Eden Wells

Follow Up Flag: Flag for follow up Flag Status: Completed Thanks so much. A clear story is now emerging. There were two efforts in DCH. One started with great intentions anda good heart and resulted in the july analysis, but was derailed by MDEQ’s misrepresentations from the start. Nobody can be faulted for not picking up the problem with that data given the MDEQ input in July, but that group (in my opinion at least) started going a wrong in early to late September by not sharing data and not being completely forthcoming with results and spinning the data a little especially vs. Mona and the Free press reporter, and then epi took over the analysis and it was back in the hands of competent scientists and over in a few days. There was the second effort prompted by MDEQ in early August, and then gained urgency as a response to our data (email below) and the likelihood VT would “scandalize us all” (email below), resulting in the Flint DW Communications plan. Just FYI...The idea that this person did not know about the high lead in water as they told you, given the e-mails was absurd, as was the idea it was not related or based on our work, or it was a draft. The e-mail trail is pretty much like what | figured it had to be. Of public interest but not really epic wrong-doing. Plus, they obviously believed MDEQ as well. Who wouldn’t. There are two pieces missing. One is the e-mails associated the Bob’s meeting on September 8". In his e-mails to me, he said it would be a great idea for me to do the blood lead work (see below), as they had just met on that subject on that day. | can’t find anything about that meeting anywhere, no notes..no mention of the meeting | can find..nothing on who attended or the purpose of the call. | still think this meeting is responsive to my FOIA including the planning of it, etc.., and who attended. If you want | can submit a new FOIA to get information about the September git phone call and/or meeting, but | don’t see why it is not responsive. The other point just for you information, is that virtually everything | got about Karen’s e-mails, came from someone else, or when | asked for it directly. So | really think something stinks about that. Mona asked her for DCH blood lead data on September 8"" and she did not even bother responding to Mona, and did not lift a finger to get the data? It doesn’t make sense. Someone probably told her not to give Mona the data, or not to respond to Mona. But you have tried really hard with her and | appreciate it. Just wanted to give you my take on how the story rolls. lam really glad | did not have to do that January 4% piece, as it would have been about how your staff was misleading you, and would have looked bad, and this really saved a lot of pain and suffering on all sides. | really appreciate your effort to get the story straight. | hope | was proven to not be completely crazy about the origins of the communications plan. Thanks, and please tell me if | need to submit a new FOIA on the September gi meeting/call, etc. with Bob. Or if you want to talk about any of this let me know. Best Regards, Marc

ATTO0002.htm Sent from my iPhone Begin forwarded message:

Great- thanks!

We are expanding the distribution of the physician info through some additional channels. Sent from my iPhone Begin forwarded message:

+ i received this from the Genesee County Medical Society yesterday. iam thinking this went out te alf members.

Sent from my iPhone Begin forwarded message:

great. we have ebout 16,000 of our lead nutrition packets thet they can take with them for each clinic. they key is buying lunch for the practices - then you will have an audience, Mona Hanne-Altisha MID MIPH FAAP ectar Pedistde Residency Hudey Children’s Hospital at Hurley Michigan State U lege Denartment of Mhannal @hurleyme.com

if it would be of any help, we could have a lead case manager attend as well to put a name and contact infarmation in physicians hands. This morning Lasked the case managers to contact the largest pediatric practices and see about meeting with them regarding case management services, sources for filters, nutrition and answer any general questions they might have. Torti L LaRocce MS, RN Director of Nursing Services Genesee County Health Deparirnent 810.237 4544 [email protected] Goatihadte attoeke bee Sectrese af tke, (0 bared whet we have tle exoagh, aad mare, (0 toons densal ate # 4 fe F ty, 18 sae Sager 2 itd ee @ feast, a daiage its a dime, a Soranpon 3 5 o motes aa Sa otpoete oe csaeheceoing Bs ok BOGE PEED, GREE OO OLOM, GORRUSION UF Obs xxxEND_PAGE:dhhs03_b0236_0908_0932_01 000909 a é f é db keatitade makes wre of eae fae, f you have received this ¢- copes. Thank you. ‘Bere Ey

Okay....f just dort want peaple falling through the cracks. TorwwL LaRocco Ms, RN Director of Nursing Services Genesee County Healih Depariment 810.237 4544 [email protected] Se o. werk BO GaaBe, RES sOee, £8 tases dew’ ate ra fF oe. é a & rat . . z geonstance, chaos te eetes, conpasine & obenig, f wend ale a feast a ease whe a howe, a Sh ee a frvord, Grade Wake saber sense af our past, dolege coats. fos tala, get cmeates a ase fom Gemcnnsis~ 8 intended for ihe excuse . you are 4 of the content use of the addressee and may contain ded recipient, any d ute, u nsfribation, ted. HP you he scehved this &- Stroy alloomles Thank you, fidential or pros ney Of any sothon iy Ing f HF a website al hitec/Awwwy For & copy o' he Health Department's Notice of information Practices, contect the Health Denartrnent ar visit the Heallh ond uss Department's

Good morning , fwilrelay, with your permission of course, this email te our Medical Services Administration, with whorn | have had the same discussions. Rest assured that | saw a multi-point plan from this health plan about how to address the issues in their patient population, and these comrnunity engagement pieces are just one part. One issue all are trying to capture is the urgency under which the enhanced testing needs to be conducted, so this is one of a number of strategies the health plans are utilizing. Another part is of utmost concern, that i know is also in multiple health olans’ strategic approaches, is that of provider engagernent. Despite the news and the blast faxes and the Health Alerts and the Pravider Letters and the Toolkits, we continue to hear fron citizens, the Governior’s Task Force and EBL case investigators and case managers, that providers are not asking about lead exposure to Flint water since April 2014, nor asking about testing/screening, or whether families have filters. f tried to set up @ provider forurn in Nov-Dec to Httle or no interest, but ami now working to get one rolling regardless, in partnership with health plans, by end of this month. twould really be helpful ff you could be there to speak about this very issue and give the perspective of 2 local physician responding to the crisis, andi a leader of best practices. We will webinar it and archive it as well (lam wondering if car make it CME-able as weil}, and Dr. Reynoids, tt would be great to have you involved as well--- Eden Eden V. Wells, ME, MPH, FACRM Chieti Medical Executive ichigan Departrnent of Health and Hurnan Services 201 Townsend St, 5™ Floor CV8 Lansing, Mi48923

xxxEND_PAGE:dhhs03_b0236_0908_0932_02 000910 Thanks for your reply, Eden. Yes, | have had discussions with Matt Davis about this as well and it was my understanding that it was recommended to expand screening, but dical homes as you said. if we all agree te drive kids te their medical homes first, the primacy of the medical home, why is that not being cone first? What are the medicaid HMOs doing to push kids fo their medical homes? How are they incentivizing visits, providing case Management, partnering with practices, enhanced transportation, etc? This is what needs te happen - nat only will all of this improve lead screening rates, but also immun rates and all other HEDIS measure that HMOs land providers} care about. Monu Hanne-Alticha MD MIPH FAAP Prograr rector Pech Residency Michiga Date: Human Me Denerira § aad Huraan Deyelonraent Mhaonal @hurleyme.corn

Hi Mona, The Governor's Task Force has made a number of preliminary recommendations to MDHHS last month, and a major one is to maximize blood lead screening. The primary care home is best, all agree, and health plans are identifying any children that have not been tested. Current thoughts are that there could be thousands. Health plans will be closely monitoring the provider follow up as well post initial screens. And, while it does not pick up potential lead exposure prior to Oct 1, water is still a potential source if public health measures are not being used, or used appropriately. Also there is a need to establish the prevalence of EBL in this impacted community- | have had long discussions with Matt Davis about this, and Larry is aware as well. | can discuss further if needed. But all, including Medicaid, agree with the primacy of the patient primary care home. E Sent from my iPhone

If [remember correctly — there was some concern that she is under IRB for her study at Hurley. And that that data is not subject on our reportable to public health under the code. The S — actually — she does not need additional IRB — she just needs parental consent to share the information with public health. I will clarify that with her. Sent from my iPhone Come to think of it, why would Mona read IRB approval for supplemental information for her research study on cord blood? (This is a different project than her study with MBHHS and our lead ragistry data, of course}

Okay. Thanks. Toni l LaRocco MS, RN Director of Nursing Services Genesee County Health Department 810.237 4844 [email protected] aad wore, & beoas dental te wy oberg, & eae tore 2 ao it a feest @ Hinge ts & Hee, & Seeraegee e . ra of. f wos o ae ee & poe sah, Gratiade wales. Y goatee af BAP LRG, bvtege, perce for tokeg, ued txoaind & wisien Sor Gomorresd, ~ : fi of y fs ‘ Pattie Es #NOTICE: Tins om proprietary, confidential eepying, of faking of any a i m tera, please nobfy me we is intended for ine exchusi ve use of ihe address: Se and may co Hl nended recipier i *, USS, distribution, . is strictly @ peaelved this e- a and RHEE RAS delete the original aad desimy all copies. Thenk you, Hee aR Department's N jee ef information Pract conlacl ihe Healih Depariment of visi ine Health For a copy off

All, l’ll be updating the attached HHS timeline as we go forward with our activities in the city of Flint. | can glean some items to include from the daily SitReps and I’m also asking that you provide any additional noteworthy items to me at the end of each week. Please forward to anyone that I’ve not included here. Thanks for your cooperation. Linda B. Dyhena, PAD. Environmental Public Health Director Giision of Environrnental Health Michigan Department of Health & Human Services S17,335.8566 dykermal@ michigan gov xxxEND_PAGE:dhhs02_b0492_1910_1910_1

ichigan.gov> When talked with Or. Mona Hanna-Attisha last Wednesday, they are still working on the IRB supplemental information requested. E

De you have a status report on this? | just got an ernail from toni Lareeco asking.

xxxEND_PAGE:dhhs02_b1194_4563_4568_1 004564 Where are we with this issue? Bath the case rnanagement and how itis being sent to the state data base? Toni L LaRocco MS, RN Director of Nursing Services Genesee County Health Department 610.237 4544 [email protected] femny lensak pele i a . e os elf thee fellhes OP 8 if ihe, fb Laees wheal we have ote é g : : oot fear U8 683 ty, 10 ean taser a meal its RUS & howe, & Suranger Fesed va if Ea baa, dad eeaates & aisir See Comores, f f HS SENS OE Par £48, heise Posie soe 2 ive use of the ad ended recipier aoe For a copy Deparment h Deparmeni’s Notice of information Practices, contact the al Rip Awa sohd us! jeaglin Decariment or visi

ttalkhed with Kathy S last week on this very topic, they are on it!

No worries, Brenda, he is likely quite aware- E Sent from my iPhone

Thanks, Bob- Sue- how should we update Chris on this? Sent from my iPhone michigan.gov> wrote: lagree--plans can view lead info in MCIR, but it’s not the most efficient way to get plan- wide lead data. in answer to Eden's question below: new lead data becomes available in the Warehouse and MCIR at the same time--generally each Monday morning. We've been anticipating the need for a weekly file to Medicaid health plans. Daisy Peng helped me with a Warehouse query that identifies the health pian Uf applicable} for each new lead result. Bob

Thanks. Wi de.

Linda—this is the MDHHS Flint Water timeline, compiled from information discussed during our internal team meeting. The timeline is current through 12-30-15. The most recent update references the provider letter distributed by Medicaid on 12-30-15 -- Blood Lead Guidelines to Address the City of Flint Residents’ Potential Exposure to Lead. At this point, | think it makes sense for your area to be the “keeper of the timeline” and ensure that it is kept up to date, and maintain version control. Let me know if you have any questions. Sue xxxEND_PAGE:dhhs03_b0891_3143_3143_1

Thank you, Corinne, will relay... E

Ps. The plans would need to look child-by-child in the MCIR. They can accumulate names as they look them up but having Bob provide them a weekly file is going to be easier for them. Sent from my iPhone