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

>; Peeler, Pa Nancy (DHHS) a> Please see attached, xxxEND_PAGE:dhhs03_b0101_0283_0286_1 000284

Please see attached.

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

sov>; Peeler, Nancy (DHHS) <[email protected]>; Wells, Eden Yea, | think that would be awesome. Angela

& Hi Bob, my only thought on this is can we include something on each page that has a cumulative number of tests done, and number of EBLL cases? Angela

Peeler, Nancy (DHHS) Hi Bob, my only thought on this is can we include something on each page that has a curnulative number of tests clone, and nurnber of EBLL cases? Angela

ican dof. How about this? lL} Total number of children tested since 9/28/15 press conference. 2} Total number of children with capillary EBLEs since 4/1/14 water change, still needing confirmation, 3} Total number of confirmed EBLL cases since 4/1/14. 4) Total nurnber of children with capillary EBLLs since 9/28/15, needing confirmation. 5} Total number of confirmed EBLL cases since 9/28/15.

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

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

Yes

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

Template.doc; DCH-1277 IRB Initial Review Application.doc Angela or Jennifer, Please see Dr. Edwards email below, and my draft response to him. I’m not very happy with him right now, but tried to respond appropriately. Given the sensitive nature of the situation, I’m checking with you first. Nancy is on annual leave, but I’ve CC’d her here. Is it OK to send this? Please feel free to make changes as appropriate. |’m also asking if it's OK now to share the attached PDF with Dr. Edwards and Dr. Hanna-Attisha. Thanks, Bob Marc, As you well know, the data you and Dr. Hanna-Attisha are requesting are derived from personal health data, which of course is confidential. There are state and federal laws governing what can be shared, and how, with researchers or the public, In addition, my Department has policies on how to determine what can be shared. | worked with you earlier this month to get data to you relatively quickly, but did not manage to complete the process before | went on annual leave for several days. | neglected to inform you that i'd be away, and | apologize for not informing you. Unfortunately we are a very smail program, and there’s no one else here to process your request—or Dr. _Hanna-Attisha’s. Since | returned on Wednesday, my time has been largely taken up with my Department's response to the current situation in Flint. | did manage to correspond to Dr. Hanna-Attisha, and provided her with the forms she’ll need for her request. | hope to submit her request to our Legal office and to our IRB contact today. Sorry | haven’t responded to your email from Monday—as | mentioned above, | was away, and then have been juggling many tasks since | returned. | think you'll be able to get approval for data with zip code identified. Ml edit your data use agreement accordingly, and will adjust it to say “limited data set” instead of “de-identified.” I'll re-submit your DUA to Legal today, You will need to submit an MDHHS IRB review application (attached) because this is considered research. You should also submit a “HIPAA Waiver Request” (attached). (1 wasn’t aware of that when we talked earlier this month.) | don’t know whether you’ll need to go through an IRB review with your institution. I've also attached a PDF that includes the numbers behind the graphs you referred to, and ’m CC’ing Dr. Hanna-Attisha so that she has it as well. Bob xxxEND_PAGE:dhhs02_b0940_3256_3344_64 003320 Robert L. Scott Childhood Lead Poisoning Prevention Program Michigan Department of Health & Human Services (S17) 335-8178 fax (517) 335-8509

Angela, Per your request, please see attached. Bob Robert L. Scott Childhood Lead Poisoning Prevention Program Michigan Department of Health & Human Services (517) 335-8178 fax (517) 335-8509 xxxEND_PAGE:dhhs02_b0075_0292_0292_1

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

igan.gov>; Bien, Stan (DCH) <biensGunichizan woy> >; Lasher, Geralyn (DCH) Angela, One suggested change to the second bullet: “The analysis that Hurley conducted is different frorn the way MDHHS has analyzed data regarding blood lead levels in Flint.” Another suggestion for the 5° bullet under Differences in Analysis: “The MDHHS analysis looks specifically at the first elevated blood fead level for each child, which provides an accurate picture of when first exposure occurred,” Thanks, Bob