What the Eyes Don't See

by Mona Hanna-Attisha

  The memo—an eight-page interim report written by Miguel Del Toral, Elin’s former colleague and the regulations manager of the Midwest water division of the EPA—was methodically detailed, science-driven, and shocking.

  The words “high lead levels in Flint” were right there at the top, in the subject line under the official EPA letterhead. Honestly, that alone should have been enough to stop everyone in their tracks. It should have prompted the state to study and fix the situation and, most important, alert the public. You don’t mess around with lead or even the suspicion of lead. Any pediatrician will tell you the same thing. The split second this memo saw the light of day, a state of emergency should have been called. And the governor should have asked for federal help.

  But somehow here I was in bed, my hair on fire, fully two months later, reading about it for the first time.

  Del Toral’s report described water testing in the home of LeeAnne Walters, a thirty-seven-year-old mother of four and military spouse who lived on Browning Avenue, on Flint’s south side. Just a few months after the water source switch in 2014, Walters noticed that her three-year-old twins, Gavin and Garrett, broke out in red bumps after they were given a bath. Gavin had immune deficiencies and was especially prone to problems. If he soaked in the bathtub for a long time, a scaly rash would form across his chest at the waterline. As Curt Guyette’s stories described, even after the city lifted its boil alerts and officially announced that the bacterial content in the water was in compliance with federal guidelines, the Walters family continued to experience rashes, along with abdominal pain and bizarre hair loss.

  LeeAnne’s eyelashes were disappearing. Her eighteen-year-old daughter, Kaylie, was taking a shower when a clump of hair fell out in her hand. And even more troubling, according to a Guyette story, Gavin had stopped growing.

  Nine months after the water switch, in January 2015, Walters went to her first city council meeting. The following month a city employee was sent to test the water in her house. Prior to taking a sample, the employee ran the tap for a few minutes—explaining that he was following MDEQ guidelines to “pre-flush.” This struck Walters as strange—if there was something in the water to worry about, wouldn’t whatever it was get flushed out too? People don’t usually flush tap water before they drink it.

  Even with flushing, the sample came back showing an astronomically high amount of lead in Walters’s water. Particles and metals in water are measured in parts per billion, or ppb, and the lead in Walters’s water tested at nearly 400 ppb. Based on the latest scientific studies, the maximum amount of lead that should be allowable in water is 0 ppb. Even the EPA agrees. But the official “action level”—the amount of lead that warrants some sort of action be taken—is set at 15 ppb.

  The memo stated that Walters took her children to the doctor for testing that revealed elevated lead levels in their blood.

  When Walters notified the city of her children’s high blood-lead levels, she was told that her household plumbing must be to blame, since the tests of city water showed lead levels in compliance with regulations. The city arranged for a garden hose to run from a neighbor’s house to Walters’s house to provide “lead-free” water.

  A few days later Governor Snyder’s office issued a statement that the Flint system was “producing water that met all the state and federal standards.”

  Walters was not reassured. For starters, when she first moved into her house, she had discovered that all the copper pipes had been stripped and stolen (not uncommon in Flint). That had forced her to install all-new plumbing made of polyvinyl chloride (PVC), a strong but lightweight plastic. She had told this to the city employee when he came to test. If all her pipes were made of plastic, how could they be leaching lead? Frustrated, she contacted the regional EPA headquarters in Chicago and eventually reached Miguel Del Toral.

  According to Elin, only a handful of people in the drinking-water universe were as careful, and knew as much, as Del Toral. During her years at the EPA, where she wrote new regulations for the Safe Drinking Water Act, she worked closely with him on a “disinfection by-products” work group. As a member of that work group, Del Toral had a reputation for high standards, extra vigilance, and immunity to the pressures of groupthink. He raised concerns about drinking water regulations that everybody else dismissed or overlooked. Finally, here he was! My idealized lab-coat-wearing public health civil servant come to life. He didn’t mind conflict and was unafraid to go his own way.

  By the time Walters spoke to Del Toral on the phone, she had searched the Web to educate herself thoroughly about water treatment and had come to some conclusions. She told Del Toral she suspected the Flint water supply was corrosive and the pipes were leaching lead. She questioned whether the city was using corrosion control.

  Del Toral found it hard to believe that the city wasn’t using corrosion control and asked Walters to read him the list of chemicals that were used to treat Flint’s water, as posted on the city website. When she was finished, he asked her to read him the list again, just to make sure he’d heard correctly. Not using corrosion control was a breach of federal law. There were no corrosion control chemicals on the city list.

  He followed up with MDEQ immediately, but his calls and emails didn’t get him anywhere. No action was taken to correct the problem.

  Next, in April 2015, Del Toral traveled from Chicago to Flint to investigate Walters’s house himself. First he thoroughly examined the plumbing, the pipes the city officials had described as the likely source of lead.

  As his memo states, his inspection of LeeAnne Walters’s home found that all the interior plumbing, including the pipes, valves, and connectors, was made of plastic certified by the National Sanitation Foundation (NSF) for use in drinking water applications. Del Toral’s sampling showed that the faucets were also not the source of the high lead levels.

  On his second visit, in May 2015, Del Toral deduced that the problems weren’t inside the house but in a service line that led to it, when he extracted portions of the line and discovered it was made of galvanized iron and lead. Del Toral also found the pre-flushing procedure done at Walters’s house prior to sampling very troubling. Pre-flushing was known to result in a “minimization of lead capture and significant underestimation of lead levels in the drinking water,” according to his memo. This was a “serious concern” because the results “could provide a false sense of security to the residents of Flint regarding lead levels in the water and may result in residents not taking necessary precautions to protect their families from lead in the drinking water.” But when he raised his concern with MDEQ, the department pushed back. Pre-flushing was not specifically prohibited by federal law, or by the Lead and Copper Rule, which governed drinking water. The department said it planned to continue the practice.

  His conclusion: the pipes serving the Walters home were leaching lead. MDEQ was using faulty testing procedures. And Flint wasn’t using corrosion control. He included the blood-lead levels of the four Walters children as evidence of impact, and he predicted that Flint could be facing an epic water crisis. He recommended that the EPA offer the city and MDEQ technical assistance.

  He directed his report to Thomas Poy, chief of the Ground Water and Drinking Water Division of the EPA, but seven other individuals were copied, including two other employees at the EPA and four officials at MDEQ. The report was dated June 24, 2015.

  Something truly disturbing happened after that. Rather than generating an instant response to the potential crisis outlined, Del Toral’s findings were second-guessed. Rather than seriously investigating the matter as quickly as possible, as any responsible federal agency would, the EPA stalled, then reprimanded Del Toral for overstepping his responsibilities and referred him to the agency’s ethics office. At MDEQ, the memo was met with even more resistance and hostility. State regulators painted Del Toral as a lone wolf and alarmist—“a rogue employee”—who had gr
ossly exceeded his authority. Embarrassed, the regional manager at the EPA even apologized to MDEQ for Del Toral’s memo, describing it as premature and incomplete.

  Seeing no alternative, Del Toral, still defiant, gave Walters a copy of his findings, which she passed along to Curt Guyette, who broke the story on July 9, 2015.

  * * *

  —

  ELIN AND I EXCHANGED texts and emails while I read. Sometimes she answered my questions in quips and scientific shorthand, but mostly we expressed ourselves in words of disbelief and angry emojis. The more I knew, the angrier I became. I was mad at myself for not paying attention to the repeated outcries of the Flint activists and even angrier at all levels of government for their lack of response and their gross indifference.

  Red flags, so many red flags—they were everywhere. The information was all right there in Del Toral’s memo. But somehow nobody with the power to make a difference had cared enough to notice.

  * * *

  —

  LOOKING BACK OVER THE summer, I saw how I had been caught in my own busy bubble—dealing with a new crop of pediatric residents on July 1 and Elliott’s shoulder surgery in mid-July, followed by the opening of our brand-new Hurley Children’s Clinic, which we celebrated with an open house on August 7. We began receiving patients just a few days later. To make the summer more complicated, Layla’s birthday was August 14, and I planned her party and the annual Hurley Pediatric beach party for the same summer weekend.

  These are my excuses. But the truth was, after a year of concern about Flint’s water being brown and smelly, and a year of assurances from officials, I’d failed to notice the dust storm caused by Guyette’s pieces and had only a faint memory of government assurances about the water and Mayor Walling drinking a glass of it on television. But while I was consumed by the day-to-day distractions of my family and work projects, other people in Flint were speaking out—moms, activists, pastors, and even our kids. They were organized and vocal. Why wasn’t anyone in government listening to them? Was it because they were poor and predominantly black? Or was it because there was no reason for the government to listen to the people because Flint was no longer a democracy? The city was in the hands of an unelected EM who was accountable to the governor, not to the people of the city.

  I quickly ran the numbers in my head. Flint had about ten thousand children under the age of six. Many of them were our patients. Over the last year, we had treated thousands of Flint kids for winter coughs and summer sniffles, for strep, broken bones, and fevers. We weighed them all, checked their ears, and listened to their heartbeats carefully. We asked their moms if they were getting proper nutrition. We discussed obesity, drugs, and violence in the community. We gave them immunizations and, when they needed help navigating the system, referrals to social workers. We tried to help them get to their appointments with transportation assistance.

  Being a pediatrician—perhaps more than any other kind of doctor—means being an advocate for your patient. It means using your voice to speak up for kids. We are charged with the duty of keeping these kids healthy.

  We took an oath.

  Where had we been?

  Where had I been?

  Now I was wondering whether I’d ever sleep or eat again.

  “If you want to get really motivated,” Elin wrote in an email, “look at the Wikipedia page on the D.C. crisis.”

  “Okay.”

  “You’ll see what you’re up against.”

  * * *

  —

  WASHINGTON, D.C., IS A mecca for recent college graduates. Entry-level jobs and internships in politics, nonprofits, and government are plentiful—and promotions can happen quickly. Elin’s career was a vertical blur, as far as I could tell. And it was because Elin was in D.C. that we had stayed in close touch over the years. She lived only a few houses away from my brother in the crunchy suburb of Takoma Park.

  Her first job, right after graduating from Carnegie Mellon, was at the U.S. Patent Office, but after a year, she found a job at the EPA, where she really wanted to be. The concept of environmental protection really meant something to her, as it had since our high school days of activism. The position—she was hired to write annual reports for the EPA’s chief financial planner—wasn’t exactly what she wanted, but she thought it would get her foot in the door, and something better would follow. But years passed, and, for all her promotions up the bureaucratic ladder, nothing did.

  September 11 woke her up—and pushed her to do more meaningful work. It was time to do some real environmental protection, not just paperwork for government contracts. She got the word out among EPA friends and learned that the Office of Ground Water and Drinking Water had some new positions for engineers. Protecting drinking water—that sounded like important work. In 2002 she began a new job in that office while taking classes part-time at the Northern Virginia campus of Virginia Tech, working toward a master’s degree in environmental engineering.

  But the job turned out mostly to mean writing more regulations for the Safe Drinking Water Act that would take years to propose, finalize, and implement. It was a time of seismic shifts in water treatment, when cities across the country were switching disinfectants, not only to combat a broader range of pathogens, but also to limit the effects of chlorine and its carcinogenic by-products, like TTHMs.

  A public health triumph, drinking water treatment has saved countless lives from persistent menaces like E. coli and halted deadly epidemics of cholera. But now there were new threats—noroviruses and something called cryptosporidium, or “crypto.” Cryptosporidium, a microscopic parasite that wreaks havoc on the digestive and respiratory tracts of human beings, is not effectively removed from contaminated water by chlorine, so the EPA decided it needed to create better drinking water treatment rules.

  Many cities turned from chlorination to chloramination. As a disinfectant, chloramine lasts longer than chlorine, is effective against crypto, and doesn’t create as many toxic by-products. By 1998, in order to comply with the new EPA regulations, an estimated 68 million Americans were drinking water disinfected with chloramine, and several major cities, including Washington, D.C., were using it.

  But there were problems—as there are with any disinfectant, depending on the amounts used, the mix of other disinfectants, and composition and quality of the source water.

  “Water treatment is an art,” Elin wrote in a text.

  ME: I’m starting to get that.

  ELIN: It’s complicated.

  ME: I get that too.

  ELIN: Every time they tweak the rules, some new thing pops up.

  The problem: chloramines made the water much more corrosive, an unforeseen consequence that didn’t come to light for several years. By that time, the corrosion had leached toxic levels of lead for years.

  * * *

  —

  THE D.C. WATER STORY broke in an alternative newsweekly, the Washington City Paper, on October 18, 2002, through the story of a resident of American University Park whose water tested very high for lead—six to eighteen times the EPA action level. The EPA scientist overseeing D.C.’s water at the time suggested that drought conditions could have raised the alkaline levels of the Potomac River, which would make the water temporarily more corrosive, and caused the service lines to leach lead into the water. It was thought that there were about thirty-five thousand lead service lines serviced by the city’s water utility company, D.C. Water and Sewer Authority (WASA). A plan was implemented to replace 7 percent of those lines each year until the lead levels dropped.

  That was the official plan anyway. Nobody questioned it until the following year, when WASA hired Marc Edwards, a young professor of civil engineering at Virginia Tech, to look into the inexplicable increase in pinhole leaks in copper water pipes in the D.C. area. It was even happening in new copper pipes, which were supposed to last fifty years. Edwards, an expert in copper corrosio
n with a degree in biophysics, began researching the rise in these strange leaks.

  Out of curiosity, Edwards decided to do a test for lead, suspecting that a chemical change in the water could be causing deterioration of the D.C. pipes. As he would later recount at congressional oversight hearings, the level of lead on his first test exceeded his meter’s range. He had to dilute the water and test again. When he did, even the diluted water tested at a minimum of 1,250 ppb of lead, a level that Edwards later said “would literally have to be classified as a hazardous waste.”

  Edwards had stumbled by accident onto the unforeseen consequences of the new EPA regulations, the very ones that Elin’s office had been working on. The switch to chloramine, now required by Safe Drinking Water Act regulations, caused increased corrosiveness in the water. Old service lines had been coated with decades of accumulated mineral deposits that formed a protective coating inside the pipes, but that protective layer was now being stripped by the corrosive water. And lead was leaching out.

  A cover-up was already under way. When Edwards brought his findings and concerns to WASA, he was told his funding and future access to monitoring data would be cut off. At the EPA, his subcontract was discontinued. Other engineers who drew attention to the toxic lead levels and recommended the utility and the EPA take much more aggressive action, like WASA water-quality manager Seema Bhat, were fired. Elin attended the first few meetings in 2003 to address the elevated lead levels, and when she began asking a lot of questions, she was mysteriously removed from the project and promoted to another division within the agency.

  Weeks, months, and finally years passed. Lead flowed freely and in heavy amounts in all four quadrants of the District, from Georgetown and Spring Valley to the farthest reaches of Georgia Avenue and Anacostia. It affected infants, children, and adults; rich, poor, and gentrified; working, middle, and upper class; white and black.