An innovative law enforcement strategy through health and housing collaboration: The Philadelphia Lead Court

Objectives: This study was designed to determine if the Philadelphia Lead Court was effective as an innovative law enforcement strategy in enforcing the existing city health code when property owners had not responded to orders from the Philadelphia Department of Public Health (PDPH) to remediate lead hazards found in the homes of children with elevated blood lead levels (BLLs). Methods: A quantitative assessment reviewed PDPH of cases from 1998-2002 (the Pre-Court Period) and from 2003-2008 (the Court Period). Compliance rates for each era were compared using a chi-square analysis. Time to compliance was determined by using Kaplan-Meier curves to look at the months until compliance, and a log-rank test compared them. The trends for BLLs of resident children will be examined for the period after compliance is achieved. Qualitative data was analyzed for trends and key themes among 15 key participants in the Lead Court process. Results: A total of 4207 unique properties from the health department records were analyzed. Within one year of the initial failed property inspection 6.6 % of the pre-Court and 72.6% of the Court cases had achieved compliance; p<.0001. The mean number of months to compliance was 50.1 (95% CI=49.3-51.0) months in the pre-Court era and 21.4 (95% CI= 20.1-22.8) months in the Court era; p<0.001. During interviews with Court participants, the responses indicated agreement that the court was very effective, with pre-Court enforcement strategies not effective. Conclusions: Lead Court is proven to be very effective, whereas the pre-court strategies were not effective. With Lead Court, most properties were remediated within one year of the initial failed inspection, and the mean number of months to compliance was less than half. This model of a specialized court could be replicated in other cities with similar problems of housing with lead hazards or difficulties in code enforcement.