Board of Health

LOWELL BOARD OF HEALTH 341 Pine Street Lowell, Massachusetts 01851 Mav 2,2018 A meeting of the Lowell Board of Health as held on Wednesday May 2,2OL8 in the Mayor's Reception Room, City Hall, 375 Merrimack St., Lowell, MA 01852. Chairwoman Jo-Ann Keegan called the meeting to order at 5:07 PM Present: Jo-Ann Keegan, RN, MSN Chairperson John Donovan Board Member Kerry Hall, Board Member William Galvin, MD Board Member Lisa Golden Board Member 1. New Business 1.1. For Acceptance: Minutes of the April d 2018 Meeting Of the Board of Health Motion: To accept the minutes of the Rpril 4,zOLg meeting of the Board of Health made by Kerry Hall, seconded by Lisa Golden. All in favor. 1. ll. Tobacco Control Monthly Report Submitted By Cesar Pungirum, Program Director. Program Director Cesar Pungirum reviewed the report with the Board. The Board accepted and placed on file. 1. lll. Tobacco Permit Suspension Public Hearing - Hei Elvis 698 Merrimack St. Lowell, MA 01854 Program Director Cesar Pungirum reviewed the violation documentation for Sale of a Minor - Second Offense issued to the establishment Hei Elvis. No representative of Hei Elvis attended the hearing. VOTE: To suspend the establishment's Sale of Tobacco Products license for a period of seven consecutive business days beginning May 14, 2018 made by Kerry Hall, seconded by William Galvin. RollCall: Jo-Ann Keegan - yes Lisa Golden - yes Kerry Hall - yes John Donovan - yes William Galvin -yes 1. lV. Monthly Development Services Report Submitted By Senior Sanitary Code lnspector David Ouellette Senior Sanitary Code Inspector David Ouellette was not present. The Board reviewed the reports and placed on file. 1. V. For Review: Trinity EMS, Inc Reports. Inclusive of Monthly Opioid/Hometown Reports Hometown Opioid Reports - Mr. Jon Kelley and Mr. Kirk Brigham reviewed the March and April reports with the Board. Causes of overdoses were discussed. lt was noted that the Boston hospitals with other stakeholders including UMASS/Lowell did a rapid survey with people that had overdosed.  BOHM050218 Page2 Quarterly Report - The Board reviewed the report with Mr. Kelley and Mr. Brigham. The Board noted that page 4 in lower right of page should be corrected to Ql 2018. Mr. Kelley had an updated report with the correction which was passed out to the Board. Board Member William Galvin asked that on page 5 Outliers section that Mr. Kelley include how many first calls there are, the percentage of those calls that were outliers, and how many were outside of the range. Member Galvin also asked if Trinity could program their system to track the number of Lst, 2nd, 3rd, etc. calls. Also the EMD-Delta figures were discussed and the use of lights and sirens for these calls vs. 911 calls. The Board asked for proposals regarding the use of lights and sirens on calls and routes to hospitals for low priority calls. Page 7 - the Board noted the increase in volume and asked what the appropriate number of trucks for the volume would be. Member Galvin asked for the number of outliers for each number of trucks. Mr. Kelley noted there are not less than 8 trucks during the day in Lowell. Page 8 - Intubation numbers, intubation training, and King tube intubations were discussed. The Board had no further questions. Motion: to take Agenda ltem Vlll out of order made by William Galvin, seconded by Lisa Golden. All in favor. 1. Vlll. Communication - Dr. Jonathan Drake (EMS Medical Dir. Lowell General Hospital). The Board reviewed and discussed the communication received from Dr. Jonathan Drake. The Board indicated that the intent of the report was to track trends over time. The Board asked that Mr. Kelley include any figures received from Lowell General Hospital to the Quarterly Reports. Motion: To return to the Agenda made by Kerry Hall, seconded by Lisa Golden. All in favor. 1. Vl. Communication: From DPW Commissioner James Donison, P.E. Communication regarding the City of Lowell herbicide 2018 Yearly Operation Plan in accordance with the Massachusetts Rights-of-Way Ma nagement Regu lations (333 CM R i.1.00). The Board reviewed the submitted Annual Operation Plan and placed on file. 1. Vlf . Nomination of Animal Inspector 2Ot7-20L8: Pending completed certified Nomination of Inspector of Animals- Darleen Wood. Ms. Wood's completed certified nomination form was received prior to the meeting. Motion: To nominate Darleen Wood as Animal Inspector made by William Galvin, seconded by Lisa Golden. All in favor. 2. Old Business 2. L Update: Lowell High School PENDING AVAILABIIITY: Mr. James Green, Deputy Commissioner of DPW, and Mr. Rick Underwood, Director of Facilities for Lowell Public Schools to update the Board about Lowell High School on any ongoing/completed repairs or issues Mr. Green and Mr. Underwood were not present to update the Board. Chairwoman Jo-Ann Keegan informed the Board that she had met with City Manager Eileen Donoghue regarding the Board's concerns. Manager Donoghue will obtain a report from DPW on the status of the Critical Health Report ongoing repairs and CO2 levels. The Board asked that DPW Commissioner James Donison, Mr. Green and Mr. Underwood be invited to the June 5, 2018 to give an update. Chairwoman Keegan recognized Ms. Laura Ortiz to speak. Ms. Ortiz discussed with the Board the recently held City Council meeting and the possible inspection of other schools for gas leaks.  BOHM050218 Page 3 3. Director's Report 3.1. Status Update: Service Zone Plan Review HHS Director Kerran Vigroux updated the Board on the current status of the Service Zone plan and the planned visit of Mr. John Brickett who will review the redlined plan with Ms. Vigroux and Mrs. Colleen da Silva, Public Health Nurse Coordinator. 3.11. Update: Divisional and Department Reports and Updates. Ms. Vigroux reviewed the divisional reports with the Board. Member Galvin inquired why STD's were not included on the Public Health Division report and was informed that they are not reportable at the Local Board of Health level. Ms. Vigroux updated the Board on the ongoing CDC in depth investigation on the increase of HIV cases. Ms. Vigroux informed the Board of the resignation of Mr. Daniel Witts, PFS Outreach Health Educator. Chairwoman Keegan asked that the Public Health Division Report to have the columns in the same order as the School Health Division Report by moving the third column to the second column location. Motion: To adjourn at7:46 PM made by William Galvin, seconded by John Donovan. All in Favor. THE NEXT MEETING OF THE CIW OF LOWELT BOARD OF HEALTH WILL BE HEID ON JUNE 6,2OL8 AT 6:00PM lN THE MAYOR'S RECEPTION ROOM.  llo"J.,.r; Lowell Board of Health Hearing TO F+ 5 - Z - 18 May 2,2018 (obr,m *on1 PurDose: The purpose of this hearing is for the Board to consider the suspension of the Tobacco Product Sales Permit issued to Hei Elvis, 698 Menimack St, for a period of seven (7) consecutive business days. Rule: Pursuant to the Lowell Board of Health regulation Restricting the Sale of Tobacco Products,a retailer that sells tobacco to a minor for a second time within 24 months shall receive a fine in the amount of $200 "and the Tobacco Product Sales Permit shall be suspended for seven (7) consecutive business days." Summarv of the Facts: Hei Elvis Records sold a pack of Marlboro cigarettes to a 17-year-old boy on 02l2lll8, during routine compliance checks conducted by the Lowell Tobacco Control Program. This was the establishment's second offense in the last two years; a previous violation had occurred on06103117 . Board's Decision:  Trinity EMS Lowell MA EMS Peformance indicators 911 Operational Peformance- Data TIMES: Trinity BLS Trinity ALS LGH ALS TIMES: Trinity BLS Trinity ALS LGH ALS Fractile % 95.sWo 94.O9% 27 sec 1 min 5 sec 1 min 2 sec Avg out of chute 22 sec 48 sec 52 sec 5 min 23 sec 5 min 47 sec 5 min 11sec Avg resp time 4 min 57 sec 5 min 30 sec 5 min 40 sec 12 min 51sec 16 min 37 sec 15 min 7 sec Avg on scene time 11 min 40 sec 8 min 54 sec 9 min 15 sec 7 min 3 sec 8 min 50 sec 14 min 45 sec Avg transport time 8 min 37 sec 12 min 16 sec 8 min 27 sec f of events >7:59 109 100 339 49 response time 249 25 # of events using Non Trinitv BLS units 3 o Trinity BLS Trinity ALS LGH ALS Trinitv BLS Trinity Al5 LGH ALS 9t.5t% 79.7t 92.54 92.48% 1 min 8 sec 1 min 7 sec 31 sec 1 min 4 sec l min 2 sec Avs out of chute 28 sec 5 min 3 sec 7 min 6 sec 5 min 8 sec Avg resp time 5 min 26 sec 6 min 53 sec 5 min 4 sec 12 min 38 sec 15 min 18 sec 15 min 55 sec Avg on scene time 10 min 31sec 8 min 45 sec 11min 53 10 min 57 sec 11 min 4 sec 11 min 2 sec Avg transport time 5 min 21sec 6 min 36 sec 10 min 24 sec # of events >7:59 476* 46 159 response time 419* 35 130 # of events using Non 3 happened in a 15 minute frame. 9,10, *= including calls EMD'ed via TEMS Trinitv 8LS units 4 and l1th 911call 0 Q2 2017 Q3 2017 Q4 2017 Ql2018 Q2 2016 Q3 2016 Q4 2015 Ql2017 95.5M 94.09% 92.4996 91.53% TEMS BtS 93.s1% 94.66% 94.79% 9s.38% -(tutPtv Ooo'/ret &1ao(  I l, I- )r( Female I u IPA .'l) Male, 34 Jj 12 and U Priority 1 30 13-15 -a ^1'ttY tt'f' Priority 2 6 L6-17 u 'b Priority 3 20 r irrrirt Avg,"t4r L8.ZT . n -Iry' I f, Ar T @Avs@ Mon 7 L.4 Red are weekends (below) 22 23 v / -/ \ )tr.r .trt' ^ Tue 24 .U^,. Wed 6 9 1.5 2.3 ; ll 25 " 0' Thu Fri Sat Sun 10 10 6 8 2.5 2.5 7.? 1.6 'l .l llunr, l ,. i I ,: ,., ,' 3 r.r !(' ll il ,'llrrtl I i.l ti 16 il i8 tq ln,lt il li 1,1 :",.'. .26 127 t28 ll, 29 4 5 0 3 30 3 31 5 32 2 Private Residence Lowell FD 10 Lowell PD 5 16 2mg doses 33 2 Public Location- Inside Trinity ALS L Trinity BLS 9 L2 4 mg doses 34 2 Public Location- Outside LGH ALS 2 Other 5 1 8mg doses 35 0 Residential Institutuion 36 L Acre 7 Back Cnt 6 Belvidere 2 Centralville 10 Downtown 15 37 3 Highlands 2 Lw Belv t Lw Hiphl6 Pawtucketville 5 Sacred Heart 2 38 L Lowell 30, Billerica 3, Chelmsford 1, Fall River 1, Gardner 1 39 L 40 4 4L 1 42 0 43 2 44 0 45 1 46 0 47 4 48 1 49 0 Q1 Q2 Q3 Q4 Yr avg Q1 Q2 Q3 Q4 Yravg 50 0 2013 0.7 L.2 1.1 0.6 0.9 2013 0.3 0.4 0.5 0.2 0.3 s1-55 1 20t4 0.8 L.4 1.6 L.4 1.3 2014 0.3 0.6 0.8 0.9 0.7 55-60 0 2015 1.4 1.7 1.9 t.4 1.5 2015 0.8 0.7 0.e 0,8 0.8 51-55 1 2016 L.7 1.6 23;,, 1.9 2015 1.0 66-70 0 20t7 2.G 2.2 20L7 1..3 2018 &:8. r 2018  ,Jf WHY ARE DRUG USER HEALTH PROGRAM SY,.\ekigre@dvl=-* IMPORTANT? Heolth problems ossocioted with iniection drug use con impoct the whole community. Whot ore some exomples? o Overdose from opioids ale at an all-time high. In z}l4,over 1,000 people died as a result of opioid- related overdose in Massachusettsl o In 2015, 85% of all opioid retrated deaths were due to heroin or illegally manufactrrred fentanyl. o Trrro out of every three people who died tom opioids in 20lS were younger than 44. o HepatidE C is on the rise in many commnnities. Hepatitis C diagmoses in ls-24 year olda have increased byZ4% between 2002 and ZOOgz o An outbreak of Hrv such as the recent one in Indiana is posribleg How do syringe occess progroms (sAps) protect community health? o Hundredg of studies have confirmed the effectiveness of ryringe access ptogrrams (sAps) in reducing the spread of HIv, hepatitia c and other blood, borne illnegseg o SAP8 are incredibty effective in accessing drug users that are not engaged in any fiorm of care. o Many drrrg nsers do not seek help urtil a health concern ig go advanced that it reguirea hospitalization. SEPs provide an opportunity to get help in a non-judgrmental environment, before health concerns become more advanced Recovery is not a linearprocess. Freguent relirpse is more the norm than the exception. o According to the World Health Organizatioil, SEPg increased entry into Eeatrnent, retention of treatment and were associated with "subgtantially leas injecting or cessation of injecting" Since establishment of harm reduction progtrarns, new HIV infections attributed to injection dnrg use have dropped by 92% in Massachusetts betweenzooz and 20126 How do SAP's Promote Public Heolth ond Scfety? o SAP'8 reduce the circulation of contarninated syringes among IDU's, educating and informing participants about the safe diaposal of uaed ayringesa o Studieg demonstrate that the availability of SAPs in comnrunities regulte in increased safe disposal of used sTringes. For instance, in Portland, Oreglon, the number of improperly discarded ayringes dropped by almost two-thirds after the implementation of a SAp. ? For more information, please contact Liz Whynott, Director of HIV Health and Prevention at Tape!ilry: lwhynott@tapertryhealth.orE I Thc Eoton Globo, "Mos. opioid dcorhs toppcd l,O0O in 2Ol,{..' 201 5. :3 MA DPH. "Shifting Epidomlcsr HtV ond Hcpotillc C Infactlon omong lnlcctlon Drug Urcru in Morsochurottt." 2012, hnP!//www.courirr-loumol.com/story/novs/lcr;al/lndiona/2O'16/07/27/W-could-hovc-ovoldcd-hlv-ourbrook-sludy-l;ayt/87621720/ a ht'tpr / / oppllcotionr"omro.who.lntrloiccf/wcb30l .pdf 5 MA DPH. "Shtftlng Epldrmi* HIV and Hcporilir C Infcction omong Inlrctlon Drug Uron In Mosrochurcth." 2012. 1 o"ttatty MC, rt ol. Dfscordcd nccdlcr do not Incroorc roon oftcr rhr opcnlng oio nordb oxchong. progrom. Arn ricon Jowrct of Egidcniology, t997tt4518l'730.7. 7 Kopfon EH, Hoimcr R. A clrcutotion rhcory of noodlc cxdrongc. AIDS. l99il8(51$67-7a. t0/28/2016  WHY ARE DRUG USER HEALTH PROGRAMS IMPORTANT? Do SAPs lncreose Crime or Drug Use? ' sAPs do not encourage the initiation of dnrg uae nor do they increase the tsequency of dlrg use among current users, according to an assessment by the Institute of Medicine. s o The pre3ence of SAPs in communities does not expand &ug-related networkg or increase crime rates. s o On the contrary, research has found that neighborhoods in Baltimore with SAps experienced an I I percent decrease in break-ins and bnrglaries, whereas areas of the city without SAps e:<perienced an 8 percent increase in crime. l0 Another study conducted in Baltimore demonstrated that the number of arrests did not increase after the establishfirent of sAps. t I Whot services ore offered ot SAps? o Routine screening for HIV, Hepatitis C, Syphilis, Chlamydia and Gonorrhea o Education about and access to pre-erposure prophylaxis (prEp) o Overdose Education and Nasal Naloxone Digtribution . Drug Treatment Referrals o Health lnsruance Enrollment o Care Coordination o Referals to Senrices (HIV Medical Care, primary Care, etc.) r Syringe Access o Safe Syringe Disposal At Tapestry S.f,Ps 460lo rnore Tapestry clients reported using Narcan ln a recovery rltnatlon in 20fs than 201{. In Eolyoker STYo mote ryzlnger w€re collected aaillSo/o more tndivtdual clients werrr seen ln 2015 than in 2014 For more information, please contact Liz Whynott, Director of HIV Health and Prevention at Tapestry: lwhynott@tapestryheelth.org 8 InstiMc of Mcdicinc. Prcvenling HIY lnfe<tion Among lniccfing Drug lJscrs in High-Rrt Counhics. An Aoorrmoat of thc tvidcncc. wo$lngton, D.C.: Notlonol Acodcmi6 Prcss; 2006. e Morx MA, el ql. Trcnd: In crimc ond lhc introduaion of o nocdlc oxdrongc prog?om. Anrctiein loonpl of Public fholrh. 2000;90(l2l:1933-6. ro Ccntar for Innovotivc Public Policica. Nccdlc Erchorge Progromt: lr Sollimorc o Surlg Tomoroc, Fl,r OPP; Aprll 20Ol rr Dohcrty MC. et ol' Dirordcd nccdbs do not Inctco!8 ofirr thc opcrdng of o necdlc cxctrongc progrqm, Ameicon Jo4|'nl ol Epidaniotogy. l997i1A5l8ll3o=7, 'oon t0/25/2018