FY 2016 BEVERLY BOARD OF HEALTH ANNUAL REPORT
It is the mission of the Board of Health and its staff to serve as a resource intended to prevent, promote, protect and meet the multitude of public health related needs of the community.
The following is a summary of the programs and inspectional activities implemented and conducted by the Board of Health and its staff for the 2016 fiscal year (July 1, 2015 – June 30, 2016).
BOARD OF HEALTH
Frank S. Carbone, Jr., MD, Chairman
William J. Alpine, Jr., Esq.
Susan M. Higgins
Medical Director, Demetrious Rizos, DO, FACP, FASN
Inspector of Animals, Matthew J. Lipinski, Certified ACOAM, NACA
HEALTH DEPARTMENT STAFF
William T. Burke III, RS, CHO, Director of Public Health
Kathleen McCullough, Secretary I/Clerk of the Board
Joseph A. Reale, RS, Environmental Analyst
Mark Tolman, MBA, REHS/RS, CHO, Health Inspector (resigned 2/2/2016)
David Goodwin, Health Inspector (4/19/16 start date)
Karen Alpine, Principal Clerk
Teresa Kirsch, RN, BSN, Public Health Nurse
DENTAL CLINIC STAFF
Dawna Kowalski, D.M.D., Dentist (fee for service basis)
Judy Tanzella, RDH, Dental Clinic Hygienist
Andrea Schuster, Principal Clerk
ENVIRONMENTAL HEALTH
The Board of Health is responsible for directing and administering a program of environmental health related services for the city and its residents. The Health Department is responsible for enforcing numerous State Sanitary and Environmental Codes as mandated by state law. In addition to the mandated state codes, Massachusetts General Law, Chapter 111, Section 31, provides the Board of Health with the authority to make reasonable health regulations. The Health Department enforces these BOH Regulations as well. A variety of inspections are conducted to determine compliance with said codes and regulations. The following is a list of inspectional activities for FY 2016:
TYPE TOTAL #
Plan Reviews/ Compliance visit 223
Food Service Inspections 215
Food Service Re-inspections 122
Food Service Complaints 27
Retail Food Inspections 43
Retail Food Re-inspections 19
Retail Food Complaints 5
Mobile Food Inspections 6
Mobile Food Re-inspections 0
Temporary Food Inspections 11
Housing Inspections 72
Housing Re-inspections 20
Rooming House Inspections 17
Change of Occupancy Inspections 289
Change of Occupancy Re-inspections 18
Lead Paint Determinations 0
Nuisance/Trash Inspections 90
Nuisance/Trash Re-inspections 41
Recreational Camp Inspections 15
Recreational Camp Re-inspections 3
Semi-Public Swimming Pool Inspections 11
Semi-Public Swimming Pool Re-inspections 8
Tanning Facility Inspections 4
Tanning Facility Re-inspections 0
Soil Testing (Title 5) 11
Septic System Construction Inspections 16
Environmental Complaints 62
Court/Administrative Hearings 2
Food Related Hearings 0
Meetings, Seminars and Conferences 268
Beach Sampling (12 weeks) 121
Beach Re-Sampling 18
Animal Complaints 4
Body Art Establishment Inspections 4
Body Art Establishment Re-inspections 0
Body Art Practitioner License Review 1
Vaccination Clinics 3
TB Surveillance 1
Residential Kitchen Inspection 4
Biological Safety Establishment Inspections 5
NUMBER of PERMITS ISSUED FY 2015
Change of Occupancy………………………………………………. 269
Food Related………………………………………………………... 294
Caterers……………………………………………………………… 11
Tobacco Sales………………………………………………………... 47
Swimming Pools……………………………………………………... 10
Recreational Camps for Children…………………………………….. 13
Disposal Construction Installers……………….…………………… 12
Septic Haulers……..………………………………………………….. 6
Tanning Facilities……………………………………………………. . 4
Dumpster Contractors………………………………………………... 8
Body Art Establishments……………………………………………... 3
Body Art Practitioners…………...…………………………………... 9
Keeping of Animals……………….………………………………… 17
Biological Safety (formerly rDNA) ………………………..……….. 5
Funeral Directors……….…………………………………………….. 2
Motels………………...………………………………………………. 1
Bathing Beaches …………………………………………………….. 11
TOTAL…………………… 722
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In FY 2016 the department continued to collaborate with other municipalities and organizations to receive grants/awards and to obtain favorable service contracts. Examples include:
GRANTS/AWARDS
· $145,047–Public Health Emergency Preparedness Grant from the Massachusetts Department of Public Health (MDPH). The grant was awarded to a fifteen-community coalition called The North Shore – Cape Ann Emergency Preparedness Coalition. The purpose of the grant is to develop a regional approach to public health emergency preparedness and develop specific public health roles/plans for infectious disease events and other emergencies where public health has a response role. This year the Coalition focused on sheltering, planning for individuals who have limited mobility and/or face communication/language barriers and continued the testing of the setup and efficiency of clinics where medical countermeasures are dispensed.
· $13,340 – Medical Reserve Corp (MRC). Funding to recruit, train and drill medical and non-medical volunteers for the North Shore – Cape Ann Emergency Preparedness Coalition to be utilized at events and in cases of disasters within the fifteen communities that comprise the coalition. There are 712 trained credentialed medical and non-medical volunteers prepared to staff Emergency Dispensing Sites (EDS), Disaster Shelters and to support public health initiatives in our communities. Grant funding allowed the development of Disaster Sheltering Station Go Kits to support Emergency Management during shelter operations.
· $171,500 – MDPH North Shore/Cape Ann Tobacco Alcohol Policy Program (NS/CA TAPP). The grant was awarded to a fifteen-community collaborative. The purpose of the grant is to provide policy promotion, retail inspections and enforcement to all tobacco permit holders within the collaborative communities. The goal of the grant is to maintain a presence in the retail environment coupled with enforcement to decrease accessibility to age restricted products. NS/CA TAPP was provided additional funding in FY16 to support the ongoing pilot program funding an FDA inspector and to allow the collaborative some additional dollars for enforcement.
One complete round of compliance checks were conducted in the City of Beverly, with a 97% rate achieved. Additional checks were conducted by the FDA and violations were reported to the Health Department for enforcement action. Violators were subject to fines and/or permit suspensions. In addition, retail educational visits along with pricing surveys were carried out at all retail tobacco merchants.
· $25,000 – Massachusetts Department of Public Health District Incentive Grant (PH-DIG). The grant was awarded to eight community partners (Beverly, Danvers, Lynn, Marblehead, Nahant, Peabody, Salem and Swampscott) that comprise the North Shore Shared Public Health Services Program (NSSPHSP). The purpose of this grant is to provide financial support for groups of municipalities to enter into formal, long term agreements to share resources and coordinate activities in order to improve the scope, quality and effectiveness of local public health services for their combined populations. The following occurred in this fiscal year: two food inspectors were contracted for the eight communities to assist in environmental inspections; two Housing Authorities went smoke free (making a total of 5 in the region); one Housing Authority has committed to going smoke-free; outreach to private landlords to educate them about our smoke-free initiative; two regional Integrated Pest Management (IPM) trainings were held for Housing Authority staff members; a rodent control flyer was developed and distributed across the region; and a press release on mosquito awareness.
· $40,800 – North Shore Community Health Network – Asthma Grant. The North Shore Shared Public Health Services Program comprising of the communities of Beverly, Danvers, Lynn, Marblehead, Nahant, Peabody, Salem and Swampscott has received this renewable grant to reduce the risk of asthma in all eight communities by developing risk mitigation programs/strategies. A childhood asthma brochure regarding reducing environmental asthma triggers in the home was developed and distributed throughout the region.
· $750 MDPH Fluoride Rinse Grant - Provides fluoride and supplies for the Fluoride Rinse Program.
· $100,000 – MDPH - Massachusetts Opioid Abuse Prevention Collaborative Grant. The City of Gloucester Health Department/Healthy Gloucester Collaborative, City of Beverly Health Department/Be Healthy Beverly and Town of Danvers/Danvers Cares under the project name Partnership for Opioid Prevention and Leadership. The grant is for three years (FY16 is year three of the grant) with extensions to 2020 of funding at $100,000 per year to collaboratively address the issue of opioid misuse/abuse and unintentional deaths and nonfatal hospital events associated with opioid poisonings in these three municipalities. Local activities included the continued operation of a medication disposal drop box in the police station available 24/7/365, distribution of the Youth Risk Behavior Survey data and continued development and capacity building of the Beverly Substance Abuse Prevention Committee (the working group of Be Healthy Beverly). Regional activities included: use of mass media to increase public concern of misuse and change perception of harm/risk; improve screening and prescribing practices of family practice pediatricians and dentists; increase law enforcement inter-agency practice/policy to carry nasal Narcan and increase diversion to mental health and treatment service and “Defy the Opi-Odds youth campaign.
· $100,000 – MDPH – Substance Abuse Prevention Collaborative (SAPC) Grant. The focus of the grant is the prevention and reduction of underage drinking and other drug use in Massachusetts communities including Beverly in conjunction with the City of Gloucester (fiscal agent & programmatic sponsor) and the Towns of Essex, Rockport and Manchester. The grant is for $100,000 per year for three years (FY16 is year one of the grant) with potential renewals. Over the past year, Beverly in conjunction with the other four communities brought stakeholders together to determine top priority needs related to underage drinking and other drug use. Proposed interventions to be completed over the next two years of the grant include: increasing youth use of appropriate coping mechanisms, expanding screening practices of youth by healthcare providers, developing community norms awareness campaign about the harms of underage drinking and visible enforcement policy and practices to reduce youth alcohol access across the Cluster. Over the coming year, pending approval of these initiatives by MDPH, Beverly would receive training, capacity building and shared resources to strengthen strategies that address underage drinking and other drug use among youth in the community.
SERVICE CONTRACTS
· As a member of the Essex County Household Hazardous Collection Network, we were able to negotiate a very beneficial collection contract with Clean Harbors Inc. for 2014, 2015 and 2016. Although the full car rate increased by $2.50 from years 2011, 2012 and 2013 we received some other cost concessions with the overall pricing below the state contract prices. The collection network will meet in early FY 17 to begin contract discussions for the 2017 season.
· The City of Beverly continues to be a member of the Northeast Massachusetts Mosquito Control and Wetlands Management District. The district services include, but are not limited to: catch basin treatments, selective ground adulticiding, habitat surveillance and emergency aerial response.
The Board of Health/Health Department offered and sponsored a wide variety of community health, environmental awareness and educational outreach programs in FY 2016. Examples include:
COMMUNITY HEALTH
Ø Beverly Dental Clinic – Provides oral health services to schoolchildren who otherwise would not have access to care. The total patient enrollment in the clinic for FY 2016 was 184, a decrease from 216 in FY 2015. The Fluoride Mouth Rinse Program continues to be implemented by the school nurses at each elementary school. The clinic provides ongoing educational outreach. The clinic total insurance reimbursement for the year was $16,981. The reimbursement will be used to offset operating costs in FY 2017. For a complete summary of clinic activities please see the FY16 Beverly Dental Clinic Annual Report.
Ø Annual Seasonal Flu Clinics – Approximately 308 doses of seasonal flu vaccine were administered at our flu clinics in the fall of 2015, which included first responders. The 2015 flu clinics were staffed by a contingent of Public Health Nurses from neighboring North Shore communities as well as several RN-to-BSN students from local colleges. In partnership with the Beverly Public Schools’ Nurse Leader, the Public Health Nurse was able to provide a limited amount of vaccine for school nurses to administer to employees at their respective schools. The Health Department was able to give Mass Task Force 1, 20 doses for their volunteers. In addition, the Public Health Nurses of the North Shore held a Pre-Flu Season Planning/Informational Meeting to coordinate clinic dates.
The Health Department continues to contract with UMass Medical Center for Healthcare Finance to bill Medicare and private health insurance plans for purchased and state-provided seasonal influenza vaccine reimbursement and/or vaccine administration. They are paid 10% of paid claims and we have found an increase in the rate of reimbursement above and beyond that 10% fee since using them.
Ø Morbidity & Mortality - There were approximately 262 deaths of Beverly residents where death occurred within the community. These figures include deaths at Beverly Hospital, nursing homes, at home by illness and through accident or suicide. Heart disease and cancer continue to be major contributors to illness and death in the city.
Ø Animal Health - The Animal Inspector quarantined 58 animals for rabies, sent 4 animals into the state lab for rabies testing and conducted 19 site inspections of where animals are housed.
Ø Communicable Disease Surveillance – In accordance with 105 CMR 300.000: Reportable Diseases, Surveillance, and Isolation and Quarantine Requirements, the health department is responsible for investigating suspected and confirmed cases of reportable disease. The following reportable diseases were investigated this fiscal year:
Case Counts for Beverly (July 1, 2015 – June 30, 2016)Disease Name / Status / Event Counts
Babesiosis / CONFIRMED / 1
Babesiosis / REVOKED / 1
Babesiosis / SUSPECT / 2
Campylobacteriosis / CONFIRMED / 14
Cryptosporidiosis / CONFIRMED / 1
Ehrlichiosis / REVOKED / 4
Enterovirus / CONFIRMED / 2
Group A streptococcus / CONFIRMED / 2
Group B streptococcus / CONFIRMED / 1
Hepatitis A / CONFIRMED / 1
Hepatitis B / CONFIRMED / 1
Hepatitis B / CONTACT / 2
Hepatitis B / PROBABLE / 4
Hepatitis B / SUSPECT / 1
Hepatitis C / CONFIRMED / 12
Hepatitis C / PROBABLE / 14
Hepatitis C / SUSPECT / 1
Human Granulocytic Anaplasmosis / REVOKED / 1
Influenza / CONFIRMED / 40
Legionellosis / CONFIRMED / 1
Lyme Disease / CONFIRMED / 8
Lyme Disease / PROBABLE / 4
Lyme Disease / REVOKED / 2
Lyme Disease / SUSPECT / 53
Measles / REVOKED / 1
Meningitis Under Investigation / SUSPECT / 1
Mumps / REVOKED / 1
Pertussis (and other Bordetella species) / CONFIRMED / 1
Refugee / CONFIRMED / 3
Refugee Family / CONFIRMED / 1
Salmonellosis / CONFIRMED / 9
TB-Active / REVOKED / 1
TB-LTBI / CONFIRMED / 16
TB-LTBI / CONTACT / 1
TB-LTBI / REVOKED / 1
TB-LTBI / SUSPECT / 8
Trichinella spiralis / SUSPECT / 1
Varicella / CONFIRMED / 1
Varicella / PROBABLE / 1
Varicella / REVOKED / 2
Vibrio sp / CONFIRMED / 2
Vibrio sp / REVOKED / 1
Viral Meningitis (aseptic) / SUSPECT / 1
Zika Virus Infection / CONFIRMED / 2
Zika Virus Infection / CONTACT / 1
Zika Virus Infection / REVOKED / 5
Total Events/Cases / 234
The above cases do not include the numerous non-laboratory confirmed illness complaints requiring investigation and follow-up. Note that although some cases may be categorized as suspect, revoked or probable, most reportable diseases require an investigation by the local board of health. There were no cases of active tuberculosis (TB) in the city during this fiscal year, however the department is occasionally expected to assist with latent cases within the city. Such cases are usually associated with new arrivals to the United States. In addition, all animal bites reported to the city must be investigated to determine whether post-exposure rabies prophylaxis is recommended. The Public Health Nurse investigated 31 such hospital reported animal bites as well as numerous complaints of bites or scratches.