Kay Doerr

case management resources continue for families Dr. Wells, xxxEND_PAGE:dhhs02_b1244_4694_4698_1 004695 What is the goal of releasing this data? Especially as it comes on the heels of Dr. Edwards finding that the water is not safe, yet. In my humble opinion, it continues to show the state is telling a story that is not reflective of the reality that residents are living with. Throughout this process, we have discussed repairing the trust relationship between the government and the residents of the City of Flint needs and | believe this only further erodes that trust. | also believe that the community very much needs high-level data. They have responded with remarkable understanding to both Drs. Edwards and Hana- Attisha so | hope you follow their pattern and share the most meaningful data. To start that means not lumping 17-7- year-olds with infants and recognizing lead has a half-life. What is bound to happen is the media will ask experts about this and the experts will highlight discrepancies in the rationale and data and the community is back to square one knowing that the people charged with getting this right still can't quite do it. Thanks, Andy

g xxxEND_PAGE:dhhs03_b0303_1121_1126_2 001123 Reynolds, Lawrence; Laura Carravallah; Marc Edwards; Valacak, Mark; Andy Leavitt; Base Camp Email; Lasher, Geralyn (DHHS); Eisner, Jennifer (DHHS); Dykema, Linda D. (DHHS)

case management resources continue for families Hi Dr. Reynolds, | just got done with an email with Mona--- This is a general public report that is high level--not a technical report, and was not meant to represent a technical report. This is general information--of course our surveillance program is tracking by zip, Medicaid, locality, etc. We can discuss further what type of reporting may be useful to a technical audience---as long as not identifiable (some zips have to be suppressed) | don't see why this can't be done (probably not every two weeks like this public one would be) Warm Regards, Eden Michig. 201 Towns: lreys2@email. com> Sent: Thursday, December 3, 2015 3:25 PM

case management resources continue for families This is a good start but maybe lacking context . Would GIS software identify clusters ? |! am disappointed to see, at this moment , thatDr. Edward's study and Dr. Mona's study which have more granular reporting are given no credence. Is there a reason ? wonsenae == Forwarded message ----------

These materials and his input on their use would be very useful.

Thanks Kay. I think there is a lot of material right now. If anything it needs to be winnowed down. Pater A. Levine, MPH Executive Director Genesee County Medical Society 4438 Oak Bridge Dr. Sulte 8 Flint, ML 48532 Phone:810-7339925 Pax: 810-2303737 email plevine@acmns. ora ‘havigicloud com> wrote: Hello, As discussed, I've been in contact with Dr. Nick Newman. He originally agreed to come to Flint if we needed him for a community forum/conversation. I sent him a message letting him know that several options for reaching out to the community were discussed at a meeting with key medical and public health leaders and the consensus was away from the "one community gathering" concept in favor of a model to engage trusted community leaders who would ultimately take the message and educational materials into the larger community. I'm forwarding his gracious response to let you know that he remains on board to help in any way that is needed. See his message below and feel free to contact him if needed. Thanks, Kay Begin forwarded message:

Hello, As discussed, I've been in contact with Dr. Nick Newman. He originally agreed to come to Flint if we needed him for a community forum/conversation. I sent him a message letting him know that several options for reaching out to the community were discussed at a meeting with key medical and public health leaders and the consensus was away from the "one community gathering" concept in favor of a model to engage trusted community leaders who would ultimately take the message and educational materials into the larger community I'm forwarding his gracious response to let you know that he remains on board to help in any way that is needed See his message below and feel free to contact him if needed. Thanks, Kay Begin forwarded message:

Laura, It looks great, there is a small section of the prirnarily Hint Township zip code that is in the city of Flint and gets Flint water, That zin cade is 48532. Mark Valacak, MPH, Health Officer Genesee County Health Department, 630 S. Saginaw St. Suite 4 Flint, Mi 48502-1540 Phone 810-257-3588 Fax 810 257-3147 E-mail x a us Please consider the environment before printing this e-mail. "There are two lasting bequesis we can hope to give our children: one is roots; the other is wir Hodding Carter *NOTICE: This e-mail, including attachments, is intended for the exclusive use of the addressee and may contain proprictary, confidential or privileged information. If you are not the intended recipient, any disclosure, use, distribution, copying, or taking of any action in reliance of the contents of this e-mail is strictly prohibited. If you have received this e-mail in error, please notify me via e-mail and permanently delete the original and dest all copies. Thank you. for a copy of the Health Department’s Notice of Information Practices, contact the Health Department or visit the Health Department’s website at Sent: Thursday, October 22, 2015 10:34 AM

Water.pdf; ATTOO001.htm Dear Eden, Mark and Kay, lam attaching a draft letter from the medical society that will likely go out today and also my commentary relating to the conversations I have had with the liver services at Henry Ford and UM Ann Arbor. I think the letter is good. I would suggest adding a paragraph - see below. I was able to talk to a Dr. Segovia with Henry Ford hepatology (recommended by Dr. Kim Brown, Director of their Liver Transplant service), and also the nurse of Dr. Askari at UM, the Director of the Wilson Disease clinic there. Dr. Segovia did not have any specific suggestions - they just tell their patients to get their water tested and act accordingly. She was interested in what we find. Dr. Askari's nurse said they tell their patients to use either DISTILLED water (not bottled - for instance they said Dasani actually has rather high levels of copper) OR get a reverse osmosis system. I found some of these systems online and they ranged in price with some around $150 or so. I don't know which ones are good. Dr. Segovia said they may have 1-2 patients with Wilson Disease at the most. Dr. Askari's nurse thought there may be 10 or less in the clinic at UM (they ask them back for annual checks when stable). She said all of their patients get the above advice. I would propose that we add a paragraph that says: "The UM Wilson Disease clinic director, Dr. Askari, recommends that all Wilson Disease patients use either specifically distilled water (not all bottled water is distilled), or a reverse osmosis system. We are hoping to get a reasonably accurate number of patients who may be affected so that we can get the information to them (through you, or through an outside referral clinic) and also see if it is possible to get funding for those who may have difficulty obtaining the necessary water or system, particularly during the next year when the water is still considered more corrosive than average. It is also important to note that copper pipes tend to be more common in newer homes, so the distribution of high concentrations of copper in water may be xxxEND_PAGE:dhhs02_b1073_3743_3745_1 003744 different than that for lead." Iam also going to send this information to Eden Wells at MDHHS at her request. When I spoke to Dr. Marc Edwards on the phone, he did send a list of all the other metals for which he tested and none were over the action limit. As may have been mentioned earlier, he also said that there were no samples which had copper over the action limit, but that is not the appropriate limit for patients with copper storage disease. This problem is clearly much less widespread than the lead problem, but after being surprised once, I don't want for us to leave anything else out this time around. Laura Begin forwarded message: Date: October 22, 2015 at 10:24:21 AMEDT