final flint water advisory task force report 21march2016

8/19/2019 Final Flint Water Advisory Task Force Report 21march2016

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December 7, 2015

Dear Governor Snyder:

On Wednesday, November 18, 2015, the Flint Water Advisory Task Force met with representatives of

the Michigan Department of Environmental Quality (MDEQ) and the Michigan Department of Health

and Human Services (MDHHS) to discuss elements of the 10-point Action Plan designed to address

various issues related to the ongoing public health protection challenges precipitated by lead in the Flint

water supply. These discussions were held at our request as part of our task to make recommendations

to prevent a similar occurrence in Flint or elsewhere, and also to monitor ongoing mitigation efforts.

Subsequent to those meetings, on Tuesday, November 24, 2015, members of the Task Force

participated in a conference call with yourself, members of the Administration, and representatives of

these agencies to discuss the progress to date on the 10-point Action Plan, as well as several other

related issues.

We want to acknowledge the steps that have already been taken to implement the action plan,

specifically in the areas of outreach efforts to facilitate blood lead testing for children, communication

with health care providers in the Flint community about the importance of testing children for lead, and

the training of additional public health nurses in the Genesee County Health Department. We do

believe, however, that additional steps need to be taken to reach additional children for blood lead

testing, assure proper follow-up with children found to have elevated blood lead levels, and to continue

water testing. We will continue to assess state and local efforts and make recommendations regarding

specific steps that we believe are warranted.

One primary concern we have at this point is that the current efforts appear to be taking place in theabsence of a larger project coordination framework that measures results and clearly delineates

responsibilities for continuing actions to protect public health. We believe the state is best positioned to

facilitate this larger framework, which should address the following:

1.

The need for MDHHS and MDEQ —and, possibly, other state agencies--to set goals for actions in

collaboration with local and federal agencies and organizations.

2.

The need for a set of corresponding timelines for the goals.

3.

The need to establish responsibility for meeting the goals in a timely fashion and for

contingency plans for the state if the goals are not being met.

4.

The need for clear, regular communication with the Flint community and stakeholder groups

regarding action steps and updates.

We also believe it important that a single person or entity—potentially independent of any one

particular state agency and mutually agreeable to this Task Force and you, Governor—be established to

provide effective coordination of ongoing activities and reporting on the status of mitigation measures.

For this, we also believe a readily understood “dashboard” should be developed that reports on the

goals, timelines and assignments. This will enable members of the Flint community, public health

providers, and state agencies to know about the status of the Flint water crisis mitigation program, as


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well as promote coordination and accountability. The Task Force is prepared to assist in the

development of that dashboard.

We believe it is vitally important that trusted members of the Flint community be engaged in

communication on this issue, as well as the distribution of information conveyed by our suggested

dashboard reporting. Accordingly, in advance of our final report, we would like to ensure the

independent coordinator suggested above engage trusted community groups to begin rebuilding

community trust in state actions.

We appreciate your personal interest in this issue, commitment to assisting the Task Force in our

review, and—most importantly—commitment to ensuring that the full measure of state resources are

brought forward to protect the public health in Flint and throughout the state.

Respectfully yours,

Flint Water Advisory Task Force:

Dr. Matt Davis

Chris Kolb

Dr. Larry Reynolds

Eric Rothstein

Ken Sikkema


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January 22, 2016

Governor Rick Snyder

Office of Governor

P.O. Box 30013

Lansing, Michigan 48909

Dear Governor Snyder:

The Flint Water Advisory Task Force (FWATF) appreciates your recent efforts to secure federal

and mobilize state emergency response resources to address the immediate water supply

issues in Flint.

This letter is to encourage a similarly robust response to the challenges of re-establishing a

reliable, trusted potable water distribution system in Flint. This is required as soon as possibleto replace the unsustainable and expensive bottled water and filter distribution program that

has been necessitated, but which clearly must serve as an interim, emergency response.

Consistent with the priorities identified in the Safe Drinking Water Emergency Order issued by

the EPA on January 21, 2016, we recommend the following actions to address scientifically

grounded concerns that the water system in Flint remains unsafe because of lead

contamination and Legionella. Public trust in the safety of the water supply may only begin to

be re-established through the state’s forthright engagement of the scientific experts who

overcame state and federal agency intransigence to expose the lead poisoning.

Our recommendations are:

Engage US EPA staff experts versed in Lead and Copper Rule (LCR) requirements –

specifically Miguel del Toral, Darren Lytle and Michael Shock. These individuals should

be empowered to guide implementation of a comprehensive LCR sampling program in

Flint that will monitor lead levels now and throughout the conversion to raw water

supply by the Karegnondi Water Authority (KWA) and full-time use of the Flint Water

Treatment Plant.

Establish an inter-disciplinary work group comprising subject matter experts drawn from

respected public utility associations and institutions of higher learning in Michigan and

elsewhere (including Marc Edwards of Virginia Tech), to oversee the conversion to KWA-supplied raw water.

Commission and/or contract with an unbiased third-party organization or consortium

(hereafter: Flint water safety scientific assessment team [FWSSAT]) that will be

responsible for assessing the quality and safety of drinking water in residences, schools

and child care settings in Flint, and hospitals and other healthcare facilities served by the


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Flint water system. The explicit focus of FWSSAT activities will be lead and Legionella;

however, the FWSSAT may include other considerations in its work.

The FWSSAT will be invested with the responsibility of declaring when the public water

supply in Flint is safe for routine consumption. The FWSSAT will employ the most

rigorous scientific standards, using a sampling strategy that is designed to optimizedetection of water contamination in home, school, and child-care settings, and

healthcare environments. All schools and healthcare facilities must be included in the

sampling approach. Rigorous sampling of residences and child-care settings (whether

centers or in-home) will also be implemented, using any and all available information

about lead water service lines. In addition, if a homeowner or renter whose dwelling

has not been included in sampling wishes to have the dwelling included, they will also

be sampled. The sampling efforts and reporting process of the FWSSAT will be fully

transparent to the public; results of testing should be published on local, state, and

federal (EPA) websites.

To assure the re-building of community trust and assure sufficient expertise for future

water quality and safety, the FWSSAT should partner with local (Flint Water Treatment)

and state (MDEQ) personnel in its activities. The FWSSAT should have an inter-

disciplinary advisory committee that includes local community leaders, local and state

officials, national scientific authorities regarding water quality and safety and public

health, and the leader of the interagency state effort regarding the Flint water crisis.

When the FWSSAT advisory committee is satisfied that the FWSSAT scientific

procedures have thoroughly assessed water quality and safety in Flint residences,

schools and child care settings, and healthcare facilities and found the water to be

sufficiently free of contamination, then the committee will advise the public of the

findings. The FWSSAT will then organize the transfer of responsibility to local and stateauthorities to sustain the sampling and reporting methods thereafter, including the

conversion to KWA raw water in the future.

We also believe that a forthright response to the Legionella outbreak must similarly engage

trusted, scientific experts drawn from independent institutions. Accordingly, we recommend:

The Michigan Department of Health and Human Services (MHHS) should make a formal

request to the federal Centers for Disease Control and Prevention (CDC) for assistance in

assessing the outbreak of Legionnaire’s disease in Flint, if they have not already done so.

MHHS, working with CDC, should develop a strategy for improving prevention, rapiddetection, and timely treatment of cases of Legionellosis in Michigan in 2016 and

beyond. While the MDHHS evaluation of the dozens of cases of Legionellosis in 2014

and 2015 has strongly suggested a link to the shift to drinking water from the Flint River

in 2014, further and more intensive evaluation of clinical isolates (i.e., samples from

infected patients) is necessary to understand the route(s) of transmission from

contaminated water to humans. The unique set of outbreak circumstances in the

setting of a change in water source strongly indicates that support from federal public


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health authorities would be a welcome way to amplify the public’s collective

understanding of risk of contracting Legionella in residences served by the Flint water

system, and in Flint healthcare facilities.

The state should specifically request federal support from the CDC – and, as

appropriate, additional federal experts and agencies – to advise and assess Flinthealthcare facilities and Flint-based healthcare providers regarding: (a) appropriate

application and timely re-application of biocides to air treatment systems and cooling

towers in all healthcare facilities in Flint, in order to prevent colonization with

Legionella; and (b) proper assessment and timely diagnosis of Legionella among patients

in Flint who present with characteristic signs and symptoms and have a history of

potential exposure to contaminated water. Of note, the risk of resurgent Legionellosis

in Spring 2016 is on the horizon; the first cases of Legionellosis in the 2014 and 2015

outbreaks were diagnosed in June and May, respectively, and Legionella is known to be

much more common in the spring, summer, and fall than in the winter months. Time is

of the essence.

MDHHS should work with its federal partners to assure that investigative efforts related

to Legionella regarding quality and safety of water are conducted in coordination with

the FWSSAT described above. Furthermore, MDHHS should regularly communicate its

findings to the Flint community regarding its efforts to prevent, detect, and treat cases

of Legionella until case levels return to pre-2014 levels.

We expect that these measures will provide members of the Flint community with assurance

that the quality of their tap water is being appropriately monitored and that forthcoming

announcements that Flint’s tap water is safe to drink are well-founded. Notwithstandingearnest state agency actions, we believe that the engagement of independent subject matter

experts, whether to assess drinking water quality or public health concerns, is critical to

overcome, over time, the understandable skepticisms that prevail in the Flint community.

We hope that you will receive these recommendations in the same spirit with which they are

offered – to advance the recovery and reinvigoration of the Flint community.

Respectfully,

Matthew Davis, M.D.

Chris Kolb

Lawrence Reynolds, M.D.

Eric Rothstein, CPA

Ken Sikkema


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final flint water advisory task force report 21march2016

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