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

Please confirm the following: 1) The people who wrote this, claim no knowledge at all about harmful levels of lead in Flint water on September 8th. Even though we published results on bad lead in water in late August, and we issued a public health warning to not drink Flint water on September 8th. And m-live had done a story on September 6th. Also, in the document, it cites numerous these very news stories talking about dangerous levels of lead in Flint water at the end. So this seems to be false on its face. If so, who listed all the articles about the potential danger from lead in the water? Did they list the articles about high lead in Flint water, without reading them, or did they copy and paste something from MDEQ? | am sorry, | just don’t see how this claim can be true given the document itself and what it says. 2) Who said draft documents are not FOIA-able? Where is that written? All existing documents and notes are FOIA-able. If DHHS think it should be withheld, you still have to acknowledge the document exists, and then give a reason why it is being with-held. 3) So DEQ made the request for help by phone, and there is no paper trail at all requesting the document? No meeting notes or nothing about the DEQ request? Just DEQ saying they need something by phone, and someone going ahead and writing it up? 4) The communications associated with the draft, were all verbal, and there are no documents associated with it up until the press conference? xxxEND_PAGE:dhhs02_b1253_4717_4719_1 004718 Thanks! Marc

Mare, Let me know if you think my email timed at 2:33 today was helpful? li regards genesis and from where it arose. a

Hello again, | followed up with my Tox folks today (| am an impatient person!) about the draft Communications Plan drafted up by one of our folks in Tox in early September— 1. This was always draft as it had never been sent up for approval and implemented- thus not felt to be FOIA-able. 2. It was first drawn up on the 8th at request of DEQ (our Tox health education group often provides support for them on health education issues), as felt that public health education was needed about water lead. 3. Tox was not aware that there was a concern about harmful levels of lead in the water during this drafting. 4. The draft was communicated on with DEDQ on a conference call on 9/11 and the following weeks with the Lead Program and with the local health department, and other stakeholders to get feedback...these were occurring up until up to your press conference. Again, thank you for your questions and concerns— Eden

Eden, obviously you were not involved, but why wasn't this communications plan implemented? It was thoughtful, thorough, and had recommendations that people could take to protect themselves. Mona Hanna-Attisha MD MPH FAAP Director, Pediatric Residency Program Hurley Children's Hospital Michigan State University

| apologize for saying “a lot to hide” and “not trustworthy.” | was angry at waiting two months for documents, and finding within 12 hours that key documents were not produced. However, that does not excuse me from making such statements. Marc

; ‘Chris Kolb’; ‘Andy Leavitt" Thanks, Marc-forwarding!

There are also e-mails missing from Karen Lishinski. She notes Mona and Dr. Reynolds requested blood lead data in one e-mail, and Mona says she requested the data by e-mail on September 8th. Yes that e-mail was not produced. Obviously, she has a lot to hide. You are going to have to do an electronic records request from backup and servers. She is not trustworthy. Don’t waste your time asking for voluntary compliance. Marc

Hi Marc, xxxEND_PAGE:dhhs02_b1245_4699_4700_1 004700 | don't think | evn- have it, as | sent you everything in my emails...do you know whose email this was from? | can address asap- E

Eden, in our cord blood lead research project, we just got a 4.8 result on a newborn's cord blood. Who can | contact to make sure they get a proper home/water investigation? | doubt these labs get into the lead program. Mona Hanna-Attisha MD MPH FAAP Director, Pediatric Residency Program xxxEND_PAGE:dhhs03_b0232_0871_0875_4 000875 Hundey Ehikiretts Hespital Micthigzan State University xxxEND_PAGE:dhhs03_b0232_0871_0875_5

Eden, in our cord blood lead research project, we just got a 4.8 result on a newborn's cord blood. Who can | contact to make sure they get a proper home/water investigation? | doubt these labs get into the lead program. Mona Hanna-Attisha MD MPH FAAP 5 xxxEND_PAGE:dhhs02_b1194_4563_4568_5 004568 Director, Pediatiic Residency Program Hurtey Chitieerés Hospital Mith¢eem State Universivy xxxEND_PAGE:dhhs02_b1194_4563_4568_6

Flint; Follow-up care, case management resources continue for families Super. Looking forward to hearing from Martha, Mona

case management resources continue for families | forgot to marion that you should be hearing from Martha Stanbury, who under our project rnanagement structure for the Flint water situation is supervising Bob Scott. Martha Stanbury is a manager within the Division of Environrmental Health, a division in the bureau that i direct. } wanted to give you sarne context. Corinne

case management resources continue for families Shouldn't be a problem... Go Green (fair weather fan)!!! Sent from my iPhone

Yes I can call in. Thanks. Mona Hanna-Attisha MD MPH FAAP Director, Pediatric Residency Program Hurley Children's Hospital Michigan State University

case management resources continue for families Thank you. VHeo ahead and send the appt.

case management resources continue for families For now, yes...If Mona can't make it, she will let us know--her life is guided by patient care! E

case management resources continue for families Good morning, We have a conference fine available at 1PM this afternoon. Shall i schedule for 1-2PM? Thank you, xxxEND_PAGE:dhhs03_b0205_0785_0791_1 000786 Jasase Boulery Exaeutive Secretary to Corinne Muller Bureau of Disease Contre’, Prevention anc Enidemioiogy Adichigen Gepartment of Meelth & Huet Services 204 Townsane Street Lansing, Michigan 48923 Phone: (S17) SS5-R734 Fax: (S17) 355-8264

case management resources continue for families Hi Mona, | talked with Corinne just now.....do you still have time at 1? Janese can set up a conference call--- Eden Sent: Thursday, December 3, 2015 7:30 PM

Flint; Follow-up care, case management resources continue for families Outstanding-that would be so cool to have a partnership like that!!! !! Ok- I will check in with Corinne, our State Epi, first thing. Forwarded to Nick as well. Eden Sent from my iPhone

case management resources continue for families gounds goad. as of now, ican talk tomorrow before $:30am, 1-2pm, or after 2:306m. FY! lam working with Hurley Chifdren's, MSU, and maybe the GCHD to create a sort of Pediatric Public Health Collaborative that would house the ongoing assessment/long term monitoring that we are doing as well as same of the secondary srevention interventions which include all of peds public health. The tearn will include part of me {30%}, research support, epidemiologist, GIS, toxic stress researchers, etc. The reason | wanted to include the health cept was primarily for access te data - like the BLLs - but also to prevent redundancy of interventions. MSU and the health dept already have an academic health dept relationship, but iden't think it includes data sharing. xxxEND_PAGE:dhhs03_b0205_0785_0791_2 000787