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MEETING PACKET NOVEMBER 2014 CITY OF SALEM, MASSACHUSETTS BOARD OF HFALTH 120 WAsHINGTON STREET,4:"FLUOR Pre H mote.Protect. TEL.(978) 741-1800 FAx(978)745-0343 KIMBERLEY DRISCOLL Ira ndin .sa, lem.com L.kRRY RAMDIN,WRF;FIS,CI-IO,GP-F5 MAYOR HEm,' H AGENT NOTICE OF MEETING Revised You are hereby noted that the Salem.Board of Health will hold its regularly scheduled meeting Thursday November 13, 2014 at 7.00 PM City Hall Annex 120 Washington St.Y4 Floor MEETING AGENDA 1. Call to order CZR 2. Approval of Minutes 3. Chairperson Communications >r" o -U 4. Public Health Announcements/Reports/Updates a. Health Agent m b. PHN Report s c. Administrative d. Council Liaison S. New Business:New matters that are not anticipated prior to posting the agenda Larry karndin Health Agent cc: MayorlKimberley Driscoll, Board of Health, City Councilors Next regularly scheduled meeting is December 9, 2014 at 7pm at City Hall Annex, 120 Washington Street 3Id Floor. R' Know your rights under the open meeting law MGL chapter 30A s& 18-25 and City Ordinance section 2-2028 through 2-2033 This n"ce po*W on "Ofthd ftftis smwAO'` City Mall, "ItHtt, maw 'f" a`l/' /d d D l 7 St /'3�i P M 4184C*Wdaolc�WM OWL Chip.SK I Health Agent report November 2014 g Announcements • The Salem City council is currently considering amending Zoning regulations to permit keeping of hens and set rules for same • Larry Ramdin has been invited to be part of the planning committee for the National INFORM (Integrated Food borne Illness and response and management) 2015,that will be held in Phoenix, Arizona. Larry was part of the original Environmental Health planning team, proctored a session and chaired the Awards committee for the 2013 conference. Community Outreach • Influenza Vaccination clinics were held for entire Salem community , Salem employees and first responder departments Public Health Highlights • Reviewed applications and issued permits for Winter • Elizabeth Gagakis inspected vendors at the Winter market and all found to be in compliance • David Greenbaum conducted training/orientation in Food Service inspections for new inspector from the City of Melrose • Delilah Castro continues to follow-up on trash complaints received by the department Meetings and Trainings • David Greenbaum Attended North Shore React meeting to discuss issues on Seniors and case updates Inspections Item Monthly Total YTD 2013 Total Certificate of Fitness 40 518 577 Inspection Certificate of Fitness 0 17 29 reinspection Food Inspection 18 372 377 Food Re-inspections 5 118 227 • Retail Food 1 23 55 Inspections Retail Food 0 7 27 reinspection General Nuisance 1 13 9 Inspections Food— 0 1 2 Administrative Hearings Housing Inspections 5 173 233 Housing re- 3 37 40 inspections Rodent Complaints 0 22 39 Court Hearings 0 5 10 Trash Inspections 30 201 146 Orders served by 0 2 2 Constable Tanning Inspections 0 1 1 Body Art 0 1 1 Swimming pools 0 23 30 Bathing Beach 0 100 102 Inspection/testing Lead Determination 0 1 4 Septic Abandonment 0 1 0 Septic System Plan 0 1 1 Review Soil Evaluation 0 1 1 Percolation tests 1 2 1 Total 113 1570 1914 • i F Suzanne Doty RN, BSN Salem Board of Health Public Health Nurse 4 ' Public Health Nurse Report Reporting on October 15th 2014 to November 13th 2014 Disease Prevention • Investigated reportable diseases and reported case information to MDPH. • In contact with North Shore Pulmonary Clinic and MGH pulmonary clinic on current active tuberculosis cases. • In contact with NSMC Infection Control department for prevention of disease within the hospital. • The Lifebridge flu vaccine clinic was held on October 141h; 22 vaccinations were administered. The Council on Aging clinic was held on October 161h',107 vaccinations were given. The employee clinic will be held on November 61h and a city wide clinic (EDS drill)will be held on November 15`h. I will also coordinate with police and fire to administer flu vaccine as well as take appointments in the PHN office. • Assisted with flu clinics in Marblehead at the Marblehead Museum on October 16th and at the Village School on October 28`h and the Beverly Council on Aging on October 161h Health Promotion • Updated the Salem Board of Health Facebook and Twitter pages with links and information on Ebola. • Provided the school nurse leader Paula Dobrow with MDPH updates, school nurse guidance and fact sheets regarding the Ebola. Meetings/Trainings • Commenced the Local Public Health Institute"Foundations for Local Public Health Practice in Massachusetts"course. This class began on October 151h, included 3 in-person class session as well as weekly modules and webinars until graduating on March 2015. • Attended a TB 101 lecture by Regional TSA nurse Jo-Ann Keegan in Manchester-by-the- Sea. • Attended the Refugee and Immigrant health: from Global Practices to Local Policies seminar on October 22nd in Waltham. Some topics that were discussed were how the internet and social media are used for surveillance of illness and how our refugee program is planning to expand programs in certain in countries. • Participated in multiple conference calls from MDPH regarding Ebola and practice and • policy procedures being put in place. • Attended a fit test training on November 3`d at the Topsfield Fire Department for training on N95 fit testing on by using a portacount respirator fit tester. • Continuing to precept Salem State University RN to BSN student Sonya Mason for her clinical rotation on public health. Monthly Report of Communicable Diseases October 2014 Disease #Of Cases New Carry Over Discharged Running total Total for 2013 Reported for 2014 Tuberculosis 4 0 4 0 5 2 (Active) Latent 0 0 0 0 31 44 Tuberculosis* Malaria 0 0 0 0 1 0 Calicivirus/No 0 0 0 0 1 0 rovirus Group B 1 1 0 1 5 2 Streptococcus Meningitis 0 0 0 0 2 0 • Hepatitis C* 2 2 0 2 19 37 Hepatitis B* 1 1 0 1 1 0 Influenza* 0 0 0 0 21 62 Lyme 0 0 0 0 1 8 Disease* Ehrlichiosis 0 0 0 0 1 0 Campylobacte 2 2 0 2 7 15 riosis Giardiasis 0 0 0 0 0 2 Shigellosis 0 0 0 0 4 2 Shigatoxin 0 0 0 0 1 0 Producing Organism Group A 0 0 0 0 1 1 Streptococcus Streptococcus 0 0 0 0 0 1 Pneuomoniae West Nile 0 0 0 0 0 1 . Chikungunya 0 0 0 0 1 0 Salmonellosis 0 0 0 0 3 3 Legionellosis 0 0 0 0 0 1 Vibrio 0 0 0 0 0 1 Varicella* 1 1 0 1 2 0 Haemophilus 0 0 0 0 0 1 Influenzae Enterovirus 0 0 0 0 0 1 Pertussis 0 0 0 0 2 2 Hansen's 0 0 0 0 0 1 Disease Total 11 7 4 7 109 187 *Notifications only, LBOH not required to follow up or investigate per DPH. Summary of Current Communicable Diseases TB: Case#1: Case continuing with DOT visits daily, compliant and feeling well. Case#2: Case continues to be seen for DOT once per week, using daily medication box, very compliant and feeling well. Case#3: Case moved to Salem in early February and has been on DOT visits since November. Daily DOT visits began in Salem upon notification of arrival on Monday February P. Patients DOT appointments are 3 times weekly. Continues to be compliant with all medications, using daily medication box properly and is attending all appointments. Case#4: This case had planned to stay in Salem for a temporary stay but is considering staying long term. At this time, I continue to do DOT visits and am keeping in contact with the regional TB nurse as well as the original DOT nurse from their home town for updates and coordinating with the clinic. Currently, this patient is seen for DOT 3-5 times per week. They are feeling well, compliant with their medications and doctors' visits, and have been tolerating therapy for several months. Campylobacteriosis' Case#1: This case had traveled to Italy during the incubation period and became sick while they were there. None of the people they traveled with have become ill or any of their household contacts since returning home. They have been treated and followed by their primary care physician. They are recovered and feeling well, no further follow up is required and the case is closed. Case#2: I was able to reach this case by phone but they refused to answer questions regarding the illness, • stating that"the doctor said I am fine."I tried to explain the necessity of my call to help protect others from getting the same illness but they continued to refuse. Their spouse has previously told me that they are retired and no one else in the house had become ill. This case follow up was completed to the best of my ability and the epidemiologist was notified, no further follow up is required and the care is closed. Group B Streptococcus: This case is an adult who was recently hospitalized for reasons other than Group B Streptococcus but upon becoming symptomatic that evening they were found to have the infection. They have been treated and released from the hospital. There is no further follow up required and the case is closed. 0 Health Dept. Clerical Report FY 2015 _.. .,,. . Permits"` Plan Reviews: . , Burial Permits Certificate of Copies / Fines Revenue Permit Fees ' $25 Fitness $50 my-14 $450.00 $815.00 $850.00 $2,115.00 Food Service Est. <25 seats s140 U USt 25-99 seats $280 : >99 seats $420 9 $900.00 $2,415.00 $1,950.00 y K $5,265.00 M; eptember 00Retail Food <l000sa $7o . , . . . . , ctober $625.00 $1,804.00 $1,350.00 $7.00 $3,786.00 1000-10,000 $28o >10,000 s420 ovember r] $0.00 Temp.Food a;3 days s300 ecemberk=k $0.00 4-74ys $hoo >7days: s Example of>j day temp food permit:. anuary-15 $0.00 ��i4(da s)divided b7= xs600 s1200 � _ ebruary ,t $0.00 Frozen Desserts $25 2 .� Mobile Food $210 March - $0.00 April $0.00 Plan Reviews New,; $180 o May $0.00 Rem del s 90 Jun e u Catering $25 per event)$too ; t $0.00 catering kitchen 4IN Body Art Est. $315 R ` Total $2,750.00 $6,034.00 $180.00 $5,100.00 $207 00 411". $14,271.00 Body Art Practitioner 135 Review Plans $180 Fiscal Year Budget 2015 Suntan Est. $140 Rec.Day Camp $10 Salary Starting Endinca Expenses Ext.Paint Removal s35 Full Time $341,229.00 $232,786.94 Starting Ending Transport Off.Subst. slo5 Part Time $15,997.00 $12,828.25 $17,050.00 $7,515.66 Tobacco Vendors $135 Overtime $2,000.00 -$1,399.99 Swimming Pools Seasonal. $140 Balance $359,226.00 $244,215.20 Health Clinic Revolving Account Annual$210.. Nonprofit$40. $11,599.77 Title V Review s18o Well Application $180 Disposal works $225118o N 1114 NOV 13P �: 0 ` Regulation 24 of the City of Salem Board of Health CITY OF. S�LElI M� g ty �� OFFICE Restricting the Sale and Use of Tobacco Products & Nicotine Delivery Products A. Statement of Purpose: Whereas there exists conclusive evidence that tobacco smoke causes cancer, respiratory and cardiac diseases,negative birth outcomes, irritations to the eyes,nose and throat (Centers far Disease Control and Prevention(hereinafter"CDC'), Health Effects of Cigarette Smoking Fact Sheet, (January 2012));whereas among the 15.7%of students nationwide who currently smoked cigarettes and were aged less than eighteen(18) years, 14.1%usually obtained their own cigarettes by buying them in a store(Le., convenience store, supermarket,or discount store)or gas station during the thirty(30)days before the survey(CDC, Youth Risk Behavior,Surveillance Summaries. 2009,MMWR 2010:59(No. SS-SS)at 11);whereas nationally in 2000, sixty-nine(69%)percent of middle school age children who smoke at least once a month were not asked to show proof of age when purchasing cigarettes (CDC, Youth Tobacco,Surveillance Summaries.2000,MMWR 2001:50(No.SS-04));whereas the U.S. Department of Health and Human Services has concluded that nicotine is as addictive as cocaine or heroin(U.S.Department of Health and Human Services.How Tobacco Smoke Causes Disease:The Biology and Behavioral Basis for Smoking-Attributable Disease:A Report of the Surgeon General,Atlanta, GA: US.Department of Health and Human Services, Centers for Disease Control and Prevention,National Centerfor Chronic Disease Prevention and Health Promotion,Of ice on Smoking and Health,2010.);whereas despite state laws prohibiting the sale of tobacco products to minors, access by minors to tobacco products is a major problem;whereas according to the CDC, cigarette price increases reduce the demand for cigarettes and thereby reduce smoking prevalence, cigarette consumption, and youth initiation of smoking(U.S. Department of Health and Human Service&Reducing Tobacco Use:A Report of the Surgeon General. Atlanta, GA. U.S Department of Health and Human Services, Centers for Disease Control and Prevention, National Centerfor Chronic Disease Prevention and Health Promotion,Offce on Smoking and Health, 2000 at 358); Whereas the 2012 U.S. Surgeon General's Report on Preventing Tobacco Use Among Youth and Young Adults, reports that in 2005 Ringel, Wasserman, &Andreyeva(U.S. Department of Health and Human Services,Nicotine Addiction,Atlanta,GA: U.S.Department of Health and Human Services, CDC,National Centerfor Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1988) conducted logistic regression analyses to examine whether increased cigar prices and state.tobacco control policies affected the rate of cigar use. (U.S.Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults,Atlanta, GA: U.S.Department of Health and Human Services, Centers for Disease Control and Prevention,National Centerfor Chronic Disease Prevention and Health Promotion, Of ice on Smoking and Health,2012 at 706). Using the 1999 and 2000 iterations of the National Youth Tobacco Survey, Ringel and colleagues analyzed data from 33,632 adolescent participants aged nine to seventeen. They found that increased cigar prices significantly decreased the probability of male adolescent cigar use and found that a 10% increase in cigar prices would reduce the sample's cigar use by 3.41/o (Ringel JS, Wasserman J,Andreyeva T,Effects of Public Policy on Adolescents'Cigar Use:Evidence From the National Youth Tobacco Survey, 95Am.J. Pub.Health 995-8(June 1,2005);whereas according to the CDC's youth risk behavior surveillance system, the percentage of high school students in Massachusetts who reported the use of cigars within the past 30 days went from 11.8% in 2003 to 14.9%in 2009 CDC, Youth RiskBehaWos Surveillance Summaries 2009.MMWR 2010 9 o. SS- ( S SS at 72 i CDC, Youth Risk Behavior. Surveillance Summaries,2003,MMWR 2004;53(No.SS-02)at 54);whereas • nicotine levels in cigars are generally much higher than nicotine levels in cigarettes. (Nat'l Cancer Institute at the Nat'1lnst. of Health, Questions and Answers About Cigar Smoking and Cancer (Oct. 27,2010)); Whereas commercial Roll Your Own(RYO)machines enable loose, unpackaged tobacco to be poured into a machine and placed into empty,unpackaged cigarette tubes to be inhaled by individuals who smoke them. This procedure provides risk of contamination of the tobacco and unsanitary conditions in the machine and is injurious to public health; whereas commercial Roil Your Own(RYO) machines located in retail stores enable retailers to sell cigarettes without paying the federal and state excise taxes that are imposed on conventionally manufactured cigarettes (RYO FILLING STATION, www.nLofillini-station.com(Feb.27,2012). High excise taxes encourage adult smokers to quit and deter youth from starting (Kenneth E. Warner,Smoking and Health Implications of a Change in the Federal CigarettteExcise Tax,255J.AM.MED.Ass'N1028(1986),Frank Chaloupka&Rosalie Liccardo Pacula, The Impact of Price on Youth Tobacco Use, in 14 SMOKING AND TOBACCO CONTROL MONOGRAPHS:CHANGING ADOLESCENT SMOKING PREVALENCE 193(US Dept Health and Human Services et al. eds.,2001)). Therefore, inexpensive cigarettes, like those produced from RYO machines,promote the use of tobacco,resulting in a negative impact on public health and increased health care costs, and severely undercut the evidence- based public health benefit of imposing high excise taxes on tobacco; Whereas the sale of tobacco products and nicotine delivery products are incompatible with the mission of health care institutions ti tutions because the are detrimental to the public Y health and undermine efforts to educate patients on the safe and effective use of . medication; Whereas educational institutions sell tobacco products to a younger population, which is particularly at risk for becoming smokers and such sale of tobacco products and nicotine delivery products are incompatible with the mission of educational institutions that educate a younger population about social, environmental and health risks and harms; Now,therefore it is the intention of the City of Salem Board of Health to regulate the access of tobacco products and nicotine delivery products. B.Authority This regulation is promulgated pursuant to the authority granted to the City of Salem Board of Health by Massachusetts General Laws Chapter 111, Section 31 that "Boards of Health may make reasonable health regulations". C. Definitions: For the purpose of this regulation,the following words shall have the following meanings: Blunt Wrap: Any tobacco product manufactured or packaged as a wrap or as a hollow . tube made wholly or in part from tobacco that is designed or intended to be filled by the consumer with loose tobacco or other fillers. 1 • Business Agent: An individual who has been designated by the owner or operator of any - establishment to be the manager or otherwise in charge of said establishment. Cigar: Any roll of tobacco that is wrapped in leaf tobacco or in any substance containing tobacco with or without a tip or mouthpiece not otherwise defined as a cigarette under Massachusetts General Law, Chapter 64C, Section 1, Paragraph 1. Commercial Roll-Your-Own(RYO) machine: A mechanical device, by whatever manufacturer made and by whatever name known,that is designed to roll and wrap tobacco into products. RYO machines located in a private home,used for personal consumption, are not Commercial Roll-Your-Own machines. E-Cigarette: Any electronic Nicotine Delivery Product composed of a mouthpiece, heating element,battery and/or electronic circuits that provides a vapor of liquid nicotine to the user, or relies on vaporization of solid nicotine or any liquid. This term shall include such devices whether they are manufactured as e-cigarettes, e-cigars, a-pipes or under any other product name. Educational Institution: Any public or private college, school,professional school, scientific or technical institution, university or other institution furnishing a program of higher education. Employee: Any individual who performs services for an employer_ Employer: Any individual,partnership, association,.corporation, trust or other organized group of individuals that uses the services of one(1)or more employees. Health Care Institution: An individual,partnership, association, corporation or trust or any person or group of persons that provides health care services and employs health care providers licensed, or subject to licensing,by the Massachusetts Department of Public Health under M.G.L. c. 112 or a retail establishment that provides pharmaceutical goods and services and subject to the provisions of 247 CMR 6.00.Health care institution includes, but is not limited to,hospitals, clinics, health centers,pharmacies, drug stores, doctor offices and dentist offices. Minor: Any individual who is under the age of twenty one(21). Nicotine Delivery Product: Any manufactured article or product made wholly or in part of a tobacco substitute or containing nicotine that is expected or intended for human consumption,but not including a tobacco substitute prescribed by a licensed physician or a product that has been approved by the United States Food and Drug Administration for sale as a tobacco use cessation or harm reduction product or for other medical purposes and which is being marketed and sold solely for that approved purpose. Nicotine delivery product includes,but is not limited to, e-cigarettes. Permit Holder: Any person engaged in the sale or distribution of tobacco or nicotine delivery products directly to consumers who applies for and receives a tobacco and nicotine delivery product sales permit or any person who is required to apply for a 2 tobacco and nicotine delivery product sales permit pursuant to these regulations, or his or her business agent. -- Tobacco Product: Cigarettes, cigars,chewing tobacco,pipe tobacco,bidis, snuff or tobacco in any of its forms. Vending Machine: Any automated or mechanical self-service device, which upon insertion of money, tokens or any other form of payment, dispenses or makes cigarettes, any other tobacco product or Nicotine Delivery Product. D. Tobacco and Nicotine Delivery Product Sales to Minors Prohibited: 1. No person shall sell tobacco or nicotine delivery products or permit tobacco or nicotine delivery products to be sold to a minor;or not being the minor's parent or legal guardian, give tobacco or nicotine delivery products to a minor. 2. Required Signage a. In conformance with and in addition to Massachusetts General Law, Chapter 270, Section 7, a copy of Massachusetts General Laws, Chapter 270, Section 6, shall be posted conspicuously by the owner or other person in charge thereof in the shop or other place used to sell tobacco products at retail. The notice shall be provided by the Massachusetts Department of Public Health and made available from the City of Salem Board of Health. The notice shall be at least 48 square inches and shall be posted conspicuously by the permit holder in the retail establishment or other place in such a manner so that it may be readily seen by a person standing at or approaching the cash register. The notice shall directly face the purchaser and shall not be obstructed from view or placed at a height of less than four(4) feet or greater than nine(9) feet from the floor. The owner or other person in charge of a shop or other place used to sell tobacco products at retail shall conspicuously post any additional signs required by the Massachusetts Department of Public Health. b. The owner or other person in charge of a shop or other place used to sell tobacco products at retail shall conspicuously post signage provided by the City of Salem board of health that discloses current referral information about smoking cessation. c. The owner or other person in charge of a shop or other place used to sell nicotine delivery products at retail shall conspicuously post a sign stating that"The sale of nicotine delivery products to minors under 21 years of age is prohibited." The owner or other person in charge of a shop or other place used to sell e-cigarettes at retail shall conspicuously post a sign stating that "The use of e-cigarettes at indoor establishments may be prohibited by local law."The notices shall be no smaller than 8.5"by 11" and shall be posted conspicuously in the retail establishment or other place in such a manner so that they may be readily seen by a person standing at or approaching the cash register. These notices shall directly face the purchaser and shall not be obstructed from view or placed at a height of less than four(4) feet or greater than nine(9) feet from the floor. 3 3. Identification: Each person selling or distributing tobacco or nicotine delivery products shall verify the age of the purchaser by means of valid government-issued photographic - identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of 27. — 4. All retail sales of tobacco or nicotine delivery products must be face-to-face between the seller and the buyer. E. Tobacco and Nicotine Delivery Product Sales Permit: 1.No person shall sell or otherwise distribute tobacco or nicotine delivery products at retail within the City of Salem without first obtaining a Tobacco and Nicotine Delivery Product Sales Permit issued annually by the City of Salem Board of Health. Only owners of establishments with a permanent,non-mobile location in Salem are eligible to apply for a permit and sell tobacco products or nicotine delivery products at the specified location in Salem. 2. As part of the Tobacco and Nicotine Delivery Product Sales Permit application process,the applicant will be provided with the City of Salem Board of Health regulation. Each applicant is required to sign a statement declaring that the applicant has read said regulation and that the applicant is responsible for instructing any and all employees who will be responsible for tobacco and nicotine delivery product sales regarding both state laws regarding the sale of tobacco and this regulation. 3. Each applicant who sells tobacco is required to provide proof of a current tobacco sales license issued by the Massachusetts Department of Revenue before a Tobacco and Nicotine Delivery Product Sales Permit can be issued. 4. The fee for a Tobacco and Nicotine Delivery Product Sales Permit shall be determined by the City of Salem Board of Health annually. All such permits shall be renewed annually. 5. A separate permit is required for each retail establishment selling tobacco or nicotine delivery products. 6. Each Tobacco and Nicotine Delivery Product Sales Permit shall be displayed at the retail establishment in a conspicuous place. 7. No Tobacco and Nicotine Delivery Product Sales Permit holder shall allow any employee to sell tobacco products or nicotine delivery products until such p �'Y p employee reads this regulation and state laws regarding the sale of tobacco and signs a statement, a copy of which will be placed on file in the office of the employer,that he/she has read the regulation and applicable state laws. 8. A Tobacco and Nicotine Delivery Product Sales Permit is non-transferable. A new owner of an establishment that sells tobacco or nicotine delivery products must apply for a new permit. No new permit will be issued unless and until all outstanding penalties • incurred by the previous permit holder are satisfied in full. 4 i 9. Issuance of a Tobacco and Nicotine Delivery Product Sales Permit shall be conditioned • on an applicants consent to unannounced,periodic inspections of his/her retail -- establishment to ensure compliance with this regulation. 10. Issuance and holding of a Tobacco and Nicotine Delivery Product Sales Permit shall be conditioned on an applicant's on-going compliance with current Massachusetts Department of Revenue requirements and policies including, but not limited to, minimum retail prices of tobacco products. 11. A Tobacco and Nicotine Delivery Product Sales Permit will not be renewed if the permit holder has failed to pay all fines issued and the time period to appeal the fines has expired and/or has not satisfied any outstanding permit suspensions. 12. Maximum Number of Tobacco and Nicotine Delivery Product Sales Permits. At any given time,there shall be no more than 60 Tobacco and Nicotine Delivery Product Sales Permits issued in City of Salem. No permit renewal will be denied based on the requirements of this subsection except any permittee who has failed to renew their current permit within(30)days of expiration will be treated as a first-time permit applicant. Applicants who purchase a business that holds a current Tobacco and Nicotine Delivery Product Sales Permit at the time of the sale of said business may apply within sixtY(60) days of such sale, and if complying 1 Yin with all application requirements shall receive,the permit held by the Seller if the Buyer intends to sell tobacco products and/or Nicotine Delivery Products. New applicants for permits who are applying at a time when the maximum number of permits have been issued will be placed on a waiting list and will be eligible to apply for a permit on a"first-come, first-serve'basis as issued permits are either not renewed or are returned to the Board. F. Cigar Sales Regulated: 1.No person shall sell or distribute or cause to be sold or distributed a single cigar 2.No person shall sell or distribute or cause to be sold or distributed any original package of two or more cigars, unless such package is priced for retail sale at$5.00 or more. 3. This Section shall not apply to: a. The sale or distribution of any single cigar having a retail price of two dollars and fifty cents($2.50)or more. b. A person or entity engaged in the business of selling or distributing cigars for commercial purposes to another person or entity engaged in the business of selling or distributing cigars for commercial purposes with the intent to sell or distribute outside the boundaries of Salem. 4. The Salem Board of Health may adjust from time to time the amounts specified in this Section to reflect changes in the applicable Consumer Price Index by amendment of this regulation. G. Prohibition of the Sale of Blunt Wraps No person or entity shall sell or distribute blunt wraps within the City of Salem. 5 i H. Free Distribution and Coupon Redemption: No person shall distribute,or cause to be distributed, any free samples of tobacco products or nicotine delivery products. No means,instruments or devices that allow for the redemption of tobacco products for free or at a reduced price below the minimum retail price determined by the Massachusetts Department of Revenue shall be accepted by any permittee. I. Out-ofPackage Sales: No person may sell or cause to be sold or distribute or cause to be distributed, any cigarette package that contains fewer than twenty(20)cigarettes, including single cigarettes. J. Self-Service Displays: All self-service displays of tobacco products and/or nicotine delivery products are prohibited. All humidors including,but not limited to,walk-in humidors must be locked. K. Vending Machines: All tobacco and/or nicotine delivery product vending machines are prohibited. L. Commercial Roll-Your-Own Machines All commercial Roll-Your-Own machines are prohibited. M. Prohibition of the Sale of Tobacco and Nicotine Delivery Products by Health Care Institutions: No health care institution located in City of Salem shall sell or cause to be sold tobacco or nicotine delivery products.No retail establishment that operates or has a health care institution within it, such as a pharmacy or drug store, shall sell or cause to be sold tobacco products or nicotine delivery products. N. Prohibition of the Sale of Tobacco and Nicotine Delivery Products by Educational Institutions: No educational institution located in City of Salem shall sell or cause to be sold tobacco or nicotine delivery products. This includes all educational institutions as well as any retail establishments that operate on the property of an educational institution. O. E-Cigarette Use: The use of e-cigarettes is prohibited wberever smoking is prohibited per M.G.L. Ch.270, §22 and the Salem Environmental Tobacco Smoke(ETS) regulation. i 6 P. Violations: 1. It shall be the responsibility of the establishment,permit holder and/or his or her business agent to ensure compliance with all sections of this regulation pertaining to his or her distribution of tobacco and/or nicotine delivery products. The violator shall — receive: a. In the case of initial violations observed at an inspection within a 36 month period, a fine of one hundred dollars ($100.00)per violation. b. In the case of violations observed at the second inspection within 36 months of the date of a current violation, a fine of two hundred dollars($200.00)per violation and the Tobacco and Nicotine Delivery Product Sales Permit shall be suspended for seven(7) consecutive business days. C. In the case of violations observed at the three or more inspections within a 36 months of a current violation, a fine of three hundred dollars($300.00) and the Tobacco and Nicotine Delivery Product Sales Permit shall be suspended for thirty(30) consecutive business days or the City of Salem.Board of Health may revoke the Tobacco and Nicotine Delivery Product Sales Permit. 2. Refusal to cooperate with inspections pursuant to this regulation shall result in the suspension of the Tobacco and Nicotine Delivery Product Sales Permit for thirty(30) consecutive business days. 3. In addition to the monetary fines set above, any permit holder who engages in the sale or distribution of tobacco or nicotine delivery products directly to a consumer while his or her permit is suspended shall be subject to the suspension of all board of health issued permits for thirty(30) consecutive business days. 4. The City of Salem Board of Health shall provide notice of the intent to suspend or revoke a Tobacco and Nicotine Delivery Product Sales Permit,which notice shall contain the reasons therefore and establish a time and date for a hearing which date shall be no earlier than seven(7) days after the date of said notice. The permit holder or its business agent shall have an opportunity to be heard at such hearing and shall be notified of the Board of Health's decision and the reasons therefore in writing.After a hearing, the City of Salem Board of Health shall suspend or revoke the Tobacco and Nicotine Delivery Product Sales Permit if the Board finds that any violations have occurred. For purposes of such suspensions or revocations, the Board shall make the determination notwithstanding any separate criminal or non-criminal proceedings brought in court hereunder or under the Massachusetts General Laws for the same offense. All tobacco products and nicotine delivery products shall be removed from the retail establishment upon suspension or revocation of the Tobacco and Nicotine Delivery Product Sales Permit. Failure to remove all tobacco and nicotine delivery products shall constitute a separate violation of this regulation. Q. Non-Criminal Disposition: Whoever violates any provision of this regulation may be penalized by the non-criminal method of disposition as provided in General Laws, Chapter 40, Section 21 D or by filing a criminal complaint at the appropriate venue. 7 I . Each day any violation exists shall be deemed to be a separate offense. • R. Enforcement: Enforcement of this regulation shall be by the City of Salem Board of Health of or its designated agent(s). Any citizen who desires to register a complaint pursuant to the regulation may do so by contacting the City of Salem Board of Health or its designated agent(s)and the Board shall investigate. S. Severability: If any provision of these regulations is declared invalid or unenforceable, the other provisions shall not be affected thereby but shall continue in full force and effect. T. Effective Date: This regulation shall take effect on September 1,2012,with the exception of Section F (Cigar Sales Regulated)which shall take effect on February 4,2013. Amended August 7,2014 The amendments to Regulation 24: Restricting the Sale and Use of Tobacco Products & Nicotine Delivery Products will become effective January 1 of 2015. After a vote of the Board of Health at a special meeting held on August 7,2014 the amendments passed: 3 affirmative 2 negative Pursuant to MGL Chap. 111 § 31, a summary of the regulation was posted in the Salem Evening News on September 5, 2014 Vote reaffirmed on September 24, 2014: 3 Affirmative 1 negative, 1 abstain City of Salem Board of Health 120 Washington Street, 4th Floor Salem MA, 01970 Dr. Barbara Poremba Ed. D MPH Chair Gayle Sullivan Dr. Shama Alam, MD Dr. Danielle Ledoux M.D. Paul Kirby Larry Ramdin Health Agent Heather Lyons-Paul- Clerk of the Board • 8 'L The following signature is authorized Signed 4JOA-11�X4- e Cxee � Dr. Barbara Poremba Ed.D, MPH RNCS Chair Salem Board of Health A UE COPY IT S 7E1V GLEAM M, MASS, 2/312015 General Laws:CHAPTER 111,Section 122 Print PART I ADMINISTRATION OF THE GOVERNMENT TITLE XVI PUBLIC HEALTH CHAPTER 111 PUBLIC HEALTH Section 122 Regulations relative to nuisances; examinations Section 122. The board of health shall examine into all nuisances, sources of filth and causes of sickness within its town, or on board of vessels within the harbor of such town, which may, in its opinion, be injurious to the public health, shall destroy, remove or prevent the same as the case may require, and shall make regulations for the public health and safety relative thereto and to articles capable of containing or conveying infection or contagion or of creating sickness brought into or conveyed from the town or into or from any vessel. Whoever violates any such regulation shall forfeit not more than one thousand dollars. httos J/m al eoi s I aturP nov/Laws/General Laws/Partl/T i tl eXVI/Chanter 111/SP.CtI nn199/Print 1/1 i 2/3/2015 General Laws:CHAPTER 111,Section 123 t ; Print FPART I ADMINISTRATION OF THE GOVERNMENT TITLE XVI PUBLIC HEALTH CHAPTER 111 PUBLIC HEALTH Section 123 Abatement by owner; penalty Section 123. Said board shall order the owner or occupant of any private premises, at his own expense, to remove any nuisance, source of filth or cause of sickness found thereon within twenty-four hours, or within such other time as it considers reasonable, after notice; and an owner or occupant shall forfeit not more than one thousand dollars for every day during which he knowingly violates such order. Prin _ 1/1 2/3/2015 General Laws:CHAPTER 111,Section 124 Print PART I ADMINISTRATION OF THE GOVERNMENT TITLE XVI PUBLIC HEALTH CHAPTER 111 PUBLIC HEALTH Section 124 Service of order for abatement Section 124. Such order shall be in writing, and may be served personally on the owner, occupant or his authorized agent by any person authorized to serve civil process; or a copy of the order may be left at the last and usual place of abode of the owner, occupant or agent, if he is known and within or without the commonwealth; or a copy of the order may be sent to the owner, occupant or agent by registered mail, return receipt requested, if he is known and within the commonwealth. If the order is directed against the owner and if the residence and whereabouts of the owner or his agent are unknown or without the commonwealth, the board may direct the order to be served by posting a copy thereof in a conspicuous place on the premises and by advertising it for at least three out of five consecutive days in one or more newspapers of general circulation within the municipality wherein the building affected is situated. hftps:Hmalegislature.gov/Laws/GeneralLaws/Partl/TitleXVI/Chapterl11/Section124/Print i 2/3/2015 General Laws:CHAPTER 111,Section 125 Print PART I ADMINISTRATION OF THE GOVERNMENT i TITLE XVI PUBLIC HEALTH CHAPTER 111 PUBLIC HEALTH Section 125 Removal of nuisance by board Section 125. If the owner or occupant fails to comply with such order, the board may cause the nuisance, source of filth or cause of sickness to be removed, and all expenses incurred thereby shall constitute a debt due the city or town upon the completion of the removal and the rendering of an account therefor to the owner, his authorized agent, or the occupant, and shall be recoverable from such owner or occupant in an action of contract. The provisions of the second paragraph of section three A of chapter one hundred and thirty- nine, relative to liens for such debt and the collection of the claims for such debt, shall apply to any debt referred to in this section, except that the board of health shall act hereunder in place of the mayor or board of selectmen. • iclafi irn nnvll aiuc/ranerall aeie/PartlfTitleX/I/f:hantar111/Rartinn195/Print 1/1