MEETING PACKET JULY 2017 JULY 201 7
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CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4T'i FLOOR Pub&Hean
Prevent.Promote.Protect.
TEL. (978) 741-1800 FAx(978) 745-0343
• KIMBERLEY DRISCOLL Iramdin@salem.com
LAR.RY R,WD.IN,RS/REHS,CHO,CP-FS
MAYOR HE.A TI-I AGENT
NOTICE OF MEETING
You are hereby notified that the Salem Board of Health will hold its regularly scheduled
meeting Tuesday July 11, 2017 at 7.•00 PM
City Hall Annex 120 Washington Street Room 313
MEETING AGENDA
c 1. Call to order
tM
caa o R 2. Approval of Minutes n
o s
Oc CCU 3. Chairperson Communications
m . �
4. Public Health Announcements/Reports/Updates
a. PHN Report
•� b. Health Agent '
c. Administrative
c d. Council Liaison Updates
• L
� 0
0 5. Mary Wheeler, Healthy Streets— Continued discussion on allowing Needle Exchange
programs
c ._ to
CL 'cb G. Ward 2 City Councilor Heather Famico
0 N %_ a. Sound level limits on non-residential HVAC and other large mechanical units
o eo c in the downtown
N = O b. Non-residential trash/recycling storage dimensions and pick-up requirements
F' V ea to 7. Board of Health program planning & city health status discussion
8. New Business/Scheduling of future agenda items
• Items that could not be anticipated prior to the posting of the agenda
• Discuss summer meeting schedule
Larry Ramdin, Health Agent
cc: Mayor Kimberley Driscoll, Board of Health, City Councilors
Next regularly scheduled meeting is September.12, 2017 at 7:00pm at City Hall Annex,
120 Washington Street 3 d Floor Room 313.
Know your rights under the open meeting law MGL chapter 30A ss. 18-25 and City
Ordinance section 2-2028 through 2-2033
r'
CITY OF SALEM
BOARD OF HEALTH
MEETING MINUTES
June 13, 2017
MEMBERS PRESENT: Chairman Paul Kirby, Nancy Crowder, Kerry Murphy
EXCUSED: Dr. Jeremy Schiller, Mary Lauby
OTHERS PRESENT: Larry Ramdin, Health Agent, Suzanne Doty, Public Health Nurse, Maureen Davis, Clerk
of the Board, Beth Gerard, Council Liaison, Peter King, Compliance Inspector NS/CA TAPP Tobacco
Compliance Officer, Elie Zeaiter, Owner of Kwik Shop Market, Mary Wheeler, Program Director, Healthy Streets
Outreach Program, Jamie Banks, Executive Director, Quiet Communities, Jeanne Kempthorne, Legal Advisory
Committee, Quiet Communities, Julie Breskin, resident-2 Salt Wall Lane, Doug Cannon, resident-64 Dearborn St.
TOPIC DISCUSSION/ACTION
1. Call to Order 7:01pm
2. Approval of Minutes N. Crowder motioned to approve the minutes. K. Murphy 2nd.
(May 9, 2017) All in favor. Motion passed.
3. Chairperson Announcements L. Ramdin reminded members he provided each with information on
• the rules and responsibilities of the Board in the blue binders they
received upon becoming a member. Also, the MAHB website has
more information on who we are, what we do and what we can do.
P. Kirby will review the documents.
4. Monthly Reports-Updates
A. Public Health Nurse's B. Gerard inquired whether we are required to keep the zero diseases
Report on the report.
They are listed as part of the report. L. Ramdin commented that the
list of diseases is in their blue binder as well.
Copy available at the BOH office
B. Health Agent's Report L. Ramdin is pleased to announce the budget was approved,
including an increase in part-time inspector Janet Mancini's hours
from 9.5 to 19 per week.
An increase of$15,000.00 was added to the budget because the
sticker program for Household Hazardous Waste had no money in it.
No cuts were made to our requests.
Increased rodent control by$2,500.00. Previously during
• construction, the power plant took care of rodent control within a
mile radius, but we will lose that help now.
P. Kirby asked about the Point walk-through with the Mayor and the
CDC.
L Ramdin stated there are some buildings with outside aesthetics
problems, but those properties are not listed as Health Dept. problem
properties. Feels tenants are afraid to report indoor conditions for
fear of landlord retaliation.
L. Ramdin met with Chris Lohring from Notch regarding the
outdoor surface. He was informed it is ok for the remainder of this
year, but he must comply for next year.
There is an ongoing situation with Kokeshi leaving their trash totes
out on the street every day. Several complaints. City Solicitor, Beth
Rennard, spoke directly with the owner and told him he cannot use
the sidewalk for trash storage.
L. Ramdin states that before opening, the owner originally presented
means of storage for his trash, then had a change and did not inform
us. Spoke to them more than three times and gave them multiple
opportunities to resolve the problem. If trash is there again, he will
be cited.
B. Gerard asked if bathing beach inspections have started.
L. Ramdin said began today(June 13th). Will have results on Friday.
Ledger restaurant is open. We have approved all permits.
Last Thursday(June 8th), approved Honey Dew near City Hall.
Copy available at the BOH office
C. Administrative Report L. Ramdin will have overtime hours and cost of• pop-ups added to administrative report.
Copy available at the BOH office
D. City Council Liaison B. Gerard announced that after two weeks of budget hear'
Updates budget was passed on Thursday. g in the
The,City Council can't add anything to the budget, they can only
subtract and can only vote on the Mayor's suggestions.
Inspectional Services and Health Dept. working collaboratively on
Problem properties.
N: Crowder motioned to accept the reports. Kerry Murphy 2"d.
All in favor. Motion passed.
5. Hearing 2"d Violation Elie Zeaiter, owner of Kwik Shop Market for the past 8 ears stated
Kwik Shop Market he hired a gentleman and told him he had to card everyone. The
10 Jefferson Avenue employee has ADHD and did not take his medication on the day of
the sale because he did not have a refill. He was out of the country
at the time of the sale. He has a POS scanner, but his employee
didn't use it. Despite the violation, he decided to give his employee
a second chance because he is a good employee and has a disability.
E. Zeaiter points out he is very careful about minor sales and takes
• the responsibility very seriously.
P. Kirby states the Board doesn't have a lot of discretion because the
sale happened.
E. Zeaiter explains he just wanted to appear to explain why it
happened. He was not expecting to have the violation excused.
• Peter King of NS/CA TAPP explains during compliance checks he
usually has a 16 or 17-year old attempt to purchase tobacco and they
don't use IDs. During this particular sale, there were actually two
violations because there was a violation for flavored product,too.
E. Zeaiter says the boxes of flavored products were put aside to be
returned for credit, but his employee didn't realize it.
P. King says some flavor packaging has been changed to colors
instead, but it is still a flavored product. The flavor list was
provided to all retailers and is updated every three to six months.
N. Crowder is a firm believer that a rule is a rule is a rule, however
she and P. Kirby and K. Murphy all gave kudos to Mr. Zeaiter for
giving his employee a second chance due to his disability and also
for understanding the gravity of the situation.
K. Murphy motioned to deny the appeal. N. Crowder 2"d. All in
favor. Motion passed.
6. Enabling Needle Exchange Mary Wheeler of Healthy Streets Outreach Program says injection
Programs— Mary Wheeler use is on the rise. Hepatitis C'cases are five times higher in
Massachusetts. Healthy Streets was established in 1991.
Massachusetts passed a needle exchange years ago, but it needed
community approval, and that is hard to do. Governor Baker passed
that only BOH needs to approve. Lynn starts their exchange on
• Monday(June 191h). Theirs will be a mobile program.
Healthy Streets is hoping they will get to the point where they don't
need any approval.
They are giving people the tools they need to empower them to help
themselves, and to help them achieve self-respect.
N. Crowder asked M.Wheeler what the data is for increased needle
use.where needle exchange programs exist.
M. Wheeler explains that needle exchange is an effective harm
reduction program. Using old needles causes skin infections, etc.
and costs the state lots of money at hospitals, etc.
M. Wheeler showed items given out at needle exchange programs.
If approved, we would need to decide if we would do 1 for 1 or
1 for 5 exchanges. She feels the 1 for 5 is better because users are
less apt to feel the need to reuse an old needle if they have more
clean ones available to them. Needle exchange provides clean tools
as opposed to users getting items out of the trash, etc.
L. Ramdin agrees that needle exchanges are preventing many
diseases.down the road.
There is no cost to the city as it is paid by DPH.
N. Crowder asks if we need legal review for BOH to vote?
L. Ramdin replies BOH just has a say, and yes—we approve. There
is no increased burden on the Health Dept.
B. Gerard points out during clean-ups she is always picking up
needles.
K. Murphy asks how do you get public support? M. Wheeler says it
depends. Some communities have open meeting discussions to
allow the public to ask questions about their concerns, etc.
• P. Kirby asks if the 1 for 1 or 1 for 5 language needs to be in our
approval of a needle exchange.
M. Wheeler states there is a template provided in the packet she
gave out to members.
L. Ramdin says Salem BOH will approve of needle exchange for
health reasons.
M. Wheeler says syringe exchange doesn't want to be out in the
open and users don't want to be out in the open either. We just need
a letter of support (template) to get the program started.
L. Ramdin points out there is a Barnstable case before the SJC now
—not sure what the outcome will be.
N. Crowder asks B. Gerard if the police are in support of needle
exchange? She says yes, Denny from Healthy Streets works with
Officer Vaillancourt of Salem PD.
L. Ramdin says there is positive change since Denny has been
involved and out. There is a decreased risk of children
fording/touching needles.
P. Kirby points out two of five members are missing and he would
like them to weigh-in. Suggest we put it on the agenda to discuss
and invite the public to attend and weigh-in before making our
decision to go ahead with a'needle exchange.
P. Kirby asked the difference between a public hearing vs. public
comment.
• L.Ramdin explains a public hearing is much more formal and must
be verbatim.
N. Crowder motioned to continue discussion and invite Healthy
Streets back, as well as inviting Chief Mary Butler, Lieutenant
King and Captain Prosniewski. K. Murphy 2"d. All in favor.
Motion passed.
7. Gas-Powered Leaf Blowers Jeanne Kempthorne and Jamie Banks of Quiet Communities
Presentation—Jeanne Kempthorne provided a video presentation about the hazards of fossil fuel-based
landscape maintenance equipment, specifically gas-powered leaf
blowers.
They have worked with Harvard School of Public Health to provide
education and expert testimony.
The machines are very polluting and extremely noisy, and the
landscapers run their machines for hours on end. There are lots of
alternatives, i.e. lithium ion battery powered equipment.
In a video taken from 50-75 feet away, the noise level was close to
occupational level. The machines emit a low frequency sound
which carries a significant distance.
There are leaf blower ordinances popping up everywhere in the U.S.
Some of the problems are dangerous and damaging noise levels,
• unhealthy emissions, exposure to carcinogens from the exhaust, use
of fuel, solid and toxic waste.
Manufacturers are aware of the health issues with the exhaust.
They release Volatile Organic Compounds, or VOCs.
Ozone-contributing pollutants from small engine machines will be
• more than cars by 2020.
A 2-stroke leaf blower put out emissions of a vehicle driving 3,900
miles.
Ground sourced particulates are blown into the air and breathed in.
The smaller the particulate, the more dangerous it is because it gets
into the lungs and bloodstream.
They are known to cause birth defects, neurological problems,
cancers, respiratory and heart disease and other chronic health
conditions.
Workers most affected, but also children and the elderly.
The CDC is becoming increasingly concerned about the noise, as is
the DEP, EPA, WHO and medical groups.
Hearing loss is irreversible and is therefore permanent.
L. Ramdin says the DEP is authorized to enforce. He asks if they've
met with legislators. J. Kempthorne says they were advised by
legislators to work on the local level.
J. Banks says the Town on Lincoln is setting the example. Showed a
letter regarding the restrictive use. Enforcement is an issue. A letter
can state that if people don't go along with the restrictions we are
prepared to regulate.
Resident Julie Breskin stated she was outside when a leaf blower
starting blowing dust,,etc. everywhere. She has asthma and could
not even stay outside and eat and enjoy the day.
• Cambridge started licensing,their landscapers. Newton goes through
inspectional services. Brookline deals with their issue on a City
Council level.
P. Kirby asks what B. Gerard thinks the City Council will do.
B. Gerard said if the BOH wants to discuss the issue, the Council
will be open to discussion.
J. Kempthorne says previous Ward 2 councilor Mike Sosnowski
tried to do a ban and it did not go well. She says the City Council at
the time took it under advisement, but did nothing.
The DEP cares about this issue, but they are understaffed.
.OSHA is concerned, but it is difficult to enforce.
J. Kempthorne thinks the BOH could recommend to the Council.
Since a ban did not work, she thinks we need to change public
awareness. Perhaps putting handouts in water or tax bills? There
needs to be a concerted effort to bring attention to this issue.
Maybe we could update the noise ordinance to include leaf blowers.
Resident Doug Cannon complained about the constant noise and
suggested we try to come up with some kind of equipment exchange
to encourage people to go electric. He also suggested we look into
registering landscapers.
Resident Julie Breskin suggested the City maintenance equipment be
replaced with electric.
• K. Murphy asks about educational materials available.
J. Banks says yes and suggests we start working with the schools.
Schools in Sonoma, California have a ban.
' B. Gerard says she is going to Sonoma and will get more
information from them.
• L. Ramdin asks if J. Kempthorne has met with the Mayor. She says
yes, but nothing was accomplished. She feels the City should be
modeling the behavior we are expecting.
B. Gerard wonders what the cost of switching equipment would be.
J. Kempthorne says there would be less maintenance with electric.
J. Banks suggests the City look for vendors with available green
options offered at a discount.
P. Kirby thanked them for sharing their information.
L. Ramdin suggested we continue the discussion in September.
8. Board of Health program planning Continued for next meeting
& city health status discussion
9. New Business/Scheduling of future N. Crowder motioned to have no meeting in August. K. Murphy
agenda items 2"d. All in favor. Motion passed.
MEETING ADJOURNED: N. Crowder motioned to adjourn. K. Murphy 2"d. All in favor.
Motion passed.
9:35pm
loPesectfull submitted
p Y
Maureen Davis
Clerk of the Board of Health
Next regularly scheduled meeting is July 11, 2017 at 7.OOpm at City Hall Annex,
120 Washington Street, 3rd floor,Room 313
•
Suzanne Doty RN BSN
Salem Board of Health
Public Health Nurse
Public Health Nurse Report
Reporting on June 8, 2017 through July 3, 2017
Disease Prevention and Health Promotion
• Investigated reportable diseases and reported case information to MDPH.
• Coordinating follow up with North Shore Pulmonary Clinic on tuberculosis cases.
• Continually recording and submitting refrigerator temperature logs, flu doses and clinic
information into the Massachusetts Immunization Information System(MIIS) for up to
date vaccine records and better continuity of care between clinics and providers.
• Posted Facebook and Instagram posts regarding information on Ticks and tick bite
prevention as well as grill safety for the summer months.
• Conducted 6 recreational camp inspections and permitted the Boys and Girls Club, the
Marblehead YMCA camps, Campfire Northshore, Children's Island, the Salem YMCA
and Naumkeag camps and Salem State University Baseball camp. Several other
inspections are scheduled for the month of July as well.
• Northshore REACT meetings have resumed. These meetings are typically held quarterly
and are hosted by Northshore Elder Services in Danvers for the communities they serve,
in attendance are health departments, police and fire departments and local senior centers
and senior housing whom meet to coordinate efforts and services for elders, hoarding
and mental health.
Meetings/Trainings
• Continued modules, conference calls and Working on Wellness webinars. Submitting on
going assignments as plans become more finalized. First round of seed funding of$2,000
awarded on December 15'h and arrived mid-January. Second round of seed funding for
$7,000 has also been awarded and arrived mid-February. The program launched on
Monday May I", Mayor Kim Driscoll send out an all staff launch email. I prepared for
this launch by creating a newsletter, ordering materials and putting together and
delivering gift baskets and bags for all departments involved. Stairwell signs are made
and being installed in the stairwells and blood pressure monitor kits have been delivered.
Announced winner of second activity challenge.
• Thursday Farmers Markets have begun, I continue to attend and set up a display table
weekly to offer blood pressure checks, supply public health information and materials
and am available for any questions the residents may have.
• Simmons student nurse, Nancy Nguyen, has started her clinical hours for the summer.
She will be shadowing me and completing a project on Tickborne illnesses to display at
the Farmers Market in July.
• Attended the Salem Overdose Prevention coalition meeting on June 13th, updates given
regarding ongoing efforts by stakeholders. A summit is being planned for the early fall
for community leaders and key stakeholders from Salem, Lynn and Peabody.
• Attended the Northshore Cape Ann Emergency Preparedness meeting on June 21"for
collaborations with health agents and nurses from surrounding towns for emergency
preparedness and current events.
• Attended the Northshore Public Health nurses meeting on June 27th where we continued
discussion on ongoing public health issues in our communities, camp updates and plans
for collaboration for flu clinics this coming fall.
• Met with Diane Dube, a local Registered Dietitian Nutritionist, on July 3rd to schedule
nutrition classes for the Working on Wellness program.
Monthly Report of Communicable Diseases: June 2017
Disease New Carry Over Discharged/ Total#Of Running Total for Total ford'
Reported Cases this Total for 2016 201 'r=
Closed h x
Month 2017 ,
tuberculosis 0 0 0 0 0 4 141
(Active) x
Latent 0 0 0 0 4 31 , '47�
Tuberculosis*
Arbovirus* 0 0 0 0 0 0 „0
r
Babesiosis 0 0 0 0 0 0 (1� ^`
Calicivirus/No 1 0 1 1 1 0
rovirus
Campylobacte 3 0 2 3 1 15 fll
riosis
Chikungunya 0 0 0 0 0 0
fi .
Dengue* 0 0 0 0 0 0
<ar'
Ehrlichiosis 0 0 0 0 0 0
Enterovirus 0 0 0 0 0 0 `l �
< r
�.
Disease New Carry Over Discharged/ Total# Of Running Total for Total or n4
•Reported Cases this Total for 2016 2015
Closed Month 2017 Group A 1 0 1 1 2 0
Streptococcus
Group B* 1 0 1 1 4 2
Streptococcus
Human 0 0 0 0 0 1
Granulocytic
Anaplasmosis
Haemophilus 0 0 0 0 2 2l
Influenzae
Hansen's 0 0 0 0 0 0 ,0
Disease
4..
Hepatitis A 0 0 0 0 0 0
Hepatitis B* 3 0 3 3 4 8
epatitis C* 2 0 2 2 20 30 e `w
Influenza* 0 0 0 0 65 19
Legionellosis 0 0 0 0 0 2
Lyme 0 0 0 0 0 0
w
Disease*
(5) (5) (5) (9) (27**)
(Probable) .
Malaria 0 0 0 0 0 2
t �f
Measles 0 0 0 0 0 1
k
Meningitis 0 0 0 0 0 0
Mumps 0 0 0 0 0 1
Pertussis 0 0 0 0 0 1
Salmonellosis 0 0 0 0 4 11 6t '
Shigellosis 0 0 0 0 0 3 r ,0 .
Disease New Carry Over Discharged/ Total#Of Running Total for `I`otalXfor "£
Reported Cases this Total for 2016 2015
Closed Month 2017
Streptococcus 0 0 0 0 3 8 f3�
Pneumoniae*
.few
Varicella* 0 0 0 0 0 1 0' ° b,
Vibrio 0 0 0 0 0 1
West Nile 0 0 0 0 0 0 0 ,'
Yersoniosis 0 0 0 0 0 0 -
y:
Zika Virus 0 0 0 0 0 1 O$
Infection
Total 12 0 11 12 114 204 1401
June 2017
*Notifications only, LBOH not required to follow up or investigation per DPH.
• **Total reflects cases that have also been reported as suspect cases.
All Communicable disease totals above are subject to change in the event that the follow-up investigation
results in the revocation of the diagnosis.
Yearly totals for 2016 have been updated for year end with the number of CONFIRMED cases.
Summary of Current Communicable Diseases
Tuberculosis:
New arrival: I was contracted by the Massachusetts Department of Immigration and Refugees regarding
an individual who newly arrived and required Tuberculosis testing and a referral to the Pulmonary clinic.
I obtained the PPD to do the test and scheduled an appointment with the patient, administered the TB test
and conducted a home visit. I then referred them to the clinic and a Tuberculosis infection was ruled out.
Suspect case: I was contacted by the Northshore Medical Center Pulmonary clinic regarding a patient
with a chest x-ray suggestive of Tuberculosis, this patient is currently asymptomatic and has had negative
blood tests in the past. Blood work has been repeated and sputum has been collected. The patient is
currently being followed by other specialist and has not started on medication for TB. At this time, the
Department of Public Health is not requiring contact testing or directly observed therapy(D.O.T.)until a
Tuberculosis diagnosis is confirmed.
Campylobacteriosis:
Case 1: This case had been on a cruise to several countries during the incubation period. They were
treated as an outpatient by their primary care and recovered. They do not work in a food service or care
setting and no known contacts have become ill. This case is currently closed.
Case 2: This case had no history of recent travel and frequented a cafeteria near their place of work which
was reported to the appropriate health department for follow up. This case does not work in food service
or in a care setting and no contacts have been sick nor was this diagnosis identified as part of a cluster.
This case is now closed.
Case 3: This case is still being follow up on and carried over into July as I await a return call from the
provider and patient to conduct the interview. No further cases have been reported.
Norovirus:
Case 1: This case was reported to Salem thought the patient was a resident of a neighboring town and part
of an investigation there. This case was identified as part of a cluster and the source was identified and
resolved. No further investigation is necessary.
Group A Streptococcus:
Case 1: This patient was hospitalized and the infection was determined to be community acquired though
it progressed to be an invasive infection. I conducted follow up with the hospital and household contacts
• as recommended by the MDPH epidemiologist. No further cases have been reported and this case is now
closed.
Acute Hepatitis B:
Case 1: 1 was contacted by MDPH to conduct a follow up investigation on this patient to determine if this
is in fact an acute case and any recent medical/surgical or contact history that may be the source of
infection. After several communications with this patient and consulting with an epidemiologist, the case
was determined to likely be a chronic infection and not acquired in a medical setting or through an
infected contact. This case is now closed.
•
i
1
Morbidity and Mortality Weekly Report
influenza A(HlNl)pdm09 viruses analyzed belonged to the Antiviral Susceptibility of Influenza Viruses
Yz g p Y
l:• Predominant 6B.1 genetic subgroup, and the remaining two CDC tested 2,569 influenza virus specimens (304
(1%) belonged to genetic group 6B.The HA gene of 1,187 influenza A(HlNl)pdm09, 1,303 influenza A(H3N2), and
(93%) influenza A(H3N2) viruses analyzed belonged to the 962 influenza B viruses)collected in the United States during
3C.2a genetic group,and the remaining 93 (7%)belonged to October 1,2016—May 20,2017 for resistance to the influenza
the 3C.3a genetic group. Of note, the 3C.2a genetic group neuraminidase inhibitor antiviral medications oseltamivir,
includes an emerging subgroup known as 3C.2a1. The HA zanamivir, and peramivir, which are currently recommended
genes of 495 influenza B/Yamagata-lineage viruses analyzed all for use against seasonal influenza.All 2,569 influenza viruses
belonged to genetic group Y3.The HA genes of 390 influenza tested were found to be susceptible to all three of these antivi-
B/Victoria-lineage viruses all belonged to genetic group VIA. ral medications.An additional 34 influenza A(H IN 1)pdm09
However, 78 (20%) of the 390 B/Victoria-lineage viruses viruses were tested for resistance to oseltamivir and peramivir
have several amino acid changes, including two amino acid and an additional 1,083 influenza A(H3N2)viruses were tested
deletions at positions 162 and 163 in the HA gene, which for resistance to oseltamivir and zanamivir; all were found to
alter the antigenic properties of these viruses. Viruses with be susceptible to these antiviral medications.
these changes are currently being referred to as the"B/Victoria
deletion variant subgroup" 2016-17 Influenza Vaccine Effectiveness
CDC has antigenically characterized 1,824 influenza Data collected through the U.S. Influenza Vaccine
viruses collected by U.S. laboratories since October 1, 2016 Effectiveness Network during November 28, 2016—April 14,
(296 influenza A(HlNl)pdm09, 772 influenza A(H3N2), 2017, indicate that influenza vaccination this season reduced
and 756 influenza B viruses). Among the 296 A(H1N1) the overall risk for influenza-associated medical visits by
pdm09 viruses,294 (99.3%)were antigenically characterized 42% (95% CI = 35%-48%). Vaccine effectiveness against
as A/California/7/2009-like, the influenza A(HlNl)pdm09 the predominant influenza A(H3N2)viruses was 34% (95%
component of the 2016-17 Northern Hemisphere vaccine. Cl=24%-42%)and vaccine effectiveness against influenza B
Among the influenza A(H3N2) viruses, 730 (94.9%) were viruses was 56% (95%CI=47%-64%).
antigenically characterized as A/Hong Kong/4801/2014-like,
a genetic group 3C.2a virus recommended as the A(H3N2) Composition of the 2017-18 Influenza Vaccine
• component of the 2016-17 Northern Hemisphere vaccine.
The Food and Drug Administrations Vaccines and Related
Among 42 viruses that were antigenically different from Biologic Products Advisory Committee(VRBPAC)has recom-
A/Hong Kong/4801/2014-like viruses (i.e., reacted poorly mended that the 2017-18 influenza trivalent vaccine to be used
with ferret antisera raised against reference viruses repre- in the United States contain anA/Michigan/45/2015 (H1N1)
senting A/Hong Kong/4801/2014-like vaccine viruses), 36 dm0 -like virus,an A/Hong 4 1 2014 H N2 -like
(85.7%) belonged to genetic group 3C.3a, represented by virus, and a B/Brisba e/60/008 lik e(B/Victoria lineage)
the A/Switzerland/9715293/2013 reference virus, which virus. It is recommended that quadrivalent vaccines, which
was included as the A(H3N2) component of the 2015-16 have two influenza B viruses,contain the viruses recommended
Northern Hemisphere vaccine. for the trivalent vaccines, as well as a B/Phuket/3073/2013-
Among influenza B viruses, 327 B/Victoria-lineage viruses like(B/Yama ata lineage)virus(2).This represents an update
g g P P
were antigenically characterized using postinfection ferret in the influenza A(H1N1) component compared with the
antisera and among these, 283 (86.5%) were antigenically composition of the 2016-17 influenza vaccines.The recom-
characterized as B/Brisbane/60/2008-like, a recommended mended Northern Hemisphere 2017-18 vaccine viruses are
influenza B component of the 2016-17 Northern hemisphere the same as the vaccine viruses recommended for inclusion
trivalent and quadrivalent influenza vaccines. Among the in the 2017 Southern Hemisphere influenza vaccines.These
44 B/Victoria linage viruses that had reduced titers against vaccine recommendations were based on a number of factors,
B/Brisbane/60/2008-like viruses, 39 (88.6%) belong to including global influenza virologic and epidemiologic surveil-
the B/Victoria deletion variant subgroup. All 429 (100%) lance,genetic and antigenic characterization,human serology
B/Yamagata-lineage viruses tested were antigenically char- studies,antiviral susceptibility,and the availability of candidate
acterized as B/Phuket/3073/2013-like, the recommended influenza viruses.
influenza B component of the 2016-17 Northern Hemisphere
quadrivalent influenza vaccines.
I
US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / June 30,2017 / Vol.66 / No.25 671
it
• Health Agent report June 2017
Announcements/Updates
• Jeffrey Barosy completed his in-Training Status for his Registered Environmental Health
Specialist credential (REHS) and is now fully credentialed.
• I will be attending the NEHA Annual Education Conference in Grand Rapids, Michigan
from July 9-14.
• We are having internal discussions on implementing a citywide recycling program that
would include businesses and large multi-unit housing. Once a draft regulation is
developed we will provide it to the Board for review
• Proposals for late night food trucks are currently being developed, possible sites are Riley
Plaza and the city lot at 259 Derby Street
Community Outreach
• The Salem Farmers Market has opened and will continue until October 12. There were
some issues with a few food permit applications and we worked with the Market sponsor
to resolve those issues. The Department has a table every week that provided information
on a variety of Health topics, we also offer blood pressure screening as well.
• Meetings and Trainings
• Jeffrey Barosy attended the Epi-Ready disease investigation training on June 28-29,
which was held in Greenfield MA. The training provides information on food borne-
illness investigation and guidelines for the investigation team
• Larry Ramdin attended the Massachusetts Asthma Action Partnership Annual Conference
in Westborough, MA. The conference addressed several issues related to Asthma risk
reduction including Climate Change, funding, healthy toolkits and home visits for older
adults.
Environmental Health Activities
• Beach testing has commence we had one weekend where results were high and we had to
close beaches at Ocean Avenue and Willow Ave. The beaches have been retested and
reopened
• Swimming Pool inspections have been completed and all pools are licensed
• We have inspected the camps and all that were slated to start have passed. There were
issues related to the camps at Salem State University that have been resolved.
• The mosquito season is upon us and monitoring for mosquitoes has begun, the program is
managed by the Northeast Mosquito Control Program
•
•
Inspections
Item Monthly Total YTD 2016 Total
Certificate of Fitness 30 181 506
Inspection
Certificate of Fitness 8 34 42
re-inspection
Food Inspection 41 123 241
Food Re-inspections 4 40 31
Retail Food 0 5 17
Inspections
Retail Food 0 1 12
• re-inspection
Temporary Food 20 55 48
General Nuisance 1 11 26
Inspections
Food— 0 0 2
Administrative
Hearings
Housing Inspections 14 54 94
Housing re- 6 32 25
inspections
Rodent Complaints 5 7 24
Court 1 1 3
Hearings/filings
•
• Item YTD 2016
Trash Inspections 87 458 574
Orders served by 0 0 3
Constable
Tanning Inspections 0 0 0
Body Art 0 0 0
Swimming pools 7 21 9
Bathing Beach 38 38 108
Inspection/testing
Recreational Camps 5 5 6
•
Lead Determination 1 1 2
Septic Abandonment 0 0 0
Septic System Plan 0 0 0
Review
Soil Evaluation 0 0 0
Percolation tests 0 0 0
Total 267 1056 1699
•
0 Health Dept. Clerical Report FY A
Buriial Permits Permits Plan Reviews Certificate of Copies / Fines Revenue Permit Fees
J U I -16 $475.00 $2,210.00 $1,950.00 $4,635.00 Food Service Est. <25 seats s140
August $700.00 $985.00 $1,500.00 $3,185.00 25-99 seats $28o >99 seats $420
September $1,475.00 $2,165.00 $4,300.00 $300.00 $8,240.00 Retail Food <l000sq' $70
October $475.00 $3,415.00 $2,150.00 $6,040.00 l000-lo,000 s28o >10,000 $420
November $500.00 $7,785.00 $2,150.00 $150.00 $10,585.00 Tempj
od 13days s35
December $700.00 $36,265.00 $700.00 $37,665. 00 4ays s7o >7days $
- - _
January-17 Example of>7 day temp food permitr
$750.00 $12,220.00 $90.00 $600.00 $13,660.00 14fdays)divided by7=2 x$7_o_=s240
February $1,075.00 $1,495.00
$1,400.00 $3,970.00 Frozen Desserts $25
March $1,525.00 $2,660.00 $1,080.00 $2,100.00 $500.00 $7,865.00 Mobile Food $210
April $775.00 $2,175.00 $810.00 $1,000.00 $525.00 $5,285.00 Plan Reviews New t18o
May $1,125.00 $2,325.00 $90.00 $1,000.00 $650.00'', $5,190.00 Remodel "sgo
June g Caterin $25 pereventl$2oo
$1,075.00 $2,315.00 $630.00 $2,500.00 $6,520.00 catering kitchen
Body Art Est. $315
Total $10,650.00 $76,015.00 $2,700.00 $21,350.00 $2,125.0011
' $112,840.00 Body Art Practitioner s135
Review Plans s18o
Fiscal Year Budget 2017 Suntan Est. $140
Rec.Day Camp $10
Salary Starting Ending Expenses Ext.Paint Removal s35
Full Time $359,539.00 $10,342.44 Starting Ending Transport Off.Subst. s1o5
Part Time $28,306.00 $1,123.90 $19,000.00 $4,463.91 Tobacco Vendors $135
Overtime $4,500.00 $1,259.31 Swimming Pools Seasonal $140
Balance $392,345.00 $12,725.65 Health Clinic Revolving Account Annual$210 Nonpiofit$40
$15,467.18 Title V Review s18o
Well Application s18o
Disposal works s225/180
Breakdown of Permits and Fines
June 2017
Permit Description Total Permits Issued Permit Cost Total
Annual Food 1 $420.00 $420.00
3 $140.00 $420.00
Temporary Food - Pop Up(1-3 days) 12 $35.00 $420.00
Temporary Food - Pop Up--(1-3 days)- Non-Profit 4 $25.00 $100.00
Ice Cream Truck 1 $210.00 $210.00
Plan Review 1 $180.00 $180.00
2 $90.00 $180.00
Plan Review- Remodel 3 $90.00 $270.00
Burial Permit 43 $25.00 $1,075.00
Exterior Paint Removal 1 $35.00
$35.00
Camp Permit 7 $10.00 $70.00
Pool Permit- Non-Profit 1 $40.00 $40.00
Certificate of Fitness 50 $50.00 $2,500.00
Funeral Director License 8 $75.00 $600.00
Total = $6,520.001
Overtime for Pop-Ups: 14 hours @$47.0143/hour= $658.20
r
Health *
innovations
Healft Streets
DrugUser Health Programs
Providing low-threshold care for individuals with substance use disorder
June 2017
Mary Wheeler
Program Director of Healthy Streets Outreach
A program of Health Innovations Inc.,
Governor Baker signed his FY17 budget into law, which included an amendment passed by both
the House and Senate that eliminates the needle exchange pilot program language, and defines
local approval to approve needle exchange programs as the local boards of health.
H.4450, Outside Section 215: "The department of public health may implement needle exchange
programs for the exchange of needles in cities and towns. Prior to implementation of a needle exchange
program, approval shall be obtained from the board of health in the hosting city or town. The city or town
shall, in a manner determined by the department, provide notice of such approval to the department. Not
later than 1 year after the implementation of a needle exchange program, the department shall report the
results of the program and any recommendations by filing the same with the senate and house chairs of
the joint committee on health care financing and the house and senate chairs of the joint committee on
public safety and homeland security."
L
Massachusetts Syringe Exchange Programs
-Boston 1994
-Cambridge 1994 '
Northampton 1995 ` _ `.�
•Provincetown 1996 �� ' = � ' 1 -"� �'
-Holyoke 2012
-Worcester 2016
-Brockton 2016 �,
ra,^c»�wr;iw�rmm w.w4rwwca nnz w sr..iwro-ao.0 . .._ ..�
North Adams 2016 �"�� ��� �" ` ' "
w (fy
y e^ Ll of
-Greenfield 2016
�a
-Gloucester 2016
-Lawrence 2016
-Lynn 2017
-Chelsea 2017 — approved and
planning process will begin in July
Syringe Access Models
➢ Fixed site
➢ Mobile/Street based
➢ Home delivery
➢ Secondary or Peer delivery models
➢ Clinic based
C
Why consider expanding services for people who use drugs?
Infectious disease such as HIV or Hepatitis C are preventable.
Drug users are frequently not engaged in care. They will often not seek help until a health
concern is so advanced that it requires hospitalization.
Recovery is not a linear process.
Frequent relapse is more the norm than the exception.
Overdose from opioids are at an all time high.
Hepatitis C rates have tripled in the last 5 years among PWIDs.
An outbreak of HIV such as the recent one in Indiana is possible.
People engaged in care are more likely to seek treatment.
Key Components of our Drug User Health Program
➢ Routine screening for HIV, Hepatitis C, Syphilis, Chlamydia and Gonorrhea
➢ Education about/access to PrEP (daily pill to prevent HIV)
➢ Overdose Education and Nasal Naloxone Distribution
➢ Drug Treatment Referrals and Transportation
➢ Health Insurance Enrollment
➢ Care Coordination, Medical Case Management
➢ Referrals to Services and Medical Escorting(HIV Medical Care, Primary Care, etc.)
➢ Syringe Access
➢ Safe Syringe Disposal
➢ Safer Injection Education and Supplies
StationaryLynn,Site in MA
(In operation since 1991 in the city, located at 100 Willow Street since 2013)
P
. Overdose ��
280 Union Vigil on Lynn Street Office . - . s �w � � `
" Commons Office at
q, .
located here started by 100
Mtn
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for over 10 Healthy Willow
years Streets in Street
2005
2 y y
a
Staff Nicole Rossi
,y with the program
The Lab: 5 "daily log" which
tracks each person
Blood draws, i a ,F who visits the
I urine C� f
, a � � �d ''"� � �= program and what
N' screening and U �" Staff Danielle ' services they
wound care.
: �. making Naloxone access.
rescue kits. %
vcrase�
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e,
Safer sex supply
and education area.
n r w
a:�• �� Condoms, female
• .° IJ condoms and lube.
°
Safer injection supplies for prevention of HIV,HCV and injection-related
infection such as abscesses,cellulitis and endocarditis.
e�
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. _�
'Ell , = ■
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tNEEDLE
DISPOSAL 1301
Needles & syringes
ONLY please
FROM- No garbage
cm Wall
s
An example of a western Massachusetts "exchange room" house supplies ranging from adhesive bandages to hand wipes. Harm reduction counselors educate clients -- many of
whom shoot heroin in places without access to running water or soap--about the importance of hygiene. Injection drug users are at risk for ailments including abscesses and a
bacteria-driven heart infection known on the streets as"Cotton Fever."Clients are encouraged to use hand wipes before and after shooting up,and to use alcohol wipes to clean
the injection site.
YCleanupsCommunit
As part of our commitment to the
i;
community at large Healthy
Streets staff travels to various
areas in the city where there are
reports of public injection sites
lU Syr
and picks up used syringes and
T ° ° other injection supplies.
Street and Mobile Outreach
Mobile outreach happens on foot and as"clinics".The clinics utilize the Health Innovations mobile unit in conjunction with Northeastern University Project
Health Moves. The vans are staffed by outreach workers, nursing students and nurses and provide on-site clinical care,testing, health insurance enrollment,
Narcan training and medical case management.
Mobile outreach allows the program to reach individuals in known drug using areas that may not seek services at a fixed site.
Au
y 4 1
r
X
fir
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y $'
� II
.:
Statewide Overdose Education and Nasal Naloxone Pilot Program
Over 5,800 Healthy Streets enrollments and close to 1500 reports of the Narcan we
gave out has been used to reverse a potentially fatal overdose.
Healthy Streets in Lynn, MA was one of the first 8 sites selected to be a Narcan pilot site
once the program went statewide in December of 2007.
_ Partnerships with:
_ Salem Police Department
,ALL
`3
- Salem Overdose Response Team
2
Salem Outpatient Clinic
Salem 7 East Psychiatric Unit
HKD Vivitrol Clinic
Salem Community Health Center
- Salem Opioid Overdose Prevention Coalition
Lahey Behavioral Health
- Lifebridge Shelter
NARrAN6,a
m
NASALSPMY,ma
State, local, and faith-based organizations around the country support syringe
TOYo&4& iP1'iQ8CAM SE�S E Ps) SEPs supported by the following faith based organizations:
o American Medical Student Association Catholic Charities of the Albany Diocese(operates SEP in Albany)
o American Academy of Family Physicians Central Conference of American Rabbis
o American Academy of Pediatrics Episcopal Church
o American Bar Association National Council of Jewish Women
o American Medical Association Presbyterian Church of the United States
o American Public Health Association Society of Christian Ethics
o American Society of Addiction Medicine Union for Reform Judaism
o International Red Cross-Red Crescent Society Unitarian Universalist Association
o Latino Commission on AIDS
• United Church of Christ
o NAACP
• United Methodist Church,General Board of Church and Society
o National Academy of Sciences
• Regional AIDS Interfaith Network
o National Black Leadership Commission on AIDS
o National Black Police Association
o National Institute on Drug Abuse
o Office of National Drug Control Policy
o Presidential Advisory Committee on AIDS
o US Conference of Mayors
o World Bank
o World Health Organization
le' lh
T. nva h
HealthU Streets
Thank
Mary Wheeler
Program Director of Healthy Streets Outreach Program
339-440-5633
mwheeler@healthinnovationsinc.com
1
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Public Safety, Law Enforcement, and
Syringe Exchange
Numerous scientific studies demonstrate that syringe SEPs Protect Law Enforcement Personnel from
exchange programs(SEPs)can play an important role in Needle Stick Injuries
reducing HIV and viral hepatitis infection and advancing
public safety,including the safety of law enforcement officials_ "In the cities that have adopted needle
For 21 years,federal law prohibited the use of federal funds exchange programs, there is a dramatic
for SEPs.While the ban was lifted in 2009,several state
and local health authorities sought and used federal funds reduction in needle sticks to firefighters who
for SEPs as part of a broader approach to preventing crawl on their hands and knees through
HIV infections. smoke filled rooms to search for victims."
• —Charles Aughenbaugh•Jr.,President,
New Jersey Deputy Fire Chiefs Association,
Background Retired Deputy Fire Chief,March 2011
• A study of police officers in San Diego found that nearly
More than 1.1 million people are living with HIV in the U-S., 30 percent had been stuck by a needle at one point in
according to estimates from the Centers for Disease Control their careers,with more than 27 percent of those injured
and Prevention(CDC).Injection drug users(IDUs)account experiencing two or more needle stick injuries.'
for approximately 19 percent of all infections(209,000 cases)
and 12 percent of all new HIV infections in 2006.'When • A study of Connecticut police officers found that needle
implemented as part of a comprehensive HIV/AIDS prevention stick injuries were reduced by two-thirds after implementing
strategy,SEPs are an effective public health approach to SEPs.te
reducing the spread of HIV/AIDS and other blood-borne
diseases in communities across the U.S.2.3•' Research
shows that SEPs promote public health and safety by taking SEPs Promote Public Health and Safety by
syringes off the streets and protecting law enforcement
Taking Syringes off the Streets
personnel from needle stick injuries,which can result in the
transmission of diseases such as HIV/AIDS and hepatitis
C.These programs also importantly link IDUs to substance "SEPs take dirty needles off the streets and
abuse treatment programs and serve as an entry point into increase the safety of our police officers."
other health services,including HIV and STD testing and entry —Bob Scott,former Captain,
into care and treatment programs s Sheriff's office,Macon County,
N.C.,February 2011
Studies have also established that SEPs do not increase SEPs reduce the circulation of contaminated syringes
crime or drug use and provide a gateway to drug treatment among IDUs,educating and informing participants about
and HIV prevention services. the safe disposal of used syringes."�"
•
• In many states,SEPs actively encourage participants to Conclusion
return as many used syringes as possible.t3 As a result,the
majority of syringes distributed by SEPs are returned."A SEPs are a cornerstone of prevention efforts to protect the
Baltimore study demonstrated that SEPs helped to reduce health and safety of police officers,fire fighters,other civil
the number of improperly discarded syringes by almost 50 servants,and the public by helping to reduce the transmission
percent.' of blood-borne diseases,including HIV/AIDS.They are also a
critical component of a comprehensive approach to preventing
• Studies demonstrate that the availability of SEPs in HIV infection,as highlighted in the U.S.National HIV/AIDS
communities results in increased safe disposal of used Strategy.'-'Since the implementation of SEPs in the late 1980s,
syringes.For instance,in Portland,Oregon,the number new HIV infections among IDUs have declined overall by 80
of improperly discarded syringes dropped by almost percent 15 Effectively addressing injection drug use and HIV/
two-thirds after the implementation of a SEP.'°In 2000, AIDS requires a coordinated partnership between health
approximately 3.5 million syringes were recovered in San providers,law enforcement,and communities.
Francisco and safely disposed of as infectious waste.''
SEPs Do Not Increase Crime or Drug Use About Syringe Exchange Programs
"Based upon the literature that's been "SSPs[syringe services programs]are
widely considered to be an effective way
presented to me, SEPs do not appear to of reducing HIV transmission among ,,.
increase crime and/or drug abuse but rather individuals who inject illicit drugs and there
greatly enhance officer and public safety." is ample evidence that SSPs also promote
—Cpl/Deputy Sheriff D.A.Jackson, entry and retention into treatment." •
Background Investigator,Guildford
County Sheriff's Office.Greensboro.N-C., —Office of U.S.Surgeon General
March 2011 Dr.Regina Benjamin,Federal Register,
February 2011
• SEPs do not encourage the initiation of drug use nor do
they increase the frequency of drug use among current IDUs represent a significant percentage of new HIV infections
users,`according to an assessment by the Institute of and nearly 20 percent of all persons living with HIV in the
Medicine. U.S.SEPs are one important component of a comprehensive
HIV prevention eftort for IDUs that includes education on risk
• The presence of SEPs in communities does not expand reduction,HIV testing,referral to drug addiction treatment,and
drug-related networks or increase crime rates. On referral to other medical and social services.
the contrary,research has found that neighborhoods in
Baltimore with SEPs experienced an 11 percent decrease in SEPs provide a safe and accessible method for IDUs to
break-ins and burglaries,whereas areas of the city without exchange used syringes for sterile ones,lowering the risk
increase in crjme_e0 Another --
SEPs experienced an 8 percent ; in increasing public safet .=°Similar
of HIV transmission and c..
9p Y
study conducted in Baltimore demonstrated that the to hospitals and other healthcare settings,SEPs collect
number of arrests did not increase after the establishment used syringes in special puncture-proof containers.These
of SEPs.21 containers are safely disposed of according to special
• One study found that new SEP participants are five times hazardous waste disposal procedures.There are currently
more likely to enter a drug treatment program than non- approximately 211 exchange programs operating one or more
participants_22 Researchers also found that IDUs who had exchange sites in 32 states:the District of Columbia,the
participated in the exchange were more likely than IDUs Commonwealth of Puerto Rico,and the Indian Nations.21 For
who had not participated to reduce or stop injecting.23 more information and a summary of SEP research,please visit,
www.samhsa.gov/ssp.
•
��3A
3
9
2S
Law Enforcement Speaks Out on SEPs
"Needle exchange programs have been "[Ending the ban on federal funding for
proven to reduce the transmission of SSPs]serves the interest of both police and
blood-borne diseases. A number of studies citizens. It will reduce needle-stick injuries to
conducted in the U.S. have shown needle police and prevent the spread of HIV/AIDS
exchange programs do not increase drug in communities across the country."
use. I understand that research has shown -Ronald E.Hampton,Executive Director,
these programs, when implemented in the National Black Police Association,Inc..
context of a comprehensive program that July 2008
offers other services such as referral to
counseling, healthcare, drug treatment, "While substance abuse prevention and
HIV/AIDS prevention, counseling and treatment remain vital, it is also essential
testing, are effective at connecting that the health consequences of injection
addicted users to drug treatment." drug use be mitigated by needle exchange
—Gil Kerlikowske.Director of the white programs."
House Office of National Drug Control —AI Lamberti,Sheriff,Broward County,
Policy and former Seattle Police Chief, Ft..August 2009
responding to a written question during his
confirmation process,April 2009
"Throwing an infected syringe into the
"SEPs are good in that they help reduce gutter, out of fear of prosecution for
risk for police officers when they go out possession of a trace of substance,
on calls. 1 personally do not believe that increases the danger of someone
SEPs increase drug use but make officers getting HIV or other serious infections
safer. These programs are important to our from a needle stick."
communities."
—Richard Gottfried,N.Y.Assemblyman,
—Cynthia Sullivan,Victim Assistance August 2010
Coordinator,Police Department,
Winston-Salem,N.C.,March 2011
This fact sheet is based on information from amfAR, The Enforcement Training Institute,Prevention Point Philadelphia,
Foundation for AIDS Research,the Centers for Disease Control and from The Risks of the Job—Protecting Law Enforcement
and Prevention, the Institute of Medicine,the Harm Reduction from Needle Stick Injury,a publication of the California AIDS
Coalition,North American Syringe Exchange Network, the Law Clearinghouse.
•
�a
www.amfar.org r
._
i
2J -
References
1. CDC.HIV in the United States(fact sheet).July 2010.hitp:/hv:•nv.cdc.gov/ 14. Des Jariais DC,Guardino V.Arasteh K,McKnight C,Milliken J,Purchase
hiv/resources/factsiieets/PDF/us.pdf. Accessed March 10,2011 D.07 November 2010).Current state of syringe exchange in the known
2. Wodak A,Cooney A.Do needle syringe programs reduce HIV infection universe.As presented at the North American Syringe Exchange Conference
among injecting drug users:A comprehensive review of the international 2010 in Austin,Texas.Slides available online at http://naser...org/netvs/2010/
evidence-Substance Use and Misuse 2006;41:(6)777-813_ nov!30/nasec-2010/.
3. Institute of Medicine.Preventing HIV Infection Among Injecting Drug Users 15. Doherty MC,Junge B.Rathouz P,Garfein IRS,Riley E.Vlahov D.The effect
in High-Risk Countries.An Assessment of the Evidence.Washington.D.C.: of a needle exchange program on numbers of discarded needles:A 2-year
National Academies Press;2006. follow-up.American Journal of Public Health.2000;90(6):936-939.
4. Marx MA.Crape B,Brookmeyer RS,Junge B.Latkin C.Vlahov D.Strathdee 16. Oliver KJ,Friedman SR,Maynard H.Magnuson L,Des Jariais DC.Impact
SA.Trends in crime and the introduction of a needle exchange program. of a needle exchange program on potentially infectious syringes in public
American Journal of Public Health.2000;90(12):1933-6. places.Journal of Acquired Immure Deficiency Syndromes.1992;5:534-535.
5. Strathdee,et al.Facilitating entry into drug treatment among injection 17. CDC.Update:Syringe Exchange Programs-United States,2002.Morbidity
drug users referred from a needle exchange program.Drug and Alcohol and Mortality Weekly Report.July 2005.
Dependence.2006;83:225-232. 18. Institute of Medicine.Preventing HIV Infect--on Among Injecting Drug Users
6. Hagan,et al.Reduced injection frequency and increased entry and retention in High-Risk Countries.An Assessment of the Evidence.Washington,D.C.:
in drug treatment associated with needle-exchange participation in Seattle National Academies Press:2006.
drug injections.Journal of Substance Abuse Treatment.2000:19(3)247-250. 19. Marx MA,et al.Trends in crime and the introduction of a needle exchange
7. Lorentz J,Hill J,Samini B.Occupational needle stick injuries in a program.American Journal of Public Health.2000;90(12):1933-6.
metropolitan police force.American Journal of Preventive Medicine. 20. Center for Innovative Public Policies.!Needle Exchange Programs:Is
2000;18:146-150. Baltimore a Bust?Tamarac,FI.:CIPP;April 2001.
B. McCampbell SW,Rubin PN. A needle exchange program:What's in it for 21. Marx,MA,et al.Trends in crime and the introduction of a needle exchange
police?Police Executive Research Forum.2000;14(10). program.American Journal of Public Health,2000;90(12):1933-6.
9. Davis CS,Beletsky L.Bundling occupational safety with harm reduction 22. Hagan H,McGough JP,Thiede H,Hopkins S,Duchin J.Alexander ER.
information as a feasible method for improving police receptiveness to Reduced injection frequency and increased entry and retention in drug
syringe access programs:Evidence from three U.S.cities.Harm Reduction treatment associated with needle-exchange participation in Seattle drug
Journal.2009;6:16. injectors.Journal of Substance Abuse Treatment.2000;19,247-252.
10. Groseclose SL.Weinstein B,Jones TS,Valleroy L.A.Fehrs LJ,Kassler WJ. 23. Ibid.
Impact of increased legal access to needles and syringes on practices of 24. Office of National AIDS Policy.U.S.National HIV/AIDS Strategy.July 2010.
injecting-drug users and police officers-Connecticut,1992-1993.Journal htip://wutiv.tvhitehouse.govisites/defaultifiles/uploads/NHAS.pdf.Accessed
of Acquired Immune Deficiency Syndromes&Human Retrovirology. April 5,2010.
1995;10(1):82-89. 25. CDC. Estimates of new HIV infections in the United States(fact sheet).
11. Doherty NIC,et al.Discarded needles do not increase soon after the August 2008.
opening of a needle exchange program.American Journal of Epidemiology. 26. amfAR.The effectiveness of harm reduction in preventing the transmission of
1997;145(8):730-7. HIV/AIDS(fact sheet).November 2007.
12. Kaplan EH,Heimer R.A circulation theory of needle exchange.AIDS. 27. amfAR.Syringe exchange programs in the United States.2011(map).http://
1994;8(5):567-74. wyvivi.amfar.org/uploadedFiles/On.-The_HiiVSEPS.pdf?n=3826.
13. Harm Reduction Coalition.Syringe Exchange Programs:Reducing the Risks
of Needlestick Injuries.Nev:York:Harm Reduction Coalition:2006.
a m fA R 120 Wall Street,13th Floor Public Policy Office amtAR/TREAT Asia
New York W 10005-3908 115017th Street,NW Exchange Towter,Suite 2104
MAKING AIDS HISTORY USA Suite406 388 Sukhumvit Road
T.+1 212.806.1600 Washington,DC 20036 Klongtoey,Bangkok 10110
amfAR,The Foundation F:+1 212.806.1601 USA Thailand
for AIDS Research T:+1 202.331.8600 T:+66(0)2 663.7561
www.amfarorg F:+1 202.331.8606 F:+66(0)2 663.7562
Letterhead
Date
Kevin Cranston,MDiv
Assistant Commissioner
Director, Bureau of Infectious Disease and Laboratory Sciences
Massachusetts Department of Public Health
305 South Street
Jamaica Plain, MA 02130
Dear Mr. Cranston:
I/we are pleased to inform you that the X Board of Health(or name of the submitting authority)
took a vote on September XX, 20XX to allow a qualified and appropriate organization to operate
a Syringe Services Program in the Town/City of X. Attached, you will find the minutes from
that meeting to reflect the vote. I/we look forward to sharing further guidance with the members
of the Board of Health as to how MDPH will move to establish a program in X as one of the ten
allowable pilot programs in the Commonwealth.
Please feel free to contact me at XXX-XXX-XXXX or(email). Thank you for our support.
( ) Y Y pp
• Respectfully,
p Y,
CC: X Town/City Board of Health(or name of submitting authority)
I
Part I ADMINISTRATION OF THE
GOVERNMENT
Title PUBLIC HEALTH
XVI
ChapterPUBLIC HEALTH
111
Section NEEDLE EXCHANGE PROGRAMS;
215 APPROVAL; REPORT
[Text of section effective until July 1, 2016 For text effective July 1, 2016,
see below.]
Section 215. The department of public health is hereby authorized to
• promulgate rules and regulations for the implementation of not more than
ten pilot programs for the exchange of needles in cities and towns within
the commonwealth upon nomination by the department. Local approval
shall be obtained prior to implementation of each pilot program in any city
or town.
Not later than one year after the implementation of each pilot program
said department shall report the results of said program and any
recommendations by filing the same with the joint legislative committees
on health care and public safety.
Chapter 111: Section 215. Needle exchange programs; approval;
report
[Text of section as amended by 2016, 133, Sec. 65 effective July 1, 2016
See 2016, 133, Sec. 203. For text effective until July 1, 2016, see above.]
Section 215. The department of public health may implement needle
exchange programs for the exchange of needles in cities and towns. Prior
to implementation of a needle exchange program, approval shall be
obtained from the board of health in the hosting city or town. The city or
town shall, in a manner determined by the department, provide notice of
such approval to the department.
Not later than 1 year after the implementation of a needle exchange
N y p
program, the department shall report the results of the program and any
recommendations by filing the same with the senate and house chairs of
the joint committee on health care financing and the house and senate
chairs of the joint committee on public safety and homeland security.
•
Harms associated with LACK of syringe access at clinical and non-clinical sites:
- Decreased access for opioid users and their families to receive Narcan and overdose education.
- Increased risk for HIV transmission. (Sterile syringe access is the only scientifically proven
intervention to reduce new HIV infections.With decreased access and increased heroin use in
Massachusetts we risk seeing a huge spike in IV drug use related HIV infections.)
-Increase in already rising new Hepatitis C infections. (Massachusetts currently has over 1,000 new
cases of IV drug related Hepatitis C infection among people ages 15-24.)
- Increase in substance use related non-emergent care ED visits. (Each visit costing upwards of
$474.00)
- Increase in substance users using the ED for substance use treatment and mental health care
referral. (Each visit costing upwards of$540.00 and the majority of people get sent home with no
treatment.)
- IV substance users purchase syringes at local pharmacies which DO NOT offer referral and
transportation to substance use treatment.
• -Pharmacy sales DO NOT provide clinical nursing care to high risk patients.(Healthy Streets has
four certified RNs on staff to aide patients in medical case management as well as a Nurse
Practitioner on-site several times a week.)
-Increase in improperly discarded syringes in the community. (Syringes purchased at pharmacies
cannot be returned there;therefore they have no"value".If a person knows they can get sterile
access to syringes they are more likely to dispose properly.)
- Decreased number of people who are marginalized,ill both physically and mentally,seeking care
and treatment for the myriad of issues they face.
•
y
Syringe Exchange vs.Syringe Access
Syringe Exchange Programs (SEP Syringe Access Programs (SAP) •
)
In Massachusetts SEPs,as stated in M.G.L. 111, Privately funded programs that utilize
c215 are funded and regulated by the pharmacies for access using vouchers or gift
Massachusetts Department of Public Health cards.
(MDPH).
SEPs in Massachusetts must be a pilot program
Obtain sterile syringes from syringe exchange
nominated by the MDPH. programs or through donations at no cost to the
state.
SEPs in Massachusetts must complete a specific Provide access to any and all community
workplan with MDPH using the evidence based members over the age of 18 who require access
intervention of"Syringe Exchange' as defined by to sterile syringes.
MDPH.
SEPs in Massachusetts are to use a 1 for 1 or 1 Able to distribute syringes to anyone over 18 •
for 1 plus 10 model for exchange. without requiring an exchange.
SEPs in Massachusetts are required to meet Not required to meet state benchmarks.
specific benchmarks not required of other
programs.
SEPs in Massachusetts use state funds to Collects syringes throughout the community
purchase syringes. from substance users, diabetics,transgender
individuals,tattoo artists,local businesses (post
office) and the street at no cost.
SEPs that are funded by the MDPH must have an Do not require community approval as the
approved location through MDPH followed by service is not a MDPH pilot program but
community approval. providing a community service in a state where
syringes are available without a prescription
and are decriminalized. •
i
e a
0 0
Disposes of used syringes Improperly disposes of used
propedy syringes and possibly shared
syringes.
Disposes of syringes In the
Access sterile syringes and streets that are most likely
proper sharp disposal contaminated with a blood
containem borne disease putting the
community at risk.
Uses dean syringes avoiding soft Reuses syringes and gets a soft-
tissue infections resulting in tissue infection which goes
costly emergency room visits. untreated
Gets are at the coal SAP for Soft-tissueinfection must be
non-emergenthealth blues. treated at theemergencyroom
when it could have been treated
by nursing staff at a local SAP.
Seeks treatment for substance
use and ran locally access a free Personseekstreatment but
servicethatroakes the callsand does not have transportation.
provides transportation.
•
Possibly relapses,retumsto SAP Person exchanges something of
for Naran and overdose value for a ride to treatment,
education. ends up using instead.
Beings family into the SAP for Person asks for treatment
education about overdose, information at the local
addiction and to support the harms
family with a loved one who is pharmacy,pharmacist stannot
addicted.
help.
Person has a family that is
SAP staff interveneswith family unsupported and
to access care for active user. undereducated in dealing with
person addicted.
Person becomes infected with a
Personretumsfor MV,Nepatitis blood bome disease,does not
C and STI rating. have money for sterile syringes
and shares.
Receives free medial case
ma
nagement through nursing
sfaffat SAP.Maintains Etc._
annection with outreach staff
and knows where to go if help is
needed.
•
I.
Available online at www.sciencedirect.com THE WIERNATrONAL JOURNAL OF
• 8CI EPIC E 6 DIRECT- DRUG
POLICY
EISEVIER International Journal of Drug Policy 16S(2005)S31-,S44
www.elsevieccom/locateldrugpo
Effectiveness of sterile needle and syringe programmes
Alex Wodak*,Annie Cooney
Alcohol and Drug Service,St Vincent's Hospital,Darlinghurst,Sydney,NSW,Australia
Received I 1 January 2005;received in revised form 4 February 2005;accepted 6 February 2005
Abstract
This is the first comprehensive international review of the evidence for needle syringe programmes.The major,and now overwhelmingly
strong,finding is that needle syringe programmes reduce HIV transmission effectively,safely and cost effectively.The size of the benefit
is substantial.There is compelling evidence that needle syringe programmes reduce HIV incidence and HIV prevalence by reducing HIV
risk behaviour.The Bradford Hill criteria,generally regarded as the most robust method of assessing public health interventions,were used
for the evaluation framework. Conservatively,six of the nine Bradford Hill criteria were fulfilled(strength of association,replication of
findings,temporal sequence,biological plausibility,coherence of evidence,and reasoning by analogy).Three of the Bradford Hill criteria
were not fulfilled(specificity of association,biological gradient and experimental evidence). Five additional criteria were clearly fulfilled
(cost-effectiveness,absence of negative consequences, feasibility of implementation,expansion and coverage,unanticipated benefits, and
application to special populations).The findings in this review are consistent with seven published national reviews conducted by,or on behalf
of,United States government agencies,which had previously found that needle syringe programmes were effective in reducing HIV infection
among injecting drug users and did not increase illicit or injecting drug use.Countries affected or threatened by HIV infection among injecting
. drug users should carefully consider the convincing evidence now available for the effectiveness and safety of needle syringe programs with
a view to establishing or expanding needle syringe programs to scale.Although some research questions still remain unanswered,and areas
exist where improved research methodology is needed,the failure to implement needle syringe programmes in time and on a sufficient scale
cannot be justified by a lack of available evidence.
O 2005 Elsevier B.V.All rights reserved.
Keywords: Needle syringe programme;HIV prevention;HIV/AIDS;Injecting drug use;Harm reduction;Bradford Hill criteria
Introduction in Amsterdam, the Netherlands, that the first official NSP
was established also in response to a hepatitis B outbreak.
HIWAIDS is probably the most serious global public HIV/AIDS soon became the rationale for this NSP and sim-
health threat since the plague.Injecting drug use is the major ilar programmes were rapidly established in many parts of
or second major risk factor for HIV in seven of the ten the world. NSPs, which are services dedicated to provid-
UNAIDS regions, accounting for 90% of the world's pop- ing needles and syringes, including exchange of used for
ulation. sterile needles and syringes, now operate officially in over
The establishment of needle and syringe programmes 65 countries(Aceijas,2004).Evaluation of the effectiveness
(NSPs)can be traced to an epidemic of hepatitis B and hep- and safety of these programmes began soon after their estab-
atitis C(and HIV as discovered later)among injecting drug lishment and there exists a vast literature supporting their
users(IDUs)in Edinburgh,Scotland between 1982 and 1984. effectiveness.
A local pharmacist began providing sterile injecting equip- Providing access to and encouraging utilisation of
ment but was soon stopped by authorities (Bums, Brettle, sterile needles and syringes for IDUs is now considered a
Gore,Peutherer,&Robertson, 1996).It was not until. 1983 fundamental component of any comprehensive and effective
HIV prevention programme (WHO, 2003). A wide variety
Corresponding author.Tel.:+61 2 9361 8012;fax:+61 2 9361 8011. of measures have been developed to improve access to and
E-mail address:awodak@stvincents.com.au(A.Wodak)_ utilisation of sterile injecting equipment such as NSPs,
• 0955-3959/$—see front matter O 2005 Elsevier B_V.All rights reserved.
doi:10.10 1 6/j.drugpo.2005.02.004
S32 A.Wodak A.Cooney/International Journal of Drug Policy I6S(2005)S3/—S44
strategies for disinfecting needles and syringes in settings has argued that if certain criteria are met in a number •
where they are reused or shared, pharmacy based distri of evaluations of observational studies, then
there is
i
button, sale or exchange schemes, vending machines and an increased probability that a statistical association is
other distribution programmes, policies and programmes causal.
to encourage more appropriate disposal of used needles The Bradford Hill criteria to infer causality have increas-
vidence from studies evaluating
used to assess e
andsyringes and liberal injecting paraphernalia legisla- ingly been g
tion. interventions.These original criteria and five additional cri-
Much effort has been expended on improving knowledge, teria have been applied to this evaluation of NSPs.The null
changing attitudes and reducing risk behaviour, but unless hypothesis used for this study is that measures to increase
the means for behaviour change also become more readily the availability and utilisation of sterile injecting equipment
available, improved knowledge and attitudes do not result do not reduce HIV risk behaviour, HIV seroprevalence or
in reduced risk. Likewise,unless efforts to increase access the HIV seroincidence among IDUs.The criteria discussed
to sterile injecting equipment are buttressed by other efforts below have been categorised as either Bradford Hill Causal
to support behaviour change, risk reduction will remain Criteria or Additional Feasibility and Implementation Crite-
unaffected. Interventions to improve access to sterile inject- ria.
ing equipment have been implemented in many countries
throughout the developed world and to a lesser extent in
transitional and developing countries. In the absence of an Bradford Hill Causal Criteria
effective vaccine against HIV, measures to improve access
to sterile needles and syringes will remain the most effective Strength of association
tool available to reduce HIV transmission among and from
IDUs. The strength of a supposed association between an expo-
This review examines whether NSPs have been demon- sure factor and an outcome is gauged by the relative risk or
strated scientifically to reduce the spread of HIV among odds ratio with associated confidence intervals used to mea-
IDUs. sure the protective effect of an intervention.
Replication of findings
Methodology .
Also referred to as"consistency",this criterion examines
This review should be considered in the light of several whether different studies conducted in different locations by
limitations.The only literature reviewedwas in English.Most different investigators have reported similar findings.
of this literature originated from developed countries,which
although peer reviewed,may still be subject to one or more Specificity of association
forms of publication bias. The overwhelming majority of
studies were quantitative and there were limited qualitative Specificity is said to be present when the alleged exposure
data to illuminate them.The literature regarding the effec- factor(or intervention)is exclusive to the outcome and when
tiveness of NSPs is so vast that there is little need to review the outcome has no other known cause or associated risk
the grey literature. factors.
Research findings not supported by randomised con-
trolled trials are often questioned by clinical medicine and Temporal sequence
public health specialists. However, conducting a strictly
randomised controlled trial to evaluate a NSP is impossible For a cause-and-effect relationship to be supported, the
due to insurmountable ethical and logistical impediments. introduction of an intervention must be followed by a reduc-
In the absence of randomisation other methodological prob- lion in the outcome factor.
lems arise including the accurate measurement of needle
sharing and injecting frequency. In addition, evaluation Biological plausibility
studies are generally conducted at different stages of HIV
epidemics with wide variations in seroprevalence and This criterion refers to the presence or absence of a likely
seroincidence. biological mechanism linking the risk exposure or interven-
In addressing such methodological concerns, a USA tion to the observed findings.
National Academy of Sciences'Institute of Medicine report
concluded that to reject NSPs, based on limitations of the Biological gradient
design of single studies, ignores both the preponderance
and pattern of the evidence and `is both poor scientific Evidence that increasing exposure to an intervention or
judgment and bad public health policy'(Normand,Vlahov, risk factor results in a commensurate positive or negative •
& Moses, 1995), citing in support Bradford Hill who change in an outcome.
A.Wodak A.Cooney/International Journal of Drug Policy 16S(2005)S31-S44 S33
• Experimental evidence seroprevalence or HIV risk behaviours among IDUs as out-
come variables were examined.Some studies assessed mul-
This criterion often provides the strongest support for cau- tiple outcomes. Six out of ten studies,which evaluated HIV
sation and measures the effect of an action. seroconversion or seropositivity as outcomes, found that
NSP use was protective (Des Jarlais et al., 1996; Health
Reasoning by analogy Outcomes International,2002;Heimer,Kaplan,Khoshnood,
Jariwala,&Cadman, 1993;Hurley,Jolley,&Kaldor, 1997;
Causality is supported by analogy if there are similar Ljungberg et al., 1991; Monterroso et al., 2000); out-
associations or causal relationships in other clinical or epi- comes in two studies were negatively associated with NSP
demiological areas of relevance. use (Btuneau, Lamothe, & Franco, 1997; Strathdee et al.,
1997)and two studies showed no effect(Patrick,Strathdee,
Coherence & Archibald, 1997; Schechter, Strathdee, & Comelisse,
1999).
When the evidence from different disciplines and different HIV risk behaviour outcomes were examined in 33 stud-
sources"hangs well together",this criterion is considered to ies with the majority focused on syringe sharing,borrowing,
be fulfilled. lendingor reuse: 23 were positive (Bluthenthal, Kral,
Erringer, & Edlin, 1998; Bluthenthal, Kral, Gee, En finger,
Additional feasibility and implementation criteria &Edlin,2000;Cox,Lawless,Cassin,&Geoghegan,2000;
Donoghoe,Stimson,&Dolan, 1989;Des Jarlais et al.,1994;
Cost-effectiveness Frischer, Elliot, & Taylor, 1993; Gibson & Flynn, 2001;
Gleghom, Wright-De Aguero, & Flynn, 1998; Guydish,
Although estimated in a number of different ways,author- Bucardo,Clark,&Bemheim, 1998;Guydish,Clark,Garcia,
ities pay increasing attention to the magnitude of benefit & Bucardo, 1995; Hartgers, Buning, van Santen, Verster,
achieved from the allocation of public resources. & Coutinho, 1989; Heimer, Khoshnood, Bigg, Guydish,
& Junge, 1998; Kaplan, 1991; Kaplan & Heimer, 1995;
Absence of negative consequences Kaplan, Khoshnood, & Heimer, 1994; Keene, Stimson,
Jones, & Parry-Langdon, 1993; Monterroso et al., 2000;
• Consideration of possible inadvertent adverse conse- Oliver, Maynard, & Friedman, 1994; Paone et al., 1994;
quences has a major impact on adoption or expansion of Peak, Rana, Mahadan, Jolley, & Crofts, 1995; Power &
interventions. Natalya, 2002; Schoenbaum, Hartel, & Gourevitch, 1996;
Singer, Himmelgreen, Weeks, Radda, & Martinez, 1997;
Feasibility of implementation,expansion and coverage Vlahov,Junge,&Brookmeyer, 1997;Watters,Estilo,Clark,
& Lorvick, 1994), one negative (Klee, Faugier, Hayes, &
Is it feasible to implement in diverse settings, including Moms, 1991) and five were indeterminate (Donoghoe,
resource-poor settings,and to expand these interventions to Dolan, & Stimson, 1992; Hartgers, Van Ameijden, van
a scale commensurate with public health need? den Hoek, & Coutinho, 1992; Klee & Morris, 1995; Van
Ameijden,van den Hoek,van Haastrecht,&Coutinho,1992;
Unanticipated benefits Van Ameijden et al.,1994;Van Ameijden&Coutinho,1998;
Van Haastrecht et al., 1996); while six studies examined
Does the intervention lead to other unintended and wel- diverse outcomes including `injecting frequency' — one
come benefits? positive (Wafters et al., 1994), `proportion of syringes
exchanged'—one indeterminate(Van Ameijden&Coutinho,
Special populations 1998),`syringe return rate or exchange rate'—three positive
(Kaplan,1991;Kaplan et al.,1994;Kaplan&Heimer,1995)
How successful are interventions in reaching special pop- and `mortality among NSP users versus non-users' — one
ulations that are particularly at risk or of considerable public indeterminate(Van Haastrecht et al., 1996).
health significance? Overall, these studies provide strong evidence to reject
the null hypothesis that attendance at NSP does not confer
protection against HIV.However,it is not possible to exclude
Results:the effectiveness of needle syringe the possibility that selection bias may account for the findings
programmes in studies comparing IDUs who attend NSPs with those who
do not.
Strength of association Several authors have offered explanations for findings
in some studies that HIV was more prevalent in attenders
Forty-five studies from 1989 to 2002 with NSP imple- compared with non-attenders (Bastos & Strathdee, 2000;
• mentation as an intervention and HIV seroconversion,HIV Coutinho, 2000; Lurie & Drucker, 1997; Schechter et al.,
S34 A.Wodak.A.Cooney/International Journal of Drug Policy 16S(2005)S31-S44
1999;Strathdee&Vlahov,2001).It is well known that NSPs Replication of findings •
in many settings attract high risk IDUs,who may therefore
have a higher risk of HIV seroconversion before ever attend- The above findings strongly support the effectiveness of
ing the programme. This self-selection factor may explain NSPs as interventions that reduce risk behaviour such as
why cities such as Montreal and Vancouver, Canada, have syringe sharing among IDUs and HIV infection. The num-
observed higher HIV seroconversion rates among NSP atten- ber of studies showing protective effects far outweighs those
ders compared to non-attenders (Lowndes & Alary, 1998; with ambiguous or negative effects. The preponderance of
Schechter et at., 1999). positive findings is strengthened by their replication by dif-
Bastos and Strathdee (2000) notes that evaluations of ferent authors, at different stages of the HIV epidemic, at
NSPs typically employ dichotomous categorisations (such different times and geographical locations and with diverse
as NSP attenders versus non-attenders,frequent versus infre- study designs.Furthermore,in instances where NSP use has
quent attenders).This simplistic approach overlooks the fact been statistically associated with increased HIV incidence
that non-attenders may have only used sterile injecting equip- or higher risk behaviours,convincing arguments for possible
meat.For example,in an analysis of NSP attenders in Ams- sources of confounding have been presented.
terdam, the Netherlands, a city where sterile syringes are The efficacy of individual NSPs has been reported in at
readily available through pharmacies, irregular NSP atten- least 10 different countries,including several resource-poor
ders,but not non-or frequent attenders,were at highest risk countries. In addition,ecological studies have found strong
of HIV seroconversion(Van Ameijden&Coutinho, 1998). associations between NSP and lower HIV incidence and
The authors concluded that irregular NSP attenders had the prevalence in comparisons involving diverse countries.Most
least exposure to sterile injecting equipment and consistent notably,the Return on Investment study(Health Outcomes
prevention messages,which placed them at highest risk of International,2002)compared HIV prevalence in 103 cities
infection. in 24 countries of which 16 countries had NSPs. HIV sero-
Studies examining NSP effectiveness have generally prevalence declined by a mean annual 18.6% for 36 cities
relied on self-reported outcome measures. At least one with NSPs compared to an 8.1%increase in 67 cities without
study compared self-reported risk behaviour with actual pro- NSPs. Hurley et at. (1997) compared HIV seroprevalence
gramme data and concluded that self-reported risk behaviour among IDUs in 52 cities without NSPs and 29 cities with
data underestimated the protective association of NSP atten- NSPs in Asia, Europe,North America, South America and
dance by 18%(Safaeian et al.,2002). the South Pacific. On average,seroprevalence increased by •
Strong as the evidence is for NSP effectiveness, these 5.9%per year in the 52 cities without NSPs and decreased
data are confounded by the presence or absence of alter- by 5.8%per year in the 29 cities with NSPs.
native availability of sterile injecting equipment through In a recent systematic review,results favouring the efficacy
pharmacies.A systematic review(Gibson,Flynn,&Perales, of NSP use were recorded from six studies with longitu-
2001)identified 42 studies evaluating NSP effectiveness.The dinallprospective designs, four studies with multiple cross-
potential confounding of pharmacy access to syringes was sectional designs,eight observational studies,five ecological
examined.Twenty-eight studies concluded that NSP use had studies and several modelling studies(Gibson et al.,2001).
positive effects(reduced risk-behaviour or seroconversion), There is sufficient evidence to consider that the criterion
12 showed no effectiveness and two found negative effects. of replication of findings has been fulfilled.
Thirteen of the 14 studies with no effect or negative effects
compared clients with non-clients of NSPs. When these 13
studies were examined carefully and an additional 12 studies Specificity of association
that compared users with non-users of NSPs were consid-
ered,all 13 studies with negative or null findings were found Many studies have demonstrated other health and social
to have been conducted in settings where IDUs had legal benefits of NSPs apart from a reduction in HIV infection
access to syringes from pharmacies as well as NSPs.By way though these benefits are less well documented and do not
of contrast,in settings with NSPs but without additional legal seem to be as powerful as the impact on HIV infection.
access to sterile injecting equipment,there were no negative Additional benefits include improved entry to primary health
or null findings.Five studies found positive effects(reduced care and drug treatment, prevention of other blood-borne
risk behaviour and/or seroconversion) despite legal access viral infections, reduced proximal bacterial infection (e.g.
through NSPs and pharmacies.Nevertheless,the relationship abscess and cellulitis) and reduced distal bacterial infec-
between pharmacy access(yes/no)and positive versus neg- lion (e.g. subacute bacterial endocarditis, brain abscess),
ative findings was significant at the P=0.002 level.Finally, reduced frequency of injecting and improved quality of
when studies in settings where legal pharmacy access was life.
available were excluded, 23 of the remaining 24 studies NSPs offer a`package'ofdifferent services including edu-
showed positive effects for NSP use. cation about protection against other blood borne viruses and
There is sufficient evidence to consider that the criterion sexually acquired HIV, education about cleaning injecting
of strength of association has been fulfilled. equipment and information about drug treatment.However, •
A.Wodak,A.Cooney/International Journal of Drug Policy 16S(2005)S31—s" S35
reductions in risk behaviour and HIV seroconversion could Biological plausibility
be the result ofother services such as acquiring clean syringes
from pharmacies,using condoms and other safer sexual prac- Although the minimum quantity of HIV necessary for
tices.There do not appear to be any studies showing a declin- infection is not known, viable HIV has been detected in
ing HIV incidence in a population with high prevalence levels syringes stored at room temperature for up to 4 weeks
in the absence of NSPs. (Abdala, Stephens, Griffith, & Heimer, 1999). Field stud-
There is insufficient evidence to consider that the criterion ies confirm that HIV can be detected in blood-contaminated
of specificity of association has been fulfilled. syringes for some weeks. The presence of HIV-1 RNA in
needles and syringes indicates the risk associated with shar-
ing of needles and syringes,and also paraphernalia and wash
Temporal sequence waters.Shapshak et al.(2000)found 39%of rinses from 36
needles and syringes containing visible blood collected from
While NSPs are not the only intervention credited with shooting galleries in Miami, United States, had detectable
achieving reduced risk behaviour, in the large majority of amounts of HIV-1 RNA with 94%of the sample containing
settings where NSPs exist, there was a subsequent reduc- antibodies to HIV-1 polypeptides.
tion in risk behaviour and, where measured, HIV serocon- Earlier studies found HIV I in 3%of blood-contaminated
version. As discussed above (see Strength of association), needle and syringes collected from exchange programmes in
in settings where NSP implementation has been followed Sydney,Australia(Wodak et al., 1987), 10%of needle and
by increased risk behaviour and/or seroconversion among syringes from shooting galleries in South Florida, United
actual NSP users,the availability of pharmacy access to clean States (Chitwood et al., 1990), 50% of used needles and
syringes has confounded results(Gibson&Flynn,2001). syringes obtained from shooting galleries in Miami,United
NSP clients have also been shown at baseline in two States (McCoy et al., 1995; Shah et al., 1996) and in New
studies to be at greater risk of HIV seroconversion than Haven, Connecticut, United States, HIV-1 was detected in
non-clients (Lowndes et al., 1998; Schechter et al., 1999), 67.5%of used"street"syringes and in91.7%ofneedlesfrom
though now it is thought the findings resulted from selec- a shooting gallery(Heimer et al., 1993).
tion bias and other factors.Uniquely,Broadhead,van Hulst, Further evidence of a link between the use ofshared inject-
and Heckathom(1999)have observed`reversal"effects on ing equipment and HIV seroconversion is provided by field
risk behaviour among IDUs when an NSP was closed down studies of the biological mechanisms of HIV transmission
in Windham,United States.Significant increases in syringe among IDUs. Practices such as registering, "booting" and
reuse and syringe sharing occurred,though changes in HIV "backloading"have been shown to increase the risk of HIV-1
infection rates were not measured. These observations are transmission by directly placing blood within the needle and
consistent with the expected direction of temporal sequence. syringe(Inciardi et al., 1994;Page,Chitwood,Smith,Kane,
A number of studies measuring behaviour at multiple & McBride, 1990; Samuels, Vlahov, Anthony, Solomon,
points over time support a temporal sequence.In New York & Celentano, 1991). Chitwood et al. (1995) used logistic
City, United States, 584 IDUs attending NSPs were inter- regression analysis adjusted for age, gender and race to
viewed on three occasions and HIV drug risk behaviour was determine risk factors associated with HIV-1 seroconversion
found to decline with the continuing use of NSPs (Paone, among IDUs and found that sharing needles and syringes
Des Jarlais, & Shi, 1998)_ Analysis of trends in HIV risk in the year prior to conversion was the primary independent
behaviours among over 5000 IDUs in New York City from risk factor. Other studies have broadened the definition of
1990 to 1997 led to the conclusion that all three injecting sharing to include injecting paraphernalia such as cookers,
risk behaviours studied declined significantly(all P<0.01) cottons and rinse water, as well as to the practice of
accompanied by a substantial increase in syringe exchange "frontloading".
participation with seroprevalence declining from approxi- IDUs with a history of diabetes have a significantly
mately 45% in 1991 to approximately 30% in 1996 (Des lower HIV seroprevalence rate(9.8%)compared with non-
Jariais et al.,2000). diabetic IDUs(24.3%;P=0.03).This result highlighted that
Heimer et al.(1993)in their evaluation of the New Haven, increased access to sterile syringes and less use of contami-
United States,needle exchange,demonstrated that the preva- nated equipmentwere important factors contributing to lower
lence of HIV in syringes decreased following an increase HIV infection rates(Nelson et al., 1991).
in the exchange rate. In a multiple cross-sectional study Latkin and Forman(2001) in a cross-sectional study of
of 1304 untreated IDUs in Oakland, United States, needle 741. IDUs in Baltimore, United States, investigated where
and syringe sharing declined over time concurrent with an IDUs obtained needles and syringes from prior to the estab-
increase in NSP use and distribution of supplies(Bluthenthal lishment of the NSP,finding that 85%obtained at least some
et al., 1998). There are no published studies reporting an needles from street needle sellers.The authors concluded that
unexpected temporal sequence. street needle sellers were an important source of needles for
There is sufficient evidence to consider that the criterion IDUs and few injectors were able to determine whether these
of temporal sequence has been fulfilled. needles were actually sterile.There is sufficient evidence to
L
S36 A.Wodak A.Cooney/International Journal of Drug Policy l6S(2005)S3I—S44
consider that the criterion of biological plausibility has been Evidence for the efficacy of NSPs in stemming the spread
fulfilled. of HIV has been questioned because of an apparent lack of
reduction in HCV transmission.HIV entered drug-injecting
populations in New York, United States, during the mid-
Biological gradient 1970s and in Australia in the early 1980s while hepatitis C
first spread among IDUs in the 1960s and therefore had a com-
Heimer et al. (1993) found in their syringe tracking pazatively higher baseline prevalence when NSPs were estab-
study in New Haven, United States,that HIV prevalence in fished in the early 1980s(Crofts,Aitken, &Katdor, 1999).
syringes decreased as the exchange rate increased.However, Furthermore,hepatitis C is about an order of magnitude more
no studies were found measuring a possible relationship infectious by blood—blood contact than HIV(Coutinho et al.,
between an increase in NSPs and reduced HIV infections. 1998;Crofts et aL,1999).Despite reported disparities there is
There is insufficient evidence to consider that the criterion increasing evidence that NSPs have led to significant reduc-
ofbiological gradient has been fulfilled. lions in both hepatitis B and C(Hagan,Des Jarlais,Friedman,
Purchase,&Alter,1995).There is sufficient evidence to con-
Coherence of the evidence sider that the criterion of coherence of the evidence has been
fulfilled.
The arguments for coherence of the evidence span several
of the Bradford Hill criteria including biological plausibility,
strength of association and replication.To minimise repeti- Experimental evidence
tion,material which has already been presented will not be
repeated in this section. An appropriate experiment could theoretically be pro-
There is strong evidence that HIV can be transmitted vided by a randomised controlled trial whereby IDUs were
when contaminated injecting equipment is shared and such randomly allocated to an experimental group who would
sharing is the strongest risk factor predicting H1V serocon- be issued with an adequate supply of sterile syringes at an
version among IDUs. Studies of IDUs risk behaviour in exchange and a control group who would not be provided
settings without NSPs show that most engaged in needle with sterile syringes. The experiment would need to take
sharing and other unsafe injecting practices. For example, place in a controlled setting isolated from access to pharmacy
Gleghom, Jones, Doherty, Celentano, and Vlahov (1995) or vending machines.
found that in a cross-sectional survey of IDUs in Balti- Other factors would need to be measured and controlled
more United States almost 50%of respondents said their such as rate of incarceration,availability and quality of drug
P h'
usual source for needles and syringes was street dealers treatment(especially methadone treatment for heroin depen-
while a further 4.1% reported friends/neighbours or shoot- dence),utilisation of strategies to reduce sexual transmission
ing galleries.A number of studies investigating the main risk (such as condoms and treatment of sexually transmitted
factors for HIV seroconversion found syringe borrowing to infections) and overlap with special populations such as
be an independent determinant(Van Ameijden,Langendam, men who have sex with men and sex workers.As discussed,
Notenboom, &Coutinho, 1999)while some studies found there are strong logistical and ethical arguments against con-
backloading and frontloading to be independent predic- ducting such experiments. There is insufficient evidence to
tors. consider that the criterion of experimental evidence has been
Modelling studies have demonstrated that obtaining fulfilled.
clean needles from NSPs reduces the circulation time of
each syringe, whether for reuse or for sharing. Evaluations
of numerous NSPs in many countries have concluded that Reasoning by analogy
IDUs who attend NSPs reduce their HIV risk behaviours
compared with those who do not attend, and that the evi- The provision of sterile injecting equipment to reduce HIV
dence is particularly consistent in areas where non-attendees infection among IDUs is analogous to the provision of con-
cannot obtain clean needles from any other sources. Even domsto reduce the sexual transmission ofHIVas both may be
in areas where pharmacy and other sources exist, the large controversial in most countries,there are myths surrounding
majority of studies show that NSP use is significantly both,yet both have high biological plausibility.
associated with a decline in risk behaviour(Gibson et aL, Condom provision is well accepted to have strong support
2001). from empirical evidence of effectiveness(Weaver,Smith,&
Evidence that a reversal to the status quo occurs after an Kippax,2005).It could be argued that both are implemented
intervention is withdrawn adds further to the coherence of less vigorously than would be justified by the evidence
arguments for causality(Broadhead et al.,1999).Some large of effectiveness,safety and cost-effectiveness.Concern has
ecological studies show a clear association with NSP imple- often been expressed that condom provision might increase
mentation and declining HIV incidence and prevalence over the frequency of sexual activity,especially among unmarried
time. partners and result in an earlier sexual initiation.There is no
A.Wodak A.Cooney/International Journal of Drug Policy 16S(2005)S31--S44 S37
convincing evidence to support these concerns(Weaver et al., A variety of HIV prevention strategies was compared for
2005). cost-effectiveness in an East coast city of the United States.
Drug use and sexual activity are sensitive issues in vir- Cost per HIV infection prevented was equal lowest for needle
tually all countries, especially when these occur among exchange and counselling/education(about US$4000;Kahn,
teenagers. Like NSPs the benefits of condom provision go Washington,&Showstack,1992).In New York City,United
beyond protection from HIV to reducing the incidence of States,the cost per HIV infection averted for a year by a NSP
sexually transmitted infections and unwanted pregnancies. was estimated to be US$2667.This is far below the estimated
Condom provision and NSPs are both cost-effective inter- cost of lifetime treatment(prior to protease inhibitors)of US
ventions. $56,000 to US $80,000 (Kahn& Sanstad, 1997). Another
There is sufficient evidence to consider that the criterion analysis of New York State-approved NSPs also concluded
of reasoning by analogy'has been fulfilled. that syringe exchange is a cost-effective and cost-saving strat-
egy with an estimated 87 HIV infections averted across seven
programmes at a total cost of US$1.8 million,resulting in a
Cost-effectiveness cost-savings of almost US$20,947 per HIV infection averted
(Laufer,2001).
Many studies have demonstrated that NSPs are cost- A cost effectiveness analysis applied a simplified Yale
effective and cost-saving. In a retrospective analysis, Lurie Needle Circulation Model to four hypothetical NSPs in four
and Drucker(1997)estimated that the number of HIV infec- United States cities with differing HIV prevalence and inci-
tions that could have been prevented in the United States had dence rates.Reductions in HIV incidence rates varied across
NSPs been implemented in the early stages of the HIV/AIDS cities from 17% to 70% across the four settings. Higher
epidemic was between 4394(with a 15%incidence reduction reductions were associated with more needles per client-year
due to NSPs)and 9666(with a 33%incidence reduction)with and greater efficiency was associated with low cost per nee-
the cost of treatment calculated at between US$244 million dle exchanged.The estimated cost savings per HIV infection
and US$538 million,respectively averted ranged from US $12,000 to US $99,000 (Kahn,
Furthermore,Lurie,Gorsky,Jones,and Shomphe(1998) 1998).
also estimated the cost per syringe distributed through five Most cost effectiveness studies have been conducted in
syringe distribution strategies (a NSP, a pharmacy-based developed countries with far fewer conducted in resource
• NSP, free pharmacy distribution of pharmacy kits, sale of poor settings. However, a cost-effectiveness study of NSPs
such pharmacy kits to IDUs and sale of syringes in phar- in Svetlogorsk,Belarus,evaluated a comprehensive strategy
macies),finding that with NSPs were the most expensive that included NSPs,safe sex counselling,condom promotion,
and syringe sales the cheapest.At an annual seroincidence bleach distribution and referral to STD services.The average
exceeding 2.1%,all strategies were estimated to be cost sav- cost per HIV infection averted was estimated at about US$68
ing. (estimated range: US $54—US $100; Kumaranayake et al.,
Others have used mathematical modelling to estimate 2000).If the cost of the mass-media campaign was included,
the cost per HIV infection averted by NSPs. Holtgrave, the cost per HN infection averted rose between US$240 and
Pinkerton, Jones, Lurie, and Vlahov(1998) estimated that US$442,still notably cost-effective.This study confirms the
100%coverage ofa previously unmet need for sterile syringes cost-effectiveness of NSPs as an HIV prevention measure in
in the USA would require 954.8 million syringes at a cost of a resource poor setting.
US $423 million.This would prevent 12,350 cases of HIV There is sufficient evidence to consider that the criterion
with subsequent HIV treatment costing approximately US of cost effectiveness has been fulfilled.
$1.3 billion.The estimated total societal expenditure was US
$277 million for NSP with US$145.8 million for pharmacy-
based sales and approximately one third of the cost coming Absence of negative consequences
from out-of-pocket payments for purchasing syringes. Per
HIV infection averted,the cost saving was US$34,278,well Studies have searched for and found no convincing evi-
under the estimated lifetime treatment costs of US$108,469. dence of the following unintended complications associated
Using conservative estimates, it was predicted that the with NSPs:greater injecting frequency(Hartgers et al.,1989;
Hamilton NSP in Canada(Gold,Gafni,Nelligan,&Millson, Watters et al., 1994); increased illicit drug use (Guydish,
1997)would prevent 24 cases of HIV infection over 5 years, Bucardo,Young,Woods,&Grinstead, 1993;Wolk,Wodak,
providing cost savings of US $1.3 million after the pro- Guinan,Macaskill,&Simpson,1990);a rise in syringe lend-
gramme expenses were taken into account producing a sav- ing to other IDUs (Hartgers et al., 1989; Schechter et al.,
ings:cost ratio of4:1.The cost-effectiveness of the Edmonton 1999); recruitment of new IDUs (Reimer et al., 1993; Van
Streetworks NSP in Canada was estimated at C $9500 per Ameijden & Coutinho, 2001; Watters et al., 1994); social
HIV infection delayed for 1 year (Jacobs, Calder, Taylor, network formation(lunge,Valente,Laddn,Riley,&Vlahov,
• Houston, Saunders, & Albert, 1999). The discounted cost 2000);greaternumbers ofdiscarded used needles(Broadhead
per case averted was less than the cost of a case of AIDS. et al.,1999;Doherty et al.,2000;Oliver,Friedman,Maynard,
S38 A.Wodak,A.Cooney/International Journal of Drug Policy 16S(2005)S31--S44
Magnuson,&Des Jarlais, 1992); less motivation to change shown to have maximum impact(Des Jarlais et at., 1995).In
(i.e. reduce) drug use (Bluthenthal, Gogineni, Longshore, Australia,the first NSP was established in 1986 and within a
&Stein,2001);and increased transition from non-injecting couple of years,a national network of programmes had been
drug use to injecting drug use(Guydish et al., 1993). implemented distributing 30 million needles and syringes for
There is sufficient evidence to consider that the criterion a population of less than 20 million in 2000(Health Outcomes
of absence of negative consequences has been fulfilled. International,2002).
However, in many countries implementation has been
delayed and the scale has been inadequate.This is especially
Feasibility of implementation,expansion and true in developing and transitional countries,as well as those
coverage countries,which have responded to illicitdrugs through a pre-
dominantly supply control perspective(Bastos&Strathdee,
NSPs have been shown to be successful in a variety of set- 2000).
tings but their expansion remains a challenge. In Germany, There is sufficient evidence to consider that the criterion
establishing NSPs in larger cities was easier than in smaller of feasibility of implementation,expansion and coverage has
cities and more conservative states,while establishing NSPs been fulfilled.
in prisons was considered desirable but only possible as lim-
ited pilot projects(Weber et al., 1999).
An evaluation of a Hawaiian NSP showed that the fol- Unanticipated benefits
lowing characteristics were required to achieve sustainable
high coverage: broad based political support; allocation of A numberof studies have demonstrated additional benefits
public funds;progressive expansion and removal of counter- resulting from NSP use,apart from a reduction in injecting
productive aspects; peer-educators; links to other services, risk behaviour and HIV infection. At the New Haven and
especially drug treatment; and periodic formal evaluation Seattle exchanges,United States,increased enrolment in drug
(Vogt,Breda,Des Jarlais,Gates,&Whiticar, 1998). treatment and higher treatment retention rates compared with
NSPs have been successfully established in a few non-users of NSPs were reported(Gibson,2000;Hagan et al.,
resource-poor settings, such as Brazil, Iran, Kathmandu in 2000;Heimer et al.,1998).An evaluation study in Baltimore,
Nepal (Peak et al., 1995), northern Thailand(Gray, 1995), United States,found that NSP attendance was independently
Hanoi,Vietnam(Quan,Chung,&Abdul-Quader, 1998)and associated with entry into drug treatment for HIV-infected •
Ukraine.A report on NSPs in northern Thailand mentioned IDUs(Strathdee et al.,1999).In San Francisco,United States,
co-operation from government agencies and non-government Bluthenthai et al.(2001)found that NSP clients'attitudes and
agencies in addition to the local communities as key fac- motivation to change their drug using patterns was positive,
tors for successful implementation(Gray, 1995).The Hanoi concluding that NSPs have a possible link to drug treatment.
NSP gained local acceptance by holding workshops with key Gibson(2000)found NSP use to be associated with sub-
community people including the local police,using outreach stantial reduction or cessation of injecting compared to IDUs
services to distribute needles and syringes rather than estab- who had never attended a NSP.
lished exchange sites, collecting used injecting equipment, During a 1-year pilot NSP conducted in a Swiss women's
and recruiting and training ex-IDUs as outreach workers prison, no abscesses were observed and there were no
(Quan et al., 1998). instances of aggressive or threatening behaviour among
Successful implementation has also been achieved in inmates using syringes(Nelles&Harding, 1995).
some transitional countries such as in Svetlogorsk,Belarus, Despite some reported disparities there is increasing evi-
(Kumaranayake et al., 2000; Vickerman & Watts, 2002) dence that use of syringe NSPs have led to significant reduc-
and in Sverdlovsk Oblast,Russia(Power&Natalya,2002). lions in both hepatitis B and C(Hagan et al., 1995).
The latter was achieved through a process of"many months There is sufficient evidence to consider that the criterion
of negotiation and discussion with all relevant agencies" of unanticipated benefits has been fulfilled.
including the Ministry for Internal Affairs,educating officials
at seminars at which international best practices were pre-
sented,a study tour to harm reduction programmes in Britain, Special populations
training workshops at the pilot sites and an early evaluation
report to satisfy politicians and health care providers. A Prisons
number of international organisations were also involved
in encouraging policy-makers and health practitioners to Mathematical modelling has been proposed as a useful
implement harm reduction strategies (Power & Natalya, technique for estimating HIV transmission through sharing in
2002). prisons(Dolan,Wodak,Hall,&Kaplan,1998).Using conser-
In a number of countries, implementation of NSP in the vative assumptions,where measurement of relevant variables
early stages ofan HIV epidemic,combined with multiple pre- for the model was unavailable,a relatively large number of •
vention initiatives including community outreach,has been HIV infections was estimated to occur in prisons,even though
A.Wodak A.Cooney/International Journal of Drug Policy 16S(2005)S31—S44 S39
• these observations were made in a country with a low HIV non-injecting drugs, injected substantially more frequently
prevalence among IDUs. and engaged more frequently in unsafe injecting practices
A pilot intervention project, which distributed 5335 such as renting,buying or borrowing used syringes and using
syringes at a rate of 0.2 syringes/day per inmate,was carried shooting galleries than both sexually active and non-sexually
out in a Bem prison,Switzerland,accommodating up to 110 active women (Schechter et al., 1999). In some countries,
women,of whom a high proportion injected with nearly half extensive HIV infection has occurred among sex workers
of these reporting sharing injecting material regularly.Sterile before a generalised epidemic,e.g.Thailand(Nelson et al.,
injecting equipment was made available from a one-to-one 1996;Paone,Clark,et al.,1999;Paone,Cooper,et al.,1999).
automatic dispenser and sharing virtually ceased during the Male IDUs who have sex with men may be a population
Mal(Nelles&Harding, 1995). who transmit HIV between groups.Lima et al.(1994)looked
By December 2000, 19 prisons in three countries had at determining risk factors for HIV-1 among IDUs(n=123)
syringe exchange programmes.All evaluations of these pro- in Rio de Janeiro,Brazil,and found that being a male IDU
grammes have been favourable and without any reported who has had sex with other men in the previous 5 years was
unintended negative consequences(Dolan,Rutter,&Wodak, a significant independent risk factor for HIV infection.The
2003).More recent data on NSPs in 53 prisons in six coun- authors concluded that men who have sex with men and IDUs
tries (Belarus, Germany, Kyrgyzstan, Moldova, Spain and may be a group through which HIV entered drug-injecting
Switzerland) has been recently published (Lines, Jurgen, networks in that city.
Stover,Laticevschi,&Nelles,2004).
Developing countries
Young IDU
Successful NSP interventions have been set up either as
Young IDUs have been found to be at higher risk of pilot programmes or ongoing services in a number of devel-
acquiring HIV. Multivariate analysis in one study showed oping countries,including three remote villages in northern
recent onset of injecting to be an independent predictor for Thailand(Gray, 1995),Hanoi,Vietnam(Quan et al., 1998)
seroconversion(Fennema,Van Ameijden,Van Den Hoek,& and Dhaka and Rajshahi, Bangladesh (Jenkins, Rahman,
Coutinho, 1997).A study of IDUs in Rio de Janeiro,Brazil, Saidel,Jana,&Hussain,2001).Evaluation results for these
found that younger age was the principal factor associated studies were reported above under Strength of association
• with high risk injecting behaviour(Telles et al., 1997). In and Feasibility of implementation,Expansion and coverage.
most countries,young people appear to be under-represented There is sufficient evidence to consider that the criterion
among IDUs attending NSPs,which may be because atten- of special populations has been fulfilled.
dance at a NSP amounts to a relatively public identification
as an IDU.
Sears, Guydish, Weltzien, and Lum (2001) investigated Discussion
an HIV prevention programme for homeless young adult
IDUs in San Francisco,United States,finding significant dif- In many countries,HIV epidemics started among IDUs,
ferences between IDUs who frequented.a secondary NSP spreading rapidly to general populations.The evidence for the
intervention site and a comparison group who did not.The effectiveness and safety of some HIV prevention strategies
latter were more at risk of sharing syringes (AOR=3.748; in this population has accumulated.
95% Cl, 1.406-9.988) and reusing syringes(AOR=2.769; Beginning in some developed countries, NSPs were
95%CI, 1.120-6.847). rapidly identified as a valuable strategy for keeping HIV
under control among IDUs.Although a wide variety of dif-
Other populations ferent activities and operational methods are now subsumed
by the term `NSP',there is sufficient commonality to allow
Several studies have observed that women who attend evaluation of this large and growing literature.Large numbers
NSPs and engage in sex work typically report greater HIV of research studies with widely differing designs in diverse
risk behaviours than non-sex worker women attending NSPs. countries have been reported.An increasing number of coun-
A study comparing sex workers with non-sex workers in five tries commenced NSPs and then began to expand them to
United States cities found that sex workers were significantly scale. Although evidence supporting the effectiveness and
more likely to inject more frequently(P<0.0005),to reuse safety of NSPs grew, HIV has continued to spread more
syringes more than twice (P<0.005), to engage in "back- rapidly among and from IDUs than the adoption and expan-
loading" syringes (P<0.005) and to obtain syringes from sion of NSPs.
non-NSP sources(P<0.05;Paone,Clark,Shi,Purchase,& Some excellent and comprehensive reviews of the evi-
Des Jarlais,1999;Paone,Cooper,Alperen,Shi,&Des Jarlais, dence for NSPs have appeared(General Accounting Office,
1999). 1993; Institute of Medicine for the National Academy of
• Sex workers in a Vancouver study, Canada, engaged in Science, 2001; Lurie et al., 1993; National Commission
heavier drug use,reported a greater variety of injecting and on Acquired Immune Deficiency Syndrome, 1991;National
Sop A.Wodak A.Cooney/International Journal of Drug Policy 16S(2005)S31—S44
Institutes of Health Consensus Panel, 1997;Normand et al., case for NSPs is already so compelling and the international •
1995;Office of Technology Assessment of the US Congress, experience so impressive that there is no longer any real jus-
1995; Satcher, 2000). All have confirmed the effectiveness tification for pilot programmes as they may further delay the
of NSPs in reducing HIV transmission.This conclusion was much needed expansion phase.
drawn with increasing confidence in more recent reviews as NSPs are only one way of increasing the availabil-
more and better quality data have become available. ity of sterile injecting equipment and these exist in many
This study is the first systematic review to consider the forms around the world with some cities requiring`one-for-
extent to which evidence for NSPs fulfils the Bradford Hill one' exchange, others attempting to achieve high levels of
criteria. These criteria, originally devised to assess infer- exchange but accepting less than 100%;while authorities in
ences of causality drawn from observational studies, have other jurisdiction provide sale or free distribution without
been used increasingly in recent years to assess intervention attempting to remove used injecting equipment from circu-
studies. This review has attempted to rigorously and con- lation.There is no evidence that any one method is notably
servatively apply the Bradford Hill criteria but in so doing more efficacious or cost effective.
has often encountered the problem of`double negatives' in Attempts to increase the availability of sterile inject-
drawing conclusions. Accordingly, readers are encouraged ing equipment should be accompanied by endeavours to
to carefully review the wording of all conclusions relating to increase its utilisation,reduce the utilisation and availability
Bradford Hill criteria. Each of these refers specifically to a of non-sterile injecting equipment and improve the disposal
null hypothesis. of used injecting equipment.These objectives are best met
The overwhelming majority of studies evaluating the through education of IDUs through peer based, explicit
effectiveness and safety of NSPs are highly supportive. But campaigns, which generally have been found to be highly
in spite of the impressive volume and quality of this sup- effective.
porting evidence,some still question the efficacy and safety Many jurisdictions have found that a diversity of
of NSPs.A somewhat tendentious interpretation of a hand- approaches is optimal with some methods working best in
ful of negative studies from Montreal(Bruneau et al., 1997) certain locations and conditions and other approaches better
and Vancouver (Strathdee et al., 1997), Canada, is relied suited in other places and conditions.The aim is to reduce
upon by critics of the proposition that NSPs are effective the circulation time of needles and syringes.
and safe,despite subsequent papers providing plausible alter- There is no convincing evidence of any major,unintended
native explanations for these negative findings (Bastos & negative consequences. After almost two decades of exten- •
Strathdee, 2000; Coutinho, 2000; Lurie & Drucker, 1997; sive research,there is still no persuasive evidence that NSPs
Schechter et al., 1999;Strathdee&Vlahov,2001). affect the initiation,or increase the duration or frequency of
This review was also inevitably limited by inherent defi- illicit drug use or drug injecting.
ciencies in the quality of the existing literature.For example, The studies reviewed in this report present a compelling
much of the literature classifies IDUs as persons who either case that NSPs substantially and cost effectively reduce the
attend or do not attend NSPs, whereas in reality this phe- spread of HIV among IDUs and do so without exacerbat-
nomenon is dimensional rather than categorical.In addition, ing injecting drug use at either the individual or societal
outcome measures are usually categorical;although again the level. This suggests that authorities responsible for areas
phenomenon is usually dimensional.For example,sharing is threatened by,or experiencing,a HIV epidemic among IDUs
usually measured as either present or absent during a partic- should adopt measures urgently to increase the availabil-
ular period,rather than estimated on a continuum(Bastos& ity and utilisation of sterile injecting equipment and expand
Strathdee,2000). implementation to scale as soon as possible.As an approxi-
mation it is reasonable to assume that providing 200 sterile
needles and syringes per injecting drug user per year is a fig-
Conclusions ure which is achievable and likely to control HIV infection
in this population. It may take several years, starting from
There is compelling evidence that increasing the avail- scratch,to reach this figure. Higher targets may be needed
ability and utilisation of sterile injecting equipment by IDUs where seroprevalence has already reached unacceptable lev-
reduces HIV infection substantially. els. The precise quantity of injecting equipment required
Overall,there is convincing evidence that NSPs,assessed is not known. Cocaine injectors require more needles and
conservatively,fulfil six of the nine Bradford Hill criteria and syringes than heroin injectors.Needle syringe programmes
all ofthe five additional criteria.Measured against any objec- are cost-effective.
tive standards,published studies support the conclusion that It is more difficult to generalise from studies of cost effec-
NSPs are effective in substantially reducing HIV transmis- tiveness of NSPs in one country to other similar countries,
sion. let alone from developed countries to resource poor settings.
Carefully evaluated pilot programmes of NSPs have their However,a number of careful studies in several developed
place in allowing the introduction of this invaluable pro- countries and some transitional countries have demonstrated •
tection of public health but they also have some risks. The convincingly that NSPs are cost-effective.
A. Wodak,A. Cooney I International Journal of Drug Policy 16S(2005)S31 S44 S41
• Needle syringe programmes have additional and worth- macy and vending machine evaluation, measures to reduce
while benefits apart from reducing HIV infection among inappropriate disposal and the reform of restrictive injecting
IDUs.There is reasonable evidence that needle syringe pro- paraphernalia legislation in countries other than the United
grammes can increase recruitment into drug treatment.Phar- States.More and better qualitative research would illuminate
macies and vending machines increase the availability and the findings of the numerous quantitative studies.Researchers
probably the utilisation of sterile injecting equipment by should make more use of continuous measures of baseline
IDUs. characteristics, interventions and outcome variables. How-
There is reasonable evidence that pharmacy availability ever,it is important to recognise that the limited implemen-
of sterile injecting equipment does provide specific benefit tation of NSPs is not fundamentally due to a lack of adequate
in addition to the benefits of NSPs. The population attend- research data. Therefore, it is unlikely that increasing the
ing pharmacies tends to be less disadvantaged than those quantity of the same kind of research as exists already will
attending community based NSPs,although there is often a increase the implementation of NSPs.
considerable degree of overlap.Pharmacy schemes comple-
ment the benefits of NSPs,although some jurisdictions have
relied entirely on pharmacy-based outlets.Vending machines
increase access in some geographical locations to some spe- References
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•
Maureen Davis
• From: Paul Kirby <,pkirby@Salem.com>
Sent: Monday,July 03, 2017 2:53 PM
To: Maureen Davis
Subject: RE: [City of Salem MA] add item to BOH agenda (Sent by Heather Famico,
hfamico@salem.com)
Hi Maureen, I think the agenda is going to be very crowded. I just spoke with Councillor Famico, there are really two
items she wants to start discussion on. We may need to move some other things off the agenda.
Her items are:
-Discussion of sound level limits on HVAC and -the-large mechanical.units ffor non-residential buildings
�2_Discussion of trash/r_ecy_cling storage dimensions and pickup requirements (non-residential)
Thanks! We'll need to touch base later this week. In the meantime have a great 4th! -Paul
From: Maureen Davis [MDavis@Salem.com]
Sent: Monday, July 03, 2017 9:02 AM
To: Paul Kirby
Subject: RE: [City of Salem MA] add item to BOH agenda (Sent by Heather Famico, hfamico@salem.com)
Sure. Thanks, Paul.
From: Paul Kirby [mailto:pkirby@Salem.com]
•Sent: Friday,June 30, 2017 6:19 PM
To: Maureen Davis<MDavis@Salem.com>
Cc: Larry Ramdin<Iramdin@Salem.com>
Subject: FW: [City of Salem MA] add item to BOH agenda (Sent by Heather Famico, hfamico@salem.com)
Hi Maureen, could you please add the item below from Councillor Famico onto the ag_enda for o_ur-July meeting?
Thanks, Paul
--------------------------------------------------------------------------------------------------------
Hi Paul,
How can I get an item on the BOH agenda? I have been trying for months to get
action on some HVAC units in the downtown and haven't had any luck. Please
advise.
Thanks,
Heather Famico
Ward 2 City Councillor
Please note the Massachusetts Secretary of State's office has determined that most emails to and from
municipal officials are public records.FMI please refer to: http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
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From the Doing Business in Salem guide
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ADDITIONAL CONSIDERATIONS
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120 WoOktglm Sttrot.a tloof,Sakan,k1a 01970:(978)619.503
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Planning Board -Site Plan Review
"Adequacy of the methods of disposal of sewage, refuse and other waste;"
REMODELING PLAN REVIEW APPLICATION FOR CURRENTLY LICENSED
ESTABLISHMENTS
Site plan showing location of business in building; location of building on site including alleys,
streets; and location of any outside equipment (dumpsters, well, septic system - if applicable)
• FOOD PERMIT -City of Salem
Plan Review
I. Schedule a meeting with Health Agent to discuss proposal and requirements for licensure.
2. Schedule a site visit.The site visit allows the applicant to describe their plans for the location and allows the
Board of Health to provide information on any work that will be required to ensure the facility is in
compliance for licensure.Because codes can change,facility upgrades may be necessary even if you will be
conducting a business similar to the type that previously existed at the location.
3. Submit plan review application:
a. Plan review application must be completely filled out it is available online at our website,at the
following link Plan Review Application
b. Plans must be submitted 30 days prior to the start of construction
c. Professionally drawn plans must show:
i. Site plan and floor plan,
ii. Elevation and wall floor joint details,
iii. Lighting,plumbing/drainage details,
iv. Lighting schedule and surface finish schedule.
d. Specification sheets for all equipment and surfaces must be provided with plan
e. Menu
f. Fee
These requirements are all detailed in the plan review application.
a
Permit Documents
The documents that are needed will depend on the type of operation.Some may not be applicable to your
establishment.We will advise you as to what is needed at the time of the plan review application.
The following are documents that may be needed to schedule the inspection are:
1. Food Establishment Application form (linked here food establishment permit)and fee(check made out to the
City of Salem)
2. Certified Food Manager Certificate(for establishments that sell anything other than prepackaged food)
3. Allergen Awareness Certificate
4: Pest Control Contract
5. Trash disposal contract
6. Grease disposal contract
7. Choke Save training certificate(if establishment has 25 or more seats)
8. Lab results(if you prepare frozen Desserts)
9. Any necessary variance requests with supporting documentation
Note:link for food establishment permit=dead link
State Requirements
410.600: Storage of Garbage and Rubbish (A) Garbage or mixed garbage and rubbish shall be
stored in watertight receptacles with tight-fitting covers. Said receptacles and covers shall be of
metal or other durable, rodent-proof material. Rubbish shall be stored in receptacles of metal or
other durable, rodent-proof material. Garbage and rubbish shall be put out for collection no
earlier than the day of collection. (B) Plastic bags shall be used to store garbage or mixed
rubbish and garbage only if used as a liner in watertight receptacles with tight-fitting covers as •
required in 105 CMR 410.600(A), provided that the plastic bags may be put out for collection
except in those places where such practice is prohibited by local rule or ordinance or except in
those cases where the Department of Public Health determines that such practice constitutes a
health problem. For purposes of the preceding sentence, in making its determination the
Department shall consider, among other things, evidence of strewn garbage, torn garbage bags,
or evidence of rodents. (C)The owner of any dwelling that contains three or more dwelling units,
the owner of any rooming house, and the occupant of any other dwelling place shall provide as
many receptacles for the storage of garbage and rubbish as are sufficient to contain the
accumulation before final collection or ultimate disposal, and shall locate them so as to be
convenient to the tenant and so that no objectionable odors enter an dwelling.
J Y g
105 CMR: DEPARTMENT OF PUBLIC HEALTH 1/26/07
105 CMR- 1630 410.600: continued
(D)The occupants of each dwelling, dwelling unit, and rooming unit shall be responsible for the
proper placement of his garbage and rubbish in the receptacles required in 105 CMR
410.600(C) or at the point of collection by the owner.
410.601: Collection of Garbage and Rubbish
The owner of any dwelling that contains three or more dwelling units, the owner of any rooming •
house, and the occupant of any other dwelling place shall be responsible for the final collection
or ultimate disposal or incineration of garbage and rubbish by means of: (A)the regular
• municipal collection system; or(B)any other collection system approved by the board of health;
or(C)when otherwise lawful, a garbage grinder which grinds garbage into the kitchen sink drain
finely enough to ensure its free passage, and which is otherwise maintained in a sanitary
condition; or(D)when otherwise lawful, a garbage or rubbish incinerator located within the
dwelling which is properly installed and which is maintained so as not to create a safety or
health hazard; or(E)when otherwise lawful, by backyard composting of compostable material,
provided that the composting operation does not attract rodents or other vectors and does not
create a nuisance, and provided further that in the case of composting by an occupant, the
occupant obtain the prior written permission of the owner. (F) any other method of disposal
which does not endanger any person and which is approved in writing by the board of health.
(See 105 CMR 410.840.)410.602: Maintenance of Areas Free from Garbage and Rubbish (A)
Land. The owner of any parcel of land, vacant or otherwise, shall be responsible for maintaining
such parcel of land in a clean and sanitary condition and free from garbage, rubbish or other
refuse. The owner of such parcel of land shall correct any condition caused by or on such parcel
or its appurtenance which affects the health or safety, and well-being of the occupants of any
dwelling or of the general public. (B) Dwelling Units. The occupant of any dwelling unit shall be
responsible for maintaining in a clean and sanitary condition and free of garbage, rubbish, other
filth or causes of sickness that part of the dwelling which he exclusively occupies or controls. (C)
Dwellings Containing Less than Three Dwelling Units. In a dwelling that contains less than three
dwelling units, the occupant shall be responsible for maintaining in a clean and sanitary
• condition, free of garbage, rubbish, other filth or causes of sickness the stairs or stairways
leading to his dwelling unit and the landing adjacent to his dwelling unit if the stairs, stairways or
landing are not used by another occupant. (D) Common Areas. In any dwelling, the owner shall
be responsible for maintaining in a clean and sanitary condition free of garbage, rubbish, other
filth or causes of sickness that part of the dwelling which is used in common by the occupants
and which is not occupied or controlled by one occupant exclusively. The owner of any dwelling
abutting a private passageway or right-of-way owned or used in common with other dwellings or
which the owner or occupants under his control have the right to use or are in fact using shall be
responsible for maintaining in a clean and sanitary condition free of garbage, rubbish, other filth
or causes of sickness that part of the passageway or right-of-way which abuts his property and
which he or the occupants under his control have the right to use, or are in fact using, or which
he owns.
•
the Massachusetts Department of Environmental Protection(DEP),or the Massachusetts Department
CITY OF SALEM BOARD OF HEALTH of Public Health(DPH).
REGULATION#7 3.7 Household
The single residential unit within a single or multi-family complex.
The effective date of this Regulation shall be January 1,2009.
3.8 Recyclable Material
Section 1.0 Authority Material that has the potential to be recycled and is identified listed and accepted as such,by North
The Board of Health,City of Salem,Massachusetts,acting under the authority of Chapter 111, Shore Recycled Fibers or other recycling companies.
Sections 31,3 1 A and 31B,of the Massachusetts General Laws,has adopted the following
Regulation#7,replacing Board of Health Regulation#7 adopted on August 21,1979 and amended 3.9 Solid Waste
on July 16,1985. Useless,unwanted or discarded solid or liquid material,as per 310 CMR(Code of Massachusetts
regulations)19.006.The term"liquid"refers to the incidental liquids discarded in trash containers or
Section 2.0 Rationale bags.Solid waste consists of rubbish,residential garbage,and small business waste.Solid Waste
2.1 The City of Salem Board of Health is promulgating rules and regulations that provide does not include cardboard,hazardous materials,recyclable materials,white goods,yard waste,or
requirement for the proper placement,collection and disposal of solid waste by residents and any material placed in a waste ban category by the DER
allowed small businesses in order to prevent public health nuisances that could lead to disease and/or
environmental contamination. 3.10 White Goods
Stoves,refrigerators,water coolers,bubbles,dishwashers,clothes dryers,washing machines,
2.2 Trash placement,collection,and disposal by those other than residents and allowed small freezers,air conditioners,dehumidifiers,microwaves,TV's and computer screens.
businesses must be done in a sanitary manner,in accordance with all applicable local,state and
federal niles and regulations,and must not create a public health nuisance. 3.11 Yard Waste
Yard Waste consists of grass,leaves,brush;and tree,vine,or shrub trimmings.
Section 3.0 Definitions for the Purpose of these Regulations
3.12 Mixed Paper
3.1 Allowed Small Business: All colors and textures of paper that can be ripped.
Those small businesses as listed in the"City of Salem,Massachusetts,Contract for Solid Waste and Brochures,catalogs,copy paper,envelopes,tissue rolls,file folders,junk mail,magazines,
Recyclable Materials,Collection and Disposal,dated July 1,2008." newspaper,paper bags,phone books,soft cover books,writing tablets,etc.
3.2 Bag Boxes,cereal,pasta,cookie,shoe,office supplies,etc.
Plastic sacks designate to store solid waste with sufficient wall strength to maintain physical
integrity when lifted by the top.The volume of the bag shall not exceed 35 gallons and the total Staples,paper clips,labels,and envelopes with plastic windows are OK.
weight of its contents shall not exceed 50 pounds.
No dirty take-out containers,juice boxes,foil-lined paper,Tyvek or Mylaz envelopes,photographs,
3.3 Bulky Waste or hard covered books.
Included,but is not limited to,items weighing over 50 pounds or too large to place in a trash barrel
such as f nnituyre of a mattress,but excludes yard waste and construction debris. 4.0 Responsibilities
3.4 Construction Debris 4.1 Residential/Allowed Small Business
Waste building materials resulting from construction,remodeling,repair and demolition operations. The occupant or occupants of every single or two family dwelling;the owner or agent of every
dwelling having three or more dwelling units and;the owner or manager of every allowed small
3.5 Containers business,shall provide containers for the storage of solid waste as described in this regulation.
A receptacle for solid waste or recyclable materials with a capacity of no greater than 35 gallons
constructed of plastic,metal,or fiberglass,having handles or construction to provide adequate 4.2 Commercial
strength for lifting,and having a tight fitting cover.The mouth of such container shall have a The owner of every business,other than the allowed small businesses,shall provide,keep clean and
diameter greater than or equal to that of the base.The weight of the container and its contents shall in good repair proper and sufficient solid waste receptacles for the storage of solid waste.Such
not exceed 50 pounds, owner shall provide for the collection and removal of the solid waste by him/herself or by a private
collector,at sufficient intervals,and in a manner to prevent a nuisance as may be determined by the
3.6 Hazardous Materials Board of Health.
Gasoline,waste oil,liquid oil based paints,turpentine,paint thinners,shellac,pesticides,auto
batteries,explosives,propane tanks,gas cylinders,PCBs,radioactive materials,medical wastes,any
other materials designated hazardous by the United States Environmental Protection Agency(EPA),
5.8 White Goods
5.0 Conditions of Collection
White goods not containing Freon and not including TV's and computer monitors,shall be collected
5.1 Time of Placement by appointment as arranged between the resident or allowed small business and the City's Solid
5.1.1 Tightly covered containers may be placed curbside for municipal collection no sooner than 6 Waste Contractor.(978)745-0635.
PM the evening before the scheduled collection.
Disposal of TV's,computer monitors and white goods containing Freon requires purchase of a
5.1.2 Bags may be placed curbside for municipal collection no sooner than 6 AM the morning of the sticker from the Department of Public services prior to scheduling collection with the City's
scheduled collection. contractor.(978)744-3302.
5.1.3 All containers and bags must be placed curbside no later than 7 AM on the day of collection 5.9 Yard Waste
and must be removed from the sidewalk on the same day as the collection.
Yard waste may not be included in regular municipal collection.It will be collected 5 times per year
5.2 Solid Waste Weight Limit on a schedule agreed upon by the city and the city's contractor,or brought to the Transfer Station on
Each household and allowed small business may place no more than 3 containers or 3 bags or a Swampscott Road.
combination of containers and bags totaling no more than 3 and weighing no more than a total of 50
pounds each;plus one bulky waste item,at curbside for municipal collection. Yard waste must be placed in yard waste paper bags or open containers clearly marked as"yard
waste."
5.3 Solid Waste Acceptable Materials
Only items included in the solid waste definition in this regulation may be placed curbside in Trimmings may be bundled in lengths no more than three feet long.Branches may not have a
containers or bags for collection. diameter greater than 3 inches long and weigh no more than 50 pounds.
5.4 Bulky waste Section 6.0:Miscellaneous Provisions
One bulky waste item per week may be placed for collection per household and allowed small
businesses. 6.1 No person shall disturb,remove or collect any solid waste,bulky waste,recyclable material,
white goods,or yard waste from any premises without consent of the owner,nor any waste placed
5.5 Cardboard out for collection upon any sidewalk or way except employees or contractors of the City.
Cardboard must be separated from solid waste,flattened and either bundled in lengths of no more
than 3 feet and weights of no more than 50 pounds or placed in paper bags or appropriate recycling 6.2 No person,firm,business,or corporation shall place or keep any container,bag,box,crate,or
containers. any other receptacle containing solid waste or recyclable materials on any sidewalk in the City
except for removal or collection by the City,its Contractor or a private collector,place curbside
5.6 Hazardous Materials appurtenant to the place such person,fore,business,or corporation resides or has a place of
Hazardous materials,such as those banned from regular solid waste disposal in accordance with 310 business.
CMR 19.017,must be handled according to local,state and federal rules and regulations.
Section 7.0:Penalties
5.7 Recyclable Materials
Recyclable materials may be placed curbside for collection on the same day as regular solid waste Whoever violates any provisions of these rules and regulations may be fined up to$1,000.00 by the
collection. Board of Health.Each day that these violations exist may constitute a separate offense.In
accordance with MGL c.40s.21D,non-criminal disposition and the issuance of a ticket may be used
There is no limit on the amount recyclable materials collected curbside.Recyclable materials as a penalty of this regulation.
include mixed paper,and commingled glass,aluminum,metal,and plastics#1 through V.
Recyclable materials may not be contaminated by significant amounts of substances in accordance Section 8.0:Severability
with 310 CMR 19.006.
If any section,subsection,sentence,clause,phrase,or portion of these regulations is for any reason
Recycled materials must be placed in City-approved bins(available for sale);or your own containers held invalid or unconstitutional by any court of competent jurisdiction,such provisions and such
with appropriate labeling. holdings shall not affect the validity of the remaining portions thereof.
Up-to-date information regarding handling recyclable materials may be obtained at the City City of Salem
Engineer's office.(978)619-5679. Board of Health
120 Washington Street
Salem,MA 01970
Janet Mancini,Acting Health Agent
Paulette Puleo,Chairperson
Martin Fair
Christina Harrington
Barbara Poremba CITY OF SALEM BOARD OF HEALTH
Carol Rainsville REGULATION#7
Noreen Casey COLLECTION OF DISPOSAL OF
Marc Salinas GARBAGE AND REFUSE
A Summary of the Regulation was published in the Salem News on Re:the amendment of adding Part A to section 3.10 of the CITY OF SALEM BOARD OF
after a vote of the board of Health on 12-09-2008 with 6 affirmative,0 negative,0 abstaining, HEALTH REGULATION 7-COLLECTION AND DISPOSAL OF GARBAGE AND REFUSE
Paulette Puleo,Chairperson Section 3.10.The new amendment will read as follows and take effect Aug.5,1985.
Date:2-10-09 3.10 A DOWNTOWN BUSINESS DISTRICT
CONTAINERS OR BUNDLES OF HOUSEHOLD AND ORDINARY COMMERCIAL
WASTE,GARDEN AND LAWN WASTE,FOR THE DOWNTOWN BUSINESS DISTRICT.
These shall be placed at the outer edge of the sidewalk appurtenant to the premises of the owner not
later than 9:am.on the day of collection,and not before 5:00 am,on the day of collection,and shall
be removed from the sidewalk on the same day as emptied.No commercial establishment in the
DOWNTOWN BUSINESS DISTRICT shall place or cause to be placed more than four(4)
standard size barrels,bags,or bundles(not to exceed 100 lbs.in weight per unit when full or 400 lbs.
total weight)per week,OR more than(10)smaller barrels,bags,or bundles with the total weight of
all units not to exceed 400 lbs.when full,per week.The streets which are termed as DOWNTOWN
BUSINESS DISTRICT,and will be affected by this regulation are as follows:
North Street West
Norman Street South
Margin Street West
Washington Street East
New Derby Street South
Derby Street South
Hawthorne Blvd. East
Essex Street North
Brown Street North
St.Peter's Street East
Federal Street across to Washington Street to North Street or to North
Compiled and Submitted by
Robert E.Blenkhom,Health Agent
October 24,1984
Approved July 16,1985
By Board of Health
Arthur Kingsley,Chairman
Vincent DiBona
Arthur J.Johnson
George H.Levesque
Arthur J.Kavanaugh,Jr.,M.D.
Pater H.Sandon
7/11/2017 Gmail-dumpsters
mail Heather Famico<heather.famico@gmail.com>
•
dumpsters
1 message
Heather Famico<heather.famico@gmail.com> Mon, Sep 26,2016 at 6:08 PM
To: Beth Rennard <BRennard@salem.com>, Larry Ramdin <Iramdin@salem.com>, Michael Lutrzykowski
<mLutrzykowski@salem.com>, "Thomas St. Pierre"<tstpierre@salem.com>
Please see the last paragraph of the ordinance below- can the Museum Place Mall dumpsters as well as
Magarian Carpets be told to screen their dumpsters as they are viewable from a public way?
Sec. 24-23. - Dumpsters.
Dumpster shall mean any receptacle used for the collection, storage and/or transportation of rubbish,
garbage, materials to be recycled, including but not limited to used clothing, and other substances and
materials, with a lid or covering.
Dumpster owner shall mean and refer to the person(s) having title to the land upon which a dumpster is
located.
• Enforcement, issuance, fees. The building department, board of health, parking department, and the fire
department are hereby designated as the enforcing agencies of this section, according to their respective
powers and duties. Any permit required under this section shall be issued by the building department on an
application provided by said department. In the event a temporary permit is issued for parking a dumpster on a
public way in accordance with this section, the permit holder shall pay a fee of$25.00 to the building
department for a two week temporary permit plus provide any additional bond which may be required by the
commissioner of the building department. In addition, if such a temporary permit is issued for a dumpster to
occupy a parking metered space(s) on a public way, a separate additional fee of$15.00 per day, per space,
excluding Sundays, shall be paid to the parking department for the period of time the permitted dumpster
occupies a parking metered space.
Location. Each dumpster must be located at a distance from the lot line, so as not to interfere with the
safety, convenience, or health of abutters, residents and the general public, and not to damage the physical
integrity of the curb and sidewalk. The location of dumpsters shall be subject to approval of the building
department and the fire department and in the case of utilizing a parking metered space, approval must also be
granted by the parking department.
Screening.All dumpsters visible from a public way or located in a residentially zoned area or within
• 50 feet of a residentially zoned area shall be enclosed or screened.
https:Hmail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver—iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=157688a67078... 1/1
7/11/2017 Fwd:DRB Meeting Agenda:4/26/17
Fwd: DRB Meeting Agenda: 4/26/17
Heather Famico
Sent:Friday,June 02,2017 9:38 AM
To: dluca@salemnews.com
Begin forwarded message:
From: Kim Driscoll <KDriscoll@Salem.com>
Date: April 22,2017 at 13:53:45 EDT
To: Heather Famico<hfamico@Salem.com>
Subject: Re: DRB Meeting Agenda: 4/26/17
Hey Heather,
Thanks for sharing this with message with me.
I want to look into the issue of the shared dumpster/recycling center more deeply with staff,but my
initial reaction is this....
Our Building Department is short staffed(one vacancy and one person out on what looks like it
might be a long term illness) so having Mike help out with review's of whether something complies
with AAB is helpful at this time.I believe Mike coordinates any review like this with Tom so as to
not overstep his boundaries.
I don't believe we have given staff(SRA,Health or Building) a directive to look for ways to share
trash/recycling and to keep our alleys free and clear of these types of items (we had some
conversation with folks when we switched over to the new WM contract,but it wasn't a policy
discussion or comprehensive in manner).I think that is a good idea for us to try and accomplish,but
like most things in tight,urban settings - it may be harder to do than it looks.At this point,I don't
believe we have done anything that prevents us from achieving this goal by approving a plan that is
compliant with our current policy.The questions for me is "How do we change the policy?How do
we rethink our use of alleys downtown?"... I think the answer will come from getting stakeholders
in the room,under the auspices of the SRA,to identify how best we can enhance use,access and
lighting of our alley ways (that naturally would include tackling the dumpster impacts).I see
stakeholders as restaurant owners,downtown residents,city officials from planning,health,
trash/recycling and building (maybe fire and police as well as there are some public safety benefits
related to enhancing alley ways).
I hear your frustration and believe me I support wanting to achieve the outcomes you seek.I will
look deeper into whether we can do something on this issue,but the larger policy discussion still
needs to be had.
I think Andrew was trying to provide you with the information you requested and give you some
insights into the initial feedback from city officials on the Ledger plan.I don't think he is currently
looking at it from the perspective as how can I improve the alley ways and encourage recycling with
our business community.
I'll be back in touch on this and can share more insights once I have a better handle on the specifics.
Best,
https://mail.salem.com/owa/?ae=Item&t=IPM.Note&id=RgAAAAD5kmxKHyBFS6%2bfZ8emdaXoBwBpDbKjN 1 nYQoeXF05XEP07AAAA8ReyAABpDbKjN I n... 1/7
i
7/11/2017 Fwd:DRB Meeting Agenda:4/26/17
Kim
Sent from my Wad
On Apr 22,2017,at 12:10 PM,Heather Famico <hfamico@Salem.com>wrote:
This relates to what happens on the ground ...
Mike is a public properties assistant,isn't licensed as a building inspector,and isn't one
to decide on aesthetics or neighborhood quality of life issues.I don't know why he was
cited as the one not to have issues with the plan as proposed.
Not promoting sharing a central trash/recycling area= increase in vehicular traffic and
more stuff in the alley. Also,this doesn't cover what their plan for recycling is.A
dumpster outside is for trash alone.
We are putting more into alleys,and by putting a dumpster there for one business we
are promoting more clogging of the arteries,and limiting future use.
Begin forwarded message:
From: "Andrew Shapiro" <AShapiro@Salem.com<mailto:AShapiro@Salem.com>>
To: "Heather Famico" <hfamico@Salem.com<mailto:hfamico@Salem.com>>
Subject: RE: DRB Meeting Agenda: 4/26/17
Good morning Heather—
Attached please find submission items provided by "Ledger." The first 16 pages or so
are branding and signage. Pages 17-18 show outdoor seating. Page 19 shows a plan for
the dumpster enclosure (I've also attached example photos of the style of dumpster
enclosure they are looking to provide). The final page shows ventilation ducts that have
been installed on the rear of the building.
https://mail.salem.com/owa/?ae=ltem&t=IPM.Note&id=RgAAAAD5kmxKHyBFS6%2bfZ8emdaXoBwBpDbKjN]nYQoeXF05XEP07AAAA8ReyAABpDbKjNI n... 2/7
1=
1
Thursday, June 15, 2017
Dear Members of the Planning Board,
As you continue your site plan review for 120 Washington Street(Map 25, Lot 4) 1 ask you to
pay particular attention to the recycling/trash, parking, and roof deck components of the plan.
Recycling/trash:
In email communication the Director of the Planning Department informed me, "The trash and
recycling removal area will be expanded to meet demand associated with the change. The
applicant is working on revised plans to delineate the type of fencing that will be used to screen
this trash area."
Upon checking with the appropriate city staff, I was told at present, the offices at City Hall Annex
produce -2 bags of trash per day = -10 bags total of trash a week, and was told that the city
does utilize the recycling dumpsters.
The addition of 14 units will add at least 4 additional bags of trash per week to the trash
dumpsters, and will add a good amount of residential recycling (as you all are aware, nowadays
more goes into recycling than trash)
. For comparison, the building I live in has 13 units (the majority are 1 br, and the majority of the
people in my building live alone) We have 4 recycling toters that get completely filled between
recycling pickups. Also to note: the City has also been working internally on an ordinance that
will require any hauler that picks up trash in the city to pick up recycling.
Please ensure that there is adequate space to store recycling and trash within the units/storage
area in the building, and that the current outside dumpster situation is properly assessed with
the appropriate additional space added prior to approving recycling/trash plans. Also, please
ensure that the dumpsters are screened (to comply with City of Salem ordinance), and, if you
could, push for something more than a chain link fence with slats. The property in question is in
the SRA district, and often the vinyl slats break and end up making an area look terrible.
•
2
Current recycling storage(photos taken Sunday, 4/30/17 and Friday, 6/10/17)
As you can see in the photos,the recycling dumpsters have a good deal of material that is not recyclable(plastic bags)
Current trash storage (photos taken Sunday,4/30/17 and Friday, 6/10/17)
1j1� �•
Update: ('`printed for BOH 7/11/17 meeting)- photos taken Sunday, July 9, 2017
•
r ,
3
•
Parking:
Prior to making conditions for parking requirements, or requiring a pass for the Museum Place
Mall garage, Riley Plaza lot, or South Harbor garage (that would be listed on the individual unit's
deed) please consult with Matt Smith, Traffic& Parking Director. Now that the garages are
automated, Matt has been running utilization reports. To keep in mind: there still isn't a set
outcome for Hotel Salem's parking, and there are other units in the works on Federal Street
(across from the courthouses, as well as the former District Court property).
Something else that should be reviewed: how many units already have parking passes to the
Museum Place Mall garage, Riley Plaza lot, or South Harbor garage in their deeds?(a
breakdown of each location)
Roof deck:
Roof decks are great,just a friendly reminder-there are residential units at 8 Barton Square as
well as the property that Aurora/New England Soup Company are in. Along those lines- proper
• sound screening of new HVACs would be quite helpful!
f
zer
Thank you all for serving on the Planning Board!
Kind regards,
Heather Famico
Ward 2 City Councillor
•
7/11/2017 RE:Hearing Notice
RE: Hearing Notice
Tom Daniel [tdaniel@Salem.com]
• Sent:Friday, May 19,2017 11:02 AM
To: Heather Famico;Amanda Chiancola
The plans show the following:
One Bedroom Units: 7
Two Bedroom Units:5
Three Bedroom Units: 2
`Thearash and recycling removal.area willbe expanded,fo meet demand associated with the change'The applicant is
working on revised plans to delineate the type of fencing that will be used to screen this trash area.
The parking is finished,so there are 14 parking spaces are proposed onsite,accessible from Barton Square.
Tom
From: Heather Famico [mailto:hfamico@Salem.com]
Sent: Friday, May 19, 2017 9:33 AM
To: Amanda Chiancola; Tom Daniel
Subject: RE: Hearing Notice
How many bedrooms in each unit?/ what's the plan for trash/recycling? (as you know the dumpster already overflows)
and, did they ever finish the parking underneath?
• From: Amanda Chiancola [achiancola@Salem.com]
Sent: Friday, May 19, 2017 8:51 AM
To: Tom Daniel; Deb Jackson; Bonnie Celi; Cheryl LaPointe; Dominick Pangallo; Thomas St. Pierre
Subject: Hearing Notice
Dear Councillor's
Please find the attached notice of a Planning Board Hearing of a Site Plan Review to convert the third and fourth floor
offices at 120 Washington Street into 14 residential units.
Best,
Amanda
Amanda Chiancola,AICP I Staff Planner
Department of Planning&Community Development
120 Washington St.,3rd Floor I Salem,MA 01970
978-619-5685 1 Fax:978-740-0404 1 achiancolaPsalem.com
SY44AO
Stb+�ll
•
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal officials are public records.FMI please refer to:
http://www.sec.state.ma.us/pre/preidx.htm.
https://mail.salem.com/owa/?ae=Item&t=IPM.Note&id=RgAAAAD5kmxKHyBFS6%2bfZ8emdaXoBwBpDbKjN l nYQoeXF05XEP07AAAA8RewAABpDbKjN l n... 1/2
7/11/2017 RE:Hearing Notice
Please consider the environment before printing this email.
•
https://mail.salem.com/owa/?ae=Item&t=IPM.Note&id=RgAAAAD5kmxKHyBFS6%2bfZ8emdaXoBwBpDbKjN l nYQoeXFO5XEP07AAAA8RewAABpDbKjN 1 n... 2/2
— I
Federal St.
•
.Trash MTR
1
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� � lobby
• C d _
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fA
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_ ! Common Amenities LweN
------------ I+ Bathrooms _ 55014SF
Lobby/Lounge 160 NSF
i Fitness Room 500 NSF
Meeting/Community Room 685 NSF
i
Terrace(Exterior) 1888 NSF
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Church St.
Ground Level
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7/11/2017 Gmail-Recycling/trash
Gmail Heather Famico<heather.famico@gmail.com>
•
Recycling/trash
2 messages
Heather Famico<heather.famico@gmail.com> Tue,Aug 2, 2016 at 1:17 PM
To:Amanda Chiancola<achiancola@salem.com>, "eschaeffer@salem.com"<eschaeffer@salem.com>
Hi Amanda and Erin,
Wanted to pass this attached brochure on to the two of you since Lynn made showing recycling and trash storage for
developments as they go before the boards.
The PEM is going to be using the attached combo unit on their building..and I believe other developers could benefit from
knowingabout it... The dum ster is for both trash and recycling,with two shoots and a pendulum style middle that
P P Y
changes the side that has more space depending on whether It Is needed for trash or recycling at a given time(the
pressure of what's put inside causes the middle barrier to move).
-Heather
Tpnq recycling compactor-Marathon.pdf
1012K
Amanda Chiancola<achiancola@salem.com> Wed,Aug 3, 2016 at 8:51 AM
To: Heather Famico<heather.famico@gmail.com>
• Hi Councillor,
Thank you for sharing! I will pass this information along to developers of other projects.
Best,
Amanda
Amanda Chiancola i Staff Planner
Department of Planning&Community Development
120 Washington St.,3rd Floor i Salem,MA 01970
978-619-1682 I Fax:978-740-0404 i achiancola@salem.com
Sxf!+T*J"hitusry
•
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal officials are public records.FMI please refer to:
http://www.sec.state.ma.us/pre/preidx.htm.
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=15650759ca9b... 1/2
7/11/2017 Gmail-Recycling/trash
Please consider the environment before printing this email.
•
From: Heather Famico [mailto:heather.famico@gmail.com]
Sent: Tuesday, August 02, 2016 1:18 PM
To: Amanda Chiancola; Erin Schaeffer
Subject: Recycling/trash
[Quoted text hidden]
•
https:Hmail.google.com/mail/u/O/?ui=2&i k=87538d4a52&jsver=iufS 2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=15650759ca9b... 2/2
7/11/2017 Gmail-Zba/site plan reviews in planning board
mail Heather Famico<heather.famico@gmail.com>
•
Zba/site plan reviews in planning board
1 message
Heather Famico<heather.famico@gmail.com> Wed, Jan 20, 2016 at 7:31 PM
To: Lynn Duncan<Iduncan@salem.com>
Dumpsters for trash are always spoken of, but there is never talk of recycling storage areas. Can we make that a
requirement?
•
•
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=1526198l f9l d... 1/1
I
7/11/2017 Gmail-New Restaurant
Gmail Heather Famico<heather.famico@gmail.com>
New Restaurant
Kathy Lique<kquinn310@gmai1.com> Sun,Apr 16, 2017 at 3:28 PM
To: Heather Famico<Heather.Famico@gmail.com>
Hi, Heather,
I wanted to let you know that the problem I had with Rockefella's dumpster has been
resolved...going on 6 months at least now. Thanks for your help with that.
However, the next restaurant is the new one in the old Eastern Bank and it's my
understanding that they have been given permission to place a "disposal station" at the
end of Higgenson Square which is right across from my front door. Experience with
Rockefella's has me quite concerned. When will they dump? 10 to 12 at night? I would
hope that they will be restricted to daylight hours (8AM to 5PM) for both putting their
trash in the dumpster and for having a garbage truck back down the street beeping and
then the crashing sound of trash being dumped into the truck. This is much closer than
Rockefella's and would obviously be noisier.
It is possible that another new restaurant will also be opening in the (now closed)
Graziani's location which would add another garbage issue. I didn't imagine moving to
Salem and being surrounded by garbage!
Whatever you can do would be much appreciated. Also, if there are city committees
and officials to whom I and my neighbors should express these concerns, please let me
know.
Thanks so much,
Kathy Lique
141 Washington St.
Kathy Lique
"Hatred never ceases through hatred but by love alone is healed. This is an ancient
and eternal law."
Buddha
https:Hmail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&msg=l 5b783cc68333cca&q=in%3Asent%20dumpster&qs=true&search... 1/1
7/11/2017 Gmail-Museum place mall garage
mall Heather Famico <heather.famico@gmail.com>
Museum place mall garage
4 messages
Heather Famico<heather.famico@gmail.com> Wed, Mar 22, 2017 at 5:53 PM
To: Dominick Pangallo<dpangallo@salem.com>, Larry Ramdin <Iramdin@salem.com>, Michael Lutrzykowski
<mLutrzykowski@salem.com>
Is this the school's dumpster? Know when it will be emptied? It's been overflowing for at least a couple of days
l
I
1
I
t
6Qf 7,
Heather Famico<heather.famico@gmail.com> Sun, Mar 26, 2017 at 10:12 PM
To: Dominick Pangallo <dpangallo@salem.com>, Larry Ramdin <Iramdin@salem.com>, Michael Lutrzykowski
<mLutrzykowski@salem.com>, "Thomas St. Pierre" <tstpierre@salem.com>
Bcc: Kim Driscoll<kdriscoll@salem.com>
see attached: Sun Night view
Any update?
[Quoted text hidden]
IMG_1734.JPG
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https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=15b I 1 b94a8l a... 1/3
7/11/2017 Gmail-Museum place mall garage
Larry Ramdin <Iramdin@salem.com> Mon, Mar 27, 2017 at 5:26 PM
To: Heather Famico<heather.famico@gmail.com>, Dominick Pangallo<dpangallo@salem.com>, Michael Lutrzykowski
<MLutrzykowski@salem.com>, "Thomas St. Pierre"<TStpierre@salem.com>
Per my staff,the Dumpster was emptied
Sincerely
Larry
Larry Ramdin MPH, MA, REHS, CHO, CP-FS, HHS
Health Agent/Vice President NEHA Region 9
Salem Board of Health
120 Washington Street S
Salem MA 01970
978-741-1800 (office)
978-745-0343(Fax)
Office Hours
Monday-Wednesday 8:00 am—4:00pm
Thursday 8:00—7:00 pm
Friday 8:00 am- 12:00 noon
From: Heather Famico [mailto:heather.famico@gmail.com]
Sent: Sunday, March 26, 2017 10:13 PM
To: Dominick Pangallo; Larry Ramdin; Michael Lutrzykowski; Thomas St. Pierre
Subject: Re: Museum place mall garage
[Quoted text hidden]
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal officials are public
records.FMI please refer to:http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
https:Hmail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=15b l l b94a8l a... 2/3
7/11/2017 Gmail-Museum place mall garage
Heather Famico<heather.famico@gmail.com> Mon, Mar 27, 2017 at 5:43 PM
To: Larry Ramdin <Iramdin@salem.com>
Cc: Dominick Pangallo<dpangallo@salem.com>, Michael Lutrzykowski <MLutrzykowski@salem.com>, "Thomas St. Pierre"
<TStpierre@salem.com>
thank you so much!
[Quoted text hidden]
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=15b l 1 b94a8l a... 3/3
7/11/2017 Re:Marley Properties
Re: Marley Properties
Paul Kirby [paul.b.kirby@gmail.com]
• Sent:Tuesday,September 06,2016 10:12 AM
To: Heather Famico
Cc: Larry Ramdin;Janet Greene[greenegma@yahoo.com]; Kim Driscoll;crowdersl@comcast.net;Jeremy Schiller adschiller@gmail.com);
Shama Alam [shama_alam@yahoo.com]; Dominick Pangallo; David Cody; Beth Rennard
Thank you for letting us know that the property is still an issue,Heather-I will follow up with Larry and discuss
next steps. -Paul
On Mon,Sep 5,2016 at 8:14 PM,Heather Famico<hfamico@salem.com>wrote:
Hi all,
This property continues to be an issue (as of 9/5). Please view the included photo of the 12+ trash bags and
trash that greet locals and visitors - note: outside of the dumpster,and under an area that does not have
sprinklers.Also rats were seen in the area the other day.
This is an issue.
What are the next steps that will be taken?I have been writing about this area for over a year now and can pass
on past emails if needed. imagel.JPG
Sent from my iPhone
On Aug 18,2016,at 10:12,Larry Ramdin<lramdin@Salem.com>wrote:
• Janet,
Thanks! Letter was still in mailbox,retrieved corrected and it out for mailing. Copy of corrected
letter attached
Sincerely
Larry
Larry Ramdm MPH, MA, REHS, CHO, CP-FS, HHS
Health Agent
Salem Board of Health
120 Washington Street
Salem MA 01970
978-741-1800 (office)
978-745-0343(Fax)
Office Hours
Monday- Wednesday 8:00 am—4:00pm
Thursday 8:00—7:00 pm
Friday 8:00 am- 12:00 noon
From: Janet Greene [mailto:cireenegma@yahoo.com]
Sent: Wednesday, August 17, 2016 7:44 PM
To: Larry Ramdin
• Cc: Kim Driscoll; Heather Famico; crowdersl @comcast.net; Jeremy Schiller(idschiller@gmail.com);
Paul.B.Kirbv@gmail.com; Shama Alam; Dominick Pangallo
Subject: Re: Marley Properties
https://mail.salem.com/owa/?ae=Item&t=IPM.Note&id=RgAAAAD5kmxKHyBFS6%2bfZ8emdaXoBwBpDbKjN 1 nYQoeXF05XEP07AAAA8RewAABpDbKjN 1 n... 1/2
7/11/2017 Re:Marley Properties
Glad you are following through on this. However,I could not tell from your letter if you gave
them 24 hours or 24 days to fix problem
Janet
Sent from my iPad •
On Aug 17,2016,at 5:46 PM,Larry Ramdin<lramdin@Salem.com>wrote:
Hello
I have been dealing with a complaint of ongoing offensive odors and what can be
loosely described as "Dumpster juice" leaking from trash dumpster at Museum place
mall and washed onto New Liberty street ending up in the storm drain.Despite
having dealt with similar issues last year,and contacting Marley Properties about the
issue on August 5-71h, the nuisance continues.The Dumpster is located next to the
garage entrance and across from the visitor center.
I have sent the attached order to Marley Properties and will take action as necessary
to get the nuisance abated.
Sincerely
Larry
Larry Ramdin MPH, MA, REHS, CHO, CP-FS, HHS
Health Agent
Salem Board of Health
120 Washington Street
Salem MA 01970
978-741-1800 (office) •
978-745-0343(Fax)
Office Hours
Monday-Wednesday 8:00 am—4:00pm
Thursday 8:00—7:00 pm
Friday 8:00 am- 12:00 noon
Please note the Massachusetts Secretary of State's office has determined that most emails to and
from municipal officials are public records.FMI please refer to:http://www.see.State.ma.us/
pre/nreidx.htm.
Please consider the environment before printing this email.
<Nuisance Order Marley Properties 8-16-2016.docx>
<Nuisance Order Marley Properties 8-16-2016.docx>
•
https://mail.salem.com/owa/?ae=Item&t=IPM.Note&id=RgAAAAD5kmxKHyBFS6%2bfZ8emdaXoBwBpDbKjN l nYQoeXF05XEP07AAAA8RewAABpDbKjN I n... 2/2
7/11/2017 Museum place mall dumpster area
Museum place mall dumpster area
Heather Famico
• Sent:Saturday,August 27,2016 10:07 PM
To: Larry Ramdin
FYI - just saw rats under there as I was walking by.
Sent from my iPhone
•
https://mail.salem.com/owa/?ae=Item&t=1PM.Note&id=RgAAAAD5kmxKHyBFS6%2bfZ8emdaXoBwBpDbKjN]nYQoeXF05XEP07AAAA8ReyAABpDbKjN I n... I/I
7/11/2017 Gmail-Museum place mall dumpster
Gmai! Heather Famico <heather.famico@gmail.com>
•
Museum place mall dumpster
1 message
Heather Famico<heather.famico@gmail.com> Sat,Aug 13, 2016 at 3:47 PM
To: Larry Ramdin <Iramdin@salem.com>, David Cody<dcody@salem.com>, Kim Driscoll <kdriscoll@salem.com>
Please see attached. Dumpster smells terribly again.Also, it is overflowing.This dumpster does not have sprinklers
above it either.
�i IMG_6454.JPG
353K
•
•
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver—iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=156857]9d47d... 1/1
7/11/2017 RE:Museum place mall dumpster
RE: Museum place mall dumpster
Larry Ramdin
. Sent:Saturday,July 30,2016 1:31 PM
To: Heather Famico
I went and have been in contact with them to remediate nuisance,they agreed to cleanup and deodorizing area,
said problems with village tavern will have chat with Tavern ownership on Monday re: trash disposal and issue
maintenance order
Sent fi-om my Verizon,Samsung Galaxy smartphone
--------Original message --------
From: Heather Famico <hfamico@Salem.com>
Date: 7/29/16 11:08 PM (GMT-05:00)
To: Larry Ramdin<lramdin@Salem.com>
Cc: Kim Driscoll <KDriscoll@Salem.com>
Subject: Museum place mall dumpster
Hi Larry,
Just following up-were you able to check out the dumpster?The smell is extremely foul.It can be smelt throughout the garage and all
around the visitors center.p
Sent from my iPhone
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal officials are public
records.FMI please refer to:http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
•
https://mail.salem.com/owa/?ae=Item&t=IPM.Note&id=RgAAAAD5kmxKHyBFS6%2bfZ8emdaXoBwBpDbKjN 1 nYQoeXF05XEP07AAAA8RewAABpDbKjN 1 n... 1/1
7/11/2017 Gmail-Turners/opus(?)
h W,A
Gmai, Heather Famico<heather.famico@gmail.com>
•
Turners / opus (?)
4 messages
Heather Famico<heather.famico@gmail.com> Sun, May 8, 2016 at 9:37 PM
To: Harry Rocheville<h rochevi lle@salempd.net>
Hi Sgt,
Had some complaints from folks at the Essex about the bars next door emptying all their bottles out into barrels around 2-
3am.Would it be possible to speak with the establishments to have them do so when they open up for the day versus late
night?
Many thanks
Heather Famico<heather.famico@gmail.com> Sun, May 8, 2016 at 9:49 PM
To: Harry Rocheville<hrocheville@salempd.net>
Meant to add--the dumpster in the small public lot that abuts the Essex and One Salem Green is being picked up at
6am. Can that also be taken care of?
[Quoted text hidden]
Harry Rocheville<hrocheville@salempd.net> Mon, May 9, 2016 at 8:25 AM
To: Heather Famico<heather.famico@gmail.com>
Yes,
I talked to the once about it will do it again it's Opus!
• Harry Rocheville
Sergeant
Community Impact Unit
Salem Police Department
[Quoted text hidden]
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal officials
are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
Harry Rocheville<hrocheville@salempd.net> Mon, May 9, 2016 at 8:26 AM
To: Heather Famico<heather.famico@gmail.com>
Yes,
I hope they are calling PD so I can cite for violation!
Harry Rocheville
Sergeant
Community Impact Unit
Salem Police Department
[Quoted text hidden]
• Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal officials are public
records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=154957b6d99c... 1/1
7/11/2017 15 Lynde
15 Lynde
Heather Famico
• Sent:Monday, February 08,2016 4:01 PM
To: Larry Ramdin
Hi Larry,
I received a resident complaint re: the dumpster at 15 Lynde Street-a larger apartment complex. Apparently the building
does not recycle, so the dumpster is constantly overflowing and unable to shut(closer to the weekly pick up date of
Wednesday)
•
https://mail.salem.com/owa/?ae=Item&t=1PM.Note&id=RgAAAAD5kmxKHyBFS6%2bfZ8emdaXoBwBpDbKjN 1 nYQoeXF05XEP07AAAA8ReyAABpDbKjN I n... 1/1
7/11/2017 Gmail-Dumpster under garage
Gmail Heather Famico<heather.famico@gmail.com>
•
Dumpster under garage
4 messages
Heather Famico<heather.famico@gmail.com> Sun, Sep 27, 2015 at 12:53 PM
To: Larry Ramdin <Iramdin@salem.com>, Dominick Pangallo<dpangallo@salem.com>, "Thomas St. Pierre"
<tstpierre@salem.com>, Julie Rose<JRose@salem.com>
Please see attached image.
This has been an ongoing issue for months-not a good impression for residents or for visitors. (Happens several times a
week)
When will this be a thing of the past?
IMG_7330.JPG
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Heather Famico<heather.famico@gmail.com> Sun, Sep 27, 2015 at 1:05 PM
To:William Legault<legaultatlarge@mail.com>
[Quoted text hidden]
IMG_7330.JPG
2 384K
.4,
Julie Rose<JRose@salem.com> Mon, Sep 28, 2015 at 7:19 AM
To: Heather Famico<heather.famico@gmail.com>, Larry Ramdin <Iramdin@salem.com>, Dominick Pangallo
<dpangallo@salem.com>, "Thomas St. Pierre"<TStpierre@salem.com>
This is private pick up from Casella. Not sure if it's a City dumpster or PEM?
• Julie
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=15014354Od42... 1/2
7/11/2017 Gmail-Dumpster under garage
From: Heather Famico [mai Ito:heather.famico@gmaiLcom]
Sent: Sunday, September 27, 2015 12:54 PM
To: Larry Ramdin; Dominick Pangallo; Thomas St. Pierre; Julie Rose
Subject: Dumpster under garage •
Please see attached image.
This has been an ongoing issue for months-not a good impression for residents or for visitors. (Happens several times a
week)
When will this be a thing of the past?
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal officials are public
records.FMI please refer to:http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
Dominick Pangallo<dpangallo@salem.com> Mon, Sep 28, 2015 at 9:47 AM
To: Julie Rose<JRose@salem.com>, Heather Famico<heather.famico@gmail.com>, Larry Ramdin <Iramdin@salem.com>,
"Thomas St. Pierre" <TStpierre@salem.com>
I believe it is for the businesses in the mall. Larry, can you have someone check on this? It's private property and a
private dumpster, but it still may be a health code issue.Thanks!
From: Julie Rose
Sent: Monday, September 28, 2015 7:19 AM
To: Heather Famico; Larry Ramdin; Dominick Pangallo; Thomas St. Pierre
Subject: RE: Dumpster under garage
[Quoted text hidden]
https:Hmail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=15014354Od42... 2/2
a
7/11/2017 Gmail-Magarian Carpet dumpster
Gmail Heather Famico<heather.famico@gmail.com>
Ma arian r g Carpet dumpster
1 message
Heather Famico<heather.famico@gmail.com> Sun, Jan 3, 2016 at 12:09 PM
To: Larry Ramdin <Iramdin@salem.com>
Overflowing again.
https:Hmail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=15208776e979... 1/1
7/11/2017 Gmail-12/16 Magarian Carpet
Gm ail Heather Famico<heather.famico@gmail.com>
12/16 Magarian Carpet
1 message
Heather Famico<heather.famico@gmail.com> Thu, Dec 17, 2015 at 12:00 AM
To: Larry Ramdin <Iramdin@salem.com>, Heather Lyons<HLyons@salem.com>
Larry,
Attached find photos from tonight.The dumpster is overflowing again and the side of the building has rug padding that
emails could burrow in. Can the owners be required to have more pickups?
2 attachments
IMG_0538.JPG
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IMG_0539.JPG
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7/11/2017 Gmail-Sunday Gmail Heather Famico <heather.famico@gmail.com>
Sunday morning
1 message
Heather Famico<heather.famico@gmail.com> Sun, Oct 11, 2015 at 8:28 AM
To: David Cody<dcody@salem.com>, Larry Ramdin<Iramdin@salem.com>, Dominick Pangallo<dpangallo@salem.com>
Dumpster next to the garage has about.25 of a dumpster's worth of additional trash next to it. It looks like a dump.
•
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=15056dfdebd l... 1/1
I
7/11/2017 Gmail-Village Tavem
Email Heather Famico<heather.fam[co@gmail.com>
•
Village Tavern
5 messages
Heather Famico<heather.famico@gmail.com> Sun, Sep 27, 2015 at 12:58 PM
To: David Cody<dcody@salem.com>
Chief,
The Village Tavern has moved their smoking area back behind the dumpster again. Please see attached what the
dumpster looks like today, keep in mind that smoking is happening immediately next to this.
Please advise,
Heather
IMG_7330.J PG
384K
SA
• David Cody<DCody@salem.com> Sun, Sep 27, 2015 at 1:06 PM
To: Heather Famico<heather.famico@gmail.com>
Thanks councilor I will follow up on this.
Sent via the Samsung Galaxy S®6,an AT&T 4G LTE smartphone
[Quoted text hidden]
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal officials are public
records.FMI please refer to:http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
David Cody<DCody@salem.com> Tue, Sep 29, 2015 at 4:04 PM
To: Heather Famico<heather.famico@gmail.com>
Councilor,we have addressed this issue with both the Tavern and the owners/managers of the mall. I will keep you
updated as things progress.
From: Heather Famico [mailto:heather.famico@gmail.com]
Sent: Sunday, September 27, 2015 12:58 PM
• To: David Cody
Subject: Village Tavern
[Quoted text hidden]
https://mail.google.com/maii/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%o20dumpster&qs=true&search=query&th=150l e266l f86... 1/2
7/11/2017 Gmail-Village Tavern
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal officials are public
records.FMI please refer to:http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
Heather Famico<heather.famico@gmail.com> Tue, Sep 29, 2015 at 4:21 PM •
To: David Cody<DCody@salem.com>
Thanks Chief. Is it possible to have your department with the health department work with them on the condition of their
dumpster as well?/several times a week it is overflowing with boxes and paper= not only a fire hazard but also not a
pleasing sight for residents and visitors who arrive.
[Quoted text hidden]
David Cody<DCody@salem.com> Wed, Sep 30, 2015 at 8:07 AM
To: Heather Famico<heather.famico@gmail.com>
Yes,we are working on that it is the Marley's recycling dumpster for the entire mall but it is the Tavern that had the
mess along side of it.
From: Heather Famico [mailto:heather.famico@gmail.com]
Sent: Tuesday, September 29, 2015 4:22 PM
To: David Cody
Subject: Re: Village Tavern
[Quoted text hidden]
•
https://mail.google.com/mail/u/O/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=150l e2661 f86... 2/2
7/11/2017 RE:Dumpster under museum place mall garage
RE: Dumpster under museum place mall garage
Heather Famico
• Sent:Monday,August 10,2015 8:57 PM
To: Larry Ramdin
understood, but it is constantly overflowing. I will continue to send photos each time. . .
From: Larry Ramdin
Sent: Monday, August 10, 2015 5:51 PM
To: Heather Famico
Subject: RE: Dumpster under museum place mall garage
Heather,
This is the cardboard dumpster it was emptied today, we will continue to monitor
Sincerely
Larry
Larry Ramdin MPH, MA, REHS, CHO, CP-FS, HHS
Health Agent
Salem Board of Health
120 Washington Street
Salem MA 01970
978-741-1800 (office)
978-745-0343(Fax)
Office Hours
Monday- Wednesday 8:00 am — 4:00pm
Thursday 8:00 — 7:00 pm
Friday 8:00 am- 12:00 noon
• -----Original Message-----
From: Heather Famico
Sent: Monday, August 10, 2015 8:54 AM
To: Larry Ramdin; William H. Legault; Dominick Pangallo
Subject: Dumpster under museum place mall garage
Welcome to Salem! This is across from the visitors center and where many who visit and
live here park. An ongoing problem. Can it be fixed?
•
https://maii.salem.com/owa/'?ae=Item&t=IPM.Note&id=RgAAAAD5kmxKHyBFS6%2bfZ8emdaXoBwBpDbKjN 1 nYQoeXF05XEP07AAAA8ReyAABpDbKjN I n... 1/1
7/11/2017 Gmail-711
GmaiiHeather Famico<heather.famico@gmail.com>
711
3 messages
Heather Famico<heather.famico@gmail.com> Sun,Apr 12, 2015 at 11:12 AM
To: Larry Ramdin <Iramdin@salem.com>
Could this be looked into?
---------- Forwarded message----------
From: Timothy R.Jenkins<dolphinadv@verizon.net>
Date: Sunday,April 12, 2015
Subject:Turkey
To: Famico Heather<heather.famico@gmail.com>
Hi Heather:
Hope you're having a great time in Turkey.
Sorry to dump on you (pardon the pun)but Ithe 7-Eleven parking lot is, as usual, filled with litter,the dumpster is visible
and full and being picked over by seagulls.
I would love to see if we can get the health department over here and give them an order to keep this place clean and
maintained.
What you think? Enjoy!
• TJ
Tim Jenkins
804-678-9747 Cell
18 Broad St.
Salem, MA 01970
dolphinadv@verizon.net
Larry Ramdin <Iramdin@salem.com> Sun,Apr 12, 2015 at 3:07 PM
Reply-To: Larry Ramdin <Iramdin@salem.com>
To: Heather Famico<heather.famico@gmail.com>
Already working on it
Sent from my Verizon Wireless 4G LTE Tablet
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Sun,Apr 12, 2015 at 4:40 PM
To: Larry Ramdin <Iramdin@salem.com>
Thanks!
[Quoted text hidden]
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=]4caf5ceadd9l... 1/1
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7/11/2017 Gmail-Fw:Dumpster at 11-13 High Street
IMmail Heather Famico<heather.famico@gmail.com>
Fw: Dumpster at 11-13 High Street
2 messages
Bob Femino<pisces11 rf@yahoo.com> Wed, Sep 18, 2013 at 5:46 PM
Reply-To: Bob Femino<piscesl1 rf@yahoo.com>
To: Heather Famico<Heather.Famico@gmail.com>
Hi Again Heather,
The following was sent to Larry Ramdin (BOH Agent) and the.Mayor's office.
Please don't forget to send me the details about your debate. A few of us may want
to attend. Can anyone go, or is it just for Federal St. neighbors?
Bob
----- Forwarded Message -----
From: Bob Femino piscesllrf@yahoo.com
Sent: Wednesday, September 18, 2013 5:35 PM
Subject: Dumpster at 11-13 High Street
• Dear Mr. Ranidin,
Hopefully you remember meeting us during the Mayor's walk-through of the Endicott
Street neighborhood on July 18. We are the co-chairs of the Greater Endicott Street
Neighborhood Assn. (GESNA).
Attached are a few photos we took this morning of the dumpster at 11-13 High
Street. While we have seen improvement to this situation, we wanted to bring to your
attention that the landlord is still not fully complying to the standards set by the Board
of Health. The dumpster still overflows on any given day.
We are pleased, however, to note that Lifebridge is now doing a better job of keeping
their dumpster covered.
Also, we were wondering if the area is still being baited for rats. Two lethargic,
possibly poisoned rats were seen recently in the area, as was a dead squirrel with
no visible signs of sickliness or wounds.
GESNA will be holding a General Meeting on Tuesday, Sept. 24, 7 PM at 120
Washington Street. The rat and dumpster issues will be sure to come up again. If
you wouldn't mind responding to this message with what the current situation is
before that meeting, we would greatly appreciate having something to report to the
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=141389f445ab... 1/2
7/11/2017 Gmail-Fw:Dumpster at 11-13 High Street
neighbors and city officials on these points. Of course, you are more than welcome
to attend the meeting, too.
Thank you for all you've done and for your attention to this,
Bob Femino and Barbara Mann
GESNA Co-Chairpersons
2 attachments
r
,t v
11-13 HIGH Dumpster 9-18-13(1).JPG
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Y' 11-13 HIGH Dumpster 9-18-13(2).JPG
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Heather Famico<heather.famico@gmail.com> Thu, Sep 19, 2013 at 7:47 PM
To: Bob Femino<pisces11 rf@yahoo.com>
Hi Bob,
Thanks for the update on this matter. Please be sure to let me know what you hear back about this issue.
The forum is being held by HESNA and FSNA and is going to be held on Monday, September 30th at 7PM at the First
Church (next to the Witch House).The first 30 minutes will be a time for people to socialize before the QA period takes
place.They didn't specify that it's only for residents of those areas-so please join!
Good to see/chat with you at the polls!
Heather
[Quoted text hidden]
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&j sver—i ufS 2U4Cs3 s.en.&view=pt&q=in%3Asent%20dumpster&qs=true&search=query&th=141389f445ab... 2/2
7/11/2017 Gmail-HVAC at mall
mail Heather Famico<heather.famico@gmail.com>
HVAC at mall
27 messages
Elizabeth Gagakis <EGagakis@salem.com> Mon, May 8, 2017 at 3:56 PM
To: "heather.famico@gmail.com"<heather.famico@gmail.com>
Councilor,
Larry had asked me to check out the noise issue at the mall with their HVAC system. I've emailed back and forth with their
management office and she isn't sure what noise I'm referring to. I've contacted her to set up a time to meet her or one of
their staff out there to point it out and find out what they can do about it.
I'll let you know what happens—I will be at a training the rest of the week but will have access to my email, so hopefully I'll
be able to set up something to get out there with them next week.
Thank you!
Liz
Elizabeth Gagakis,REHS
Senior Sanitarian
City of Salem Board of Health
120 Washington Street,4th Floor
Salem,MA 01970
Phone 978-741-1800
Fax 978-745-0343
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal officials are public
records.FMI please refer to:http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
Heather Famico<heather.famico@gmail.com> Mon, May 8, 2017 at 5:12 PM
To: Elizabeth Gagakis<EGagakis@salem.com>
Thanks Liz,
Have you done a decibel measurement for that area?
When did you contact to set up a time to meet?
[Quoted text hidden]
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20hvac&qs=true&search=query&th=15cf93f5O7788743... in
7/11/2017 Gmail-HVAC at mall
Heather Famico<heather.famico@gmail.com> Fri, May 19, 2017 at 10:34 PM
To: Elizabeth Gagakis<EGagakis@salem.com>, Larry Ramdin <Iramdin@salem.com>
Bcc: Beth Rennard <brennard@salem.com>
Update?
[Quoted text hidden]
Elizabeth Gagakis <EGagakis@salem.com> Tue, May 23, 2017 at 11:18 AM
To: Heather Famico<heather.famico@gmail.com>, Larry Ramdin <Iramdin@salem.com>
Councilor, I met with Brett Marley and one of their maintenance men last week.At the time we were out there, standing at
the fountain we could not hear anything besides the construction vehicles working on the hotel and the HVAC system
above the Village Tavern entrance.There was not anything from the roof of the mall we could hear, and they said there
had not been anything broken down or that required work recently.
I'd like to maybe meet you out there so you can show me more exactly what you hear where? It'll help me show them so
they can correct any issues that exist. Let me know if that would work for you, I could do anything next week between
Tuesday-Friday.Thanks!
Liz
From: Heather Famico[mailto:heather.famico@gmail.com]
Sent: Friday, May 19, 2017 10:35 PM
To: Elizabeth Gagakis<EGagakis@Salem.com>; Larry Ramdin <Iramdin@Salem.com>
Subject: Re: HVAC at mall
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Tue, May 23, 2017 at 11:27 AM
To: Elizabeth Gagakis<EGagakis@salem.com>, Larry Ramdin <Iramdin@salem.com>
Larry has met me on site before and has heard what I have been speaking of. I've also pointed it out to others when
walking.
Will walk by this evening to hear the level of sound then.
Unfortunately with construction some sounds are not audible until the construction time of the day ends, which does not
align with the city schedule, usually.
There are other areas in the downtown as well that need servicing.There is constant humming.
For one example I will send you the video I sent last week of the Salem Five building on Essex street. I will work on
compiling a more complete list
I feel these things need to be fixed as the licensing board is looking at outdoor entertainment licenses that base the sound
on ambient noise levels.
[Quoted text hidden]
Larry Ramdin <Iramdin@salem.com> Tue, May 23, 2017 at 4:20 PM
To: Heather Famico<heather.famico@gmail.com>, Elizabeth Gagakis<EGagakis@salem.com>
I also visited today and had a discussion with the bank about the noise,they are in the process of replacing the HVAC
units and will prioritize.As an aside all noise has to be calculated into the background levels, e.g. during the work day
all work related noise should be measured if we are to establish background levels.
htt s://mail. oo le.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view= t& =in%3Asent%20hvac& s=true&search= ue &th=]5cf93f5O7788743... 2/7
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Sincerely
Larry
Larry Ramdin MPH, MA, REHS, CHO, CP-FS, HHS
Health Agent/Vice President NEHA Region 9
Salem Board of Health
120 Washington Street
Salem MA 01970
978-741-1800 (office)
978-745-0343(Fax)
Office Hours
Monday-Wednesday 8:00 am—4:00pm
Thursday 8:00—7:00 pm
Friday 8:00 am- 12:00 noon
From: Heather Famico [mailto:heather.famico@gmail.com]
Sent: Tuesday, May 23, 2017 11:27 AM
To: Elizabeth Gagakis; Larry Ramdin
[Quoted text hidden]
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Tue, May 23, 2017 at 5:37 PM
To: Elizabeth Gagakis<EGagakis@salem.com>, Larry Ramdin <Iramdin@salem.com>
Agreed, but especially w the evening (outside entertainment being proposed until 11 pm)id like the hvacs etc fixed up.
Is there any list of hvac units in the SRA area?
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Tue, May 23, 2017 at 8:52 PM
To: Elizabeth Gagakis<EGagakis@salem.com>, Larry Ramdin <Iramdin@salem.com>
I'm just getting home for the night(8:45). Units audible 1+blocks in both directions.
Another to add to your list to check on-Hawthorne hotel.
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Fri, May 26, 2017 at 6:52 PM
To: Elizabeth Gagakis<EGagakis@salem.com>, Larry Ramdin<Iramdin@salem.com>
There is a really bad one.Tavern has the deeper found but one is a higher frequency. I can hear it w my windows shut.
What evening can we meet?
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Fri, May 26, 2017 at 6:55 PM
https:Hmail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=i ufS2U4Cs3 s.en.&view=pt&q=in%3Asent%20hvac&qs=true&search=query&th=15cf93f507788743... 3/7
7/11/2017 Gmail-HVAC at mall
To: Elizabeth Gagakis<EGagakis@salem.com>, Larry Ramdin <Iramdin@salem.com>
Deeper sound
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Sat, May 27, 2017 at 3:41 PM
To: Elizabeth Gagakis<EGagakis@salem.com>, Larry Ramdin<Iramdin@salem.com>
I found the source of the constant higher sound last night! If you go onto the roof of the garage, go toward the Essex
Condos on the side that overlooks Essex Street. The HVAC units that are on the roof below you are the ones that are
emitting the constant higher pitch sounds. Here's a link to the video I took of it: https://drive.google.com/file/d/OB9e-D-
Kcl5 Zb1hlRmhmVzYtdTA/view?usp=sharing
This is the current list of the most obnoxious problem units that need to be fixed:
1. Roof of the mall (mentioned in the paragraph above)
2. Salem Five (Essex and Salem Green) https://drive.google.com/file/d/OB9e-D-Kcl5_ZZHJXWDIvYkVPa2s/view?usp=
sharing
3. unit above Village Tavern (to the right of their entrance)
4. Hawthorne Hotel
Here's a link I found as to what the sounds can be caused by, and solutions: https://learn.compactappliance.com/loud-
hvac-noises/
When will you take care of these?What are the next steps?Although I have been emailing for at least 2 years, I was
contacting the building department at first, and not health. The sounds near the mall I contacted about on 4/3. What is
the legal procedure for sound complaints? Do I need to contact the Board of Health to be put on an agenda, or does
contacting your office suffice?
The constant frequencies of#1, 2, 3 are affecting me greatly. It irritates my ears. When I am home it reminds me of
when you leave a loud concert and in the hours that follow your ears are irritated. The sound is affecting my sleeping, it
can be heard with my windows shut. I.know I live downtown, and I know there are other factors like people who are
outside walking and talking, but the sounds listed above are constant. I've been emailing about the humming sounds 0
since 2015, and 2 years later they are still going strong. I honestly believe the sounds have resulted in a hearing loss for
me.
i
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Sat, May 27, 2017 at 3:42 PM
To: Beth Rennard <BRennard@salem.com>
Beth,
See below. Also, can we meet on Friday 6/2 to review the outdoor entertainment proposal? Can you send me the latest
feedback when you're back from Texas please?
---------- Forwarded message----------
From: Heather Famico <heather.famico@gmail.com>
Date: Sat, May 27, 2017 at 3:41 PM
Subject: Re: HVAC at mall
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Fri, Jun 2, 2017 at 9:10 AM
To: Elizabeth Gagakis<EGagakis@salem.com>, Larry Ramdin <Iramdin@salem.com>
Update?When can this be taken care of?
[Quoted text hidden]
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent°/o20hvac&qs=true&search=query&th=]5cf93f5O7788743... 4/7
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Larry Ramdin <Iramdin@salem.com> Fri,Jun 2, 2017 at 5:36 PM
To: Heather Famico<heather.famico@gmail.com>
Let us discuss, I am in Monday abd Tuesday, my budget meeting Tuesday has been moved are u availabke after 4
Tuesday,
Bank is taking care of their unit
Sent from my Verizon,Samsung Galaxy smartphone
--------Original message--------
From: Heather Famico<heather.famico@gmail.com>
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Fri, Jun 2, 2017 at 5:53 PM
To: Larry Ramdin <Iramdin@salem.com>
I won't be back til 6pm...
[Quoted text hidden]
Larry Ramdin <Iramdin@salem.com> Fri, Jun 2, 2017 at 7:01 PM
To: Heather Famico<heather.famico@gmail.com>
Can do that
Sent from my Verizon, Samsung Galaxy smartphone
--------Original message---------
From: Heather Famico<heather.famico@gmail.com>
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Tue, Jun 6, 2017 at 6:01 PM
To: Larry Ramdin<Iramdin@salem.com>
Realized just now I didn't write back. I'm popping by old town hall.
If you aren't first on the budget agenda for tomorrow, could we meet right at 6? Unless tonight still?Or thurs?
[Quoted text hidden]
Larry Ramdin <Iramdin@salem.com> Tue,Jun 6, 2017 at 6:15 PM
To: Heather Famico<heather.famico@gmail.com>
It will have to be tomorrow, on my way out of town, 6:00 is good
Sent from my Verizon, Samsung Galaxy smartphone
--------Original message--------
From: Heather Famico<heather.famico@gmail.com>
[Quoted text hidden]
Larry Ramdin <Iramdin@salem.com> Tue, Jun 6, 2017 at 6:21 PM
To: Heather Famico<heather.famico@gmail.com>
https://mail.google.com/mai l/u/0/?ui=2&ik=87538d4a52&jsver=i ufS2U4Cs3s.en.&view=pt&q=in%3Asent%20hvac&qs=true&search=query&th=15cf93f5O7788743... 5/7
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7/11/2017 Gmail-HVAC at mall
It will have to be tomorrow, on my way out of town, 6:00 is good
Sent from my Verizon,Samsung Galaxy smartphone
--------Original message--------
From: Heather Famico<heather.famico@gmail.com>
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Tue, Jun 6, 2017 at 7:43 PM
To: Larry Ramdin<Iramdin@salem.com>
Thanks Larry.Where can we meet? My train arrives at 5:58
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Wed, Jun 7, 2017 at 5:32 PM
To: Larry Ramdin <Iramdin@salem.com>
Meet next to the fountain that is between Rockafellas and Fountain Place? I'll be there by 605
[Quoted text hidden]
Larry Ramdin <Iramdin@salem.com> Wed, Jun 7, 2017 at 5:35 PM
To: Heather Famico<heather.famico@gmail.com>
OK,see you there, I was just going to send an e-mail suggesting same
Sincerely .
Larry
Larry Ramdin MPH, MA, REHS, CHO, CP-FS, HHS
Health Agent/Vice President NEHA Region 9
Salem Board of Health
120 Washington Street
Salem MA 01970
978-741-1800 (office)
978-745-0343(Fax)
Office Hours
Monday-Wednesday 8:00 am—4:00pm
Thursday 8:00—7:00 pm
Friday 8:00 am- 12:00 noon
From: Heather Famico [mailto:heather.famico@gmail.com]
Sent: Wednesday, June 07, 2017 5:32 PM
To: Larry Ramdin.
https:Hmail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver—iufS2U4Cs3s.en.&view=pt&q=in%o3Asent%20hvac&qs=true&search=query&th=]5cf93f5O7788743... 6/7
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• Heather Famico<heather.famico@gmail.com> Tue, Jun 13, 2017 at 6:15 PM
To: Larry Ramdin <Iramdin@salem.com>
Any update?And, did you have the other locations I cited checked?Also, Salem 5 sound is getting worse.
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Wed, Jun 28, 2017 at 6:09 PM
To: Larry Ramdin<Iramdin@salem.com>
Larry,
What is the status of this?The AC that Rockafellas has in the alley is terrible too.
Please let me know,or let me know if I should petition the board of health to have the items put on their agenda.
Thank you
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Wed, Jun 28, 2017 at 7:04 PM
To:jdschiller@gmail.com
---------- Forwarded message----------
From: Heather Famico<heather.famico@gmail.com>
Date: Wed, Jun 28, 2017 at 6:09 PM
Subject: Re: HVAC at mall
• [Quoted text hidden]
Larry Ramdin <Iramdin@salem.com> Fri, Jun 30, 2017 at 8:21 AM
To: Heather Famico<heather.famico@gmail.com>
Heather,
Please feel free to ask the the Boh to,be heard
Larry
Sent from my Verizon,Samsung Galaxy smartphone
--------Original message--------
From: Heather Famico<heather.famico@gmail.com>
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Fri, Jun 30, 2017 at 9:44 AM
To: Larry Ramdin <Iramdin@salem.com>
Will do. Have already contacted them.
[Quoted text hidden]
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS 2U4Cs3s.en.&view=pt&q=in%3Asent%20hvac&qs=true&search=query&th=15cf93f507788743... 7/7
7/11/2017 Gmail-New loud hvac/AC units
Gm ail Heather Famico <heather.famico@gmail.com>
New loud hvac /AC units
3 messages
Heather Famico<heather.famico@gmail.com> Tue, May 16, 2017 at 10:05 PM
To: Beth Rennard <brennard@salem.com>, Larry Ramdin <Iramdin@salem.com>
Salem Five. Corner of Essex and Salem Green.Coming from AC registers. (One is to the left of the camera to the right of
the ATM door another to the left of'vault'on Salem Green.
Cabot Wealth Management building too.
These as well as the mall unit need to be fixed prior to any ambient noise measurements for licensing.
Heather Famico<heather.famico@gmail.com> Wed, May 17, 2017 at 9:00 AM
To: Beth Rennard <brennard@salem.com>, Larry Ramdin <Iramdin@salem.com>
Video taken from an Phone
https://drive.google.com/open?id=OB9e-D-Kcl5—ZZHJXWDIvYkVPa2s
On Tue, May 16, 2017 at 22:05 Heather Famico<heather.famico@gmail.com>wrote:
Salem Five. Corner of Essex and Salem Green. Coming from AC registers. (One is to the left of the camera to the right
of the ATM door another to the left of'vault'on Salem Green.
Cabot Wealth Management building too.
• These as well as the mall unit need to be fixed prior to any ambient noise measurements for licensing.
Heather Famico<heather.famico@gmail.com> Wed, Jun 28, 2017 at 7:04 PM
To:jdschiller@gmail.com
----------Forwarded message----------
From: Heather Famico <heather.famico@gmail.com>
Date: Wed, May 17, 2017 at 9:00 AM
Subject: Re: New loud hvac/AC units
To: Beth Rennard <brennard@salem.com>, Larry Ramdin <Iramdin@salem.com>
Video taken from an Phone
https://drive.google.com/open?id=OB9e-D-Kcl5—ZZHJXWDIvYkVPa2s
On Tue, May 16, 2017 at 22:05 Heather Famico<heather.famico@gmail.com>wrote:
Salem Five. Corner of Essex and Salem Green. Coming from AC registers. (One is to the left of the camera to the right
of the ATM door another to the left of'vault'on Salem Green.
Cabot Wealth Management building too.
These as well as the mall unit need to be fixed prior to any ambient noise measurements for licensing.
•
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver—iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20hvac&qs=true&search=query&th=]5ctOf30b8457f3c&... 1/
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Clap Heather Famico<heather.famico@gmail.com>
Hvac
6 messages
Heather Famico<heather.famico@gmail.com> Mon,Apr 3, 2017 at 5:46 PM
To: Larry Ramdin <Iramdin@salem.com>
Hi Larry,
Left a voicemail earlier but following up with an email--what's the status of the hvac noise issues downtown?The one in
the corner near the photo place and the one above villas tavern (when that one is on it's also terrible)
Larry Ramdin <Iramdin@salem.com> Mon,Apr 3, 2017 at 6:26 PM
To: Heather Famico<heather.famico@gmail.com>
Heather,
Passed it on to a member of my team for follow-up,will get back to you on it.
Sincerely
Larry
. Larry Ramdin MPH, MA, REHS, CHO, CP-FS, HHS
Health Agent/Vice President NEHA Region 9
Salem Board of Health
120 Washington Street
Salem MA 01970
978-741-1800 (office)
978-745-0343(Fax)
Office Hours
Monday-Wednesday 8:00 am—4:00pm
Thursday 8:00—7:00 pm
Friday 8:00 am- 12:00 noon
From: Heather Famico [mailto:heather.famico@gmail.com]
Sent: Monday, April 03, 2017 5:46 PM
To: Larry Ramdin
Subject: Hvac
•
Hi Larry,
https:Hmail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20hvac&qs=true&search=query&th=15cfOf32dc]77e00... 1/2
7/11/2017 Gmail-Hvac
Left a voicemail earlier but following up with an email--what's the status of the hvac noise issues downtown?The one in
the corner near the photo place and the one above villas tavern (when that one is on it's also terrible)
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal officials are public •
records.FMI please refer to:http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
Heather Famico<heather.famico@gmail.com> Sat,Apr 8, 2017 at 6:24 PM
To: Larry Ramdin <Iramdin@salem.com>
Did your team get to it last week?
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Sun, May 7, 2017 at 10:21 AM
To: Larry Ramdin<Iramdin@salem.com>
Hi Larry,
Any update on this?5/6 and still humming along ...
On Mon,Apr 3, 2017 at 18:26 Larry Ramdin <Iramdin@salem.com>wrote:
[Quoted text hidden]
Larry Ramdin <Iramdin@salem.com> Sun, May 7, 2017 at 10:49 PM
To: Heather Famico<heather.famico@gmail.com>
Liz will be in touch on this, i am out until Thursday, can we meet to discuss smoking issue
Sent from my Verizon,Samsung Galaxy smartphone •
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Wed, Jun 28, 2017 at 7:04 PM
To:jdschiller@gmail.com
[Quoted text hidden]
•
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20hvac&qs=true&search=query&th=15cfOf32dc]77e00... 2/2
7/11/2017 Gmail-Some questions
Gmai4 Heather Famico<heather.famico@gmail.com>
Some questions
11 messages
Heather Famico<heather.famico@gmail.com> Wed, Jan 18, 2017 at 4:21 PM
To: Larry Ramdin <Iramdin@salem.com>
1. Do HVAC unit sounds fall under health at all? Do you know if any cities have regulations?
2.Any time next Thursday for a meet up?
Larry Ramdin <Iramdin@salem.com> Thu, Jan 19, 2017 at 8:56 AM
To: Heather Famico<heather.famico@gmail.com>
It can be addressed as a noise issue, also we ca meet next Thursady, what is convenient for you?
Sent from my Verizon,Samsung Galaxy smartphone
[Quoted text hidden]
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal officials are public
records.FMI please refer to:http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
Heather Famico<heather.famico@gmail.com> Thu, Jan 19, 2017 at 9:12 AM
To: Larry Ramdin <Iramdin@salem.com>
But what about future projects,we always talk about screening the units...but is the volume discussed etc? I know
Burlington MA went through this with the mall. Do you know anything about that?
Next Thursday morning?
[Quoted text hidden]
Larry Ramdin <Iramdin@salem.com> Thu, Jan 19, 2017 at 9:45 AM
To: Heather Famico<heather.famico@gmail.com>
It is discussed st yhe one stop meetings snd should be s plsnning approval condition6
Sent from my Verizon,Samsung Galaxy smartphone
--------Original message--------
From: Heather Famico<heather.famico@gmail.com>
Date: 1/19/17 9:12 AM (GMT-05:00)
To: Larry Ramdin <Iramdin@Salem.com>
[Quoted text hidden]
Larry Ramdin <Iramdin@salem.com> Thu, Jan 19, 2017 at 9:49 AM
• To: Heather Famico<heather.famico@gmail.com>
I have a meeting next Thursday morning will be back in Salem by noon
https://mail.google.com/mail/u/O/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20hvac&qs=true&search=query&th=15cfOf3d722e03d6... 1/3
i
7/11/2017 Gmail-Some questions
Sent from my Verizon,Samsung Galaxy smartphone
--------Original message--------
From: Heather Famico<heather.famico@gmail.com>
Date: 1/19/17 9:12 AM (GMT-05:00)
To: Larry Ramdin<Iramdin@Salem.com>
[Quoted text hidden]
Larry Ramdin <Iramdin@salem.com> Thu, Jan 19, 2017 at 9:55 AM
To: Heather Famico<heather.famico@gmail.com>
Yes volume is discussed and they
Are required to control noise
Sent from my Verizon,Samsung Galaxy smartphone
--------Original message--------
From: Heather Famico<heather.famico@gmail.com>
Date: 1/19/17 9:12 AM (GMT-05:00)
To: Larry Ramdin <Iramdin@Salem.com>
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Thu, Jan 19, 2017 at 10:06 AM
To: Larry Ramdin<Iramdin@salem.com>
Could you take a walk by the east India fountain when pem work isn't happening to hear the HVAC?Also, there's another
loud one that can be heard in the lot that is behind city hall(the one that connects to the alley between church st and
Essex st) r
[Quoted text hidden]
Larry Ramdin <Iramdin@salem.com> Thu, Jan 19, 2017 at 10:26 AM
To: Heather Famico<heather.famico@gmail.com>
I asked Liz to check out Essex st,will do out on bereavement back Monday
Sent from my Verizon, Samsung Galaxy smartphone
------Original message--------
From: Heather Famico<heather.famico@gmail.com>
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Thu, Jan 19, 2017 at 10:28 AM
To: Larry Ramdin <Iramdin@salem.com>
Thanks Larry
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Tue, May 16, 2017 at 7:48 PM
To: Beth Rennard <brennard@salem.com>
Chain about hvac downtown.
This is the stuff that needs to be addressed before any outside entertainment is approved. It's part of ambient noise. •
Going to look at emails that were sent even before this(Jan 2017.. still going in may 2017)
----------Forwarded message---------
From: Heather Famico<heather.famico@gmail.com>
https://mail.google.com/mail/u/0/?ui=2&ik=87538d4a52&j sver=i ufS 2U4Cs3 s.en.&view=pt&q=in%3Asent%20hvac&qs=true&search=query&th=l 5cfOf3d722e03d6... 2/3
7/11/2017 Gmail-Loud hvac in vicinity of east India fountain
Gmall Heather Famico<heather.famico@gmail.com>
Loud hvac in vicinity of east India fountain
3 messages
Heather Famico<heather.famico@gmail.com> Fri, Jan 13, 2017 at 7:35 PM
To:Andrew Shapiro<ashapiro@salem.com>, Dominick Pangallo<dpangallo@salem.com>, Kim Driscoll
<kdriscoll@salem.com>, Michael Lutrzykowski <mLutrzykowski@salem.com>, "Thomas St. Pierre" <tstpierre@salem.com>
Hi all,
There is a VERY loud hvac in vicinity of east India fountain ... sounds like you're near a military aircraft.
Any idea of where it is/how to get it taken care of?
Heather Famico<heather.famico@gmail.com> Fri, Jan 13, 2017 at 7:35 PM
To: Larry Ramdin <Iramdin@salem.com>
FYI
[Quoted text hidden]
Heather Famico<heather.famico@gmail.com> Fri, Jan 13, 2017 at 7:48 PM
To: Mary Butler<mebutler@salempd.net>
Just an FYI
---------- Forwarded message---------
From: Heather Famico<heather.famico@gmail.com>
• Date: Fri,Jan 13, 2017 at 19:35
Subject: Loud hvac in vicinity of east India fountain
To:Andrew Shapiro<ashapiro@salem.com>, Dominick Pangallo<dpangallo@salem.com>, Kim Driscoll
<kdriscoll@salem.com>, Michael Lutrzykowski <mLutrzykowski@salem.com>, Thomas St. Pierre
<tstpierre@salem.com>
Hi all,
There is a VERY loud hvac in Vicinity Of east India fountain ... sounds like you're near a military aircraft.
Any idea of where it is/how to get it taken care of?
•
https://mail.google.com/mail/u/O/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20hvac&qs=true&search=query&th=1599a72c757827d7... 1/1
I _
7/11/2017 Gmail-HVAC(?)next to the fountain across from the PEM
Gmail Heather Famico <heather.famico@gmail.com>
HVAC(?) next to the fountain across from the PEM
1 message
Heather Famico<heather.famico@gmail.com> Sun, Sep 20, 2015 at 11:33 PM
To: "Thomas St. Pierre"<tstpierre@salem.com>, Michael Lutrzykowski <mLutrzykowski@salem.com>
Could you two check out the HVAC (?)that is next to the fountain across from East India Hall at the PEM? It's humming
loudly, and can be heard from Central and Essex with windows closed.
(Please note: I think it's that location..)
Thank you!
https:Hmail.google.com/mail/u/0/?ui=2&ik=87538d4a52&jsver=iufS2U4Cs3s.en.&view=pt&q=in%3Asent%20hvac&qs=true&search=query&th=14fedf6e 1 a2372a5... 1/1
•
MA Noise Laws
Interior Noise Code:
Massachusetts enforces a mandatory statewide building code to regulate both
airborne (measured as STC) and structure-borne (measured as IIC) noises in the
interior of residential buildings. All new construction must abide by these
ordinances to be considered compliant with the code.
The provision relative to noise, 780 CMR 1214.0, reads as follows:
780 CMR 1214.0 SOUND TRANSMISSION CONTROL IN RESIDENTIAL BUILDINGS
1214.1 Scope: 780 CMR 1214.0 shall apply to all common interior walls, partitions and
floor/ceiling assemblies between adjacent dwelling units or between dwelling units and adjacent
public areas such as halls, corridors, stairs or service areas in all occupancies in Use Group R.
1214.2 Air-borne noise: Walls, partitions and floor/ceiling assemblies separating dwelling units from each
other or from public or service areas shall have a sound transmission class (STC) of not less than 45 for air-
borne noise when tested in accordance with ASTM E90 listed in Appendix A. This requirement shall not
apply to dwelling unit entrance doors; however, such doors shall be tight fitting to the frame and sill.
1214.3 Structure-borne sound: Floor/ceiling assemblies between dwelling units or between a dwelling unit
and a public or service area within the structure shall have an impact insulation class (IIC) rating of not less
than 45 when tested in accordance with ASTM E492 listed in Appendix A.
Exterior Noise Codes:
Massachusetts also enforces an exterior noise ordinance, measured in decibels
(dB). While this ordinance provides a minimum compulsory requirement across
the state, individual towns and cities implement their own noise ordinances in
addition to the state-mandated law.
The ordinance for exterior noise, M.G.L. Chapter 111, Section 142A-M, reads as
follows:
A noise source will be considered to be violating the Department's noise regulation (310 CMR 7.10)if
the source:
1. Increases the broadband sound level by more than 10dB(A) above ambient, or
2. Produce a"puretone"condition—when any octave band center frequency sound pressure level exceeds
the two adjacent center frequency sound pressure levels by 3 decibels or more.
These criteria are measured both at the property line and at the nearest inhabited residence. "Ambient"is
•
i
defined as the background A-weighted sound level that is exceeded 90% of the time, measured during
equipment operating hours. "Ambient'may also be established by other means with consent of the
Department.
Ordinances Listed by City/Town:
Boston MA: Between the hours of 11:OOPM and 7:OOAM decible levels must
be no higher than 50dBA. At all other times, decible levels shall be louder than
70dBA. Click Here To View The Law.
Billerica MA: Different laws for different type of areas. Residential law: 60dBA
from 7:OOAM to 10:OOPM, and 50dBA from 10:OOPM to 7:OOAM. Click Here To
View The Law.
Braintree MA: During the daytime, the max decible levels can not exceed
60dBA. At all ofther times, it can not exceed 50dBA. Click Here To View The
Law.
Cambridge MA: Different laws for different type of areas. Residential law:
60dBA from 7:OOAM to 6:OOPM, and 50dBA at all other times. Cambridge also
specifies the max dBA at specific octive levels. Click Here To View The Law.
Everett MA: Between the house of 6:OOPM and 7:OOAM sound must be no
greater than 50dBA at property line. Click Here To View The Law.
Newton MA: Noise levels shal be no more than 10dBA above the background
noise level at property line. Click Here To View The Law.
Marborough MA: Different laws for different land classification. Residential
law: 53 dBA in the day time, and 43dBA at all other times. Marborough also
specifies the max dBA at specific octive levels, along with different dBA levels in
different land classification. Click Here To View The Law.
Somerville MA: Depending on the duration of the noise, Somerville has
different thresholds of maxiumin decible levels. Somerville classifies the duration
of noise in three groups; less than 10 minutes, between 10 minutes and 2 hours
long, and in excess of 2 hours long. With those groups, between the hours of
7:OOAM and 6:OOPM, the max dB levels are 75, 70, 60 respectfully. For the time
periods of 6:OOPM and 10:OOPM the max decible levels are 70, 60, and 50
respectfully. Finally for the hours between 10:OOPM and 7:OOAM, the max
decibles would be 60, 50, 40 respectfully. Click Here To View The Law.
Quincy MA: During the hours of 8:OOAM to 5:OOPM Monday - Friday, and
9:OOAM to 5:OOPM for weekends and holidays, the law states that the max
decibles is 75dBA. For hours after 5:OOPM, the max decibles would be
• 65dBA. Click Here To View The Law.
• Waltham MA: Noise levels shal be no more than 10dBA above the background
noise level at property line. Click Here To View The Law.
•
•
7/11/2017 Screen Shot 2017-07-11 at 2:08.30 PM.png
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1tF EEA Home > Agencies > MassDEP > Contacts&Locations> Noise Disturbances
File a Noise Complaint
In Massachusetts,Boards of Health(BOH)work closely with MassDEP to address environmental and public health
About MassDEP
complaints.The Board of Health is the primary responder for most noise disturbances in a community and works closely i t
with both MassDEP and with local police departments to ensure that noise complaints are properly addressed.
Who should I contact?
Contact your local Board of Health for noise disturbances from business operations and activities,from campgrounds u
and other outdoor venues and from heavy equipment such as heating and ventilation systems,air conditioners,other
rooftop machinery,wind turbines and construction.
Contact your local Police Department for disorderly conduct/disturbing the peace complaints and for noise
disturbances from recreational vehicles such as dirt bikes and ATVs.
A to Z Quick Links ► '
back to main complaints page i About MassDEP Index ►
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•
https://drive.google.com/drive/my-drive 1/1
f a c t s h e e t
LL71 Responding to Local Noise, Odor and
Dust Complaints
Across Massachusetts, environmental and public health officials are seeing an
M a 6 e B o n u e e 1 1 e increase in the number of noise, odor and dust complaints they are called upon to
D e p a r t m e n t
or handle.
ENVIRONMENTAL
P R O T E C T I O N
The local board of health or public health department is usually the first line of defense
against these and other nuisance conditions. Municipal officials can respond to
nuisance complaints in an informed, effective and timely way.
In some cases,the Department of Environmental Protection (DEP)can assist and
support local officials in their response, or take the lead in responding. This fact sheet
was developed to guide municipal officials as they follow up on nuisance complaints
and to help them determine when it might be appropriate to request DEP assistance.
Local Response
Most noise, odor and dust complaints can be handled on the local level. Boards of
health have broad authority under state law(M.G.L. Chapter 111, Sections 31C and
122)to investigate and control nuisance conditions. They and other local government
agencies are empowered by DEP (310 CMR 7.52)to take enforcement action against
• violators of DEP's noise, odor and dust regulations(310 CMR 7.09-7.10).
When investigating nuisance complaints, municipal officials should determine whether:
• Nuisance conditions unreasonably interfere with the enjoyment of residential
property and/or the operation of a business; and/or
• The source of the nuisance, if a business, has the necessary licenses, permits and
approvals to be operating and conforms to local zoning requirements; and/or
• Offending activities constitute a violation of local nuisance by-laws or ordinances
that may be more stringent than state regulations or statutes.
In many cases, those responsible for nuisance conditions are unaware of the problems
they are causing and, in the interest of being good neighbors,will willingly take the
necessary steps to solve them. In these instances, local officials need only notify the
offending parties.
Other cases may require local officials to exercise their skills of diplomacy and
mediation in helping the parties to a dispute reach an accommodation. For still others,
local enforcement action can be an effective solution. When these efforts are
unsuccessful, coordinating local actions with DEP follow-up may be necessary.
Local officials should keep a log of all complaints they receive and clearly document
their investigations and findings.
•
Responding to Local Noise,Odor and Dust Complaints•Page 1
i
How DEP Can Help
DEP can assist and support local officials in investigating noise, odor and dust
complaints and taking appropriate enforcement actions by:
• Providing policies, guidance and other forms of technical assistance;
• Answering questions and offering regulatory expertise on request; and
• Lending sound level meters and other equipment to boards of health or other local
agencies on request.
For details, contact the service center in the DEP regional office nearest you.
Telephone numbers are provided below.
Criteria for Direct DEP Involvement
DEP may respond directly to local noise, odor and dust conditions at the request of
local officials if:
Massachusetts Department of . The identity of the complainant(s) is supplied to the agency*; and
Environmental Protection
One Winter Street . Nuisance conditions pose a potential imminent hazard to public health or the
Boston,MA 02108-4746 environment, are causing significant impacts across municipal or state boundaries,
or are symptomatic of a serious environmental compliance problem; or
Commonwealth of
Massachusetts • There have been numerous complaints about the facility that is the source of the
Mitt Romney,Governor nuisance,there is a history of violations by the same party, or a state facility is
causing the problem; or
Executive Office of
Environmental Affairs • Local officials have pursued and exhausted all other avenues without successfully
Ellen Roy Herzfelder,Secretary resolving the matter; or
• The complaint is about a pure tone noise from a source that cannot readily be
Department of identified.
Environmental Protection
Edward P.Kunce, *Complainant names and addresses must be known to DEP, but under the Fair Information and
Acting Commissioner Practices Act(M.G.L. Chapter 644), the agency is required to keep all such information confidential
while any investigation or enforcement action is ongoing.
Produced by the
For Additional Information
Bureau of waste Prevention,
February 2003.
To learn more about responding to noise, odor and dust complaints or to request state
Printed on recycled paper.
assistance or support, please contact the service center in the nearest DEP regional
office.
This information is available in
alternate format by calling our • Central Region, Worcester: (508)792-7683
ADA Coordinator at . Northeast Region, Wilmington: (978)661-7677
(617)574-6872. • Southeast Region, Lakeville: (508)946-2714
L1 • Western Region, Springfield: (413)755-2214
Responding to Local Noise,Odor and Dust Complaints•Page 2
• Noise Pollution Po
licy Interpretation
Noise is a public health concern that falls within the scope of Massachusetts Department of
Environmental Protection (MassDEP) authority as a form of regulated air pollution(M.G.L.
Chapter 111, Sections 142A-M provide statutory authority for MassDEP's Air Pollution Control
Regulations,310 CMR 7.00, and the MassDEP Noise Policy�.
Definitions(310 CMR 7.00)
• Noise is defined as "sound of sufficient intensity and/or duration as to cause a
condition of air pollution."
• Air pollution means "the presence in the ambient air space of one or more air
contaminants or combinations thereof in such concentrations and of such
duration as to: (a) cause a nuisance; (b) be injurious, or be on the basis of
current information, potentially injurious to human health or animal life, to
vegetation, or to property; or (c) unreasonably interfere with the comfortable
enjoyment of life and property or the conduct of business."
When Does MassDEP Evaluate Noise Impacts?
MassDEP evaluates how noise may affect people when 1)the agency reviews applications for
approval under its air pollution regulations(310 CMR 7.02)for construction of facilities that will
generate more than threshold amounts of pollutants such as nitrogen dioxide, sulfur dioxide,
carbon monoxide, volatile organic compounds, particulate matter, and substances that are toxic in
air;and 2)the agency responds to complaints from the public about noise generated by an
existing source:
• When reviewing applications for pre-construction approval of new sources of air
pollution, MassDEP examines the potential increase in sound levels over ambient
conditions and the impacts of noise at both the source's property line and at the
nearest residence or other sensitive receptor (e.g., schools, hospitals) located in
the area surrounding the facility and occupied at the time of the permit
review. Please note: MassDEP requires that an air approval be obtained when
a proposed facility is expected to emit more than threshold amounts of specific
pollutants. If noise is the only air pollutant expected to be emitted by a facility, a
pre-construction air approval is not required.
• When MassDEP responds to a complaint about an existing source of noise, it
focuses on protecting affected people at their residences and in other buildings
that are occupied by sensitive receptors from nuisances and the public health
effects of the noise. Please note:An existing source of sound may or may not
have needed a MassDEP air approval before it was built.
Where Are MassDEP's Noise Criteria Applied?
The MassDEP noise pollution policy describes criteria that MassDEP uses to evaluate noise
• impacts at both the property line and the nearest occupied residence or other sensitive receptor.
• When noise is found to be a nuisance or a threat to health, MassDEP requires the source to
mitigate its noise.
Noise levels that exceed the criteria at the source's property line by themselves do not
necessarily result in a violation or a condition of air pollution under MassDEP regulations (see 310
CMR 7.10 U). The agency also considers the effect of noise on the nearest occupied residence
and/or building housing sensitive receptors:
• In responding to complaints, MassDEP measures noise levels at the
complainant's location and at other nearby locations that may be affected (e.g.,
residences and/or buildings with other sensitive receptors). If the noise level at a
sensitive receptor's location is more than 10 dB(A) above ambient, MassDEP
requires the noise source to mitigate its impact.
• A new noise source will be required to mitigate its sound emissions if they are
projected to cause the broadband sound level at a residence or building housing
sensitive receptors to exceed ambient background by more than 10 dB(A).
• A new noise source that would be located in an area that is not likely to be
developed for residential use in the future (e.g., due to abutting wetlands or
similarly undevelopable areas), or in a commercial or industrial area with no
sensitive receptors may not be required to mitigate its noise impact on those
• areas, even if projected to cause noise levels at the facility's property line to
exceed ambient background by more than 10 dB(A). However, a new noise
source that would be located in an area in which housing or buildings containing
other sensitive receptors could be developed in the future may be required to
mitigate its noise impact in these areas.
This policy has been designed to protect affected residents and other sensitive occupants of
nearby property, but not necessarily uninhabited areas in and around the source's
property. Sources of noise may need to implement mitigation if residences or buildings occupied
by sensitive receptors are developed where they may be affected by the source's noise.
•
•
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February 1, 1990
DAQC Policy 90-001
DIVISION OF AIR QUALITY CONTROL POLICY
This policy is adopted by the Division of Air Quality
Control. The Department's existing guideline for enforcing its
noise regulation (310 CMR 7.10) is being reaffirmed.
P O L I C Y
A source of sound will be considered to be violating the
• Department's noise regulation (310 CMR 7. 10) if the source:
1. Increases the broadband sound level by more than 10
dB(A) above ambient, or
2. Produces a "pure tone" condition - when any octave band
center frequency sound pressure level exceeds the two
adjacent center frequency sound pressure levels by 3
decibels or more.
These criteria are measured both at the property line and at
the nearest -inhabited residence. Ambient is defined as the
background A-weighted sound level that is exceeded 90% of the
time measured during equipment operating hours, The ambient may
also be established by other means with the consent of the
Department.
proved: br a 1 1990 Effective: lmmediately
Barbara A. Kwet
Acting Director
Division of Air Qua it Control
100% Recycled Paper