ANNUAL REPORT of the BOARD of HEALTH --1996

In the summer of 2002, James A. Gordon was re-appointed to a three-year term on the Board of Health. Mr. Gordon is a great asset to the Board and the Town of Framingham. The Board of Health reorganized--electing Thomas L. Treadwell, MD as chairman and Nelson Goldin as the board secretary. Mr. Gordon submits timely articles on current public health issues to the newspaper in order to further our goal of a healthier Framingham.

Homeland Security has placed a great emphasis on local Boards of Health as the first line of defense in a bio-terrorist attack. Both State and Federal officials have provided the Health Department’s staff with training and expertise in order to be better prepared in the event of an attack. The Board is a strong member of the L.E.P.C. which would take the lead in such an incident. Health Department staff participated in the simulated disaster exercise conducted by the L.E.P.C. in October. This exercise included a bio-terrorist scenario and the activation of our new mobile decontamination trailer at the hospital emergency room entrance. Framingham should be very proud of the Town’s establishment of a certified L.E.P.C. that could be used to address terrorism events as well as natural disasters that may occur. The L.E.P.C. can bring tremendous resources and expertise together to address these types of events should they happen in Framingham. The Board of Health has provided the community with literature, seminars and other educational tools so that the citizens of Framingham can be knowledgeable and vigilant in their daily lives.

A major task of the Board of Health is the surveillance of communicable diseases within the community. The public health nursing staff follows and tracks all diseases deemed dangerous to the public health by the Mass. Dept. of Public Health. This activity allows us to see and evaluate trends in disease within the community with the goal of preventing its spread from the source of infection. This activity is especially important in this new age of bio-terrorism. The Public Health Nurses continue to offer immunizations to children and adults during nurse office hours. Immunization clinics for high-risk groups are conducted throughout the year to provide services for residents in need. Tuberculosis surveillance and prevention remain a high priority at the Board of Health as well as our cardiovascular clinic and our educational activities. The flu vaccine was in short supply this year as the State Dept. of Public Health cut our allotment of vaccine by 20% this year. The Board of Health conducted seven clinics and was able to immunize almost 2200 Framingham residents. In addition, we offered adult immunization for tetanus and pneumonia at these clinics.

In 2002, the Board of Health received a severely under-funded grant of $59,000 to continue with its Tobacco Control Program. This reduction has decreased our tobacco control staff to one part-time person. Even with our reduced staff we are still aggressively educating retail merchants as to their role in preventing access to tobacco products by minors. This is accomplished by using compliance visits and compliance checks. On the Average, 94% of Framingham’s tobacco retailers did not sell cigarettes to minors during these checks. On our last round of compliance checks in late 2002, NO retailer sold to a minor. The Board of Health commends these retailers. The Board continues to be a strong advocate for smoke-free workplaces and smoke-free dining. In January 2002, the Board of Health revised their Regulations to preclude smoking in all workplaces in the Town—including bars and restaurants. The Regulation is to take effect on March 1, 2003.

The Environmental Health Section has seen a high workload over the past year from both food establishments changing owners and totally new establishments. In addition, due to budget constraints we lost one sanitarian for half the year. The Food Code governing the food service industry requires extensive training for our sanitarians. The new training is time-consuming and has also created a new workload on our sanitarians by requiring our department to impart this new knowledge to the operators of Framingham’s food service establishments. This is requiring our sanitarians to spend more time in each establishment. The new Food Code emphasizes safe food handling, storage and preparation as well as employee health and hygiene. Again this year, the staff has overseen septic system installations and repairs in areas of the Town with no public sewers and well installations in areas with no Town water. The Board of Health investigated 262 housing complaints in 2002. Recreational camps, public beaches, swimming pools, tanning and body piercing establishments are also routinely inspected by Board of Health sanitarians.

The Board of Health would like to express its appreciation to the staff, the medical community, and all the other Town departments for their assistance and cooperation in the past year.

Respectfully submitted,

Thomas L. Treadwell, MD, Chairman

Nelson Goldin, Secretary

James A. Gordon

The mission of the environmental health division of the Board of Health remains the same. The staff works to protect the community from any chemical, physical or biological agent that could adversely affect the health of the citizens of Framingham.

The major sub-divisions of this section include inspection of food establishments, bathing areas (Public beaches, semi-public swimming pools, and whirlpools), and inspection of residential housing units within the Town. The main focus of the food related inspections is the prevention of food-borne and water-borne diseases. These diseases are easily and commonly acquired through the introduction of contamination into food and water. Inspection and education of food service and bathing area personnel are the main tools used in this prevention activity. Inspections related to the food and water sanitation account for approximately 60% of the man-hours available in this division.

Under Chapter II of the State Sanitary Code, environmental health staff must investigate all housing complaints received by the Board of Health. These complaints must be closely followed until compliance is attained. In 2002, the Board received 262 complaints, which required approximately 4 inspections per complaint to gain compliance with the code. Lead paint determinations are also required in units where children under six reside. Trash improperly put out for collection, especially the large items and restricted items, have created many complaints to the Board of Health. A trash education program targeted at problem areas has shown great success.

The Title V regulations governing subsurface sewage disposal have resulted in more inspections and longer, more detailed reviews of septic system installations and repairs. The Board of Health has five Licensed Soil Evaluators on staff for this work. As the more rural areas of Town are developed the Board of Health will see more septic work as well as the installation of private water supplies.

Miscellaneous actions, primarily garbage and rubbish complaints, coupled with air and water pollution, noise and odor complaints also add to the total number of inspections accomplished by the division.

The East Middlesex Mosquito Control Project conducts a program in Framingham consisting of mosquito surveillance, larval and adult mosquito control, ditch maintenance and public education.

For the third consecutive year, the risk of mosquito borne transmission of West Nile Virus (WNV) continued to be a serious local concern. In 2002 there were 22 residents from the metropolitan Boston and Worcester areas that contracted WNV including 3 fatalities. There were also large numbers of crows and other birds that were killed by WNV. The Project participated in the State’s Surveillance and Response Plan to Reduce the Risk of West Nile Virus Transmission and Human Encephalitis. The Project also participated in research efforts to evaluate control methods against WNV species.

In 2002 mosquito populations reached peak levels in June. The adult mosquito surveillance program used traps to collect mosquitoes from as many as 4 Framingham locations per night. Between June and September mosquitoes were collected on 7 different nights. Selected trap collections in August and September were tested for WNV by the Mass. Dept. of Public Health.

The larval mosquito control program relies on the biological larvicide Bti (Bacillus thuringiensis var. israelensis). Bti is classified as relatively non-toxic by the EPA. An April helicopter application of Bti controlled mosquito larvae at 30.5 wetland acres. Field crews using portable sprayers applied Bti in the spring and the summer to 25 wetland acres when high densities of mosquito larvae were found breeding in stagnant water.

The adult mosquito control program used truck mounted aerosol sprayers at night to treat 4,101 acres when survey traps indicated high populations of mosquitoes. The Project used a formulation of resmethrin to control adult mosquitoes. Advance notification of the spray program was done through newspaper notices in the MetroWest Daily News, notices on the Project’s web site and via a recorded telephone message at 781- 893-5759.

The Project maintains waterways as a preventative mosquito control service that seeks to manage wetlands by reducing the buildup of standing water caused by obstructions such as sand, sediment and debris. An excavator was used to maintain 973 feet of the Eames Brook near Mt. Wayte Ave. The excavator also maintained 142 feet of a ditch on the north side of the Mass. Turnpike adjacent to Grove St. Field crews used hand tools to remove debris from ditches by Hartford St. and Underwood Ave.

The Project’s public education program is designed to develop awareness within the public and the private sectors as to their roles in mosquito control. The Project serves as a resource to residents, schools, municipal officials and the local media on controlling mosquitoes, breeding sites and mosquito borne diseases. A web page provides residents with information on mosquitoes, Project control programs and related topics. The website address is www.town.sudbury.ma.us/services/health/emmcp.

A review of this year indicates how the public health nurses continue to be a valuable resource to the town of Framingham. We anticipate that as we plan future programs at the local level, we will encounter problems that originate at the national level. These may include threats to the public health from communicable disease, environmental health issues and bio-terrorist concerns. Framingham’s public health nurses will continue to play a major role in assuring the health, safety and welfare of town residents and the greater Metro-West community.

The Framingham Board of Health continues to offer more hours of free nursing clinic time than any other Board of Health in this area. Nursing clinics are held twice daily as well as two hours of evening clinic weekly. We offer blood pressure monitoring, TB testing for those at high risk, lead screening for children 6 years old and under, and immunizations to children and adults. Services are FREE for town residents!

Nursing Clinic Hours are: Monday–Friday 8:30-9:30am and 4:00-4:45pm.; Monday Evenings 6-8pm.

Other clinics occur here at the office and in the community at different sites for the convenience of Framingham residents. We offer a Cardiovascular Clinic at the Callahan Senior Center every first Tuesday of the month. We operate this clinic with Metro-West Medical Center, who provides a doctor with whom the seniors can confer about their cardiac health while they get their blood pressure checked. This service is meant to supplement and not replace the senior’s own health provider. With the approval of the patient, health information is shared with the senior’s provider. This past year 261 people attended the clinic. We also held our annual dermatology clinic this year in our office to screen those at high risk for skin cancer.

Every year, the first two clinics of the flu season are held at the Callahan Senior Center for those 65 years of age and older and for those with medical concerns that put them at high risk. We offer flu shots to all adults, and pneumonia and tetanus shots to adults that are eligible. This year, even with a 20% reduction in vaccine from the State, we were able to offer flu vaccine to all who needed it. We held seven flu clinics this year for residents of all ages. Several clinics targeted specific populations at risk. This office participates in the Medicare B Reimbursement program. Last year, the town was reimbursed approximately $7000 due to the efforts of the staff of the Board of Health. Thank you all for your hard work.

One of the major programs this nursing department is responsible for is a regional Tuberculosis Chest Clinic. This state-funded clinic provides services not found elsewhere in our community and works to prevent the spread of tuberculosis in the community. We manage the clinic with the Metro-West Medical Center. It is strategically located in the out-patient clinic department and serves a population at high risk. Experts, who provide clinical evaluation and treatment, are readily accessible. A culturally sensitive atmosphere is provided with the help of trained interpreters. The public health nurses organize the clinic, arrange appointments for those in need, organize contact investigations and provide directly observed medication therapy with the help of the dedicated out-patient clinic staff and the support staff at the Board of Health. At one time, TB skin tests were offered routinely. Today we provide targeted testing for high-risk populations. In 1999, this office tested 1068 people. In 2002, 302 people were TB skin-tested in our nursing clinics because they were considered to be at high risk for acquiring tuberculosis. Those who needed further evaluation were referred to chest clinic. This past year, the percentage of patients who kept their clinic appointments, and were seen for evaluation and treatment has increased dramatically due to diligent outreach and follow-up by this office.

The nursing department of the Board of Health is responsible for the investigation of communicable illness in this community. The public health nurses receive information from and work closely with local doctor’s offices, the state department of public health (DPH) and federal agencies such as the Center for Disease Control. Working with these health agencies, the nurses are responsible for surveillance of illness and maintaining a database, both of which help to determine the etiology of disease. Recently, our statistical database was useful in tracking a mini-outbreak of chicken pox in the Framingham elementary schools over three months. (Last year we documented 4 cases; this year we had a total of 21 cases.) The incidence of most communicable illness leveled off. An exception was an increase of reported Lyme Disease, which tripled from 11 cases in 2001 to 32 cases in 2002. We continue to have a significant incidence of Hepatitis with 47 cases this year. Salmonella cases were cut in half, from 14 cases last year to 7 cases in 2002.

This office would like to note all the local, state and federal agencies that have worked so well with this office over the past year. We appreciate the guidance and support we can count on from the Mass. Division of Tuberculosis Prevention and Control. We participate in the Immunization Initiative with DPH and value our strong working relationship as this state funded program helps us to offer free immunizations to all. We continue our close association with Metro-West Medical Center; sharing responsibility for the regional Chest Clinic. This office also helps to staff the MWMC out-patient pediatric clinic twice a week and we have jointly sponsored health programs in the community. We thank all the departments of the hospital that collaborate with us and help us to provide health care for needy populations in this community. We would also like to thank the American Cancer Society, the American Heart Association, and WIC. It is with the cooperation and support of these organizations and the health information and materials they provide, that we have been able to hold health fairs and various events that benefit the community. With these and other agencies that we work in partnership with, we forge alliances and make healthy connections. This helps us in our goal to keep the public informed of good healthy behaviors. Did you get your flu shot this year? Are your kids fully immunized, especially your children under school age? When was the last time you had a tetanus shot? Tuberculosis is preventable-- are you at risk? Want more energy this new year? Quit smoking!! Help us to promote a healthier Framingham!!

The Framingham Board of Health’s Tobacco Control Program (the “Program”) is funded by the Massachusetts Department of Public Health (MDPH) through the Health Protection Fund. The Health Protection Fund was established upon passage of voter referendum Question 1 in November 1992. Partial funding is also provided by the Master Settlement Agreement, an agreement between the Attorneys General of most states and the tobacco industry. The Program enforces the Framingham Board of Health’s “Rules and Regulations Relative to the Sale, Vending and Distribution and Use of Tobacco within the Town of Framingham,” and the Town of Framingham Bylaw, Article V, Section 5 “Clean Indoor Air”. The Program outreaches and educates the Framingham Community on tobacco issues and policies.

In the beginning of 2002 the Program had a budget of $96,598. During the year the state made four budget cuts to the program. The Program budget, as of December 31, 2002, was $59,639. These budget cuts resulted in the Program Director working part-time rather than full-time, and the elimination of the enforcement agent.

Under the current bylaw, establishments without a liquor license or those with a liquor license but without a separate bar area, must be 100% Smokefree. Establishments with a liquor license may allow smoking in a separately enclosed bar area, provided that minors are not allowed in the area, that food is only incidental to the alcoholic beverages served in the bar area and that access to common areas (e.g. bathrooms) is not through the bar area. Establishments holding Club Alcohol licenses and bars, as defined in the Bylaw, may have smoking provided that certain conditions are met.

The Board of Health had already enacted comprehensive regulations that protect the public from secondhand smoke and also control minors’ access to tobacco products. The “Youth Access” provisions of the regulations included licensing of all tobacco merchants, fining and possibly suspending the license of merchants who sell tobacco to minors, requiring that merchants train employees about laws concerning the sale of tobacco products, ensuring that all tobacco products are kept off of the counters and thus making it more difficult for minors to steal tobacco, and removing vending machines from all establishments into which minors can enter. The regulation also requires that each merchant post signage reminding clerks and minors about the illegality of selling tobacco to minors. The second part of the current Board of Health Regulations sections prohibits smoking in most public places and workplaces, with the exception of restaurants and bars. Schools are also exempt because they are covered by state law.

In January the Board of Health strengthened its regulations. The strengthened regulations broadened its definition of “public place” and “worksites” so that all public places and worksites, including bars and bar areas of restaurants are required to be smokefree. To eliminate the inconsistency between the new wording of the regulation and the existing bylaw, the Board of Health sponsored a warrant article for the May Town Meeting. The warrant article asked Town Meeting to rescind the bylaw. Town Meeting referred the article back to the sponsor. The modified regulation is scheduled to go into effect March 1, 2003.

In furtherance of ensuring that minors cannot purchase tobacco products in Framingham, the Program carried numerous compliance checks during 2002. The minors used were 15 to 17 year olds who looked their age and were dressed age appropriately. During those compliance checks minors entered all tobacco merchants at least once. The Framingham tobacco merchants had a compliance rate of 96% in 2002. The compliance rate for Framingham merchants has shown a steady increase since the FBOH-TCP began doing the checks. During the early stages of the Program, in August 1994, the compliance rate was 43% and in 1996 the compliance rate was 79%. The compliance rate was 90% in 1997, 91% in 1998, 93% in 1999, 94% in 2000 and 94% in 2001.

The Program publishes a quarterly newsletter which is sent to all tobacco merchants. The newsletter explains all tobacco laws, offers ways for merchants to be in compliance, gives information on tobacco related issues and keeps the merchants up-to-date on other relevant matters. Newsletter articles are translated into Portuguese to help Brazilian merchants easily understand the important issues. All merchants are also offered training programs to educate their employees on the proper way to conduct tobacco sales. Merchant education programs are tailored to the needs of the individual merchants are usually conducted in the stores at times that are convenient for the employees.

During the year the Program referred people who want to quit smoking to the Wayside Quit Smoking Program. This ensured that all residents and employees have access to affordable cessation programs in both English and Portuguese. The Wayside Quit Smoking Program, was funded through the MDPH, has group and individual counseling available to its clients. Due to statewide budget cuts the all cessation programs in the state, including the Wayside Quit Smoking Program were eliminated in December. There is currently no subsidized cessation available in the area.

The Program worked with the Framingham Fire Department on the “Take it Outside” campaign. The project raised awareness of the dangers of smoking indoors, including secondhand smoke and home fires. By raising awareness the goal of people not smoking in their homes could be met.

The MDPH sponsors numerous trainings and seminars for the Program staff. These trainings and seminars ensure that the staff is knowledgeable on all tobacco related issues. This is critical because tobacco issues are being discussed nationally and the Program staff regularly called upon to communicate this information locally. The Program staff continues working on statewide projects that will benefit the residents of Framingham

Revenues to the General Fund

Food Service Permits $47,476

Massage, Tanning, Body Piercing $ 3,130

Milk, Frozen Desserts $ 940

Tobacco Permits $ 2,234

Septic Permits $ 3,450

Copies $ 134

Test Strips $ 749

Rubbish Transportation $ 550

Recreational Camps/Motels $ 250

Pools/Whirlpools $ 4,100

Restitution Fees $ 125

Medical Re-imbursement $11,920

Other Dept. Revenue $ 244

FEES TO GENERAL FUND $75,405

PUBLIC HEALTH NURSE ACTIVITY REPORT

2002 Nursing Report

IMMUNIZATIONS-OFFICE	Jan	Feb	Mar	Apr	May	June	July	Aug	Sept	Oct	Nov	Dec	Totals
Hepatitis A	1	1	0	0	1	0	0	0	0	0	0	0	3
Hepatitis B	27	32	47	56	39	11	4	66	31	18	13	20	364
DTaP	4	0	1	0	1	0	0	6	5	5	3	0	25
Td	17	26	18	15	17	8	6	56	24	9	10	14	220
IPV	9	12	7	9

Reminder… Annual health program for women over 50!!

Day of Health and Safety… Nevin’s Hall, Memorial Building...May 3, 2003…8:00am-1:00pm

Metro-West Medical Center

Revenues to the General Fund