Correspondence between

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

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

xxxEND_PAGE:dhhs03_b0236_0908_0932_03 000911 Why are we still doing mass lead screenings? Mona Hanna-Attisha MD MPH FAAP Hurley Children's Hospital Michigan State University mhannal @hurleyme.com Begin forwarded message:

frn hanpy to move tt to the second column and change the language however Ton! would prefer, Just let me know what that language would be and { will update. Angela

instead of adding another column that would say the exact sarne thing in every row, we added a line to the community column as the GCHD is located in the community. The language says: Testing available at GCHD. if that language should be more expansive or datailed, I'm open to suggestions. Angela

ithink | have emailed this about ten times already, there needs to be a third colurnn under testing rnethodology titled GCHD - that is an independant site where kids can get blood lead tested- separate from the primary care providers and separate from community/health plan events.

At ane point, we mentioned doing a lead fair at the farmer's rnarket, but Toni followed up and the farmer's market folks were not interested | think secondary to some recent water-related pratests, fights, etc (the market is below our clinic}. We will dadly sae patients at cur clinic, but ave just fer blood work, we try to be theiy medical home. Mona Hanna-Attisha MD MPH Director, Pediatric Residency Program Hurley Children’s Hospital at Hurley Medical Center Assistant Professor, Department of Paediatrics and Human Development Michigan State University College of Human Medicine Office: $10-262-7257 [email protected]

Hi Mora, {thought af one point you had offered that testing could be offered out of the Hurley clinic at the Farmer’s Market? | may have misunderstead that. That's why we listed ii— and can delete that caolurnn if that isn't an option.

great format. xxxEND_PAGE:dhhs02_b1070_3737_3738_1 003738 the "letter to families" column says throughe AUR i think the first “encouragas" should nat b: thera, it’s like that for whole column. The Hurley clinic is not open te the public. [t is the same as any primary care clinic. That column should be removed. Mayhe it should he replaced by the “Health Department" since that is another site for tasting. Mona Hanna-Attisha MID MPH Director, Pediatric Resiclancy Program Hurley Children’s Hospital at Hurley Medical Center Assistant Professer, Department of Pediatrics and Human Gevelapment Michigan State University College of Human Medicine Office: 810-262-7257 mbannal @hurleyme.corm

Hi all — we’ve been bouncing this around, in terms of format, think this captures what we have talked about. Please take a look, share comments/questions on format, content, etc. Thanks! Nancy xxxEND_PAGE:dhhs03_b0537_1876_1876_1

Hi all —- we’ve been bouncing this around, in terms of format, think this captures what we have talked about. Please take a look, share comments/questions on format, content, etc. Thanks! Nancy xxxEND_PAGE:dhhs02_b1070_3737_3738_2

{think that we are being responsive and we need to work hard to educate ail concerned. There are clinics that are an option as well as the medical horne. This is a knee jerk reaction.

Ro you have his direct nurber?

Yes, and Nick doesn't disagree, but getting out there and testing may be the need to deal with high levels of compaunity strass----did you ever get to talk to Tawwab? He didi not respond te mry cail--—-

interesting. Go these people understand that the half-life of lead in blood is only 1-2 months? What is the purpose of having these kids testing ~ normal levels may be falsely reassuring and it’s highly unlikely that we will pick ug many ESLLS in this school age population. There are aise issinss of consents, release of info to PMDs, follow-up, ete. But peaole want something done, and they want something done fast. People are understandably mad. fini just not sure if this is the best option, but there may be no choice.

Importance: High Folks, Got off the phone with our Director. He is pushing to have on-site lead testing at schools, particularly the 3, in addition to getting primary care providers involved. Pushing to have that done SOUN, Imagine sending horne permission slips on a Monday and attesting on a Thursday. Could get mass volunteers to help. His words! fwill need to get on the phone with a few politicians early this afternoon bout this as well. | will get back to you all.

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My edits on provider letter. Couple comments: e §6ofHd CDC recommend that we screen all kids up to Syrs? Should this be dene annually now? e §=6inthe letter ft says, that if the level is fess than S, we should recheck in 3-6 months? Not sure we need to de that?? Tier tks arte ineletemet nnn escent Sent: Wednesday, October 21, 2015 11:05 AM

| agree--- with caveat's CDC jsut provided---we can't do much but to ensure that they are not drinking the water (and ingesting any other sources of lead). FYI, that was the FASTEST response | have ever gotten out of CDC!!!

Great article, In box 1, lead in water is a risk factor and “blood lead testing should be performed Ifa single risk factor is identified at the earliest contact.” So | would take this at first contact with OB, blood lead should be done and education on nutrition and vitamins, ete. Gur QB's don't know this, This need to be shared.

Let me check with our ATSDR doc, Mark Johnson (Boy there are a lot of Marks...)---because | wonder if the concerns for Flint beg the question. However, | have no idea what the medical removal for lead is for a pregnant women, is that chelation, and is it the same as a child? Anyway, | will follow up with him now.

| dort think anyone knows to test pregnant women. Should we develop a separate communication to O8’s? As @ secondary research project, we will be tested maternal lead at delivery and cord blood lead. But the above sounds fike tt should be a recomraended screening???