Correspondence between

Benichivan go> Hi Bob, Just following up on this. Does this report say that we’ve had 5 EBLLs since 9/24/15? And if so, why does the column next to that say we've had 12 EBLLs this waek? Just making sure i'm reading this right! Angela

Please see attached.

xxxEND_PAGE:dhhs03_b0560_1958_1960_1 001959 Hi Bob, Do we have an updated report? Thanks so much! Angela

Not to be a pain, but if changes are required, they should be able to make those updates themselves rather than dictating them in an ernail. Updated letters with the correct phone number attached. Angela

Eden and Angela, Per your request, please see attached. Consider this a 1° (well, 3°) draft, and let me know if you have suggestions or questions. xxxEND_PAGE:dhhs03_b0560_1958_1960_2 001960 Thanks, Bob

We've been having the same conversation here — yes, we can do that, happy to do that. Bob was starting to work ona format this morning. lf you have specific information you would want in a weekly report, let us know, as that will help us to pull what you really need. I know Epi was also talking about a weekly analysis of sorts, which | think would go more in-depth than the counts and such we can give you as a starting point. Nancy

Yes, lalmost think we should get weekly summary. How many test have been done since the first press conference (9/28?)

Hi Nancy and Bob, Out of curiosity, could we begin looking at pulling some data about recent Flint BLL data? | think all results have to be reported to us within 5 days of the test result, correct? If so, is there any chance we can begin taking a look at what that data is telling us? Not wanting to do anything with it yet, but just trying to think a little more proactively. Thanks, Angela Minicuci Office of External Relations and Communications Michigan Department of Health and Human Services Office: (517) 241-2112 Mobile: i [email protected] www.michigan.gov/mdhhs E-mail Confidentiality Notice: This message, including any attachments is intended solely for the use of the named recipient(s} and may contain confidential and/or privileged information. Any unauthorized review, use, disclosure, or distribution of any confidential and/or privileged information contained in this e-mail is expressly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy any and ail copies of the original message. xxxEND_PAGE:dhhs03_b0560_1958_1960_3

Forwarding infe that Genesee County Health Department sent us last week when we asked if they were providing free lead testing for anyone who asks, regardless of their insurance - see 2° attachment. | apologize that we didn’t think to forward this sooner. Nancy

Draft, v2 is attached. i drafted this using the talking points and press releases, In order to have a consistent message. Looking forward to your input!

Bob, I like what you had to say. That’ s basically what I told her, but she wants to hear it from someone other than a spokesperson J Are you available for a call with her? Angela

Yes

I think Bob is the best person to speak to them about the lead data, if you are comfortable with that, Bob. My secret hope is that we can work in the fact that this pattern is similar to recent past. :) Sent from my iPad

Angela, fn availabhe today, but mm no epidemiciagist. The best | could say is something like this: “While the trend for Michigan a5 a whee has shown a stededy decrease in lead puisoning year by year, smaller areas such as the city of Flint have their bums from year to year while still trending downward overall.” Does that sound reasonable? Bob

Importance; High Hi Nancy and Bob, The Detroit Free Press wants to do a bigger story about the issue of lead in Flint. | made it clear to her yesterday that we could not say the lead poisonings are related to the water, but she instead wants to do a story about the increase of overall lead poisonings in Flint between 12/13 and 14/15. Are either of you available to speak with her today? Thank you, Angela

We’re not clear about what data we can give out. Can you call us? 517-373-0860. Angela Minicuci Office of External Relations and Communications Michigan Department of Health and Human Services Office: (517) 241-2112 Mobile: (517) 763-3609 [email protected] 1 www.michigan.gov/mdhhs E-mail Confidentiality Notice: This message, including any attachments is intended solely for the use of the named recipient(s) and may contain confidential and/or privileged information. Any unauthorized review, use, disclosure, or distribution of any confidential and/or privileged information contained in this e-mail is expressly prohibited. ff you are not the intended recipient, please contact the sender by reply e-mail and destroy any and all copies of the original message. xxxEND_PAGE:dhhs02_b0940_3256_3344_08 003264 Peeler, Nancy (DHHS)

i would leave it out for now

The Next Stens slide no longer recornmends that the city declare a health advisory. it now says ‘support city’s health advisory’. Hf Flint will be issuing a health advisory, will Genesee County support this? Angela

Either way is fine with me. Sent from my iPad

sav>; Eisner, .£ou>; Lasher, Geralyn (DCH) <ia Do we want to add, in the first section, that MDHHS is working with Hurley to obtain approval for sharing a broader data set with Hurley for their review. Sent from my iPad On Sep 24, 2015, at 1:46 PM, Minicuci, Angela (DCH) <! iAGeral

Hi everyone, With the Hurley press event at 3pm, can you please take a look at the following/attached talking points to make sure these are accurate and send me your edits? Thank you. e The results of the Hurley Children’s Hospital are under review by the Michigan Department of Health and Human Services. e The analysis that Hurley conducted is different than the way MDHHS collects data regarding blood lead levels. e MDHHS is looking to see if we can replicate the results of the Hurley study to see how they achieved their results. Differences in Analysis e MDHHS data provides a much more robust picture of the entire blood lead levels for the Flint area, and specifically, accounts for data over the full course of the past five years. e Looking at the past five years as a whole provides a much more accurate look at the seasonal trends of lead in the area. 2 xxxEND_PAGE:dhhs03_b0768_2808_2810_2 002810 e Seasonal exposure is higher in the summer for a variety of reasons including children playing outside in the soil, and when windows are open and lead paint is more likely to be in the air. This seasonal increase would be unrelated to the water system. e Our data includes children from the entire city, including all medical facilities, rather than just Hurley, has a larger age group of children, and includes a much larger sample size. e MDHHS data also looks specifically at the first test with elevated blood lead levels which provides a much more accurate picture of when and how first exposure occurred. e The Hurley data includes a smaller sample size, much more limited time period (January-September of 2013 and 2015 only), and a smaller age group of children. WIC Children eFor children with elevated blood lead levels that receive WIC benefits, they may be eligible to receive ready made formula with a test result that indicates that the child has an elevated blood lead level. e WIC cannot cover bottled water. xxxEND_PAGE:dhhs03_b0768_2808_2810_3

Geralyn, Vm net aware of a specific policy or process, but the Division of Environmental Health has at times recommended that the Director issue a “health advisory” to alert the public of a potential hazard. in each case, we have based this recommendation on data regarding levels of chemical contaminants in environmental media, wild game, or sport caught fish. We've also twice recommended that the Director make a finding of imrninent and substantial hazard when the available information suggests that a chemical storage facility presented 4 fire or explosive risk, When the issue of lead in city of Flint drinking water first came to my attention, | contacted the DEO Drinking Water Program and then provided a summary of my conversation with DEQ staff (please see the attached e- mail from July 23, 2015}. i've recently reviewed a written response drafted by DEG staff to Congressman Dan Kildee that suggests none of the information summarized in my e-mail has changed. We're continuing to follow the situation and have discussed with the DEG some options for a public outreach effort. We're having a call tornorrow with the DEQ and Genesee county staff to further axplore the options. Let me know if! can provide any further information. Linda ®. Dykema, PAD. Environmental Public Health Director Division of Environrnental Health Michigan Department of Health & Hurnan Services 517.335.8566 [email protected]

Importance: High Naney aiid LinttAMme hate gotten a call fim legislative offfess asking us to declare a “tadtth advisovy” in Flint due to Wait they belreve are high levels of lead im the weiter system so that the TC program ean then pay fer butted water aiid ready to feed fornia for pearte in the Flint area. \fe are fairly certain there is an actaal proses to hardte these tyees ef requests ard the department WoURn't just eescree a hedith advisey if the data didn't support it But can you help edifeite us on WheFe we Sstard on this Issue. Thartk you-eg xxxEND_PAGE:dhhs02_b0322_1242_1243_2

Thanks, Angela — 1 will reach out to him on Monday. After | contacted you, had a call from CDC. They are hearing about the issues/questions regarding Flint, and were suggesting that we take time to develop a response to any questions we are getting, that is carefully considered. | think that means we need your assistance! What’s the best way to connect with you or your staff for this purpose? xxxEND_PAGE:dhhs02_b0936_3233_3249_02 003235

Hi Nancy, | don’t see an issue with this. Seems pretty straightforward to me. Angela