text: Own or manage a building that may need a water management program? Find out what you need to know about 
   
   Healthcare facilities face unique challenges. Learn more about water management programs in healthcare facilities. 
   
   Take this free training on creating a water management program. ||||| Increased cases of Legionnaires Disease Investigated in Genesee County 
   
   Angela Minicuci 517-241-2112 
   
   FOR IMMEDIATE RELEASE 
   
   LANSING, Mich. – The Michigan Department of Health and Human Services is reporting an increase of Legionnaires’ disease (LD) in Genesee County in summers of 2014 and 2015. While the MDHHS cannot conclude that the increase is related to the water emergency in Flint, the State of Michigan is treating this situation with the same urgency and transparency as the lead response in the city of Flint. 
   
   MDHHS has confirmed data through March 2015, and is finalizing preliminary data through November 2015, which indicates an additional increase in cases. From June 2014 to March 2015, 45 LD cases were confirmed in Genesee County, including seven associated fatalities. From May 2015 through November 2015, 42 LD cases, including one case of Pontiac Fever, were reported in Genesee County. There were three associated fatalities. The age range of these individuals was 26–94, with illness onset dates from June 6, 2014 to March 9, 2015 and May 4, 2015 to October 29, 2015. 
   
   Legionella is a type of bacteria commonly found in the environment that grows best in warm water, such as hot tubs, cooling towers, hot water tanks, potable water systems, and decorative fountains. When people are exposed to the bacteria, it can cause Legionellosis, a respiratory disease that can infect the lungs and cause pneumonia. The bacteria can also cause a less serious infection called Pontiac fever. Legionella cannot spread from one person to another person. 
   
   “While Legionellosis cases are not uncommon, we are concerned about the increase in cases seen in Genesee County,” said Eden Wells, M.D., chief medical executive with the MDHHS. “We are releasing this report and continuing surveillance and investigations to ensure that appropriate actions are being taken to protect the health of the residents of Flint.” 
   
   During LD outbreak investigations, clinical specimens are often evaluated against environmental specimens to aid in determining an infection source. One reason that the increase in cases cannot be directly related to the change in Flint water supply is due to the lack of clinical Legionella isolates from case patients. Clinical isolates are necessary to interpret the findings of an environmental investigation in an outbreak. 
   
   In the fall of 2014, MDHHS noticed an increase in people with LD and offered assistance to Genesee County Health Department (GCHD) with case investigations to determine exposures. In January of 2015, MDHHS stepped in to coordinate GCHD’s response. By April 2015, MDHHS had developed an interview questionnaire and began conducting case investigations to look at travel, work, and locations visited during the two weeks prior to symptom onset. These two weeks are considered the incubation period for LD. 
   
   Of the confirmed first 45 cases, the source of water at the primary residence was City of Flint water for 47 percent of cases. When looking at additional community sources, more than half of the individuals had a healthcare facility exposure in the two weeks prior to their illness onset and the facility has since implemented multiple environmental and procedural measures to alleviate the situation. Preliminary data from May through November 2015 regarding case investigation information is being finalized and will be released soon. 
   
   Ten people had no exposure to a Flint hospital in the two weeks prior to illness nor were their homes on the Flint water system. Other possible exposures were evaluated and no other known community exposures were identified. Enhanced surveillance has continued for the remainder of 2015 and into 2016. 
   
   MDHHS has been and continues to work with the Michigan Department of Environmental Quality (DEQ), Centers for Disease Control and Prevention (CDC) and the Environmental Protection Agency (EPA) on this matter. MDHHS shared an initial report with federal partners in June 2015, and initiated and has continued to facilitate regular communication with our federal partners and GCHD to monitor cases. 
   
   Vigilant legionellosis awareness and surveillance is occurring in Genesee County. MDHHS informed hospitals in Genesee County of the increase of cases in January 2015, as well as recommended actions on their part throughout all of 2015. MDHHS has also recommended that the GCHD work with the clinical community in Genesee County to assist in LD surveillance through accurate identification, testing, and reporting of all suspect cases. 
   
   Most people exposed to Legionella do not become ill. People at higher risk of getting sick include: individuals over 50 years old; current or former smokers; those with chronic lung disease; people with a weakened immune system from diseases like cancer, diabetes, or kidney failure; and individuals who take medications that weaken the immune system, such as steroids or chemotherapy. 
   
   MDHHS is releasing the summary report which was shared in December 2015. 
   
   
   
   For information about the Flint water emergency, visit www.michigan.gov/flintwater. 
   
   # # # ||||| (CNN) Residents of Flint, Michigan, already reeling because of lead contamination in their drinking water, got more disturbing news on Wednesday. 
   
   Gov. Rick Snyder announced the number of cases of Legionnaires' disease has spiked in Genesee County in the two years since Flint switched its water supply from the Great Lakes to the Flint River. 
   
   But the increase cannot be directly attributed to the switch, said Nick Lyon, director of the Michigan Department of Health and Human Services. Not all the people who got Legionnaires' were exposed to Flint water, he said. 
   
   From June 2014 to November 2015, at least 87 county residents developed Legionnaires' disease, compared to between six and 13 cases in the four preceding years, Lyon said. Ten patients died, he said. 
   
   The water looked smelled and tasted funny 
   
   Health officials are not changing recommendations about how Flint residents should deal with the water crisis. They should keep drinking bottled water and use water filters, Snyder said. 
   
   Legionnaires' disease is a respiratory bacterial infection usually spread through mist that comes from a water source. It is not transmitted person to person. Symptoms of the disease include fever, chills and a cough. The CDC estimates 8,000 to 18,000 people are hospitalized with Legionnaire's disease in the United States every year. 
   
   Flint, an economically depressed city of about 100,000 people, started getting its water from the Flint River about two years. It previously bought Lake Huron water through the city of Detroit. The state government made that change to cut costs. 
   
   Soon after the switch, the water started to look, smell and taste funny. People complained. 
   
   On January 5, Snyder declared a state of emergency for Genesee County as a result of the water crisis. 
   
   He apologized for the state's actions, but residents and officials are furious. The state denied the problem existed for months and failed to use anti-corrosive treatment on the river water, which might have reduced the iron. 
   
   'Flint residents are victims in this crisis' 
   
   "Flint needs more action and less talk from Governor Snyder," U.S. Rep. Dan Kildee said in a press release. "It is important to remember that this crisis was created by a state-appointed emergency financial manager, and it is the state's ultimate responsibility to act and make it right. Flint residents are the victims in this crisis, and they deserve a more urgent response equal to the gravity of this crisis." 
   
   Flint switched back to Detroit water in October. 
   
   "It will require more time and effort before the water is safe to drink again," the city of Flint website said . "Until that time, residents and water customers are urged to continue using water filters and bottled water." 
   
   Dr. Marc Edwards, a Virginia Tech researcher who studied Flint water and found high levels of lead, said it would be almost impossible to make a definitive link between the water source and Legionnaires' disease. To do so, he said, would require matching the strain of Legionnaires' in someone's body to the strain in the water. 
   
   "What's clear is that there's an association, which means that the increase of the Legionnaires increased pretty dramatically," he said. "And there's a strong likelihood that it's related to the water supply. 
   
   "We'll never know for sure, but we did find very high levels in the time period when they were on the Flint River water." 
   
   Edwards said this might be the first case of Legionnaires' associated to lack of corrosion control. 
   
   "This is already a tragedy," he said. "It's a crisis of conscience in government. This could potentially just add to it. But they're being very forthcoming about it at this point. There are just so many places where you wish people had done things differently." 
   
   National Guard activated 
   
   Snyder activated the state National Guard on Wednesday to assist with the water crisis. 
   
   Seven guardsmen arrived in the town Wednesday, and up to 30 are expected by Friday, Snyder said in a news release. 
   
   They will help distribute bottled water and water filters at fire stations and other public buildings, he said. That will allow Red Cross volunteers to go door-to-door to hand out water, filters and testing kits. 
   
   FEMA announced that it approved Snyder's request for federal assistance, according to agency spokesman Rafael Lemaitre. The governor had asked FEMA to step in to coordinate with other federal agencies. ||||| An investigative science reporting series by Flintwaterstudy.org 
   
   The Flint Water Crisis (FWC) and its aftermath as revealed in the ongoing legal cases (Wells, Lyon, Edwards vs Wayne State, Edwards versus Schwartz et al.) and this FlintWaterStudy blog series is destined to become a historic and instructive engineering ethics case study. We continue to document our efforts to navigate ethical dilemmas and hold “public safety paramount” as embodied in ethical codes of conduct such as that of the American Society of Civil Engineers. 
   
   After FlintWaterStudy first made the startling claim that a few engineers had primary responsibility for the Flint Water Crisis, our position was affirmed December 2015, and finally reached closure when two of the engineers pled guilty December 26, 2018. In 2015, Governor Snyder apologized for their mistakes and took actions promoting reform at MDEQ (and EPA). His appointment of independent and knowledgeable truth-speakers to the Flint Water Advisory Task Force in 2015 was critical — this Task Force’s reports withstood the test of time and their recommendations effectively guided the disaster response. Snyder also invited critics Dr. Mona Hanna-Attisha and Dr. Edwards to work on the recovery alongside the agencies they were previously fighting against, worked to close loopholes with Michigan’s tough new Lead and Copper Rule, and funded FACHEP to investigate the Legionnaires’ Disease outbreak. 
   
   And while it is true that every level of government had some responsibility for creating the FWC, it should also be noted that every level of government came together in an unprecedented and exemplary fashion after January 2016 to help fix the Flint water system. After President Obama declared a Federal Emergency, Dr. Edwards participated in over a dozen FWC data summits and hundreds of interagency teleconference calls focused on controlling lead and Legionella. The National Guard, the Federal Emergency Management Agency (FEMA), the Centers for Disease Control (CDC), Michigan Department of Health and Human Services (MDHHS), Michigan Department of Environmental Quality (MDEQ), Genesee County Health Department (GCHD), City of Flint (COF), United Way and others played exemplary roles. Whistleblower Miguel Del Toral was released from effective house arrest and became the public face of the Environmental Protection Agency emergency response, while hundreds of EPA and MDEQ employees worked tirelessly for Flint. 
   
   By mid-2016 it was obvious that these extraordinary efforts, along with the switch back to treated Lake Huron water purchased from DWSD/GLWA on October 16, 2015, had produced major improvements in water quality. Chlorine disinfectant levels rose after switching back to Detroit water, EPA implemented enhanced corrosion control and boosted chlorine, and financial credits supported a “Flush for Flint program.” The 90th percentile lead level was dropping below the EPA action level and every reasonable recommendation made to control Legionella was implemented. While the system had not yet fully restabilized, the trends were promising and the Flint Federal Emergency designation officially ended August 14, 2016. 
   
   FACHEP’s Toxic Mindset 
   
   FACHEP was funded in February 2016 under emergency procedures and their Phase 1 study results were published in late June 2016. Their Phase 2 work had a primary goal to “Reduce the occurrence of Legionellosis-associated cases, hospitalizations and deaths to levels at or below those seen in years prior to 2014.” It took a few months to negotiate and fund the substantial $3.4 million FACHEP Phase 2 budget and vet a correspondingly expansive scope of work, and the work was slow because Professor Shawn McElmurry was inexperienced with human subjects research–he literally had to complete the most basic training before he could even conduct the work. 
   
   The behavior of FACHEP collaborators and emails between May and August 2016 reveal an increasingly toxic and unscientific mindset, suggesting a growing sense of frustration that Flint’s rapidly improving water quality would leave them with no urgent problems to solve. In this series we argue that those who took the public mantle of FACHEP leadership considered themselves to be the sole entity worthy of the residents’ trust and who had the expertise to solve the FWC. This mindset may have arisen from McElmurry’s touching story of FACHEP’s “divine conception” due to his myth of work in Flint from 2010-2015 and Wayne State’s public proclamation of “unique expertise.” 
   
   Consider testimony from Drs. McElmurry, Kilgore, and Zervos (WSU) about a May 2016 meeting discussing the FACHEP Phase 2 work plan with Mr. Lyon. During that meeting, they argued that if FACHEP’s requested $11-13 million in funding was not immediately granted, “people will die” due to delays in engaging their expertise. A witness attending this meeting with FACHEP faculty stated: 
   
   Dr. Kilgore turned red and pounded his hand on the table and said, “People are going to Fucking die” if the research was not able to proceed immediately and as planned. 
   
   To their chagrin, all the data that came in during summer 2016 proved that those diligently working on the water emergency since October 2015 were not the uncaring incompetents from which FACHEP imagined they would save Flint residents. Moreover, FACHEP Phase 1 documented increasing chlorine levels and no detectable Legionella in samples collected from homes during January 2016. The incidence of Legionnaires Disease had plunged dramatically through September 2016, compared to the 2014-2015 outbreaks, without any help from FACHEP whatsoever. 
   
   A set of revelatory emails was exchanged just two days before the Federal Emergency ended, after an upbeat Flint Water Interagency Coordinating Committee meeting and as McElmurry was finally completing his last required human subjects paperwork. After arguing that certain disagreements with the team’s ideas (to be discussed in future blogs) were due to “purely political” reasoning, McElmurry noted: 
   
   We really are running out of time. With summer nearly complete….I can’t tell you how furious I am with the state, they have completely screwed us and the people of Flint… 
   
   This statement echoed the prior false claim that “people will die” unless FACHEP funding was immediately granted. McElmurry expressed further angst that “Marc Edwards also gave (sic) presentation saying legionella detected in residential households was low,” raising fears that a primary FACHEP goal had already been achieved before their work even began, and there were concerns that the State was “pulling out of Flint.” 
   
   The email discussion concluded with Dr. Zervos appropriately suggesting that FACHEP should consider “working totally independently from the <GCHD and MDHHS> health departments,” a point that McElmurry immediately agreed with: 
   
   I am fine with working outside of health department (sic), their conflict of interest is even worse than the State…it will just be extremely difficult for some aspects of the project. 
   
   At this point, we raise a critical ethical question. If the circumstances were truly as noxious as expressed, was it ethical for FACHEP faculty to accept research funding from MDHSS in the first place? For example, codes of ethics state that engineers “shall act for each employer as faithful agents or trustees,” “shall advise their clients or employers when they believe a project will not be successful,” and “shall disclose all known or potential conflicts of interest that could influence or appear to influence their judgment or the quality of their services.” It strikes us as fundamentally unethical and unfair to all parties, to accept research funding from a client who you believe has just “completely screwed us,” particularly for a project that you felt would not be successful. And how it is possible that the personal conflicts would not affect FACHEP’s judgment or quality of services? Unfortunately, rather than seeking out other sponsors as was discussed, or even going to the media with their complaints which was also mentioned, they decided to take the funding. 
   
   Not surprisingly given FACHEP’s toxic attitude, three exemplars of unethical tactics and incompetence, were to reach a crescendo almost immediately after their Phase 2 launch including: 1) Low chlorine alerts, 2) Claims to have discovered “dangerous” bacteria on Flint’s point of use filters, and 3) Implying Flint water was causing a Shigella outbreak. We will first review the “low chlorine” issue, because it illustrates the maddening position of Dr. Eden Wells and how the only FACHEP team member with significant drinking water experience (Dr. Susan Masten, Michigan State University) eventually became alienated from the rest of the team. 
   
   Meet the whistleblower from Michigan State University 
   
   We have come to know Dr. Masten as a quiet, knowledgeable, humble, and highly ethical professor, characteristics destined to clash with some other collaborators selected by McElmurry. Dr. Masten has remarkable moral humility and a healthy respect for the second canon of Civil Engineering ethics, which, to the present day, compels her to be the first to acknowledge the limitations of her own expertise and her own shortcomings. She considers her core expertise to be drinking water treatment with some experience in monitoring municipal water distribution systems. The topics of building plumbing, Legionella and chlorine regulation are not within her expertise. Dr. Masten was also McElmurry’s teacher when he attended MSU, and she once considered him a friend and colleague. These factors make the events described herein all the more painful, yet laudatory. 
   
   In the interest of full disclosure, through February 2018, Dr. Edwards and Dr. Masten respected but did not really like each other. It was only after Dr. Faust informed Dr. Edwards that McElmurry had gone out of his way to malign Edwards with her, that he recalled some ill feelings about Dr. Masten had similarly originated from McElmurry. Edwards decided to reach out to Dr. Masten to better understand what happened and apologize for hard feelings based on hearsay, when he learned Dr. Masten had anger about Dr. Edwards that also originated from McElmurry. Both Masten and Edwards then went to Dr. Faust, who confirmed McElmurry had also bad mouthed Masten. Confused? Well, to put it simply, three people who once disliked each other for no good reason, were now fast friends, and a pathological rumor-mongerer had been exposed. As we dug deeper, we found that strategically maligning others was a habit of McElmurry and other FACHEP leaders. In this case, the false statements effectively prevented Drs. Faust, Edwards, and Masten from exchanging revelatory information, whereas in other cases, these tactics morphed into something even more twisted. 
   
   Before we finally dive into this story, we must once again remind readers about the difficult tightrope water utilities walk in terms of controlling the levels of chlorine in distributed drinking water. Specifically, if chlorine levels in distributed water are too low, there is concern that the incidence of some waterborne diseases might increase. Conversely, if chlorine levels are too high, consumers may get itchy skin, complain of “swimming pool” smells and tastes in water, and the levels of trihalomethanes (THMs) can exceed regulatory limits. Based on her extensive experience and analysis, Dr. Masten co-authored an excellent paper highlighting all these problems and trade-offs for Flint in late 2016 from a perspective of water treatment. 
   
   How much chlorine is “too low” or “too high” in a given Michigan home? In terms of the minimum, Michigan law states that: 
   
   The residual disinfectant concentration in the distribution system, measured as total chlorine…shall not be undetectable in more than 5% of the samples each month for any 2 consecutive months that the supply serves water to the public. 
   
   In other words, 95% of samples collected at defined monitoring points of the distribution system, must have detectable (≥ 0.1 mg/L according to MDEQ) levels of chlorine. The maximum chlorine is set by the U.S. EPA Maximum Residual Disinfectant Level (MRDL) of 4 mg Cl 2 /L. Hence, according to the chlorine balancing act as defined by Michigan law, a chlorine level of 0 to 4 mg/L is perfectly acceptable at a given home. The American Water Works Association (AWWA) has the same recommendation, but with a recommended minimum of 0.2 mg/L (instead of 0.1 mg/L) for 95% of sampling sites. It is also worth noting that millions of Michigan residents use ground water with no chlorine residual at all (including MSU) as is common all over the U.S. 
   
   FACHEP’s First Press Release: Lower Chlorine Than Recommended 
   
   The “low chlorine” fiasco started when FACHEP prepared their first press release October 16, 2016, just after McElmurry returned from three weeks in Australia. McElmurry claimed he completed a “literature review” on chlorine recommendations, and inserted the following concerning statement into the press release about levels of chlorine in Flint homes. 
   
   So far we’ve also found chlorine levels in about 20 percent of the homes to be less than current recommendations. The American Water Works Association recommends maintaining a residual chlorine level between 0.2 mg/L and 2.0 mg/L at all times. We’ve identified some homes that are below 0.2 mg/L. 
   
   Upon review of the draft release, Dr. Wells immediately noticed a key concern, stating “we advise you repeatedly that controls were needed—this appears again to be results without context.” This meant FACHEP should show data from other cities (i.e., controls), to make sure they would never make it falsely appear to Flint residents that they were in some kind of unique danger when that was not the case. FACHEP had already collected data showing many homes outside of Flint had non-detectable levels of chlorine as allowed under Michigan law, but McElmurry ignored Dr. Wells and did not put that information in the press release. Dr. Edwards also reviewed a copy of the press release and explicitly noted the statement on the AWWA chlorine recommendation was highly misleading. He subsequently sent Wells a direct web link to a 2015 AWWA reference about chlorine levels. For whatever reason, Edwards’ input was also not reflected in the final press release. 
   
   After the statement was published, Flint consumers received sampling results with worrisome statements that chlorine should always be 0.2 – 2.0 mg/L to protect them from Legionnaires disease. FlintWaterStudy then received phone calls from Flint residents who were very concerned that their chlorine was “too low” (i.e., 0-0.2 mg Cl 2 /L) or “too high,” (i.e., 2.1-4.0 mg Cl 2 /L), even though Michigan law allows chlorine to be anywhere between 0 – 4 mg/L. Lawyers at the state immediately jumped at the claim 20 percent of Flint homes were failing to meet AWWA recommendations, and Dr. Wells urgent efforts to get information from McElmurry on what to do about this problem were unsuccessful. Wayne State’s risk communication “expert” Dr. Matt Seeger was the first to respond to Wells urgent request: 
   
   As I indicated earlier, FACHEP is making no public health recommendations. We are not a health department and whatever we say would be inappropriate. We are trying very hard to stay in our lane. We referenced existing documents in the release 
   
   By “existing documents,” Seeger was apparently referencing McElmurry’s use of a citation from a 1990 AWWA book that was written before distribution monitoring of TTHMs were required. (i.e., Pontius, AWWA, 1990, p 1194). It took us a few weeks to obtain this hopelessly outdated reference, and it turns out there is no such recommendation on page 1194, nor could we find it anywhere else in the book. In fact, there were many statements about residual chlorine in the book contradicting McElmurry’s quote. 
   
   Considering that there were two other FACHEP train wrecks in progress at the exact time (to be described in future blogs), Dr. Wells was being too kind when she wrote back the evening of October 19, 2016: 
   
   Your group today seems to want to throw out some vague information about finding some cases, without controls, with no context and THEN throw your hands up and say “oh we have nothing to do about it, that is a public health issue”. Your statements stating that you have no role exemplifies your lack of knowledge or sensitivity to public health issues when producing early unconfirmed and uncontrolled results from your studies… (such as what you are telling residents about their chlorine levels) that THEN has to be dealt with by the local and state health department, if not also the DEQ, the City, federal CDC and EPA, …. The questions we are getting from our attorneys were for whether the any of these issues indicated a boil water alert!…These experiences …have taken up an INORDINATE amount of time from local state and federal agencies who are already stressed to the maximum to try to deal with responses for important day-to-day issues in our state. We are funding you to be responsible research partners for a PUBLIC HEALTH issue. While you are independent, you do not operate in isolation, and you are responsible for the impact that your statements may cause in the population that you deliver them to. 
   
   On the morning of October 20 2016, McElmurry finally emailed a response to Wells, repeating his quote that supposedly came from the 1990 AWWA book, which he was interpreting to mean that every resident with chlorine less than 0.2 mg/L in their water was in danger. He then asked Wells to figure out what to do about this “problem,” and suggested that Wells should consider issuing a warning to residents with less than 0.2 mg/L chlorine and point of use filters to “boil water” before consumption. 
   
   McElmurry drags others into the debacle 
   
   At that point, Dr. Wells directed McElmurry to the chlorine subject matter experts (SME) at EPA, Dr. Jonathan Pressman and Mr. Mark Durno, who had been intensively working on improving the chlorine situation in Flint for almost a year. Over the next week they also grew frustrated with McElmurry, who admitted he had errors in residential addresses, some of the low chlorine results were from homes with whole house filters designed to remove chlorine, and he therefore could not help EPA help the State solve the problem he supposedly had uncovered. While they waited for McElmurry to get the addresses, on October 24th, Dr. Pressman point blank asked McElmurry the same question Dr. Edwards had in mind when he first read the press release: 
   
   I’m curious to know the reference of the quote…from your press release…The sources of chlorine residual advice that I am most immediately familiar with, such as the AWWA partnership for safe water, use a 95% of the time statement, not “at all times.” 
   
   Incredibly, although McElmurry must have known that he personally inserted that erroneous phrase into the press release just a week earlier, he emailed Dr. Masten: 
   
   I feel like he is splitting hairs here but I’ll have to respond. I can’t remember how this sentence made it in….if we had a real quote to reference or not. Do you? 
   
   What? McElmurry had needlessly created a false alarm amongst Flint residents and disrupted multiple agencies working to protect public health, and he now wanted Dr. Masten to bail him out and find a real quote to support his mistake? Over the next few days, Dr. Masten looked hard to find something, but in the end she could did not find a “real quote to reference.” As was typical whenever McElmurry was confronted with an important question that demanded a response, and providing an honest answer would expose his mistakes and ignorance, he simply never responded to Pressman at all. McElmurry also refused to answer Dr. Edwards when asked the same direct question months later. 
   
   When McElmurry finally got around to providing EPA the addresses, the expert chlorine response team with representatives from Flint, MDEQ, and EPA was dispatched to investigate. On October 31st, 2016, they reported back that hydrant sampling near the “low chlorine” sites reported by FACHEP had good chlorine at > 0.61 mg/L. Dr. Pressman then requested that if McElmurry was going to keep telling residents that they had “low chlorine,” he should immediately inform the city of Flint so they could respond. 
   
   By this point McElmurry knew, or should have known, that his scientific basis for providing “low chlorine” alerts to residents and the agencies were bogus. So why on earth did he keep issuing them? The emails suggest he even derived satisfaction from continuing to raise alarms with the agencies for no good reason. For instance, after sending an email alerting EPA and the city to “low chlorine” in a Flint home November 29, 2016, he proudly forwarded it to Dr. Seeger with a statement: “They are going to love me.” Dr. Seeger responded “Wow.” 
   
   And as McElmurry continued to sample for chlorine around the State of Michigan, getting the control data that Wells had repeatedly requested, he not surprisingly found many other homes meeting the Michigan standard but violating the McElmurry standard. He was issuing low chlorine letters and email alerts to residents and government officials in Ecorse and River Rouge, MI through late November 2017. 
   
   FACHEP makes a mockery of ethical codes 
   
   It was around November 2017 when Dr. Masten’s growing concern over what she considered unethical behavior by FACHEP’s leaders, reached a breaking point. FACHEP was trying to rush out a Proceedings of the National Academy of Sciences (PNAS) publication concluding that the 2014-2015 Legionella deaths in Flint were due to chlorine levels dropping below 0.2 mg/L in consumer’s homes. In the text of the accepted paper the team had a misleading statement that claimed (bold emphasis added): 
   
   To reduce the risk associated with bacterial growth in water distribution systems, regulatory agencies recommend a minimum free chlorine residual of 0.2 to 0.5 mg/L. …chlorine residual is the most widely reported measure of water quality within distribution systems… 
   
   Dr. Masten emailed the lead author Dr. Michelle Swanson to explicitly point out what all of FACHEP should have known: 
   
   This is still factually incorrect. Chlorine residual is NOT the most widely measure of water quality. In fact, it is NOT a measure of water quality at all. It is a measure of the amount of disinfectant that remains in water. One can have a low chlorine residual and the water can be of excellent quality. One could have a high chlorine residual and the water could be of poor quality. 
   
   After Swanson refused to give Masten time to correct this and other errors in the manuscript, Masten made a very difficult decision to remove her name from the accepted publication. Immediately after this PNAS paper was published, it was used to support FACHEP in their now public disagreement with Mr. Lyon and Dr. Wells, and in court to support criminal charges brought against them. At that point, Dr. Masten decided she was ethically obligated to write the journal editors about her concerns with the document. The erroneous text that Dr. Masten called out was not changed in the final manuscript. In fact, the PNAS paper does not even acknowledge that the present day Michigan law had a standard for detectable chlorine (0.1 mg Cl 2 /L) at 95% of test sites. 
   
   Throughout this ordeal, FACHEP’s engineering faculty (other than Masten) repeatedly lectured anyone questioning miscues like their “low chlorine” alert, that the engineering code of ethics mandate to “hold public safety paramount” justified their every action. But those same faculty repeatedly violated that same code of ethics, by working outside their core area of expertise, which did not include Legionella, chlorine measurements, Shigella or lead. It seems as if FACHEP leadership had created an alternative universe, in which they were the true heroes of the FWC, fighting against villains, real or imagined, such as Dr. Wells, Mr. Lyon or even Dr. Masten. This mindset is revealed in several illustrative statements, some of which are delusional considering that their real work started AFTER the Federal Emergency and Legionella outbreak had ended. 
   
   Illustrative and highly dubious claims of FACHEP faculty heroism 
   
   Source/ Date Statement Wayne State Press Release on PNAS article 2/6/2018 “This abandonment of basic human and civil rights by those who once had the public trust led to water quality, safety and access issues that endangered the public health. In the midst of this maelstrom, a group of engineers along with medical, public health and social scientists assembled a research team to pursue answers to problems that others would rather leave unexamined. The authors of these papers from several universities and members of the research team — which included community members in meaningful roles — affirmed the higher purpose of science — to expand knowledge and serve the common good. As this FACHEP team developed, the key underpinning was the attention to clear, honest communication and careful listening to disenfranchised, marginalized Flint residents.” Dr. Sullivan (FACHEP) 10/20/2016 Thanks, all, for the integrity you’ve already demonstrated to Flint. History will show that in the aftermath of tragedy at the hand of opportunists, you were among the first to demonstrate the nobility of great men. Dr. Ben Pauli (FACHEP) 11/24/2016 Of all the people and groups that are doing or have done testing in Flint, I think our team stands out for demonstrating that a commitment to the residents need not preclude a commitment to good science, and vice versa. Dr. McElmurry 
   
   2/7/2018 Responding to a Facebook post that said: Thank Shawn McElmurry for Standing Up for Flint During the Legionella Outbreak…You Rock! * 
   
   McElmurry wrote “all of this would have been swept under the rug <without FACHEP>” 
   
   * There is no evidence that McElmurry and FACHEP did anything of substance during the Flint Legionella outbreak. 
   
   If anyone on FACHEP is to be considered ethical and heroic, in our opinion it will be Dr. Masten, who gave up authorship on a PNAS paper and made other sacrifices as a matter of principle. As her reward for doing the right thing, she was subsequently locked out of future FACHEP conference calls and shunned by the other faculty. 
   
   
   
   An enlightening conference call and FACHEP crybullying 
   
   As noted in our previous blog, the relationship between FACHEP and the State was without normal checks and balances. Specifically, because government failures created the FWC, FACHEP was fully aware that the press would always take the side of presumably noble and independent faculty in any disputes. Based on media coverage since 2016, it is apparent that they were correct in this assumption. In their emails, FACHEP faculty openly discussed that special prosecutors were looking to charge high ranking public officials within MDHHS for the Legionnaires’ Disease outbreak, and there is even some evidence these faculty had been speaking with the prosecutors. FACHEP repeatedly exploited that power imbalance. 
   
   In evaluating the evidence against Wells and Lyon related to FACHEP, we must give special weight to situations that do not involve he-said /she-said recollections. The last communication between Dr. Zervos (FACHEP) and Dr. Wells came March 3, 2017, when he wrote an angry email accusing her of being unethical (emphasis added): 
   
   Dr Wells, your comments to us at earlier meetings such as, “Do you know who is funding you?” or your more recent mandate to us to put a stop to the retrospective epidemiologic component of the project, can only be interpreted as a threat, and a clear attempt to influence our independent work and scientific integrity. 
   
   The “earlier meeting” in question, was a teleconference call on October 21, 2016, where the issue of the “low chlorine” alerts described herein was discussed. To our knowledge, even as of today, Dr. Wells is probably completely unaware that FACHEP’s written statements in the press release were based on McElmurry’s use of a now 28-year old AWWA citation that does not agree with modern AWWA recommendations or Michigan law. And that FlintWaterStudy, or even McElmurry for that matter, cannot even find a reference for the recommendation that caused so much trouble. 
   
   At the start of the call, Wells ethically informed everyone it would be recorded and transcribed for all parties. The call starts in typical FACHEP fashion — Dr. McElmurry announcing that FACHEP can only spare 30 minutes to work through concerns raised by his research sponsor. The MDHSS employees whose life had been upended by multiple FACHEP train wrecks currently in progress, can be heard to say “What the hell?” while the phone was muted, in obvious reference to McElmurry’s misplaced priorities. 
   
   Listen 
   
   Wells started by noting the awkward position that FACHEP had placed the State in with the “low chlorine” press release claims. McElmurry then made a false statement to Wells, based on what was possibly his zero years of experience measuring chlorine in Flint homes (despite claims of 5 years work) that the data: 
   
   was far beyond what it normally–what would normally be expected within a water distribution system and that’s why we thought it was important to relay that information to the public and the water utility 
   
   Wells reinforced the need for appropriate controls and sharing critical data immediately with their public health partners before going public, which is something McElmurry was not set up to do as mentioned previously. McElmurry then referred to FACHEP’s policy of communicating results to the public before they even have a chance to do quality control or analyze what they mean (i.e., “real time” reporting): 
   
   I am concerned about the values, that’s why I reported it as soon as I realized that we had this problem. I’m reporting to real time (??). 
   
   As we will repeatedly see in future blogs, what FACHEP’s leaders would most consistently reveal in “real time,” was that they were incompetent and operating outside their expertise. But Wells then informs McElmurry about the ethical obligation to not just report problems, but to also provide vetted information to residents on what to do about them. She then stated “apparently you have done this type of research before,” and asked how he had ethically handled it, to which McElmurry stated: 
   
   So the answer to that is I have done this kind of thing, we’ve measured chlorine before and we found it low. And I reported that back to the EPA and DEQ. In, you know, about the same time that I’m doing now. You know, I have not had the same level of urgency from the DEQ and the EPA regarding the data I’m showing. 
   
   When this all comes out at trial, we certainly hope that evidence is demanded from McElmurry to document exactly when, where, and how he previously reported “low chlorine” data back to EPA and DEQ. Especially when a “low chlorine” measurement at a home does not violate Michigan law and he cannot find the reference in his press release. Call us skeptical, but by this point, his statement to Dr. Wells sounds like other unsupported McElmurry claims about his work in Flint. 
   
   The transcript goes on and on in this manner, with Dr. Wells bending over backwards to try to be understanding and work with FACHEP, when she makes the following statement: 
   
   And so there’s been some feeling that perhaps while academia is, you know, collecting all this data and may be able to sort of talk about this in the press–and, again, I’m not faulting you on the press release, but the impression was is oh, well, you know, MDHHS will go figure out what to do about this, and I–and so I just want, I plead that, you know, public health, to us in our world reigns supreme, and we will–we will continue to advocate for your role as an independent, as independent as can be, but remember we’re funding you, and our IRB is with you, but we want you to be as independent, we want you to find anything with the system that had anything to do with the Legionella outbreaks would be great, but to please understand our passion and some of our knowledge when it comes to trying to do these studies in the public sector. All right? 
   
   Listen 
   
   According to Zervos, this mention of funding, “can only be interpreted as a threat, and a clear attempt to influence our independent work and scientific integrity.” Interestingly, after the transcript of the call was finally admitted at trial, Zervos still insisted “I took it as intimidation.” We take Zervos’ claim as an example of “crybullying,” a tactic that FACHEP truly excels at and which they deployed repeatedly. We have attached 77 pages of Zervos trial testimony, a highlighted 45 page transcript of the conference call, and the conference call recording itself to provide supporting documentation for readers that allow their own conclusions to be drawn about FACHEP’s credibility when it comes to “threats” and “intimidation” from Dr. Wells (and by extension Mr. Lyon). Our own perspective is that she was bravely trying to do her job, as best she could, given the power imbalance in the face of repeated unethical and incompetent behavior by FACHEP. 
   
   The DHHS call transcript ends, with the State employee’s, justifiably mocking the warped engineering code of ethics as embraced by FACHEP’s inept leadership as follows: 
   
   (Many thank you’s and goodbyes) Phone all hang up MS. HANLEY: Wow, that’s concerning. I mean–- DR. WELLS: He still hasn’t gotten that household data. MS. HANLEY: What the heck? Seriously. Those of us here around the table could be doing what–it doesn’t take a rocket scientist. DR. WELLS: No, it doesn’t. MS. HANLEY: Really? Hand entering? DR. WELLS: Yeah. MS. HANLEY: I can’t believe it. And it’s like—I mean, what do you need for it to be a public health emergency? I don’t get it. I mean, we talked about, not just Ebola, but the Zika and whatever else. I mean, there aren’t a lot of people who have it, but there’s the threat that it could spread, right? And so I just don’t understand why it is that they’re slicing hairs like that, and they’re sitting there spending the time to make these determinations. MS. CALLO: Right, when they’re telling us that, oh, it’s my ethics, my engineering code of ethics, remember that? Anyway, at one point I got this big speech they have this engineering code of ethics <indistinct> it was Nancy Love (fades out and recording stops) 
   
   Listen 
   
   All emails, testimony and relevant documents cited in the article above can be downloaded below: 
   
   Oct 20, 2016 Conference Call in FULL (audio) 
   
   Primary Author: Dr. Marc A. Edwards ||||| Buy Photo Governor Rick Snyder addresses questions about a spike in a form of pneumonia in Genesee County. (Photo: Daniel Bethencourt Detroit Free Press)Buy Photo 
   
   Since Flint switched its water source to the Flint River, officials have seen a spike in the number of cases of a severe form of pneumonia, called Legionnaires' disease — but officials say they're still looking for the cause. 
   
   There have been 87 cases in Genesee County from June 2014 to November 2015 — and 10 of those cases resulted in death, said Dr. Eden Wells, chief medical executive with the Michigan Department of Health and Human Services, or MDHHS. 
   
   That number is a jump from previous few years, when the county saw between 6 and 13 cases. It’s not clear how many were fatal. 
   
   While state officials said they couldn’t make a connection between the water and the spike in disease, a drinking water expert who studied Flint said the rise in cases was “dramatic,” and added there’s a “very strong likelihood” the river’s water played a role. 
   
   “I applaud the state for releasing this (report),” said Marc Edwards, who heads the Virginia Tech Research Team which was a key player in exposing lead contamination in the city's water. 
   
   Officials with the MDHHS say they noticed the spike in the fall of 2014. Months later, in April, MDHHS said they began interviewing residents who were affected. 
   
   That summer, Edwards and his team noticed that in some large buildings, which can have older plumbing systems, there were high levels of the bacteria that can cause the illness. 
   
   “Our hypothesis is that something about the Flint River and lack of corrosion control, plus big buildings, is creating these problems,” Edwards said Wednesday. 
   
   Though officials held a news conference Wednesday to alert the public about the spike, they made clear that there were no changes in recommendations for bathing or showering. Edwards also noted that the water is safe for residents to shower in. 
   
   “There’s every reason to believe (the spike) is something in the past,” he added. 
   
   Legionnaires' disease is a lung infection caused by Legionella, a type of bacteria that grows best in warm water. The bacteria usually enter the body from a person breathing it in, but it can't spread between people. The most vulnerable are those with weakened immune systems. 
   
   Gov. Rick Snyder said he learned of the disease cases only “a few days ago," and acknowledged during questioning that the increase in Legionnaires' disease “just adds to the disaster we are already facing.” 
   
   Flint’s water became contaminated with lead in 2014, once its supply source was switched from Lake Huron to the Flint River water, which was treated at the city water treatment plant. 
   
   The state downplayed and largely ignored the immediate complaints about the smell, color and taste. In October, the Michigan Department of Environmental Quality acknowledged it had failed to ensure the necessary safeguards for corrosion. That failure resulted in lead leaching into the water. 
   
   Lead causes permanent brain damage in children and is linked to other health and behavior problems. 
   
   The crisis became even more apparent this month, when Snyder declared a state of emergency, and Michigan State Police joined others in distributing bottled water and water filters. The state has also urged all Flint parents with children younger than 6 to have their children’s blood tested for exposure to lead. 
   
   In response to Snyder’s announcement Wednesday, Senate Minority Leader Jim Ananich, D-Flint, demanded that national infectious disease specialists arrive in Flint “tomorrow” and added, “We need an investigation into the past outbreak so we know what happened, whether there is any ongoing threat, and how to make sure it doesn’t happen again.” 
   
   Flint’s water is still unsafe to drink. Officials on Wednesday did not give a firm time estimate as to when the water might be drinkable once again, though Edwards noted that lead levels in a few homes have already gone down dramatically. 
   
   At the news conference on Wednesday, Snyder fielded questions about his administration’s handling of the crisis. He said that a good portion of the fault “could lie” with the Michigan Department of Environmental Quality, and welcomed the federal investigation already under way. 
   
   “We’re taking every action within reason, and going beyond reason to address this,” he said. He also said, “This is something you wish that never happened, and let’s see that it never happens again in the state of Michigan.” 
   
   Contact Daniel Bethencourt: dbethencourt@freepress.com or 313-223-4531. Follow on Twitter at @_dbethencourt. 
   
   Fund established for Flint children 
   
   A fund has been established to address the short- and long-term needs of Flint children exposed to lead through contaminated drinking water, the Community Foundation of Greater Flint announced Monday. 
   
   “Our Flint children deserve every opportunity to be healthy and successful," said Dr. Mona Hanna-Attisha, the Hurley Medical Center pediatrician who helped expose the tragedy. "The creation of this Fund will further ensure that our children are afforded the resources and interventions to overcome this population-wide exposure to lead.” 
   
   Donations can be made online at www.flintkids.com 
   
   Read or Share this story: http://on.freep.com/1UPCf8i
target: – Michigan Gov. Rick Snyder announced a new development Wednesday in Flint's water crisis that "just adds to the disaster we are already facing": specifically, a marked increase in cases of Legionnaires' disease that could be linked to the area's tainted water, reports the Detroit Free Press. From June 2014 to November 2015, there were 87 cases in Genesee County, 10 of them fatal, per the Michigan Department of Health and Human Services. In the previous four years, Legionnaires' cases ran from six per year to 13, CNN notes. And while the MDHHS isn't able to definitively tie the spike to Flint's water, it's taking the news seriously, and a drinking water expert who's been studying Flint's water tells the Free Press there's a "very strong likelihood" that it played a role. MDHHS officials first observed the rise in Legionnaires' cases in the fall of 2014, per the Free Press, and researchers found the bacteria to blame was proliferating in larger buildings, many with older plumbing. "Our hypothesis is that something about the Flint River and lack of corrosion control, plus big buildings, is creating these problems," Marc Edwards, head of an independent Virginia team looking into the crisis, tells the Free Press. Speaking Wednesday, Snyder said he learned of the issue just "a few days ago" and appeared to place some blame on the state's Department of Environmental Quality, the paper notes. "We're taking every action within reason, and going beyond reason to address this," he said. State health officials say it's OK for residents to shower and bathe, though they still can't drink the water. Edwards' team agrees, though he laments how it's all been handled. "It's a crisis of conscience in government," he tells CNN. "There are just so many places where you wish people had done things differently."