FLINT, Mich. — Standing at a microphone in September holding up a baby bottle, Dr. Mona Hanna-Attisha, a local pediatrician, said she was deeply worried about the water. The number of Flint children with elevated levels of lead in their blood had risen alarmingly since the city changed its water supply the previous year, her analysis showed.
Within hours of Dr. Hanna-Attisha's news conference, Michigan state officials pushed back — hard. A Department of Health and Human Services official said that the state had not seen similar results and that it was working with a much larger set of data. A Department of Environmental Quality official was quoted as saying the pediatrician's remarks were " unfortunate ," described the mood over Flint's water as "near-hysteria" and said, as the authorities had insisted for months, that the water met state and federal standards.
Dr. Hanna-Attisha said she went home that night feeling shaky and sick, her heart racing. "When a state with a team of 50 epidemiologists tells you you're wrong," she said, "how can you not second-guess yourself?"
No one now argues with Dr. Hanna-Attisha's findings . Not only has she been proved right, but Gov. Rick Snyder publicly thanked her on Tuesday "for bringing these issues to light."
Nearly a year and a half after the city started using water from the long-polluted Flint River and soon after Dr. Hanna-Attisha's news conference, the authorities reversed course, acknowledging that the number of children with high lead levels in this struggling, industrial city had jumped, and no one should be drinking unfiltered tap water. Residents had been complaining about the strange smells and colors pouring from their taps ever since the switch.
Already this month, federal and state investigations have been announced, National Guard troops were distributing thousands of bottles of water and filters, and Mr. Snyder was calling for millions in state dollars to fix a situation he acknowledged was a "catastrophe."
Yet interviews, documents and emails show that as every major decision was made over more than a year, officials at all levels of government acted in ways that contributed to the public health emergency and allowed it to persist for months. The government continued on its harmful course even after lead levels were found to be rising, and after pointed, detailed warnings came from a federal water expert, a Virginia Tech researcher and others.
For more than a year after an emergency manager — appointed by Mr. Snyder to oversee the city — approved a switch from the Detroit system to water from the Flint River to save money, workers assigned to manage the city's water system failed to lower lead risks with a simple solution: adding chemicals to prevent old pipes from corroding and leaching metals like lead. Disagreements and miscommunication between state and local officials about what federal law requires of so-called corrosion control measures further delayed fixing the problem, the documents show.
"This could have been nipped in the bud before last summer," said Daniel Giammar, an environmental engineer at Washington University in St. Louis.
The testing of homes in Flint for lead, too, was insufficient and flawed, some experts say. Officials failed to focus on the many homes with lead service lines that were most likely to be tainted, instead looking at wider problems that would have muted the calls of alarm.
The city authorities also urged, and state regulators allowed, methods of sampling that experts say had been shown to underestimate lead levels. Residents were advised, for example, to run their water before taking samples, a move that tends to flush out concentrations of lead particles that might have accumulated.
And through it all, officials persisted in playing down and dismissing the concerns of Flint residents — one referred to concerned residents groups as "anti-everything" — and authoritatively vouching for the water's purity, even as they themselves were debating whether it was pure.
Three months before Dr. Hanna-Attisha voiced her fears and findings, a regulations manager for the federal Environmental Protection Agency had sent a detailed interim report to the state and federal authorities that included unambiguous warnings like this: "Recent drinking water sample results indicate the presence of high lead results in the drinking water, which is to be expected in a public water system that is not providing corrosion control treatment."
It is unclear how many people have had elevated lead levels in their blood over the last year and a half. The state has identified 233 since April 2014, but Dr. Hanna-Attisha said its numbers likely "grossly underestimate" exposure, partly because testing was generally limited to 1- and 2-year-olds until recently. Lead remains traceable in the blood for only about a month after exposure.
As criticisms have mounted, high-ranking officials have resigned, including Howard Croft, Flint's director of public works; Dan Wyant, the state's Environmental Quality director; and Susan Hedman, the E.P.A. regional director .
Dave Murray, a spokesman for Mr. Snyder, issued a statement on Friday calling the crisis "a failure of government — at the local, state and federal levels." He added that the governor was "committed to fixing the problem and addressing the immediate and long-term needs of the people of Flint."
Dr. Hanna-Attisha also cited the wholesale failure of government. "They had the information," she said. "They just weren't looking closely or believing it."
On April 25, 2014, Flint, whose population had dwindled from more than 195,000 in 1960 to fewer than 100,000 people , switched to using the Flint River as its water supply. The city had drawn water from Detroit's system for decades, but it was expensive, and so Flint joined efforts to create a new, regional system that would draw from Lake Huron.
Costs had become a central concern in a city that has lost thousands of auto industry jobs. Fiscal troubles were so significant that the state sent an emergency manager — with ultimate decision-making power — to oversee a recovery. Until the new pipeline to Lake Huron was constructed, the city would take its water from the Flint River, which it had used as a backup.
City leaders toasted the switch with cups of water . Residents were less sure. For years the Flint River had been a dumping ground — for cars and even bodies. Aware of the doubts, the city's first news release on the switch trumpeted state and local officials' assurances.
Then came the odd colors from the tap — greens and browns — and the offensive smells and tastes. Soon there were reports of rashes and clumps of hair falling out. Parts from a General Motors engine plant here were corroding, so the company stopped using Flint's water.
Tammy Loren, a mother of four who rents a home, was having a hard time believing the answers she got about why her sons' skin had itchy rashes. At various times over the last year and a half, she said, their doctors diagnosed scabies, ringworm and other fungal infections, but prescribed medicines never worked. The family even had the home treated by an exterminator, thinking the problem might be fleas.
"The water was brown, and it had a disgusting smell," said Ms. Loren, whose sons are now 14, 12, 11 and 10. "It was like dirt coming out."
For months, Ms. Loren said, she conducted her own research on the Internet and asked plaintive questions on community Facebook pages. Her family started drinking bottled water when it could, but Ms. Loren, who receives federal disability payments for her back and other problems and relies on food stamps, said it was not that often.
"There was times when we couldn't afford it," she said. "We just kept drinking out of the tap."
Through it all, the government reassurances were constant, insistent and unequivocal. "It's a quality, safe product," Mayor Dayne Walling told The Flint Journal in June 2014.
At points, the city's water tested positive for E. coli bacteria, which can cause intestinal illness, and residents were advised to boil their water. City officials pumped extra chlorine into the system to address the bacteria issue, which led to elevated levels of total trihalomethanes, or TTHMs, chemical compounds that may cause health problems after long-term exposure.
A state briefing in February last year acknowledged the TTHM level was "not 'nothing' " but also not an imminent "threat to public health."
In July, Flint sent residents a letter saying it was "pleased to report" the "water is safe."
But officials' efforts to soothe residents about other contaminants seemed to overshadow the growing signs of trouble about lead.
By March 2015, with residents turning up at public events bearing bottles of murky water , the City Council voted to "do all things necessary" to reconnect to Detroit's water system. But the state-appointed emergency manager, Gerald Ambrose, said no. He repeated the official mantra: The water meets state and federal standards. And he noted, once more, that Detroit water was among the most costly in the state.
"Water from Detroit is no safer than water from Flint," Mr. Ambrose said.
Corrosion Control Failure
Behind the scenes, though, officials seemed far less sure.
By the end of February, Miguel Del Toral, the E.P.A. regulations manager who had learned of high lead content in one Flint resident's water, was raising a fundamental question with his state and federal colleagues: What was Flint using to treat the river water to avoid corrosion?
"They are required to have O.C.C.T. in place which is why I was asking what they were using," he wrote in an email on Feb. 27, using the initials for "optimal corrosion control treatment."
Surely, the assumption was, the city was adding a chemical to the water to coat its aging pipes and prevent corrosion, since controlling corrosion is required by a federal rule governing lead and copper. The water that Flint had drawn for years via Detroit from Lake Huron had been treated with orthophosphate, a common anti-corrosion additive. And Flint River water is naturally even harder and more corrosive, experts say, than the water the city was buying from Detroit.
An official from Michigan's Department of Environmental Quality answered Mr. Del Toral's inquiry the same day: Flint has "an optimized corrosion control program." But less than two months later, the state said it had been wrong. There actually was no treatment in place in Flint to stop corrosion, a timeline of events provided by the state now shows.
The authorities themselves did not agree on what the federal rules meant. Some state officials believed that testing needed to be done over a year before a new plan could be put in place to block corrosion, documents suggest, while other officials thought the treatment with chemicals needed to start the moment Flint began receiving water from the river.
"We made a mistake," Mr. Wyant, then the state's environmental quality director, said in October. Corrosion controls, he said, "should have been required from the beginning."
The lead issues should have been anticipated long before the city switched water supplies, experts said. "I think that's pretty obvious, in going from having a corrosion inhibitor to not having one, you might have expected to have increased corrosion," said Professor Giammar.
By June, Mr. Del Toral wrote in a memo to state and federal colleagues that Flint had essentially stopped providing treatment used to mitigate lead and copper levels in drinking water, which he called a "major concern from a public health standpoint."
E.P.A. officials contend that they pressed Michigan regulators to take more decisive action after Mr. Del Toral's report, but for months federal officials did little to inform the public of those findings or take decisive action. It was not until Thursday that the federal agency issued an emergency order and assumed oversight of lead testing in Flint.
Flaws in Testing
All along, Flint's water was being tested for lead.
Yet when health officials studied tests showing higher levels of lead in children's blood in the summer of 2014, they suggested that the increases were a result of ordinary seasonal fluctuations . Water samples, too, showed rising levels of lead in the first half of 2015 compared with late 2014, and a Flint Journal data analysis concluded that they were at their highest in 20 years .
There was so much lead found in water at the home of LeeAnne Walters that officials shut her water off in April and temporarily installed a garden hose to carry water from a neighbor's house. Still, state officials noted that the city's levels remained within federal and state standards.
But the water tests themselves were flawed, experts say.
According to the American Civil Liberties Union of Michigan, which conducted its own investigation, as did researchers at Virginia Tech , the city was not only advising residents to run their water before collecting a sample, but doing other things to "skew the outcome of its tests to produce favorable results." For example, the A.C.L.U. reported in September, the city retested water from homes found to have low lead levels, but not from homes whose initial levels were high.
The city also appeared to be unsure which houses had lead service lines connecting them to its water distribution system, the report said. Federal law requires cities testing for lead in drinking water to focus on homes with the highest risk for contamination, but the report found no evidence Flint had done so.
Dr. Hanna-Attisha said that after she shared her methodology with the state, it replicated her findings. Mr. Snyder then announced that the state would provide filters and test tap water.
Marc Edwards, the Virginia Tech professor who helped identify and expose Flint's lead problem, said the state "had no sense of urgency at all, nor did E.P.A."
Ms. Loren, the mother of four, said her sons' skin remained irritated, and she is worrying obsessively about their lead levels, particularly that of her 11-year-old, who has learning disabilities.
"My trust in everybody is completely gone, out the door," she said. "We've been lied to so much, and these aren't little white lies. These lies are affecting our kids for the rest of their lives, and it breaks my heart."
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