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FYI There was a follow up and | 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. Jennifer Eisner Public Information Officer Michigan Department of Health and Human Services 2 or [email protected]

Thanks, Jen! Dave Murray Press Secretary | Executive Office of Governor Rick Snyder [email protected] 517-335-6397, office! 4 mobile Twitter:@michigandmurray

Dave Murray Press Secretary | Executive Office of Governor Rick Snyder 517-335-6397, office xxxEND_PAGE:executiveofficeemails20_b1261_3185_3185_1

Dave Murray igandmurray

Dave Murray H ~j mobile Twitter:@michigandmurray

Importance: High Do you have an email for Rebecca Williams? Here’s the statement for your review: The Michigan Department of Health and Human Services has consistently provided Flint residents with information regarding blood lead levels. 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 Z!P 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 1 xxxEND_PAGE:executiveofficeemails20_b1256_3167_3168_1 thoroughly reviewed. 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 following up with city residents who has tested with elevate levels. 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:executiveofficeemails20_b1256_3167_3168_2

Upcoming Press Releases e Monday, December 21 — Holiday safe sleep reminder e Monday, December 21 — Michigan child welfare improvements e Tuesday, December 22 — Public comment period for behavioral health waiver e Tuesday, December 22 — SYNAR tobacco vendor press release e TENTATIVE Tuesday, December 22 — Tahir Whitehead spends time with children in foster care program e Wednesday, December 23 — Next Flint report on blood lead level testing will be posted e Monday, December 28 — Michigan tobacco quitline reminder e Week of January 1— Autism coverage and Medicaid common formulary press release e =©Week of January 1 — Birth defects prevention month Jennifer Eisner Public Information Officer Michigan Department of Health and Human Services Office: 517-241-2112 or Eisnei@michlean gay Cell: xxxEND_PAGE:executiveofficeemails20_b1242_3136_3136_1

Jen and Brad, There is a story posted in the Washington Post this morning regarding Flint water that appears to not include any information about the state governments role in helping the city with its struggles. I've been in contact with the reporter to express our displeasure and she is open to adding to the story. I'm handling the response from our office about the task force and action plan. Brad, | want to stay looking forward. Can you tell her about the school testing and results so far, that show the challenges seem to be limited to fixtures? Jen, can you direct her to the page where you are posting the results and explain the testing and filter distribution? I'll send the reporter's contact information. Dave Sent from my iPad xxxEND_PAGE:deq14_b0905_3230_3230_1

Good evening team, Thank you for the continuing effort on this release. | know much hard work has gone into this. Meegan and | worked on the release — | appreciated her fresh eyes — and made some wordsmithing changes. Governor has asked for some additional information to be included as well. Most of the changes are marked in bold. Please review them. Governor has asked: Do the elevated lead levels stick with a person for life? Why do the lead levels spike on a seasonal basis? We took a stab at answering this, but please review. We also need a breakdown of the 1,361 people tested by child and adult, so we can say 21 of XXX children tested.... And 9 of XXX adults tested... Thank you very much! Dave Dave Murray xxxEND_PAGE:executiveofficeemails20_b0423_1551_1551_1

xxxEND_PAGE:executiveofficeemails20_b1774_4288_4289_1 Hi guys, Getting some pressure about an ETA. Do you have any idea? Dave Murray Press Secretary | Executive Office of Governor Rick Snyder Lagteemeeestoutncion Twitter:@m higandmurray <Flint Blood Testing Report 1Dec15.pdf> <Flint EBL Data Press Release V7.docx> xxxEND_PAGE:executiveofficeemails20_b1774_4288_4289_2

Sara and Dave: Attached please find a proposed comms plan for your review — we will update the document with dates as the timeline comes together. Please feel free to give me a call with any questions, edits or suggestions. Thank you, Jennifer Eisner Public Information Officer Michigan Department of Health and Human S Office: LT gee ervices v xxxEND_PAGE:executiveofficeemails21_b0197_0418_0418_1

Updates highlighted in the attached! Angela

“a Bl I apologize if that wasn't made clear but we have said all along that these numbers may change as additional tests come in, and I believe I said that in one of our phone conversations. With all data there is almost always a data lag - vaccination coverage levels are delayed about a year - and this summary report, as stated in the release, is intended to provide updates on the numbers of tests completed and cumulative results on an ongoing basis. Sent from my iPhone

Press Releases: e ~=TBD - Flint EBL Data e Monday, November 23 — Family Health History e Tuesday, November 24 — Lung Cancer Awareness Month e Monday, December 30- Michigan 4x4 Grants Awarded Speaking Engagements: e Monday, November 23 — Chief Deputy Director Becker is speaking at the Bureau of Community Services staff meeting e Tuesday, November 24 — Director Lyon is speaking at the National Adoption Day event at the Hall of Justice e Tuesday, December 1 — Director Lyon is Speaking at a symposium on maternal health and mortality at the Henry Center Jennifer Eisner Public Information Officer Michigan Department of Health and Human Services Office: 517-241-2112 or Fisnerh@rnichigan. gov Cell i xxxEND_PAGE:executiveofficeemails21_b0195_0415_0415_1

Jim Redford said legal tearn also needs to review the relaase and supporting docurnents.

i don’t think this should happen today at all. Governor is at an important event in Southeast Michigan this morning, and | think we need some direction from him and ethers on this issue.

Brown, Jessica (GOV) <i : i ov>; Kennedy, Jordan (GOV) <*. : 4 LOWS Heaton, Anna (GOV) < Biehl, Laura (GOV) <High! Jarrod (GOV) <4 <Tomirnas (DHHS)

Good evening, MDHHS friends, Here are suggested changes to the press release. | think it’s vitally important to have our “people first” approach, and be very up front about the results. | also think it’s important to show up high what we will do with this data. Please consider the changes. | also think it’s worth a conversation about whether we want to release this on a Friday morning. This is a challenging situation to be sure, but | think these results are fairly encouraging considering some of the heated rhetoric on this issue. Thank you, Dave FOR IMMEDIATE RELEASE CONTACT: Jennifer Eisner DRAFT (517) 241-2112 MDHHS releases October data outlining blood lead levels in Flint Results show 24 of 963 people tested had elevated levels LANSING, Mich. - Blood lead level testing results released today revealed that 24 of 963 adults and children tested in Flint in October had elevated levels, according to the Michigan Department of Health and Human Services. MDHHS is working closely with the Genesee County Health Department to reach out to families testing with higher levels and help them reduce their exposure to lead sources. Information was gathered from tests administered citywide to 963 children and adults between October 1 and October 30. Eighteen people age 17 or younger had elevated blood lead levels. Six adults over the age 18 were identified with elevated blood lead levels. The report is intended to inform residents about blood lead level testing efforts in Flint and provide cumulative total numbers. “Our goal is to help families reduce their exposure to lead sources,” said Dr. Eden Wells, chief medical executive with the MDHHS. “We have made 2 xxxEND_PAGE:executiveofficeemails21_b0610_1441_1444_2 progress in testing and identifying those with elevated blood lead levels, and the department will continue to work closely with county health department to reach these families. We will update these numbers on a regular basis and remain diligent in our ongoing outreach and education.” The data in the report include the total number of tests conducted and the total number of elevated blood lead levels greater than 5 micrograms per deciliter, and captures both capillary and venous blood tests. People who have had multiple tests are counted only once. The full report is posted online at www mich untwater and will be updated as more data becomes available. The testing is part of the state’s action plan to address health concerns related to Flint’s water infrastructure. Last month, MDHHS collaborated with the county health department and local partners to distribute educational resources and informational letter to Flint parents regarding lead testing. GCHD nursing staff are conducting direct outreach to families when an elevated blood lead level has been detected, serving as an important resources by addressing questions and concerns, providing information, and meeting them in their home environment. MDHHS continues to provide free water filters and replacement cartridges to Flint residents at four locations including the MDHHS Flint offices and the Genesee County Community Action Resource Department. For a full list of locations and hours of distribution, visit To help residents properly install water filters, and to demonstrate how to replace the original when it expires, MDHHS has created an instructional on the MOHHS Youfube chesnel, For additional updates on Flint water including updates on blood lead levels and testing results, visit #HH#

Good afternoon: Attached, please find the blood lead level test results for Flint zip codes 48501-48507, as well as a corresponding press release and talking points. With your approval and edits, we are planning to notify 3 xxxEND_PAGE:executiveofficeemails21_b0610_1441_1444_3 external partners tomorrow at 9:30 a.m. then post the report on www. ic! finbwater and issue the press release at 10 a.m. Please let us know if you have any questions or concerns. Thanks and best, Jennifer Eisner Public Information Officer Michigan Department of Health and Human Services Office: 517-241-2112 or Eig cell __ PPI xxxEND_PAGE:executiveofficeemails21_b0610_1441_1444_4

:2a¢>; Brown, Jessica Good afternoon: Attached, please find the blood lead level test results for Flint zip codes 48501-48507, as well as a corresponding press release and talking points. With your approval and edits, we are planning to notify external partners tomorrow at 9:30 a.m. then post the report on wiv ‘ter and issue the press release at 10 a.m. Please let us know if you have any questions or concerns. Thanks and best, Jennifer Eisner Public Information Officer Michigan Department of Health and Human Services or =: Dy xxxEND_PAGE:deq14_b0864_2866_2866_1

Press Releases Jennifer Eisner Public Information Officer Michigan Department of Health nd Human Services Office: 517-241. 2112 or £:: fi xxxEND_PAGE:executiveofficeemails21_b0170_0315_0315_1

Other than it being Thursday and nearly already the end of the week? Afraid that may do more harm than goad. Also, aren't there updates on both water testing and blood lead level results corning out today?

Hello — Today Dr. Wells had a phone interview with Robin Erb regarding blood lead levels in Flint. Robin said she’s hearing concern from parents who feel like they don’t know what to do. Robin heard about the parent letter and wanted to know what it contains, when it will be going out, and what other steps we’re taking to provide clear direction to residents. Dr. Wells confirmed that yes, we are working with the local health department to finalize a letter that will be distributed to parents in the next couple of days. Dr. Wells reminded her of the wv an.goy/Hintwater website that has been up since the first week of October, and said that many of those documents are being distributed through various channels by our partner and provider networks. She also acknowledged that in some areas this can be a difficult to reach population, and so it’s important that we think creatively about how to reach them — that we cannot rely solely on the news or internet. Dr. Wells emphasized that our priority population is children 0 — 6 years old, which is why the parent letters will be so beneficial. SAR IT Once the letter is ready to go, | told Robin we would share it with her. This is for a Sunday story. Jennifer (Smith) Eisner Public Information Officer Michigan Department of Health and Human Services 517-241-2112 xxxEND_PAGE:executiveofficeemails21_b0305_0637_0637_1

We're still getting some questions answered on our end but for now, the only edit | have would be to define DEO and MDBHHS in the fourth oaragragh where it begins with ‘State agencies teday...’ For the event tomorrow, we have an outline of what Nick and Eden would cover below: Director Lyon Recommendations for residents Recommendations for schools Additional MDHHS staff available to assist with data and case management Eden Weils NSF Certification Additional testing? Lead exposure reduction tips Angela

Attached talking points updated to include info re: extended hours for water filter distribution, school testing results, NSF filter certification. Thank you, Jennifer (Smith) Eisner Public Information Officer Michigan Department of Health and Human Services 517-241-2112 xxxEND_PAGE:executiveofficeemails20_b1642_4024_4024_1