Family Physicians Helping Flint Community

As doctors who care for people of all ages, and whose broad scope of knowledge enables them to treat the entire body, Family Physicians are on the front lines of healthcare. They also play a key role in the public health system and mitigating public health crises, like the one affecting so many lives in the City of Flint today. Considering the potential for irreversible and costly impacts associated with lead exposure, prevention, diagnosis and mitigation are critical.

Upon learning of Flint’s water contamination, the Michigan Academy of Family Physicians’ leadership, membership and staff went into action, collaborating at the local and state level to provide wide-ranging aid. Among the healthcare professionals who are on the front lines administering blood tests, referring families to community resources, and collaborating across specialties and with the public health system and hospitals, are Mary Marshall, MD, a solo practitioner in Grand Blanc, and Paul Lazar, MD, FAAFP, chair of the Department of Family Medicine at McLaren-Flint Family Medicine Residency.

“Many people mistakenly think that, because Grand Blanc is outside the City of Flint, the community is insulated from this crisis,” said Dr. Marshall. “We are right next door to Flint, and many of my patients live in and rely on water from the city. For example, next week I am scheduled to administer blood level testing for a child from a day care on the University of Michigan-Flint campus.”

Children aren’t the only ones affected by elevated blood lead levels. While their developing brains put them at higher risk for behavioral changes and difficulty with critical thinking, adults can also display symptoms of lead poisoning. Screening children is now a standing order at Dr. Lazar’s Flint practice, but “we will test anyone who wants it, and a lot of people have been asking,” he said.

While knowing the level of lead in the body is important so steps can be taken to minimize the effects, insurance may not cover lead testing for adults.

“For many Flint residents, especially those from low-income households, paying the out-of-pocket costs of testing is a huge barrier, if not a complete deterrent,” said Dr. Lazar.

In their efforts to protect the residents of their communities, and to be a part of the change that is so desperately needed today and for a healthy future, Dr. Marshall and Dr. Lazar are “in the thick of things.” They are reaching out to their colleagues, connecting to their local health departments, and reading literature to learn all they can about the intricacies of lead poisoning, how to identify the likely sources of the toxin for each individual patient, and the evidence-based best next steps.

“The most important course of action we, as Family Physicians, can take for our patients is to educate ourselves, look and screen, ask the right questions, sift through the misinformation, and get beyond the politics,” said Dr. Marshall.

It is clear that Family Physicians have a large role in screening for lead poisoning and developmental issues in the children and families afflicted by the Flint water crisis. Their expertise, however, goes far beyond the provision of comprehensive medical care, as confirmed by Kim Yu, MD, FAAFP, president of the Michigan Academy of Family Physicians.

Among that expertise is serving as a vital conduit for connecting patients to local resources. After all, at the heart of Family Medicine is community. Family Physicians truly know the communities they serve, having well-established relationships with other healthcare providers and knowledge of local services important to their patients’ health.

“If I had a wish list, one wish would be for insurance companies to pay for nutrition counseling without a specific diagnosis such as diabetes. Vitamin C and dietary iron hinder the body’s absorption of lead. Eating root vegetables like carrots and potatoes that have not been scrubbed clean can also be a source of the toxin, if grown in lead-rich soil. Ensuring that patients know these facts is essential,” said Dr. Lazar.

Guaranteeing that education, referral and intervention services are available requires funding. To that end, Dr. Yu and MAFP staff met with legislative leadership following Governor Rick Snyder’s 2016 State of the State address, which focused heavily on the Flint water crisis, to share input on legislation to fund critical medical, nutrition and social services, among other provisions.

As the membership association representing over 4,000 Family Physicians, Family Medicine residents and medical students across the state, the Michigan Academy of Family Physicians is the voice for the specialty and the patients whom Family Physicians serve.

“This puts us in a unique position to be a resource as legislation and policy is drafted for safeguarding the health and wellbeing of Michigan residents,” said Dr. Yu.

Ultimately, the Michigan Senate passed an emergency supplemental funding package on January 28, which would provide $28 million in aid to Flint to pay for additional lead screenings for young children through the Early On program; cover medical, wrap-around and nutritional services for children provided by the Genesee Intermediate School District; and extend Governor Snyder's emergency declaration through April 14. The House concurred with the Senate version and House Bill 5220 now heads to Governor Snyder for his signature.

As additional details of the Flint water crisis emerge, the Michigan Academy of Family Physicians continues to arm the state’s Family Medicine community with the most up-to-date information and resources, said Dr. Yu. Over 1,000 family doctors, residents and students represented by the MAFP live and work in Flint and the surrounding communities, and are connected to knowledge sharing and practice support through their membership.

“Michigan Family Physicians will continue to work with our fellow pediatricians and local health departments to provide complete, comprehensive care for all residents of our state. I believe that with early intervention, good nutrition, regular preventive care and follow up, we can try to alleviate some of the devastating impacts caused by this crisis,” said Dr. Yu.

One resource for the most up-to-date information for healthcare professionals and residents is the State of Michigan's Taking Action on Flint Water website. If you don't practice in or around Flint but would like to help, visit HelpForFlint.com where you can sign up to volunteer or make a donation.

Below are other notable happenings that took place as of press time:

• As part of an amendment to an energy bill being debated in the U.S. Senate, Senators Debbie Stabenow (D-MI) and Gary Peters (D-MI) proposed $400 million to fix or replace lead-contaminated water pipes in the City of Flint. Read more.
• It was announced that the U.S. Department of Health and Human Services (HHS) will lead the federal government's work to collaborate with state and city officials to identify the size and scope of the problem and then develop and execute a plan to mitigate the short- and long-term health effects of lead exposure. Read more.
• Governor Snyder announced appointments to the new Flint Water Interagency Coordinating Committee, charged with overseeing long-term solutions for the Flint water system. Among the committee appointees is Dr. Mona Hanna-Attisha. Read more.
• Governor Snyder announced that MDHHS will submit a formal request to HHS to expand Medicaid eligibility for all residents in the impacted areas up to age 21, regardless of their income level, so they can receive additional healthcare services to address potential problems caused by lead exposure.
• Michigan Attorney General Bill Schuette named former prosecutor Todd Flood to lead the the state's investigation of the water crisis. Read more.