Correspondence between

The attached is rare of a communications decurnent — it has been updated to capture the info provided by Sue. Jennifer Eisner Public information Officer

FYI, there was a follow up asking about the emails and I responded with: There were seasonal increases during the third quarters of 2014 and 2015, but the extent of these increases were not apparent until zip code levels were analyzed. As a result of this process, we are thoroughly reviewing the way we analyze data. Our after action report will help determine how we conduct this process in the future. Stale Original Message-----

With edits from the gov’s team in bold.. The Michigan Department of Health and Human Services has consistently provided information regarding blood lead levels in the city of Flint. When initially looking at the citywide and county elevated blood lead level numbers, the increase appeared to be consistent with the routine seasonal fluctuation seen in the summer months. It wasn’t until the Hurley report came out that our epidemiologists took a more in-depth look at the data by ZIP code, controlling for seasonal variation, and confirmed an increase outside of normal trends. As a result of this process, we have determined that the way we analyze data needs to be thoroughly reviewed. Additionally, Gov. Rick Snyder has created a Flint Water Task Force to review all city, state and federal responses and actions and is expected to make recommendations moving forward. Our department is focused on ensuring that appropriate casé management and follow up is occurring in Flint. Summary reports outlining blood lead level testing are posted.online on a bi-weekly basis, and we are working closely with local partners to fulfill data requests as we receive them. Regarding the FOIA, Mr. Edwards received all of the requested documents, with personal information redacted, on Friday, December 18. Jennifer Eisner Public information Officer Michigan Department of Health and Human Services Office: 517-241-2112 or [email protected] xxxEND_PAGE:dhhs03_b0333_1234_1237_1 001235

The Michigan Department of Health and Human Services has consistently provided information regarding blood lead levels in the city of Flint. When initially looking at the citywide and county elevated blood lead level numbers, the increase appeared to be consistent with the routine seasonal fluctuation seen in the summer months. It wasn’t until the Hurley report came out that our epidemiologists took a more in-depth look at the data by ZIP code, controlling for seasonal variation, and confirmed an increase outside of normal trends. As a result of this process, we have determined that the way we analyze data needs to be thoroughly reviewed. Additionally, Gov. Rick Snyder has created a Flint Water Task Force to review all city, state and federal responses and actions and is expected to make recommendations moving forward. Our department is focused on ensuring that appropriate case management and follow up is occurring in Flint. Summary reports outlining blood lead level testing are posted online on a bi-weekly basis, and we are working closely with local partners to fulfill data requests as we receive them. Regarding the FOIA, Mr. Edwards received all of the requested documents, with personal information redacted, on Friday, December 18. Jennifer Eisner Public Information Officer Michigan Department of Health and Human Services

Final? On Dec 21, 2015, at 2:36 PM, Eisner, Jennifer (DHHS) <fisne: Thank you ~ hera’s what we have: The Michigan Department of Health and Human Services has been, and continues to be, committed to full disclosure of information regarding the city of Fint and blood fead levels. To suggest otherwise is not corsistent with how we have responded. hen initially looking at the citywide and county elavated blood lead level numbers, the increase appeared to be consistent with the routine seasonal fluctuation saan in the sunamear months, wast until the Hurley report came out that our epidemiologists took a more in-depth look at the cata by zip cade, controling for seasonal variation, and confirmed an increase outside of normal trends, As a result of this process, we have determined that the way we analyze data collected needs to be thoroughly reviewed. Qur after action report will help determine how we conduct this process in the future. Our department is focused on ensuring that appropriate case raanagemant and follow up is occurring in Flint. Summary reports outlining blood feacd level testing are pasted online on a ol-weekly basis, and we are working closely with local partners to fulfill data requests as we receive them. Regarding the FOIA, Mr. Edwards received all of the requested documents, with personal information redacted, on friday, Decamber ig, Jennifer Eisner Public Information Officer partment of Health L?-244-2142 or & tan Services xxxEND_PAGE:executiveofficeemails19_b098_280_282_2 xxxEND_PAGE:executiveofficeemails19_b098_280_282_3

That works. | was also typing something similar as G’s response came in. | had this: “When initially looking at the citywide and county elevated bload lead level numbers, the aggregate data suggested a seasonal fluctuation consistent with trends noted prior to the switch in the water source.”

When initially looking at the citywide and county elevated blood lead level numbers, the increase appeared to be consistent with the routine seasonal fluctuation seen in the summer months.

Qualify how??? Instead of saying they did not indicate anything other than Should we say instead: Seasonal fluctuation was indicated.

xxxEND_PAGE:dhhs03_b0333_1234_1237_3 001237 | have an issue with one sentence. | think the "they did not indicate@ could be qualified.

Pro ok. with this.

Importance: High For your review asap.. the reporter has a 3 p.m. deadline.. The Michigan Department of Health and Human Services has been, and continues to be, committed to full disclosure of information regarding the city of Flint and blood lead levels. To suggest otherwise is not consistent with how we have responded. When initially looking at the citywide and county elevated blood lead level numbers, they did not indicate anything other than seasonal fluctuation. It wasn’t until the Hurley report came out that our epidemiologists took a more in- depth look at the data by zip code, controlling for seasonal variation, and confirmed an increase outside of normal trends. As a result of this process, we have determined that the way we analyze data collected needs to be thoroughly reviewed. Our after action report will help determine how we conduct this process in the future. Our department is focused on ensuring that appropriate case management and follow up is occurring in Flint. Summary reports outlining blood lead level testing are posted online on a bi-weekly basis, and we are working closely with local partners to fulfill data requests as we receive them. Regarding the FOIA, Mr. Edwards received all of the requested documents, with personal information redacted, on Friday, December 18. xxxEND_PAGE:dhhs02_b0078_0296_0296_1

‘

Importance: High All -- Marc Edwards is issuing a report this afternoon based on the documents he received via FOIA. He's already sent copies to members of the media -- we haven't seen the report yet but will need to respond once we do. Thank you, Jennifer

> The governor's team has given the go ahead. We've adjusted the timeline slightly to issue the press release and post the report at 2:30 p.m. Embargoed stakehalder notifications will now happen at 2 pam. as outlined below: 2pm. ® Send final embargo release and summary report to: o Genesee County Health Department —- Geralyn Lasher o by. Mone Hannah-Attisha - Geralyn Lasher o Task Force Members ~ Geralyn Lasher o City of Fling Mayor's Office — Geralyn Lasher o Congress are legislature - Elizabeth Hertel 2:30 p.m. ® issue press release and summary report ® Past press release ard summary report to MDHHS website newsraam and Flint Water website, www suchigan gov/Hintwater xxxEND_PAGE:dhhs03_b0197_0766_0768_1 000767 3 pan. * Pitched media interviews with Dr. Eden Wells Thank you, Jennifer Eisner Public information Dicer Michigan Department of Health an i AL-2112 or Bignari@

Comms Plan - Flint EBL Data Summary 12315.docx Looping in Elizabeth. Jennifer Eisner ic Information Officer Health and Human Services ichigar Department

Importance: High wackertl [email protected]>; Moran, Susan Good morning: The attached updated press release includes additional information and edits as requested by the governor’s office. Please review as soon as possible, as we will be sending our final version back to them and DEQ at 11 a.m. In addition to the press release updates, the governor has the following questions — please review the responses and provide edits/ feedback before 11 AM: Do the elevated lead levels stick with a person for life? We do see blood lead levels decrease after education takes place and exposure to lead sources is reduced. Lead has a half- life in blood of approximately 25 days; in soft tissue, about 40 days; and in the non-labile portion of bone, more than 25 years. Why do the lead levels spike on a seasonal basis? When reviewing historical trend data, the risk of lead exposure is highest during the third quarter of each year — July through September. Seasonal variation is the result of a number of factors including increased exposure to lead in dust and soil in the summer months. Also attached is the communications plan. The notifications will be timed as follows: Communications Timeline — December 3, 2015 11 a.m. e Send final release and summary report to Governor’s office, Michigan Department of Environmental Quality 1 xxxEND_PAGE:dhhs02_b0120_0397_0398_1 000398 1:30 p.m. e Send final embargoed release and summary report to: o Genesee County Health Department — Geralyn Lasher Dr. Mona Hannah-Attisha — Geralyn Lasher Task Force Members — Geralyn Lasher City of Flint Mayor’s Office — Geralyn Lasher Congress and legislature — Elizabeth Hertel Oo 00 0 2 p.m. e Issue press release and summary report e Post press release and summary report to MDHHS website newsroom and Flint Water website, qe Thank you, Jennifer Eisner Public Information Officer Michigan Department of Health and Human Services Offi 20 i a xxxEND_PAGE:dhhs02_b0120_0397_0398_2

Correction from Eden on the 18% explanation

"Note". Not nite . My apologies. E Sent from my iPhone

Follow Up Flag: Flag for follow up Flag Status: Flagged I'll let them know. Thanks!

All -- Attached are Nick's updated talking points, as well as updated general Flint talking points. These include the most current info about filters. Thank you, Jennifer xxxEND_PAGE:dhhs02_b1002_3577_3577_1