Minutes
Cape & Islands Health Agents Coalition Meeting
Friday, April 30, 2010
9:30 AM – 12:00 Noon
Dennis Police Department
90 Bob Crowell Road South Dennis, MA
Welcome!



Introductions
Approval of Minutes from March 19, 2010.
MOTION: To accept the minutes from the March 19th C&I HAC meeting. SECONDED.
PASSED UNANIMOUSLY.
Attendees:
Lee A. McConnell, BCDHE, Amy L. Wallace, BCDHE, Brian Baumgaertel, BCDHE, Amy
Morris, Harwich HD, Hillary Greenberg, Wellfleet HD, Paula Champagne, Harwich HD, Sue
Rask, BCDHE, Carl Lawson, Yarmouth HD, Elisabeth Haskell, BCDHE, Shirley Fauteux, Oak
Bluffs BOH, Maura Valley, Tisbury BOH, Jennifer Flood, Dennis HD, Robbie Hendricks,
Mashpee Wampanoag, Bruce Murphy, Yarmouth HD, Bob Canning, Orleans HD, Diane
Brown-Couture, MDPH, Nancy Ellis Ice, Brewster HD, Pat Pajaron, Truro HD, Lynn Mulkeen
Perry, BCDHE, Terry Hayes, Dennis HD, Peg Stanton, Barnstable HD, Glen Harrington,
Mashpee HD, Judith Giorgio, Chatham HD, Richard Ray, Nantucket HD, Jean Roma,
CCMRC, Jane Crowley, Eastham HD, Thomas McKean, Barnstable HD, Dave Carignan,
Falmouth HD, Carrie Furtek, Bourne HD, Brian Carlson, Provincetown HD, Sean O’Brien,
BCDHE (some attendees did not sign in today).
Unwanted Medication Disposal Options
Michael Maguire, Household Hazardous Waste Program
 Mike replaced Marilyn Lopes in the Household hazardous material program.
 HHW collections on CC.
 Operates sharps container, mercury container, flare collection and unwanted medical
disposal collections.
 He receives many calls from residents, FDs and transfer stations to accept unwanted
medications.
 Do not accept them at your dept. This is illegal.
 You must have a PD rep and a pharmacist at the collection and fill out paperwork with
DEP.
 Unless the PD is dying to do this, he doesn’t recommend doing collections because of cost
and where the waste ends up.
 Three types: Over the counter which goes into a garbage can and to the dump. The other
half is prescription meds. You need pharmacists at the collections to inventory all meds
and document, etc.
 There are a list of 25-30 meds that are hazardous. “Coumadin” and nitrous patches are
among those.
 If a town collects something like Coumadin, they can’t bring it to Sea Mass for incineration.
1





















The town usually will be stuck with a list of hazardous waste in buckets in a storage facility
at the PD.
You have to pay to dispose. Payment will also have to go to pharmacist and PD detail for
collection; and 15% residual fee for the hauler to come to the sight and destroy the
unwanted meds.
The hazardous waste company that is there that day takes on generator status (not the
pharmacy where the meds were distributed).
The town doing a collection takes on this liability when they host a collection.
Brochures are available. Mike recommends residents take meds, put in a zip lock bag,
crush, combine with hand sanitizer, make them unattractive and take labels off bottles.
Waste disposal goes to Sea Mass and the Bourne Landfill.
If a town wants an unwanted medication collection, there is one tomorrow in Barnstable.
You can stop in at the PD to see how it works.
Yarmouth has done one and will do another.
If you factor in PD detail, it can cost around $1K for the town.
The meds collection program pdf can be emailed to Amy to be distributed to all.
Jane: Noticed that CVS were noted on the collection.
PD says that prescription drugs are the number one contraband. The pharmacies are
interested in doing this but a regulated interest.
Jean: The CCMRC has five registered pharmacists available for deployment to your
collections. This might save the towns some money.
The homeowner receives the product and the pharmacies don’t have control over it, once
it is out of the pharmacy’s hands, they don’t own it. The homeowner does.
Yarmouth has done tremendous research on what their policy is.
CC Hospital has not done a lot to address this issue. They know there is pressure on this,
but only hospice and medical facilities in Yarmouth have changed their policies.
These are things we should think about in our communities to prevent this from being
flushed.
Does the FDA agree with disposing of all drugs this way?
There are 13 they don’t want flushed and these are listed on Mass DEP’s website. This
law may change to stop flushing.
Does the flyer have liability if it recommends not flushing?
No, the brochure addresses it and we know the law will change to discourage flushing of
meds.
Farmer’s Market Food Safety Training & Education (.1 CEUS offered today!)
Kim Concra, Nutritionist, BC Cape Cod Cooperative Extension









Kim Concra joined us last summer to teach about food inspections and safety after a
disaster.
Kim has been going to the Food Safety Conference and has more nationally available data
coming soon. Today, she has brought a copy of her slides and a booklet to correspond to
this workshop.
This presentation comes from what she has learned through the GAP program.
Kim’s objective with this training is to provide an overview of Food Safety for Farmer’s
Markets by looking at available resources.
MA Food Code Supplement, GAP (Good Agricultural Practices) curriculum, out of state
resources for vendor training and consumer fact sheets.
Kim covers the history of some food borne illness.
Produce Outbreaks by Commodity are presented from 1996-2006.
Current problems with harmful microbes can include young children, the elderly, immunecompromised individuals.
Produce associated outbreaks affect business in that produce buyers and food retailers
addressing the issue because of their customers.
2































The problems of the harmful microbes can come from anywhere from harvesting to
packaging to marketing and distribution.
It happens from the farm to the fork!
There are many outbreaks associated with recreational water.
There isn’t much guidance on food safety for farm market vendors.
Kim lists the pros and cons and discusses that there is not formal training regarding food
safety, but what does exist is ServSafe and GAPs training.
ServSafe is extensive in covering microbial risk. Good focus on hygiene, how bacteria
grow – but it is geared to food service not to farms and farmer’s markets.
GAPs is national, starts at pre-planting level, provides templates for farm safety plan, and
certification is costly and auditors are paid from where their office is.
Kim shares the audit list for farms and farmer’s markets. This available online too.
There is a lot of education on hand washing.
This is important while farm workers are out picking, planting and processing. They must
understand how to use the facilities correctly if they are from another culture and have
been taught different habits due to poorer sanitation conditions.
Pathogens of concern in fresh produce: bacteria, viruses, and parasites.
If you want to be GAP certified, you have to go to a training.
There are shorter training, but not for certification. This training used to be long and
tedious with larger audiences. It’s been re-formatted through Cornell University to be
shorter and more efficient.
The handouts are available through the UMass website under nutrition information
training.
Kim discusses a food certification training program in Kentucky that specifically addresses
the sampling issues.
GAPS.Cornell.edu is the link for the GAPs training.
Farm market basics are essential in terms of a safety plan, education in the field on proper
harvesting, packing and storage procedures – FATTOM.
Kim also covers the basics AT farmer’s markets. A good list for cross checking local
market sellers. Store food six inches above ground, keep produce shaded, use spray
bottle of potable water, proper glove use, if it’s cut, it’s processed! Separate the food
handling from the money handling.
The booklet Kim provides is a great resource for educational information and guidance on
regulating this process locally.
What would help the C&I HAC with regards to farmer’s market food safety and vendor
training?
Please list these ideas on your evaluations.
ServSafe class coming soon in Mashpee.
Paula: Outreach to the coordinators?
Kim: I’m at the beginning of this program and I am in touch with some universities for good
solid answers.
Paula: We are at the beginning in the towns too. Harwich is trying markets every other
weeks. If we jump in, we can make it look like the standard with a training course.
Kim: You can make it a simple tutorial and the market managers can also be asked to take
a training.
Paula: We spent a lot of time with the market manager in our town.
Sue: Do you know where the markets are and who is in charge?
Kim: We have that. We have a good part of this network though the Buy Fresh, Buy Local
initiative.
Lee: When I called Bill Clark initially and we spoke of coordinating meetings with the
Health Agents and try to standardize the trainings. I will follow up to move this forward.
Kim: We will continue training in the off season. We had 40 people in early 2010 in
Bourne.
3



Barnstable and Falmouth point out the farmer’s markets also try to supply regular food
products like pizza. There are surprises to deal with each time a market sets up.
Sue: Some markets feel they don’t have to address food safety; or that if it’s made in their
kitchen its safe.
Kim: Start with the market manager to educate
Beach Sampling 2010 – Brief Follow Up Discussion
Bethany Sadlowski, Environmental Project Assistant


























Bethany returns to follow up on her discussion of beach sampling at the March, 2010
meeting.
The Dennis BOH voted not to enforce the regulation at this time and go to the state to
have the decision reversed.
Announcements from Bethany: I have sent out all the registration packets to the existing
semi-public associations to have them register with our program.
If you want us to handle the permitting, we will assign the number using the EPA ID
number. I will send you this info then in the mail. Forms are coming back in the mail
already.
The deadline is May 14th.
If I don’t hear from certain associations, I will contact you.
Sign examples are on the computer today. Sign o Rama will do these for $10 per sign.
The section on the bottom for water quality acceptable, are adhesive stickers and if you
have an exceedance, it doubles as a closure sticker. One time use and you can write on it.
The signs are not immune to being stolen or defaced. We will order a small amount of the
algae bloom stickers.
Even though Dennis will not enforce, it will use a sign that says “bathing water quality not
tested.” The Dennis BOH was “horrified” by the language.
Jane: What is the problem with the language?
Bacteria levels.
Any wording can scare the hell out of the public.
George: We have to make sure the sign focused on what is monitored. We made it say
and imply only what we did.
Richard: This signage has to go on beaches on the those we have tested over the years.
There is concern over right of ways and will these have to be tested and signed?
Bethany: It’s not definitive and the LBOH will have to make a judgment call. The state has
said that they will let you use your judgment.
Funding of the permits goes to the town?
Yes, that is correct.
George: Or you can use this permit money to be set aside for the beaches. If you collect it
in your town, it can go the black hole general fund. At the County we can set up a fund
account to feed the cost into it, and cover a person to help rabidly enforce this, verses not
enforce at all.
Richard: How many towns are anticipated a blue green algae issue this summer?
About Five towns.
Richard: I contacted DEP, George Zoto, and he came to Nantucket and sampled two
ponds of concern. He also agreed to monitor our ponds with our assistance. (He lives in
Barnstable). He will do our ponds for blue green algae.
Glen: We had the algae, we did not have the toxicity.
Richard: We had this and PR nightmare. We don’t want to go through this again.
George: If you have blue green algae concerns, send in a sample with your beach sampler
for the county to take a look at it.
Bob: Our town said it is an unfunded mandate and they will not do it. Licensing coming
through with this?
4













George: We have already signed our contract at the same level as last year with MDPH.
The same amount of samplers will work. We are not going to audit, we are protecting the
public health.
Terry: I had the beach director create new signs and applications are with him, otherwise
we are not enforcing any portion of it.
Bob: We are thinking of lands that are not thought of as bathing beaches and they still
want them sampled. We will continue doing what we did last year.
Tom: Do we anticipate earlier than expected algae blooms this year?
George: There will be some warning and then some mixing later this year. When it looks
like there is a bloom, send in a sample. Not all blue green algae create it. We did not bid
on the DPH contractor this year. We will do a rough cell count.
The County will order the signs at $10 a piece. You can get them through Bethany.
The semi-publics have ordered some.
If you are going to sign up semi-publics this year, please let me know.
George: Get your sign order in a.s.a.p.
Bruce: The case on sampling on both sides of the jetties, I haven’t heard back about this.
Terry: The reps from DPH
Can the Vineyard order signs even though you don’t do sampling for us?
Yes. The signs may take two weeks. Make your check to Barnstable County if you wish to
purchase signs through Bethany.
H1N1 Research Follow Up Discussion
Justeen Hyde, Public Health Institute of Cambridge, MA



















Justeen was hired by the Coalition of LPH a few months ago, made up of the public health
associations of which there are five.
They wanted follow up research on H1N1 actions and lessons learned across the state.
There were a lot of innovative practices that I can tell and share with others across the
state.
I want to start off that you planned for this for a long time, and you drew from that to face
problems along the way.
Did you work with new partners in your community? What did you do?
George: By arranging a meeting with all schools and educators initially to discuss what
might be coming, even before the state had answers. The target grouping at that time was
schools. This pulled those school leaders in one room with public health to discuss this.
CCMRC was also a “new” agency to work with - newly established.
We had a dysfunctional MRC down here, and now it is functioning.
Because we didn’t believe it could come up so fast, we hired at least 50 per diem nurses
to have them as a back up. A lot of towns used these and it worked out.
The biggest partner was the VNA, and worked out the potential grind of revenue
streamed/payed nurses, volunteer nurses.
We sat down with them and went over what we were going to do. Kept communicating on
what the towns’ needs were.
The VNA was asked to use their managerial strengths and direct the clinics. The VNA, the
School administrators.
Training: The county nurses and the MRC staff trained them.
Jean: The MRC used the school health institute, online training and the problem was with
the age group and vaccinating children.
Justeen: Would you make a recommendation to add pediatric immunization training?
Absolutely.
Governing officials involvement?
Stood back and let the local PH officials do their job. They knew we had been preparing
for this and “got out of the way.”
Town of Sandwich met with local pediatric offices and covered these issues.
5



























Paula: Very little vaccine usage to cover this in the private offices and I was surprised at
this.
The message to the state that there was a lack of coordination on vaccines and who was
going to do what. Especially informing the childcare providers who had what and who was
going to vaccinate.
Falmouth: It was irregular in that LBOH had always received vaccinations for children from
the state and then we were excluded.
We tried to pull up the slack, and shortly after, the state was giving the vaccine to the state
without telling LBOH, and kids were getting vaccinated at their pediatricians, and irregular
participation on our end because we were not informed. They did not tell us they had it
and not report to us on anything. LBOH was denied vaccine distribution and had to defer
to VNA with a provider number.
Would you have rather the vaccine come through the Health Department?
Yes.
Dennis: Most of the towns on the Cape ordered through the VNA. Next year, we would
individually order vaccine.
Mashpee: We were told by DPH to register regionally for vaccine. The towns with nurses
got their vaccine, and it was irregular. They were vaccinating and the towns without nurses
were not.
The VNA did a great job, but we did what we were told to do.
The VNA got small amounts and distributed this among 13 towns.
Pediatricians getting vaccine and paying for nursing staff and prepared, but not all people
showed up and cost some money and created some efficiency. There was no outreach to
the pre-schools.
CCMRC: School aged children were vaccinated in the schools. This prevented confusion.
As the island off of Cape Cod, we have a smaller population and partnered with Nantucket
Cottage Hospital. We were able to control what we had and where it went. Using hospital
resources. Other than the pharmaceutical industry botching production. This year we are
signing up the nursing offices providing vaccine. We will work around this.
In terms of delaying vaccine, what planned prevention work did you do?
CCMRC: Many brochures on caring for people at home and school nurses were educating
on hand washing.
Feedback from the schools? Yes, we built in education into the regional high school and
all the towns participated in Brewster, Orleans, Eastham, Truro, and Provincetown.
The movement of the consent form from the state was slow, too slow..
The communication during the vaccination clinic process was good with DPH, sometimes
the outcome of paperwork was not so good.
Out reach with bi-lingual caring for people at home literature.
Lessons learned for next year?
CCMRC: Working to train those bilingual volunteers to help staff hotline phones.
Pediatric clinics were a different experience.
Dennis: Our experience trying to regionalize down here was “we got screwed” and we will
get our own vaccine listing and do this on our own next time. We won’t go through the
regional process of disseminating vaccine. Working cooperatively was great, but there
were towns that only got eight doses.
The dosage and timing of vaccine arriving. And that was a frustration while we were
geared up and set up and ready to go – only to have the state, the Federal government
and media giving mixed messages about vaccine arrival.
The only thing that stopped the demand for vaccine in our community on Nantucket was
school vacation.
Development of new vaccine will take time, what would you do differently in preparation?
Nantucket: Plan for the same level of infection for next year. If it doesn’t show up, great, if
it does, we are working to not have it happen to us.
6


George: Someone might have looked at regional differences and where the epicenter is.
Develop that message on where it will go and send it from the State or Feds, and tell us
where the vaccine is being sent to, based on need or demand.
This would have been an underlying message out there. Without this it looked like we
were inept at delivering something we should have had. If the message is that the SE US
is receiving it based on need, the message can go to the public and keep them from
thinking we are not doing our job.
Updates:
 Nurses Update:




We were able to assist some towns with facility site set up.
If you need help with your call down list, contact the nurses.
The TAR for this year is being worked on and updated and you may be contacted for info.
Our plan is to update your EDS plan and distribute it on CD.
 C&I HAC Grant and Fiscal Update




If you have not gotten any of your invoices in, please submit them as we are trying to finish
this up.
We have a couple of fax toner cartridges available.
A couple of towns were in a bind and I have four with me today.
Next week, I am meeting with our grant coordinator to give you a final report of all five
grants we are using: PHER, PHEP and the two CDC grants.
 CC Medical Reserve Corps (MRC) Update





The MRC is really active on the Cape.
Projects include Adult immunization and Safe Sun Education and the Regional Medical
Sheltering.
Each team will have a leader and we are working on the guidelines now.
CCMRC appreciation luncheon is coming up next month on the 19th, you will see you
invitation if not already.
There may be a DPH summer intern to work with Jean and the CCMRC to do education
over the summer. It is targeted to adolescents. Let CCMRC know which beaches you
want.
 Multiyear Training & Exercise Plan (MYTEP) Update



The MYTEP schedule has been kept up including the EDS clinics and other trainings.
This was given from the Contracted Nurses to DPH.
The deliverable was met back in December but we continue to note our efforts for the
CDC.
 MDPH Update and News







In addition to the AAR that Justeen Hyde is working on. The state is doing one and the
Coalitions are doing them.
As soon as I get AARs, I will share them across Region 5.
It is important that these do not sit on the shelf.
Regionalization: this is something that DPH is encouraging, and there is conference call
coming up on this.
Join this call and weigh in with your thoughts and concerns. Now is the time to be heard.
This is important as a lot has been done regionally on the Cape and Islands.
I know nothing about beaches, but if you have questions and are awaiting guidance and
clarification from DPH, please work through the bureau of environmental health and set up
a meeting.
7
Vaccination Clinics Update:










200 doses of the Zoster will be registered through Clinic Ace.
As of the end of next week, we will be ready for registering.
Elisabeth: Are these multi-vaccine clinics? The PHEP funds for EDS clinics need a paper
trail in terms of metrics, a through put and communication and remind the people having
this clinic, you need to Cc the contracted nurses for a paper trail in terms of funding
requests.
The multi vaccine clinic is scheduled for the 20th and on the 23rd. This is for Zoster.
Yarmouth will host also.
Hep A clinic on June 3rd in Truro.
Also in Harwich sometime in June.
Upper Cape can have one in June, but we need a host.
The multi vaccine clinic will be hosted in Falmouth.
Publicity materials are on their way and being formulated and sent out by Sue.
Make sure you have a liaison there to handle the paperwork and documentation with
MDPH to access the funding!
News – Open Announcements – Handouts
Adjourn
8