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MEETING PACKET OCTOBER 2014 m CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH rp�{.�L� GwCw4'yL l�l 120 WASHINGTON STREET,4TH FLO ven[�He.protect. TEL. (978) 741-1800 FAx(978) 745-0 OCT -9 A 11: 2U KIMBERLEY DRISCOLL lramdin@salem.com FILE rt, RAMDIN RS/KERB,CHO,CP-FS MAYOR CITY CLERK, S `�' `' AATHAGENT NOTICE OF MEETING Revised You are hereby notified that the Salem Board of Health will hold its regularly scheduled meeting Tuesday Octoberl4, 2014 at 7.00 PM City Hall Annex 120 Washington St.3`d Floor MEETING AGENDA 1. Call to order 2. Approval of Minutes I 3. Chairperson Communications 4. Public Health Announcements/Reports/Updates a. Health Agent r • b. PHN Report c. Administrative d. Council Liaison a 0 M 5. Discussion of proposed Board of Health_Regulation 5A: Backyard Poultry Keeping and review of c public comment 0 U w(� 6. Communication and open meeting law �N� mo ; 7. New Business ev 8. Adjournment r C O .o � L C O O W v Larry Ramdin +r c Health Agent 0 0N ea cc: Mayor Kimberley Driscoll, Board of Health, City Councilors � N Next regularly scheduled meeting is November 13,2014 at 7pm at City Hall Annex, 120 Washington Street 3,d Floor. Know your rights under the open meeting law MGL chapter 30A ss. 18-25 and City Ordinance section 2-2028 through 2-2033 CITY OF SALEM BOARD OF HEALTH MEETING MINUTES September 9, 2014 DRAFT MEMBERS PRESENT: Dr. Barbara Poremba, Chair, Dr. Shama Alam&Dr. Danielle Ledoux OTHERS PRESENT: Larry Ramdin Health Agent, &Council Liaison Beth Gerard TOPIC DISCUSSION/ACTION 1. Call to Order 7:00pm 2. Minutes of Last Meeting Dr. Alam motioned to approve minutes Dr. Ledoux 2nd. Approved (July 8th &August 71h) unanimously Dr. Poremba asked the Board if there were any objections to taking the agenda out of order, starting with the public comment section on, the Keeping of Backyard Poultry—No objections. 4. Chairperson Announcements Dr. Poremba reminded the members that there are online trainings and MAHB has a training program as well November 15th, Paul Kirby will be going to the MAHB training EDS training drill clinic will be held on November 15th, at Salem High School. Board members are encouraged to attend ICS 100 and 200 & 700 online trainings are available online for members interested in getting certified. Chair asked for update on status on amendment to the size of the Board. Dr. Alam did try to meet with Councilor Seagal with no response. She tried to get an informal meeting to ask if the health and safety committee to meet on the matter of the Board of Health size. Larry said the Mayor has submitted a nominee to the city council for a new Board member. Board discussed concerns about stagnation of this issue. 5. Hawthorne Hotel Hearing The Hawthorne Hotel has requested their hearing be moved to November's meeting—No Objections 6. Monthly Reports-Updates A. B. Health Agent The very 1 st electronic death registration was done. An electronic Report payment was made as well. L Ramdin will look at city ordinance on zoning pertaining to chicken coops David Greenbaum & Elizabeth Gagakis are taking the FDA food borne illness training courses this week S. Doty&H. Paul will be starting the foundations of local public health course in October. Public Health concerns re: Ebola and Enterovirus 68 and implications for Salem discussed. Approved unanimously; copy available at the BOH B. Public Health S. Doty, Public Health Nurse is in Alabama taking a FEMA Nurse's Report training course. D.O.T.s are being cover by neighboring communities while Suzanne is in training this week. Approved unanimously; copy available at the BOH C. Administrative Approved unanimously; copy available at the BOH Report D. City Council Liaison Was excused from the meeting Updates Dr. Ledoux motioned to accept reports - 2nd Dr. Shama Alam Approved unanimously 3. New Business Discussion and Public Comment on Dr. Poremba introduced the guidelines of the public comment backyard poultry keeping section of the meeting. All handouts from the public and additional emails will be put into record. Emails should be sent to Larry Ramdin at lraindin@salem.com by September 29, 2014(20 days after this meeting) so the emails can be distributed to the Board before the next meeting. The following spoke during the public comment section: Lea Benson— 19 Pickman Street Kevin and Kristen Cordy— 1 Orchard Street Patrick Scanlan- 42 Dearborn Street Patricia Scanlan- 42 Dearborn Street Kathy Karsh— 76 Memorial Drive Denise , Chris &Allie Granniss— 3 Fairfield Street Jim Adams— 5 Manning Street Michelle.Conway— 69 Orchard Street Jane Stewart— 18 Dalton Parkway Ward 5 Councilor Josh Turiel—238 Lafayette Street Cady Goldfield— 37 Moffatt Road Maura Murphy- 70 Dearborn St Geoff Millar 20 Abbott St Jen Lynch 38 Charles St Pat Gozemba- 17 Sutton Ave Ward 2 Councilor Heather Famico - 195 Essex Street Dr. Poremba closed the public comments section. The Board took a 10 minute recess. Dr. Poremba called the meeting back to order. Reports and Chair announcements were discussed. Board discussed comments and regulation. P. Kirby asked how this regulation came about. L. Ramdin responded that there have been concerns about the raising of animals in the city. At this point we have a very broad regulation. There are also a number of diseases related to poultry. Bird flu is on the radar along with other diseases. Chickens are farm animals they are not domesticated house hold pets so the city needs a separate regulation for them. This regulation along with all other Board of Health regulations, permit us to conduct inspections. Dr. Ledoux asked what public health issues we should be covering under this regulation. L Ramdin responded that general nuisances presented by the keeping of poultry, the prevention of creating attractive nuisances, rodent &pest breading or harborage of food provision conditions, and the spread of disease. He also explained to the Board that they can change anything in the draft regulation that you want before they vote on it. He can gather information for the members to help them make this decision. The Board requested that L. Ramdin provide more information on disposing of dead chickens, diseases that chickens can carry & who would be allowed to get a variance to this regulation given the number of residents that have more than 6 chickens. 6.Misc. Motion to adjourn by Dr. Alam, no objections 7.. MEETING ADJOURNED: 9:30pm • Respectfully submitted, Heather Lyons-Paul Clerk of the Board Next regularly scheduled meeting is October 14, 2014 at 7pm At City Hall Annex, 120 Washington Street, 3.d floor conference room Salem. Health Agent report October 2014 Announcements • Heather Lyons- Paul And Suzanne Dot started the Foundations of Local Public Health" Y Y training that discusses the role and functions of local public health practice in Massachusetts • The City has begun a cigarette but recycling program and has installed cigarette butt recycling receptacles in the downtown area. • As of November 1, 2014 all death certificates and Burial permits must be issued electronically, except fetal death notifications • The Town of Marblehead has taken action to prohibit the use of thin film plastic bags and expanded Styrofoam take-out containers • The Danvers Board of Health is considering regulations to prohibit persons under 18 from using Tanning Beds and booths • The Peabody Board of Health is taking action to ban indoor use of electronic cigarettes • Cheryl Bartlett, DPH Commissioner will be leaving the Department in December to take up a position at Cape Cod Healthcare Community Outreach • We are providing information on EBOLA to the community as it becomes available Public Health Highlights • The Haunted happenings events passed without any major issues. The Environmental Health Staff conducted inspections of food vendors every weekend. • Court action was instituted against 2 Salem property owners for failure to comply with the requirements of the state sanitary code. Meetings and Trainings • Larry Ramdin was part of a panel that discussed the"Food establishment licensing requirements and procedures" at the Enterprise center, Salem State University on October 17` , the attendees were members of the Enterprise center food group. • We continue to participate in Ebola conference calls and updates hosted by the CDC and the MDPH • David `Greenbaum attended the Hoarding task Force meeting at Northshore Elder services. The meeting discussed current hoarding cases and strategies to appropriate funding received to address hoarding Inspections Item Monthly Total YTD 2013 Total Certificate of Fitness 69 478 577 Inspection Certificate of Fitness 1 17 29 reinspection Food Inspection 86 354 377 Food Re-inspections 3 113 227 Retail Food 0 22 55 Inspections Retail Food 0 7 27 reinspection General Nuisance 1 13 9 Inspections Food— 0 1 2 Administrative Hearings Housing Inspections 19 168 233 Housing re- 2 34 40 inspections Inspections Item Monthly Total YTD 2013 Total Certificate of Fitness 69 478 577 Inspection Certificate of Fitness 1 17 29 reinspection Food Inspection 86 354 377 Food Re-inspections 3 113 227 Retail Food 0 22 55 Inspections Retail Food 0 7 27 reinspection General Nuisance 1 13 9 Inspections Food— 0 1 2 Administrative Hearings Housing Inspections 19 168 233 Housing re- 2 34 40 inspections i � Rodent Complaints 5 22 39 Court Hearings 3 5 10 Trash Inspections 49 171 146 'I 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 0 1 1 Total 1457 1914 w Suzanne Doty RN, BSN Salem Board of Health Public Health Nurse Public Health Nurse Report Reporting on September 3rd 2014 to October 14"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. • Completed 2 home visits for homebound residents of Salem for their influenza vaccine. • Flu Vaccine clinic scheduled for October le at Lifebridge in Salem. Additional clinics scheduled are the Council on Aging clinic on October 161h, the employee clinic on November 6th and a city wide clinic on November 151h. I will also be coordinating with police and fire to administer flu vaccine as well as taking appointments in the office. • On October 8t",assisted with the Marblehead Council on Aging flu clinic. Health Promotion • Continuing to hold blood pressure clinics and provide public health information at the Salem Farmers Market on a weekly basis. • Updated the Salem Board of Health Facebook and Twitter pages with links and information on Enterovirus-D68 and Ebola. • Provided the school nurse leader Paula Dobrow with MDPH updates and fact sheets regarding the Enterovirus-D68. Meetings/Trainings • Attended the North Shore React meeting on September 4th where we discussed current issues regarding elders in the north shore communities and listened to a presentation regarding financial exploitation and the most common scams. • Met with the public health nurses from surrounding towns on September 51h to discuss and coordinate assisting each other with flu clinics. • From September 71h to September 131h attended the Centers for Domestic Preparedness training. The first three days consisted of lectures regarding planning and preparedness for an influenza pandemic as well as a large table top exercise. The last 2 days were the hands on training where we donned level B and C personal protection equipment. We ran through triage and decontamination drills in full gear and also tested nerve agent substances. r. • On September 16'h, Sonya Mason, a nursing student from Salem State University's RN to BSN program,began her internship with us until December of this year.We will be meeting weekly on Tuesdays and she will be participating in communicable disease investigation, flu clinics, and meetings pertaining to emergency preparedness, the pulmonary clinic meeting, Massachusetts Public Health Nurses meeting and as well at attending the farmers market. , • On September 17'h met with Paula Dobrow and the Salem Public Schools nurses to introduce myself and become acquainted with them.Accompanied by Senior Sanitarian David Greenbaum, we spoke about our roles at the health department and how we can be of assistance to the public schools. • On September 19'h attended a conference call with MDPH regarding Enterovirus D68. • On October 2"d attended a hoarding task force meeting to discuss grant moneys received for helping persons with hoarding disorder and well as to assist with creating a uniform assessment form for eligibility. • On October 3`d attended the North Shore Medical Center Pulmonary Clinic quarterly meeting for updates on the clinic and updates from MDPH as well as to discuss current active cases on directly observed therapy. • On October 61.h attended a lecture from MDPH Medical Director Alfred Demaria on emerging diseases with an emphasis on Ebola. Additional topics included Chikungunya, Enterovirus-D68, Influenza,and Hepatitis C. • On Friday October 10'h will be attending the MAPHN northeast chapter meeting at Tewksbury State Hospital. R Monthly Report of Communicable Diseases September 2014 _ Disease #Of Cases New Carry Over Discharged Running total Total for 2013 Reported for 2014 Tuberculosis 4 1 3 0 5 2 (Active) Latent 1 1 0 1 31 44 Tuberculosis* Malaria 0 0 0 0 1 0 Calicivirus/No 0 0 0 0 1 0 rovirus Group B 0 0 0 0 4 2 Streptococcus Meningitis 0 0 0 0 2 0 Hepatitis C* 3 3 0 3 17 37 Influenza* 0 0 0 0 21 62 Lyme 0 0 0 0 1 8 Disease* Campylobacte 3 3 0 3 5 15 riosis Giardiasis 0 0 0 0 0 2 Shigellosis 2 2 0 2 4 2 Shigatoxin 1 1 0 1 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 1 1 0 1 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 ` r . Pertussis 1 1 0 1 2 2 Hansen's 0 0 0 0 0 1 Disease Total 17 14 3 13 108 187 *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. Shigellosis: Case#1:This patient is an adult food worker. They were kept out of work during their infection period and treated by their primary care physician with antibiotics. A stool sample was submitted to the lab and upon a negative result they were allowed to return to work. No contacts of this case became ill and the patient has fully recovered, no further follow up required. Case#2: This patient acquired the illness after an outpatient procedure, I consulted with the epidemiologist on the case and no further follow up is needed at the time. The patient is treated and feeling well,no contacts or other patients have become ill related to this event. This case has been closed. Campylobacter: Case#1: This case was a young adult who is a resident of another town but staying in Salem most of the • week, they required follow up regarding being withheld from food handling. They were allowed to return to their duties after a negative stool sample was submitted to the lab.This patient has recovered and no further follow up is needed. Case#2: This patient has been retired for over a decade and does not attend any supervised care setting or handle food. They had eaten a meal out of state the day before they started to become ill. No household contacts have become ill, proper precautions were taught and the patient is feeling well after being treated by their primary care physician. No further action required by LBOH. Case#3: Several letters were sent and multiple phone calls were made to this patient. The last phone call made stated the number was no longer in service. This case was lost to follow up. Salmonella: Case#1: This case was originally contacted by the Marblehead public health nurse; who was covering while I was at a training. I followed up with this case as requested by the epidemiologist. This patient had been symptomatic on and off for a month but I was able to retrieve as much information as they could remember about where they ate during the time they could have acquired the illness. I reported the information to the epidemiologist, this patient has recovered and no further cases were reported in Salem. There is no further action required by LBOH. • Pertussis: Case#1: An adolescent was diagnosed with pertussis a month after they developed a cough. This case was treated with antibiotics and their household contacts were treated as well.None of their contacts have been diagnosed with pertussis at this time. The patient was diagnosed over 20 days after the infectious period had ended, meaning that any of their contacts would be past the point of prophylactic treatment. They had received their TDaP vaccine as recommended by the state guidelines and all vaccine information has been reported to the state, it is possible that this cases immune response has waned by the time they came in contact with the disease. There is no confirmed contact that is known of at this time with another pertussis patient. This patient does not attend Salem Public Schools and was not working in Salem during the time that they were contagious. I have been working closely with the epidemiologist to inform all parties and follow up on the case where necessary. Lyme Disease: Note:There were 4 suspect cases of Lyme disease during the month of September. These cases do not require follow and are not confirmed cases. Health Dept. Clerical Report FY 5 Burial Permits Permits Plan Reviews Certificate of Copies / Fines Revenue Permit Fees $25 Fitness $50 July-14 $450.00 $815.00 $850.00 $2,115.00 Food Service Est. <2,SSeats $140 August $900.00 $2,415.00 $1,950.00 $5,265.00 25-99 seats $28o >99 seats $420 September $775.00 $1,000.00 $180.00 $950.00 $200.00 $3,105.00 Retail Food <l000sq' $70 October $0.00 1000-10,000 $280 >10,000 .$420 November $0.00 Temp.Food 1-3 days s3oo December $0.00 4-7 days s600 >7days s January-15 Example of>7 day temp food permit. $0.00 14(da s)divided bY 7=2 x s600=$1200 February $0.00 Frozen Desserts $25 March $0.00 Mobile Food $210 April $0.00 Plan Reviews New s18o May $0.00 Remodel sgo June Catering $25 per eventl$20o $0.00 catering kitchen Body Art Est. $315 Total $2,125.00 $4,230.00 $180.00 $3,750.00 $200.00 $10,485.00 Body Art Practitioner 135 Review Plans $180 Fiscal Year Budget 2015 Suntan Est. $140 Rec. Day Camp $10 Salary Startinq Endin_q Expenses Ext.Paint Removal $35 Full Time $341,229.00 $265,413.69 Starting Endincl Transport Off.Subst. slo5 Part Time $15,997.00 $14,053.25 $17,050.00 $9,409.01 Tobacco Vendors $135 Overtime $2,000.00 $1,054.59 Swimming Pools Seasonal $140 Balance $359,226.00 $280,521.53 Health Clinic Revolving Account Annual$210 Nonprofit$40 $11,599.77 Title V Review $180 Well Application $180 Disposal works $2251.80 Regulation SA: Backyard Poultry Keeping Section 1: Purpose and Authority: The purpose of this regulation is to reduce/control the risk of zoonotic illnesses to humans and prevent the occurrence on nuisance conditions. 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 states "Boards of Health may make reasonable health regulations". Section 2:Definitions ABUTTER shall mean the owner of properties physically abutting a property BOARD shall mean the Salem Board of Health PEN shall include the Chicken Coop/house and any run or other appurtenance directly congruent to the chicken coop in which the chickens are kept. PERSON.shall mean a person, persons,association, partnership,trust,company,corporation or other legal entity. POULTY shall include, but is not limited to,chickens,guinea fowl,peafowl, pheasants, a. partridges,quail and turkey. b. YARD--A portion of a lot, upon which the principal building is situated,unobstructed artificially c. from the ground to the sky and having at least two sides open to lot lines. d. YARD, FRONT--A yard extending for the full width of the lot between the front line of the e. nearest building wall or building part not specifically excluded by§ 235-25 and the front lot line. f. YARD, REAR--A yard, unoccupied except by an accessory structure or accessory use as herein permitted,extending for the full width of the lot between the rear line of the building wall and the rear lot line. g. YARD,SIDE--A yard extending for the full length of a building between the nearest building wall and the side lot line Section 3: Permits 1. No person shall keep poultry without first having obtained a permit from the Board of Health. 2. Permits are issued to a specific individual and are not transferable or assignable. 3. Permits expire annually on December 31st of each year Crp, 4. No poultry or eggs produced by backyard farmed poultry shall be offered for sale or used in commercial establishments S. The number of animals kept shall be limited to six(6) birds per lot 6. No poultry shall be kept on property that is not used for residential purposes 7. The slaughter of Hens on the property is prohibited 8. No person shall keep any hens in any building used as a dwelling Section 4: Permitting process: a. Applicant must submit a completed application on the prescribed form with the appropriate fee. The application shall not be deemed complete and fil e until all required documentation is submitted. b. Plans to scale with size of lot,existing structures,the henhouse, pen,fences,and distances of henhouse and pens from all abutting property lines and habitable structures. C. Maintenance plan describing cleaning schedule, pest and predator control measures,and nuisance prevention measures. d. Waste management plan that describes procedures for waste and animal disposal. e. Health management plan that documents that chickens are properly vaccinated and from an approved source,and procedures for managing sick or injured birds. f. Written statements signed by the property owner(s)granting permission for the henhouse. g. If the coop is in a common open space,written approval from all residents with legal access to the common space is also required. h. Upon receipt of the completed application and supporting documentation,the Board of Health will conduct a site inspection. i. The Board of Health will schedule a public hearing.The hearing date must be scheduled so as to allow a minimum of 14 days for abutter notification. j. Following a public hearing,the Board of Health will make a determination as to whether to grant a permit. k. In cases in which the coop is to be constructed after the public hearing,the Board of Health may approve a permit conditional upon a successful inspection of the constructed coop. I. The applicant must comply with all other laws and regulations concerning zoning and construction,and must obtain a building permit when required. M. Permit holders must conform to the conditions of the permit at all times, including with respect to the number of birds permitted. 4. No poultry or eggs produced by backyard farmed poultry shall be offered for sale or used in commercial establishment s 5. The number of animals kept shall be limited to six(6)birds per lot - 6. No poultry shall be kept on property that is not used for residential purposes 7. The slaughter of Hens on the property is prohibited 8. No person shall keep any hens in any building used as a dwelling Section 4:Permitting process: a. Applicant must submit a completed application on the prescribed form with the appropriate fee. The application shall not be deemed complete and file until all required documentation is submitted. b. Plans to scale with size of lot,existing structures,the henhouse,pen,fences,and distances of henhouse and pens from all abutting property lines and habitable structures. C. Maintenance plan describing cleaning schedule,pest and predator control measures,and nuisance prevention measures. d. Waste management plan that describes procedures for waste and animal disposal. e. Health management plan that documents that chickens are properly vaccinated and from an approved source,and procedures for managing sick or injured birds. f. Written statements signed by the property owner(s)granting permission for the henhouse. g. If the coop is in a common open space,written approval from all residents with legal access to the common space is also required. h. Upon receipt of the completed application and supporting documentation,the Board of Health will conduct a site inspection. i. The Board of Health will schedule a public hearing.The hearing date must be scheduled so as to allow a minimum of 14 days for abutter notification. j. Following a public hearing,the Board of Health will make a determination as to whether to grant a permit. k. In cases in which the coop is to be constructed after the public hearing,the Board of Health may approve a permit conditional upon a successful inspection of the constructed coop. 1. The applicant must comply with all other laws and regulations concerning zoning and construction,and must obtain a building permit when required. M. Permit holders must conform to the conditions of the permit at all times, including with respect to the number of birds permitted. I� n. The Board of Health may suspend or revoke a permit, after a public.hearing if requested,for an applicant's failure to comply with the terms of the permit or if a public health or nuisance condition is created. o. The Board of Health or its agent may order the immediate removal of the hens upon a determination that they pose a health risk. Section 5:Siting and construction 1. No coop or run shall be located nearer than ten (10)feet to the principal building,and no coop or run shall be located nearer than 15 feet to any side or rear lot line. Side lots in this instance refer to a projected line starting from the front lot line,terminating at the rear lot line parallel 15 feet from the side or 15 feet from the rear lot line. 2. No coop or run shall be located within any required front yard or within any side yard of a corner lot. 3. Coop space must allow a minimum of 2.5 square feet per hen and one nest box per 3 hens. 4. Runs must allow a minimum of 4 square feet per hen. 5. Coops or pens shall not be larger than 120 square feet. 6. Coops and runs shall not be located in the front yard or in a side yard that abuts a public street. 7. All coops shall be constructed in such a way and with such materials as to be easily cleanable. 8. All runs shall have a securely built frame and be designed to be predator-proof. 9. Henhouses shall not be located within 200 feet of the high water mark of any known source of drinking water supply or within 50 feet of any drinking water well. 10. The poultry keep shall ensure that runoff from the poultry coop and run does not leave their property line Section 6: Animal Health and Welfare: 1. Chickens must be treated in a humane manner at all times, including access to fresh food and water,and protection from the elements. 2. All hens must be sourced from a Salmonella Pullorum-free flock or a hatchery participating in NPIP(National Poultry Improvement Program.). 3. In the event a hen is known or suspected to be sick or injured,the Owner is responsible for providing adequate home care or veterinary care or for humanely culling and disposing of the hen in a prompt and sanitary manner. 4. The Owner shall report to the Board of Health if any hens are diagnosed with a disease transmissible to other animals or to humans. • 5. Hens must be enclosed and segregated from wild migratory fowl.They may be allowed out of the enclosure only into a securely fenced area when supervised. Section 7: Nuisance Control: Animal pens, runs,and adjacent lands must be maintained in a sanitary condition and free from offensive odors at all times to prevent the occurrence of nuisance conditions. 1. Noise a. No.roosters are permitted on residential property. b. Perceptible noise from chickens/poultry at the property boundary must conform to all existing noise regulations and by laws. 2. Odor a. Odors from chickens, chicken manure, or other chicken-related substances shall not be perceptible at the property boundaries. b. If possible,waste must be composted with carbonaceous material such as hay, bedding,or leaves. if composting is not possible,waste must be stored in a sealed container until disposal. At a minimum,weekly cleaning of henhouses is required. More frequent cleanings may be required as needed to prevent odor. Bedding shall be maintained dry and any wet caked manure shall be removed immediately from the chicken pen. 3. Predator and Pest Control: A. Necessarymeasures must be taken to prevent a buildup of redator, pest or rodent populations due p p p , p p p to the presence of hens on the property. 1. Chicken feed must be stored securely in a rodent-proof container. 2. Chicken feed leftover from feedingmay not remain past dusk in an area accessible to rodents or Y other pests. 3. Pen must be enclosed with aviary netting or other predator-proof material. Section 8: Complaints 1. Upon the receipt of a written complaint,the Board orits agent shall investigate the matter and provide a written response to the complainant and licensee.If it is determined that a hearing . 5. Hens must be enclosed and segregated from wild migratory fowl.They may be allowed out • of the enclosure only into a securely fenced area when supervised. Section 7:Nuisance Control: Animal pens,runs,and adjacent lands must be maintained in a sanitary condition and free from offensive odors at all times to prevent the occurrence of nuisance conditions. 1. Noise a. No.roosters are permitted on residential property. b. Perceptible.noise from chickens/poultry at the property boundary must conform to all existing noise regulations and by laws. 2. Odor a. Odors from chickens,chicken manure,or other chicken-related substances shall not be perceptible at the property boundaries. b Wpossible,waste must be composted with carbonaceous material such as ha P y,bedding,or • leaves. If composting is not possible,waste must be stored in a sealed container until disposal. At a minimum,weekly cleaning of henhouses is required. More frequent cleanings may be required as needed to prevent odor. Bedding shall be maintained dry and any wet caked manure shall be removed immediately from the chicken pen. 3. Predator and Pest Control: A. Necessary measures must be taken to prevent a buildup of predator, pest or rodent populations due to the presence of hens on the property. 1. Chicken feed must be stored securely in a rodent-proof container. 2. Chicken feed leftover from feeding may not remain past dusk in an area accessible to rodents or other pests. 3. Pen must be enclosed with aviary netting or other predator-proof material. Section 8: Complaints 1. Upon the receipt of a written complaint,the Board or its agent shall investigate the matter and provide a written response to the complainant and licensee.If it is determined that a hearing should be held, such hearing will be conducted as noted in Section 10. Section 9:Variances 1. Variance to any of these regulations may be requested in writing to the Board.When such a request is received,a hearing shall be scheduled and held in accordance with the requirements of Section 10. 2. Variances shall be granted only under the following conditions: a)Strict enforcement of these regulations will constitute a manifest injustice,AND b)The granting of the variance shall not in any way impair the public,the environment, or animal health. 3. The Board may impose any conditions it deems appropriate to protect the public,the environment,and animal health. Section 10.Hearing 1. When a written request for a variance or a complaint is received,a Public Hearing shall be required. 2. The Public Hearing shall be held at the next scheduled Board of Health meeting but in no case earlier than 14 days of the request. 3. The applicant of a variance shall notify all abutters of the property as noted in Section 6.2 of these regulations. 4. The Public Hearing shall be advertised in a Legal Notice in a local paper at least 7 days in advance of the date of the hearing.The cost of the Legal Notice for a variance shall be borne by the applicant. 5. Any person to whom an Order to Correct is received shall have the opportunity to request a hearing before the Board.The request shall be in writing and received in the office of the Board of Health within seven(7)days of the date the order is served. Section 11.Penalties 1. Any person found in violation of these regulations shall be fined,upon conviction, not more than$1,000 per violation. 2. Any person who is issued a license by the Board and is found to be in violation of these or any other applicable regulation, may be subject to the immediate suspension or revocation of said license. 3. These regulations may be enforced by the use of the Non-Criminal citations as put forth in MGL Chapter 40,section 21D. Fines shall be$50 for the first violation, $100 for the second violation,and$150 for the third and any subsequent violation. 4. Each day of non-compliance shall constitute a separate and new offense. Section 9:Severability: 1. 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. Effective Date:These regulations will take effect on Public Hearing: Vote: Board of Health Legal Notice: Certiifed Copy to MA DEP: Section 11.Penalties _ 1. Any person found in violation of these regulations shall be fined,upon conviction, not more than$1,000 per violation. 2. Any person who is issued a license by the Board and is found to be in violation of these or any other applicable regulation,may be subject to the immediate suspension or revocation of said license. 3. These regulations may be enforced by the use of the Non-Criminal citations as put forth in MGL Chapter 40,section 21D. Fines shall be$50 for the first violation,$100 for the second violation,and$150 for the third and any subsequent violation. 4. Each day of non-compliance shall constitute a separate and new offense. • Section 9:Severability: 1. 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. Effective Date:These regulations will take effect on Public Hearing: Vote: Board of Health Legal Notice: Certiifed Copy to MA DEP: Larry Ramdin From: Jen Lynch <lynch.sheehan@gmail.com> Sent: Wednesday,September 10, 2014 7:04 AM To: Larry Ramdin Cc: Josh Turiel; Mayor Kim Driscoll Subject: BOH Regulations - Edited Attachments: Regulation 5A.pdf Good morning Larry, I hope you will share my thoughts and comments with the BOH (attached). I think it is paramount that the BOH coordinate efforts with the Zoning Board, since there are portions of your regulations that conflict and compete with what they are working on. There are several sections here that do not have any bearing on public health, and in my opinion overreach. I was dismayed at the lack of transparency last night, and would be very interested to see the sources from which you are drawing your conclusions. There is a lot of research out there on the benefits (and risks) involved in backyard chicken keeping, including federally dedicated websites at the USDA(health by irds.aphis.usda.goy) and others, which address health concerns directly. I presume the idea behind regulating the chickens is the same as why the city needs to regulate dogs-so if there is an issue, there are protections for those affected by the owners negligence. Creating regulations that are this burdensome will, frankly, not encourage people to voluntarily come forward and register their flocks. I suspect you will have rogue chicken farmers and illegal flocks throughout Salem. This is not something on which the city should be spending time or money. We have an animal control agent,that is well poised to handle inspections as needed. Other, more urban areas than Salem, have been able to embrace chickens and urban agriculture without implementing these Draconian measures. I feel like this has already gotten completely out of hand, and I sincerely hope that you and the rest of the board work to scale the regulations back to something reasonable. All the best, Jen Lynch i Larry Ramdin From: Jen Lynch <lynch.sheehan@gmail.com> Sent: Wednesday, September 10, 2014 7:04 AM To: Larry Ramdin Cc: Josh Turiel; Mayor Kim Driscoll Subject: BOH e Regulations - Edit ed td Attachments: Regulation 5A.pdf Good morning Larry, I hope you will share my thoughts and comments with the BOH(attached). I think it is paramount that the BOH coordinate efforts with the Zoning Board, since there are portions of your regulations that conflict and compete with what they are working on. There are several sections here that do not have any bearing on public health, and in my opinion overreach. I was dismayed at the lack of transparency last night, and would be very interested to see the sources from which you are drawing your conclusions. There is a lot of research out there on the benefits (and risks) involved in backyard chicken keeping, including federally dedicated.websites at the USDA(healthybirds.aphis usda gov) and others, which address health concerns directly. I presume the idea behind regulating the chickens is the same as why the city needs to regulate dogs-so if there is an issue, there are protections for those affected by the owners negligence. Creating regulations that are this burdensome will, frankly, not encourage people to voluntarily come forward and register their flocks. I suspect you will have rogue chicken farmers and illegal flocks throughout Salem. This is not something on which the city should be spending time or money. We have an animal control agent,that is well poised to handle inspections as needed.. Other, more urban areas than Sale have l� m, a been able to embrace chickens and urban agriculture without implementing these Draconian measures. I feel like this has already gotten completely out of hand, and I sincerely hope that you and the rest of the board work to scale the regulations back to something reasonable. All the best, Jen Lynch i City of Salem Board of Health Salem, MA 01970 From: Cady Ann Goldfield, 37 Moffatt Rd.,Salem, MA (978.745.6097) August 11, 2014 Dear Board of Health Directors, For the past 20+years I have been a resident of South Salem, and during the entirety of that time I have kept rare/endangered-breed bantam (miniature) chickens, both female and male, along with a small number of waterfowl—all strictly as pets—on my small property, with the permission and support of my neighbors. I keep the facilities clean,secure, quiet and odor-free, and have an annual inspection by the Animal Control Officer and by the Mass. state poultry inspector(both required by Mass. state regulations,overseen by the Mass. Dept.of Agricultural Resources). My experience in poultry-keeping spans 45 years. It has been an important facet of my way of life, and has influenced my professional career as well. I grew up on the suburban North Shore with bantam chickens and geese.As an undergraduate at the University of Rhode Island in the 1970s, I was a student of agriculture, poultry science,game bird management, livestock husbandry, horticulture, and related subjects, in tandem with studies in urban affairs and natural resource development. I currently am a horticultural consultant,and also an adjunct instructor in the Environmental Horticulture degree program at North Shore Community College. Urban agriculture is within my profession and expertise. Following last month's joint meeting of the Salem City Council and Planning Board, during which I was one of the commenters on the Urban Agriculture matters discussed that evening, it was suggested that I share with the Board of Health my analysis and thoughts of the draft ordinance proposal concerning the keeping of chickens.. As is probably quite evident, I have a serious investment in the creation of an ordinance that could have a direct impact on my lifestyle and liberties.That is why I.am asking that the Board of Health give consideration to this informal review of the Planning Board's draft document while your board is in the process of establishing procedures and regulations to accompany any future ordinance(s)on the keeping of chickens in the city of Salem. Thank you, most sincerely,for your time and attention. . Cady Ann Goldfield 37 Moffatt Rd. Salem, MA Review of the proposed Zoning Ordinance amendment pertaining to Urban Agriculture: Original text is underscored; my comments are in plain print: Section 10.0 of the City of Salem Zoning Ordinance is hereby amended by adding the following definitions: Urban Agriculture: An umbrella term that describes a range of food growing practices for personal consumption and uses that may include the keeping of hens, but does not include other livestock and does not include the selling of agricultural products. The above terminology is specific to the current trend in backyard food-raising. However, in regards to the keeping of poultry and livestock for non-agricultural purposes, it is vague. How will the city address the keeping of chickens and other livestock strictly as pets and/or hobby purposes? Does this mean that chickens may be kept only for Urban Agricultural/food purposes... and that ONLY(female) chickens may be kept,and that all other livestock and fowl will no longer be permitted as pets or hobby?. Hens: Female chickens. Note: Chickens come as standard breeds—the'full=sized breeds such as Leghorn, Rhode Island Red, and others used for agricultural purposes; and,they also exist as bantam breeds,which are miniature birds that typically are only one-fifth to one-quarter the size of a standard breed chicken. Bantams are ornamental fowl, designated as pet and hobby breeds, and are not considered to be agricultural in purpose.They take up less space and make far less waste and noise than standard-size breeds.This is something to consider if there will be restrictions applied on the number of birds allowed per property, and also should be considered in allowing roosters in some instances(their crows are as diminished as their size). Run: an outdoor enclosure generally made of wire mesh. No comments on above. Coop:An enclosed shelter in which a chicken lives. Are permanent, substantial structures such as barns and garages (converted into housing for livestock) included in this designation? Livestock: any domestic animals raised for home use,consumption,or profit such as horses pigs llamas,goats,fowl,sheep, buffalo and cattle. How will this reference to "livestock" pertain to animals kept as pets?Will there be allowanced for the keeping of these animals and fowl as pets outside of the Urban Agriculture designation?The wording is vague in this draft ordinance regarding the general keeping of livestock breeds as pets, not as part of a home-consumption backyard agricultural practice. (p.2) Customary agricultural, horticultural and floricultural operations:the growing or harvesting of agricultural, horticultural and floricultural crops,the raising of all classes of livestock,the production of eggs, milk, honey and other animal products, or the carrying out of any other prescribed agricultural activity or process,for the primary purpose of making a profit or providing a livelihood. Does not include residential gardening for personal consumption or use, nor the keeping of hens in accordance with the regulations for Urban Agriculture, as described therein. Please see previous comment on livestock. Section IL Section 3.0 TABLE OF PRINCIPAL AND ACCESSORY USE REGULATION is herby amended by adding the following new row immediately following Adult day care under E.Accessory Uses: RC R1 R2 R3 61 B2 B4 B5 I BPD Urban Agriculture Y Y Y Y Y Y Y Y Y Y No comments on the above. Section III: Section 3.2 Accessory Uses is hereby amended by adding the following provision, immediately following Section 3.2.6 Commercial Vehicles: 3.2.7. Urban Agriculture. 1.Sale of eggs and any other agricultural products is prohibited. No comments on above. 2.The keeping of hens shall be subject to the following rules: a) Hens may be kept per the Table of Principal and Accessory Use Regulations on properties in residential use only. No comments as yet, as I do not know what the codes in the above Table refer to. b) Ownership, care and control of the hens shall be the responsibility of a resident of the dwelling on the lot. c) If the keeper of the hens is not the lot owner,written permission from the lot owner permitting the keeping of hens on the of shall II I a be attached to the Board of Health permit application. No comments on above. (p.3) d) No roosters may be kept under an Urban Agricultural use on lots in Salem. While under the Urban Agriculture usage of hens for food (egg) purposes, it is not necessary or desirable to have a rooster,the keeping of miniature (bantam) chickens for non-agricultural show/hobby breeding requires roosters in order to produce chicks.As I mentioned earlier regarding the small size of bantams and their accompanying lower noise levels, perhaps there should be a separate designation for these non-agricultural, miniature, pet birds. Bantam chickens are considered to be non-agriculture/non-farm animals, and are considered pet and hobby/ornamental birds. For example,for the past 20 years I have bred, raised and kept, as pets, Nankin bantams,an extremely rare breed of bantam chicken, currently under the status of Critically Endangered by the world heritage- breed organizations. I am one of only a few people in New England to own a flock of these birds, and I keep a controlled number of roosters for genetic variability in breeding. I breed just enough to sustain the flock population, and give away birds to other pet/hobby bantam-chicken keepers. In the past, I have also donated birds to a non-profit heritage organization—Gore Place—in Waltham, Mass. Because of the structure and solidity of my barn, and the positioning of the facilities on my property, as well as the small size (and voice)of the birds themselves,they do not cause a disturbance, as my immediate neighbors will attest. How would the Urban Agriculture ordinance address individualized situations such as this?Would there be a process for"grandfathering"those of us who already have a long-established flock, a workable setup, and cooperative relationship with our neighbors?A flat-out ban on all roosters, without regard for individual circumstances,would be a draconian measure, in my opinion. e) No coop or run shall be located nearer than ten (10)feet to the principal building and no coop or run shall be located nearer than 15 feet to any side or rear lot line,terminating at the rear lot line parallel 15 feet from the side or 15 feet from the rear lot line. No coop or run shall be located within any required front yard or within any side yard of a corner lot. Presumably,this is to provide a buffer from noise,odors and other issues for abutters. However, it does not account for situations where the property line abuts open space and/or undeveloped land on lots where the abutters' houses are set far back from the property line. It also does not address situations where the animals are housed in substantial structure such as a barn or converted garage that has no doors or openings on the sides facing the property lines. In this latter situation,the structure itself serves as a natural buffer for noise, odors and any other issues. For instance,on my 60'x116' lot, my birds are housed in a 50+year-old barn, 12'X20', built into a hillside,with a concrete foundation and lumber construction.An attached 18' X 5' run alongside the inside of my backyard, is not visible to either the neighbors or the street.There is an 18 x20 duck/goose pen attached to that, also not visible to the neighbors or street.The barn is just inside the rear and side property lines, but,the side and back of the barn both present a solid wall to the property lines.The property on the side is buffered i by the side wall of the barn while the back of the barn faces the rear abutter.The home of the abutter� in the back is 100'from the property line,with a steep, wooded slope (unbuildable,with a drainage easement) in between,all the way to the property line. (p.4) The structure and its situation create a barrier for sound and sight.Such conditions should be considered as exceptions to set-back rulings, as they are superior to the open chicken-coop arrangement when it comes to protecting neighbors' privacy and screening from the presence of chickens. f) Coops and runs shall not exceed six(6)feet in height, and shall have a combined area of no more than 120 square feet. Construction of'a chicken coop and run shall not preclude the location of additional accessory structures,such as garages and tool sheds,and as described under Section 3.2.4 Accessory Buildings and Structures,on the same property. Formal coops are not the only form of housing for chickens. Barns and converted garages, with runs attached,are even more substantial housing than the popular"hen huts"that are being sold nationwide now.An Urban Agriculture ordinance should take into consideration the alternative (and often superior) forms of housing besides the commercially built and home-made coops and moveable shelters that are becoming part of the urban/suburban backyard. There are no compelling reasons why a chicken-keeper who has a pre-existing barn,garage or large shed that exceeds the proposed coop size and configuration, should not be able to use that facility to house chickens. If anything,they provide better security, protection against predators, privacy, sound-buffering and protection from the elements than do many of the commercially available, pre-fab chicken coops that are popping up around the country. g) the on-site slaughtering of hens is prohibited. If the homeowner has proper facilities and training for this, and it is not a mass, commercial function, why should this be prohibited?The main issue, in my opinion, is humaneness. Perhaps there could be a special permit that people must apply for and show that they are qualified. h) No person shall keep any hens in any building used as a dwelling. Presumably,this refers to keeping chickens as house pets. Although, in my opinion, chickens-even as pets-are not indoor cage birds, I have found that, properly cared for,they are no more a health risk than are typical large cage birds such as macaws and parrots. In some instances, such as for apartment dwellers,the keeping of bantam (miniature) hens as cage birds in the proper caging, should be permissible just as it is permissible to keep a macaw,which is much larger than a bantam hen. Also,some leeway should be allowed to permit the temporary housing of backyard-agriculture chickens in a human dwelling for"sickbay" purposes(i.e.treatment of a bird for illness or injury);for emergency housing, such as if there is storm or other damage to or destruction of the birds' coop; and also for the keeping of chicks, as chickens used for backyard agriculture are frequently purchased as day-old chicks and raised to maturity. Chicks are not capable of living alone in an outdoor dwelling and must be kept in a heated brooder. i)Any person desiring to keep'hens shall apply to the Board of Health for a permit. Again, how will the city differentiate between Urban Agriculture "keeping of hens," and the keeping of other fowl and livestock strictly as pets and hobby animals, not as part of the Urban Ag movement? (p.5) • Section IV:This Ordinance shall take effect as provided by City Charter. No comments on the above. Notes:There are already some state regulations in place,overseen by the Mass. Dept.of Agricultural Resources(MDAR),that the Salem City Council, Planning Board, and Board of Health should be aware of: 1.It is a state requirement that all municipal Animal Control Officers take an annual census (a "barn book")of, and do a site inspection for, all livestock residing in their municipality, both commercial and residential.The animals and their dwellings must be inspected for adequate shelter,ventilation, water/food and cleanliness/sanitary conditions.The Animal Control Officer provides this information to the MDAR,which in turn makes it available to the U.S. Department of Agriculture (USDA). If the Health Inspector also conducts inspections,this could be redundant. Perhaps the function of the Animal Control Officer could be attached to the Health Department in this instance,to eliminate such redundancy. 2. In addition,chickens and related fowl (turkeys, peafowl,guinea fowl and game birds such as pheasants, partridge and quail) are required to be blood-tested annually by the Mass.State Poultry Inspector(for our region, Megan Magrath is the inspector).The tests are for Exotic Newcastle Disease and for Avian Influenza. Waterfowl (ducks,geese, swans) are exempt from this requirement, however, and the MDAR may also waive the requirement for chickens that are never taken off-property or exposed to chickens/birds from another property. So, Urban Agriculture hens would have to remain on their owners' property and never be exposed to chickens or other fowl from other sites, in order to be exempt from the annual blood test. My recommendation is that this information be prominently displayed on any permit application form and other communications with city residents who wish to keep chickens under the Urban Agriculture usage amendment. (p.6) Finally, I recommend that people new to chickens,who apply for permits, be required to take an "Introduction to Chickens"workshop,which could be organized and presented by an individual,or individuals,with the expertise and capabilities to do so. It would introduce not just the birds and their care, but also lay out the requirements for keeping them in the City of Salem.Such programs have been offered in other North Shore communities, with great success. Larry Ramdin From: Beth Gerard <bethgerard.ward6@gmai1.com> Sent: Tuesday, September 09, 2014 7:09 PM To: Heather Lyons; Larry Ramdin Subject: Fwd: Backyard Chickens Attachments: DSC_3822jpeg; DSC_3823 jpeg; DSC_3824 jpeg Ward 6 Councillor Beth Gerard 49 Larchmont Road 978-219-7249 ---------- Forwarded message ---------- From: "Maura Murphy" <murph, 7�2aol.co.m> Date: Sep 8, 2014 10:03 AM Subject: Backyard Chickens To: <robertkmccarthyAverizon.net>, <legaultatlargegmail.com>, <emiloatlargeggmai.l.com>, <sar,geatlarge74(a7aol.com>, <heather.famicokgmail.com>, <davidCadavideppley.org>, <TaSiegel9msn.com>, <Josh9io.shturiel.com>, <bethgerard.ward6gamail.com>, <fmokeefepe@verizon.net> Cc: <dmenon�a,salem.com> Good Afternoon, For those who may not know me my name is Maura Murphy and I live at 70 Dearborn Street in Salem. Four years ago, with the help of the Easter Bunny, my family started down the road of having Backyard Chickens. In good faith we asked questions to find out what rules Salem had about Backyard Chickens. At that point,the only information we came across was the concern of a noise ordinance. So, in good faith we started the journey. We consulted our neighbors and asked if they had any issues. None were shared. We invested in a lovely coop and had a secure run professionally built. Living on the edge of the Kernwood Country and the beautiful Greenlawn Cemetery, we knew that the wild life in our neighborhood was quite extensive. Foxes and coyotes have been seen roaming our streets before we had chickens, and I am happy to say we have never lost any of our backyard poultry to any of our neighborhood wildlife. Why you may ask? It's because if the proper structure is built,the wildlife can't get the poultry, and if the wildlife can't get the poultry,there is no reason for them to visit our backyard. We also do not have any rodent issues even though we live right on the North River. Why? It's because we take precautions not to leave our chicken feed out in the open, and when we feed our feathered friends, we only feed them what they are going to • consume. You really don't have to be a rocket scientist to have backyard chickens. During some of the past meetings you have heard neighbors telling horrible stories of the hell like situations living next to backyard chickens. Each and every surrounding neighbor supports our backyard chickens and the i wonderful ambiance our feathered friends create. My neighbors are NOT in their backyards wearing breathing respirators or covered from head to toe in hazmat suits. In fact, you may find most of my neighbors in my backyard with their kids or grandkids,just coming over to visit the "Chicks at 70 Dearborn Street." • Some anti chicken people have talked about the germs, waste, feathers and dander of backyard chickens. To be honest,the Canada Geese, the squirrels, and the gulls leave more of that "stuff' around than our chickens do. Just like having dogs or cats, you have to be a responsible neighbor and clean up after them. By the way, did you know that backyard chickens with access to green foods contain less cholesterol and saturated fats, more vitamin A, D, &E, and more beta carotene, folic acid, and omega-3 polyunsaturated fatty acids than caged hens. I am happy to say that my personal cholesterol has dropped to a safer level since eating our backyard eggs. My primary care physician was about to prescribe meds to lower my cholesterol but thanks to our chickens and their fresh eggs, I dodge that bullet! Hmm perhaps I can get a prescription to have Backyard Chickens. I invite any of you to come by, anytime, and visit our backyard living landscape. Take a moment, watch them dirt and sunbathe, scratch for bugs, or hang out on their roost. It can be quite relaxing and enjoyable, and not a backyard of misery that some may have you believe. Thank you for your time and your efforts. Maura A. Murphy • 2 PERSPECTIVE WHAT IS A PUBLIC HEALTH "EMERGENCY"? • What Is a Public Health "Emergency". Rebecca Haffajee,J.D., M.P.H.,Wendy E. Parmet,J.D., and Michelle M. Mello,J.D., Ph.D. ®n March 27, 2014, Massachu- typical rights afforded to indi- newable at the governor's discre- gsetts Governor Deval Patrick viduals and entities, be suspend- tion; only some of them can be declared the state's opioid-addic- ed to protect public health? terminated by the legislature (see tion epidemic a public health State laws providing public table). emergency. The declaration em- health emergency powers permit The spirit of emergency-pow- powered the Massachusetts pub- designated officials — typically ers laws seems to enshrine three lic health commissioner to use governors and their top health key criteria for suspending nor- emergency powers to expand officers — to take extraordinary mal lawmaking processes: the access to naloxone, an opioid legal actions. The laws provide situation is exigent, the anticipat- antagonist that can reverse over- flexibility in responding to emer- ed or potential harm would be doses; develop a plan to acceler- gency situations,when adherence calamitous, and the harm cannot ate the mandatory use of prescrip- to ordinary legal standards and be avoided through ordinary pro- tion monitoring by physicians and processes could cost lives. cedures. The archetypal scenario pharmacists;and prohibit the pre- State laws vary in their defini- is the sudden outbreak of a high- scribing and dispensing of hydro- tions of "emergency" or "disas- ly communicable, lethal disease codone-only medication(Zohydro, ter." Many refer to an occurrence — such as the unlikely event of Zogenix), which had been re- or imminent threat of widespread an Ebola outbreak in a U.S. city cently approved by the Food and or severe damage, injury, or loss — when immediate action is re- Drug Administration, amid much of life or property resulting from quired to avert catastrophe. In controversy.' The governor also a natural phenomenon or human such circumstances, acute con- allocated $20 million for addic- act (see table). Some mention cern for public health is believed tion-treatment services. only the magnitude of the poten- to outweigh substantial trade-offs The public health problem — tial harm, not its source. Others of values we ordinarily hold dear, the advent of a potentially dan- — including the Massachusetts including individual autonomy, gerous new drug following 140 law—provide no definition, leav- due process, and democratic law- deaths due to heroin overdoses ing it to the governor to deter- making. in 4 months and a 90% increase mine what constitutes an emer- Recognizing the extraordinary in unintentional opiate overdoses gency. nature of emergency powers, of- between 2000 and 2012 — war- Once a public health emergen- ficials have invoked them infre- ranted a robust response. Never- cy is declared,designated officials quently. We know of only three theless, Patrick's unusual invoca- can harness powers that are typi- other instances of their use in the tion of emergency public health cally unavailable without legisla- modern era in Massachusetts; powers, which are traditionally tive approval, by issuing emergen- each arose from a sudden, short- reserved for infectious disease cy orders.These expansive powers term crisis, and the orders issued outbreaks, natural disasters, or may include deploying military were quite limited in scope. acts of terrorism, offers an op- personnel, commandeering prop- Massachusetts governors invoked portunity to consider some im- erty, restricting freedom of move- the powers to assume state con- portant questions. Should wide- ment, halting business opera- trol of a nursing home on the spread injuries, such as those tions, and suspending civil rights brink of sudden closure in the caused by opiates or motor vehi- and liberties. Emergency orders 1970s, to tap into a private cle crashes, be viewed as public can also tap resources reserved source when a town's water sup- health emergencies?Should chron- for the proverbial rainy day. ply ran dry in 1993, and to con- ic health conditions such as hy- Emergency powers sit largely duct aerial spraying to combat pertension or obesity be similarly outside the ordinary structures of eastern equine encephalitis in categorized?When should normal checks and balances. Even when 2006.2 Other states have invoked lawmaking processes, and the time-limited, they're generally re- emergency powers in response i 986 N ENGL J MED 371;11 NEf M.ORG SEPTEMBER 11,2014 The New England Journal of Medicine Downloaded from nejm.org at NER PUBLIC HEALTH DEPARTMENT TRIAL on September 11,2014.For personal use only.No other uses without permission. Copyright 0 2014 Massachusetts Medical Society.All rights reserved. PERSPECTIVE WHAT IS A PUBLIC HEALTH "EMERGENCY"? PublicIllustrative State Laws on Emergency Powers for Definition of"Emergency" State Statute or"Disaster" Key Executive Powers When Powers End _ Indiana Emergency Manage- Occurrence or imminent Act as militia commander-in-chief,suspend Earlier of termination ment and Disaster threat of widespread or laws relating to the normal conduct of by the governor or Law(Indiana Code severe damage,injury,or state business;use all available govern- by concurrent res- S10-14-3) loss of life or property re- ment resources;commandeer or use olution of General sulting from any natural private property;control freedom of Assembly or pas- phenomenon or human movement relating to evacuation and sage of 30 days act,including an epidemic the disaster area;suspend or limit the (unless renewed and public health emer- sale,dispensing,or transportation of by governor) gency alcohol,explosives,and combustibles; and appropriate emergency or contin- gency funds(General Assembly also plays a role in appropriations) Massachusetts Declaration of Emer- Not defined Public health commissioner can take action On governor's decla- gency Detrimental and incur liability necessary to maintain ration to the Public Health public health and prevent disease(sub- (Mass.Gen.Laws ject to approval of governor and Public Ch.17,y2A) Health Council) Pennsylvania Governor and Disaster Not defined Act as military commander-in-chief;sus- Earlier of termination Emergencies pend laws relating to normal order of by the governor or (35 Pa.Cons.Stat. government business;use all available by concurrent res- g7301) government resources;commandeer or olution of General use any private,public,or quasi-public Assembly or pas- property;control freedom of movement sage of 90 days relating to evacuation and the disaster (unless renewed area;and suspend or limit the sale,dis- by governor) pensing or transportation of alcohol, firearms,explosives,and combustibles Washington Washington State Event or set of circumstances Control freedom of movement of persons; When terminated by Emergency Man- that demands immediate exercise powers without regard to pro- the governor after agement Act action to preserve public cedures and formalities of law;enter restoration of or- (Ch.38.52 R.C.W.) health,protect life,protect into contracts and incur obligations on der in the affected property,or provide relief behalf of the government;use existing area to any stricken community government resources;and comman- overtaken by such circum- deer private services and equipment stances;or that reaches such a dimension or degree of destructiveness as to warrant the governor's de- claring a state of emergency to influenza outbreaks and nat- powers prompted spirited ex- they seem potentially applicable ural disasters. An opiate emer- changes in 2001, when academics to garden-variety health threats. gency was declared by Florida's drafted the Model State Emergen- Certain applications of emer- surgeon general in 2011 to crack cy Health Powers Act (MSEHPA) gency powers to common health down on "pill mills" — medical after the September 11 attacks threats may incite minimal con- practices issuing excessive num- and the anthrax threats. The ini- troversy and confer meaningful bers of opioid prescriptions.3 tial version defined "public health benefits. Tapping emergency Since this declaration and the emergencies" as including "epi- funds can provide access to des- ensuing orders were directed by demic diseases," raising concern perately needed public health the state legislature, however, that it could apply to diseases services, such as substance-abuse they didn't raise the same con- such as annual influenza or HIV— treatment, that might otherwise cerns about risks of unchecked AIDS.4 Although the revised go unfunded. Still, respect for executive power that most emer- MSEHPA narrowed the definition democratic governance suggests gency declarations would. of emergencies, many state laws that appropriations decisions The scope of emergency health are drafted broadly enough that should ordinarily remain in the • N ENGL J MED 371;11 NEf M.ORG SEPTEMBER 11,2014 987 The New England Journal of Medicine Downloaded from nejm.org at NER PUBLIC HEALTH DEPARTMENT TRIAL on September 11,2014.For personal use only.No other uses without permission. Copyright 0 2014 Massachusetts Medical Society.All rights reserved. PERSPECTIVE WHAT IS A PUBLIC HEALTH "EMERGENCY"? • control of a democratically ac- vate business interests. By long- legitimacy as well as a backlash countable legislature. standing tradition, executive against public health laws more Emergency-powers laws may actions affecting private interests generally. also be used with little objection are subject to judicial review to Governor Patrick's declara- to send a signal to legislatures ensure that officials have acted tion, in our view, does not ven- that a problem urgently requires within their authority and fol- ture far down this rabbit hole. attention. For example, a gover- lowed appropriate procedures. Most of the policies that were nor can create a task force to However, given the vast discre- advanced to address the opioid- consider how to address a health tion that emergency powers addiction crisis in Massachusetts harm. Emergency declarations grant officials and the suspen- were prudent. But the declaration can generate publicity and spur sion of rulemaking procedures, sets a troubling precedent in the political progress when legisla- meaningful judicial review may eyes of some who believe that tive gridlock or the influence of be elusive, even if permissible. law can be a positive force for special interests has thwarted Although the hallmarks of a tra- public health. Faced with a sub- needed action. ditional emergency — exigency, stantial public health problem Notably, legislative inaction calamitous harm, unavoidability such as opioid addiction, offi- regarding opioid addiction was of harm through ordinary pro- cials may be tempted to use their not a problem in Massachusetts; cesses — may justify relaxing emergency powers. But like opi- prescription-monitoring man- such legal protections, health ates, those powers should be dates were in process, and legis- threats related to noncommuni- used only when needed. lators were considering related cable diseases or commonplace Disclosure forms provided by the authors bills — the consolidated version injuries seldom will. are available with the full text of this article of which was recently enacted.5 Most important, concerns at NEJM.org. Moreover, regular executive- about due process are amplified From the Department of Population Medi- branch processes — nonemer- when emergency orders restrict tine, Harvard Medical School and Harvard gency executive orders and agen- individual freedoms and property Pilgrim Health Care Institute(R.H.),North- • eastern University School of Law (W.E.P), ties administrative rulemaking rights. The notion that highly co- and the Department of Health Policy and Pprocedures permit action to ercive measures such as manda- - P Management, Harvard School of Public be taken on health problems tory blood tests, quarantines, or Health (M.M.M.)—all in Boston;and the when legislatures appear stuck. property seizures could be im- Edmond J.Safra Center for Ethics,Harvard Because they sidestep normal posed for common threats with- University,Cambridge,MA(M.M.M.). rulemaking processes in which out democratic procedures and 1. Governor Patrick declares public health affected parties can raise con- full due process offends our con- emergency, announces actions to address terns and highlight legal vulner- stitutional values. The lack of opioid addiction epidemic. Press release of the Official Website ofthe Governor of Massa- abilities, orders issued through clear triggering thresholds for chusetts,March 27,2014(http://www.mass emergency powers may be espe- terminating emergency powers is gov/governor/pressoffice/pressreleases/ cially susceptible to challenges particularly troubling, creating 2014/0327-governor-declares-public-health -emergency.html). under federal law, which state the possibility that critical legal P"Z Y g 2. Smith S.In public health bill,a contagion laws cannot suspend. Zogenix, protections might be suspended offear.Boston Globe.September 17,2009:AL the manufacturer of Zohydro, indefinitely. 3. State of Florida Department of Health. brought such a challenge, alle - There is also an instrumental Declaration public health emergency. g g � g July 1,2011(http://newsroom.doh.state.Fl.us/ ing that Patrick's ban on its reason to be concerned about the wp-content/uploads/newsroom/2011/07/ product was unconstitutional. A overuse of emergency powers. If 07.01.2011-Emerge ncyDecla ration.pdf). 4. Annas GJ. Bioterrorism, public health, federal judge agreed, ruling that this crucial tool is used too read- and civil liberties. N Engl J Med 2002;346: it was preempted by the federal ily, public health officials may 1337-42. government's supreme role in find themselves like the boy who 5. The 188th General Court ofthe Common- wealth of Massachusetts.Bill S.2142:an Act drug regulation. cried wolf: their warnings about to increase opportunities for long-term sub- Some applications of emer- emergencies may go unheeded. stance abuse recovery. May 2014 (https:// gency powers raise heightened Moreover, the public may lose malegislature.gov/Bills/188/Senate/S2142). concerns. For example, emergen- trust in health officials, which DOI:10.1056/NEJMp1406167 cy orders may interfere with pri- may result in a loss of political Copyright©2014 Massachusetts Medical Society. • 988 N ENGLJ MED 371;11 NEJ M.O RG SEPTEMBER 11,2014 The New England Journal of Medicine Downloaded from nejm.org at NER PUBLIC HEALTH DEPARTMENT TRIAL on September 11,2014.For personal use only.No other uses without permission. Copyright©2014 Massachusetts Medical Society.All rights reserved.