Board of Health

CITY OF SALEM BOARD OF HEALTH MEETING MINUTES February 13, 2018 MEMBERS PRESENT: Paul Kirby, Chair, Dr. Jeremy Schiller, Mary Lauby, Nancy Crowder, Kerry Murphy OTHERS PRESENT: Larry Ramdin, Health Agent, Suzanne Darmody, Public Health Nurse, Maureen Davis, Clerk of the Board, Beth Gerard, City Council Liaison, Geri Yuhas, Mary Wheeler and Denny DesRosiers, Healthy Streets, Michele Sweeney and her colleague Patrice DeLeon, Salem State University, Dr. Kimberly Waller, Salem State University TOPIC DISCUSSION/ACTION 1. Call to Order 7:02pm N. Crowder motioned to take item #5 out of order. Kerry Murphy 2nd. All in favor. Motion passed. 2. Mary Wheeler and Denny M. Wheeler distributed information sheets. Official start date of the DesRosiers, Healthy Streets - syringe exchange program was 12/5/2017. To date, they have picked up Syringe Service Program over 1,200 syringes and gave out over 1,000. The program uses home delivery and street outreach. At outreach, D. DesRosiers distributes double-sided, folded information sheets in plastic bags to keep them dry. There is a list of the now 18 Syringe Service Programs across MA, including Salem. This is the only “advertisement” of the program. Most find out about the program through word-of-mouth. There is a core group of five or six people they see every week, once a week. Eleven individuals total. Majority of clients being seen are white males. Overdose rates have gone down to extremely low in Salem, so not many Naloxone (Narcan) kits distributed. Door knocks have helped. Decline in ODs likely due to users using safer after being educated, but also because a lot of people have died. J. Schiller asked if the numbers are better or worse than expected. M. Wheeler said the number of people is about what was expected, but the number of syringes being distributed is higher than expected. P. Kirby asked if they have received any additional funding. M. Wheeler said no extra funding, but DPH is very appreciative that they started the program for us anyway. D. DesRosiers feels education to users is very helpful. Keeps some people out of the emergency room. They distribute “clean kits” to those users who reuse needles. Show people how to properly clean their syringes with bleach and water if they do decide to reuse it. It helps to reduce infection and HIV, but the goal is for them not to reuse needles. They are given extensive education to inject in different sites to let their veins heal and how to wipe a site properly. D. DesRosiers also works with Officer Vaillancourt a couple of days a week doing needle sweeps and letting users know the community is supporting them. They are caring and compassionate no matter what  stage users are in. They do follow-ups whether clients are actively using, clean, etc. to show them that if they need anything at all they are there to help them. They partner with Lifebridge where they go at lunchtime to educate people and to see if anyone needs any help getting into detox programs, distribute Narcan, etc. They also work with 13-15 chronically homeless and pass out band-aids, razors or anything else they may need disposed of properly. J. Schiller noted we have received no negative impact from the program. M. Wheeler said the goal with the state is to take in more syringes than they give out. P. Kirby told M. Wheeler to let us know if she feels we should change the 1-for-1 ratio and the Board will speak to Chief Butler at that time. M. Lauby asked M. Wheeler if she feels the problem will ever get better. M. Wheeler said the numbers may lessen as people die, but she doesn’t really see it getting any better. There just won’t be as many people to use the drugs. About half the people they are seeing in Salem have birthdays in the 1990s. There is no more initiation into drugs through pill use. People go right into potent and fatal drugs. There are “fake pills” out there, which are just pressed pure Fentanyl, etc. Very frightening. P. Kirby noted that years ago crack use lessened, but M. Wheeler said now people are afraid of Fentanyl, so some are going back to smoking and shooting crack cocaine. P. Kirby told M. Wheeler to let us know how we can support them in any way and thanked them for their work. He asked that she provide data from both their work on the program and also the work provided by D. DesRosiers and Officer Vaillancourt. M. Lauby motioned to take item #6 out of order. Kerry Murphy 2nd. All in favor. Motion passed. 3. Michele Sweeney, Salem State M. Sweeney provided all with information on the program. The University - Healthcare Studies Healthcare Studies Program is a new program that was created to help Program students who were not strong in the sciences, but were interested in healthcare. The program started in the fall of 2016 with 30 students enrolled. Now, one year later, 180 students are enrolled. The Healthcare Seminar class lets students explore minors. Bachelor of Science Degree in Healthcare Studies students complete a mandatory minor and also take electives to support the major. It is structured so the student can go in many directions. 120 credits are required to graduate. Interns, juniors and seniors, are currently interning in many companies. For example, an intern can work at a company for five hours, twice a week to reach 120 hours. Students can also shadow at a site for three hours. Employers can bring a problem to the student, and they will bring it into the classroom for real-life experiences. She would like to be able to educate her students on what the Board of Health actually does. L. Ramdin said the appointed Board of Health is the legal body. They oversee the big picture of public health on the policy side. The Health Dept. is the operational side of the Board of Health. We implement their policy, plus a lot of mandated requirements placed on us by the Dept. of  Public Health. He said we would be willing to partner with Salem State whenever the opportunity works out for both sides and gave M. Sweeney his business card. M. Lauby said we are slowly working on a strategic plan for an overall population health agenda, such as what services are available for Salem and when and where are the services. There is no funding for those projects. M. Sweeney would like students to have an opportunity for projects where leadership is involved. P. Kirby stated he works for the Medicaid Agency and could also help out with health policy opportunities. J. Schiller pointed out there are a myriad of options with the collaboration of the City and the University. L. Ramdin said lots of people are not aware of what we actually do. K. Murphy is meeting next week with Patricia Zaido for Salem for All Ages and is also working with the Council on Aging and will be in touch. M. Sweeney said she wanted to plant a seed with us. Many of the students are non-clinical based. They really love healthcare and their interests are very diverse. B. Gerard feels health policy is needed around here. She has a Masters in Health Policy and is currently an analyst at Salem Hospital, but her background is in policy. With U.S. health policy vs. MA health policy, MA is leading the way in so many ways. The MA Medicaid program is the best in the country. M. Sweeney feels the Board can only help enrich their programs by sharing our knowledge and will help the students focus on what they want to do. - 10-minute break - 4. Approval of Minutes M. Lauby moved to approve minutes. N. Crowder 2nd. All in favor. (January 9, 2018) Motion passed. 5. Chairperson Communications Nothing to communicate. 6. Monthly Reports-Updates a. Public Health S. Darmody showed all a copy of the weekly report she receives from the Nurse’s Report state. The first pediatric death from the flu in MA was a 6-year old first grader. Over 60 deaths nationally. K. Murphy asked if there is any change in the effectiveness of the flu vaccine. S. Darmody said no, she has not heard of any change. Copy available at the BOH office. b. Health Agent’s J. Schiller was asked by a couple of people about the HEPA vac on Report sanders. L. Ramdin said Salem was built tight together. We had requests to review the HEPA vac with sanding. Martin Fair, a former Board member who was the Health Director in North Reading at the time, went out on  several occasions with people who wanted it reviewed and they were still getting a lot of sand and dust all over the place. Dust should not travel across your property and must be contained within a specific area. J. Schiller asked if our decision is based on data. L. Ramdin said it is based on direct observation. Our BOH regulation does not allow electric sanding on any exterior surfaces. We cannot control the dust. It is based on the requirements of DEP air pollution regulations, which we must enforce. L. Ramdin reminded the Board to act on situations from a public health standpoint and not because people are talking. P. Kirby said it looks like the Health Dept. did a great job with the water main break on Highland Avenue and offered his thanks. L. Ramdin said Pequot Highlands had no heat. He is working with the junior engineer to find out why because backflows were working. He gave a copy of the budget to the Board. He said he has been speaking to Lisa in Human Resources to change the Sanitarians’ title to “Environmental Health Specialist”, a title that is more reflective of all the work they do. He requested a salary increase for himself. He has a budget meeting with the Mayor on March 8th. He pointed out he has a lot of requirements with his position and he is just asking for equity for comparable positions. B. Gerard said with the budget, the Council votes only on what the Mayor approves. The Council can only subtract from what is approved, they cannot add anything. L. Ramdin puts the increase amount in his budget and the Board of Health can, and does, support it. M. Lauby asked L. Ramdin to send the Board the analysis. B. Gerard said the Mayor has been doing level funding, but they must look at comparisons in surrounding communities of comparable size. He gave the Board copies of overdose data. Most ODs are occurring at home. Most are 31-40 years old. Copy available at the BOH office. c. Administrative No comments/questions. Report Copy available at the BOH office. d. City Council B. Gerard welcomed Geri Yuhas to the Board. Liaison Updates The plastic bag restriction is going well. Paper bags being used. Had first passage of recreational marijuana zoning. The Mayor had B1, B2, BPD and industrial zoning. Planning Board added B4, B5, then it went to Ordinances, Licenses and Legal Affairs and they took out B1 and B2. Went to floor and B2 zoning was put back in. Buffer zones were discussed. State says 500 feet from schools, but no more. Police Chief Butler was concerned it would be concentrated to B5. Amendments: funeral homes and houses of worship are included in the 500-foot buffer. A 1,000-foot buffer from Salem State will not pass because it is illegal. Can have up to four licenses. The first license can’t be issued until July 1st. Must have support from the neighbors around the facility. The Cannabis Control Commission will have a hearing at North Shore  Community College on Friday afternoon. Second passage at next Council meeting. L. Ramdin wanted to discuss the Maitland Farm issue. The decision was made not to grant them a variance or change the zoning. An ordinance change was discussed. People can get an agricultural exemption for commercial composting, but he did not have one. The City agricultural regulation is over five acres. The State’s regulation is two acres. Maitland is looking to move the pickling operations there. They need to be open about their true intentions so they can be guided through the process. L. Ramdin feels information is being withheld. There is a problem with the neighbors feeling blindsided. Once you cut the produce, the matter moves from agriculture into food safety realm. L. Ramdin spoke of an article in the Salem News about use of marijuana in public and enclosed spaces. There are concerns about nuisance orders, especially in shared spaces. We need to look at the regulations. He will send the article to the Board. Beverly banned smoking totally, not just tobacco. Smoking clubs are currently banned in Salem. People are permitted to smoke in private clubs. One community’s proposal is to charge a $50.00 monthly fee to have a private smoking club. There are several implications to that. L. Ramdin said the chief of the inspection bureau in Denver presented at a professional association and some of his concerns are whether or not high humidity rooms are going to cause secondary mold problems, etc. Some of the soil being used contains fertilizer that are carcinogens and the residue is showing up in the buds. We should not make it appear as if we are creating regulations to prohibit marijuana use. J. Schiller motioned to approve the reports. K. Murphy 2nd. All in favor. Motion passed. 7. Board of Health program planning a. Discussion of FY 2019 P. Kirby and K. Murphy met with the Mayor. She is aware of the Health Department budget additional workload on the Department with the updated Certificate of request Fitness ordinance and the number of temporary pop-up food permits. The Mayor suggested outsourcing temporary rental (Air BnB, etc.) inspections to contractors, at least temporarily until we get caught up. She seemed supportive of our budget changes, but also seemed to want to discuss the inspectional services model more. She said it would allow the Health Dept. to focus on more health-related issues and take the inspectional part away, allowing for more strategic planning, etc. L. Ramdin said this is not about service delivery. The skill sets required to perform the specific jobs will remain the same. P. Kirby said we should give the inspectional services model a hearing. The inspectional services model was brought up about eight years ago and the City Council voted it down.  J. Schiller agreed and said we need to get all the information we can. K. Murphy said the Mayor wants us to get a steering committee together with Kimberly Waller, Beth Rennard and one of the Board members to investigate it. L. Ramdin agrees the Board should consider it, but knows of places that use that model and their directors have admitted to him that it is not working, however they will not say so publicly because they don’t want to be fired. b. Kimberly Waller - recap K. Waller passed out sheets showing an inspectional services department meeting with Lynn Health proposed organizational chart and personnel structure. She said she can Department on send the PowerPoint presentation to the Board. inspectional services model She met with Lynn and found the pros of the inspectional services model to be lots of cross information and meetings, as well as one-stop services for residents applying for permits. One of the cons is that the Public Health Division feels a little isolated and feels like what they are doing is quite different from other departments It took Lynn five to seven years to put together their inspectional services division. They contracted out some services and it worked very well. They saw a lot of cost savings. J. Schiller feels we need to see more information. He also feels we have to approach it with an open mind. K. Waller would like to look at other communities, like Chelsea. 8. New Business/Scheduling of K. Waller will have her presentation for the March meeting. future agenda items 9. MEETING ADJOURNED: J. Schiller motioned to adjourn the meeting. K. Murphy 2nd. All in favor. Motion passed. 9:34pm Respectfully submitted, Maureen Davis Clerk of the Board Next regularly scheduled meeting is Tuesday, March 13, 2018 at 7:00pm At City Hall Annex, 120 Washington Street, Room 313, Salem, MA