Correspondence among

Laura, It looks great, there is a small section of the prirnarily Hint Township zip code that is in the city of Flint and gets Flint water, That zin cade is 48532. Mark Valacak, MPH, Health Officer Genesee County Health Department, 630 S. Saginaw St. Suite 4 Flint, Mi 48502-1540 Phone 810-257-3588 Fax 810 257-3147 E-mail x a us Please consider the environment before printing this e-mail. "There are two lasting bequesis we can hope to give our children: one is roots; the other is wir Hodding Carter *NOTICE: This e-mail, including attachments, is intended for the exclusive use of the addressee and may contain proprictary, confidential or privileged information. If you are not the intended recipient, any disclosure, use, distribution, copying, or taking of any action in reliance of the contents of this e-mail is strictly prohibited. If you have received this e-mail in error, please notify me via e-mail and permanently delete the original and dest all copies. Thank you. for a copy of the Health Department’s Notice of Information Practices, contact the Health Department or visit the Health Department’s website at Sent: Thursday, October 22, 2015 10:34 AM

Water.pdf; ATTOO001.htm Dear Eden, Mark and Kay, lam attaching a draft letter from the medical society that will likely go out today and also my commentary relating to the conversations I have had with the liver services at Henry Ford and UM Ann Arbor. I think the letter is good. I would suggest adding a paragraph - see below. I was able to talk to a Dr. Segovia with Henry Ford hepatology (recommended by Dr. Kim Brown, Director of their Liver Transplant service), and also the nurse of Dr. Askari at UM, the Director of the Wilson Disease clinic there. Dr. Segovia did not have any specific suggestions - they just tell their patients to get their water tested and act accordingly. She was interested in what we find. Dr. Askari's nurse said they tell their patients to use either DISTILLED water (not bottled - for instance they said Dasani actually has rather high levels of copper) OR get a reverse osmosis system. I found some of these systems online and they ranged in price with some around $150 or so. I don't know which ones are good. Dr. Segovia said they may have 1-2 patients with Wilson Disease at the most. Dr. Askari's nurse thought there may be 10 or less in the clinic at UM (they ask them back for annual checks when stable). She said all of their patients get the above advice. I would propose that we add a paragraph that says: "The UM Wilson Disease clinic director, Dr. Askari, recommends that all Wilson Disease patients use either specifically distilled water (not all bottled water is distilled), or a reverse osmosis system. We are hoping to get a reasonably accurate number of patients who may be affected so that we can get the information to them (through you, or through an outside referral clinic) and also see if it is possible to get funding for those who may have difficulty obtaining the necessary water or system, particularly during the next year when the water is still considered more corrosive than average. It is also important to note that copper pipes tend to be more common in newer homes, so the distribution of high concentrations of copper in water may be xxxEND_PAGE:dhhs02_b1073_3743_3745_1 003744 different than that for lead." Iam also going to send this information to Eden Wells at MDHHS at her request. When I spoke to Dr. Marc Edwards on the phone, he did send a list of all the other metals for which he tested and none were over the action limit. As may have been mentioned earlier, he also said that there were no samples which had copper over the action limit, but that is not the appropriate limit for patients with copper storage disease. This problem is clearly much less widespread than the lead problem, but after being surprised once, I don't want for us to leave anything else out this time around. Laura Begin forwarded message: Date: October 22, 2015 at 10:24:21 AMEDT

Wellsk 3a michigan gav> WH thasa filters {listed below) also remove laad? if so, can just recornmend those filters to the patients (arn working with Pete to estirnate how many there may be) and that may be our solution, They would need to meet the recommiendatians of the Wilson’s Disease Society that Eden sent. Pete said he can send out emali on Monday. fio you have recornmendations as ta how to proceed Mark?

Laskad Jim Hanry of my anviranmental health staff to research the copper filtar raduction issue and talk to the people at NSF. His findings are below, | had a friend who used to work at NSF but is long retired. remernbered from a conversation that often manufactures get products certified for particular chemicals and there is a cost increase with each particular additional certification. So they limit the testing based upon what makes ecanarnic sense for them. inthis exarnple, ft dees not meen that the filters we are distributing do nat red copner but ore likely that they did not pay for that cartification test to be run. Hf that test was not run they cannot clair to he “certified by NSF". Oddiy Brita dines acivertise that their filter reduces copper but it is rot listed on the sheet in the box a certified by NSF for thet. xxxEND_PAGE:dhhs03_b0015_0026_0030_3 000029 NSF did sunply the filters list certified for copper reduction, which is included below for your information. Mark Valacak, MPH, Health Officer Genesee County Health Department, 630 S. Saginaw St. Suite 4 Flint, MI 48502-1540 Phone 810-257-3588 Fax 610 257-3147 E-mail mvalacak@gchd. us der the environment before printing this e-mail. "There are two lasting bequests we can hope to give our children: one is roots; the other is wings.” Hodding Carter *NOTICE: This e-mail, including attachments, is intended for the exclusive use of the addressee and may contain proprietary, confidential or privileged information. If you are not the intended recipient, any disclosure, use, distribution, c dopying, or taking of any ac} tion in n reliance of the contents of this e-mail is strictly prohibited. If you have received this e-mail in error, pl me via e-mail and permanently delete the original and destroy all copies. Thank you. For of the Heaifli Department’s Notice of Information Practices, confact the Health Department or visit the Health rom: oe . Sent: Friday, October 18; 2015 10:23 AM