By Matthew Dolan, Elisha Anderson, Paul Egan and John Wisely
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."
(c)2016 the Detroit Free Press