Flint e-mails: State, city appear unable to share info Matthew Dolan , Elisha
Anderson , Paul Egan and John Wisely , Detroit Free Press More than eight
months before Gov. Rick Snyder disclosed a deadly Legionnaires' disease
outbreak in the Flint area, federal health officials worried a lack of
cooperation
in Michigan could be hampering the public health response. Thousands of pages
of e-mails obtained by the Detroit Free Press on Monday show increasing concern
about the quality of the Flint's drinking water as tensions grew over a lack of
coordination to combat the waterborne disease. County health officials
were warned for reaching out to federal experts for help while they struggled
to persuade Flint city officials to provide needed information, the e-mails
show. Others in e-mails wondered about ethical breaches and the possibility of
a cover-up. In sum, a review of the e-mails provided by Genesee County from
several public-information requests appear to illustrate the inability, if not
unwillingness, of city and state agencies to share information with the
county as it investigated multiple Legionnaires' cases. The clash among
bureaucrats went on privately for months despite growing fears inside Flint
among
residents that something was deeply wrong with the city's drinking water. "We
are very concerned about this Legionnaires' disease outbreak," Laurel Garrison
of the Centers for Disease Control and Prevention, wrote to Genesee County
health officials in an April 27, 2015, e-mail. "It's very large, one of the
largest we know of in the past decade, and community-wide, and in our opinion
and experience it needs a comprehensive investigation. Garrison added in
her e-mail that "I know you've run into issues getting information you've
requested from the city water authority and the MI Dept of Environmental
Quality.
Again, not knowing the full extent of your investigation it's difficult to make
recommendations, and it may be difficult for us to provide the kind of
detailed input needed for such an extensive outbreak from afar. There were at
least 87 cases across Genesee County during a 17-month period, including
nine deaths, but the public was never told about the increase when it was
happening even after an initial wave of more than 40 cases were under
investigation
by early 2015. It is unclear whether swifter action by government officials
could have prevented a return of the outbreak last summer. But a public health
investigation is ongoing. Legionnaires' disease is a pneumonia caused by
bacteria in the lungs. People get sick if they inhale mist or vapor from
contaminated
water systems, hot tubs or cooling systems, or in some cases, showers. Genesee
County Health Department officials could not be reached for comment Monday
night. Typically, Genesee County saw between six and 13 Legionnaires' cases a
year, according to officials. In 2014, the number jumped to 42. In 2015,
there were 45 confirmed cases. Officials investigating the outbreak in 2014
worried about disclosing a suspected cause. Liane Shekter Smith, the head of
the Office of Drinking Water and Municipal Assistance for the state Department
of Environmental Quality contacted state health officials "a couple of times"
to discuss the Legionnaires' outbreak in 2014, according to e-mails. "She was
concerned that an announcement was going to be made soon about the water
as the source of the infection; I told her the Flint water was at this point
just a hypothesis," Susan Bohm of the Department of Health and Human Services
wrote to officials in Genesee County in an e-mail dated Oct. 21, 2014. Last
week, Snyder announced Sheketer Smith's termination, saying "putting the
well-being
of Michiganders first needs to be the top priority for all state employees. The
e-mails released Monday also showed how local officials struggled to contain
the outbreak. On Feb. 10, 2015, Genesee County Health Department epidemiologist
Shurooq Hasan wrote to an outside expert about 47 Legionnaires' disease
cases in 2014, which was almost four times the number of cases in 2013. "We
have investigated a hospital as a potential source for the disease, but have
expanded our investigation to include the city water supply," Hasan said in the
e-mail. "Of our 47 cases, 25 cases have occurred within the city water
supply distribution system. No common links have been found between the cases.
The majority of our cases are home bound immune-comprised individuals who
have not traveled and are not readily mobile," he wrote. Hasan said those
stricken were in such bad condition that they are unable to answer questions
that would assist with the investigation. On June 8, 2015, Jim Collins of DHHS
e-mailed several officials at the county health department saying he had
spoken with officials at the federal Centers for Disease Control and Prevention
that morning about the Legionnaires' issue. He then chastised county officials
for talking to the CDC without state approval. "Relative to communications
around the investigation, I believe that CDC is in agreement that their
involvement
really should be at the request of the state, rather than the local health
department," Collins said. "To be clear, we do value the skills and resources
of our CDC colleagues, but we also recognize that their involvement needs to
have some structure," and "I want to reinforce the necessity that investigation
communications from the Genesee County Health Department need to be directed to
staff at the MDHHS. By Dec. 5, Tamara Brickey, the Genesee County Health
Department's public health division director, said in an e-mail to other county
health officials that "the state is making clear they are not practicing
ethical public health practice. "Now evidence is clearly pointing to a
deliberate cover-up," Brickey wrote. "In my opinion, if we don't act soon, we
are
going to become guilty by association. Snyder publicly revealed the
Legionnaires' outbreak on Jan. 13 of this year, saying he had learned of it
just days
earlier. A spokesman for the governor Monday night reiterated that the governor
acted quickly after he learned of the outbreak. But last week, other e-mails
released by the liberal group Progress Michigan showed an aide in Snyder's
office was notified in March 2015 more than nine months before Snyder said he
learned of the problem that there was an increase in Legionnaires' disease
cases in Genesee County. The aide, Harvey Hollins, said in an interview last
week he did not brief the governor on the issue at the time because he told
state environmental department officials to gather more information and make
their own recommendation if warranted. Public notifications about such
outbreaks are typically handled by the local health departments, Geralyn Lasher,
spokeswoman for the Michigan Department of Health and Human Services, said
Monday. Lasher said the state provided help to the Genesee County Health
Department
on wording for a public press release, but she was unsure if the department
ever released it. Flint's switch to using the Flint River as its water supply
in April 2014 was followed almost immediately by complaints from residents
about discolored, pungent water that had caused a number of ailments. Local
and state officials insisted for months the water was safe to drink but
reversed course after independent testing discovered unsafe lead levels
throughout
the system believed to be caused by leaching from lead piping. Flint is now
under a state of emergency because of the lead issue Today, state officials
say they have been unable to link the Legionnaires' outbreak definitively to
the Flint River water supply. County health officials feared as far back as
the fall of 2014 the outbreak was connected to the switch to using the Flint
River for drinking water. The new e-mails show other state health officials
investigated the outbreak at least a year before the governor's public
announcement. On Jan. 27, 2015, Michigan Department of Health and Human Services
epidemiologist Shannon Johnson e-mailed the county health department about the
Legionnaires' disease issue, saying "at this point, the priorities in the
public health investigation are to determine the scope of the outbreak and to
define as clearly as possible the characteristics of the cases of Legionnaire's
Disease ... "A current map of the municipal water system needs to be obtained
and cases' residences mapped in relation to the water system," Johnson said.
Overall, county officials express concerns about a growing number of people in
the Flint area contracting Legionnaires' disease. The state Department of
Health and Human Services had begun assisting the county in the fall of 2014,
and the Legionnaires' investigation had become "very intensive" in early
2015, according to Dr. Eden Wells, Michigan's chief medical executive. The
first wave of 42 cases was commonly known within the state health department,
Wells said, but the agency did not take the information to the governor until
confirming a second wave of 45 cases and analyzing them together. But back
on Jan. 27, 2015, a county health official expressed frustration in an internal
e-mail that he couldn't obtain information from local and state officials
to investigate suspicions the water supply was behind the Legionnaires'
outbreak. "Initially the water plant was cooperative, but since the beginning of
November they have not responded to multiple written and verbal requests.
Howard Croft has not responded the email that I sent yesterday morning, either,"
James Henry, a county environmental health supervisor, wrote in the e-mail. "I
have explained our responsibilities to investigate and that our intent to
work together with the City to identify potential risks so they can be reduced
or eliminated. I was hoping to avoid FOIA, but we are getting nowhere. In
another e-mail, written a day earlier, on Jan. 26, Henry wrote: "MDEQ, Mike
Prysby and Steve Busch declined to meet with our office. They did not have
any comparable information regarding other public water systems relative to
Legionella or Heterotrophic bacteria. They encouraged us to conduct our
investigation
and mentioned that they could assist with obtaining information from the water
plant. I explained that they are the regulatory agency and participation
is expected. On Feb. 5, Howard Croft, the city of Flint's public works
director, alerted Henry about "another person who is reporting a rash on their
child.
A note from a doctor, Croft wrote, asserted that the woman's son "breaks out
when he is in the bath with the city water. He asked Henry to work with the
woman and supply any needed data that could "help determine the cause. Henry
responded less than two hours later. He didn't provide the data but instead
spelled out how he said the city had not responded to the county's earlier
request for information. Henry said the county health department attempted as
far back as November 2014 to obtain information about the city's water system.
"Your office has not provided a return phone call or response to emails,"
he told Croft in the e-mail. In January, Henry said that he also filed a
Freedom of Information request with the city to try to obtain information about
city water, but his request did not provide what he sought. "I am still hopeful
that we can work collaboratively to protect the health of the community
and resolve any issue with the Flint water supply. Henry wrote. By November
2015, Henry had grown frustrated by the lack of cooperation he said he received
from state environmental officials. The Michigan Department of Environmental
Quality "reminds me of a stubborn 2yr old child," Henry wrote on Nov. 6 to
Genesee County Health Officer Mark Valacak. "Instead of doing what is right,
they'll willfully take another spanking just to be defiant. On Dec. 4, Henry
recapped events over several months in an e-mail to other county health
officials and singled out a specific state health department official he said
had
sabotaged their Legionnaires' disease investigation. "I think deaths could have
been avoided, had he not! Henry said. He said he thought state officials
were motivated to impede the investigation because they "were concerned that
Genesee County's largest U.S. legionella outbreak, would implicate the Flint
water system, for which they were responsible. Henry wrote that "some of the
people at the state agencies are simply criminals," and "I do find it rather
impressive how good they are at covering their tracks. Contact Matthew Dolan:
313-223-4743 or msdolan@xxxxxxxxxxxxx. Follow him on Twitter @matthewsdolan.
Free Press photographer Ryan Garza contributed to this report.
This article is provided to you as a courtesy of NFB
