SECTION: TELEGRAPH ,1A In a city where more than 20,000 children have been exposed to brain- damaging doses of lead paint in the past two decades, officials acknowledged last week that no effort has been made to track them - and that many have likely passed into the prison system unnoticed.
Unaware of the mental deficits of the defendants who appear before them, judges routinely shuttle lead-poisoning victims into the criminal justice system without educational or medical treatments that might help them overcome their affliction.
With more than 1,000 cases of reported lead paint poisoning every year, Baltimore ranks as one of the most toxic cities in America, according to The U.S. Department of Housing and Urban Development.
Research has shown that lead poisoning increases the tendency toward both violence and drug abuse, and a recent University of Pittsburgh study suggests that poisoned children are almost twice as likely to commit crimes.
But the state's criminal justice system collects no data on the lead-poisoning history of criminal defendants. Even juveniles are sentenced without judges ever becoming aware that many have suffered irreversible brain damage in early childhood.
"Lead poisoning is not subtle," said Dr. Gerry Gioia, an expert on brain injuries at Baltimore's Mount Washington Pediatric Hospital.
"In a city like Baltimore, where we have so many kids coming into contact with such a well known and well-documented environmental toxin, it's a major risk factor for brain dysfunction. This is not an academic question, by any means."
Baltimore State's Attorney Patricia C. Jessamy said she has been concerned about the problem for at least two years - ever since she received troubling reports from tutors in a reading program run by her office for first-time, nonviolent juvenile offenders.
Tests revealed that nearly one out of every five kids scored in the range of mild mental retardation or worse.
"That's when my eyes got opened," she said. "These were kids who were acting out in school, were truant, were aggressive, who couldn't read at all.
"We need a system that identifies these children at the moment they are poisoned, and then tracks them all along so services can be delivered to them before they are thrown at the door of the courthouse. By the time they show up here, nobody knows who's been poisoned and who has not."
The state's failure to track poisoning victims came to light in an article in The Sun on Sept. 10 about a young woman who developed a long record of arrests for violent crime after suffering severe lead poisoning as a toddler.
Barbie Kress, 31, went on to spend her elementary school years in special education classes before dropping out after the eighth grade. She later made 11 trips through Baltimore's court system - spending weeks in the city Detention Center over the past decade - without anyone noting that her brain had been damaged by lead paint.
"This has blocked generations and generations of little kids from even beginning to function in school, and when they wind up on the street unable to hold a job, we dump them in prison," said Ruth Ann Norton, director of the nonprofit Coalition to End Childhood Lead Poisoning.
"It is astounding that we have not looked at this before now."
Nicholas Conti, deputy director of medical services for the Circuit Court of Baltimore, which performs health background checks on defendants, said his staff of about 15 doctors and caseworkers is so overloaded that medical histories in most cases are cursory at best.
In all but a small fraction of the 3,700 adult and juvenile cases reviewed annually, evaluators depend almost entirely on reports by a defendant's family in compiling a medical history for judges to consider before sentencing.
"We've had kids involved in major hit-and-run accidents - comatose in the hospital with brain trauma for days or even weeks - and it never occurred to the mother to report it as part of the child's medical history," Conti said. "The kid appears in court, gets processed, convicted and sentenced without anyone in the system being made aware of the event.
"Lead paint? That's not even on the radar screen."
The same is true for fetal alcohol syndrome, prenatal drug abuse by mothers and shaken baby syndrome - to name three other potentially brain-damaging afflictions commonly seen by doctors in Baltimore.
In addition to chronic staff shortages at the courthouse - where 16 public defenders each handle an average caseload of 400 juveniles every year - most delinquents come from poor families that have been uprooted repeatedly by evictions, rowhouse fires and deplorable housing conditions.
"They move around a lot over the course of their lives, and they might receive treatment at any number of health clinics or doctors' offices," said David Fishkin, chief of the juvenile defenders. "Locating and gaining access to their childhood medical records can be difficult.
"But that's no excuse. Lead paint poisoning is an issue that goes to the heart of basic questions about a kid's competency, even to the threshold question of responsibility. There needs to be a more systematic way of picking up on it."
Currently, no such system exists. At best, fewer than one out of every 10 juvenile defendants receive even a cursory review of their medical histories, court officers say.
"Every now and then, we'll get some statement about a severe childhood injury or illness ... in open court," said Judge Martin P. Welch, chief of the juvenile division, which oversees 8, 500 delinquency cases a year.
"As far as having a psychiatric evaluation or medical history attached to the file so the judge can make an independent evaluation, no, not very often. Lead paint might be mentioned in my courtroom 10 times a year, and we know the problem is more prevalent than that."
Robert Shepherd, a professor at the University of Richmond Law School and a nationally known expert on juvenile delinquency, said evidence of severe childhood lead poisoning could very well affect the outcome in hundreds of criminal cases in cities such as Baltimore.
"Brain injury seems like a terribly obvious thing to ask about in a juvenile case - and it's fairly well understood by most judges," he said. "But it's not on most defense lawyers' lists of essential questions, and it could make all the difference, especially at the sentencing phase.
"Defendants are being tried, convicted and, in some parts of the country, sentenced to death without these factors ever coming to light."
In at least two capital murder cases involving young adults - one in South Carolina and another in Missouri - evidence of serious childhood lead poisoning discovered after convictions was rejected by appeals courts, records show.
Both men, Earl Matthews Jr. of Charleston, S.C., and Gerald Smith of St. Louis, Mo., have since been executed.
"Part of the problem is that so many capital defendants arrive at this end of the system without anybody ever inquiring about their lead- poisoning status when they were juveniles," said Dan Gralike, deputy director of the Missouri Public Defenders System, which assisted in representing Smith.
"The question doesn't get asked until they kill somebody, and maybe not even then."
Conversely, evidence of lead poisoning presented to a jury in Columbia, S.C., in 1997 resulted in a life sentence for another murder defendant over the pleas of prosecutors for a death warrant.
In that case, the same jury that found Lavar Bryant guilty of a screwdriver killing shortly after he turned 18 years old decided that he had been rendered mentally retarded by lead paint and unable to control his violent impulses.
Diminished IQ, problems with language and reading, hyperactivity, impulsive behavior and inability to adapt to stressful circumstances are among the hallmarks of serious lead poisoning, Gioia said.
The toxin is usually ingested through hand-to-mouth contact during early childhood, when crawling children are most likely to come into contact with fine particles of lead dust and chips from disintegrating paint in homes built before 1960. The substance was banned by federal law in 1978.
Once ingested, lead strikes at the developing brain, binding to nerve endings and preventing the absorption of iron, calcium and other minerals essential for proper nervous system development. At higher doses, the toxin can cause irreversible brain damage.
Dr. Peter L. Beilenson, Baltimore's health commissioner and the architect of an initiative to modernize the city's lead paint enforcement system, said his office is now seeking grants to study the problem. Specifically, he wants to investigate the lead-poisoning backgrounds of 100 randomly selected adult felons, 100 juvenile offenders and 100 special education students from Baltimore.
"I don't have any doubt that lead poisoning will be seen as a significant factor driving all these things," he said. "Every study I've seen suggests that we will see a significant correlation across the board in all three of these populations."
He is moving ahead with plans to computerize the Health Department's list of lead-poisoning victims so public agencies can access the information online.
"We're not just trying to systematize this data," he said. "Our goal is to make it available at the push of a button to every agency and health care provider who comes into contact with these kids."
Among other recent Health Department initiatives:
A plan to spend $8. 7 million removing lead paint from up to 600 Baltimore homes next year. The money will be given to qualified landlords and homeowners in the form of loans and grants to repair or replace windows, doors and other high-risk painted surfaces in houses located in 11 city ZIP codes with the highest rates of lead poisoning.
A campaign to inspect properties owned by landlords with "sordid histories" of lead poisoning among tenants. Landlords who refuse to clean up their rental houses or remove them from the market will be prosecuted, whether or not the property has been implicated in a recent poisoning.
A new policy requiring all city health inspectors to conduct thorough checks of property ownership before issuing lead paint citations. The move is aimed at preventing landlords from using questionable ownership documents to dodge enforcement.