Board of Health

CITY OF SALEM BOARD OF HEALTH SPECIAL MEETING MEETING MINUTES November 20, 2018 MEMBERS PRESENT: Paul Kirby, Chair, Dr. Jeremy Schiller, Kerry Murphy, Geraldine Yuhas, Datanis Elias ABSENT: Maureen Davis, Clerk of the Board OTHERS PRESENT: Elizabeth Gagakis, Acting Health Agent, Lisa Cammarata, Director of Human Resources, Janet Mancini, Health Department employee, Kimberly Waller, candidate for Health Agent position TOPIC DISCUSSION/ACTION 1. Call to Order 7:00pm 2. Interview for Health Agent P. Kirby introduced K. Waller as the candidate being interviewed for the position - Kimberly Waller Health Agent position. Questions were printed out, but P. Kirby prefers a more free-flowing discussion. P. Kirby said some members know K. Waller from her excellent volunteer work with and for the Board. K. Waller was asked to tell the Board a little about herself. She said her first health job was in Salem, Massachusetts for the Dept. of Public Health where she focused on community health with the Point neighborhood and other areas. She also worked in school health with 32 towns around the North Shore and helped them identify their health priorities and assisted community groups with grant writing, etc. Most recently she has worked for an international organization as a Director of Operations for the Asia/Middle East programs. She always focused on public health, community health and working with health systems to figure out how to reach the most difficult to reach, vulnerable populations. She worked for the federal government for about 10 years in three different countries and oversaw various health programs with a broad- based health portfolio, anything from tuberculosis, malaria, HIV/AIDS, etc. and was working with the government and different counterparts to figure out what was going on nationally and how to work at the local level to reach populations for TB treatments, etc. She has a Masters in public health and community health education and a PhD in international health policy. P. Kirby asked what attracted her to the position and how she thinks it would fit for her. K. Waller said having worked with the Board she got a good sense of what the Board does and what’s going on. She knows Salem and is really excited about the growth of Salem and the leadership in Salem and how progressive the Mayor is. She is bringing her skillset back home and really wants to contribute. The job description is really exciting to her. Considering different options in terms of regionalization or efficiencies of departments is of interest to her. K. Murphy asked how she would apply her international work to a more community-based public health. K. Waller said it gives her a sense of what other models are out there. She said everything she does is actually based for the local level to reach the most vulnerable. In her other roles she has worked with both community groups and Mayors. Her main focus has been on community health. G. Yuhas asked how she would plan to get certifications for inspections. K. Waller said she would get certified as soon as possible. She has a background in the restaurant industry. She has personal experience from having Salmonella and reporting to the State. K. Murphy said Salem has a very diverse population and there are a number of health disparities here. We are higher than the State average. She asked how K. Waller how she would address them if she were running a health department. K. Waller responded that she would start by looking at data. She said it is hard to get good data about Salem to understand the issues. She would make health data available on the website and have surveys available. She would talk to different community groups and ask their opinions and perceptions. She would talk to the Police Department and Salem Hospital, etc. It would be good to get a sense of what they think are the health issues. We could have open meetings to discuss what people think are the main issues and then finding out what resources or opportunities we have to address them. She would do some kind of combination of those ideas. G. Yuhas asked what kind of leader she is and how she deals with staff. K. Waller said in dealing with staff, she can adapt to what the staff’s needs are. She likes to give people autonomy. She would like to know what long-term goals staff have. She would be clear about her expectations and work together with team members who are unhappy or not productive to find solutions so the team morale doesn’t suffer. P. Kirby asked if she ever dealt with employees that were union members. K. Waller said she has not had a lot of experience with unions. J. Schiller asked what her sense is of the ISD model as she is aware that there is a proposal for a possible restructure. K. Waller said we really have to preserve the integrity of what is working well. This is an area she can grow in, so she is really interested and excited about that. It would depend on a lot of factors. She said one big issue that was raised was that public health took a back seat when things shifted to inspectional services, so that is something to really look into. Purview must also be considered. It is a sensitive topic and we would need to be careful and cautious and not rush into anything. J. Schiller said a person having the knowledge of inspections within restaurants or code that relates to health would be a resource to the restaurant or individual needing that guidance. Using the approach of guidance rather than a punitive approach would better serve all involved. He said based on K. Waller’s skillset, it seems like a resource that she has been dealing with people in different situations. It is really communicating what you know in a way that is going to be productive. K. Waller agreed and said in some cases you would need to be firm and take a punitive and authoritative kind of role, but at the same time work with them and ask how they are going to deal with the situations to adhere to the regulations. She said she also has experience in health promotion. A collaborative approach would be nice, if possible. P. Kirby asked E. Gagakis if she had anything to add regarding the code enforcement, etc. E. Gagakis said the inspections are what the majority of the staff does. She really needs someone to technically advise her. She asked if K. Waller knows the food code at all. She said she really doesn’t, but she can learn. E. Gagakis asked if she knows or has any experience with the housing code, because food and housing are the two biggest inspections we do. Tenant complaints can get very complex. K. Waller said she does not have any experience in that area. G. Yuhas asked what kind of housing complaints we get. E. Gagakis said there are many different kinds of complaints. At this time of year, heat is a main complaint. At times we need advice on septic issues. Body art can be a challenge, too. We really need the technical support and advising. Anyone can go by a checklist at an inspection, but education and experience are best. K. Waller asked how often restaurants are inspected. E. Gagakis said they should be inspected twice a year, but with our current staffing we are lucky to get to each restaurant once a year. DPH sponsors ServeSafe training for food safety and public health inspector training for housing. The classes last several months. P. Kirby asked how one would balance getting certifications while working. K. Waller said she tried to get her food safety certificate, but she was just working too much. E. Gagakis reported that the new short-term rental ordinance is beginning in April. There will be zoning restrictions on them. D. Elias asked how soon K. Waller would be able to start if she were hired. She asked if she could start at the beginning of January. K. Waller said she gets back from a trip on December 31st. K. Waller asked if we feel the Department is understaffed. E. Gagakis said yes, we are very understaffed. When she was first hired there were 11 or 12 employees in the Department. They were down to only five for several years and now there are six and a half. D. Elias asked if K. Waller has a lot of experience with budgets. P. Kirby asked if she has had to advocate for more resources. K. Waller said she has negotiated to increase many budgets in her day. She feels if you have proactive relationships with people you can increase budgets when you can demonstrate a need. K. Waller asked about a working group of different health departments that get together and whether we have been able to tap into resources from senior staff in other communities. E. Gagakis said we have a really good relationship with all the health agents and inspectors in surrounding communities so when she has needed help she has been able to call someone, which is great. There is also the North Shore Shared Public Health Services group and the Emergency Preparedness Coalition out of Cape Ann. We all help each other. K. Waller said Massachusetts is one of the only states in the entire country that still has a health department per town and has not shown a lot of efficiencies. There are way too many health departments. There is an expectation on the State level of trying to find out how multiple towns can work together. L. Cammarata asked how K. Waller would navigate reporting to multiple bosses, i.e. collaboration with the Mayor and the Board. K. Waller said it would be challenging for anyone in this role. The Health Department is structured to have autonomy so that the Mayor doesn’t have a lot of control over that. The state commission is taking a look at that. More Mayors are becoming more involved and authority is being questioned. For example, she believes there was a case in New Bedford where the board sued the mayor for firing the Health Agent. In the end the judge did not come down against the mayor so it didn’t really hold up in court. Having good, productive relationships with all parties and good communication about what is possible and what is not and trying to find feasible middle ground could go a long way. There are no clear regulations stating the number of people there should be in a department, so having those kinds of facts would be helpful to state your case about departmental needs. P. Kirby asked what her first priority would be if she got the Health Agent position. K. Waller said she would work on getting all her certifications and familiarize herself with the codes. She would also look at the staff and the team and how we can make a case for what we really need. The public health stuff could be later. K. Waller asked what the Board is considering for the future of the Health Department and expectations of the role. K. Murphy said we really don’t know yet. We hope to know more within the year. The plan is to hire a consultant to help decide what, if any, model would work best for us all. G. Yuhas said we all agree that we first need to hire a Health Agent and then revisit the idea of ISD in a year. J. Schiller said he would like to make a definitive decision that is supported by both the Board, the Health Agent and the Health Department. Whether the decision is in line with the Mayor or not, he feels it is more important that the Health Agent and the Board make a decision together that they both agree on. L. Cammarata said it is just a different way of doing business. Maybe there are more efficient ways of doing inspections. The consultant will just be a fresh set of eyes to look at it from the outside looking in. It doesn’t mean what we’re doing now isn’t working. It doesn’t discredit anyone or mean things aren’t being done right. She said she has tremendous respect for E. Gagakis and J. Mancini and the work they do. L. Cammarata asked K. Waller if she would like to provide a summation. K. Waller said as far as the job description and the requirements are  concerned, she thinks it is a great fit and she is really excited about it. As far as the needs of the Department, she can hear that there are tensions and the Department is short-staffed, to say the least, and it sounds very challenging. It seems like there needs to be a bigger budget and more staff. She understands it is super challenging and thinks it would be interesting to figure out how to resolve the problems. Salem is the right size to consider some models that provide opportunities for more support from the State. The Board having direction in aligning with the Mayor would be very important or the Health Agent wouldn’t be able to be very effective. K. Waller thanked the Board for the opportunity to speak and said she appreciates all the good work they do. She would be excited to work with them in the future. Discussion of K. Waller’s interview took place. The consensus was, although she is highly educated and very intelligent, she is not technically qualified for this particular position at this time. P. Kirby reported that one of the candidates, whose name will not be mentioned, sent an email asking to be withdrawn from consideration. They simply realized they were happy where they were. We are down to two candidates. The second candidate, who as we all know used to work in Salem, is scheduled for Monday, December 10th which will be the regular monthly meeting. P. Kirby said we will put discussion of ISD on the agenda for the next meeting. MEETING ADJOURNED: G. Yuhas motioned to adjourn. K. Murphy 2nd. All in favor. Motion passed. 8:47pm Respectfully submitted, Maureen Davis Clerk of the Board Next regularly scheduled meeting is Monday, December 10, 2018 at 7:00pm At City Hall Annex, 98 Washington Street, 1st Floor, Salem, MA