Download Draft Agenda - Barnstable County Department of Health and

Minutes
Cape & Islands Health Agents Coalition Meeting
Friday, September 24, 2010
9:30 AM – 12:00 Noon
Dennis Police Department
90 Bob Crowell Road South Dennis, MA
Welcome!
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Introductions
Approval of Minutes from August 27, 2010.
No motion to approve minutes due to no quorum at this meeting.
Attendees:
George Heufelder, BCDHE, Lynn Mulkeen-Perry, BCDHE, Amy L. Wallace, BCDHE, Brian
Baumgaertel, BCDHE, Bob Collett, BCDHE, Nancy Ellis-Ice, Brewster HD, Pat Pajaron, Truro,
HD, Donna Lazorik, MDPH, Judith Giorgio, Chatham HD, Carl Lawson, Yarmouth HD, Matt
Poole, Edgartown BOH, Diane Brown-Couture, MDPH, Angela Waldron, Wampanoag Health,
Hillary Greenberg-Lemus, Wellfleet HD, Robbie Hendricks, MWT, Brenda Richerson, MWT,
Terry Hayes, Dennis HD, Sean O’Brien, BCDHE, Thomas McKean, Barnstable HD, Katie
Mueller, Cape Cod Volunteers, Bob Canning, Orleans Health, Jennifer Flood, Dennis Health,
Carrie Furtek, Bourne BOH (some attendees did not sign in today).
Fall, 2010 Flu Vaccine Update:
Donna Lazorik, RN, MS – Immunization Program, Bureau of Infectious Diseases
Mass Department of Public Health
 Donna is here to discuss updates on the flu season and has mostly good news
to share.
 Vaccine will come through this October and is recommended for ages 6
months and older.
 40 million more doses will be available than in the past.
 Manufacturers predict that 60% will be out by the end of September.
 MDPH purchased 1 million doses.
 Starting last week, DPH began allocating vaccine to local HDs.
 Next week, they will promote it out to schools.
 Two groups that are at increased risk for influenza are native Americans,
Alaskans and morbidly obese.
 These must have access to vaccine.
 Only a handful of confirmed cases representing all three strains have been
detected in Mass.
 It is hard to predict what we will be seeing this year.
 Handouts are on the table in back.
 There are three reimbursement projects available.
 Medicare roster billing – for 65 and older Medicare beneficiaries.
 Medicare reimburses for more than $25 per dose, allowing for revenue in your
town.
 Senior Advantage plans also get reimbursed as the same rate as Medicare.
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Younger than 65 and children. Commonwealth Medical developed contracts
with insurers and towns that wanted to participate.
One page form. Submitted to Commonwealth Medicine, which sent it out to the
appropriate health plans.
The health plans were reimbursing at a rate of $13.76 per dose.
George: Was this an open subscribership?
Donna: Yes, across the state.
There is going to be a webinar coming up and I will make sure the information
gets out.
We are encouraging towns to participate in these reimbursement projects.
Towns that have been doing this awhile to generate money for their revolving
funds and general funds when they go up to request their budgets.
If you are not doing it, you are leaving a significant amount of money on the
table.
There is a flyer from Public Sector Partners take a commission on claims
successfully reimbursed.
George: Does the reimbursement have to go to the town or can it go to the
VNA or for reimbursing contracted nurses.
Donna: It can’t go to commercial vaccinators. It can go to the towns (for the
young child reimbursement).
George: Can it go to the County to pay for vaccinator nurse services?
Diane: From our point of view it can, but it is an agreement between you and
the town.
George: We experienced last year we used different vaccinators per diem. It
might be reimbursable in this mechanism so we can keep serving the towns.
Donna: We started planning this during H1N1 and schools would be very
important. Last year there was PHER funding, and this year the Bureau of
Emergency Preparedness is trying to use this for flu season, and whether or
not this can be used to cover all your expenses – I don’t know.
Towns were able to use the PHER funding for their H1N1 flu clinics.
As of right now, MDPH has taken their concerns to the CDC. The CDC is
aware of the issue of using PHER funding for what is reimbursable. We don’t
know if we will be able to use it for seasonal flu clinics.
But, for school clinics, the reimbursable funding looks good.
Dennis: We have been doing the roster billing for the past five years and the
revolving account helps us buy vaccine and run the clinics.
Donna: Who will do school based clinics?
Edgartown, Falmouth may and one is scheduled in Chatham.
Donna: If you ordered flu mist you will get it but now we are out for future
orders. More than 70 K doses were ordered but it all went.
The 2009 H1N1 strain is included in this year’s vaccine with the seasonal flu.
There is no strain dominating this year.
It is likely that we will see all three.
Matt: The doses for children are the standard?
Donna: We still have thymerisol free doses. Most are .5 single dose vials.
You can request those specifically if you want those.
Donna is thanked by the Coalition for attending with this update.
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Regional Tobacco Control Update
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Bob Collett, Director – Barnstable County Regional Tobacco Control
During the past, the FDA had passed a set of its own regulations for specifically
cigarettes at retailers and how they can be marketed.
They prohibited terms like “light” and “mild”.
These will be removed from shelves because as of June 22nd, manufacturers are not
allowed to make items with these descriptors.
Smokers are under the misconception that these were safer to smoke than regular.
“Light” cigarettes are no safer than regular.
Science shows that smokers inhale these types of cigarettes deeper and get as many
toxins in their system. Your level of addiction increases.
You will not see these in your towns.
The level of inspections has increased lately. I have only found a few of these items
because they can see down the road what they have to do with them.
Most of these regs will be supplemental to the regs at the local level – and yours are
more stringent.
They are not going to enforce the 30 days, they will let them sell these products down
(and not hurt the retailers too much).
Question: So, will they stop producing or take the name off?
The pack looks exactly the same. Now, they will label it “medium” instead of “light”.
There are loopholes in this law. This is prohibiting the cancellation of the term
“medium” at this time.
They are getting around the law.
The misconception was out there widely, since the first Surgeon General report. Since
1965, light cigarettes have been out on the market.
There is a ban on vending machines. There is one left in Oak Bluffs.
The sale of cigarettes and smokeless tobacco is banned in establishments that are not
18 and older.
There are a few southern states that do not ban smoking entirely (indoors).
There is smoking and non-smoking sections in some restaurants in southern states.
The vending machine piece is pretty self explanatory under local regs.
Tobacco retailer training programs are covered on the next sheet (this is a reference
document Bob is using to guide everyone through the new regulation changes).
This is all stuff that we have on our local regs. 27 or under, you should ask for ID.
27 is consistent with what was used for alcohol (under 30).
The health effects of tobacco use must also be displayed. There is a pending lawsuit in
NYC and it may require graphic warning labels in the future. They do this in Canada and in
some places in Europe.
When people come in to buy cigarettes, they are coming in to buy newspapers and
other miscellaneous stuff. When you can suspend a tobacco retailer’s license for repeated
underage sales, you really hit them in the pocketbook.
If a guy has three sales in two years. The BOH suspends their license for 2-3 days.
That is about $10K in revenue.
It can stop the problem immediately as it is very effective. The thirty cents on the pack
of cigarettes they earn is not the issue; it’s the other items the smoker is buying that hits
the store hard.
There are three FDA offices working to do random checks in our towns from year to
year. The FDA will be around to issue a first violation. The first penalty is a training
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program, then a training program with a $250 fine and then $250 and $500 fines on up for
continued violations. On up to $5K.
We are limited in Massachusetts by the amount of fines that we can charge. It is
maxed out at $300.
But the feds are not under these restrictions and they can charge and charge again.
They have their own training program.
Question: Is there any chance that they will be in an establishment five times in three
years?
Bob: They will communicate with me at the local level.
They keep the tracking and communication system consistent to follow the violators.
They are current or former NTCP employees. They are leaving Mass Tobacco Control to
go the FDA.
There is really a huge disincentive now for retailers to sell to kids and the FDA will
come down hard.
There is a permanent suspension piece in most of your regulations.
On the next piece, restricting the sale of smokeless tobacco. Cigars are not covered.
This includes e-cigarettes, blunts, flavored tobacco products that I brought to show you
last time.
Bourne: How do you enforce this? Generally they use items like e-cigarettes in bars.
Bob: When someone violates, we get a phone call. If someone smokes in a restaurant,
we get a call. The e-cigarette emits vapor. Some would complain because they see a
vapor.
E-cigarette: It looks like a cigarette. You purchase a small cartridge or nicotine and
artificially lights and sends a vapor into the air. Some towns have banned them.
Some of the other components on the sale of distribution is the ban on marketing and
merchandising of free stuff. Coupon redemption is permitted as long as Massachusetts
laws are followed.
Things like Marlboro miles will now go away.
Tents at festivals in towns (similar to a wine tasting). They would have to establish that
it is “adults only” and they would have to get a local permit. On a national basis it might be
easier.
Cigar booths would have to get a DOR permit and a local permit.
Bourne: We have a new establishment coming in and he is doing cigars and tobacco
and it doesn’t say anything about cigarettes.
Bob: A tobacco permit is needed from the town.
During our inspections, I have come across vendors with no DOR permit. I report it to
the DOR. In re-permitting your establishments, they should be showing you a copy of their
permit each year. And it needs to be current.
These are good for two years. They are renewing now. They expire in even numbered
years.
In Wareham, there is something noteworthy to mention. The state is testing the waters
for limiting localities such as CVS, who sell tobacco products behind the counter.
Limiting the number of tobacco permits you issue is another item coming up. Like
liquor permits that get issued. If you place a higher value on the permits, you may get
more responsible retailers.
George: In the towns that have done this, are they developing the information on what
will result.
Pharmacies and grocery stores don’t rely on the same traffic as convenience stores.
In speaking with some of the pharmacists, they get it. They know the impact of
tobacco, but they don’t call the shots in terms of retail.
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Relative on recent inspections, we did a survey on what is out there. The compliance
checks this past quarter covered about 80% of the stores.
The cigar products keep changing and coming out with new items.
Mass Health does cover cessation services.
Another topic that the state is looking at taking on is addressing the problem of second
hand smoke in public housing. We have been waiting to see where this is going to go.
Many phone calls from residents complaining about neighbors. There is a person at the
state that is specifically working on this project. I can take care of calls on this type of
complaint if you refer the problem to me.
HUDD gave permission to all of their facilities to prohibit smoking if they want to.
Condo associations can do this too. There is one in Orleans.
The smoking rate among young adults is down to 15% in Massachusetts – I am glad to
announce this. We are marketing the right message to them.
The goal the state has come up with is to reduce smoking 5% by 2022.
This is ambitious. Materials are here for you to display in your offices on the subject of
smoke free homes.
Not trying to demonize a smoker but to take it outside instead.
Maybe take these to the Headstart office of WICC offices.
There are more available through the Mass Tobacco clearing house. I can order for
you or you can order on your own.
The people in the lower socioeconomic demographic are the heaviest smokers (and
drinkers and gamblers, etc.). That is why HUDD is getting involved and pushing the word
out there.
They are so overwhelmed with the other problems that exist there, they don’t look at
this as a big problem.
The smoking rate in the western suburbs of Boston, it is about 45. In the city, it is much
higher.
Tom: Have they found any correlation in the higher priced cigarettes? In New
Hampshire, they are cheaper.
Bob: For every 10% increase in cost of cigarettes, it results in a 4% decrease in usage.
Taxing is not liked, but the most effective strategy.
So, if prices go up, enrollment in cessation classes also goes up.
Cape Cod Volunteers
Katie Mueller, AmeriCorps-VISTA, Volunteer Initiative Coordinator
Cape Cod Volunteers is an initiative of the Cape Cod Foundation in partnership with
Barnstable County and CapeCodOnline.com
 We provide a one-on-one service that helps community members identify their own
interests and passions and then match them with meaningful opportunities to serve Cape
Cod. Cape Cod Volunteers also promotes volunteering in general to engage more people
in service to their community.
 To make it easier to get involved in volunteering, our website
(www.capecodvolunteers.org), launched in July 2010, serves as a database for Cape Cod
Volunteer activities.
 Many volunteers have asked:
Q: Where do I start? Before Cape Cod Volunteers, there was no comprehensive database of
volunteer opportunities. Many people found volunteer opportunities through neighbors or
friends, but reported dissatisfaction: perhaps the experience wasn’t meaningful, or it did not fit
the volunteer’s schedule, lifestyle, or interests. So we launched the Cape Cod Volunteers
website (www.capecodvolunteers.org) in July 2010 to act as a searchable database of local
volunteer activities. Users can use the site to search for volunteer opportunities based on their
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skills, interests, location, and however much or however little of a commitment they want to
make.
The other question that came up in the assessment was Q: What if it’s not the right fit
for me?
People are naturally afraid to commit to something they might not like. Because they don’t
know how to leave a volunteer position, they may stop themselves from getting involved and
miss out on all that volunteering has to offer. Cape Cod Volunteers helps individuals:
• identify their skills,
• figure out the best way to put those skills to use in the community,
• and guide them through the sometimes-overwhelming process of finding a meaningful
volunteer opportunity. We want to work with the volunteer until the right match is
made.
• Whether it’s showing people how to try out volunteer opportunities or walking them
through the process of leaving an opportunity that isn’t a proper fit, we can provide the
support that prospective volunteers need to figure out how they can have the most
impact in our community.
• We hear this question from many people. You can be sure that we are here to stay
because we have done the research and put three and a half years of development
into this organization. We have established that our top priority must be to match
volunteers with meaningful volunteer opportunities. We took the time to evaluate ‘what
worked’ and ‘what didn’t’ in prior attempts. We have developed a sustainable volunteer
network model to avoid being distracted by fundraising. Moreover, the development of
the Cape Cod Volunteers model was informed by a 2006 community assessment in
which 200 community members participated.
• Our top priority is to match volunteers with meaningful volunteer opportunities. By
taking the time to get to know prospective volunteers and by working with them to find
appropriate placements, we can point volunteers to places where their talents and
interests will have the most impact, thereby strengthening your corps of volunteers;
saving you resources; and ultimately building your capacity to further your mission.
When you register with us, we learn about your services, and later, when those perfect
volunteers come along, we will know where to send them.
• I just really want to emphasize that when people think website, they often think of
something stagnant. We’re more than that. We are here to serve you and to focus on
volunteer recruitment and matching the best volunteers for you to your organization so
that you don’t have to. You’ll also save your marketing funds because when Cape Cod
Volunteers is in the news, so are you. (In the first two months ALONE, we had already
been featured in several publications, including Cape Cod Times, Cape Cod
Magazine, and the Falmouth Enterprise.) And even though we’re only a few months in,
we’re already starting to hear about some positive volunteer matches made through
the Cape Cod Volunteers website.
• The website as the drop-in centers are still in the planning stages. You can start by
going to www.capecodvolunteers.org which will take you to our homepage.
• 2,500 unique visitors in < 3 months
• We can’t do CORI’s.
• The way it works, you register & post volunteer opportunities.
• The site provides feedback about spelling, if a section seems too long, which you can
override.
• Approval – screen for content, minor spelling/grammatical errors, if I think something
might be confusing to a volunteer, I’ll contact you for clarification, and we use
Guidestar to verify nonprofit tax status.
• Your opportunity turns up in volunteer search.
• Then, the volunteer contacts you.
Here are items you should have on hand:
 Primary contact's e-mail address, phone number, and mailing address
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Password for your agency
Employer Identification Number (EIN) -- optional
Background info (including agency's mission statement, history, and description of
services)
 Coordinator's name, e-mail, phone, and the address for each volunteer opportunity
listing
 Title of your opportunity listing, description, and dates (1 volunteer opportunity posting
should be posted during the initial registration process!)
 We also have tips for registering from volunteers themselves
 Upload your logo
 List your contact info so community members can contact you right through the site
 Let community members know about who you are. There’s a place to list your
 Mission
 Description
 History
There are 2 types of Volunteer Opportunities:
 Date-specific: Required to have one or more specific dates and expire when date has
passed. (e.g., you need volunteers to serve food at your annual fundraiser)
 Ongoing: Volunteer assistance is needed on a continual basis (e.g., stuffing
envelopes, filing, etc)
 Remain on website until you disable or delete them.
 You can specify things like how many volunteers you want, what kind of skills would be
useful, and when you want them.
 What you select here determines the “searchability” of your volunteer opportunity, or
what kind of searches will turn up your volunteer opportunity.
 You can see, I’ve checked off that the volunteer will be working with children ages 5-12
on weekdays and they have to be adults in volunteer opportunity form.
 When a volunteer is interested in your opportunity, they will get in touch with you by
phone, e-mail, or fax to learn more. This initial contact is known as an inquiry or
referral.
 An e-mail notification will be sent to the primary contact when a volunteer fills out a
referral form through the website for your volunteer opportunity.
 Once you start recruiting volunteers through the website, you can also use it to keep
track of volunteer hours. Volunteers can log hours themselves by submitting a claim,
which you review and approve.
 Or your organization can log hours for a volunteer by using the referral record that
matched them to the opportunity, and/or by using the Hours tab on your Agency
myHome page.
 Use the Wishlist to post the items your organization needs.
 In turn, volunteers can list items they wish to donate.
 Site users can browse the list and make a donation. You can also look through what
others have available to donate. If you find an item that your agency needs, you can
easily contact the donor to claim that donation:
 News Items are posted to educate Agencies on national or community events.
 Community Spotlight highlights upcoming volunteer opportunities and events.
 Both are posted by Administrators. They are helpful in recruiting or recognizing your
volunteers, or learning about upcoming professional training opportunities.
 Nov 1st: CCF initiative becomes CCV organization, led by current Foundation VP Lisa
McNeill and myself.
 Within first 2 months of public launch, we have had more than 2,000 unique visitors, 69
volunteer accounts.
 Katie Mueller: 508-790-3040 [email protected]
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Updates:
News – Open Announcements – Handouts:
C&I HAC Grant and Fiscal Update:
 As you know, there was a small subcommittee of folks (the Executive Subcommittee of
the C&I HAC) pulled together to review the payment compensation of the contracted
nurses and the director of the MRC.
 The results of this meeting had Jane Crowley, Paula Champagne, George and Sean in
attendance. It was putting Jean Roma into a step increase after she was there a year.
 The compensation for the nurses should remain the same.
 We will have to vote on this at some time. There are financial difficulties of the towns.
 Most folks felt the nurses are compensated on an appropriate level and on par with
what other coalitions were doing.
 Jean Roma had a COLA increase and would be put into a step increase.
 The conversation went for about ½ hour and there was general agreement.
 The rates for the nurses are $35 an hour and Elisabeth gets $45 an hour as the
Contracted Nurses coordinator.
 Jean Roma gets $25 an hour and would get an increase of $.75 cents an hour.
 Jean has done a great job and pulled together a great effort so we thought that this is
one way to show our appreciation.
 We need an MRC and she has done a great job at it.
 Terry: Jean was amazing in the interview.
 At the next meeting we will vote on this when we have a quorum.
 We have the purchase order in for MHOA.
 We are going to put in for other registrations as they come in.
 Terry: As I mentioned earlier the CDC has not come up with what is expendable. Next
year’s PHEP grant will be a one-time cut.
 This will allow the PHER to continue. They will likely cut our budget next year.
 George: Flyer on the Cranberry Workshop from Bill Clark at Cooperative Extension
has gone out to you all.
 I am working on CEUs for a portion of this.
 Some of the aspects of the Cranberry operations are relative to public health.
 I will contact Bill for the morning session speakers and credentialing for this.
 There is a $20 fee for the whole day, but the CEUs will only be offered for the morning.
 Bill has not gotten back to me yet on a reduced fee for only attending in the morning.
 The Health Agents grant will not cover the cost of this workshop.
 It may be 2.5 CEUs and Bill puts on a good program. The Mass estuary info will be
useful as well as the fertilizer issues.
CC Medical Reserve Corps (MRC) Update:
 No update
Contracted Nurses Update:
 Their update was emailed to the Coalition yesterday by Elisabeth Fuller-Haskell.
MDPH:
 Mentioned in an email sent out earlier this week, I am attending the SNS workgroup to
discuss issues related to the SNS and EDS.
 After the meetings, I will send out notes of the meetings along with any handouts that
are distributed.
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I will have the opportunity to bring issues and questions to this group, so let me know.
Last meeting, I brought up sharing information on rapid dispensing plans. We are
working on this in Region 5.
The other question I asked was for MDPH to come up with sample scenarios to come
up with for Anthrax. Timeline and protective actions.
It would be very different if we had an Anthrax event and it was picked up through
other agencies. How will this roll out through the epi point of view?
It will give a perspective on what type of challenges this will involve.
George: I would urge the agents to look at the Powerpoint that Diane sent out and look
at how people would stay in line for prophylaxis and the 50 survey questions. It
indicated that receiving the information from local health officials and from the state
would be interesting. It will be challenging.
Harvard school of Public Health put out the survey.
George: It will make us think about our educational outreaches.
Diane: PHER funds were discussed.
I also sent out a strategy for setting up the EDS. There was concern in Bristol on how
to avoid paying for Police detail even though some of the set up requires PD detail.
Seasonal Beach Sampling – Final Update:
 George: In your email you should have the final details.
 The season is done.
 The final bill will go to the state for your samples.
 The season went good.
Discussion:
 Terry: How many attended the Allergen training? This was a complete waste of time.
 As of October 1st, you have to let your servers know to ask if people have allergies.
 They came up with a definition of a menu board and a menu.
 It lists items at the food establishment and their prices. The examples were poor.
 I want everyone to know that by October 1st in Dennis, we will get the info out to all our
establishments. We will put a poster at each establishment that serves food.
 Wellfleet: We made a packet of info and a laminated poster. The establishments were
already aware of this.
 It was a waste of time and it could of have been done in less time.
 Terry: The issue of Michael Keller from an environmental corporation is brought up. He
has done two inspections in the last two months and the systems have failed.
 I am seriously contemplating requesting that he not turn in any inspection reports.
 One of the issues we had was that he would do an inspection and turn in a report and
not come in and look at our town requirements.
 Getting him to complete reports and follow up is very slow.
 The Housing Assistance Corp. in Dennis and the system that he inspected has now
collapsed and the house is unoccupied.
 The funding request from Falmouth is discussed. Dave Carignan requested funding
from the Health Agents Grant be considered for him to purchase a bullhorn for flu
clinics. He is not present today.
 All: We need to have bullhorn training when we get the bullhorn for David.
Adjourn
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