Documents obtained by the Waterloo Chronicle show Waterloo Region health officials were reluctant to inform the public about a breakdown in the water fluoridation system servicing the City of Waterloo, contrary to Ministry of Health guidelines.
Those are just some of the troubling findings that have come out of a Chronicle investigation, a year after breakdown and repair of the fluoride injection systems at three major water supply points left much of the city’s water absent of the controversial water additive.
The documents suggest a major breakdown in communication, a misunderstanding of ministry protocols and even an unwillingness to go public about the problems in a timely fashion.
Region of Waterloo water operators informed the Waterloo Public Health Department on May 7 that the main fluoride dosing systems for the city’s drinking water had been shut down due to equipment failure and repairs. All fluoride injection sites were down.
It wasn’t until Nov. 17 that health officials went public and revealed fluoride had been turned off for six months. This was contrary to a Ministry of Health regulation stating that public health has a duty to report to the public about lowered fluoride levels after 90 days.
E-mails reveal health official knew as early as Aug. 28 about the scope of the problem with the release of quarterly fluoride reports. That report showed the artificial fluoride levels were down at all distribution points, and would be down for much of the rest of the year.
But instead of recommending going public, as required by Ministry of Health, Dr. Robert Hawkins, the dental consultant with Public Health, suggested they delay releasing the alert.
“Water treatment staff have informed us that fluoride should be added again by mid-to-late October,” said Hawkins in a Sept. 4 e-mail to Chief Medical Officer of Health Dr. Liana Nolan.
“If you would like to proceed with a public notification please let me know. Given that the fluoride systems should be operating within the next two months, I would suggest that it may not be necessary.”
Nolan responded: “I would not proceed with public notification at this time. I really want to know why we were not informed and also to better understand what the problem is/was with fluoride in the first place.”
In response to the Chronicle’s questions about timing, Nolan said they were reacting to the August 28 fluoride report as new information. She said they wanted to get all the information possible before going public.
“We have a responsibility to make the information public,” said Nolan. “And as soon as we had all of the information and it was clear to us that we needed to inform the public, we did.
“I still think it was pretty fuzzy in September.”
The Ministry of Health’s protocols on Community Water Fluoride Levels state the local board of health “shall ensure that the medical office of health submits a report to the board of health after that fluoride concentration is below 0.5 parts per million for more than 90 days.”
In this case notification should have gone out after Aug. 4, 2009 — that was the 90-day cutoff. There is nothing in the protocols to suggest this is anything but a hard reporting deadline.
Public health is also required to notify all dentists, physicians and pharmacists and inform them of the low fluoride concentration, and inform the public through the media. They are also supposed to institute a contingency water-monitoring plan.
While public health officials waited until mid-October for repairs to be completed, in another flurry of e-mails it became apparent those repairs would drag on.
Nolan, sent an Oct. 27 e-mail to Thomas Schmidt, director of water services, when she learned about the problems at the main injection site. She requested that pump be fixed first.
“Can your plans be altered? I am trying to avoid having to go public with this, as it will be very confusing to try to explain.”
When asked about the apparent reluctance to go public, Nolan said given their reporting responsibility, which they take very seriously, they had to have correct information.
As it became apparent that there would be no quick fix to the problem, Public Health started drafting a formal response Nov. 3. That was almost six months after being officially informed of the breakdown.
But it still took them until Nov. 17 to release the final report.
“We spent the next few weeks gathering the information so we could actually report,” said Nolan. “At that point we can’t just say we don’t understand what’s going on.
“If we need to report something we need to know what to report.”
As for informing the City of Waterloo’s water services department, they were the last to know. On Nov. 12, Nolan advised Bill Garibaldi, the city’s director of water services, not to release it to council for fear it would quickly get into the hands of anti-fluoridation opponents.
“I am not advocating that you share this with your councillors,” said Nolan in an e-mail. “I am just giving you a heads up.”
“Hi Liana, yes, we believe we need to inform our councillors,” Garibaldi replied.
On Nov. 17 the public was made fully aware that fluoride wasn’t flowing through local water pipes. By that time some of the breakdowns went back almost seven months.
“I think the complexity, with the number of issues going on at the same time, cause the delay,” said Nolan.
“But until we got exactly what we needed we couldn’t produce the report. And as soon as we got the information we relased it.
“This issue wasn’t that ‘Oh this was a fluoride issue’ — It’s a water issue and water issues are complicated.”
The entire water fluoridation system went back online in December.
May 7 – MV3 junction, which distributes about 59 per cent of Waterloo’s water, suffers a major breakdown. All of Waterloo is now fluoride free.
The Water Services department’s Frank Infante informs Hawkins. Depending on availability of parts dosing will restart in a month.
June 23 -Peter Clarke from the Region’s water services department informs Hawkins that repairs to MV2, a minor system, have been delayed due to maintenance issues.
June 24 – In an e-mail to Nolan, Hawkins writes given the limited importance of MV2 he didn’t think notification of dentist and public is necessary.
“Makes sense,” says Nolan in an e-mail response to Hawkins.
Aug. 4 – The 90-day guideline for reporting to the public about lowered concentrations of fluoride in the water passes. There is no indication any action has been taken.
Aug. 28 – Hawkins gets June fluoride reports from water services and notes that all of the water dosing systems have been off since May.
He informs Nolan that all water systems have stopped adding fluoride due to maintenance issues, and that some of the breaks go back to April. Hawkins says to his knowledge there was no previous correspondence.
Sept. 4 – Water services inform Hawkins that fluoride should be added again by mid-to-late October. Hawkins suggests, “that it may not be necessary” to inform dentists and the public.
Nolan responds: “I would not proceed with a public notification at this time.”
Waterloo fluoridation has now been off in Waterloo for four months.
Sept. 10 – Olga Vrentzos, manager of water operations and maintenance, says in an e-mail to her knowledge Public Health had been informed at the time of the fluoride stoppage and when repairs commenced.
Sept. 14 – Hawkins sends the Ministry of Health protocols to water services.
In an e-mail to Nolan, Hawkins acknowledges that Public Health may have been informed about the other systems undergoing repair. The key point is that regular communications and updates didn’t occur. “At this point, I suggest that we don’t notify dental offices and the public if the fluoride sysemts are online by mid-October.” Nolan writes back: “I agree with your assessment.”
Oct. 23– Hawkins asks Vrentzos for an update on the repairs. He asks if the fluoride system will be back online by the end of October as scheduled.
Water fluoridation has been off in the City of Waterloo for five months by this point.
Oct. 26– Vrentzos informs Hawkins that work to complete repairs of MV3 won’t be done until December.
Oct. 27– Hawkins sends a note to Vrentzos about the importance of the wells. He is told that MV2/3 provides the largest portion of water to Waterloo.
Hawkins writes: “We were hoping that the main fluoride systems would be operational by the end of this month. Is so, we’re not going to inform the public of the stoppage.”
In an e-mail to Nolan, Hawkins writes that they may now have to consider informing the public and dental offices because the systems have been down for more than 90 days.
Nolan says getting the larger system up and running is a priority, and sends a note to Thomas Schmidt, the director of water services.
“Can your plans be altered? I am trying to avoid having to go public with this, as it will be very confusing to try to explain,” she aid.
Schmidt e-mails water manager Nancy Kadousek to look into the pace of repairs. “With the whole fluoride issue having so much public attention I think it is critical for us to get these systems operational asap,” he writes.
Oct. 29– When informed that up to 77 per cent of the city will not get fluoridated water until December, Public Health starts framing a response. Nolan wants to send it out as a press release or memo to the region Community Services Committee. “I am still trying to understand what we need to communicate to the public,” Nolan writes to Kadousek.
Nov. 5 – Nolan drafts a response to release to the Community Services Committee Nov. 17. The fluoridation dosing systems has now been off in Waterloo for six months.
Nov. 12– Nolan informs Bill Garibaldi, director of water services for the City of Waterloo.
Garibaldi asks how this is going “public?” He asks if it is going to the media and when Waterloo City Council will know.
Nolan writes to Waterloo Region CAO Mike Murray, “With this going to Waterloo Councillors proactively, it will be in Robert Fleming’s hands at 4:30 tomorrow.”
Nov. 13– Nolan tells Hawkins that the percentages of the population affected by each distribution sites continue to change. The percentage of the population affected by each site is unknown.
Nov. 17– The Public Health department informs the public about the fluoride stoppage. It has been off for six months.
December -All of the water fluoridation systems are up and running.