deliberations about changing the Lead and Copper  Rule and possibly its accompanying guidance documents and training. We  support EPA’s efforts in re-evaluating the public education requirements of  the rule, but believe that EPA also needs to provide more practical  assistance that water systems can use when educating their customers  about lead in drinking water.
section_title: Although Lead Exposure Causes Serious Health Effects, Research on Low-Level Exposure to Lead in Drinking Water Is Limited
paragraphs: Much is known about the health effects of lead exposure, particularly lead’s  impact on brain development and functioning in young children. However,  according to experts we interviewed, limited studies have been conducted  on the heath effects of exposure to low levels of lead in drinking water.  Officials in EPA’s Office of Water and Office of Research and Development  told us they are beginning to address certain information gaps about the  health risks of lead in drinking water. However, the timetable for  completing this effort is not clear.
subsections: section_title: Lead Exposure Causes Serious Health Effects, Particularly in Children
paragraphs: Health experts agree that lead is toxic to almost every organ system, and  much research has documented its adverse health effects. While many  body systems can be severely affected by high chronic and acute lead  exposures, lead is dangerous in large part because moderate to low chronic  exposure can result in adverse health effects. The threshold for harmful  effects of lead remains unknown. Over the years, as new data has become  available, CDC has revised its recommendations on the threshold of blood  lead levels that should raise concern and trigger interventions. In 1975,  CDC’s blood lead level threshold of concern stood at 30 micrograms per  deciliter. In 1991, CDC lowered the blood lead level of concern to 10  micrograms per deciliter. Research conducted since 1991 provides  evidence of adverse effects at even lower levels—at less than 10  micrograms per deciliter among children younger than 6.
Because of their behavior and physiology, children are more sensitive than  adults to exposure to lead in a given environment. For example, children  generally come into more contact with lead because they spend more time  on the ground, where there may be lead-contaminated soil or dust.  Mouthing and hand-to-mouth behaviors also increase the likelihood that  children may ingest soil or dust. Physiologically, children take in more food  and water per pound of body weight, and their absorption of lead is  estimated to be 5 to 10 times greater than adults. Finally, children are more  sensitive than adults to elevated blood lead levels because organ systems,  including their brain and nervous system, are still developing. This ongoing  development increases the risk of lead’s entry into the brain and nervous  system, and can result in prolonged or permanent neurobehavioral  disorders.
In contrast, most adult exposures to lead are occupational and occur in  lead-related industries, such as lead smelting, refining, and manufacturing.  Adults exposed to lead can develop high blood pressure, anemia, and  kidney damage. Lead poses a substantial threat to pregnant women and  their developing fetuses because blood lead readily crosses the placenta.  Pregnant women with elevated blood lead levels may have an increased  chance of miscarriage, premature birth, and newborns with low birth  weight or neurologic problems.
CDC tracks children’s blood lead levels in the United States through the  National Health and Nutrition Examination Surveys and state and local  surveillance data. The surveys between 1976 and 1980 found evidence of  an estimated 88 percent prevalence of lead levels greater than or equal to  10 micrograms per deciliter in children aged 1 to 5 compared with an  estimated prevalence of 2.2 percent in 1999 to 2000. Health experts  generally attribute this decline to the elimination of leaded gasoline and  lead solder from canned foods, and a ban on leaded paint used in housing  and other consumer products. Data provided by the District of Columbia to  CDC for 2001 show that, of an estimated 39,356 children younger than 6,  16,036 were tested for lead. Of those, 437, or 2.73 percent, had blood lead  levels greater than or equal to 10 micrograms per deciliter.
More recently, in response to the discovery of high lead levels in drinking  water in the District of Columbia, CDC and the D.C. Department of Health  studied blood lead levels of residents most at risk for lead exposure. This  study was designed to determine the extent to which lead in drinking water  was contributing to blood lead levels of District residents. One portion of  the study focused on residents of homes with known lead levels in drinking  water greater than 300 ppb, much greater than the EPA action level of 15  ppb. Health officials attempted to contact nearly all residents of homes  with lead concentrations at this level, and collected blood samples for lead  analysis from residents who agreed to the procedure. Of the 201 residents  tested, all were found to have blood lead levels less than CDC’s levels of  concern for adults or children, as appropriate.
Another portion of this study examined blood lead data collected by the  District of Columbia Department of Health’s blood lead surveillance  system. Results of blood lead tests conducted from January 1998 through  December 2003 were compared for a nonprobability sample of homes with  known lead service lines and homes with nonlead service lines. During  2000 through 2003, the period when lead levels in drinking water increased,  the number of people with blood lead levels greater than 5 micrograms per  deciliter decreased for the sample without lead service lines but did not  decrease in a statistically significant way for the sample with lead service  lines. In the District of Columbia, blood lead levels are generally greater in  homes with lead service lines. In general, the older homes most likely to  have lead service lines are also those most likely to have other lead  hazards, such as lead in paint and dust.
section_title: Research on the Health Effects of Lead in Drinking Water Is Limited
paragraphs: A good deal of research has been conducted on the health effects of lead  associated with certain pathways of contamination, such as the ingestion  of lead paint and the inhalation of dust contaminated with lead. According  to a number of public health experts, drinking water contributes a  relatively minor amount to overall lead exposure in comparison with other  sources. However, the most relevant studies on the isolated health effects  of lead in drinking water date back nearly 20 years—including the Glasgow  Duplicate Diet Study on lead levels in children, upon which the Lead and  Copper Rule is partially based.
While lead in drinking water is rarely thought to be the sole cause of lead  poisoning, it can significantly increase a person’s total lead exposure— particularly for infants who drink baby formula or concentrated juices that  are mixed with water from homes with lead service lines or plumbing  systems. For children with high levels of lead exposure from paint, soil, and  dust, drinking water is thought to contribute a much lower proportion of  total exposure. For residents of dwellings with lead solder or lead service  lines, however, drinking water could be the primary source of exposure. As  exposure declines from sources of lead other than drinking water, such as  gasoline and soldered food cans, drinking water will account for a larger  proportion of total intake. Thus, according to EPA’s Lead and Copper Rule,  the total drinking water contribution to overall lead levels may range from  as little as 5 percent to more than 50 percent of a child’s total lead  exposure.
According to recent medical literature and the public health experts we  contacted, the key uncertainties about the effects of lead in drinking water  requiring clarification include the incremental effects of lead-contaminated  drinking water on people whose blood lead levels are already elevated from  other sources of lead contamination and the potential health effects of  exposure to low levels of lead.
section_title: EPA Is Beginning to Address Certain Information Gaps in the Health Risks of Lead in Drinking Water
paragraphs: EPA has acknowledged the need to improve health risk information  available to drinking water systems and local governments about lead in  drinking water. According to officials from EPA’s Office of Water, one way  to improve this information would be to develop a health advisory for lead.  EPA health advisories are written documents that provide information on  the health effects, analytical methodology, and treatment technology that  would be useful in dealing with the contamination of drinking water and  have been issued for many other water contaminants, such as  cryptosporidium (a water-borne microbe). The advisories serve as informal  technical guidance to assist federal, state, and local officials responsible for  protecting public health when contamination occurs. For example, a  cryptosporidium health advisory was prompted, in part, by an outbreak of  the microbe in 1993 in Milwaukee, Wisconsin, where an estimated 400,000  people became ill.
Office of Water officials note that the agency currently does not have a  health advisory for lead and believe the problems local District agencies  had in communicating the health risks of lead in drinking water highlight  the need for one. Office of Water officials also noted a health advisory  document for lead would be useful for other water systems and state and  local officials in communicating risk if they identify problems with lead  during monitoring under the Lead and Copper Rule. In 1985, EPA drafted a  health advisory for lead, but never issued it to the public. At present, EPA’s  Office of Water has drafted a plan to prepare a lead health advisory and  have it reviewed by experts within EPA and by external peer reviewers.  However the anticipated completion date for the advisory has not been  determined.
To ensure that the health advisory for lead is up-to-date, the Office of Water  also plans to produce a “white paper” that documents how research data  were used in setting the action level for lead and updates that assessment  using new data on lead exposure and uptake in the body. Officials in these  offices told us that the white paper should provide sufficient information to  allow health risk at the action level to be discussed in the lead health  advisory. They told us that data used to develop the 15 ppb action level in  the 1991 rule were based on a small group of studies published before 1989  and on early models of the agency’s Integrated Exposure Uptake Biokinetic  Model for Lead (IEUBK), which predicts blood lead concentrations for  children exposed to different types of lead sources. The Office of Research  and Development is currently developing an “all ages lead model” that  supplements the IEUBK model, and should allow for new predictions of  fetal blood lead levels derived from maternal exposure levels. According to  EPA, the agency plans to have the model peer reviewed first and any issues  from the peer review addressed before the model is used in regulatory  decision making. These predictions may be incorporated into the white  paper being prepared by the Office of Water. However, a timetable for  completing the updated model and the white paper has not been  determined. Current draft plans for the health advisory and white paper  neither discuss how these projects fit into a broader agency research  agenda nor identify how they will be funded or if they need to be  coordinated with CDC or other research organizations.
section_title: Conclusions
paragraphs: In 2004, poor coordination among local District of Columbia agencies and  EPA aggravated the problems they had in responding to elevated lead levels  and communicating accurate and timely health risk information to affected  District residents. Since that time, local agencies and EPA have improved  their coordination. Nonetheless, these agencies still face considerable  challenges in ensuring the safety of the District’s water supplies. For one  thing, while lead levels have come down in recent months, they still remain  well above the Lead and Copper Rule’s 15 ppb action level. In addition, only  time will tell if or how quickly WASA’s ambitious lead service line  replacement program will further lower lead levels in drinking water.
The District’s experience has also exposed weaknesses in the Lead and  Copper Rule’s public education requirements. EPA is collecting  information about compliance with the rule and is also considering  changes to the Lead and Copper Rule and its accompanying guidance  documents and training. We support these efforts and believe the clear  deficiencies of the rule’s public education requirements—vividly illustrated  in the District of Columbia—call for action to assist water systems in  educating their customers about lead.
The District’s experience has also underscored gaps in available knowledge  about health risks associated with lead-contaminated drinking water. In  acknowledging these gaps, EPA has pointed to projects planned by its  Office of Water and its Office of Research and Development as key steps to  address the problem. However, the timetable for completing these projects  is not clear, and it is also not clear how this work will fit into a broader  research agenda or if this agenda will involve other key organizations such  as CDC.
section_title: Recommendations for Executive Action
paragraphs: To provide timely information to communities on how to improve  communication of lead health risks, we recommend, as part of its  comprehensive re-examination of the Lead and Copper Rule’s public  education requirements, that the Administrator of EPA direct the Office of  Water to identify and publish best practices that water systems are using to  educate the public about lead in drinking water.
To improve the health risk information on lead available to water systems  and regulatory staff, we recommend that the Administrator of EPA develop  a strategy for closing information gaps in the health effects of lead in  drinking water that includes timelines, funding requirements, and any  needed coordination with CDC and other research organizations.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to EPA for comment. In its March 14,  2005, letter (see app. II), EPA expressed appreciation for the information in  the report, identified some of its recent and ongoing efforts to address the  problems we identified, and indicated it will give full consideration to our  recommendations. Of particular note, EPA agreed with our  recommendation that the agency identify and publish best practices that  water systems can use to educate their customers about lead in drinking  water. EPA said it will work with its regions and water utility associations  to identify best practices and disseminate them to a wide audience, and will  work with stakeholders to change the mandatory language in its  regulations to make sure it is relevant and understandable.
The agency indicated neither agreement nor disagreement with our  recommendation to develop a strategy for closing information gaps on the  health risks of lead in drinking water. EPA noted instead it was awaiting  revision of the agency’s exposure model for evaluating the effects of lead  exposure from different media on blood lead levels. It also said it was  “working to prepare a health advisory that would inform the discussion”  and was developing a summary of toxicokinetic research published since  1991. EPA said these efforts should be completed later this year or early  next year. We note that while EPA’s planned efforts to address information  gaps in knowledge of health risks from lead in drinking water appear to be  worthwhile activities, we continue to believe the agency should commit to  the kinds of planning steps (such as budgeted resources and timetables)  that will help to ensure its planned efforts are addressed in a timely manner  and have their intended effect. We also continue to believe that EPA should  coordinate its efforts with CDC and other parties to ensure that the most is  achieved from all agencies’ collective efforts. EPA also provided technical  comments and clarifications that have been incorporated, as appropriate.
On February 23, 2005, we met with WASA officials to discuss the factual  information we were planning to include in our draft report. At that time,  WASA provided oral comments and technical suggestions. We subsequently  provided the draft report to WASA for formal comment. WASA, however,  did not comment on this draft.
As agreed with your office, unless you publicly release the contents of this  report earlier, we plan no further distribution until 30 days from the report  date. At that time, we will send copies of this report to the appropriate  congressional committees; interested Members of Congress; the Acting  Administrator, Environmental Protection Agency; and other interested  parties. We will also make copies available to others on request. In  addition, the report will be available at no charge on the GAO Web site at  http://www.gao.gov.
Should you or your staff need further information, please contact me at  (202) 512-3841 or stephensonj@gao.gov. Individuals making key  contributions to this report included Steve Elstein, Samantha Gross, Karen  Keegan, Tim Minelli, and Carol Herrnstadt Shulman.
section_title: Scope and Methodology
paragraphs: To identify actions that key government entities are taking to improve  coordination, we reviewed key documents, such as the consent decrees  between the District of Columbia Water and Sewer Authority (WASA) and  the Environmental Protection Agency (EPA) and testimony by the involved  agencies, that identified steps each agency agreed to take to improve  coordination, efficiency, and accountability. We then met with officials of  these entities and gathered documentation from them to gauge the  progress of planned changes. Additionally, we reviewed reports written by  various groups about lead in drinking water in the District of Columbia,  including reports by the District of Columbia Inspector General, the D.C.  Appleseed Center for Law and Justice, and the law firm of Covington and  Burling. Finally, to gain perspective on the issue of coordination, we  interviewed officials from other water systems and their federal and state  regulatory agencies and consulted with industry groups in the drinking  water delivery field.
To identify the extent to which WASA and others are gathering information  to determine which adult and child populations are at greatest risk of  exposure to lead, we reviewed WASA’s efforts to locate lead service lines.  We also reviewed the plans that WASA has submitted to EPA to replace  lead service lines and materials describing WASA’s program to encourage  homeowners to fully replace lead service lines. We interviewed WASA and  EPA staff about the progress of the lead service line identification and  replacement programs, interviewed officials at other water systems to  discuss lead service line replacement, and reviewed studies on partial lead  service line replacement.
To determine how other drinking water systems that have exceeded the  action level for lead conducted public education and outreach, we met with  parties knowledgeable about the Lead and Copper Rule, including EPA  headquarters and regional staff and relevant industry groups, in part to find  water systems with particularly innovative and effective public education  and outreach programs. From this group, we focused on water systems in  large cities with diverse populations that had exceeded the action level for  lead since 2000, according to EPA data. We then interviewed officials from  these water systems and reviewed documents to learn about their public  education efforts, how they target their efforts, and how they measure  success. We also spoke to officials from government and nongovernment  entities that partner with these water systems in their education programs.  To learn about public education under the Lead and Copper Rule, we  attended an EPA workshop where water system managers, environmental  and consumer groups, and other experts shared their opinions on best  practices in the industry and EPA’s current policies. We also reviewed  reports and public testimony pertaining to public education in the District  of Columbia and elsewhere.
To evaluate the state of research on lead exposure, we interviewed public  health officials and academic researchers that representatives of  government and nongovernmental organizations in the fields of drinking  water and public health identified as experts on lead. We interviewed these  experts to get their perspective on lead’s health effects, particularly the  health effects of ingestion of low levels of lead and lead in drinking water.  We also discussed data gaps on the health effects of lead, the research  efforts planned and under way to fill these gaps, and alternative strategies  that might better ensure that these gaps are addressed efficiently and  effectively. These experts also helped us identify the medical and public  health literature we reviewed on the health effects of lead exposure,  particularly through drinking water. To learn about efforts to locate and  monitor the blood lead levels of individuals exposed to elevated levels of  lead in drinking water in the District, we examined a published study and  interviewed officials at the District of Columbia Department of Health and  the Centers for Disease Control and Prevention. Finally, we interviewed  EPA officials and reviewed EPA strategic plans and other documentation to  learn about EPA’s plans to address key information gaps on the health  effects of lead exposure.