MHD-MWW Water Quality Technical Workgroup

State: WI Type: Model Practice Year: 2005

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Following a massive Cryptosporidium waterbome outbreak in 1993, the City of Milwaukee Health Department (MHD) and Milwaukee Water Works (MWW) formed a technical workgroup to address the myriad of regulatory and public health practice issues inherent in assuring high quality and safe drinking water within the Metropolitan Milwaukee service area. The workgroup comprised a number of key stakeholders in developing protocols for early detection, routine monitoring, risk communication and response to potential water contamination events. Representatives on the workgroup included staff from the State of Wisconsin Department of Natural Resources (regulatory), State of Wisconsin Division of Public Health, Milwaukee Metropolitan Sewerage District, MWW (plant operations and engineering) and MHD (laboratory, epidemiology and environmental). Initial workgroup outcomes included drafting protocols for field response, public notification and water monitoring critical to preserving public safety and health in the event of drinking water contamination in the aftermath of the Crytposporidium outbreak.

The MHD-MWW water quality technical workgroup meets on a monthly basis to review data, evaluate current processes, examine new research and share pertinent information. Since 1993, the workgroup has developed pathogen specific response protocols, established parameters and thresholds for emergency response, developed utility specific benchmarks for finished water quality, conducted studies of nearby watershed influences to treatment plant source water and responded to numerous treatment plant operational "events" of public health concern. The collaborative framework has been further leveraged in the arena of "drinking water security". The MHD-MWW water quality technical workgroup has initiate dialogue around necessary planning associated with early warning and detection systems and integration of water utility response protocols into the community-wide Emergency Operations Plan (EOP). The MHD-MWW collaboration represents a new paradigm in terms of a sustainable and critical partnership enjoining a common goal of assuring safe and potable drinking water within rapidly changing political, environmental and social environs.

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Milwaukee City Health Department
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MHD-MWW Water Quality Technical Workgroup
Following a massive Cryptosporidium waterbome outbreak in 1993, the City of Milwaukee Health Department (MHD) and Milwaukee Water Works (MWW) formed a technical workgroup to address the myriad of regulatory and public health practice issues inherent in assuring high quality and safe drinking water within the Metropolitan Milwaukee service area. The workgroup comprised a number of key stakeholders in developing protocols for early detection, routine monitoring, risk communication and response to potential water contamination events. Representatives on the workgroup included staff from the State of Wisconsin Department of Natural Resources (regulatory), State of Wisconsin Division of Public Health, Milwaukee Metropolitan Sewerage District, MWW (plant operations and engineering) and MHD (laboratory, epidemiology and environmental). Initial workgroup outcomes included drafting protocols for field response, public notification and water monitoring critical to preserving public safety and health in the event of drinking water contamination in the aftermath of the Crytposporidium outbreak. The MHD-MWW water quality technical workgroup meets on a monthly basis to review data, evaluate current processes, examine new research and share pertinent information. Since 1993, the workgroup has developed pathogen specific response protocols, established parameters and thresholds for emergency response, developed utility specific benchmarks for finished water quality, conducted studies of nearby watershed influences to treatment plant source water and responded to numerous treatment plant operational "events" of public health concern. The collaborative framework has been further leveraged in the arena of "drinking water security". The MHD-MWW water quality technical workgroup has initiate dialogue around necessary planning associated with early warning and detection systems and integration of water utility response protocols into the community-wide Emergency Operations Plan (EOP). The MHD-MWW collaboration represents a new paradigm in terms of a sustainable and critical partnership enjoining a common goal of assuring safe and potable drinking water within rapidly changing political, environmental and social environs.
Assuring safe drinking water is a core program function of many local public health agencies. While water utilities and regulatory agencies operate, manage and enforce the many provisions of the USEPA Safe Drinking Water Act (SDWA), it is generally the responsibility of the public health authority to provide some level of oversight and responsibility in the assurance of safe and potable drinking water within a community. The significant health consequences (estimated 400,000 ill and > 100 deaths) associated with the Crytposporidium outbreak in Milwaukee, WI in April of 1993 underscored the importance of the need for public health vigilance in the monitoring and assurance of safe drinking water within a large metropolitan area. The public health impact, both in terms of illness and economic implications, was of a magnitude never before experienced nor imagined. One result of the outbreak was the recognition of the need for closer public health and water utility collaboration in the routine monitoring and review of water quality treatment plant processes, finished water quality and its relation to emerging infectious diseases and related surveillance systems within the community. Months after the outbreak, an inter-agency water quality technical workgroup was formed to begin the task of creating a forum and protocols for water utility, public health and other stakeholder involvement in assuring safe drinking water within the Metropolitan Milwaukee Service area. The overriding goal of the workgroup is to develop, institute and evaluate preventive measures (e.g. procedures, protocols and policies) that would mitigate the impact of any future waterborne disease incidents. Post 9/11, the workgroup has evolved to include discussions on water security in the context of an intentional contamination event. This forum routinely brings and leverages expertise across both public health and water utility professionals proactively around water quality and public health through mutual data review, consensual response protocols, relevant research, coordinated risk assessment and models and joint risk communication to public, media and elected officials. The collaboration between the MWW and MHD is unique and crosses both disciplinary and cultural boundaries of each organization. The forum and model of interaction is novel in terms of combining joint review and analysis of both environmental drinking water quality treatment plant data and benchmark parameters with public health reportable and syndromic communicable disease data. In addition, this model of inter-agency cooperation has resulted in distinct response protocols to "unusual events" in the context of utility operations, public health surveillance or naturally or manmade environmental contamination. The model of interaction has also the added benefit of providing the framework for discussions on "water security" post 9/11 and in concert with to national and regional preparedness initiatives.
Agency Community RolesThe formation of the water quality technical workgroup was eventually mandated through city resolution within months after the Cryptosporidium outbreak. The chair of the group held by the water utility with staff from treatment plant operations, engineering and administration in attendance. Public Health members include public health epidemiology, laboratory and environmental staff. Representatives from the Wisconsin Department of Natural Resources (regulatory) and wastewater treatment plant also regularly attend. Periodically, members of environmental groups and other governmental agencies at local and state levels attend for agenda specific items. Public health provides leadership and requisite focus on drinking water safety and health outside of assurance of regulatory compliance with USEPA Safe Drinking Water Act provisions and in the context of emerging infectious disease, examination of potential naturally occurring waterborne disease clusters and in preparation of response to potential, suspected or real threats to water security.  Costs and ExpendituresCurrent costs associated with the collaborative are now primarily in-kind and involve primarily staff attendance on a monthly basis by both water utility and public health (<.15 FTE per year). However, initial personnel costs over the first year were somewhat higher due to identification of necessary data streams, design of reporting mechanisms, and administrative support in development of response protocols. Additional monies were periodically spent by the MWW and WDNR (USEPA) support of watershed monitoring by the MHD (5K per year) and for risk modeling by a private consultant (5K) using existing databases and information compiled by the collaborative over the years.  ImplementationMeetings for the MHD-MWW Water Quality Technical Workgroup are convened monthly. Review of water plant operations logs, finished water quality parameters, environmental watershed sampling and monitoring programs and public health communicable disease data are shared. Data and reports from both the WDNR and local wastewater treatment plant are discussed as available and pertinent to drinking water safety.
Two discernable outcomes from this collaboration that have greatly enhanced drinking water safety have been the development of a water contamination response protocol including notification, sampling and treatment plant operations components as well as a risk assessment model specifically addressing health risk to Crytposporidium infection through consumption of drinking water. Another important outcome has been the natural evolution of the workgroup toward discussion and development of joint protocols around water security especially as related to early warning and detection systems related to distribution system monitoring. The MWW MHD water quality "collaborative" has recently been recognized and highlighted by the USEPA in a guidance document for water utilities nationwide to be released in April 2005.  
The collaborative has been sustained for approximately 12 years primarily through MWW and MHD commitment to continued routine exchange of information, mutual interest in review of constantly evolving research and technology and refinement of contamination event response protocols especially in arena of emerging infectious disease and water security. There is also a keen political commitment on behalf of City elected officials to continue to ensure close coordination between public health and water utility administrators and staff. Finally, there has been a routine financial commitment on behalf of the MWW through its annual budget to ensure that special projects or initiative essential to better understanding preventive 'best practices" are examined. This does not preclude the MHD and others from pursuing grant funding for projects such as watershed monitoring to enhance current data and water quality monitoring management.  
 
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