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MEETING PACKET MARCH 2011 � MARCH 2011 i 9 g 7 ,I M CITY OF SALEM, MASSACHUSETI'S BOARD OF HEALTH 120 WASHINGTON STREET,4"{FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978)745-0343 2011 MAR —2 A 11' 19 MAYOR DGRF..F..NBAUM@SALGM.COM FILL DAVID GREENBAUM,RS CITY CLEF ?K, A-EJ"t. I'll A S. ACTING HEAL'-AGENT NOTICE OF MEETING You are hereby notified that the Salem Board of Health will hold its regularly scheduled meeting on Tuesday, March 8, 2011 at 7.00 PM at City Hall Annex, 120 Washington St Room 311, MEETING AGENDA 1. Call to order 2. Approval of Minutes from February 8, 2011 3. Chairperson Announcements 4. Public Health Announcements/Reports/Updates a. Health Agent b. Public Health Nurse c. Administrative d. Councilor Liaison 5. Discussion on The Board of Health Exterior Paint Removal Regulation and RRP 6. Update on The Health District Application 7. Miscellaneous 8. Executive Session—Personnel Matter 9. Adjournment Next regularly scheduled meeting is Apri1.12, 2011 at 7pm at City Hall Annex, 120 Washington Street Room 311 ley Na�igA^ aln ®card David Greenb um 11 l 91} on rA6 Acting Health Agent �A A cat �. Cc: Mayor Kimberley Driscoll, Board of Health, City Councilors CITY OF SALEM BOARD OF HEALTH MEETING MINUTES February 8, 2011 i MEMBERS PRESENT: Dr. Barbara Poremba, Chairperson, Kemith LeBlanc, Martin Fair, Marc Salinas & Gayle Sullivan OTHERS PRESENT: David Greenbaum, Acting Health Agent, Tracy Giarla, Public Health Nurse & Councilor Liaison Thomas Furey MEMBERS EXCUSED: Dr. Larissa Lucas TOPIC DISCUSSION/ACTION 1. Call to Order Meeting called to order by Dr. Poremba, Chair, at 7:OOpm. 2. Minutes of Last Meeting Motion by K. LeBlanc to accept the minutes. 2nd (Jan 11, 2011) 4 in favor, 0 opposed. Motion Passes 3. Chairperson Announcements Dr. Poremba informed the Board that she sent information regarding Roof Collapses to D. Greenbaum to be placed on the Board of Health website. This information was prepared by a nursing student at SSU. She also requested that a Spanish flyer on bed bugs be added to our website. A letter from the Mayor was provided to the board about the • planning grant for regionalization (copy of letter available at office). D. Greenbaum met with the Health Agents of Peabody, Lynn and Marblehead to discuss applying for the planning grant to explore the possibility of sharing services amongst a number of communities including Salem, Peabody, Marblehead, Lynn Nahant, Swampscott, Beverly and Danvers. M. Salinas asked D. Greenbaum his opinion on this subject. D. Greenbaum stated that because the grant is to explore the possibility of sharing services and if we do not apply for the planning grant we will not be able to apply for the implementation grant that it makes sense to move forward and go through the planning process Motion by K. LeBlanc to endorse working together with communities on the North Shore to submit a planning grant application to explore the opportunity of a shared services agreement. 2nd 4 in favor, 0 opposed. Motion Passes 4. Monthly Reports-Updates A. Administrative K. LeBlanc asked if there could be a 6 month breakdown of the Report payroll for next month's meeting (copy available at office). D. • Greenbaum will provide this in all future submissions. Submitted into record (copy available at office) B. Public Health Nurse Report a CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGRI�',I,-.',NBAUM@SAt.r;m.com D,\vID GRI?ENBAUM,RS Acting Health Agent Report ACTING HF.At.ri-lAGr;NT January 2011 Meetings/Trainings 1. Attended a negotiating meeting for HHW collection to select a vendor to run HHW events. The committee selected Clean Harbors as the vendor for 2011- 2012-2013 collection events. 2. Attended a Hoarding Task Force meeting at North Shore Elder Services. 3. Attended a meeting in Peabody with MAPC, Peabody, Marblehead and Nahant to discuss the regional health district grant incentive program. MAPC agreed to write the planning grant application. The communities interested in the grant are Peabody, Salem, Marblehead, Nahant, Lynn, Swampscott and Danvers. Significant Communication or Complaints from Residents 1. Mr. Richard Harrell came to the Board of Health office to discuss my response to the letter from his attorney requesting an inspection at 117 Lafayette Street. Mr. Harrell's concern was that in my response I quoted the code reference for single room occupancy units and he was concerned that this was inaccurate. I • explained to him that since the building was originally a rooming house that that is how I based my response. He was confused as to whether the units are apartments or single room occupancy units. I explained to Mr. Harrell that to clear up any confusion of what the units are I would measure the units during routine Certificate of Fitness inspections to determine what the square footage of the units are. In an effort to resolve this matter inspectors contacted the building manager to see if it would be possible to measure for square footage in any units that were currently vacant. The building manager allowed us to measure two vacant units. In addition, the tenant in the unit that Mr. Harrell used to occupy allowed us to measure that unit as well. All units measured approximately 160sq feet of floor space. I informed Mr. Harrell of my findings and that the Salem Board of Health considered the matter closed. Mr. Harrell continues to find this unacceptable and contacts this office in person or by email. He has also reached out to the MA DPH Community Sanitation Program for help in this matter. I have called to speak to the person Mr. Harrell has contacted but as of this writing have not heard back from him. Inquiries or Reports from the Media NONE Other Public Health Information Update on the Grant/Collaboration Opportunity MAPC has written the planning grant application and submitted it to DPH. The communities that have signed on to the application are Lynn, Marblehead, Peabody, • Salem and Swampscott. The application was forwarded to the Board via email on March 1, 2011. r e CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4,"FLOOR TEL. (978) 741-1800 WERLEY DRISCOLL FAX(978) 745-0343 MAYOR 1ll(,RI?I:i,NBAUM lnI SALI:'.M.COM DAviD GR* ENBAUM,RS AC'i'ING HEAI;n i A(,ENT Public Health Nurse Report February 2011 Activities Disease Prevention • In contact with North Shore Pulmonary Clinic regarding active cases and case contacts. • Investigated communicable disease cases and reported to the MDPH. • 1 ppd test administered to a contact of an active case in Peabody. Meetings/Clinics • Attended the NSCAEP meeting at Peabody DPW. • Met with the NSCAEP PHER Sub Committee regarding group purchases for the coalition. • Attended the North Shore Hoarding Task force meeting at NSES Danvers. • Met with Council on Aging Social Services regarding two elders at risk in the community. • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTI-I 3 120 WASHINGTON STREET,411 FLOOR TEL. (978) 741-1800 • KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGRBF.NBAUM G.SAI.,I M.COM DAVID GRi:-,NBA.UM,RS AC:'1'INC Hf;rV.;l'I-i.AC,'1.3N'1' Monthly Report of Communicable Diseases February 2011 Disease New Carry over Discharged Reported Group A Strep 1 0 1 1 Hepatitis C 2 0 2 2 Hepatitis B 1 0 1 1 • Influenza 2 0 2 2 Salmonella 0 0 0 0 Strep Pneumo 2 0 2 2 Tuberculosis 0 1 0 1 Varicella 0 0 0 0 Group A Strep: 87 y/o female. Cellulitis of the leg. Pt recovered. 2 Chronic Hepatitis C: 58 y/o female. 51 y/o male. 1 Chronic Hepatitis B: 54 y/o male. Strep Pneumoniae: 7 y/o male. Pt. expired. 2 Influenza: 24 y/o female. 43 y/o male. Tuberculosis: 75 y/o male. Will complete therapy on March 8, 2011 • Administration Monthly Report February-11 Burial Permits @$25.00 $1,175.00 Permits $4,602.00 Certificate of Fitness@$50.00 $1,200.00 Copies $0.00 Fines Total Monies Collected = $6,977.00 Finance Dept Total$ Available Balance as Annual Budget Expended Transferred on 1118110 of 2/28/11 Total Salary/Longevity $337,609.00 Lg $173,778.83 Q $4,571.66 $168,401.83 Estimated Salary Paid For 6 Months $122,093.65 Money Available For Spending n $7,745.15 Money Available in Purchase Orders $5,959.77 Annual Budget Expended Available Balance Non-Personnel $21,200.00 $7,495.08 $13,704.92 0 0 PROPOSED AMENDMENTS TO CITY OF SALEM BOARD OF HEALTH REGULATION 23 RULES AND REGULATIONS FOR EXTERIOR PAINT REMOVAL AND ABRASIVE BLASTING SECTION III—PERMITS 3.0 A permit must be obtained from the Board of Health by the Owner of the property or the Renovation Contractor or the Deleading Contractor at least five (5)business days prior to the commencement of work. 3.1 The application for a permit shall minimally include: the address of the residence or facility, the mane of the Owner, the name business address and license number of the Deleading Contractor or Lead— Safe Renovation Contractor conducting the Deleading Work, the start date and estimated completion date for the work, the work methods to be used (sanding, scraping, covering, encapsulation, etc.) and whether the work will be conducted as Class I, Moderate—risk or Low—risk Deleading work. A permit shall only be granted to an Owner if the application is accompanied by a signed statement and schematic of testing locations from a Lead Paint Inspector or Risk Assessor certified pursuant to 105 CMR 460.000 or a Certified Lead— Safe Renovator supervisor using a recognized test kit, as specified in 40 CFR Parts 745.83 and 745.88, and following the kit manufacturer's instructions, has tested each component affected by the renovation and determined that the components are free of paint or other surface coatings that contain lead equal to or in excess of 1.0 milligrams per square centimeter or 0.5% by weight. A permit may be issued to an Owner without a copy of the prerequisite statement and testing schematic if the dwelling/facility was constructed after 1980. 3.2 Do you want to change the fee structure? SECTION IV—ABRASIVE BLASTING AND ELECTRIC SANDING 4.0 Abrasive blasting on exterior surfaces of any structure within the City of Salem is prohibited. Electric sanding is allowed under the requirements and work practices set out in 454 CMR 22.00: DELEADING AND LEAD—SAFE RENOVATION REGULATIONS. • 203 WASHINGTON ST.#256 PRESERVE SALEM,MA 01970 SERVICES car-pentry?painting rooting!gutters PHONE:978.745.8745 FAX:978.745.3476 SALES@PRESERVESERVICES.COM To the Board of Health, The below recommendations are pertaining to how to update the no electric sanding on the exterior of homes ordinance in Salem. Recommendations: 1. Require a permit on all houses built prior to 1978 for exterior painting that disturbs over 300sq/ft(you don't need a permit when you are painting your front door) performed by a contractor. This required • permit will generate thousands of dollars. 2. Require proof of EPA licensing. I.E. Photocopy of EPA license/registration numbers. Put a field on your permit for license numbers. 3. Require a signed EPA RRP booklet. This ensures the homeowner has been educated on the dangers of lead. 4. Raise the fine for not getting a permit to$250 to substantially increase compliance without spending money. 5. Require all contractors to follow EPA RRP rules including only sanding with an EPA certified hepa- vacuum sanding systems. What I would not recommend: 1. Field inspections of every job. There are thousands of paint jobs done annually in Salem. Unless numerous inspectors are hired it will not be practical. The EPA has a very detailed final job inspection that is performed by trained contractors. Sincerely Yours, Sean O'Connor • Owner Page 1 of 1 David Greenbaum From: sean@preserveservices.com • Sent: Wednesday, February 16, 2011 10:29 AM To: David Greenbaum Subject: Salem board of health Hi David, 1 other recommendation I would suggest on painting permit process is to require a certificate of workers compensation. When I pull building permits they require a photocopy of my certificate of insurance. Sean • 3/8/2011 r CITY OF SALEM, MASSACHUSETTS M 3y BOARD of HFALTI I 120 WASI IINGrON S"1REi-,,[;411,Fwolz Tr,,]..(978)741-1800 q,-JMBERLE,Y DRISCOLL FAX(978)745-0343 MAYOR DGRL?ENBALIM CI,SiU;F;M.COM D�wit)GR1:-,1;NBAUNI ACTING HI AL.r1I A(;LNT February 28, 2011 State Representative John D. Keenan State House Room 195 Boston,MA 02133 Dear Representative Keenan, The Salem Board of Health strongly supports HB 1243 requiring housing authorities in Massachusetts set aside a Aftimum of 20% of their housing units as smoke free. The Salem Board of Health feels that this bill is a positive step to protect residents of public housing against the harmful effects of secondhand smoke. Therefore the Salem Board of Health asks that you consider supporting or co-sponsoring House Bill 1243 and help protect the public health of residents living in public housing Sincerely, Dr. Barbara Poremba, Chair Salem Board of Health • " g CITY OF SALEM, MASSACHUSETTS u � . BOARD OF F-IEAI.:I'Il 120 WASHINGTON STREET,411,FLOOR Tll,.(978)741-1800 KIMBERLEY DRISCOLL FAx(978)745-0343 MAYOR DGRJ:?F?NBAUM@SAl..;EM.COM DAvn)GRE]"NBAUM ACTING HEAL,-f AGl3NT February 28, 2011 State Senator Frederick E. Berry State House Room 333 Boston,MA 02133 Dear Senator Berry, . Salem Board of Health strongly supports HB 1243 requiring housing authorities in Massachusetts set aside a mtn�mum of 20% of their housing units as smoke free. The Salem Board of Health feels that this bill is a positive step to help protect residents of public housing against the harmful effects of second hand smoke. Therefore the Salem Board of Health asks that you consider supporting or co-sponsoring House Bill 1243 and help protect the public health of residents living in public housing Sincerely, Dr. Barbara Poremba, Chair Salem Board of Health • 1K ` mc7F.£ �sIil,vv ' �r Ke {C3t7e � )(6c: (iTt� t(3#7 " APC METROPOLITAN AREA PLANNING COUNCIL MDPH Public Health District Incentive Grant Program Application North Shore Shared Health Services Project I. Background The North Shore communities of Lynn, Marblehead, Peabody, Salem and Swampscott began discussions about how best to regionalize delivery of public health services among their communities in January and subsequently included the Metropolitan Area Planning Council (MAPC) in the discussion during a meeting in Peabody City Hall on February 9, 2011. Salem has indicated that they are firmly committed to regionalization (i), while each of the other applicants has said they are willing to consider(iii) a regional shared services approach. Danvers and Nahant have also been identified as potential partners in a shared services region, but were not prepared to sign on to the application as of February 28, 2011. • Interest in regionalizing health services in this proposed district actually goes back to 2009, when an earlier attempt to reach agreement between Salem and Peabody on a shared services model was not supported by the then-Salem Board of Health, despite significant work and progress toward an agreement between the two cities' health agents and both mayors. Since that time, the Salem Board of Health has changed significantly and members are now open to the idea of regional or shared services arrangements. Peabody and Salem have therefore taken the lead in this project, with Lynn, Marblehead and Swampscott also confirming their interest. Additionally, in 2009 MAPC, as part of a District Local Technical Assistance (DLTA) project aimed at promoting regionalization on the North Shore, delivered a forum on public health department regionalization efforts around the state, which included representatives from Salem, Peabody, Danvers and Swampscott. All of the engaged communities are members of the same Tobacco Control Collaborative and the same MDPH Emergency Preparedness Coalition. The region is wholly constituted within the Executive Office of Health and Humans Services Northeast Region. The communities have an extensive history of working together on regional initiatives including the CHNA, hazardous waste collection events, providing prescription medication disposal options and substance abuse prevention programs. The municipal leaders in each community also participate in the North Shore-Coalition of mayors and manager, which is coordinated by MAPC. Leadership for this collaboration has been provided by Salem Mayor Kimberley Driscoll and Salem Health Agent David Greenbaum, as well as Peabody Health Director Sharon Cameron. Cameron and Peabody • have been identified as the lead municipality in the project. 60 Temple Place, Boston, MA 021 1 1 - 617-451-2770 Fax 617-482-7185 • www.mapc.org Jay Ash,Pre>ident Viicfiel E?Cicc:o<(),l tcf. Pr )'(.Ien,, 1:1ari�yr?1.C1(ltt�'dS.:;t.0 t'iily t.iraU:_) Shepard,TIE:(eSur f Marc Craisen,Fxu L1 hle C ir(?C(2")! r 9 i M d lK t ;.e eti' i 7 e.X' .'(1} r 3 1?C3 tJ a �?, f K f J MAPC METROPOLITAN AREA PLANNING, COUNCIL II. Goals and Objectives The North Shore Shared Health Services Project intends to use the planning period and any funding provided to engage municipal officials and Boards of Health in collaborative planning to form a district; enable the applicant municipalities to recruit additional municipalities to the district; assess and document needs and opportunities for sharing staff, services, and functions among partner municipalities; identify appropriate district models and develop plans for shared staffing service delivery or the establishment of a cafeteria model; develop plans for cooperative governance, financial management, and administration of programs, among district members; develop plans to meet district workforce qualifications, that are consistent with the MDPH and CDC proposals for health department certification; develop plans to meet performance requirements of districts; develop a proposed budget for district start-up and operations; and prepare and submit an application for implementation grants under this program. These planning objectives are aimed at improving the scope and quality of local public health services in the participant communities; reducing geographic and demographic disparities in the capacity of the municipalities to meet Boards of Health statutes; strengthening the qualifications • of the region's local public health workforce; preparing the partner municipalities for voluntary national accreditation; and aiding the communities in achieving optimal results with available resources for protecting and promoting public health and preventing injury and disease. The applicant communities do intend to develop a proposal for a multi-year implementation award by the end of the planning process. The communities are committed to investigating all of their options with regard to regionalizing service delivery, and undertaking the approach that is deemed to have the best chance for success through the planning process. III. District Profile The population size and land area for each community is included in Table 1. Lynn, with a population of approximately 90,000, is the largest community within the proposed district while Peabody, at 16 sq. miles, has the largest land area. The total population size for the proposed district will be 212,375 based on 2000 census data, with a land area of 42 sq miles. All of the proposed municipalities fall within the Executive Office of Health and Human Services Northeast Region; the communities do not encompass a single county. Table 1. Population Size and Land Area • 60 Temple Place, Boston, MA 021 1 1 617-451-2770 Fax 617-482-7185 • www.mapc.org A 3 .. .G'y' ��l;,`Tc'.:± C,�)[ k4lOiE'i', u r 1KSmart Growth & Regional Collaboration " APC METROPOLITAN AREA PLANNING COUNCIL Salem Peabody Marblehead Swampscott Lynn District Population+ 40,407 48,129 20,377 14,412 89,050 212,375 Land Area(sq mi)+ 8 16 4.5 3.5 10 42 +2000 US Census Table 2 presents population characteristics for each municipality as well as the proposed district. Peabody, Marblehead and Swampscott tend to share similar demographic characteristics particularly in regards to age, race and ethnicity. Salem and Lynn also tend to share similar demographic characteristics in regards to age, race, and income. Overall, the combined district will encompass a broad range of income, educational levels, ages, race and ethnic backgrounds, Table 2. Population Characteristics of Communities and Proposed District • Salem Peabody. Marblehead Swampscott Lynn District Age(%) 0-24 36 28 27 28 36 31 25-44 31 30 28 28 31 29 45-64 20 25 29 26 20 24 65+ 13 23 16 18 13 16 Median Age(yrs) 34 40 42 42 34 38 Race (%) White 85 94 98 98 68 88 Black 3 1 0.4 0.7 11 3 Asian 2 1 1.0 0.7 6 2 American Indian, Alaska Native 0.2 0.1 0.1 0.1 0.4 0.2 Two or more 3 2 0.7 5 2 Ethnicity(°�) Hispanic 11 3 0.9 1.3 18 7 Not Hispanic 89 97 99 99 82 93 60Temple Place, Boston, MA 02111 617-451-2770 • Fax 617-482-7185 www.mapc.org iciy`A. i,`-e,,if'JenI • �,Aic f l5e�'i(:Co(l, ✓!"('�J .n�e.'1!( Ma ily n �...("ntr as. )" 'e!("''ry • ' t.: . ,��;.'�:,'(�,Tt.( i•w- • hlar. Draisen.Ik('(:'I 17✓!=(:;feC:7;77 c r AKS rn a r t c._: r o tv z ti t R e t 1 o n a i o t (a zF'o r a t l L7 ri iviAPC METROPOLITAN AREA PLANNING COUNCIL Income Median Household Income $44,033 $54,829 $73,968 $71,089 $37,364 56,256 Below Poverty Level (%) 6 4 3 3 13 6 Education (%) Less than High School 15 15 4 5 26 13 High school graduate or Higher 85 85 96 95 74 87 Bachelor's Degree or Higher 31 23 62 50 16 36 Housing Housing Units 18,175 18,898 8,906 5,930 33,511 85,420 Homeownership Rate (%) 49.1 71.2 66 60 49.1 59 +2000 US Census • Each of the communities faces various challenges in delivering public health services. Due to staff shortages and budget cuts mandates from MDPH are not being met in Salem. In addition there is little outreach for hard to reach populations like new immigrants for issues such as accessing health care services and receiving immunizations. There is a large Spanish population in Salem causing a communication barrier for things like adequate housing and providing information on health services in the area. Peabody struggles to implement chronic disease prevention and substance and wellness programs. They also have difficulty reaching underserved populations. Lynn is grappling with TB infectious disease management, teen pregnancy, high cancer rates, substance abuse/opiod addiction, rodents/bed bugs/trash management, and obesity. Lynn, like Salem and Peabody also struggles with language barriers and reaching underserved populations. Marblehead is challenged in educating staff on new technological advancements that can assist in delivering health services. The town also has been unable to complete a needs assessment. Swampscott faces challenges from increasing demands but decreasing staff size. Though the communities face different issues at times, the district, as a sum of its parts, will need to address many of these issues at the district level. As we engage in the planning process, we anticipate that other challenges facing the proposed district will emerge. IV. Capacity and Need i 60Temple Place, Boston, MA 02111 • 617-451-2770 • Fax 617-482-7185 • www.mapc.org 'ay Ash,snre.i,ent • Michelle CIccdo, Marilyn("on re s,_.'e(retary • Gra,.:e S Shepard,Treo( ,'a r • Marc 'Draisen.>r,1m live:E))I(:oo! 1Kr . . ,_ . r � Fr , rColt�rt>t ctrt3tl " APC METROPOLITAN AREA PLANNING COUNCIL Currently all communities complete mandated inspections including food, recreational camps, pools, housing and body art facilities in accordance with state requirements. Salem, Peabody, Swampscott and Marblehead also conduct flu and vaccination clinics. Peabody, Swampscott and Marblehead complete communicable disease investigation and follow up. Peabody and Swampscott complete activities and deliverables related to public health emergency preparedness. Salem and Peabody implement hazardous waste disposal programs. Peabody, Swampscott, and Marblehead conduct environment and sanitation complaints follow up. Salem participates in a variety of health fairs to educate community members about public health issues. Peabody also provides school nursing services, substance abuse prevention activities as well as wellness activities. Swampscott issues burial permits, conducts trash/recycling collection and enforcement, completes beach water testing, monitors air pollution and other environmental issues, and recently developed a mercury in fish advisory. Lynn conducts no additional public health services beyond inspectional components. To provide the current public health services, the Salem health department employs full time one senior sanitarian, one sanitarian, one code enforcement officer, a public health nurse, and a principal clerk. The Peabody health department employs a Director of Health and human • services, one sanitary inspector, one code enforcement inspector, a public health nurse, one administrative clerk, eleven FTE school nurses, and one school nurse leader. The department also employs a 2.5 FTE administrative clerk. The Lynn health department is staffed by one director, five sanitary inspectors, two public health nurses, and 1.5 food inspectors. The Marblehead health department is staffed by a public health nurse (30 hours/wk), one health inspector(25 hours/wk), health clerk (37.5 hours/wk shared with Waste Division), and one full time public health director (shared with Waste Division). The Swampscott health department employs one full time health director and an office clerk. The department employs one part-time public health nurse (11 hours/wk) and also contracts animal control and dead animal removal services. At the current staffing levels, the communities note several challenges in meeting the mandated Board of Health requirements. Food inspections are not being completed twice a year in Salem. Peabody can complete initial food inspections but are unable to complete follow up inspections to achieve full compliance. Swampscott struggles to provide additional vaccination clinics to enable more residents to access the clinics. Marblehead and Lynn are able to meet the mandated requirements presently. In addition to staffing challenges that causes difficulties in meeting mandated requirements, the communities also face issues related to population, industry and municipal financing. Salem has a diverse population with a large Hispanic population in a small area known as the as The Point Neighborhood. This area is poor and densely populated with numerous rental units. Peabody also has large Brazilian community and a large Spanish- speaking community and need for outreach/care in other languages. 17.4% of Peabody public 60 Temple Place, Boston, MA 021 1 1 617-451-2770 Fax 617-482-7185 • www.mapc.org Smart C�r-owtfx e it rta Callabcrati- rn MAPC. METROPOLITAN AREA PLANNING COUNCIL school students speak a primary language other than English (5 other main languages). The health departments must also face changing community demographics and dynamics. Peabody, like the other communities, is witnessing a growth in its senior population and must develop services to meet the needs of this group. Salem also has the Dominion power plant that creates a number of issues from dust complaints to general health concerns for its citizens. Peabody has history of tanning industries with resulting environmental contamination as well as potential exposure to toxic materials from former leatherworkers. The public transportation system in Peabody is also less than ideal. All of the communities must contend with challenges related to municipal financing. Budget cuts each year are particularly detrimental to these health departments as a majority of their budget tends to be for personnel. With decreasing budgets causing increased difficulty hiring additional staff or increasing time for current staff, effectively managing current responsibilities as well as providing for additional needs poses a major challenge. Several opportunities exist through the development of a health district to help address several of the challenges faced by these communities. A proposed district would yield additional staffing • resources, augmenting current inspectional staffing and increasing inspectional capabilities beyond the minimum standards. As the communities want to broaden the provision of public health services to include chronic disease prevention/healthy lifestyles promotion campaigns,the development and implementation of these activities would occur at a district level. Combining resources could aid in increasing public health nursing or education staff that would implement these district- wide activities, conduct outreach to vulnerable and underserved populations, and develop other services to meet the needs of the communities. Health department staff would also have the resources to apply for grants to develop or expand public health services. Community members would also be able to utilize public health staff and programs that are currently only offered in an individual town. With increased human and financial resources, district health staff would have more opportunities to take advantage of educational workshops and trainings such as the integration of technology into their work. We expect as we engage in the planning process, staff of the three health departments will have the opportunity to explore other areas in which regionalization will benefit the local populations. V. Planning Process Upon an award announcement for the North Shore Shared Health Services Project the applicant communities will meet jointly with MAPC to begin the planning process. Peabody, as the lead municipality and MAPC as the proposed primary consultant to the process, will take the lead in organizing, posting, recording and follow-through on all planning meetings and public outreach efforts. Outreach efforts will include engaging the board of health members from the five • 60 Temple Place, Boston, MA 021 1 1 • 617-451-2770 • Fax 617-482-7185 • www.mapc.org Jay Ash,,'Piesid(,7t N'lichelle Ciccdo,�.r e-Pr(-iikiiem • NAardy, ContlL°as,S. E?GYv - Gra(e St.�,r.;.3'CS. PIUJ•F.' Marc Draisei1,FAl<L;1tua D"f.'CfOt ., !.. `� a ab t rI ., 'Y - (�t 0 Ii LT f L 0 C z _ '7 i SZ r 0 } " APC METROPOLITAN AREA PLANNING COUNCIL communities, as well as communicating with health department and municipal officials in the above named communities that will be invited to join the regional planning process. MAPC and Peabody expect the planning process will involve a minimum of eight to 12 meetings between the involved communities, as well as meetings with locally elected municipal officials and municipal managers, and a minimum of four(4) public outreach meetings will be held at accessible regional locations across the five town region. Additional public meetings may also be held, particularly if additional communities join the project. Health department designees or representatives will be appointed to the North Shore Shared Health Services planning committee from each of the applicant communities and any communities that later join the region. Additional outreach will be made to include local private and non-profit health service providers during the planning process, so that existing relationships and programs between regional and local health care providers and the participant communities health departments can be taken advantage of and to inform and provide the region with an holistic approach to improving and enhancing health department service delivery in the region. • Communication between the planning committee members and all other partners identified in the planning process will be managed and overseen by MAPC, which will function as the partnership's primary consultant on the project. MAPC's role as primary consultant on the project will be to engage the participant communities and the planning committee in a process that will help them identify the best model for providing shared services to the region. MAPC will also assist with the design of a mutually acceptable shared service delivery model, governance structure and documents, and implementation and operations budgets. MAPC's extensive history in the arena of regional collaboration and shared services positions them well to assist the communities as they navigate away from a local health delivery model to a shared services approach that will allow local voices to be heard and costs to be shared equitably. The planning process will be undertaken in three phases, with an outreach and needs assessment phase from April through June, a planning and development phase in July and August and a grant application phase in September. VI. Performance Goals and Requirements 60Temple Place, Boston, MA 02111 • 617-451-2770 Fax 617-482-7185 www.mapc.org ay! `.kl, ;�!,1C:` ;1( ��tlCriEl` C.CCO(),sitf' IF' tCi'(?i �la.'IirCi{(11:1e25, .'Clc.'Cify' L(aC.''.. shepa d Fiv tl'P! • Marc Dra1sen,F.XEYlt11'J('L,?J;t:Clor } MAPC METROPOLITAN AREA PLANNING COUNCIL Currently, the communities have not determined which specific district model would be most appropriate for the needs of all involved municipalities. During the planning process we expect to determine the final model from information gathered through planning meetings, engagement with local public and private providers and organizations, public outreach efforts, a review of the current infrastructure of each health department. The data gathered will then be used to develop different models and the communities will determine the best model that enables the district to provide efficient and effective public health services. All municipalities within the proposed district recognize the importance of strengthening the public health department workforce to successfully provide public health services. Setting workforce standards creates a clear understanding of what the necessary qualifications are at every level of employment in the district and allows for all employees to be evaluated by the same criteria. However, several concerns and challenges regarding workforce development have also been identified. The main challenges that the proposed district intends to address include 1) Possibility of instituting potential waivers for advanced degree requirements for current staff having substantial experience, 2) Appropriate levels of flexibility in regards to degree substitutions for current and future staff, 3) Developing financial support for staff to obtain advanced degrees as needed to meet the requirements, 4) Addressing any potential union issues • that could be affected by the requirements. While the municipalities want to ensure they have highly qualified and trained employees on staff, they also want to ensure that current valued and experienced staff members are retained and workforce qualifications do not outpace the available pool of candidates. In regards to Board of Health (BOH) certification, again the municipalities understand the value of having formally trained Boards of Health. BOH certification requirement will create uniformity across a region and give board members a solid foundation on their roles and responsibilities. Challenges that the district intends to address include: 1) Ensuring the certification process does not deter interested individuals and 2) Possibility of implementing an online certification process or offering trainings in the local vicinity and evenings. During the planning process, the district fully intends to ensure that a viable plan is developed to address these issues and enables the proposed district to meet the requirements for workforce and BOH qualifications. The communities have identified several opportunities to address district service requirements in the planning process. The planning process will provide the opportunity to explore the best method or model as a district to implement the obesity, tobacco, substance abuse campaigns, ensuring all towns are participating in MAVEN, and complete the community assessment. The communities do not anticipate challenges with implementing these requirements as several of the . 60 Temple Place, Boston, MA 02111 617-451-2770 Fax 617-482-7185 www.mapc.org �i(' �:,.:i, fC'ii�t;FY Mar".L t 3r111, X�Cii('I:/L tf/({>ClEi! v �" Aps METROPOLITAN AREA PLANNING COUNCIL requirements align with activities the communities would like to integrate in their public health services delivery such as tobacco control and obesity campaigns. The communities will also explore ways to find funding to sustain these activities. Currently, all the communities currently work together in the same CHNA (Community Health Network Area) and in the MTCP Collaborative (Massachusetts Tobacco Cessation and Prevention). All municipalities are also in the DPH Emergency Preparedness Region 3 and Sub- Coalition 3D. The communities are interested in collaborative opportunities with local hospital, health centers, and educational institutions and have begun to discuss potential partnerships. Several communities have a strong infrastructure of hospitals and primary care providers, including community health centers that may be able to provide services to the community such as home sharps disposal. North Shore Community College, Endicott College, and Salem State University are in close proximity and could serve as points of collaboration in developing wellness programs, vaccination efforts, substance abuse prevention programs, important health research and assessments for use in health policy development, evaluation, and internships. Other partnerships include Health and Education Services/CAB partnerships on substance abuse prevention, working the strong faith community within the region to reach underserved populations, and working with large employers, such as Northshore Mall on employee and • community wellness education as well as vaccination efforts. Recognizing that the impact on the health of the communities is not limited to activities within traditional public health spheres, the communities have engaged and collaborated with other departments particularly those that influence the social determinants of health. The Salem Board of Health has an excellent working relationship with other municipal departments such as the Building Department, Electrical Department, Police and Fire Departments. An example of this would be group inspections of substandard housing units. Whenever there is an issue that may require help from another department any department can call another and get the required assistance to resolve the issue. Peabody has existing partnerships with Peabody Public Schools, Peabody Dept of Parks and Recreation, Peabody Library, Peabody Community Development Office, Council on Aging, and Human Resources Office on wellness initiatives for employees, students, and community at large. Lynn works closely with school dept. currently working to integrate public health with planning and community development efforts through grant funded initiatives. Swampscott works very closely with public works, inspectional services, police, fire, recreation and planning departments. A district model could provide the opportunity for expanding work with other departments. Presently, it would be difficult for an individual town to have the ability to fully engage other • departments due to staffing and budget issues. As more resources are available to augment staff 60 Temple Place, Boston, MA 02111 • 617-451-2770 Fax 617-482-7185 • www.mapc.org .�i3y A5�1, '.E,:±r C';'it M,}rilY't c o"l[fe..2.5,e(, F_;.,,r Z.:iSc3(.-'i, ��f�i'(;;�3iC1, rf€'GSc.ilf'r Marc.{.1tt3!'�E?n.FJiEY.1i(iUf'1 1if'f Iti� I"VIAPC METROPOLITAN AREA PLANNING COUNCIL in providing current public health services, more time would be devoted to seeking out opportunities to ensure public health considerations, needs, and impacts are included in the planning and implementation stages as towns develop housing, transportation, and other policies that influence the social determinants of health. For example, the district may now have the capacity to develop a public health advisory group that would be available to review and advocate for policies that could affect the health of the community. VII. Budget Narrative The proposed planning grant funds will primarily be used to retain the services of the Metropolitan Area Planning Council as a consultant for legal, financial and organizational development and as staff to the planning committee during the six-month planning phase of the project. MAPC will utilize a team approach to serving the regional planning committee and ensuring a successful planning phase for the communities involved in the partnership. Primary members of the MAPC team include Senior Municipal Services Coordinator Joseph Domelowicz Jr., Senior Project Coordinator Lola Omolodun, Legal Counsel Jennifer Garcia and Public Health Intern • Ashley Malins. In total, MAPC expects to utilize approximately 330 total work hours of staff time to assist in the planning process, develop governance and budgetary models and draft the implementation grant for the region. The dedication of MAPC resources has an associated cost of approximately $25,000, of which MAPC is requesting$20,000 in the grant and will provide another $5,000 of in-kind contributions that will cover payroll taxes and benefits, as well as any additional staff time needed. The applicant communities also recognize the need for obtaining additional consultant assistance to focus on areas outside of MAPC's expertise and are requesting $15,000 for those costs. Additional consultants will be identified during the planning phase, and hired by MAPC. The communities have asked for a total of$2,409 in the grant to accommodate meeting time outside of normal work hours, but have jointly budgeted $13,378 of in-kind contributions to the grant to pay for staff time during the planning process. The applicants have also estimated a need for $2,591 in the grant for meetings costs. However, given the diverse population in the region and the need for multi-lingual notices, surveys and materials they will contribute $9,041 of in-kind contributions for meetings materials and communications as well. This will include the use of municipal or public spaces to hold meetings, when possible, and the use of local, internal resources to reproduce meeting materials and communications/outreach materials, including pamphlets and surveys. i 60 Temple Place, Boston, MA 02111 • 617-451-2770 Fax 617-482-7185 www.mapc.org ��)`.°iti�t !7 f..:/:.;rE'iii :°44CriP�t'�t,,t(}'Ci,V (. (31C?),Gf.�ii Ptt}al i�vr.`.�t illf•?<.5. >f'(..F't..:"y' i i(JC:.-' �.i f'.:)rtr.j,r,'()S..i>r t,h:r": Draisen,C.1'(-a.a.J .?0c ATTACHMENT B (REQUIRED)-BUDGET FORM • Name of Proposed District: North Shore Regional Health Partnership Dates Budget will Cover: April 2, 2011 until September 30, 2011 EXPENSES Project Total Total In-Kind Request Salaried Personnel include name & position) Peabody Health Director Sharon Cameron 5,890 4,785 1,105 Salem Health Agent David Greenbaum 4,093 3,325 768 Marblehead Health Director Wayne Attridge 1,500 1,500 0 Swampscott Health Jeff Vaughan 1,904 1,768 136 Lynn health Director Mary Ann O'Connor 2,400 2,000 400 Sub-Total Salaried Personnel 15,419 13,378 2,409 Payroll Taxes and Fringe Benefits (provide % of salary) 28% 35% Total Salaried Personnel 15,787 13,378 2,409 Consultants Metropolitan Area Planning Council 25,000 5,000 20,000 Other consultants 15,000 15,000 Total Consultants • Training Meetings 5,091 2,500 2,591 Materials 3,500 3,500 Communication 3,500 3,500 Other Costs Total Other Costs Total Direct Expenses 67,878 27,878 40,000 Indirect Costs max. 12%--include details in budget narrative TOTAL EXPENSES REVENUE Municipal Cost Sharing Foundation Grants Other Revenue TOTAL REVENUE NET REVENUE OR EXPENSE • w e 2 • APPENDIX A—BACKGROUND AND RESOURCES National research indicates that for local health jurisdictions covering population sizes up to about 500,000 residents, the essential functions of a public health department are more efficiently and cost-effectively carried out by one larger department rather than several smaller ones.' Research and experience in other states suggests that: • Public health districts may enable communities to expand the.range of services available for their residents. • Districts have the potential to allow communities to afford more qualified, professional staff by pooling resources and expertise. • Districts have greater capacity to apply for grants and are more competitive in grant applications, bringing additional resources to their communities. Unlike most states, Massachusetts does not have a county or regional system for local public health. The Commonwealth has 351 separate cities and towns, each with its own Board of Health responsible for providing or assuring access to a comprehensive set of services defined by state law and regulation. Although it ranks 131" in the nation for population size and 44t" in land area, Massachusetts has more local health departments than any other state in the U.S. Also unlike most states, Massachusetts has no dedicated state funding to support local public health operations. Local health departments and boards of health are supported primarily by local • revenues. Local public health funding varies dramatically among communities, and size of municipal population is not a reliable predictor of funding levels. It is not necessary, from a system perspective, for each city and town in Massachusetts to pay for management of its own health department. By sharing management and administrative costs across municipal lines, Massachusetts communities could reallocate resources to increase inspectional services, disease prevention and control, health education, tobacco control, underage drinking, and other services currently in short supply. For the last several years, a Regionalization Working Group, operating with leadership and staff support from the Boston University School of Public Health, has been developing recommendations to promote public health districts in Massachusetts. The Working Group includes representatives from all five of the state's public health professional associations, local health officials, the state departments of public health and environmental protection, and legislators. Its efforts have been supported by national organizations and foundations, including the National Association of County and City Health Officers, the Kellogg Foundation, and the Robert Wood Johnson Foundation. Many Working Group recommendations were adopted by a special Regionalization Advisory Commission created in 2009 by an act of the Massachusetts General Court and chaired by the Lieutenant Governor. ' Mays,Glen P, Megan C McHugh, Kyumin Shim,Natalie Perry, Dennis Lenaway, Paul K. Halverson,and Ramal Moonesinghe. "Institutional and Economic Determinants of Public Health System Performance."American Journal of • Public Health 96:3 (2006): 523-532.) � l 3 • From the perspectives of both experienced municipal leaders and public health officials, the principal values of public health regionalization are to: • Improve the scope and quality of services available to the public (such as coordinated, professional response to public health emergencies); • Stabilize local costs and achieve maximum impact with limited resources; and • Avoid municipal liability for health problems arising from unmet responsibilities. There are vast disparities now in the scope and quality of public health services available, depending on where people live. Regionalization has the potential to ensure more equitable protection for the state's entire population. Regionalization should not be undertaken primarily as a short term, cost saving measure. Cost impacts may vary for different municipalities involved, and depending on when and how districts are formed, cost benefits may take several years to accrue. A 2008 Pioneer Institute report on regionalization noted, "While the cost benefits from regionalization are clear, the ability to provide better services is equally important.,,2 Public health regionalization should be based on the following principles advanced by the Massachusetts Public Health Regionalization Working Group: 1) Equity—the state's entire population deserves access to high quality services to protect public health and prevent injury and disease. 2) Impact—regionalization should strengthen the capacity of Massachusetts cities and towns • to deliver the essential services of public health defined by the U.S. Centers for Disease Control and Prevention. 3) Respect—municipalities need incentives for voluntary participation and continued authority to establish and enforce local public health regulations. 4) Flexibility—municipalities may utilize different models of shared governance, staffing, management, financing, and enforcement to meet their needs; one size doesn't fit all. 5) Sustainability—regionalization requires adequate and sustained funding and technical assistance to support a qualified public health workforce at the state and local levels. The Massachusetts Public Health Regionalization Working Group has defined two major models for public health districts: Comprehensive Services District—all local health services for municipalities participating in the district are carried out by one set of employees. Governance and legal policy making authority are retained by the municipal Boards of Health or may be delegated to a regional health board. Shared Services District—a limited number of local public health services—not all—are carried out in common for municipalities participating in the district. Shared services models may include agreements that all district members will share certain services (e.g.,public health nursing, environmental inspections, clinic operations), or agreements that the district will 2"Regionalization:Case Studies of Success and Failure in Massachusetts," Pioneer Institute 43 (2008):2. http://www.pioneerinstitute g /pdf/wp43 pdf The paper includes a chapter on the Nashoba health district. 4 provide a"cafeteria" style menu of services from which participating municipalities may choose whatever services they desire from the district. • Different governance, management, and cost sharing arrangements are possible under each of the models. For more information, including case studies of existing public health districts in Massachusetts, visit http://sph.bu..edu/images/stories/scfiles/practice/status report 9-1-09.pdf, p. 7 and Appendix 3. For more information about local public health and public health regionalization in Massachusetts, MDPH recommends the following web links: • Boston University School of Public Health(Regionalization Work Group reports): http://sph.bu.edu/Regionalization/massachusetts public-health-regionalization- proj ect/menu-id-617432.html • Coalition for Local Public Health report on the Massachusetts local health workforce: http://mphaweb.org/resources/strength Iph 6 06.pdf • Massachusetts Regionalization Advisory Commission website: http://www.mass. ov/?pa e�gov3subtopic&L=5&LO=Flome&L1.=Our+Team&L2=Lieu tenant+Governor+Tim.othy+P.+Murray&L3=Councils%2C+Cabinets%2C+and+Commi ssi ons&L4=Regionalization+Advisory+Commission&sid=Agov3 • MetroWest Community Health Care Foundation Regionalization Initiative: http://mchcf.org/Kevin itiatives/RegionalPublicHeal.th/tabid/203/Default.aspx For the MDPH Manual of Laws and Regulations Relating to Boards of Health, visit: http://www.m.ass.gov/Eeohhs2/docs/dph/emergency prep/board of health manual.pdf • For information about Board of Health training available from the Local Public Health Institute of Massachusetts, visit: http://sph.bu.edu/otlt/LPHI/OrientationtoLPH/ For information about voluntary national public health accreditation, visit the Public Health Accreditation Board website at: http://vrkw.phaboard.org/ For information about the Ten Essential Services of Public Health defined by CDC, visit: http:H,,vww.cdc.gov/od/ocphp/nphpsp/Documents/Essential%20Services%20Presentation.ppt For information about community health assessments, visit the CDC website at: http://www.cdc.gov/.healthycommunitiesprogram/tools/change., htm For information about evidence based interventions to address tobacco, obesity, and other diseases, visit the CDC Community Guide website at: http://w,xvw.tliecommunity_guide.org//index.html For information about the MDPH Community Health Network Areas, visit the MDPH Office of Community Health website at www.mass.gov/dph/ohc and click on "Community Health Networks." • 5 For information about MDPH data systems: • MAVEN: http://www.mass.gov/?pageID=eohhs2terminal&L=6&LO=Home&L 1=Provider&L2=Reporting+t o+the+State&L3=Diseases+%26+Conditions&L4=Reportable+Diseases%2C+Surveillance+and+I so l ation+%26+Quarantine+Requirements&L5=Office+o f+Integrated+Surveil lance+and+Informati cs+Services&sid=Eeohhs2&b=terminalcontent&f dph cdc p isis maven&csid=Eeohhs2 MassCHIP: http://w-ww.mass.gov/?pagelD=eohhs2subtopic&L=4&LO=Home&LI=Reseqrcher&L2=Comm.uni ty+Health+and+Safety&L3=MassCHIP&sid=Eeohhs2 • a Appendix B—Executive Office of Health and Human Services Regional Map • Executive Office of Health and Human Services Regions An�I'l j h f 1 „ 'Lei'�"^�•. I,,IyF,�. j-�' l yT\ s, �l•� } -- V f t' .,. S N . - j 4+. - 'S' 1 ,1 ZIA EOHHS Regions Y Boston 1 ! Northeast Central ! Southeast n . i MetrO VVest __-i Western 7 f�L 31 0 5 70 ]H 3i .G it � • J Yie= +Q 1 L�acat Ra .Ya Rm Fltl 1 ' 0' beet Y f �-. RM1A AeR�.f�+14$' rYlJt f�ATT SY'i� - fK k a'»� r.ry.d.a�.+ru 'an. .meaye,rmn io*r�'•-•� �• •� �. r�;y r.f-n, tit MASS �.�(�lS1FYN11 I "lt - +rwrshmNm tan i�us+n.•.YL�i -N>.:.4tif�1 J,. �� . „+� alzeu+hrce A Ma.^a- N li.L'nearwtn �P a :nl'r�LL :Lme +MT?,'hJ] nMvr Wa k.l'Y'F(cfµ.ICil.alfeY..w dus+w W4k,. �i 1 AND i • r CITY OF SALEM, MASSACHUSETTS BOARD OF HFAL H 120 WASHINGTON STREET,4"' FLOOR • TEL. (978) 741-1800 K.IMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGRFENBAUM CISA]J,.M.COM D,, VII)GRI'.I:NBAUM,RS ACTING HI:?Aun i A(.;TINT Facsimile Transmittal To: N v--►_s<stJ NG I�j-ro N Fax # Ci`L`) - RE: Li;-TTi.Q rcn, i 1�� ►T'dtL Date : 1- 9- 1, Page(s): including this cover# 2- Message: PLC--rkSZ;- 5 & • �� 1�bfL_ Board of Health News ----------------------------------------------------------------For Your Information OFFICE HOURS: Monday, Tuesday, Wednesday 8:00 AM to 4:00 PM Thursday 8:00 AM to 7:00 PM Friday 8:00 AM to 12:00 NOON • ti 1 Dear Editor I was reminded this week on patient rounds about the serious effects of minor illnesses on the elderly. Common viruses and "colds" that keep young people in bed for a day can have serious and fatal consequences for this group. Influenza season is among us but there is no nightly news report or weekly CDC web-conference giving frightening statistics—that was last year. Last year the Board of Health distributed over 5,000 vaccinations in Salem, this year only 1,000. The cases of severe influenza this year do seem to be lower; whether that is the result of less testing and reporting or actual success of the mass vaccination achieved last year, is unclear. I urge your readers to be as vigilant as last year and get the vaccine despite the silence in the media. Influenza vaccination not only protects the individual, but more importantly protects the frail, very young, very old, pregnant women with whom we interact on a daily basis in schools, on the bus or train, at work, in stores. Healthy individuals may be carriers and pass the virus on without any symptoms. Vaccination is a public health, population intervention to help the many. I'm surprised when speaking to people who have not had the influenza vaccine and the reasons they give: "it makes me sick," "I never get the flu and don't need it." Recent limited outbreaks of measles are a reminder of the importance of population vaccination. Influenza is a very serious illness and as we saw in 2009, it is no longer limited to the winter months. Please get your influenza vaccine, if not for yourself, for your neighbor, your children, your grandparents, your bus driver. There are lots of places to get the vaccine but your Board of Health has it for FREE. Larissa J. Lucas, MD City of Salem, MA Board of Health • • I TRANSMISSION VERIFICATION REPORT TIME 03/08/2011 22: 26 NAME FAX 9787450343 TEL 9787411800 SER.# 000BON341991 DATEJIME 03I08 22:26 FAX NO./NAME 919789274524 DURATION 00:00:35 PAGE(S) 02 RESULT OK MODE STANDARD ECM CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,4"`FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR DGRE ENBAUMnQe SAL.EM.COM 2011, VIr R 2 q P Z- 2t DAVTD GRF FNBAum,RS ACTING HEAuni AGENT I.ITY (;`_r_RK, S 1AS NOTICE OF SPECIAL MEETING You are hereby notified that the Salem Board of Health will hold its regularly scheduled meeting on Thursday March 31, 2011 at 6:00 PM at City Hall Annex, 120 Washington St Room 311, SPECIAL MEETING AGENDA 1. Call to order $ o • 2. Executive Session—Personnel Action 3. Adjournment V Next regularly scheduled meeting is April 12, 2011 at 7pm at City Hall Annex, 120 Washinoa�a . Street Room 311 David Greenbaum l Acting Health Agent 0 c Cc: Barbara Poremba, Chairperson &Board of Health members CVO C: C Know your rights under the open meeting law M.G.L. c. 39 s. 23B, and City Ordinance sections 2-2028 through 2-2033