What the Eyes Don’t See

The preliminaries

• Flint
  • A kid born in Flint will live 15 years less than a kid born in a neighboring suburb. 
  • Flint is a struggling deindustrialized urban center that has seen decades of crisis–disinvestment, unemployment, racism, illiteracy, violence, and crumbling schools.
    • Flint had about 10,000 children under the age of 6.
• There are no immediate signs of lead exposure.
  • Even at lower levels, the damage is irreversible, resulting in developmental delays, cognitive impairment (a drop in IQ) as well as memory issues, mood disorders, and aggressive behavior.
  • Because powdered formula was the norm for Flint newborns, and because the powder is mixed with water, newborns were drinking bottles of lead water.
  • Additionally, with older kids, doctors were recommending lower sugar in their diets, pushing for water instead of juice or soda. 
• Adverse childhood experiences (ACE) are toxic stresses.
  • A child’s first years are the most critical in her development.
  • A child’s neuro-endocrine-genetic physiology can be altered. Prolonged, extreme, and repetitive stress or trauma due to an ACE, including poverty, racism, violence, chronically activates stress hormones and reduces neural connections in the brain.
  • The more ACEs a child has, the greater the chances of long-term physical and behavioral health issues.
  • Six or more ACEs drop a child’s life expectancy by 20 years.
• A child’s total environment is medical.

Flint water switch – background

• In 2011, Hanna-Attisha was director of the pediatric residency program at Hurley Medical Center, a public teaching hospital affiliated with Michigan State University, where most of Flint’s children are treated.
• In 2011, Michigan governor Rick Snyder, seeking to cut costs, declared that nearly bankrupt Flint was in a state of “local government financial emergency” and appointed an unelected emergency manager (EM) to run the city.
  • EMs didn’t answer to the people, which stripped the mayor of much of his power; EMs answered to Snyder.
  • One EM decided to change the source of Flint’s tap water.
    • For many years, Flint bought safe water from the Detroit Water and Sewerage Department.
    • They decided to build a new pipeline, and in the meantime, the stopgap water source would be the Flint River. The water switched in April 2014.
• This was an enormous mistake. The Flint River was a toxic industrial dumping site.
  • That’s why we have agencies like the Michigan Department of Environmental Quality (MDEQ) and the federal Environmental Protection Agency (EPA) – they are supposed to make sure the water is safe to drink.
    • People said their tap water smelled bad and tasted worse. It was brownish, greenish, and disgusting. Soon the city released boil alerts because of bacteria.

Hanna-Attisha’s investigation

• Hanna-Attisha then met up with her childhood friend Elin, who used to work at the EPA.
  • Elin read a memo written by a former EPA colleague, Miguel Del Toral. He had come to Flint after being contacted by a resident, LeeAnne Walters, and did an independent test of the water. He said that Flint was not using corrosion control.
    • A system of Flint’s size is required to have corrosion control as part of the Safe Drinking Water Act.
    • Water is naturally corrosive, but water systems are supposed to treat the water to reduce corrosivity. 
    • In Flint, the service lines–the lines that run from the street into people’s homes, are made of lead, and plumbing inside people’s homes have lead, too. If Flint was not using corrosion control, that meant there was lead in Flint’s water.
    • Del Toral found that the lead levels in Flint water were really high, and he suspected that MDEQ wasn’t testing correctly.
      • MDEQ was probably just testing for the results they wanted, which would underestimate the amount of lead in the drinking water.
      • The woman’s water tested at 400 ppb, and the maximum amount of lead should be 0 ppb. The official “action level” the amount of lead that warrants some sort of action is set at 15 ppb.
    • Not using corrosion control violated federal law; he followed up with MDEQ immediately but no action was taken.
      • Del Toral reported to the chief of Ground Water and Drinking Water at the EPA and officials at MDEQ, but he was second-guessed, reprimanded, and painted as a rogue employee. Defiant, Del Toral leaked his own memo.
• The next day, Hanna-Attisha met with a Genesee County Health Department worker.
  • Usually, when money was tight, public health budgets were often the first to be reduced. It made no sense that communities with the most struggles and most poverty–and therefore the most health issues–were always allocated the least amount of money, but it was how it worked, as the property tax revenue was smaller in poor counties.
    • In Flint, despite years of state oversight of the city and its services, the budget deficits had never been closed, not even by EMs.
    • When a city doesn’t generate enough tax revenue because property taxes don’t bring in enough money, the poor people who live there are punished with higher utility bills, and as a result they pay a higher share of income than other residents for basic public health protections.
  • She informed the health worker that there were water problems in Flint, involving lead, and he said that water isn’t under the jurisdiction of the health department, it was under public health.
    • The county health department collected all the blood-lead-level data for the county, and he didn’t know if anyone had looked.
  • Later that day, she sent an email to the county health director, concerned about the potential for an increase in lead poisoning from Flint’s drinking water.
• Meanwhile, a man named Marc Edwards (a world expert on pipe corrosion and recipient of a MacArthur genius grant, who had worked on the D.C. water crisis) had come to Flint, invited by Del Toral and Walters. He had found high levels of lead in the water.
  • Almost immediately, MDEQ spokesperson Brad Wurfel began pushing back, saying that the water met state and federal safe drinking standards.
• Just after this, she found out that in October 2014, just 6 months after the switch, General Motors stopped using the Flint River water because the water was corroding metal engine parts.
• At this point, she needed blood-lead-level data.
  • Their clinic had some, but it was part of a larger pool of blood-lead data, but the only way to get those numbers was through the county health department. She also wanted data from the state health department, which had the same information for all kids in Michigan.
• First, she got the numbers for her own clinic patients and an employee from her office, Jenny, started running through the data.
  • Second, she called the state – Karen Lishinski at the Michigan Department of Health & Human Services.
    • Hanna-Attisha asked Lishinski if there was an increase in blood-lead levels. Karen nonchalantly said, “Yes, we looked at the lead levels over the summer, and we did see a spike.” Hanna-Attisha asked for the rules and Karen said she would send them (but never did).
  • Third, via Elin, she got in touch with Dan Kildee, who represented Flint in Congress. Kildee’s legislative director, Jordan Dickinson, said that he would help her get the blood data from the county and state.
• Then, Marc Edwards and his research team posted more results about water testing. The numbers were dramatic: several samples exceeded 100 ppb and one exceeded 1000 ppb ( 0 is the maximum safe amount, and 15 ppb is action level).
• She called a meeting on September 9 with Jenny and her team of Community Pediatrics residents, explaining what had happened. They all began sifting through the data to try and determine where these kids lived and what kind of water they were getting.
  • They decided to look only at kids five and younger, and to look at only the highest level. They also looked at levels before and after the switch.
  • The clinic results showed a statistically significant increase in percentage of kids with higher lead levels since the water switch in 2014.
    • But the sample was very small–to get access to a much bigger sample, she and Jenny would have to have Hurly review board’s permission.
• Next, Hanna-Attisha informed Edwards that she was designing a study of blood-lead levels in Flint.
  • Hanna-Attisha soon got the clinic data that confirmed that Flint kids were being poisoned. 
  • At the meeting with Edwards, he explained that the Flint River’s water was innately corrosive, which presented a lot of challenges that the city couldn’t handle.
    • She then asked him what would happen if someone demonstrated that blood-lead levels increased after the water switch, and he said that that would be a game-changer.
• After the meeting, she contacted the Genesee County Health Department’s Women, Infants, and Children program to see if they could send ready-to-feed formula.
  • She found out that the USDA couldn’t get a waiver unless there was actually a health advisory or official emergency. So that meant that they had to prove there was danger and harm before anything could be done.
  • They began looking at the data again. They had a comparison for levels before and after the water switch, and while they used the same number of months, they didn’t use the exact same months of the year.
    • Water-lead levels are affected by heat and seasons of the year.
      • Then they controlled for seasons and used the highest lead level if a child had more than one.
    • The number of elevated blood-lead levels was still higher after the water switch. Kids were being harmed every day, with every sip of water they drank, with every bottle of formula.
• On September 21, they met with Mayor Walling to show the study results, reveal the proof of elevated blood-lead levels, and urge him to issue a health advisory.
  • Also present were Natasha Henderson (Flint city manager) and Howard Croft (public works department head). There was also Senator Ananich, a Michigan state senator, and his chief of staff, Andy Leavitt. One of her residents was there, as was Kirk Smith (member of the health coalition) and Jenny, and a few other physicians.
  • She cited research showing that when lead was in drinking water, the greatest impact was on pregnant mothers and formula-fed infants.
  • She also compared Flint to the rest of Genesee county, where the water was the same. This comparison made it clear that there was no statistically significant increase in elevated blood-lead levels in the rest of the county.
  • Mayor Walling said that they met with EPA and DEQ, who assured them there was no corrosion issue, and it was too expensive to switch back. 
  • She then gave the mayor an ultimatum – if he wouldn’t stand with her and make the announcement that there was lead in the water, it would happen without him.
• When Governor Snyder’s officer heard that she was calling a press conference, they went nuts. They called Hurley, upset that Senator Ananich had seen a draft of the presentation already, and asked for her data immediately.
  • Hanna-Attisha was furious–she had been warning state officials for weeks, and suddenly she was in trouble for not being in touch with Governor Snyder directly. 
• Walling declined to join them at the press conference. Around 100 people were at the conference.
  • She walked through the research, and at one point held up a baby bottle filled with Flint water, saying that this is what our babies are drinking, for their first year of life, during the period of most critical brain development.
• The blowback began immediately. Before bothering to analyze her findings, the governor’s office and state agencies launched a systematic effort to undermine her.
  • As part of their counterattack, it released a tally sheet of total numbers of children in Flint zip codes with elevated lead levels. It was very basic and crude.
  • Hanna-Attisha then decided to use geographic information systems software to sharpen the exact neighborhoods in the city where the water was received.
    • The more precise mapping technique increased the percentage of kids with elevated lead levels to more than double.
• The next day, the mayor’s office issued a lead advisory.
• She then spoke with reporters at the Detroit Free Press–they not only agreed with her findings and backed her up, but noted that the state’s single-minded mission to distract and deny had caused it to miss the fact that its own data, made public, confirmed Hanna-Attisha’s study.
• The next week, she received a call from Eden Wells, the chief medical officer for the state, who was the state’s point person for the water controversy.
  • Later, Hanna-Attisha discovered that when Wells called her, Director Lyon had directed her to prove Hanna-Attisha wrong, even before seeing the research.
  • Edent sent an email saying that Hanna-Attisha knew what she was doing; Hanna-Attisha believes that if it weren’t for Eden, the state’s denial could have continued months longer.

State of emergency and switching the water source

• The media grew more vigilant and critical, specifically the Detroit Free Press, which in October 2015 called the water crisis an obscene failure of government.
  • At a press conference with the state, Nick Lyon lied and said that only 43 kids had been exposed to lead. Instead, it was 8,657 children. 
  • Afterwards, Eden Wells told the Detroit Free Press that lead exposure was population-wide in Flint, not just a few dozen children.
  • On October 16, 2015, the water switched back.
• Next, a state of emergency had to be declared.
  • 18 months of corrosive water had done great damage to the underground network of water pipes.
  • Shortly after taking office, Flint’s new mayor, Karen Weaver, declared a citywide state of emergency.
  • This forced Governor Snyder to declare an emergency in Genesee County a few weeks later, which got the National Guard to distribute bottled water and filters, and prompted President Obama to declare a federal emergency on January 16, 2016.
• Hanna-Attisha helped draft the framework for a tomorrow fund, with a 20-year timeframe. Eventually, Governor Snyder agreed that more than $100 million would be dedicated to Flint kids.

Government communications discovered via FOIA requests

• Later, communications between state officials became public; these demonstrated that they did not try to get to the bottom of anything:
  • Officials told Flint residents that the water was safe to drink, but arranged for water coolers to be delivered to the Flint State Office Building so state employees wouldn’t have to drink tap water. 
  • The city, controlled by the state, deliberately manipulated the water samples from Flint homes so they wouldn’t have to notify the public about lead.
  • In July 2015, an MDHHS analysis showed that blood-lead levels had spiked a year ago. They covered it up. This was the spike Karen LIshinski had inadvertently revealed to Hanna-Attisha.
  • As early as December 2014, members of the public raised red flags about a strange escalation in cases of Legionnaires’ disease–a severe lung infection caused by waterborne bacteria. Two top staff in the governor’s office were notified, as was the county health department, but they did nothing. This led to 87 cases and at least 12 deaths.
  • At the EPA, when asked about using federal money to buy water filters for residents, the Region 5 Water Division chief Debbie Baltazar wrote, “I’m not sure if Flint is the community we want to go out on a limb for.”

What happened to the government actors

• More than 50 lawsuits had been filed.
• Criminal charges were announced, as well.
  • Three members of MDHHS epidemiology and lead staff–Corinne Miller, Bob Scott, and Nancy Peeler–were charged with actively covering up the spike in blood-lead-level data.
  • Chief medical officer Eden Wells and MDHHS director Nick Lyon were charged regarding the Legionnaires’ disease outbreak.
    • Wells with obstruction of justice, Lyon with misconduct.
    • Both were charged with involuntary manslaughter, and then along with three others, Busch, Howard Croft, and Liane Shekter-Smith, for failure to act.
  • Howard Croft was fired and charged with two felonies–false pretenses and conspiracy to commit false pretenses in connection with the water crisis.
  • Flint city official Mike Glasgow was accused of tampering with a lead report.
  • Flint emergency manager Darnell Earley was charged with involuntary manslaughter. Shekter-Smith was fired.
• MDEQ spokesman Brad Wurfel was fired; his boss, Dan Wyant, resigned.
• Susan Hedman, the director of EPA Region 5 (where Del Toral worked) resigned.
• Flint city manager Natasha Henderson was fired.

• Personal stories of Dr. Mona’s family’s immigrant background, as well as her deep interactions with patients
• The parallels between the Flint water crisis and the D.C. water crisis, which was similarly a culmination of disgusting neglect and resulted in horrifying, decades-long consequences on D.C. citizens
• Relentless coverage from reporters hugely dissatisfied with the state’s response – Ron Fonger for The Flint Journal and MLive.com, as well as Curt Guyette from the ACLU of Michigan with funding from the Ford Foundation
• A brief history of public health departments
• A brief history of General Motors and its impact on Flint
• The remarkable Alice Hamilton–a medical doctor, social justice pioneer, and professor who specialized in lead toxicology cases
• Public health villain Charles Kettering, who forced leaded gasoline into the world
• Story after story of the people and families who drank the lead water, and how that altered their lives forever