District of Columbia's Drinking Water: Agencies Have Improved	 
Coordination, but Key Challenges Remain in Protecting the Public 
from Elevated Lead Levels (31-MAR-05, GAO-05-344).		 
                                                                 
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.								 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-05-344 					        
    ACCNO:   A20581						        
  TITLE:     District of Columbia's Drinking Water: Agencies Have     
Improved Coordination, but Key Challenges Remain in Protecting	 
the Public from Elevated Lead Levels				 
     DATE:   03/31/2005 
  SUBJECT:   Consumer education 				 
	     Federal regulations				 
	     Government information dissemination		 
	     Hazardous substances				 
	     Health hazards					 
	     Interagency relations				 
	     Municipal governments				 
	     Performance measures				 
	     Potable water					 
	     Regulatory agencies				 
	     Water pollution control				 
	     Public health					 

******************************************************************
** This file contains an ASCII representation of the text of a  **
** GAO Product.                                                 **
**                                                              **
** No attempt has been made to display graphic images, although **
** figure captions are reproduced.  Tables are included, but    **
** may not resemble those in the printed version.               **
**                                                              **
** Please see the PDF (Portable Document Format) file, when     **
** available, for a complete electronic file of the printed     **
** document's contents.                                         **
**                                                              **
******************************************************************
GAO-05-344

United States Government Accountability Office

GAO	Report to the Chairman, Subcommittee on Environment and Hazardous Materials,
           Committee on Energy and Commerce, House of Representatives

March 2005

DISTRICT OF COLUMBIA'S DRINKING WATER

Agencies Have Improved Coordination, but Key Challenges Remain in Protecting the
                        Public from Elevated Lead Levels

                                       a

GAO-05-344

[IMG]

March 2005

DISTRICT OF COLUMBIA'S DRINKING WATER

Agencies Have Improved Coordination, but Key Challenges Remain in Protecting the
Public from Elevated Lead Levels

  What GAO Found

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.

United States Government Accountability Office

Contents

  Letter

Results in Brief
Background
Agencies Have Improved Coordination, but Challenges Remain in

Reducing Lead Levels WASA and Other Agencies Are Taking Steps to Identify
At-Risk Populations and Reduce Their Lead Exposure Experiences of Other
Water Systems Highlight Ways to Better Educate the Public Although Lead
Exposure Causes Serious Health Effects, Research

on Low-Level Exposure to Lead in Drinking Water Is Limited Conclusions
Recommendations for Executive Action Agency Comments and Our Evaluation

1 3 6

9

12

17

22 27 28 28

Appendixes                                                           
               Appendix I:            Scope and Methodology                31 
              Appendix II:  Comments from the Environmental Protection     33 
                                              Agency                    
                              Table 1: Summary of Selected June 2004    
     Tables                               Consent Order                 
                              Requirements and Compliance Activities       10 
                            Table 2: WASA's Priority Lead Service Line  
                                           Replacement                  
                                             Program                       14 
                           Table 3: Portland's Targeted Lead Education     20 
                                             Program                    
    Figures                 Figure 1: Inventory of WASA Service Lines         
                            Figure 2: Lead Service Line Configuration   13 15

Contents

Abbreviations

CDC Centers for Disease Control and Prevention
EPA Environmental Protection Agency
IEUBK Integrated Exposure Uptake Biokinetic Model for Lead
MCL maximum contaminant level
MCLG maximum contaminant level goal
MOU memorandum of understanding
MWRA Massachusetts Water Resources Authority
ppb parts per billion
WASA District of Columbia Water and Sewer Authority
WIC Women, Infants, and Children

This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed in
its entirety without further permission from GAO. However, because this
work may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this material
separately.

A

United States Government Accountability Office Washington, D.C. 20548

March 31, 2005

The Honorable Paul Gillmor
Chairman
Subcommittee on Environment and Hazardous Materials
Committee on Energy and Commerce
House of Representatives

Dear Mr. Chairman:

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,1 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

1GAO, Drinking Water: Safeguarding the District of Columbia's Supplies and
Applying Lessons Learned to Other Systems, GAO-04-974T (Washington, D.C.:
July 22, 2004).

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.2 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.3 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

242 U.S.C. 300f-300j. 340 C.F.R. pt. 141, subpart I.

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.

Results in Brief	WASA and other government agencies implementing the Safe
Drinking Water Act's regulations for lead have taken steps to improve
their coordination, but challenges remain to reduce lead levels. According
to EPA officials, WASA appears to be on track to meet the terms of a June
17, 2004, consent order the two agencies signed. The consent order
required WASA to take a number of corrective actions that, by necessity,
enhanced its coordination with EPA and the D.C. Department of Health.
Among these actions were developing a plan to identify additional lead
service lines,

improving the selection of sampling locations and reporting of water
testing results to EPA, developing a strategy to improve WASA's public
education efforts, and collaborating with the D.C. Department of Health to
set priorities for replacing lead service lines. WASA has also agreed to
implement several recommendations the D.C. Inspector General made in a
January 2005 report to improve coordination between EPA, WASA and the D.C.
Department of Health. However, improved coordination has not, and may not,
resolve all problems. EPA and WASA officials remain concerned about lead
levels in drinking water. Tap water test results that WASA submitted in
January 2005 indicate the drinking water WASA provided still exceeds the
action level for lead of 15 parts per billion. 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.

WASA is taking steps to identify those customers most at risk from
exposure to lead in drinking water and to reduce their exposure. WASA and
EPA are focusing on lead service lines as the primary source of lead in
drinking water in the District of Columbia. Under the consent order, WASA
is identifying those most at risk by updating its inventory of lead
service lines, primarily by determining the composition of service lines
made of unknown materials. In addition, to reduce the exposure of District
residents to lead in drinking water, WASA is accelerating its rate of lead
service line replacement and, consistent with the consent order, providing
priority replacement for populations particularly vulnerable to the health
effects of lead. Locations eligible for priority replacement of lead
service lines include day care centers and homes housing children up to 6
years old with elevated blood lead levels. However, questions remain about
the success of this replacement program because WASA often replaces only
part of the lead service line. Generally, ownership of service lines is
shared-WASA owns the portion from the water main to the property line, and
homeowners own the portion from the property line to the home. Homeowners
may pay to replace their portion of the lead service line at the same time
as WASA replaces its portion, but are not required to do so. Only 2
percent of homeowners replaced their portion of the service line in fiscal
years 2003 and 2004. WASA officials attribute low homeowner participation
to cost concerns, but believe its incentive program-which includes
lowinterest loans, grants, and a fixed-fee structure-is increasing the
number of full pipe replacements. Available data from fiscal year 2005
show that 14 percent of customers have replaced the private portion of
their home's lead service line.

Other water systems use innovative methods to educate their customers
about lead in drinking water 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 community groups, and
targeting and adapting information to audiences most susceptible to lead
exposure through drinking water. Many of these practices go well beyond
the requirements of the Lead and Copper Rule. Representatives from the
water industry and community groups as well as other experts have found
several shortcomings with the Lead and Copper Rule's public education
requirements. They noted, for example, that the rule's required
notification language is confusing and that a water system has up to 60
days to notify its customers if the system exceeds the action level for
lead. EPA is both examining water systems' compliance with the Lead and
Copper Rule's public education requirements and considering changing the
rule or its accompanying guidance documents and training. While we support
this effort, the clear deficiencies of the rule's public education
requirements call for more immediate action to assist water systems in
their efforts to educate the public. Therefore, we recommend that EPA
identify and publish best practices that water systems are using to
educate the public about lead in drinking water.

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, and these studies are now nearly 20 years old.
Acknowledging the need for improved and up-to-date information, officials
in EPA's Office of Water and its Office of Research and Development
indicate that they are beginning to address certain information gaps about
the health risks of lead in drinking water. For example, the Office of
Water is planning to prepare a health advisory document for lead to help
utilities and state and local officials explain the risks of lead exposure
to the public. Additionally, the Office of Water is planning to develop a
paper summarizing the results of research conducted on lead exposure since
the Lead and Copper Rule was published in 1991. However, the timetable for
completing these projects is not clear, and it is also not clear how this
work will fit into a broader agency research agenda or if this research
needs to involve other key organizations, such as CDC. To address this
issue, we recommend that 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.

Background	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.4
Large systems, including WASA's, generally must take at least 100 tap
water samples in a 6month 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

4For each monitoring period, a system must report the 90th percentile lead
level of homes monitored. For example, if a system monitors 100 homes, it
sorts its results from the lowest to the highest concentrations and
reports the concentration it observed in the 90th sample.

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.5 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:

o 	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.

o 	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.

o 	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

5The water system must also offer to sample the tap water of any customer
who requests it, though the system is not required to pay for sample
collection or analysis.

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.

o 	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.6 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.7 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.

6Under the rule, a water system can stop replacing lead service lines if
lead concentrations are below the action level for two consecutive 6-month
monitoring periods.

7On January 14, 2005, EPA Region III issued a supplemental consent order
stating that WASA used an improper methodology to collect many of these
samples. The order requires WASA to physically replace by the end of
fiscal year 2007 any lines that were deemed "replaced" because they showed
a lead level below 15 ppb in these improper tests.

  Agencies Have Improved Coordination, but Challenges Remain in Reducing Lead
  Levels

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.

    WASA Has Improved Coordination with Other Agencies

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.

Table 1: Summary of Selected June 2004 Consent Order Requirements and
Compliance Activities

        Required WASA action      Submitted to EPA         EPA action         
                                                    Provided comments to plan 
Submit tap water sampling plan  June 25, 2004         on July 14, 2004; no 
                                                    approval required under   
                                                             order            
Develop a new public education                   Provided comments to plan 
                plan               July 19, 2004           on August 2, 2004; 
                                                   no approval required under 
                                                             order            
      Develop a plan to update                                                
     inventory of lead service                       Approved September 29,   
               lines               August 2, 2004             2004

With D.C. Department of Health approval, develop plan for August 2, 2004
Approved September 29, 2004 prioritizing replacement of lead service lines

Develop plan to encourage homeowners to consent to full August 2, 2004
Approved August 10, 2004 replacement of lead service lines

Develop plan for enhanced database management and August 16, 2004 Provided
comments to plan on September 3, reporting 2004; no approval required
under order

Source: EPA.

WASA also agreed to implement 11 of the 12 recommendations contained in
the D.C. Inspector General's January 2005 report.8 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

8District of Columbia, Office of the Inspector General, Audit of Elevated
Levels of Lead in the District's Drinking Water, OIG No. 04-2-17LA (Jan.
5, 2005).

Inspector General's view that an MOU would serve to define the two
agencies' roles and responsibilities and help improve their coordination
and partnership.

    Lead Levels Remain Above the Action Level

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.9 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

9EPA officials believe that the removal of free chlorine, rather than the
addition of chloramines, resulted in the increase in corrosion.

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.

  WASA and Other Agencies Are Taking Steps to Identify At-Risk Populations and
  Reduce Their Lead Exposure

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.

    WASA Is Updating Its Lead Service Line Inventory

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.10
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.

10WASA's baseline inventory is the number of lead service lines present on
June 30, 2001. This baseline number changes over time as WASA identifies
the composition of additional lines.

                   Figure 1: Inventory of WASA Service Lines

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,

2%

Lead lines replaced (2,229)

                     Lead service lines remaining (21,408)

Unknown material (31,380)

Nonlead service lines (76,915)

                                 Source: WASA.

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.

    WASA Is Accelerating Lead Service Line Replacement and Targeting At-Risk
    Populations

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;11 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.

 Table 2: WASA's Priority Lead Service Line Replacement Program Number of lead
                             service lines replaced

                                                   Children    
                                                   under 6, or 
                           Children under          pregnant or Total priority 
                                   6 with          nursing     
            Year           elevated blood Day-care       women   replacements 
                                     lead centers              
Fiscal 2004 (completed)            135       46         137 
Fiscal 2005 (estimated)            289      119        592a         1,000b 

Source: WASA.

Notes: WASA priorities for replacement in 2004 were different from the
2005 priorities. WASA's first priority in 2004 was day-care centers,
followed by children with elevated blood lead and high-risk residents
(children under 6, or pregnant or nursing women).

aWASA is forwarding 2,097 notices to customers who identified themselves
as members of this group, and customers must provide verification.
Additionally, not all of these homes will actually have a lead service
line, when tested.

bThe June 2004 consent order requires WASA to replace 1,000 service lines
on a priority basis by the end of fiscal year 2006. WASA officials plan to
meet this deadline by the end of fiscal year 2005.

11Elevated blood lead in children younger than 6 is defined as 10
micrograms per deciliter or greater, according to CDC guidelines.

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

o 	a low-interest loan program for low-income residents, offered through a
local bank;

o 	grants of up to $5,000 for low-income residents, offered by the
District of Columbia Department of Housing and Community Development; and

o 	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.

  Experiences of Other Water Systems Highlight Ways to Better Educate the Public

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.

Other Water Systems Used WASA's experience highlights the importance of
conducting an effective Innovative Methods to public education program. In
its June 2004 consent order, EPA found that Educate the Public about WASA
had committed only a few violations of the public education

    Lead in Drinking Water

requirements of the Lead and Copper Rule.13 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:

o 	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.

o 	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.

13The June 2004 consent order that WASA signed with EPA describes some
violations of the public notification requirements of the Lead and Copper
Rule, including using language slightly different from that required by
the rule and issuing fewer public service announcements than required.

o 	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.

Table 3: Portland's Targeted Lead Education Program

                              Targeted population

Homes at Low-Childhigh risk for Older income oriented Home Specific Broad
Activity lead in water homes residents services remodels populations
population

Annual lead brochure X X X X X X

Annual Consumer Confidence X X X X X X
Report

Postcard outreach to homes built X
between 1970-1985, with children 6
and under

Childcare outreach X X

Lead education and LeadLine XXXXX X
brochure distribution

Lead education video X X X

Outreach to health providers X X

Landlord training and landlord X
outreach

Community forums: African-X X X
American, Vietnamese, Russian
communities

Billboards, bus ads, and theater ads X X

Newspaper ads in community X X X
newspapers

Home Depot, permit center, and X X
community location displays

Location of clinics and workshops X X X

Head Start outreach X X X

Canvassing in target areas X X X

Low-income renters-outreach by X X X
Community Alliance of Tenants

Blood lead testing for children of X X X
migrant workers

Mailing to child-care facilities X

Source: Portland Water Bureau.

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.

    Lead and Copper Rule Public Education Requirements Have Several Shortcomings

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:

o 	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.

o 	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.

o 	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.14

o 	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.

  Although Lead Exposure Causes Serious Health Effects, Research on Low-Level
  Exposure to Lead in Drinking Water Is Limited

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.

14Public notification for violations with the potential to have serious
adverse effects on human health as a result of short-term exposure is
required within 24 hours.

    Lead Exposure Causes Serious Health Effects, Particularly in Children

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.15 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.

15The Agency for Toxic Substances and Disease Registry defines acute
exposure as 14 days or fewer, intermediate exposure from 15 to 365 days,
and chronic exposure as 365 days or more.

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.16 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 2000.17 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.18 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

16The National Health and Nutrition Examination Surveys represent a series
of crosssectional surveys, which used stratified, multistage, cluster
samples of households with a target population of civilian,
noninstitutionalized residents of the United States. The analysis of the
surveys was weighted using population estimates obtained from the U.S.
Bureau of the Census.

17Given the low prevalence of elevated blood lead levels and a limited
sample size, the CDC estimates that elevated lead levels falls within the
range of 1.0 to 4.3 percent, with a 95 percent confidence interval, for
the surveys in 1999 to 2000.

18L. Stokes et al., "Blood Lead Levels in Residents of Homes with Elevated
Lead in Tap Water-District of Columbia, 2004," Morbidity and Mortality
Weekly Report, vol. 53 (Mar. 30, 2004).

known lead service lines and homes with nonlead service lines.19 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.

    Research on the Health Effects of Lead in Drinking Water Is Limited

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.20

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

19Nonprobability samples are not randomly selected from the population
being studied. This means that every member of the population does not
have an equal chance of being selected for the study. Because this study
uses a nonprobability sample, the results of the study cannot be
generalized to the population of District of Columbia residents.

20R.F. Lacey et al., "Lead in Water, Infant Diet and Blood: The Glasgow
Duplicate Diet Study," The Science of the Total Environment, vol. 41 (Mar.
1, 1985).

as little as 5 percent to more than 50 percent of a child's total lead

21

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.

    EPA Is Beginning to Address Certain Information Gaps in the Health Risks of
    Lead in Drinking Water

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.

21U.S. Environmental Protection Agency, Lead and Copper Rule, The Federal
Register, vol. 56, no. 110 (June 1991), 7.

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.

Conclusions	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.

  Recommendations for Executive Action

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.

  Agency Comments and Our Evaluation

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 [email protected]. Individuals making key
contributions to this report included Steve Elstein, Samantha Gross, Karen
Keegan, Tim Minelli, and Carol Herrnstadt Shulman.

Sincerely yours,

John B. Stephenson Director, Natural Resources and Environment

Appendix I

Scope and Methodology

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

Appendix I Scope and Methodology

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.

Appendix II

Comments from the Environmental Protection Agency

Appendix II
Comments from the Environmental
Protection Agency

Appendix II
Comments from the Environmental
Protection Agency

GAO's Mission	The Government Accountability Office, the audit, evaluation
and investigative arm of Congress, exists to support Congress in meeting
its constitutional responsibilities and to help improve the performance
and accountability of the federal government for the American people. GAO
examines the use of public funds; evaluates federal programs and policies;
and provides analyses, recommendations, and other assistance to help
Congress make informed oversight, policy, and funding decisions. GAO's
commitment to good government is reflected in its core values of
accountability, integrity, and reliability.

Obtaining Copies of The fastest and easiest way to obtain copies of GAO
documents at no cost

is through GAO's Web site (www.gao.gov). Each weekday, GAO postsGAO
Reports and newly released reports, testimony, and correspondence on its
Web site. To Testimony have GAO e-mail you a list of newly posted products
every afternoon, go to

www.gao.gov and select "Subscribe to Updates."

Order by Mail or Phone	The first copy of each printed report is free.
Additional copies are $2 each. A check or money order should be made out
to the Superintendent of Documents. GAO also accepts VISA and Mastercard.
Orders for 100 or more copies mailed to a single address are discounted 25
percent. Orders should be sent to:

U.S. Government Accountability Office 441 G Street NW, Room LM Washington,
D.C. 20548

To order by Phone:	Voice: (202) 512-6000 TDD: (202) 512-2537 Fax: (202)
512-6061

  To Report Fraud, Contact:
  Waste, and Abuse in Web site: www.gao.gov/fraudnet/fraudnet.htm

E-mail: [email protected] Programs Automated answering system: (800)
424-5454 or (202) 512-7470

Congressional	Gloria Jarmon, Managing Director, [email protected] (202)
512-4400 U.S. Government Accountability Office, 441 G Street NW, Room 7125

Relations Washington, D.C. 20548

Public Affairs	Paul Anderson, Managing Director, [email protected] (202)
512-4800 U.S. Government Accountability Office, 441 G Street NW, Room 7149
Washington, D.C. 20548
*** End of document. ***