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Needham Board of Health

AGENDA Friday, September 9, 2016 7:00 a.m. – 9:00 a.m.

Charles River Room – Public Services Administration Building 500 Dedham Avenue, Needham MA 02492

• 7:00 to 7:05 - Welcome & Review of Minutes (July 29 & August 29)

• 7:05 to 7:30 - Director and Staff Reports (July & August)

• 7:30 to 7:45 - Discussion about Proposed Plastic Bag Ban Christopher Thomas, Needham Resident

• 7:45 to 7:50 - Off-Street Drainage Bond Discussion & Vote

• 7:50 to 8:00 - Update on Wingate Pool Variance Application

* * * * * * * * * * * * *

Board of Health Public Hearing

• 8:00 to 8:40 - Hearing for Proposed New or Amended BOH Regulations o Body Art o Synthetic Marijuana o Paraphernalia

• 8:40 to 8:50 - Board Discussion of Policy Positions

• Other Items (Healthy Aging, Water Quality)

• Next Meeting Scheduled for Friday October 14, 2016

• Adjournment

(Please note that all times are approximate)

1471 Highland Avenue, Needham, MA 02492 781-455-7500 ext 511 (tel); 781-455-0892 (fax) E-mail: [email protected] Web: www.needhamma.gov/health

NEEDHAM BOARD OF HEALTH July 29, 2016 MEETING MINUTES

PRESENT: Edward V. Cosgrove, PhD, Chair, Jane Fogg, Vice-Chair, M.D., and Stephen Epstein, M.D STAFF: Timothy McDonald, Director, Donna Carmichael, Catherine Delano, Maryanne Dinell, Tara Gurge GUEST: Kevin Mulkern, Aquaknot Pools, Inc., Keith Mulkern, Aquaknot Pools, Inc., David Friedman, Wingate, Paul Humphreys, Michael Tomasello, Callahan, Inc.

CONVENE: 7:00 a.m. – Public Services Administration Building (PSAB), 500 Dedham Avenue, Needham MA 02492

DISCUSSION: Call To Order – 7:06 a.m. – Dr. Cosgrove, Chairman

APPROVE MINUTES: Upon motion duly made and seconded, the minutes of the BOH meeting of June 17, 2016 were approved as submitted. The motion carried. The vote was unanimous.

DIRECTOR’S REPORT – Timothy McDonald Mr. McDonald’s report for June 2016 included an update on the Healthy Aging Through Health Design Project. Mr. McDonald stated that he expects to have a final report, in draft form, available for the Board’s consideration by Monday, August 8. He added that the Board of Selectmen would receive a presentation on this project in early September. Mr. McDonald stated the project includes information from the Qualitative Assessment with 21 Key Informant Interviews, Four Focus Groups, a Regulatory Design Review, a Quantitative Survey, and Research and Best Practices. Mr. McDonald stated that findings show that seniors want to stay in Needham but many cannot because of either fiscal constraints or physical movement within their homes. Mr. McDonald stated that the town might want to consider ways to help people to modify their homes so they can stay in their homes.

Mr. McDonald reported on water safety at the Hillside Elementary School. He reported that more extensive water quality testing of all drinking water sources in the Needham Public Schools was conducted in mid-June and returned a clean bill of health for every Needham Public School with the exception of Hillside Elementary School. Two samples at the Hillside Elementary School Needham Board of Health Meeting - 2 - July 29, 2016 did test above the EPA action-level of 15 parts per billion on the initial sample but were found to be slightly below the EPA action-level on the second sample (the one taken following a 30 second flush). Mr. McDonald pointed out that this highlights the importance of having “fresh” water to consume (that is, not water which has been sitting overnight in a water fountain or sink faucet). Mr. McDonald has held several informational meetings for parents of the Hillside School community who nevertheless remain very concerned.

STAFF REPORTS • Public Health Nurses Report – Donna Carmichael, RN & Alison Paquette, RN Ms. Carmichael presented a brief review on communicable diseases and animal bites. Ms. Carmichael reported on one situation with a bat exposure. She expressed concern about not receiving reports from Beth Deaconess Hospital in Needham and Newton-Wellesley Hospital.

Ms. Carmichael stated that she had a follow-up visit with a family in Needham whose house was damaged by fire. She stated that she worked with the Fire Department and the Red Cross in getting the family shelter.

Ms. Carmichael reported on the number of sunscreen dispensers that have been placed throughout the town.

• Traveling Meals Coordinator Report - Maryanne Dinell Ms. Dinell report included an update on meals deliveries and the contract with Beth Israel Deaconess Hospital Needham. Dr. Cosgrove asked if there would be a price increase. Ms. Dinell stated that there will be no increases this year, but an increase will occur next year.

Mr. McDonald stated that Traveling Meals delivered 21% more meals this year. He added that this was due to Ms. Dinell’s retaining very dedicated volunteers, as well as being responsive to non-traditional situations. Mr. McDonald stated that the program is for clients that truly have a need but allows for flexibility. He added that in July the Traveling Meals program provided meals to two young residents who had a very challenging situation and did not have regular food access. A brief discussion followed.

• Environmental Health Agents Report - Tara Gurge Ms. Gurge reported that Volante Farms had closed its doors after the 4th of July weekend because of a strong odor. The odor came from a product that was used by a contractor for an exterior floor application but was applied as an Needham Board of Health Meeting - 3 - July 29, 2016

interior application. The farm opened in a limited capacity mid July and returned to full capacity the end of July.

Ms. Gurge reported on two emergency calls that the Fire Department had received for two restaurants, Sweet Corner and Not Your Average Joe’s. Ms. Gurge stated that Sweet Corner experienced a malfunction in their freezer unit that caused a small fire and minimal damage. Not Your Average Joe’s experienced a malfunction with one of their wood fire ovens. Ms. Gurge stated that she conducted follow-up inspections for each restaurant.

Ms. Gurge also reported that she received a call from the Fire Dept. to inspect a home on Pershing Road due to housing concerns. Ms. Gurge added that an inspection was conducted with the Building Department and an Order Letter was sent. She is still working with the resident and will conduct a follow-up inspection.

Ms. Gurge reported on the Pool Plan Reviews for Wingate and Rosemary Pool. Ms. Gurge stated that the Wingate Pool Plan Review is still in process. Ms. Gurge presented a brief overview on what the project would entail.

• Senior Substance Use Prevention Coordinator – Catherine Delano Ms. Delano’s reported on the Poster Campaign project and her work with Mr. McDonald on the budget for the Drug Free Communities (DFC) grant. Ms. Delano stated that some of the funding from this grant would be used to hire an intern who will also work in a part-time capacity.

Ms. Delano stated that the conversation continues with the MetroWest Adolescent Survey questions in terms of getting more questions on the bi-annual survey, specifically about access to marijuana and edibles.

Ms. Delano reported that Kerrie Attwood, a Social Worker from the Needham Council on Aging, contacted her to speak to the Council on Aging in September on substance use by older adults.

Mr. McDonald stated that the Superintendent of Needham Public Schools has withdrawn his commitment to administer the MetroWest Adolescent Survey to grades 6-12. Mr. McDonald stated that by withdrawing his commitment continued funding from the State is in jeopardy. After some discussion, Mr. McDonald stated that if the Public Health Department does loose the grant the Board would need to Needham Board of Health Meeting - 4 - July 29, 2016

involve the Finance Committee and the School Committee on next steps.

PROPOSED PLASTIC BAG BAN - Christopher Thomas, Needham Resident Mr. McDonald stated that this issue will be discussed during the Annual Town Meeting. Christopher Thomas wanted to learn more about what the Public Health Department’s role is on this matter. Mr. McDonald stated he invited Mr. Thomas to present his ideas to the Needham Board of Health. Mr. Thomas was not present for the discussion. Mr. McDonald will reschedule this discussion item.

BOARD OF HEALTH PUBLIC HEARING – 7:45 a.m.

POOL PLAN REVIEW Ms. Gurge summarized the details of the New Pool Plan Review for Wingate. She stated that Wingate would like to install a 4’ indoor swimming pool in their new building. Part of the swimming pool design includes an alcove area that contains a treadmill. Ms. Gurge described the setup of the treadmill. She reported on the State regulations governing safety regarding this request. Ms. Gurge stated that, in order to allow the treadmill to be installed in the pool, a variance is needed. A discussion followed on the design of the treadmill, which is in a strictly designated area, not electronically powered, but hydraulically powered. A discussion also followed on the design elements of the pool.

Motion and Vote Stephen Epstein moved and Edward Cosgrove seconded the motion to approve the variance as outlined in the Pool Plan Review for Wingate. The motion carried. The vote was unanimous.

Mr. McDonald stated that the Board should consider staffing ratios. He explained that although it is appropriate if the physical therapist is in the pool supervising a person on the treadmill, it is not appropriate if someone is swimming in the pool while the physical therapist is supervising someone on the treadmill. Mr. Friedman stated that the Aquatic Director will have lifeguard certification and would oversee the general pool area. He added that anyone working on the treadmill would be under the direct supervision of a licensed physical therapist.

Ms. Gurge point out that the only other issue with this Pool Plan is decreased water flow. Ms. Gurge noted that Wingate has agreed to put in additional water supply and return outlets, which will increase the water flow.

Needham Board of Health Meeting - 5 - July 29, 2016

Mr. McDonald stated that he and Ms. Gurge would work with a representative from Wingate to draft a detailed variance for the Board’s review to ensure its alignment to what the Board has agreed to, which would then be forwarded to the State.

Motion and Vote Edward Cosgrove moved to amend the previous vote. Jane Fogg seconded the motion. Edward Cosgrove moved to approve the variance as outlined in the Pool Plan Review for Wingate subject to a review of the draft that Mr. McDonald and Ms. Gurge will prepare. The motion carried. The vote was unanimous.

PROPOSED NEW OR AMENDED BOH REGULATIONS: Body Art, Synthetic Drug and Mr. McDonald presented a brief update on the regulations for Body Art Establishments and Practitioners, Restriction of Synthetic , and Restriction of Drug Paraphernalia. Mr. McDonald pointed out that the regulations include all changes as discussed by the Board at the June meeting. Mr. McDonald stated that a Case for Change Memo has been prepared for each regulation. He also stated that the Public Comment period has been extended to early September. The Board would review, discuss and vote on this item at the September meeting.

BOARD POLICY POSITIONS - The discussion included a conversation on the Registered Marijuana Dispensary (RMD) located at 29-37 Franklin Street. Mr. McDonald presented a map of the surrounding area. Mr. McDonald pointed out that this area encompasses the entire buffer zone, which, is 1000 ft. Discussion continued on the mixed-use overlay that was voted on by Town Meeting, May 2016 He spoke about his meeting with Chris Coleman and Lee Newman relative to the Board’s concerns. A brief discussion followed on the buffer zone and the Board of Health’s role regarding the variance. The Board will continue the discussion on this matter with the Board of Selectmen at their September meeting on September 19.

Mr. McDonald stated that the Board of Selectmen would like to discuss the consolidation of the Public Health Department into a Health and Human Services Department. A brief discussion followed regarding support for this plan. Mr. McDonald stated that funding for the DSR4 second Environmental Health Agent position will be on the Special Town Meeting Warrant in October.

OTHER ITEMS Mr. McDonald presented an update on the Park and Recreation Commission’s decision, relative to the Rosemary Pool design, to cancel the 2017 swimming season at Rosemary Lake. Mr. McDonald Needham Board of Health Meeting - 6 - July 29, 2016 noted that based on the information Ms. Gurge had sent to them the Board might agree with their decision.

Mr. McDonald briefed the Board on efforts to create an additional Revolving Account to fund substance use activities. Mr. McDonald explained some of the obstacles he faces regarding this initiative.

Mr. McDonald outlined a list of items he is preparing for the Board’s consideration. These include the Healthy Aging Final Report draft, the Case Study on purchasing Narcan from pharmacies, and a revised map of the overlay mixed-use district.

Mr. McDonald stated he has hired a part-time intern to assist with additional research on traffic emissions. Mr. McDonald also stated that Somerville has a draft ordinance on set back requirements on roads. Mr. McDonald described a few of the setback requirements. He stated that he is looking to get the working materials they used in developing the draft ordinance.

Mr. McDonald reported on the bids received for developing the concussion database. He noted that the bids came in too high for the budget. Dr. Epstein stated he would contact his Information Technology regarding their ability to take on this project.

Mr. McDonald stated that, working with the Community Council he has applied to the Cardinal Health Foundation for the Disposal Grant. This is an award of $25,000 to work on disposal and signage. Ms. Delano and her team will be working on this project.

Dr. Epstein spoke about the Beth Israel Deaconess Hospital Needham, Community Health Grant. The grant award is $1,500 and would go to the FRIENDS of Needham Public Health to support Traveling Meals.

Dr. Fogg stated that the practice she started 12 years ago will be become part of Atrius Health in October.

Dr. Cosgrove stated that at the last meeting of the Mass Association of Health Boards he was elected to the Executive Board.

Adjournment – Upon motion duly made and seconded, that the July 29, 2016 BOH meeting adjourn at 8:45 a.m. The motion carried. The vote was unanimous.

Next meeting is scheduled for, Friday, September 9, 2016 Respectfully submitted: Cheryl Gosmon, Recording Secretary NEEDHAM BOARD OF HEALTH August 29, 2016 MEETING MINUTES

PRESENT: Edward V. Cosgrove, PhD, Chair, Jane Fogg, Vice-Chair, M.D., and Stephen Epstein, M.D STAFF: Timothy McDonald, Director GUEST: Kate Fitzpatrick, Town Manager Christopher Coleman, Assistant Town Manager

CONVENE: 5:00 p.m. – Needham Town Hall, 1471 Highland Avenue, Needham MA 02492

DISCUSSION: Call To Order – 5:03 p.m. – Dr. Cosgrove, Chairman

APPROVE MINUTES: There was no approval of the Board of Health’s meeting minutes from June 29, 2016; review and approval of such will occur at the Board’s next regularly scheduled meeting on Friday September 9, 2016.

DISCUSSION WITH TOWN MANAGER The Town Manager, Ms. Fitzpatrick, and the Assistant Town Manager, Mr. Coleman, met with the Board of Health to discuss a number of operational considerations for the Public Health Division and the Town of Needham.

Ms. Fitzpatrick discussed the possibility of further integrating the divisions within the Health & Human Services Department (Public Health, Council on Aging, Veterans Services, and Youth Services). She stated that she believes that the divisions provided crucial government services, and she would like the divisions to be more closely connected to both each other and to other departments within the Town. Ms. Fitzpatrick went on to mention the warrant for Fall Town Meeting and the inclusion of the DSR4 supplemental budget request for a full-time environmental health agent to help address the increasing demand for inspections and environmental health services in the community. The hiring of a second full-time environmental health agent would likely prompt a revision to the Division’s workload, and additional responsibility/authority for Tara Gurge, the Division’s environmental health agent.

Dr. Cosgrove responded that he was generally supportive of increased cooperation across the four divisions, but wants to be sure that integration efforts are unrelated to the question of whether sufficient resources are available for each division to Needham Board of Health Meeting - 2 - July 29, 2016 achieve its goals and objectives and to serve its target population.

Dr. Fogg raised a concern about the Public Health Division’s ability to respond to the increasing demands on its time. She mentioned her interest in prioritizing functions that have the largest impact on the public’s health. Dr. Fogg specifically noted that some types of permits and inspections are much more central to the Public Health Division’s mission than others.

Mr. McDonald noted Dr. Fogg’s concern and request, and said the Public Health Division staff will assemble a prioritization list for discussion with the Board at a future meeting (likely October).

Dr. Epstein mentioned the challenges of limited staff time to advance the Board’s priorities, including the coordination of information that is sent from long-term care facilities with patients when they are transported to hospital emergency departments. Mr. Coleman and Mr. McDonald noted that such a topic might be a prime area for collaboration between Public Health and the Council on Aging.

Ms. Fitzpatrick acknowledged the concerns articulated by the Board of Health, and reminded the Board that the Town has taken an incremental approach to improve the coordination and collaboration between its departments and divisions. She anticipates that the Town will continue to take an incremental approach and will engage all parties (Town departments and divisions, as well as Boards and Committees) as it plans how best to organize itself in the coming months.

All three members of the Board of Health requested that the Town Manager provide a revised organizational chart that would highlight those areas in which the divisions within the Health & Human Services Department might more closely collaborate.

Adjournment – Upon motion duly made and seconded, that the August 29, 2016 BOH meeting adjourn at 5:46 p.m. The motion carried. The vote was unanimous.

Next meeting is scheduled for, Friday, September 9, 2016 Respectfully submitted: Timothy Muir McDonald, Director of Public Health Needham Public Health

Director’s Report

To: Needham Board of Health From: Timothy Muir McDonald, Public Health Director Date: August 29, 2016 Re: Monthly Report for July 2016 ______

July was a busy time for the Public Health Division and for me, as a vacation to Maine along with the annual meeting of the National Association of County and City Health Officials (NACCHO) combined to make for a month with lots to do but little time in the office to get those things done. Luckily I have a great staff, and they (and especially Tara) did a great job of keeping me informed and covering all the items that arose while I was out of the office.

Foundations of Local Public Health Tara and I are currently enrolled in an excellent course offered by the Local Public Health Institute at the Boston University School of Public Health. It is a cross-disciplinary course intended for public health workers that focuses upon the three core functions and ten essential services. The course consists of three full-days in a classroom, two online webinars, and 16 self-paced online courses (each about 2-3 hours). Although the course schedule has been challenging it has also been quite illuminating. More information on the course is available here.

Annual Meeting of the National Association of County and City Health Officials (NACCHO) NACCHO held its annual meeting in Phoenix1 from July 18– 21. The theme of this year’s meeting was: Cultivating a Culture of Health Equity. This was my first time attending NACCHO’s annual meeting, and I found it to be akin to drinking from a fire hose. Lots of sessions in which I was interested occurred concurrently, and I made the mistake of trying to go to one half or one quarter of each session. Most of my focus was on sessions that discussed accreditation, using performance measures to drive quality improvement in public health departments, and electronic inspection processes.

How to Run a Department WELL As a form of professional development, one of my goals for the late summer and fall is to conduct a series of eight to twelve (8-12) interviews on the subject of what I’m calling “How to Run a Department WELL”. I will meet one-on-one with some of my more experienced and/or more accomplished peers to discuss how they organize and run their departments, how they set goals, and motivate staff members, and how they interact with town, state, and federal officials in the course of their work. I hope to gather a set of points to consider as I work to become a better Public Health Director.

Sincerely,

Timothy Muir McDonald Director of Public Health, Town of Needham

1 Phoenix…in July? Really?! Wasn’t it absurdly hot in Phoenix in July? Yes, yes it was. But that’s why hotel rooms and conference spaces were cheap.

1471 Highland Avenue, Needham, MA 02492 781-455-7500x511(tel); 781-455-0892 (fax) E-mail: [email protected] Web: www.needhamma.gov/health

Needham Public Health Department July 2016 Health Agents - Tara Gurge and Brian Flynn Activities

Activity Notes Animal Permit Plan 3 –Animal Permit application plan reviews for the properties located at: Reviews/Application - #220 Nehoiden St. – For 4 chickens. Application approved. Final inspection Status conducted by Animal Control. Permit issued. - #453 Greendale Ave. – For 4 chickens. Application approved. Initial inspection conducted. (Final inspection pending by Animal Control.) - #139 Richdale Rd. – For 4 chickens. (Plan review still in process.) Owner will mail out another letter to abutters. Animal Permits 1 – Animal Permit mailed. Demo review/approval 5 - Demolition sign-offs: • 37 Fairview Rd. • 299 Brookline St. • 124 Elder Rd. • 21 Washington Ave. • 341 Nehoiden St. Emergency/Fire Dept. 1 – Emergency calls received from Fire Dept. for: Call - Sweet Corner (#1056 Great Plain Ave.) – Call received on the weekend regarding a reach-in freezer that caught fire. It was put out by the staff with a fire extinguisher. Follow-up site visit conducted to re-open establishment. Food – July 4th I conducted a pre-operation inspection over at the Memorial Park pavilion and Celebration Inspections also checked out the restrooms, on Friday, July 1st. Brian conducted follow-up inspections on Sunday, July 3rd. No violations observed. Food – Complaints 0 – New Food Complaints received.

Food – Temporary Food 13 – Temp. food event permit applications received/permits issued to: Permits - Center Café (Chef in the House) (x4) – Cooking Demos on Sundays (across from Farmers Market venue.) - Hillside School PTC – New family picnic event. - Needham Track Club – For event at DeFazio Field. - Sam’s Hot Dog Cart – For event at Needham Pool and Racquet Club. - Dylan & Pete’s Ice Cream Truck – For event at PTC. - Amigo’s Locos Food Truck – For event at PTC. - Daddy’s Bonetown Burger Truck – For event at PTC. - Sate Grill Truck – For event at PTC. - Chubby Chickpea Truck – For event at PTC. - Stoked Pizza Truck – For event at PTC. Food – Plan Review 1 – Food Permit Plan Review conducted for: - RFK Kitchen – Met with owner to review food permit plan review items. Follow-up email sent. Food – Pre-operation 3 – Pre-operation inspections/follow-ups conducted for: inspections/follow-ups - Rebecca’s Café (Olin College kitchen) – Pre-operation inspection conducted. conducted (Final kitchen renovation inspection pending.) - Sweet Corner - Pre-operation inspection conducted due to reach-in freezer fire. - Volante Farms – Conducted pre-operation inspection after floors were ground down to remove exterior product, and refinished with interior floor product. Food – Annual Permits 1 – Annual food service permit issued to: - 7-Eleven (#845 Highland Ave.) – For Change of owner. Housing – Complaints/ 4 – Housing Complaints/Follow-ups: Follow-ups - #321 Hillside Avenue – Received a call from abutter about odors coming through basement area. Spoke to owner. Tenants left trash in basement. She removed. UPDATE – Tenants were evicted on July 21st. Owner in process of repairing residence (damage caused by tenants). Will call us when ready to conduct a final inspection, before any new tenants move in. - #51 Pershing Rd. – Received a call from Fire Dept. to come out to site due to housing concerns with clutter, egress concerns, etc. Inspection conducted with Building Dept. Order letter sent. UPDATE – In process of working with owner on addressing the items. (Final inspection pending.) - #228 Marked Tree Rd. – Call from Police Dept. Met Building Dept. on site to speak to resident about recent concerns from neighbors. Neighbors called about overgrown yard and pests being present (going into home, etc.). Owner stated that he would submit a copy of a pest control report, and will start calling landscaping companies to trim up the yard. UPDATE: Received copy of pest control report. Owner still working with Building and Health Depts. in addressing housing concerns. (On-going.) - #26 Highland Terrace/#49 Riverside St. – Report from neighbor about feral cats and other pests being present. She also reported trash and empty cat food cans outside the Riverside St. property and trash and bags of yard waste being present. Site visit conducted with Donna C., Danielle (Animal Control) and Karl Harmon (Needham Police). Met with owner about complaint. Letter sent. Nuisance – Complaints 2 – Nuisance Complaints - Volante Farms – Complaint received about strong polyurethane odors inside of store due to recent floor refinishing that was conducted on site. Store closed. Site visits conducted (x5). Pre-operation insp. conducted. - #757 Highland Ave. (Webster Green Apts.) – Complaint received about overflowing trash/dumpster concerns. Site visits conducted (x4). Dumpsters overflowing. Spoke to maintenance manager on site. Trash removed. Special Permit Plan 2 – Special permit plan review comments sent. Reviews (Planning Board)

Pool Plan Reviews 2 – New Pool plan reviews conducted for: - Rosemary Town Pool – Additional pool materials reviewed on proposed filter system. Attended meeting on Pool @ PSAB. (Plan review still in process). - Wingate Pool

Pool Variance Requests 1 – Pool Variance request received from: - Wingate Pool – BOH approved variance request for the installation of a treadmill in the newly proposed pool. Variance request review still in process with the MA DPH Community Sanitation Program (submitted back on Friday, August 12, 2016).

Septic – Addition to a 1 – Addition to a Home on a Septic System Plan Review conducted for: Home Plan Review - #1516 Central Ave. – Approval sent.

Septic – Plan 2 – Septic Plan Reviews/Approvals issued for: Reviews/Approvals - #1516 Central Ave. – Septic plan approval letter sent. - #1554 Central Ave. – Septic plan review comments sent (revised plans pending.)

Septic – Soil Tests 2 – Septic Soil/Perc Tests conducted at: - #6 Charles River St. - #267 Cartwright Rd.

Septic Trench Permit 1 – Septic Trench Permit issued to: - Jim Brooks – JPAC Enterprises (For job at #109 Brookside Rd.)

Septic Installer Exam 1 – Septic installer exam issued to: - Jim Brooks – JPAC Enterprises.

Septic Installer Permit 1 – New Septic Installer permit issued to: (New) - Jim Brooks

Special Permit Reviews 1 – Special permit review conducted for: - #114 First Ave. (Restaurant Depot) – Comments sent.

Tobacco – Complaints 0 – Complaints received

Tobacco Insp. 2 – Tobacco inspections conducted.

Tobacco (change of 1 – Change of owner submitted for 7-Eleven on Highland Ave. New permit issued. Owner)

Wells 1 – Approval to drill letter issued for: - #147 Tower Rd. – For 3 closed-loop geothermal wells.

Zoning Board Plan 1 – Zoning Board plan review conducted for: Reviews - Mill Creek Project (Greendale Ave.)

Yearly

Category Jul Au S O N D J F M A Ma Ju FY’ FY’ FY’ Notes/Follow- 17 16 15 Up Biotech 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 Biotech permits Bodywork 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 Bodywork Estab. Insp. Bodywork 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 Bodywork Estab. Permits Bodywork 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 Bodywork Pract. Permits Bottling 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 Bottling Permit insp. Demo 5 0 0 0 0 0 0 0 0 0 0 0 5 110 100 Demo reviews Domestic 1 0 0 0 0 0 0 0 0 0 0 0 1 16 15 Animal Animal permits Food 12 0 0 0 0 0 0 0 0 0 0 0 12 209 220 Routine insp. Service Food 3 0 0 0 0 0 0 0 0 0 0 0 3 35 26 Pre-oper. Service Insp. Retail 2 0 0 0 0 0 0 0 0 0 0 0 2 71 71 Routine insp. Resid. 0 0 0 0 0 0 0 0 0 0 0 0 0 11 8 Routine insp. kitchen Mobile 6 0 0 0 0 0 0 0 0 0 0 0 6 9 10 Routine insp. Food 7 0 0 0 0 0 0 0 0 0 0 0 7 50 52 Re-insp. Service Food 1 0 0 0 0 0 0 0 0 0 0 0 1 176 170 Annual Service/ permits Retail Food 13/ 0 0 0 0 0 0 0 0 0 0 0 13/6 107 96/ Temp. food Service 6 /54 44 permits/ Temp. food insp. Food 0/0 0 0 0 0 0 0 0 0 0 0 0 0/0 9/ 18/ Farmers Service 16 45 Market permits/ Market insp. Food 0/0 0 0 0 0 0 0 0 0 0 0 0 0/0 21/ 17/ New Compl/ Service 21 21 Follow-ups Food 1 0 0 0 0 0 0 0 0 0 0 0 1 32 35 Plan Reviews Service Food 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 Admin. Service Hearings Grease/ 0 0 0 0 0 0 0 0 0 0 0 0 0 29 25 Grease/ Septage Septage Haulers Hauler permits Housing 0 0 0 0 0 0 0 0 0 0 0 0 0 7/4 7/4 Annual (Chap II routine insp./ Housing) Follow-up insp. Housing 2/4 0 0 0 0 0 0 0 0 0 0 0 2/4 18/ 8/ New Compl./ 37 10 Follow-ups Hotel 0 0 0 0 0 0 0 0 0 0 0 0 0 3/0 2/0 Annual insp./Follow- ups Nuisance 2/9 0 0 0 0 0 0 0 0 0 0 0 2/9 44/ 43/ New Compl./ 50 47 Follow-ups Pools 0 0 0 0 0 0 0 0 0 0 0 0 0/0 9/3 10/ Pool 7 insp./follow- ups Pools 0 0 0 0 0 0 0 0 0 0 0 0 0 9 10 Pool permits Pools 2 0 0 0 0 0 0 0 0 0 0 0 2 8 7 Pool plan reviews Pools 1 0 0 0 0 0 0 0 0 0 0 0 1 4 6 Pool variances Septic 1 0 0 0 0 0 0 0 0 0 0 0 1 8 9 Septic Abandon Forms Septic 1 0 0 0 0 0 0 0 0 0 0 0 1 9 10 Addition to a home on a septic plan rev/approval Septic 0 0 0 0 0 0 0 0 0 0 0 0 0 23 14 Install. Insp. Septic 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 COC for repairs Septic 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 COC for complete septic system Septic 6 0 0 0 0 0 0 0 0 0 0 0 6 61 61 Info. requests. Septic 2 0 0 0 0 0 0 0 0 0 0 0 2 8 3 Soil/Perc Test. Septic 0 0 0 0 0 0 0 0 0 0 0 0 0 6 4 Const. permits Septic 1 0 0 0 0 0 0 0 0 0 0 0 1 9 10 Installer permits Septic 1 0 0 0 0 0 0 0 0 0 0 0 1 6 6 Installer Tests Septic 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 Deed Restrict. Septic 2 0 0 0 0 0 0 0 0 0 0 0 2 14 8 Plan reviews Sharps 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 Disposal of insp. Sharps insp. Sharps 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 Disposal of permits Sharps permits Subdivision 0/0 0 0 0 0 0 0 0 0 0 0 0 0/0 3/0 7/1 Plan review- Insp. of lots /Bond Releases Special 1/1 0 0 0 0 0 0 0 0 0 0 0 1/1 16 12 Special Permit/ Permit/ Zoning Zoning memos Tobacco 1 0 0 0 0 0 0 0 0 0 0 0 1 13 12 Tobacco permits Tobacco 1/1 0 0 0 0 0 0 0 0 0 0 0 1/1 25/ 21/ Routine 7 2 insp./ Follow- up insp. Tobacco 0 0 0 0 0 0 0 0 0 0 0 0 0 48 36 Compliance checks Tobacco 0/0 0 0 0 0 0 0 0 0 0 0 0 0/0 4/4 3/3 New compl./ Compl. follow-ups Trash 0/0 0 0 0 0 0 0 0 0 0 0 0 0/0 30/ 29/ Trash Hauler Haulers/ 2 2 permits/ Medical Medical Waste Waste Hauler Haulers permits Wells 1 0 0 0 0 0 0 0 0 0 0 0 1 6/0 14/ Permission to 1 drill letters/ Well permits

FY 17 Critical Violations Chart (By Date)

Restaurant Insp. Date Critical Violation Description

Fuji 7/18/16 - Cold Holding - Need to ensure that walk-in cold-holding temp. is Steakhouse - Conformance with Approved maintained at 41 deg F or below. Had serviced. Procedures/HACCP Plan (for - Need to ensure that Sushi pH Log is maintained and Acidified Sushi Rice) entries are made when rice is prepared (Log was - Food Contact surfaces cleaning not up to date). Updated log; and sanitizing - Ensure that dish machine reaches a min. temperature of 180 deg F or greater for final hot water sanitizing rinse. Had serviced.

Needham Public Health Department July, 2016 Monthly Report Maryanne Dinell- Traveling Meals Program Coordinator

Monthly Description Reason Notes/Follow-Up (ongoing, completed, etc.) Month of Clients need help with their 48 clients on the Traveling Meals Program July, 2016 daily meals. 32 Springwell clients 16 private pay clients - Needham residents

728 2- meal 23 Clients receive meals 5 517 meals delivered to Springwell Clients packages were times a week 211 meal delivered to private pay residents delivered in 30 Clients receive meals 3 July days a week Total # meals delivered 728 @ 5.50 per meal =cost of $4004.00 2 clients Students with Summer No open cafeteria Joined the Program in need of food Program in July 4 clients off 2 students moved Program 1 client on his own able to cook for himself 1 client hospitalized due to transferred to rehab fall-

Category Jul Au Sep Oct Nov Dec Jan Feb Mar Apr May Jun FY ‘16 FY ‘17 Total Total Meal 728 9687 728 Delivery General 40 1091 40 Telephone Calls- received Assistance 3 34 3 Calls-to Springwell Not at 7 77 7 home at delivery 911 0 0 0

Category Jul Au Sep Oct Nov Dec Jan Feb Mar Apr May Jun FY ‘16 FY ‘17 Total Total

Meetings, Events, and Trainings BI Type Description/Highlights/Votes/Etc. Attendance Board of Monthly meeting held at PSAP 9 Health Meeting

Donations, Grants, and Other Funding [List any donations received, grants funded, etc. over the past month.]

Description Type (D,G,O) Amount Given Source Notes

Traveling Meals Program

July, 2016 FY 17

# Meals # Meals FY16 % Change Month FY2015 FY2016 Cost # Meals Jul 855 728 $4,004.00 -15% Aug 793 Sep 794 Oct 800 Nov 672 Projected-12 Mo. Dec 829 $ 48,048.00 Jan 757 # 8,736 Feb 791 Mar 970 Apr 800 May 778 Jun 850 Totals: 9,689 728 4,004.00 1250

1150

1050 Traveling Meals Program FY 2017 970 950 FY2016

850 855 850 829 800 800 793 794 791 778 750 757 728

Numberof Meals Delivered 672 650

550 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Month of Meal Delivery

My Documents / Budget/ FY04 Printed 9/6/2016 Needham Public Health Division – Nurses Report Donna Carmichael RN & Alison Paquette RN

COMMUNICABLE DISEASES and Animal Bites NEEDHAM HEALTH DEPARTMENT

FISCAL YEAR 2017

DISEASES: JUL AUG SEPT OCT NOV DEC JAN FEB MAR Apr MAY JUN T17 T16 T15 BABESIOSIS 0 0 3 Borrelia Miyamota 0 1 na CAMPYLOBACTER 0 9 12 CHICKENPOX 0 9 6 CRYPTOSPORIDIUM 0 0 0 E-Coli 0 0 0 EHRLICHIOSIS/ HGA 0 2 2 Enterovirus 0 3 2 GIARDIASIS 0 1 5 HEPATITIS B 0 5 8 HEPATITIS C 3 3 12 13 Influenza 2 2 102 77 Legionellosis 0 0 2 Listeriosis 0 1 0 LYME 5 5 58 57 MEASLES 0 0 0 MENINGITIS 0 0 0 Meningitis(Aseptic) 0 0 0 Mumps 0 2 0 Noro Virus 0 2 0 PERTUSSIS 0 1 1 SALMONELLA 1 1 5 1 SHIGA TOXIN 1 1 0 0 SHIGELLOSIS 0 3 2 STREP Group B 0 3 2 STREP ( GAS) 0 1 2 STREP 0 1 PNEUMONIAE 0 TUBERCULOSIS 0 0 1 TULAREMIA 1 1 0 0 Latent TB- High Risk 0 1 0 Vibrio 0 1 1 West Nile virus 0 0 0 TOTAL DISEASES 13 13 222 197 Revoked Diseases 8 7 Investigated 2 2 Contact Investigation 0 0 NA Animal/Human Bites DOG 0 8 10 CAT 0 2 0 BAT 1 1 5 5 SKUNK 0 1 0 RACOON 0 0 0 Fox 0 0 0 TOTAL BITES 1 10 18

ImmunizationsJul Aug Sept Oct Nov Dec Jan Feb Mar Apr May June FY17 FY16 FY15 B12 2 2 23 22 Flu 0 0 816 723 (Seasonal) TDap 1 1 0 2 Consult 30 30 475 390 Fire/Police 4 4 40 49 Schools 8 8 88 59 Town 12 12 216 125 Agencies Community 6 6 139 157 Agencies

ASSISTANCE PROGRAMS FY17 FY16 FY 15 Food 0 21 35 Pantry Food 0 6 4 Stamps Friends 0 1 - $300.00 1- YTD

Gift of 0 YTD 17 $25.00 Warmth Good 0 $5189.00 22- YTD Neighbor Park & 0 5 - $1448 $6133.00 Rec RTS 0 $300/fam 6 -$1650 Salvation 0 4 $275/Fam Army Self Help 0 0 3 Water 0 0 1 Abatement

Gift Cards – $50.00 – 2cards/1 family

Gift Card Donation - 0

WELLNESS Programs FY17 FY16 FY15 Office Visits 39 447 287

Safte Visits 0 10 33 Clinics 1 31 34 Housing Visit 2 8 27 Housing Call 6 70 186 Camps- 6 72 63 summer Tanning Insp 0 0 2 Articles 0 2 8

Presentations 0 2 2 Cable 1 1 1 4

EMPLOYEE WELLNESS July AUG SEPT OCT NOV DEC JAN FEB MAR APR MAY JUNE FY17 FY16 FY15 BP/WELLNESS 120 137 - DPW/RTS 18 18 87 52 FLU VACCINE 0 0 CPR/AED 26 29 INSTRUCTION 0 0 9 8 Education 0 0 HEALTH ED 67 102 Tick Borne 28 28 HEALTH ED 80 90 Mosquito Borne 28 28 HEALTH ED 327 221 FLU 0 0 34 29 FIRST AIDE 6 6 GENERAL 188 230 HEALTH EDUCATION 20 20 33 34 Police weights 0 0 TOTAL 1028 981 EMPLOYEE CONTACTS 100 100

Emergency Planning

Meetings, Events, and Trainings Title Description/Highlights/Votes/Etc. CCIT Meeting with Tim, Carol, Riverside and police CCIT Planning

Suicide Prevention Meeting with Schools and Riverside

Riverside Riverside Meeting on Town Contract

Webinar MDPH Webinar Review on Enteric Diseases

Sunscreen Dispensers Cable interview as well as coordinating signage/placement and workings of dispensers with Parks and Forestry and intern from Melanoma Foundation.

Needham Health Department Catherine Delano, Senior Substance Use Prevention Program Coordinator July 2016 Monthly Report

Section 1: Summary In the month of July, I attended the CADCA midyear conference. This conference provided strategies and information about how to work with coalitions and best implement the DFC grant. I also worked with my team to complete a case for change memo for synthetic drugs, research about the public health rationale for zoning setback/buffer zones, and a draft of a position paper on recreational marijuana legalization for the Board of Health. I met with Tom Lyons to discuss our drugged driving campaign. He is working on a video and we will meet again in August to discuss final steps. Additionally, the Community Crisis Intervention Team (CCIT) began monthly meetings.

Section 2: Activities Activity Notes Supervised intern – Angela Giordano Website changes Helped Angela around changes that we would like to make with our website

Budget Developed budget and began letter of description to the feds; redirect and carryover

3rd Quarter Financial report Completed the third quarter financial report and submitted to the feds

MetroWest optional questions Continued the conversation with Shari & Kathy and Carol in an attempt to get more questions on our bi-annual survey, specifically around marijuana, edibles, and access. BOH To Do’s Our team completed a draft of the health policy position on marijuana legalization, research into public health rationale for zoning setback/buffer zones , and a case for change memo for synthetic drugs

Section 3: Meetings & Conferences Title Description Attendance CCIT We met to begin the 5 implementation of the Community Crisis Intervention Team for Needham DFC Conference Call Bi-monthly call with MetroWest 8 DFC grantees. Call is used as for town updates and collaboration. Tom Lyons Tom and finalized our project 2 plan for the drugged driving campaign Meeting with Kelli Keck I met with Kelli at the 2 conference in Las Vegas. Kelli is our point person from Epiphany. CADCA Mid-year Training Attended the week long CADCA mid year training about coalition building Domestic Violence training Attended a 3 hour training about 10 domestic violence that was facilitated by the organization Reach

Carol Read, M.Ed., CAGS, CPS Page 1 of 2 Pages

Substance Abuse Prevention and Education ~ Initiative Highlights Needham NPHD, NCYSAP and SAPC* ~ July 2016

SAPC grant collaboration with the towns of Dedham, Needham, Norwood and Westwood.

SAPC grant ~

Town coalition meeting attendance: No July town meetings- Phone and email communication to provide educational and therapeutic support resources, process Strategic Plan initiatives and provide Technical Assistance to enhance town coalition capacity.

Parent Survey initiatives- Final data compilation report due dates: Westwood- August, 12th- Norwood- September 12th

SAPC Leadership Team: Monthly planning meeting- July 11th Dedham Town Hall

Review and discussion of evidence based and best practice strategies for SAPC Strategic Plan Report submitted June 17th including AlcoholEdu for High School students and parents, Responsible Beverage Server (RBS) and Compliance check program for licensees’ Final report timeline for Norwood and Westwood parent surveys, NPN Conference attendance and Logic Model building training sessions with Emily Bhargava. Cathy Cardinale Dedham, Tim McDonald, Needham, Linda Shea, Westwood, Sigalle Reiss, Norwood, Public Health nurses Donna Carmichael, Karen Regan and Jessica Gardner.

SAPC Strategic Plan- Submitted June 17th: BSAS Evaluator comments Scott Formica, SSRE, received July 22nd. MA- DPH BSAS Amal Marks, Grant Manager. Technical Assistance Tracy Desovich, MPH, MassTAPP- Comment review call scheduled August 9th, meeting TBD

SAPC Quarter 4 Report: July 28th On-line submission of grant activities related to the SPF process grant year one, regional stakeholder participation and capacity. Scott Formica, Evaluator, BSAS.

Needham Public Health support initiatives:

Community Crisis Intervention Team (CCIT) Needham Police Department July 13th - Resident support. Collaboration and consultation with Needham team: Lt. Chris Baker, NPD, Donald Anastasi, NFD, Donna Carmichael, Catherine Delano, Tim McDonald and Tracy Zitoli, LICSW Riverside Community Care Emergency Services team leader- Community Liaison.

Resident Support- Respond to resident calls related to mental health conditions and/ educational resources. Referral to counseling, assessment, treatment and recovery resources. 2 Needham adult requests: 81 year old Female, 60 year old Female.

Riverside Transitional Support Program (TSP) Call with Nora Kenny- Houser, Manager and Sadie (TSP SW) to identify options for continuation of services for resident.

Riverside Community Care- July 25th Town of Needham services contract annual review and discussion. Eliza Jacob Dolan, LICSW Supervisor- Anne Priestly, Manager. (TM-DC)

Prevention projects:

CDC | ChangeLabs |CADCA initiative CADCA Mid- Year July 2016. CDC’s Prevention Status Reports on Excessive Alcohol Use – A Report on CADCA’s ChangeLab Project workshop Monday, July 18th Participation as a public health representative in an Expert Panel of coalition and state prevention and public health representatives to create a plan for the dissemination of state specific Prevention Status Reports on Excessive Alcohol Use (PSRs on EAU) PSR’s focus on polices that address excessive alcohol use (- underage drinking – drinking while pregnant and ) including commercial host liability (Dram Shop) raising alcohol taxes and limiting alcohol outlet density.

CADCA Mid- Year Training Institute 15th Annual Community Anti- Drug Coalitions of America mid- year training July 17th- July 22nd Las Vegas, NV. Dr. Moira O’Neil, FrameWorks Institute, Keynote speaker. Training sessions related to alcohol and other drug use prevention over 5 domains: individual, family peer, school and community. Focusing on engaging community stakeholders in the implementation of evidence- based and best practice prevention strategies on the environmental level.

Narcan access memo: Submitted July 7th Collect emails, notes on pharmacy visits and phone calls and collaborative access efforts with Norfolk County Prevention leaders, create a narrative and timeline outlining efforts to access Narcan in Needham pharmacies. Research relevant data related to overdose and opioid overdose deaths (local, county and state)

Marijuana Legalization- Public Health: Outreach to state and federal prevention, public health and sources to obtain science based, data driven reports related to the public health impact of marijuana legalization for recreational use.

Needham Public Health Department meetings:

Performance evaluation meeting: July 1st employee annual review (TM) Marijuana forum- Call with Ramin Abrishamian, Needham Interfaith Clergy Association Collaboration on educational forum Thursday, September 22nd Powers Hall. Website review meeting– July 6th (TM-CD-AG-JS) Needham Psychologist: July 6th Beth Pinals, Ph.D. Substance Use Disorder assessment, treatment resource request. Metrowest Adolescent Health Survey MWAHS 2016: July 14th and July 28th HS and MS (grades 7&8) optional question planning Shari Kessel Schneider (CD)

*SAPC technical assistance calls, coordinator meetings, budget consultation with BSAS Grant Manager and compliance related to the SAPC grant program are documented in the BSAS-SAPC quarterly reports.

8 days out of office (5) CADCA Las Vegas (2) vacation days (1) holiday July 4th

Respectfully submitted by Carol Read September 5, 2016 Page 2 of 2 Pages Needham Public Health Department

July 2016

Substance Abuse Prevention & Education Needham Coalition for Youth Substance Abuse Prevention ~ NCYSAP Karen Mullen, Project Coordinator/Capacity Building

Section 1: Activities Activity Notes SALSA- Students Advocating Life Without Completed data input and submitted to Scott Formica Substance – RADD- Rockets Against Destructive for analysis 7/7/16. Decisions. Coordinate & finalize data input for SALSA pre & post surveys. Video #3/Parent PSA- Coordinated logistics for Video Shoot scheduled for Tues. 7/26 & Wed. 7/27 in video shoot Youth Services room/Town Hall. Recruited & briefed 4 parents for video, coordinated logistics with Needham Channel & participants. Ray of Hope Nomination for Nicole Luka- Wrote & Submitted nomination to Needham Youth SALSA Leadership Team member Services for Nicole Luka- 7/21/16. 5th Quarter Planning Confirmed 4 event dates for fall (9/9, 9/23, 10/14 & 10/21), Requested permits for events, confirming DJ & Police Detail. Planning fundraising campaign for August, 2016. SALSA Fundraising Planning fundraising for August, 2016. NHS PTC, BID Needham, Needham Women’s Club etc.

Needham Public Health

Director’s Report

To: Needham Board of Health From: Timothy Muir McDonald, Public Health Director Date: September 4, 2016 Re: Monthly Report for August 2016 ______

August was a busy month where the Public Health Division moved forward its projects and especially focused upon educating and informing the community.

Sunscreen Dispensers The Town of Needham partnered with the Melanoma Foundation of New England on a public information initiative and a community sunscreen placement project aimed at reducing the incidence of melanoma, the deadliest form of skin cancer. On the Town side, Needham’s Public Health, Park and Recreation, and Parks and Forestry Divisions cooperated to provide Needham residents with six sunscreen dispensers for public use. The program is part of the Melanoma Foundation’s Practice Safe Skin initiative. Dispensers were placed at Rosemary Pool, DeFazio Park, and at Greene’s Field. When the swimming seasons concluded, the dispensers at Rosemary Pool were moved to Cricket Field and Memorial Park. A Needham Cable Channel news segment on the project is available here.

Public Information Push The Board of Health’s staff has made a concerted effort over the summer months to increase public education and information efforts. This has manifested itself in a couple of different ways, including a Letter to the Editor published in the Needham Times about the proposed regulations, a guest column

1471 Highland Avenue, Needham, MA 02492 781-455-7500x511(tel); 781-455-0892 (fax) E-mail: [email protected] Web: www.needhamma.gov/health about the dangers of synthetic drugs written by Senior Substance Use Prevention Program Coordinator Catherine Delano, Public Health Program Coordinator/Intern Angela Giordano, and Police John Schlittler, and a series of Needham Cable Channel News Segments.

• Regulation Restricting Synthetic Drugs • Regulation Restricting Drug Paraphernalia • Amendments to the Board’s Existing Body Art Regulations • A Primer on Mosquito-Borne Disease

Healthy Aging through Healthy Community Design The cooperative Healthy Aging through Healthy Community Design project occupied a substantial portion of my time in the month of August, largely with editing and formatting the final report. It will be presented to the Board of Selectmen on the evening of September 6th, and will be a topic for discussion at the Board of Health’s next meeting on Friday September 9th. As a reminder, a Needham Channel News segment on the Healthy Aging through Healthy Community Design project was filmed in mid-May. The video is available here: https://youtu.be/ogkHdb9in8A, and a copy of the front cover of the report is included at right.

Community Forum on Ballot Question #4: Recreational Marijuana Legalization In partnership with the Needham Interfaith Clergy Association and State Representative Denise Garlick, the Public Health Division and the Needham Coalition for Youth Substance Abuse Prevention are holding a community forum to discuss the November ballot question which has the potential to legalize recreational marijuana use in the Commonwealth.

The event is free and open to the public, but pre-event registration will be required just to make sure there are enough packets, handouts, and refreshments for all attendees. The focus of the event is to educate and inform the residents of Needham and surrounding communities about the impacts to the public's health and to the community at large from marijuana legalization. The event will include:

• Dr. John Kelly, Director of the Recovery Research Institute at the Massachusetts General Hospital (MGH), the Program Director of the Recovery Management Service (ARMS) and the Associate Director of the Center for Addiction Medicine at MGH, speaking about the effects of substance use on the developing and the science of addiction.

• Kevin Sabet, PhD, the Director of the Drug Policy Institute at the University of Florida and, with Patrick J. Kennedy, the co-founder of Project SAM (Smart Approaches to Marijuana), speaking about the marijuana legalization effort nationally, the impacts to public health and public safety that have been felt in Colorado and Washington State (the two states that have legalized). • Attorney John Scheft, the head of Law Enforcement Dimensions and a counsel at the Bellotti Law Group as well as a former Assistant Massachusetts Attorney General and Assistant

2

Middlesex County District Attorney, will present a primer on the nuts and bolts of Ballot Question #4 with a specific focus upon the ways the ballot initiative will strip local communities of control of licensing and zoning.

The Public Health Division is actively promoting the community forum through two posters. Please see image below.

Sincerely,

Timothy Muir McDonald Director of Public Health, Town of Needham

3

Needham Public Health Department August 2016 Health Agents - Tara Gurge and Brian Flynn Activities

Activity Notes Animal Permit Plan 1 –Animal Permit inspection conducted at the property located at: Reviews/Inspections - #139 Richdale Rd. – For 4 chickens. Follow-up inspection conducted to measure proposed coop to property line setback distances. Need to request a variance from rear lot line. (In process of notifying abutters.) Bodywork establishment 1 – Bodywork inspection conducted at: inspection - Season Day Spa (#25 Brook Rd.) – Conducted follow-up inspection with the state and local police, to ensure compliance with BOH Bodywork regulation requirements. Bodywork Establishment 1 – Bodywork establishment permit issued to: Permit - Season Day Spa (#25 Brook Rd.) Bodywork Practitioner 2 – Bodywork practitioner permits issued to: permits - Wei Li (owner) – To practice bodywork at Season Day Spa. - Yanping Zhang – To practice bodywork at Season Day Spa. Cable Channel interview 1 – Needham Cable interview on Body Art regulation requirements/updates, on BOH Body Art conducted with Tim. Regulations Demo reviews/approvals 12 - Demolition sign-offs: • #89 Glendale Ave. • #1 Prospect St. • #40 Lantern Ln. • #6 Charles River St. • #24 Fuller Rd. • #63 Tudor Rd. • #39 Mallard Rd. • #48 Dartmouth Rd. • #15 Pleasant St. • #54 Rosalie Rd. • #30 Bonwood Rd. • #200 First Ave. (Commercial Bldg.) Emergency/Fire Dept. 1 – Emergency calls received from Fire Dept. for: Call - #629 Highland Ave. (3 office bldgs.) – For gas smell. Site visit conducted. Fire Dept. cleared area and worked with owner to address concern. Food – PanMass Conducted a pre-operation inspection over at the Olin College lot for annual Challenge Event/Olin PanMass Challenge event. No issued observed. College Lot Food – Complaints 3 – New Food Complaints received: - Dunkin Donuts (Highland Ave.) – Report of fruit flies present on site. Site visit conducted. Received copies of pest control reports. Also forwarding me weekly cleaning logs of floor drain cleanings. (Will continue to monitor.) - Dunkin Donuts Mini Mart (Great Plain Ave.) – Report of unsanitary store. Resident also reported that they bought a pre-packaged ice cream and brought it back since it looked tampered with. Site visit conducted. The store manager stated that it had thawed and was refrozen. Manager discarded all re-frozen ice cream products. - Blue on Highland – Report of pest on site. Site visit conducted. No pests observed. Got copies of pest control reports. (Will continue to monitor and receive copies of pest control reports.) Food – Temporary Food 8 – Temp. food event permit applications received/permits issued to: Permits - Center Café (Chef in the House) (x4) – Cooking Demos on Sundays (across from Farmers Market venue.) - Charles River Ctr. Horticulture Prog./Needham Community Farm – Farm 2 Fork dinner @ Pine St. community farm site. - Volante Farms – Dinner in the Field event. - Roxy’s Grill Cheese Truck – Event at Carter Memorial Methodist Church. - Pan Mass Challenge – Tent set up on Olin/Babson parking lot. Food – Plan Reviews 3 – Food Permit Plan Reviews conducted for: - RFK Kitchen – Additional plan review conducted for new items. Approved. - North Hill Bakery – Review of plans for new equipment to be installed. - Volante Farms – Reviewed plans for new proposed kitchen in basement area. (Still in process.) Food – Pre-operation 1 – Pre-operation food establishment inspection conducted at: inspection - RFK Kitchen (#948 Great Plain Ave.) – Conducted initial pre-operation inspection. Still in process of building out restaurant. (Follow-up insp. pending.) Housing – Complaints/ 2 – Housing Complaints/Follow-ups: Follow-ups - #51 Pershing Rd. – Received a call from Fire Dept. to come out to site due to housing concerns with clutter, egress concerns, etc. Inspection conducted with Building Dept. Order letter sent. UPDATE – In process of working with owner on addressing the items. Received copy of signed/dated letter from Oil Company. Still clearing out egresses. (Final inspection pending –set for mid-Sept.) - #26 Highland Terrace/#49 Riverside St. – Report from neighbor about feral cats and other pests being present. She also reported trash and empty cat food cans outside the Riverside St. property and trash and bags of yard waste being present. Site visit conducted with Donna C., Danielle (Animal Control) and Karl Harmon (Needham Police). Met with owner about complaint. Letter sent. UPDATE – Follow-up site visit conducted. Building Dept. in process of working with the state. Follow-up letter to be mailed by the Health Dept. re: these on-going concerns. Nuisance – Complaints/ 3 – Nuisance Complaints/Follow-ups: Follow-ups - YMCA Pool – Report from resident about indoor air quality issues with strong chlorine odors. Site visits conducted (x4). Pool voluntarily closed down for annual maintenance and repair. New UV light to be installed. (Pre-operation insp. pending.) - #757 Highland Ave. (Webster Green Apts.) – Complaint received about overflowing trash/dumpster concerns. Site visits conducted (x4). Dumpsters overflowing. Spoke to maintenance manager on site. Trash removed. UPDATE – Still continuing to monitor. Additional complaints were received. - #629 Highland Ave. (Medequip. Bldg – 3 office bldgs.) – Report received from Fire Dept. of strong gas smell on site. Site visit conducted. Fire Dept. cleared area and worked with owner to address concern. Also called Environmental Company to come out to dispose of spill. Pool Plan Review 1 – New Pool plan review conducted for: - Rosemary Town Pool – Additional pool materials reviewed on proposed filter system. Attended meeting on Pool @ PSAB. (Plan review on-going.) Septic – Addition to a 2 – Addition to a Home on a Septic System plan reviews conducted for: Home plan reviews - #1554 Central Ave. – Approval sent. - #1254 South St. – Plan review comments sent.

Septic Construction 1 – Septic construction permit issued for: Permit - #109 Brookside Rd. – For septic upgrade.

Septic – Plan 1 – Septic Plan Review/Approval issued for: Review/Approval - #1554 Central Ave. – Septic plan approval letter sent.

Septic – Installation 8 – Septic system installation inspections conducted at: Inspections - #109 Brookside Rd. – Conducted septic installation inspections. (As-built plan pending.)

Subdivision Off-Street 1 – Subdivision off-street drainage bond release request received for: Drainage Bond Release - Riverbend Lane Subdivision/ 708 South Street. Release request by builder, Request Greg Petrini, Petrini Corporation, of off-Street drainage bonds for Lots 4, 4A and 5 @ $3,500.00 for each lot, for a total release request of $10,500.00.* *BOH to discuss.

Tobacco – Complaints 0 –Tobacco Complaints received

Tobacco Insp. 3 – Tobacco inspections conducted.

Trash – Waste Hauler 1 – Trash Hauler Truck inspection conducted for: Truck Inspection - All State Waste (I truck) Wells 1 – Approval to drill letter issued for: - #865 Central Avenue (North Hill) – For 1 irrigation well.

Zoning Board Plan 1 – Zoning Board plan review conducted for: Review - #238 Highland Ave. (New pre-school)

Yearly

Category Jul Au S O N D J F M A Ma Ju FY’ FY’ FY’ Notes/Follow- 17 16 15 Up Biotech 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 Biotech permits Bodywork 0 1 0 0 0 0 0 0 0 0 0 0 1 11 0 Bodywork Estab. Insp. Bodywork 0 1 0 0 0 0 0 0 0 0 0 0 1 3 0 Bodywork Estab. Permits Bodywork 0 2 0 0 0 0 0 0 0 0 0 0 2 10 0 Bodywork Pract. Permits Bottling 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 Bottling Permit insp. Demo 5 12 0 0 0 0 0 0 0 0 0 0 17 110 100 Demo reviews Domestic 1/0 0/1 0 0 0 0 0 0 0 0 0 0 1/1 16 15 Animal Animal permits/ Permits/ Inspections Insp. Food 12 16 0 0 0 0 0 0 0 0 0 0 28 209 220 Routine insp. Service Food 3 1 0 0 0 0 0 0 0 0 0 0 4 35 26 Pre-oper. Service Insp. Retail 2 10 0 0 0 0 0 0 0 0 0 0 12 71 71 Routine insp. Resid. 0 1 0 0 0 0 0 0 0 0 0 0 1 11 8 Routine insp. kitchen Mobile 6 1 0 0 0 0 0 0 0 0 0 0 7 9 10 Routine insp. Food 7 3 0 0 0 0 0 0 0 0 0 0 10 50 52 Re-insp. Service Food 1 0 0 0 0 0 0 0 0 0 0 0 1 176 170 Annual Service/ permits Retail Food 13/ 8/3 0 0 0 0 0 0 0 0 0 0 21/9 107 96/ Temp. food Service 6 /54 44 permits/ Temp. food insp. Food 0/0 0/0 0 0 0 0 0 0 0 0 0 0 0/0 9/ 18/ Farmers Service 16 45 Market permits/ Market insp. Food 0/0 3/3 0 0 0 0 0 0 0 0 0 0 3/3 21/ 17/ New Compl/ Service 21 21 Follow-ups Food 1 3 0 0 0 0 0 0 0 0 0 0 4 32 35 Plan Reviews Service Food 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 Admin. Service Hearings Grease/ 0 0 0 0 0 0 0 0 0 0 0 0 0 29 25 Grease/ Septage Septage Haulers Hauler permits Housing 0/0 0/0 0 0 0 0 0 0 0 0 0 0 0 7/4 7/4 Annual (Chap II routine insp./ Housing) Follow-up insp. Housing 2/4 0/2 0 0 0 0 0 0 0 0 0 0 2/6 18/ 8/ New Compl./ 37 10 Follow-ups Hotel 0 0 0 0 0 0 0 0 0 0 0 0 0 3/0 2/0 Annual insp./Follow- ups Nuisance 2/9 3/9 0 0 0 0 0 0 0 0 0 0 5/ 44/ 43/ New Compl./ 18 50 47 Follow-ups Pools 0 1/3 0 0 0 0 0 0 0 0 0 0 1/3 9/3 10/ Pool 7 insp./follow- ups Pools 0 0 0 0 0 0 0 0 0 0 0 0 0 9 10 Pool permits Pools 2 1 0 0 0 0 0 0 0 0 0 0 3 8 7 Pool plan reviews Pools 1 0 0 0 0 0 0 0 0 0 0 0 1 4 6 Pool variances Septic 1 3 0 0 0 0 0 0 0 0 0 0 4 8 9 Septic Abandon Forms Septic 1 2 0 0 0 0 0 0 0 0 0 0 3 9 10 Addition to a home on a septic plan rev/approval Septic 0 8 0 0 0 0 0 0 0 0 0 0 8 23 14 Install. Insp. Septic 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 COC for repairs Septic 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 COC for complete septic system Septic 6 6 0 0 0 0 0 0 0 0 0 0 12 61 61 Info. requests. Septic 2 0 0 0 0 0 0 0 0 0 0 0 2 8 3 Soil/Perc Test. Septic 0 1 0 0 0 0 0 0 0 0 0 0 1 6 4 Const. permits Septic 1 0 0 0 0 0 0 0 0 0 0 0 1 9 10 Installer permits Septic 1 0 0 0 0 0 0 0 0 0 0 0 1 6 6 Installer Tests Septic 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 Deed Restrict. Septic 2 1 0 0 0 0 0 0 0 0 0 0 3 14 8 Plan reviews Sharps 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 Disposal of insp. Sharps insp. Sharps 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 Disposal of permits Sharps permits Subdivision 0/0 1/0 0 0 0 0 0 0 0 0 0 0 1/0 3/0 7/1 Plan review- Insp. of lots /Bond Releases Special 1/1 0/1 0 0 0 0 0 0 0 0 0 0 1/2 16 12 Special Permit/ Permit/ Zoning Zoning memos Tobacco 1 0 0 0 0 0 0 0 0 0 0 0 1 13 12 Tobacco permits Tobacco 1/1 3/1 0 0 0 0 0 0 0 0 0 0 4/2 25/ 21/ Routine 7 2 insp./ Follow- up insp. Tobacco 0 0 0 0 0 0 0 0 0 0 0 0 0 48 36 Compliance checks Tobacco 0/0 0 0 0 0 0 0 0 0 0 0 0 0/0 4/4 3/3 New compl./ Compl. follow-ups Trash 0/0 1/0 0 0 0 0 0 0 0 0 0 0 1/0 30/ 29/ Trash Hauler Haulers/ 2 2 permits/ Medical Medical Waste Waste Hauler Haulers permits Wells 1 1 0 0 0 0 0 0 0 0 0 0 2 6/0 14/ Permission to 1 drill letters/ Well permits

FY 17 Critical Violations Chart (By Date)

Restaurant Insp. Date Critical Violation Description

Fuji 7/18/16 - Cold Holding - Need to ensure that walk-in cold-holding temp. is Steakhouse - Conformance with Approved maintained at 41 deg F or below. Had serviced. Procedures/HACCP Plan (for - Need to ensure that Sushi pH Log is maintained and Acidified Sushi Rice) entries are made when rice is prepared (Log was - Food Contact surfaces cleaning not up to date). Updated log; and sanitizing - Ensure that dish machine reaches a min. temperature of 180 deg F or greater for final hot water sanitizing rinse. Had serviced.

Needham Public Health Department August, 2016 Monthly Report Maryanne Dinell- Traveling Meals Program Coordinator

Monthly Description Reason Notes/Follow-Up (ongoing, completed, etc.) Month of Clients need help with their 49 clients on the Traveling Meals Program August, 2016 daily meals. 35 Springwell clients 14 private pay clients - Needham residents

812 2- meal 23 Clients receive meals 5 602 meals delivered to Springwell Clients packages were times a week 210 meal delivered to private pay residents delivered in 26 Clients receive meals 3 August days a week Total #812 meals delivered @ 5.50 per meal =cost of $4466.00 4 clients 1 Springwell Client 2 Clients maybe long term Joined the 3 Private Pay Residents 2 need this service short time Program in July 3 clients off 1 client on his own Prefers to care for self with help of family Program 2 clients hospitalized due to transferred to rehab fall-

Category Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun FY FY ‘17 ‘16 Total Total Meal 728 812 9687 1540 Delivery General 40 78 1091 118 Telephone Calls- received Assistance 3 2 34 5 Calls-to Springwell Not at 7 2 77 9 home at delivery 911 0 0 0 0

Category Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun FY FY ‘17 ‘16 Total Total

Meetings, Events, and Trainings BI Type Description/Highlights/Votes/Etc. Attendance Board of Monthly meeting held at PSAP 9 Health Meeting

Donations, Grants, and Other Funding [List any donations received, grants funded, etc. over the past month.]

Description Type (D,G,O) Amount Given Source Notes

Traveling Meals Program

August, 2016 FY 17

# Meals # Meals FY16 % Change Month FY2015 FY2016 Cost # Meals Jul 855 728 $4,004.00 -15% Aug 793 812 $4,466.00 2% Sep 794 Oct 800 Nov 672 Projected-12 Mo. Dec 829 $ 50,820.00 Jan 757 # 9,240 Feb 791 Mar 970 Apr 800 May 778 Jun 850 Totals: 9,689 1,540 8,470.00 1250

1150

1050 Traveling Meals Program FY 2017 970 950 FY2016

850 855 850 829 812 800 800 793 794 791 778 750 757 728

Numberof Meals Delivered 672 650

550 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Month of Meal Delivery

My Documents / Budget/ FY04 Printed 9/6/2016 Needham Public Health Division – Nurses Report Donna Carmichael RN & Alison Paquette RN

COMMUNICABLE DISEASES and Animal Bites NEEDHAM HEALTH DEPARTMENT

FISCAL YEAR 2017

DISEASES: JUL AUG SEPT OCT NOV DEC JAN FEB MAR Apr MAY JUN T17 T16 T15 BABESIOSIS 0 0 3 Borrelia Miyamota 0 1 na CAMPYLOBACTER 0 9 12 CHICKENPOX 0 9 6 CRYPTOSPORIDIUM 0 0 0 E-Coli 0 0 0 EHRLICHIOSIS/ HGA 1 1 2 2 Enterovirus 0 3 2 GIARDIASIS 0 1 5 HEPATITIS B 1 1 5 8 HEPATITIS C 3 1 4 12 13 Influenza 2 2 102 77 Legionellosis 0 0 2 Listeriosis 0 1 0 LYME 5 4 9 58 57 MEASLES 0 0 0 MENINGITIS 0 0 0 Meningitis(Aseptic) 0 0 0 Mumps 0 2 0 Noro Virus 0 2 0 PERTUSSIS 0 1 1 SALMONELLA 1 1 5 1 SHIGA TOXIN 1 1 2 0 0 SHIGELLOSIS 0 3 2 STREP Group B 0 3 2 STREP ( GAS) 0 1 2 STREP 0 1 PNEUMONIAE 0 TUBERCULOSIS 0 0 1 TULAREMIA 0 0 0 Latent TB- High Risk 0 1 0 Vibrio 0 1 1 West Nile virus 0 0 0 TOTAL DISEASES 12 8 20 222 197 Revoked Diseases 8 7 Investigated 3 1 4 Contact Investigation 0 0 NA Animal/Human Bites DOG 1 1 8 10 CAT 0 2 0 BAT 1 1 2 5 5 SKUNK 0 1 0 RACOON 0 0 0 Fox 0 0 0 TOTAL BITES 1 2 1 10 18

ImmunizationsJul Aug Sept Oct Nov Dec Jan Feb Mar Apr May June FY17 FY16 FY15 B12 2 2 4 23 22 Flu 0 0 0 816 723 (Seasonal) TDap 1 0 1 0 2 Varicella 0 1 1 Consult 30 48 78 475 390 Fire/Police 4 6 10 40 49 Schools 8 10 18 88 59 Town 12 22 34 216 125 Agencies Community 6 10 16 139 157 Agencies

ASSISTANCE PROGRAMS FY17 FY16 FY 15 Food 0 1 1 21 35 Pantry Food 0 0 0 6 4 Stamps Friends 0 0 0 1 - $300.00 1- YTD

Gift of 0 0 0 YTD 17 $25.00 Warmth Good 0 0 0 $5189.00 22- YTD Neighbor Park & 0 1 1 5 - $1448 $6133.00 Rec RTS 0 0 0 $300/fam 6 -$1650 Salvation 0 0 0 4 $275/Fam Army Self Help 0 0 0 0 3 Water 0 0 0 0 1 Abatement

Gift Cards – 0

Gift Card Donation - 0

WELLNESS Programs FY17 FY16 FY15 Office Visits 39 41 80 447 287

Safte Visits 0 0 0 10 33 Clinics 1 0 0 31 34 Housing Visit 2 0 0 8 27 Housing Call 6 0 70 186 Camps- 6 8 14 72 63 summer Tanning Insp 0 0 0 0 2 Articles 0 0 0 2 8

Presentations 0 0 0 2 2 Cable 1 0 1 1 4

EMPLOYEE WELLNESS July AUG SEPT OCT NOV DEC JAN FEB MAR APR MAY JUNE FY17 FY16 FY15 BP/WELLNESS 120 137 - DPW/RTS 18 14 32 87 52 FLU VACCINE 0 0 0 CPR/AED 26 29 INSTRUCTION 0 0 0 SMOKING 9 8 Education 0 2 2 HEALTH ED 67 102 Tick Borne 28 0 28 HEALTH ED 80 90 Mosquito Borne 28 0 28 HEALTH ED 327 221 FLU 0 0 0 34 29 FIRST AIDE 6 4 10 GENERAL 188 230 HEALTH EDUCATION 20 12 20 33 34 Police weights 0 0 32 TOTAL 1028 981 EMPLOYEE CONTACTS 100 32 132

Emergency Planning

Meetings, Events, and Trainings Title Description/Highlights/Votes/Etc. CCIT Meeting with Tim, Carol, Riverside and police CCIT Planning

Meeting Meeting with School Nurse Leader

MAPHN Meeting in Milton on Ultra violet rays

Webinar Flu

Sunscreen Dispensers Coordinating signage/placement and workings of dispensers with Parks and Forestry and intern from Melanoma Foundation. DVAC Planning Meeting with Tim and Belinda

Needham Health Department Catherine Delano, Senior Substance Use Prevention Program Coordinator August 2016 Monthly Report

Section 1: Summary This month Tim, Carol, and I have been planning the logistics around the Forum: Marijuana Legalization? Why it Matters to You. The Interfaith Clergy of Needham, The Needham Department of Public Health, The Needham Coalition for Youth Substance Use Prevention, and state Rep. Denise Garlick are all sponsors of the forum, which will be held on September 22. Additionally, the Department was awarded a new grant that focuses on medication disposal. I will take the lead on this grant. I am in the process of hiring a graduate intern to assist in the implementation of the grant. Carol and I are still waiting to hear back from EDC about the optional questions for the 2016 MWAHS.

Section 2: Activities Activity Notes Supervised intern – Angela Giordano This was Angela’s last month with us. She will still help with projects when she is able. Cardinal Health Grant The department of public health was awarded a $25,000 grant for Rx medication disposal. I will take the lead on this grant.

New Intern A posting was put up for a graduate intern to help with the implementation of the Cardinal Health Rx Medication Disposal grant.

Synthetic Drug Interview Tim, Carol, and I were filmed for a segment on synthetic drugs for the Needham Channel.

Forum Planning Tim, Carol, and I have been planning a forum to educate the general public about the public health implications/impact of Question #4: Legalizing Recreational Marijuana

Section 3: Meetings & Conferences Title Description Attendance CCIT Monthly CCIT meeting. 7

Goal Setting Met with Tim to discuss my goals 2 over the next year. Cardinal Health grant Met with Tim and the director of 3 the community council to discuss implementation of the grant. MWAHS Conference Call Carol and I spoke with Shari at 3 EDC to discuss the MetroWest Adolescent Health Survey Optional Questions. We are still waiting to hear back regarding a final decision on the questions to be added. NCYSAP Meeting I held my first coalition meeting. ~15 We discussed the logic model as well as updates about what the DFC team has been working on. Hidden in Plain Sight training Training about how to use the ~30 hidden in plain sight equipment in order to borrow and use for our community. Hidden in Plain sight is a mock of a teenagers bedroom to educate parents about how to find drugs or paraphernalia as well as suspicious signs. Suicide Prevention Training Participants learned about the ~50s scope of the problem of suicide in the US and Massachusetts, review current information on suicide risk factors, and examine personal reactions to dealing with suicidal behaviors. Substance Use Programs in Tim, Carol, Karen Shannon, and I 5 Schools met with Jennifer Cohen, an active Needham Mother about taking steps to have Needham Middle and High School implement a drug prevention curriculum

Needham Health Department Karen Shannon, Program Support Assistant July and August 2016 Monthly Report

Section 1: Summary

During the months of July and August we completed taping for the third public service video, informally referred to as “I Wish I Had Known,”(title subject to change) which will highlight the importance of good family communication throughout the tween and teenage years. We are targeting early Fall for airing our 2nd and 3rd PSAs via The Needham Channel and other marketing outlets to the Needham community. DFC deliverables saw the completion of three mandated reporting requirements, near completion of our new Logic Model, with assistance from Epiphany Evaluation Services, and delivery of an NCYSAP meeting (August 2). I attended the CADCA Mid-Year Training Institute in Las Vegas, NV from July 17-21 and returned with many outstanding materials for use in our prevention strategies and programming.

Section 2: Activities

Activity Notes

Public Service Videos Collaborated with Karen Mullen and Angela Giordano for taping the third and final PSA installment. “I Wish Had Known” which communicates the importance of solid communication between parents and their tween/teens. We interviewed 3 local parents who have “been through it” with their teenage and adult children. Worked with Marc Mandel of The Needham Channel, who taped the interviews.

DFC Reporting Assisted in completion of the Semi-Annual Progress Report (February-July 2016) and the Coalition Classification Tool (CCT), a 300-question survey about our coalition. The Semi-Annual Report was submitted 3 days before the 8/19/16 due date. The 2nd Quarter Federal Financial Report (FFR) was completed and submitted also (reference Catherine Delano’s report).

Logic Model Continued process of completing our Logic Model with Catherine Delano. Completed root causes and local conditions for alcohol, marijuana and prescription drugs. Strategies and outcomes in development. Epiphany Community Services/ Worked remotely with Kelli Keck to REACH software review our logic model, using her feedback to refine and develop LM. Participated in training webinar, “Tracking Key Events” conducted by Deacon Dzierzawski, to learn more about data entry on the REACH system.

Special Warrant Article Request: Researched and developed position Revolving Account points for requesting a revolving account for the Public Health Div. via a Town Meeting Special Warrant Article. Revolving funds would support use of tobacco and potentially also alcohol and RMD licensee permit revenues for expenses required for licensee compliance checks and training. NHS Athletics Department: Coaches’ Assisted Catherine with preparation for Meeting her presentation to the athletic coaches. Working with Monica and Angela, we assembled 85 packets containing articles, brochures and community resources for coaches. Drafted presentation notes for Catherine.

Section 3: Meetings & Conferences

Title Description Attendance NCYSAP (large group) Catherine Delano led her first 13 Meeting: 8/2/16 coalition meeting. Assisted in preparation of agenda and distribution materials. CADCA Mid -Year Training Attended Mid-Year Training 2,000 Institute, Las Vegas, NV, in Las Vegas, NV with July 17-21 Catherine D. and Carol R.

Kelli Keck conference call (x2) Reviewed draft of our new 4 logic model (LM), used feedback from Kelli to continue development and refinement of LM. “National Evaluation Webinar Training Webinar by DFCMe n/a for 2016 August Reporting coordinators. Period” “All Stars Booster Certification Offered through BSAS and 30 Level 2 Training: Effectively AdCare Educational Institute, Preventing Prescription Drug conducted by Kathleen Misuse & Other Drug Use” Nelson-Simley

“Suicide Assessment and Offered through BSAS and 50 Intervention Training for AdCare Educational Institute, Mental Health Professionals” conducted by Riverside Trauma Center

Needham Health Department Monica De Winter, Program Support Assistants July and August 2016 Monthly Report

Section 1: Summary

During the month of July and August I have worked one day per week. The majority of my work focused on preparing for and helping to coordinate the NCYSAP coalition meeting on 8/2/16 and completing the DFC Semi-Annual Progress Report which was due 8/19/16.

Section 2: Activities

Activity Notes RMD zoning research Researched and drafted notes of rationale for zoning setbacks and buffer zones for RMD’s

Public Service Videos Reviewed and drafted additional talking points for PSA #3; worked on PSA #2 logistics; worked on communication/logistics for revising PSA #2 with Mark Mandel Logic Model conference call with Kelli Keck of Ephiphany Evaluation Services DFC Semi-Annual Progress Report Worked with Karen S. on completing report and submitted it 8/19/16 Preparation for coaches’ meeting Prepared materials for Catherine to distribute and talking points to use for 8/29 coaches meeting re: alcohol & drug use and athletes

Section 3: Meetings & Conferences

Title Description Attendance NCYSAP Coalition meeting on Helped draft agenda, prepare 15 8/2/16 for and reviewed/edited meeting minutes for distribution DFC email correspondence Spoke with DFC Project Officer, Dan Fletcher, to update the contact information for all email correspondence with DFCMe

REACH software Training Webinar by 12 Epiphany Services "Tracking Key Events"

Needham Public Health Department

August 2016

Substance Abuse Prevention & Education Needham Coalition for Youth Substance Abuse Prevention ~ NCYSAP Karen Mullen, Project Coordinator/Capacity Building

Section 1: Activities Activity Notes SALSA- Students Advocating Life Without Prepare & Review 2016-17 budget & goals. Meeting Substance Abuse with Tim McDonald 8/25/16 SALSA & 5th Quarter Fundraising Planning fundraising drive for Sept/Oct. 2016. Pollard MS, NHS PTC, BID Needham, Needham Women’s Club, Trip Adviser, Needham Banks, individual donors etc. SALSA 2016-17 Planning Meeting with SALSA Leaders 8/29/16 to review survey results, determine annual goals, assign roles and responsibilities

Meeting with NHS Principal Aaron Sicotte 8/24/16

Scheduled meeting with Pollard Health teacher Sherrin O’Neil for 9/7 to review survey analysis and annual goals

Coordinating annual training for Sat. 9/24 at NHS.

5th Quarter Planning Plan, coordinate and publicize 9/9 event. Recruit volunteers, designed fliers and copy to promote event(s) at NHS and in the Needham community. Video #3 Production Finalized parent interviews, coordinated logistics for shoot. Editing Video #2 and #3 in early September w/Marc Mandel at the Needham Channel.

Carol Read, M.Ed., CAGS, CPS Substance Abuse Prevention and Education ~ Initiative Highlights Needham NPHD, NCYSAP and SAPC* ~ August 2016

SAPC grant collaboration with the towns of Dedham, Needham, Norwood and Westwood.

SAPC grant ~

Town coalition meeting attendance: No August town meetings- Phone and email communication to provide educational and therapeutic support resources, process Strategic Plan initiatives and provide Technical Assistance to enhance town coalition capacity. Coordination of National Prevention Network (NPN) Conference registration Dedham coalition coordinator, Jessica Gardner, Public Health nurse

Strategic Planning meetings:

MassTAPP Technical Assistance- Tracy Desovich, MPH August 19th SAPC Strategic Plan edit consultation

SAPC 206-2017 Budget – Review 2015 budget proposed and actual with adjustments. Draft 2016-2016 budget to reflect Strategic Plan initiatives. Submitted to BSAS August

Logic Model building – Emily Bhargava, Consultant Dedham and Westwood coalitions Dedham- August 18th 8:30am-10:30am 4 attendees (Selectman, PH Director, PH nurse and Director School Health Services) Westwood August 18th 11:00am-1:00pm 5 attendees (Town Manager, PH Director, HS Principal, Director Youth and Family Services, Westwood Police Officer)

Needham Public Health-Needham Coalition for Youth Substance Abuse Prevention (NCYSAP)

NCYSAP meeting: August 2nd Needham Public Library Catherine Delano facilitator. Review and update of coalition strategic planning process, Narcan access, Needham RMD applicant process and BOH RMD regulations, updates on coalition prevention initiatives with Karen Shannon, Monica DeWinter and Angela Giordano, BU-SOPH Intern.

Resident Support- Respond to calls related to mental health conditions and/substance use disorder educational resources. Referral to counseling, assessment, treatment and recovery resources. 3 requests: M-18 years (marijuana), M-18 years (alcohol- marijuana), M-21 years (marijuana- ). August 16th team meeting- Resident support MA-DMH Paul Murphy- Beth Sturgeon CBFS Psych. Case Supervisor.

Marijuana conference: August 17th Coalitions Learning Together** group. Marijuana Commercialization Blue Hills Community Health Alliance CHNA 20 Quincy 100 attendees. Collaboration initiative: CHNA 20 Arlene Goldstein Manager, South Shore Hospital, Kim Noble and Avon- Stoughton prevention coalitions. Presentations by: Chief John Carmichael, Walpole PD, Karen Walsh Pio, South Hadley prevention coalition, Stephanie Patton, MPH Stoughton OASIS, Lyn Frano, SAPC Stoughton Flyer attached

Page 1 of 5 Pages The Needham Channel-News Ashley Julier Contributor to NPHD- NCYSAP segments on Synthetic Drug BOH regulation and Drug Paraphernalia BOH regulation. Contribution of prevention science and data related to synthetics, drug paraphernalia, PD misuse, opioid overdose strategies

Needham Public Schools-School Health- August 10th Barbara Singer, Director School Health Services K-12. Inaugural meeting with Chief Schlittler, Lt. Baker, Tim McDonald, Donna Carmichael and Catherine Delano. Introduction to town support services all age residents and Information sharing for town school collaboration.

Community Crisis Intervention Team (CCIT) Needham Police Department August 10th - Resident support. Collaboration and consultation with Needham team: Lt. Chris Baker, NPD, Donald Anastasi, NFD, Donna Carmichael, Catherine Delano, Tim McDonald and Tracy Zitoli, LICSW Riverside Community Care Emergency Services team leader- Community Liaison.

NPHD initiatives: Needham BOH policy Marijuana Legalization- Public Health: Data collection-outreach to state and federal prevention, public health and drug policy sources to obtain science based, data driven synopsis related to the public health impact of marijuana legalization for recreational use. Meeting August 24th to be drafted by Angela Giordano and Catherine Delano.

Marijuana Forum: Marijuana Legalization: Why it Matters to You. Thursday, September 22nd, Needham Town Hall Powers Hall*. Outreach to event speakers: Kevin Sabet, P.H.D., Chief John Carmichael, Walpole PD, John Sofis Scheft, Attorney, Dr. John Kelly, MGH. Coordination of adult event flyer with Allan Downing, Noonan Graphics. *Collaboration on event logistics, agenda and Google registration link with NCYSAP Director Catherine Delano.

Webinar:

MassTAPP – MA- DPH – BSAS August 24th Improving Access At Pharmacies, Dr. Trish Case, Northwestern University, Dr. Traci Green, Boston University- BMC. Overview of the GETNLX initiative- including pharmacy visits by community members, “secret shopping” protocols and tools for volunteers to use to report on visits to local pharmacies when requesting information or requesting purchase of Narcan.

Meetings:

Metrowest Adolescent Health Survey MWAHS 2016: August 3rd Call Shari Kessel Schneider, EDC and Dr. Kathy Pinkham, NPS Health Education Director HS and MS (grades 7&8) optional question planning (CD) Allston- Brighton Task Force- August 4th Helen Connelly Director resource sharing- Walk For Recovery collaboration Saturday, September 24th first citywide collaboration with The Mayor of Boston’s Office for Recovery Services Riverside CC- August 2nd- Strategic Planning collaboration NPHD new program funding through BIDN community benefit program. Laurie Hutchison, Kent, Nora Kenny Houser. (TM-DC-CD) Marijuana Forum: August 8th – Event planning: flyer content- speakers- agenda (TM-CD) Page 2 of 5 Pages Hidden In Plain Sight - August 9th Train the trainer initiative room display. South Shore Hospital, Rockland Kim Noble, Trainer. (CD) Commonwealth Psychology Associates: August 11th Courtney Lab, Psy.D. Request for collaboration. Professional development training featuring Marisa Silveri, Ph.D. Clinicians, school guidance, teachers, college administrators and health educators- Outreach to Wellesley, Newton and Needham. CEU’s provided- To be presented to Tim McDonald and Catherine Delano as option for collaboration. Cardinal Health grant: August 12th Review of grant application, Strategic Planning for NC- 7 region implementation. (TM-CD) Health Curriculum: August 24th Needham Public Schools Substance curriculum content enhancements Jennifer Cohen, NCYSAP member. (TM- CD-KS) Needham Interfaith Clergy Association: August 11th Event collaboration: Call Initial planning related to funding with Kevin Sabet SAM, and Ramin Abrishamian, President. McLean Hospital Neuroimaging Center Harvard Medical - August 26th Marisa Silveri, Ph.D., Alcohol- Marijuana brain development. SAPC event planning January 2017 Riverside Trauma Center- August 31st Jim McCauley, Assistant Director 20 year service tribute.

Prevention support requests: Calls | Meetings

Ashland Coalition August 31st- Marijuana educational forum Kristin French, MPH- Amy Turncliff, Ph.D. Agenda planning- event structure – facilitation C. Read Town of Natick- August 18th Strategic Planning Opioid Prevention FTE Catie Sugarman, MPH-

*SAPC technical assistance calls, coordinator meetings, and compliance related to the SAPC grant program are documented in the BSAS-SAPC quarterly reports.

1 day out of office (1) day vacation Respectfully submitted by Carol Read September 6, 2016 Page 3 of 5 Pages

**Coalitions Learning Together: Marijuana Commercialization (event overview and agenda pages 4 and 5 below)

Why Now? Be the change you Needham ❏ Over thirty other communities in want to see! Massachusetts have banned plastic bags including Wellesley, Sign our petition to stop the sale of Single-Use Newton, and Brookline. wasteful and hazardous plastic Plastic Bag Ban ❏ Brookline estimates one million bags around Needham. Your show bags have been removed from of support will allow us to pass this their municipal waste. ban like so many towns before us. ❏ Needham has been a leader in multiple green initiatives and this would be a logical next step. ❏ The only way of enacting true change is to start small and banning plastic bags is our way of doing this.

The Plastic Bag Problem

About us America uses over 100 billion

We are Needham High School single-use plastic bags annually. students determined to help our Plastic bags are an unnecessary environment. Banning plastic bags environmental hazard, cause in our hometown is a great way to multiple health concerns, and are start. We all use these bags, Contact us: economically costly to the town. unthinkingly. We see them cluttered These bags are light enough so the along the sides of the Transfer Email: wind is able to blow them out of Station, in the parks and even at [email protected] waste facilities littering our

times in our own front yards. Yet we environment. The bags then slowly don't see the islands of trash in our Facebook: down into dangerous oceans or the microplastics in our Facebook.com/NeedhamPlasticBagBan microplastics which seep into the soil and in turn the entire soil. The impact is real, growing and Online Petition: frightening. But there is a solution. ecosystem. Microplastics have Change.org/p/town-of-needham-single- And you can help. been linked to birth defects and use-plastic-bag-ban types of cancers. Alternatives to Plastic Bags Needham’s Ban would: • Decline a bag when you can • Prohibit the distribution of plastic carry something in your hand or bags less than 4 mils in thickness pocket • Give businesses a time period between six months to a year to • For multiple items, carry adjust to the ban reusable bags in your car or • Require that paper bags be purse completely biodegradable and made out of 100% recyclable • While biodegradable plastic materials bags exist, these require special • Exempt thin-film plastic bags handling and are not yet without handles such as economically viable. Use them Facts about Plastic Bags newspaper, laundry, produce, as an alternative, but reusable meat, and bulk foods bags bags are better ❏ Plastic bags reduce the revenue • Give the Health Department the • Always request paper over generated by Needham selling its authority to administer and plastic bags recyclables - bags jam recycling enforce the ban with fines that machines so Needam is paid less. would increase after each offense ❏ 70% of all ocean pollution is plastics and bags make up 19% of that. Marine life mistakenly eats or get tangled by these plastics ❏ There are ‘islands’ of trash in the Pacific Ocean in an area the size of Texas - floating pollution is 90% plastics, the most common of which are plastic bags. ❏ Over one trillion plastic bags are used annually worldwide. How can I make a difference? ❏ Over thirteen countries have • Sign our petition to help get the already made bans or other laws ban on the Town Meeting Agenda against plastic bags. • Share our cause and get support

Needham Public Health Department 1471 Highland Avenue, Needham, MA 02492 781-455-7500 ext. 511 www.needhamma.gov/health 781-455-0892 (fax)

Memo ON HOLD (didn’t mail) To: Greg Petrini, Petrini Corporation From: Tara Gurge, Health Department Date: October 27, 2014 Re: Surety – Riverbend Lane Subdivision/ 708 South Street. Release request of Off-Street Drainage Bonds for Lots 4, 4A and 5

The Health Department has received a request that you are seeking a release in the performance off-street drainage bonds for the definitive subdivision lots noted above. We understand that the Town is currently holding $3,500.00 for each lot, for a total release request of $10,500.00.

The Health Department requires that the following information be submitted and reviewed prior to accepting your request for a release of your off-street drainage bonds: 1.) Please provide to the Health Department an updated list giving the number of total lots/units and their locations shown on a plan (including their street addresses); 2.) Provide an updated list of the number of lots/units currently occupied at this time and their dates of occupancy. (NOTE: The Board of Health cannot release any off-street drainage bonds unless the resident has been living in the completed residence for at least a year); 3.) Please notify, via certified mail, all owners and abutters of your reduction of surety request to determine if they have any drainage/erosion concerns (see enclosed sample draft letter that can be used). The Health Department must receive copies of each signed certified mail card.

Please note that The Health Department will need to conduct site visits prior to any bond release request. Please call the Health Department if you have any questions or concerns at (781) 455-7500; Ext. 262.

Encl.: Draft Bond Release Letter

cc: Roy Cramer, Attorney Lee Newman, Planning Board

RiverbendLaneSubdivBondReleaseRequest-14

Needham Board of Health

August , 2016

12 Mr. Steven Hughes Director, Community Sanitation Program Bureau of Environmental Health Massachusetts Department of Public Health 250 Washington Street, 7th Floor Boston, MA 02108

RE: Needham Board of Health Variance Approval for Therapeutic Pool at Wingate Residences Needham

Dear Mr. Hughes,

At its most recent Board of Health meeting on Friday July 29, 2016, the Needham Board of Health conducted a Public Hearing on three proposed regulations and also held a Public Hearing for a variance to certain provisions of 105 CMR 435.00. This application and variance request was filed by Wingate Development (the Applicant) for a proposed therapeutic pool that will be located in the Wingate Residences Needham (located at 235 Gould Street, Needham, MA 02494). Present at this Open Meeting and Public Hearing were:

Board of Health • Edward Cosgrove, PhD, Board of Health Chair • Jane Fogg, MD, MPH, Board of Health Vice Chair • Stephen Epstein, MD, MPP, Board of Health Member

Needham Public Health Department • Timothy Muir McDonald, Director of Public Health • Tara Gurge, Environmental Health Agent • Donna Carmichael, Public Health Nurse • Catherine Delano, Senior Substance Use Prevention Coordinator • Maryanne Dinell, Traveling Meals Program Coordinator • Cheryl Gosman, Recording Secretary

Other Interested Parties • Keith Mulkern, Aquaknot Pools • Kevin Mulkern, Aquaknot Pools • David Feldman, Vice President for Real Estate, Wingate Development • Paul Humphries, The Architectural Team • Michael Tomasello, Callahan Inc.

1471 Highland Avenue, Needham, MA 02492 781-455-7500x511(tel); 781-455-0892 (fax) E-mail: [email protected] Web: www.needhamma.gov/health Background

Wingate Residences is under Phase III of new construction at their facility located at 235 Gould Street in Needham, MA. The facility is expanding with a new long-term care facility building that is focused upon assisted living. Wingate’s management would like to include an “Aqua Fitness and Wellness Center” in the new facility, with the goal of having residents use the four foot deep pool for aqua aerobics, lap swimming, and water-based therapeutic exercises.

For the water-based therapeutic activities, Wingate hopes to use an immersed treadmill to provide low-impact cardiovascular activity for residents. Wingate proposes that all treadmill-based physical therapy would occur under the direct supervision of a Licensed Physical Therapist. A largely separated area for the proposed treadmill is featured in the pool design. This area may be accessed by walking into the pool from the zero-entry stairs and walking across the lap swim lane or it may be accessed directly from a pool entry ladder so that a person entering the pool for treadmill-based therapy would not interfere with an individual swimming for exercise in the lap area of the pool. Once in the therapy area, the individual is isolated from the two swimming lanes (please see attached pool diagram.)

A diagram of the proposed pool is included as an attachment to this letter, as are Wingate’s pool application, letter to the Needham Public Health Department, and a product brochure for the targeted type of water-based treadmill system.

Variance Requested

Wingate Needham requested a variance from the Needham Board of Health to allow for the closely supervised operation of an underwater therapeutic treadmill. Specifically, Wingate requested relief from 105 CMR 435.05 (3), which states that, “No projection except ladders and grab rails shall be permitted from any pool wall or floor surface, provided that a fill spout may be constructed under the diving stand, rounded fittings projecting not more than two inches from the wall may be installed. A recessed stairway shall not be considered a projection for the purposes of 310 CMR 12.00.”

Board of Health Findings

The Needham Board of Health, following a public presentation by Wingate and a sustained question and answer period, found the following:

• That water-based therapeutic activities, when properly supervised by a licensed physical therapist, can improve health and wellness of older adults and may mitigate disabilities1 and physical limitations that develop with age.2 And, as the federal Centers for Disease Control & Prevention (CDC) asserts, water-based therapeutic activities are particularly important for

1 Shir, Daniel. Benefits of Swimming for People with Disabilities. National Center of Health, Physical Activities, and Disability (NCHPAD) Blog. August 3, 2015. Accessed August 3, 2016. Available at: http://blog.ncpad.org/2015/08/03/benefits-of-swimming-for-people-with-disabilities/ 2 Sato D, Kaneda K, Wakabayashi H, and Nomura T. The water exercise improves health-related quality of life of frail elderly people at day service facility. Quality of Life Research. 2007; 16:1577-85. 2

the bone health of older adults and especially post-menopausal women.3 Given the resident population which Wingate serves, this form of underwater physical therapy in a controlled environment which will occur only under the supervision of a licensed physical therapist will be a significant health and wellness benefit to the Wingate community and all its residents. There are many reasons that the use of an underwater treadmill is preferable to general walking in a pool for older adults and those who are rehabilitating following an injury or surgery. These include the underwater treadmill’s ability to monitor progress (time, distance, speed), the ability of residents using an underwater treadmill to hold on with two hands and thus improve stability, and the way that an underwater treadmill allows the Licensed Physical Therapist to tailor a rehabilitation or exercise program that gradual increases distance or resistance over time. • That the concern which exists about water flow and pool filtration given the semi-permanent placement of the treadmill in the pool and the relative exclusion of the treadmill area from the larger, lap swim portion of the pool is resolved by the placement of an additional two (2) floor drains in the therapy area along with wall supply outlets, to ensure no restriction of water flow. • That the treadmill fits flush with the pool bottom, and thus presents no hazards for tripping. When the treadmill is not in use, it will remain in the therapy pool, but its structure and installation are such that, if the need ever arose, the treadmill could be removed from the pool. • That all corners of the pool will be rounded so there will not be any 90 degree corners that may pose a potential safety hazard. In addition, all pool corner edges will be marked with a 4” stripe of contrasting color to help create swimmer awareness and preserve user safety.

With its unanimous approval for the variance requested by Wingate Needham, the Needham Board of Health imposed the following restrictions, limitations, and operating conditions:

• Whenever a therapeutic session is in progress involving the underwater treadmill, it may only occur under the supervision of a Licensed Physical Therapist who must also have an active lifeguard/first aid/CPR certification. Supervision of the underwater treadmill by the Aquatics Director is NOT permitted. • If simultaneous activities will occur in the pool, two individuals, each of which have an active lifeguard certification and at least one of which must be a Licensed Physical Therapist, must be present AT ALL TIMES. For example, if an individual is swimming laps and an individual is using the treadmill, the latter must be under the supervision of a Licensed Physical Therapist who must also have an active lifeguard/first aid/CPR certification, and the former must be under the supervision of the Aquatics Director, who also must have an active lifeguard/first aid/CPR certification. • If simultaneous activities will occur in the pool such as an individual swimming laps while another individual uses the treadmill, the Aquatics Director must first deploy a float line to clearly separate the lap swimming area of the pool from the underwater treadmill area. The use of a float line combined with the close supervision of both the lap swimmer and the treadmill user along with the configuration of the pool makes it extremely unlikely that a lap

3 Rotstein A, Harush M, and Vaisman N. The effect of water exercise program on bone density of postmenopausal Women. Journal of Sports Medicine and Physical Fitness. 2008; 48(3):352-9. 3

swimmer would be able to mistakenly access the therapeutic area of the pool. • No resident of Wingate may engage in aquatic therapy without the express approval (in writing) of their primary care physician. Such approval shall be maintained on file at Wingate by either the Licensed Physical Therapist or the Aquatics Director, and must be updated or re- issued by the primary care physician at least once every calendar year. Records of physician expressed approval may be reviewed at any time by the Needham Public Health Department, and will be consistently reviewed as part of the annual inspection process and as well as during routine investigations conducted by Needham Public Health Department staff members following any complaints. • The level of pool filtration provided by the additional pair of floor drains and wall outlets in the treadmill therapy area may not be in any way compromised or obstructed by the placement or operation of the treadmill, nor by the existing wing wall which separates the therapy area from the lap swim area of the pool. Additional pre-operation inspections and water quality tests to ensure appropriate water filtration shall be required by the Board of Health; the Director of Public Health may utilize his discretion in the level of additional tests that are required to ensure the safe and hygienic operation of the pool.

Further, the Needham Board of Health, in its unanimous decision to provide a variance from the regulatory specifications of 105 CMR 435.05 (3), found that the two-part test in 105 CMR 435.46 for variance approval has been satisfied.

The first part of the two-part variance test is whether the rigid enforcement of the regulatory standards in 105 CMR 435.00 without the relief associated with the variance requested “would do manifest injustice”. The Needham Board of Health unanimously found that the health and wellness benefits of closely supervised therapeutic session on an underwater treadmill are substantial, especially to those individuals that will reside in Wingate Needham. The individuals for which underwater treadmill therapy might prove beneficial include older adults, adults with physical impairments or disabilities, those individuals recovering from a recent injury, and especially post- menopausal women. To deny this particular form of aquatic physical therapy based upon this therapy’s departure from the strict “projection” section of the regulations would constitute a manifest injustice to Wingate residents whose health conditions require low impact water-based cardiovascular activity, given both that:

• the Needham Board of Health concluded that Wingate has proposed (in its application) significant steps to assure a safe and hygienic pool environment;

and that

• the Needham Board of Health imposed additional restrictions, limitations, and operating conditions upon the applicant which further assure that the environment in the proposed Wingate Needham therapeutic pool will achieve a rigorous standard for safety and hygiene.

The second part of the two-part variance test is whether “the applicant has proved that the same degree of protection required under 105 CMR 435.00 can be achieved without the strict application of the particular provision.” The particular provision in question is 105 CMR 435.05 (3), which states that, “No projection except ladders and grab rails shall be permitted from any pool wall or floor surface, 4 provided that a fill spout may be constructed under the diving stand, rounded fittings projecting not more than two inches from the wall may be installed. A recessed stairway shall not be considered a projection for the purposes of 310 CMR 12.00.”

Given that the initial application proposal by Wingate included a largely excluded area for the safe operation of the therapeutic treadmill away from the lap swim area of the pool, as well as the configuration of the treadmill, the inclusion of a pair of additional floor drains and wall outlets to ensure adequate water filtration, as well as the restrictions, limitations, and operating conditions imposed upon the applicant by the Needham Board of Health (those specified in bullet form on page three of this letter), the Needham Board of Health unanimously concluded that the proposed therapeutic pool at Wingate Needham will provide the “same degree of protection” afforded under a strict, variance-free application of 105 CMR 435.00.

Therefore, the Needham Board of Health presents this unanimous approval of a variance from the conditions of 105 CMR 435.05 (3) for Wingate Needham, and invites the Community Sanitation Program, Bureau of Environmental Health, Massachusetts Department of Public Health to provide its approval, disapproval, or modification in line with the conditions specified in 105 CMR 435.46.

Please contact the Needham Public Health Department if you need additional information or have questions about the variance request approved by the Needham Board of Health on July 29, 2016, and officially posted on August 4, 2016.

Please call the Public Health Department office and speak to either Mr. Timothy Muir McDonald or Ms. Tara Gurge. Both Mr. McDonald and Ms. Gurge may be reached at 781-455-7500, ext. 511. Thank you for taking the time to review this pool variance approval.

Sincerely,

Edward Cosgrove, PhD Stephen Epstein, MD, MPP Jane Fogg, MD, MPH Chair Vice Chair

CC: Timothy Muir McDonald, Director of Public Health Tara Gurge, Environmental Health Agent Kate Fitzpatrick, Town Manager David Feldman, Vice President for Real Estate, Wingate Development

Attachments: Wingate Pool Application and Variance Request Wingate Letter Pool Diagram Treadmill Specifications Sheet

5

Needham Public Health

Memorandum

To: Needham Board of Health From: Tara Gurge, Environmental Health Agent Date: July 25, 2016 Re: Updates to Needham Board of Health Body Art Regulation ______

The Needham Board of Health enacted Body Art regulations in 2001, establishing operating standards, fees, fines and penalties for failure to abide by the regulations. The law requires tattoo and body piercing operators to obtain an establishment permit in order to operate a tattoo or body piercing studio and for all tattoo and piercing artists to obtain an individual practitioner permit. As of July 1, 2016, the Needham Public Health Division has not received any applications for Body Art permits of any kind.

As the popularity of tattoos continues to grow, so does the concern about potential risks. Some risks, such as the spread of infections through the use of unsterilized needles, have long been known. Tattooing and body piercing also carry risks of infection and bloodborne disease transmission as well as allergic reactions, prolonged bleeding, swelling, scarring and general discomfort. Existing medical conditions such as allergies, heart disease, diabetes, skin disorders or conditions that affect the immune system may increase the risk of complications from tattooing and body piercing, according to the US Food & Drug Administration (FDA).

The Needham Public Health Division recently received an inquiry about whether a local salon could start offering the service of ‘Microblading’, which is a process that uses temporary ink injected under the skin. The Massachusetts Department of Public Health’s Community Sanitation Program advised us to include this under our existing Body Art regulations. Please see the following definition:

Microblading: is a pulling or swiping motion with a set of slightly curved needles. It results in a fine line or scoring of the skin into which the temporary color is delivered by multiple needles being moved as they rotate through the skin in a slight curve. (NOTE: This is usually conducted in the facial area to help define the eyebrows.)

In consultation with the Director, I have updated and revised our existing Body Art regulations to include this definition. If approved by the Board of Health following a public hearing, this addition will proactively strengthen the Needham Board of Health Body Art Regulation to account for the ever changing variants and new and improved techniques of body art.

1471 Highland Avenue, Needham, MA 02492 781-455-7500x511(tel); 781-455-0892 (fax) E-mail: [email protected] Web: www.needhamma.gov/health

Attached is the Needham Board of Health Body Art Regulation with red-line edits that include new definitions, and additions to Sections 7.3, 7.6.4, 7.12.1, and 7.19. Notable additions to the regulation are summarized below:

 The definition of “Microblading” has been added. It states: It is a pulling or swiping motion with a set of slightly curved needles. It results in a fine line or scoring of the skin into which the temporary color is delivered by multiple needles being moved as they rotate through the skin in a slight curve.  The expansion of the definition of Tattoo, where we also included the use of temporary inks. (i.e. Tattoo: Means the temporary or indelible mark, figure or decorative design introduced by insertion of dyes or pigments into or under the subcutaneous portion of the skin.)  The expansion of the definition of Tattooing, where we also state the use of temporary inks.  Updated the section on Posting Requirements, we updated this section to include the name, address and phone number of the Needham Public Health Department.  Under Practitioner Training and Experience, we expanded the section on the annual fee for the Body Art Practitioner Permit shall be set at the level determine by the Board of Health in its fee schedule, which shall be adjusted from time to time.

Sincerely,

Tara E. Gurge, R.S., C.E.H.T., M.S. Environmental Health Agent

CC: Timothy McDonald, Director of Public Health

ARTICLE 7 REGULATION FOR BODY ART ESTABLISHMENTS AND PRACTITIONERS

SECTION 7.1 PURPOSE

Whereas body art is becoming prevalent and popular throughout the Commonwealth; and whereas knowledge and practice of universal precautions, sanitation, personal hygiene, sterilization and aftercare requirements on the part of the practitioner should be demonstrated to prevent the transmission of disease or injury to the client and/or practitioner; now, therefore the Board of Health of the Town of Needham passes these rules and regulations for the practice of body art in the Town of Needham as part of our mission to protect the health, safety and welfare of the public.

SECTION 7.2 AUTHORITY

This regulation is promulgated under the authority granted to the Needham Board of Health under Massachusetts General Law Chapter 111, Section 31 which states that “boards of health may make reasonable health regulations”.

SECTION 7.3 DEFINITIONS

Aftercare means written instructions given to the client, specific to the body art procedure(s) rendered, about caring for the body art and surrounding area, including information about when to seek medical treatment, if necessary.

Applicant means any person who applies to the Board of Health for either a body art establishment permit or practitioner permit.

Autoclave means an apparatus for sterilization utilizing steam pressure at a specific temperature over a period of time.

Autoclaving means a process which results in the destruction of all forms of microbial life, including highly resistant spores, by the use of an autoclave for a minimum of thirty minutes at 20 pounds of pressure (PSI) at a temperature of 270 degrees Fahrenheit.

Bloodborne Pathogens Standard means OSHA Guidelines contained in 29 CFR 1910.1030, entitled "Occupational Exposure to Bloodborne Pathogens.”

Board of Health means the Town of Needham Board of Health and its designated agents.

Board of Health Agent means the Director of Public Health and any town employee designated by the Director, which may include Public Health Department staff, law enforcement officers, fire officials, and code enforcement officials, as well as contractors.

Body Art means the practice of physical body adornment by permitted establishments and practitioners using, but not limited to, the following techniques: body piercing, tattooing, cosmetic tattooing, branding, and scarification. This definition does not include practices that are considered medical procedures by the Board of Registration in Medicine, such as implants under the skin, which procedures are prohibited.

Body Art Establishment or Establishment means a location, place, or business that has been granted a permit by the Board, whether public or private, where the practices of body art are performed, whether or not for profit.

Body Art Practitioner or Practitioner means a specifically identified individual who has been granted a permit by the Board to perform body art in an establishment that has been granted a permit by the Board.

Body Piercing means puncturing or penetrating the skin of a client with pre-sterilized single-use needles and the insertion of pre-sterilized jewelry or other adornment into the opening. This definition excludes piercing of the earlobe with a pre-sterilized single-use stud-and-clasp system manufactured exclusively for ear-piercing.

Braiding means the cutting of strips of skin of a person, which strips are then to be intertwined with one another and placed onto such person so as to cause or allow the incised and interwoven strips of skin to heal in such intertwined condition.

Branding means inducing a pattern of scar tissue by use of a heated material (usually metal) to the skin, making a serious burn, which eventually becomes a scar.

Cleaning area means the area in a Body Art Establishment used in the sterilization, sanitation or other cleaning of instruments or other equipment used for the practice of body art.

Client means a member of the public who requests a body art procedure at a body art establishment.

Contaminated Waste means waste as defined in 105 CMR 480.000: Storage and Disposal of Infectious or Physically Dangerous Medical or Biological Waste, State Sanitary Code, Chapter VIII and/or 29 Code of Federal Regulation part 1910.1030. This includes any liquid or semi-liquid blood or other potentially infectious material; contaminated items that would release blood or other potentially infectious material in a liquid or semi-liquid state if compressed; items on which there is dried blood or other potentially infectious material 2 and which are capable of releasing these materials during handling; sharps and any wastes containing blood or other potentially infectious materials.

Cosmetic Tattooing, which may also be known as permanent cosmetics, micro pigment implantation, or dermal pigmentation, means the implantation of permanent pigment around the eyes, lips and cheeks of the face and hair imitation.

Director means the Director of Public Health.

Disinfectant means a product registered as a disinfectant by the U.S. Environmental Protection Agency (EPA).

Disinfection means the destruction of disease-causing microorganisms on inanimate objects or surfaces, thereby rendering these objects safe for use or handling.

Ear piercing means the puncturing of the lobe of the ear with a pre-sterilized single-use stud-and-clasp ear- piercing system following the manufacturer's instructions.

Equipment means all machinery, including fixtures, containers, vessels, tools, devices, implements, furniture, display and storage areas, sinks, and all other apparatus and appurtenances used in connection with the operation of a body art establishment.

Exposure means an event whereby there is an eye, mouth or other mucus membrane, non-intact skin or parental contact with the blood or bodily fluids of another person or contact of an eye, mouth or other mucous membrane, non-intact skin or parenteral contact with other potentially infectious matter.

Hand Sink means a lavatory equipped with hot and cold running water under pressure, used solely for washing hands, arms, or other portions of the body.

Hot water means water that attains and maintains a temperature 110º-130ºF.

Instruments Used for Body Art means hand pieces, needles, needle bars, and other instruments that may come in contact with a client's body or may be exposed to bodily fluids during any body art procedure.

Invasive means entry into the client’s body either by incision or insertion of any instruments into or through the skin or mucosa, or by any other means intended to puncture, break, or otherwise compromise the skin or mucosa.

Jewelry means any ornament inserted into a newly pierced area, which must be made of surgical implant-grade stainless steel; solid 14k or 18k white or yellow gold, niobium, titanium, or platinum; or a dense, low-porosity plastic, which is free of nicks, scratches, or irregular surfaces and has been properly sterilized prior to use.

Light colored means a light reflectance value of 70 percent or greater.

Microblading is a pulling or swiping motion with a set of slightly curved needles. It results in a fine line or scoring of the skin into which the temporary color is delivered by multiple needles being moved as they rotate through the skin in a slight curve. 3

Minor means any person under the age of eighteen (18) years.

Mobile Body Art Establishment means any trailer, truck, car, van, camper or other motorized or non-motorized vehicle, a shed, tent, movable structure, , home or other facility wherein, or concert, fair, party or other event whereat one desires to or actually does conduct body art procedures.

Operator means any person who individually, or jointly or severally with others, owns, or controls an establishment, but is not a body art practitioner.

Permit means Board approval in writing to either (1) operate a body art establishment or (2) operate as a body art practitioner within a body art establishment. Board approval shall be granted solely for the practice of body art pursuant to these regulations. Said permit is exclusive of the establishment’s compliance with other licensing or permitting requirements that may exist within the Board’s jurisdiction.

Person means an individual, any form of business or social organization or any other non-governmental legal entity, including but not limited to corporations, partnerships, limited-liability companies, associations, trusts or unincorporated organizations.

Physician means an individual licensed as a qualified physician by the Board of Registration in Medicine pursuant to M.G.L. c. 112 § 2.

Procedure surface means any surface of an inanimate object that contacts the client's unclothed body during a body art procedure, skin preparation of the area adjacent to and including the body art procedure, or any associated work area which may require sanitizing.

Sanitary means clean and free of agents of infection or disease.

Sanitize means the application of a U.S. EPA registered sanitizer on a cleaned surface in accordance with the label instructions.

Scarification means altering skin texture by cutting the skin and controlling the body’s healing process in order to produce wounds, which result in permanently raised wheals or bumps known as keloids.

Sharps means any object, sterile or contaminated, that may intentionally or accidentally cut or penetrate the skin or mucosa, including, but not limited to, needle devices, lancets, scalpel blades, razor blades, and broken glass.

Sharps Container means a puncture-resistant, leak-proof container that can be closed for handling, storage, transportation, and disposal and that is labeled with the International Biohazard Symbol.

Single Use Items means products or items that are intended for one-time, one-person use and are disposed of after use on each client, including, but not limited to, cotton swabs or balls, tissues or paper products, paper or plastic cups, gauze and sanitary coverings, razors, piercing needles, scalpel blades, stencils, ink cups, and protective gloves.

Sterilize means the use of a physical or chemical procedure to destroy all microbial life including highly 4

resistant bacterial endospores.

Tattoo means the temporary or indelible mark, figure or decorative design introduced by insertion of dyes or pigments into or under the subcutaneous portion of the skin.

Tattooing means any method of placing ink or other pigment into or under the skin or mucosa by the aid of needles or any other instrument used to puncture the skin, resulting in either permanent or temporary coloration of the skin or mucosa. This term includes all forms of cosmetic tattooing.

Temporary Body Art Establishment means the same as Mobile Body Art Establishment.

Three dimensional “3D” Body Art or Beading or Implantation means the form of body art consisting of or requiring the placement, or insertion of an object, device or other thing made of matters such as steel, titanium, rubber, latex, plastic, glass or other inert materials, beneath the surface of the skin of a person. This term does not include Body Piercing.

Ultrasonic Cleaning Unit means a unit approved by the Board, physically large enough to fully submerge instruments in liquid, which removes all foreign matter from the instruments by means of high frequency oscillations transmitted through the contained liquid.

Universal Precautions means a set of guidelines and controls, published by the Centers for Disease Control and Prevention (CDC), as "Guidelines for Prevention of Transmission of Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) to Health Care and Public Safety Workers" in Morbidity and Mortality Weekly Report) (MMWR), June 23, 1989, Vo1.38 No. S 6, and as "Recommendations for Preventing Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to patients during Exposure Prone Invasive Procedures" in MMWR, July 12,1991, Vo1.40, No. RR 8. This method of infection control requires the employer and the employee to assume that all human blood and specified human body fluids are infectious for HIV, HBV, and other blood pathogens. Precautions include hand washing; gloving; personal protective equipment; injury prevention; and proper handling and disposal of needles, other sharp instruments, and blood and body fluid contaminated products.

SECTION 7.4 EXEMPTIONS

1. Physicians licensed in accordance with M.G.L. c. 112 § 2 who perform body art procedures as part of patient treatment are exempt from these regulations. 2. Individuals who pierce only the lobe of the ear with a pre-sterilized single-use stud-and-clasp ear-piercing system are exempt from these regulations.

SECTION 7.5 RESTRICTIONS

1. Tattooing, piercing of genitalia, branding or scarification may not be performed on a person under the age of 18. 2. Body piercing, other than piercing the genitalia, may be performed on a person under the age of 18 provided that the person is accompanied by a properly identified parent, legal custodial parent or legal guardian who has signed a form consenting to such procedure. Properly identified shall mean a valid 5

photo identification of the adult and a birth certificate of the minor. 3. No body art shall be performed upon an animal. 4. The following body piercings are hereby prohibited: piercing of the uvula; piercing of the tracheal area; piercing of the neck; piercing of the ankle; piercing between the ribs or vertebrae; piercing of the web area of the hand or foot; piercing of the lingual frenulum (tongue web); piercing of the clitoris; any form of chest or deep muscle piercings, excluding the nipple; piercing of the anus; piercing of an eyelid, whether top or bottom; piercing of the gums; piercing or skewering of a testicle; so called “deep” piercing of the penis – meaning piercing through the shaft of the penis, or “trans-penis” piercing in any area from the corona glandis to the pubic bone; so called “deep” piercing of the scrotum – meaning piercing through the scrotum, or “transcrotal” piercing; so called “deep” piercing of the vagina. 5. The following practices hereby prohibited unless performed by a medical doctor licensed by the Commonwealth of Massachusetts: tongue splitting; braiding; three dimensional/beading/implementation tooth filing/fracturing/removal/tattooing; cartilage modification; amputation; genital modification; introduction of or other liquids.

SECTION 7.6 OPERATION OF BODY ART ESTABLISHMENTS

Unless otherwise ordered or approved by the Board, each body art establishment shall be constructed, operated and maintained to meet the following minimum requirements:

7.6.1 PHYSICAL PLANT

1. Walls, floors, ceilings, and procedure surfaces shall be smooth, durable, free of open holes or cracks, light colored, washable, and in good repair. Walls, floors, and ceilings shall be maintained in a clean condition. All procedure surfaces, including client chairs/benches, shall be of such construction as to be easily cleaned and sanitized after each client. 2. Solid partitions or walls extending from floor to ceiling shall separate the establishment’s space from any other room used for human habitation, any food establishment or room where food is prepared, any hair salon, any retail sales, or any other such activity that may cause potential contamination of work surfaces. 3. The establishment shall take all measures necessary to ensure against the presence or breeding of insects, vermin, and rodents within the establishment. 4. Each operator area shall have a minimum of 45 square feet of floor space for each practitioner. Each establishment shall have an area that may be screened from public view for clients requesting privacy. Multiple body art stations shall be separated by a dividers or partition at a minimum. 5. The establishment shall be well ventilated and provided with an artificial light source equivalent to at least 20 foot candles 3 feet off the floor, except that at least 100 foot candles shall be provided at the level where the body art procedure is being performed, and where instruments and sharps are assembled and all cleaning areas. 6. All electrical outlets in operator areas and cleaning areas shall be equipped with approved ground fault (GFCI) protected receptacles. 7. A separate, readily accessible hand sink with hot and cold running water under pressure, preferably equipped with wrist or foot operated controls and supplied with liquid soap, and disposable paper towels stored in fixed dispensers shall be readily accessible within the establishment. Each operator area shall have a hand sink. 8. There shall be a sharps container in each operator area and each cleaning area. 6

9. There shall be a minimum of one toilet room containing a toilet and sink. The toilet room shall be provided with toilet paper, liquid hand soap and paper towels stored in a fixed dispenser. A body art establishment permanently located within a retail shopping center, or similar setting housing multiple operations within one enclosed structure having shared entrance and exit points, shall not be required to provide a separate toilet room within such body art establishment if Board-approved toilet facilities are located in the retail shopping center within 300 feet of the body art establishment so as to be readily accessible to any client or practitioner. 10. The public water supply entering a body art establishment shall be protected by a testable, reduced pressure back flow preventer installed in accordance with 142 Code of Massachusetts Regulation 248, as amended from time to time. 11. At least one covered, foot operated waste receptacle shall be provided in each operator area and each toilet room. Receptacles in the operator area shall be emptied daily. Solid waste shall be stored in covered, leak-proof, rodent-resistant containers and shall be removed from the premises at least weekly. 12. At least one janitorial sink shall be provided in each body art establishment for use in cleaning the establishment and proper disposal of non-contaminated liquid wastes in accordance with all applicable Federal, state and local laws. Said sink shall be of adequate size equipped with hot and cold running water under pressure and permit the cleaning of the establishment and any equipment used for cleaning. 13. All instruments and supplies shall be stored in clean, dry, and covered containers. Containers shall be kept in a secure area specifically dedicated to the storage of all instruments and supplies. 14. The establishment shall have a cleaning area. Every cleaning area shall have an area for the placement of an autoclave or other sterilization unit located or positioned a minimum of 36 inches from the required ultrasonic cleaning unit. 15. The establishment shall have a customer waiting area, exclusive and separate from any workstation, instrument storage area, cleaning area or any other area in the body art establishment used for body art activity. 16. No animals of any kind shall be allowed in a body art establishment except service animals used by persons with disabilities (e.g., Seeing Eye dogs). Fish aquariums shall be allowed in waiting rooms and nonprocedural areas. 17. Smoking, eating, or drinking is prohibited in the area where body art is performed, with the exception of non-alcoholic fluids being offered to a client during or after a body art procedure.

7.6.2 REQUIREMENTS FOR SINGLE USE ITEMS INCLUDING INKS, DYES AND PIGMENTS

1. Single-use items shall not be used on more than one client for any reason. After use, all single-use sharps shall be immediately disposed of in approved sharps containers pursuant to 105 CMR 480.000. 2. All products applied to the skin, such as but not limited to body art stencils, applicators, gauze and razors, shall be single use and disposable. 3. Hollow bore needles or needles with cannula shall not be reused. 4. All inks, dyes, pigments, solid core needles, and equipment shall be specifically manufactured for performing body art procedures and shall be used according to manufacturer's instructions. 5. Inks, dyes or pigments may be mixed and may only be diluted with water from an approved potable source. Immediately before a tattoo is applied, the quantity of the dye to be used shall be transferred from the dye bottle and placed into single-use paper cups or plastic cups. Upon completion of the tattoo, these single-use cups or caps and their contents shall be discarded.

7

7.6.3 SANITATION AND STERILIZATION MEASURES AND PROCEDURES

1. All non-disposable instruments used for body art, including all reusable solid core needles, pins and stylets, shall be cleaned thoroughly after each use by scrubbing with an appropriate soap or disinfectant solution and hot water, (to remove blood and tissue residue), and shall be placed in an ultrasonic unit sold for cleaning purposes under approval of the U.S. Food and Drug Administration and operated in accordance with manufacturer's instructions. 2. After being cleaned, all non-disposable instruments used for body art shall be packed individually in sterilizer packs and subsequently sterilized in a steam autoclave sold for medical sterilization purposes under approval of the U.S. Food and Drug Administration. All sterilizer packs shall contain either a sterilizer indicator or internal temperature indicator. Sterilizer packs must be dated with an expiration date not to exceed six (6) months. 3. The autoclave shall be used, cleaned, and maintained according to manufacturer's instruction. A copy of the manufacturer's recommended procedures for the operation of the autoclave must be available for inspection by the Board. Autoclaves shall be located away from workstations or areas frequented by the public. 4. Each holder of a permit to operate a body art establishment shall demonstrate that the autoclave used is capable of attaining sterilization by monthly spore destruction tests. These tests shall be verified through an independent laboratory. The permit shall not be issued or renewed until documentation of the autoclave’s ability to destroy spores is received by the Board. These test records shall be retained by the operator for a period of three (3) years and made available to the Board upon request. 5. All instruments used for body art procedures shall remain stored in sterile packages until just prior to the performance of a body art procedure. After sterilization, the instruments used in body art procedures shall be stored in a dry, clean cabinet or other tightly covered container reserved for the storage of such instruments. 6. Sterile instruments may not be used if the package has been breached or after the expiration date without first repackaging and re-sterilizing. 7. If the body art establishment uses only single-use, disposable instruments and products, and uses sterile supplies, an autoclave shall not be required. 8. When assembling instruments used for body art procedures, the operator shall wear sterile, disposable medical gloves and use medically recognized sterile techniques to ensure that the instruments and gloves are not contaminated. 9. Reusable cloth items shall be mechanically washed with detergent and mechanically dried after each use. The cloth items shall be stored in a dry, clean environment until used. Should such items become contaminated directly or indirectly with bodily fluids, the items shall be washed in accordance with standards applicable to hospitals and medical care facilities, at a temperature of 160°F or a temperature of 120°F with the use of chlorine disinfectant.

7.6.4 POSTING REQUIREMENTS

The following shall be prominently displayed:

1. A Disclosure Statement, a model of which shall be available from the Board. A Disclosure Statement shall also be given to each client, advising him/her of the risks and possible consequences of body art procedures. 2. The name, address and phone number of the Needham Public Health Division. 3. An Emergency Plan, including: 8

a) a plan for the purpose of contacting police, fire or emergency medical services in the event of an emergency; b) a telephone in good working order shall be easily available and accessible to all employees and clients during all hours of operation; and c) a sign at or adjacent to the telephone indicating the correct emergency telephone numbers.

4. An occupancy and use permit as issued by the local building official. 5. A current establishment permit. 6. Each practitioner’s permit.

7.6.5 ESTABLISHMENT RECORD KEEPING

The establishment shall maintain the following records in a secure place for a minimum of three (3) years, and such records shall be made available to the Board upon request:

1. Establishment information, which shall include: a) establishment name; b) hours of operation; c) owner's name and address; d) a complete description of all body art procedures performed; all procedures need written protocol reviewed and approved by the Board of Health; e) an inventory of all instruments and body jewelry, all sharps, and all inks used for any and all body art procedures, including names of manufacturers and serial or lot numbers, if applicable. Invoices or packing slips shall satisfy this requirement; f) A Material Safety Data Sheet, when available, for each ink and dye used by the establishment; g) copies of waste hauler manifests; h) copies of commercial biological monitoring tests; i) Exposure Incident Report (kept permanently); j) a copy of these regulations. 2. Employee information, which shall include: a) full legal names and exact duties; b) date of birth; c) home address; d) home /work phone numbers; e) identification photograph; f) dates of employment; g) Hepatitis B vaccination status or declination notification; and h) training records 3. Client Information, which shall include: a) name; b) age and valid photo identification; c) address, work and home phone number of the client; d) date of the procedure; e) name of the practitioner who performed the procedure(s); f) description of procedure(s) performed and the location on the body; g) a signed consent form as specified by 7(D )(2); and, h) if the client is a person under the age of 18, proof of parental or guardian identification, 9

presence and consent including a copy of the photographic identification of the parent or guardian. i) Client information shall be kept confidential at all times.

4. Exposure Control Plan:

Each establishment shall create, update, and comply with an Exposure Control Plan. The Plan shall be submitted to the Board for review so as to meet all of the requirements of OSHA regulations, to include, but not limited to, 29 Code of Federal Regulation 1910.1030 OSHA Bloodborne Pathogens Standards et seq, as amended from time to time. A copy of the Plan shall be maintained at the Body Art Establishment at all times and shall be made available to the Board upon request

5. No person shall establish or operate a Mobile or Temporary Body Art Establishment.

SECTION 7.7 STANDARDS OF PRACTICE

Practitioners are required to comply with the following minimum health standards:

1. A practitioner shall perform all body art procedures in accordance with Universal Precautions set forth by the U.S Centers for Disease Control and Prevention. 2. A practitioner shall refuse service to any person who may be under the influence of alcohol or drugs. 3. Practitioners who use ear-piercing systems must conform to the manufacturer’s directions for use, and to applicable U.S. Food and Drug Administration requirements. No practitioner shall use an ear piercing system on any part of the client’s body other than the lobe of the ear. 4. Health History and Client Informed Consent. Prior to performing a body art procedure on a client, the practitioner shall: 5. Inform the client, verbally and in writing that the following health conditions may increase health risks associated with receiving a body art procedure: a) history of diabetes; b) history of hemophilia (bleeding); c) history of skin diseases, skin lesions, or skin sensitivities to soaps, disinfectants etc.; d) history of allergies or adverse reactions to pigments, dyes, latex or other sensitivities; e) history of epilepsy, seizures, fainting, or narcolepsy; f) use of such as anticoagulants or low-dose aspirin regime, which thin the blood and/or interfere with blood clotting; and g) any other conditions such as hepatitis or HIV.

6. Require that the client sign a form confirming that the above information was provided, that the client does not have a condition that prevents them from receiving body art, that the client consents to the performance of the body art procedure and that the client has been given the aftercare instructions as required by section 7(K). 7. A practitioner shall maintain the highest degree of personal cleanliness, conform to best standard hygienic practices, and wear clean clothes when performing body art procedures. Before performing body art procedures, the practitioner must thoroughly wash their hands in hot running water with liquid soap, then rinse hands and dry with disposable paper towels. This shall be done as often as 10

necessary to remove contaminants. 8. All practitioners should be properly immunized against hepatitis B virus (HBV). 9. All procedures performed at the establishment shall have a written protocol which is reviewed and approved by the Board of Health. 10. A practitioner shall wear disposable, single use medical gloves to prepare the body art site and sterile, disposable single-use gloves to perform the procedure. Gloves shall be changed if they become pierced, torn, or otherwise contaminated by contact with any unclean surfaces or objects or by contact with a third person. 11. The gloves shall be discarded, at a minimum, after the completion of each procedure on an individual client, and hands shall be washed in accordance with section (E) before the next set of gloves is put on. 12. Under no circumstances shall a single pair of gloves be used on more than one person. The use of disposable single-use gloves does not preclude or substitute for hand washing procedures as part of a good personal hygiene program. 13. The skin of the practitioner shall be free of rash or infection. No practitioner affected with boils, infected wounds, open sores, abrasions, weeping dermatological lesions or acute respiratory infection shall work in any area of a body art establishment in any capacity in which there is a likelihood that that person could contaminate body art equipment, supplies, or working surfaces with body substances or pathogenic organisms. 14. Any item or instrument used for body art that is contaminated during the procedure shall be discarded and replaced immediately with a new disposable item or a new sterilized instrument or item before the procedure resumes. 15. Preparation and care of a client’s skin area must comply with the following: a) Any skin or mucosa surface to receive a body art procedure shall be free of rash or any visible infection. b) Before a body art procedure is performed, the immediate skin area and the areas of skin surrounding where body art procedure is to be placed shall be washed with soap and water or an approved surgical skin preparation. c) If shaving is necessary, single-use disposable razors shall be used. Following shaving, the skin and surrounding area shall be washed with soap and water. d) The washing pad shall be discarded after a single use. e) In the event of bleeding, all products used to stop the bleeding or to absorb blood shall be single use, and discarded immediately after use in appropriate covered containers, and disposed of in accordance with 105 CMR 480.000.

16. Petroleum jellies, soaps, and other products used in the application of stencils shall be dispensed and applied on the area to receive a body art procedure with sterile gauze or other sterile applicator to prevent contamination of the original container and its contents. The applicator or gauze shall be used once and then discarded. 17. The practitioner shall provide each client with verbal and written instructions on the aftercare of the body art site. The written instructions shall advise the client: a) on the proper cleansing of the area which received the body art; b) to consult a health care provider for: 1. unexpected redness, tenderness or swelling at the site of the body art procedure; 2. any rash; 3. unexpected drainage at or from the site of the body art procedure; or 4. a fever within 24 hours of the body art procedure; and 5. of the address, and phone number of the establishment. 11

6. A copy shall be provided to the client. A model set of aftercare instructions shall be made available by the Board. 18. Contaminated waste shall be stored, treated and disposed in accordance with 105 CMR 480.000: Storage and Disposal of Infectious or Physically Dangerous Medical or Biological Waster, State Sanitary Code, Chapter VIII.

SECTION 7.8 EXPOSURE INCIDENT REPORT

An Exposure Incident Report shall be completed by the close of the business day during which an exposure has or might have taken place by the involved or knowledgeable body art practitioner for every exposure incident occurring in the conduct of any body art activity. Each Exposure Incident Report shall contain:

1. A copy of the application and consent form for body art activity completed by any client or minor client involved in the exposure incident; 2. A full description of the exposure incident, including the portion of the body involved therein; 3. Instrument(s) or other equipment implicated; 4. A copy of body art practitioner license of the involved body art practitioner; 5. Date and time of exposure; 6. A copy of any medical history released to the body art establishment or body art practitioner; and 7. Information regarding any recommendation to refer to a physician or waiver to consult a physician by persons involved.

SECTION 7.9 INJURY AND/OR COMPLICATION REPORTS

A written report of any injury, infection complication or disease as a result of a body art procedure, or complaint of injury, infection complication or disease, shall be forwarded by the operator to the Board which issued the permit, with a copy to the injured client within five working days of its occurrence or knowledge thereof. The report shall include:

1. the name of the affected client; 2. the name and location of the body art establishment involved; 3. the nature of the injury, infection complication or disease; 4. the nature of the advice given to the client; 5. the name and address of the affected client’s health care provider, if any; 6. any other information considered relevant to the situation.

SECTION 7.10 COMPLAINTS

1. The Board shall investigate complaints received about an establishment or practitioner’s practices or acts, which may violate any provision of the Board's regulations. 2. If the Board finds that an investigation is not required because the alleged act or practice is not in violation of the Board's regulations, then the Board shall notify the complainant of this finding and the reasons on which it is based. 3. If the Board finds that an investigation is required, because the alleged act or practice may be in 12

violation of the Board's regulations, the Board shall investigate and if a finding is made that the act or practice is in violation of the Board's regulations, then the Board shall apply whatever enforcement action is appropriate to remedy the situation and shall notify the complainant of its action in this manner.

SECTION 7.11 APPLICATION FOR BODY ART ESTABLISHMENT PERMIT

1. No person may operate a body art establishment except with a valid permit from the Board. 2. Applications for a permit shall be made on forms prescribed by and available from the Board. An applicant shall submit all information required by the form and accompanying instructions. The term “application” as used herein shall include the original and renewal applications. 3. An establishment permit shall be valid from the date of issuance and for no longer than one year unless revoked sooner by the Board. 4. The Board shall require that the applicant provide, at a minimum, the following information in order to be issued an establishment permit: a) Name, address, and telephone number of: 1. the body art establishment; 2. the operator of the establishment; and 3. the body art practitioner(s) working at the establishment; b) The manufacturer, model number, model year, and serial number, where applicable, of the autoclave used in the establishment; c) A signed and dated acknowledgement that the applicant has received, read and understood d) the requirements of the Board’s body art regulations; e) A drawing of the floor plan of the proposed establishment to scale for a plan review by the Board, as part of the permit application process; and, f) Exposure Report Plan g) Such additional information as the Board may reasonably require. 5. The annual fee for the Body Art Establishment Permit shall be $200. 6. A permit for a body art establishment shall not be transferable from one place or person to another.

SECTION 7.12 APPLICATION FOR BODY ART PRACTITIONER PERMIT

1. No person shall practice body art or perform any body art procedure without first obtaining a practitioner permit from the Board. The Board shall set a reasonable fee for such permits. 2. A practitioner shall be a minimum of 18 years of age. 3. A practitioner permit shall be valid from the date of issuance and shall expire no later than one year from the date of issuance unless revoked sooner by the Board. 4. Application for a practitioner permit shall include: a) name; b) date of birth; c) residence address; d) mailing address; e) phone number; f) place(s) of employment as a practitioner; and g) training and/or experience as set out in (E) below. 13

7.12.1 Practitioner Training and Experience

1. In reviewing an application for a practitioner permit, the Board may consider experience, training and/or certification acquired in other states that regulate body art. a) Training for all practitioners shall be approved by the Board and, at a minimum, shall include the following: b) bloodborne pathogen training program (or equivalent) which includes infectious disease control; waste disposal; hand washing techniques; sterilization equipment operation and methods; c) and sanitization, disinfection and sterilization methods and techniques; and d) Current certification in First Aid and cardiopulmonary resuscitation (CPR). e) Examples of courses approved by the Board include "Preventing Disease Transmission" (American Red Cross) and "Bloodborne Pathogen Training" (U.S. OSHA). Training/courses provided by professional body art organizations or associations or by equipment manufacturers may also be submitted to the Board for approval.

2. The applicant for a body piercing practitioner permit shall provide documentation, acceptable to the Board, that s/he completed a course on anatomy and physiology with a grade of C or better at a college accredited by the New England Association of Schools and Colleges, or comparable accrediting entity. This course must include instruction on the system of the integumentary system (skin). 3. The applicant for a tattoo, branding or scarification practitioner permit shall provide documentation, acceptable to the Board, that s/he completed a course on anatomy and physiology with a grade of C or better at a college accredited by the New England Association of Schools and Colleges, or comparable accrediting entity. This course must include instruction on the system of the integumentary system (skin). Such other course or program as the Board shall deem appropriate and acceptable may be substituted for the anatomy course. 4. The applicant for all practitioners shall submit evidence satisfactory to the Board of at least two years actual experience in the practice of performing body art activities of the kind for which the applicant seeks a body art practitioner permit to perform, whether such experience was obtained within or outside of the Commonwealth. 5. A practitioner’s permit shall be conditioned upon continued compliance with all applicable provisions of these rules and regulations. 6. The annual fee for the Body Art Practitioner Permit shall be set at the level determined by the Board of Health in its fee schedule, which shall be adjusted from time to time.

SECTION 7.13 GROUNDS FOR SUSPENSION, DENIAL, REVOCATION, OR REFUSAL TO RENEW PERMIT

1. The Board may suspend a permit, deny a permit, revoke a permit or refuse to renew a permit on the following grounds, each of which, in and of itself, shall constitute full and adequate grounds for suspension, denial, revocation or refusal to renew: a) any actions which would indicate that the health or safety of the public would be at risk; b) fraud, deceit or misrepresentation in obtaining a permit, or its renewal; c) criminal conduct which the Board determines to be of such a nature as to render the establishment, practitioner or applicant unfit to practice body art as evidenced by criminal 14

proceedings resulting in a conviction, guilty plea, or plea of nolo contendere or an admission of sufficient facts; d) any present or past violation of the Board’s regulations governing the practice of body art; e) practicing body art while the ability to practice is impaired by alcohol, drugs, physical disability or mental instability; f) being habitually drunk or being dependent on, or a habitual user of , , , , or other drugs having similar effects; g) knowingly permitting, aiding or abetting an unauthorized person to perform activities requiring a permit; h) continuing to practice while his/her permit is lapsed, suspended, or revoked; i) having been disciplined in another jurisdiction in any way by the proper permitting authority for reasons substantially the same as those set forth in the Board's regulations; and j) other just and sufficient cause which the Board may determine would render the establishment, practitioner or applicant unfit to practice body art;

2. The Board shall notify an applicant, establishment or practitioner in writing of any violation of the Board's regulations, for which the Board intends to deny, revoke, or refuse to renew a permit. The applicant, establishment or practitioner shall have seven (7) days after receipt of such written notice in which to comply with the Board's regulations. The Board may deny, revoke or refuse to renew a permit, if the applicant, establishment or practitioner fails to comply after said seven (7) days subject to the procedure outlined in Section 15. 3. Applicants denied a permit may reapply at any time after denial.

SECTION 7.14 GROUNDS FOR SUSPENSION OF PERMIT

The Board may summarily suspend a permit pending a final hearing on the merits on the question of revocation if, based on the evidence before it, the Board determines that an establishment and/or a practitioner is an immediate and serious threat to the public health, safety or welfare. The suspension of a permit shall take effect immediately upon written notice of such suspension by the Board.

SECTION 7.15 PROCEDURE FOR HEARINGS

The owner of the establishment or practitioner shall be given written notice of the Board’s intent to hold a hearing for the purpose of suspension, revocation, denial or refusal to renew a permit. This written notice shall be served through a certified letter sent return receipt requested or by constable. The notice shall include the date, time and place of the hearing and the owner of the establishment or practitioner’s right to be heard. The Board shall hold the hearing no later than 21 days from the date the written notice is received.

In the case of a suspension of a permit as noted in Section 13, a hearing shall be scheduled no later than 21 days from the date of the suspension.

SECTION 7.16 SEVERABILITY

If any provision contained in the model regulations is deemed invalid for any reason, it shall be severed and 15 shall not affect the validity of the remaining provisions.

SECTION 7.17 FINE FOR VIOLATION

Any person or entity violating any term or condition of this Board of Health regulation, shall be subject to a fine of fifty dollars ($50) for the first violation and a fine of one hundred dollars ($100) for the second violation, and increasing for each subsequent violation up to the amount of three hundred dollars ($300). Each day that a violation continues shall constitute a separate and distinct offense.

SECTION 7.18 NON-CRIMINAL DISPOSITION

In accordance with MGL chapter 40, section 21D and Article 9 of the Town of Needham General By-Laws, whoever violates any provision of these Rules and Regulations may be penalized by non-criminal disposition.

SECTION 7.19 EFFECTIVE DATE

These rules and regulations became effective as of February 8, 2001. A revised definition section, along with minor content edits and format revisions, was approved by a [unanimous] vote of the Board of Health on [July 29, 2016] and the amended regulation became effective on September X, 2016. Adoption of the revised regulation occurred following open meetings held on May 13, 2016 and on June 17, 2016, and public hearings on July 29, 2016 and September 9, 2016.

16

Needham Public Health

Memorandum

To: Needham Board of Health From: Catherine Delano, Senior Substance Use Prevention Coordinator Angela Giordano, Public Health Prevention Specialist Date: July 27, 2016 Re: Case for Change—Synthetic Drugs and Drug Paraphernalia Regulations ______

Synthetic drugs (synthetic marijuana and ) are laboratory-made chemical compounds in the form of crystals, chemicals sprayed onto plant material, or liquids to be used in vaporizers. Such substances may be marketed and sold as “herbal incense” or “potpourri” and are often marked “not for human consumption;” however, they are being used in the same manner and for the same purposes as scheduled drugs1. These drugs are known to have unpredictable and intense effects on the user due to the variety of chemicals and concentration of chemicals used in the manufacturing process which lacks quality controls and government oversight2. Much of what is known about the physical and psychological health effects of these substances is derived from emergency department visits, calls to poison control centers, and online forums. The Centers for Disease Control and Prevention (CDC) noted a dramatic spike in calls to U.S. poison control centers between 2014 and 2015 with reports of adverse reactions to synthetic marijuana use3. The American Association of Poison Control Centers tracked 1,462 calls for adverse exposures to synthetic from January 1st to June 30, 2016. This tally is slightly behind the pace of 2015 in which the total calls for the year topped out at 7,794, the most in recent history4. In July of 2016 the New York City Department of Health and Mental Hygiene issued a public health advisory that noted a rise in emergency department visits due to adverse events after use of synthetic marijuana5. However, the problem is not isolated to New York City. The Substance Abuse and Mental Health Services Administration (SAMHSA) reported a significant increase in the number of emergency department visits that involved synthetic use from 11,406 visits in 2010 to 28,531 in 2011 (p <.05) with patients aged 12-17 doubling between 2010 and 2011 (from 3,780 to 7,584), and a fourfold increase for patients ages 18-20 in the same time period (from 1,881 to 8,212;

1 Castellanos, D. & Gralnik, L.M. 2015: An update for pediatricians in clinical practice. World Journal of Clinical Pediatrics. 2016 Feb 08;5(1):16–24. 2 The White House Office of National Drug Control Policy [Internet]. Synthetic Drugs (a.k.a. K2, Spice, , etc.). n.d. [cited 2016 July 19]. Available from https://www.whitehouse.gov/ondcp/ondcp-fact-sheets/synthetic-drugs-k2-spice-bath-salts 3 Center for Disease Control and Prevention [Internet]. Notes from the Field: Increase in Reported Adverse Health Effects Related to Synthetic Cannabinoid Use — , January–May 2015. 2015 Jun 12; [cited 2016 Jun 21]. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6422a5.htm 4 American Assocation of Poison Control Centers [Internet]. Synthetic Cannabinoids. 2016 Jun 30; [cited 2016 July 19]. Available from http://www.aapcc.org/alerts/synthetic-cannabinoids/ 5 New York City Department of Health and Mental Hygiene [Internet]. 2015 Advisory #20 Increase in synthetic cannabinoid (K2)- related adverse events and emergency department visits, New York City. 2016 July 14; [cited 2016 July 19]. Available from https://a816- health30ssl.nyc.gov/sites/nychan/Lists/AlertUpdateAdvisoryDocuments/Synthetic%20Cannabinoids%20(7%2014%2016)_1623.pdf

1471 Highland Avenue, Needham, MA 02492 781-455-7500x511(tel); 781-455-0892 (fax) E-mail: [email protected] Web: www.needhamma.gov/health

p<.05) 6. Visits to emergency departments and calls to poison control centers illustrate the significant public health danger that synthetic drugs pose to our communities. The documented adverse health effects from synthetic drug consumption include a wide range of physical and psychological impacts. They include elevated and rapid heart rate, vomiting, violent behavior, suicidal thoughts, raised blood pressure, kidney damage, seizures, , , extreme agitation, panic attacks, and in some cases death. In addition these substances can also be addictive to the user78. Data from emergency department visits and poison control center calls indicate that youth and young adults are the primary users of synthetic drugs. Synthetic drug products are specifically marketed to young adults and teens with brightly colored foil packages, cartoon characters, and a variety of street names such as K2, Spice, Joker, Black Mamba, Kush, and Kronic. They are typically available for purchase at gas stations, convenience stores, and through the internet9. A 2012 survey conducted by Monitoring the Future found synthetic marijuana to be the second most frequently used drug among high school seniors after marijuana (11% of 12th, 9% of 10th, and 4% of 8th graders). This number significantly declined across grades in 2015 to 5, 4, and 3 percent for 12th, 10th, and 8th graders respectively, which indicates that policy efforts at the state and federal level to reduce the availability of synthetic marijuana likely had an effect on youth use10. A study conducted on a representative sample of US high school seniors found odds of synthetic marijuana use significantly increased among youth that reported lifetime use of alcohol, cigarettes, or other illicit drugs, and a more robust increase in odds for reported marijuana use that increased with higher reported frequency11. These increased odds of use of synthetic marijuana is relevant to the Needham High School 12th grade population that reported lifetime use of cigarettes (30%), alcohol (72%), and marijuana (54%) at high rates. In addition, overall reported lifetime substance use among all Needham high school students are notable with 19% cigarette use, 54% alcohol use, and 32% marijuana use with 22% reported use of marijuana in the past 30 days12. Efforts to protect the public from the health threat that synthetic drugs pose, especially for youth and young adults, includes federal and state bans on existing chemical compounds and analogue drugs13. However, there is still a need to be vigilant as new chemical compounds continue to be created to work around current bans14. The number of new synthetic drug compounds continues to crop up as illustrated by the 158

6 Substance Abuse and Mental Health Services Administration Drug Abuse Warning Network [Internet]. The CBHSQ Report Update: Drug-Related Emergency Department Visits Involving Synthetic Cannabinoids. 2014 Oct 16; [cited 2016 July 19]. Available from http://www.samhsa.gov/data/sites/default/files/ShortReport-2047.pdf 7 National Institute on Drug Abuse. Drug Facts: Synthetic Cannabinoids. 2015 Nov [cited 2016 Jun 19]. Available from https://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids 8 National Institute on Drug Abuse. Drug Facts: Synthetic (“Bath Salts”). 2016 Jan [cited 2016 Jun 19]. Available from https://www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts 9 National Institute on Drug Abuse. Drug Facts: Synthetic Cannabinoids. 2015 Nov [cited 2016 Jun 21]. Available from https://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids 10Wadley, J. & Lee, J. [Internet]. Use of ecstasy, , synthetic marijuana, alcohol, cigarettes declined among US teens in 2015. 2015 Dec 16 [cited 2016 July 20]. Available from http://www.monitoringthefuture.org/pressreleases/15drugpr.pdf 11 Palamar, J.J. & Acosta, P. Synthetic Cannabinoid Use in a Nationally Representative Sample of US High School Seniors. Drug Alcohol Depend. 2015 Feb 11;149: 194-202. 12Education Development Center, Inc. 2014 Metrowest Adolescent Health Survey Report. Framingham: Metrowest Health Foundation; 2015. 13 The White House Office of National Drug Control Policy [Internet]. Synthetic Drugs (a.k.a. K2, Spice, Bath Salts, etc.). n.d. [cited 2016 July 19]. Available from https://www.whitehouse.gov/ondcp/ondcp-fact-sheets/synthetic-drugs-k2-spice-bath-salts 14 National Institute on Drug Abuse. Drug Facts: Synthetic Cathinones (“Bath Salts”). 2016 Jan [cited 2016 July 19]. Available from https://www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath- salts 15 new substances identified in 2012 . There is an opportunity for the Town of Needham to align itself with current policy efforts to protect the public from the ongoing threat to public health that synthetic drugs pose. While initial inspections conducted by the Needham Police Department have not revealed any vendor that currently sells synthetic drugs in Needham, now is the time to put regulations in place that counteract the public health threat that comes with the availability and use of synthetic marijuana, synthetic stimulants, synthetic hallucinogens, and other dangerous products. With the purpose to protect the pubic health and safety of the Town of Needham and its residents, the Needham Board of Health should propose regulations to prohibit persons from trafficking in, possession of, and use of synthetic drugs within the town. Included in these regulations are provisions that cover existing synthetic drugs and flexibility to add new compounds that are created to mimic the effects of scheduled drugs. As it has been demonstrated in the literature, the market for synthetic drugs is primarily adolescents, a vulnerable population more susceptible to harm due to their developmental stage. This information places further need to set regulations in place to protect the public health of the Needham community from the harm of synthetic drugs. In addition, the Needham Board of Health should propose regulations to prohibit persons from trafficking in, possessing, and using drug paraphernalia within the town as it facilitates the use of controlled substances, chemical agents, and dangerous products in a manner that jeopardizes personal health. As currently written, the draft Needham Board of Health regulation on drug paraphernalia is careful to exempt the lawful use of items by medical marijuana cardholders, in accordance with both state and local regulations protecting the use of marijuana by patients with a documented medical need. Regulations on drug paraphernalia have been adopted or are under consideration by Boards of Health in Dedham, Reading, Melrose, Wakefield, and Northbridge. Attached is the proposed Needham Board of Health Regulation for Restriction of Synthetic Drugs and Regulation for the Restriction of Drug Paraphernalia.

Sincerely,

Catherine Delano, LCSW, MPH Angela Giordano, MPH (c)

CC: Timothy Muir McDonald, Director of Public Health

Attachments: Article 22—Regulation for the Restriction of Synthetic Drugs Article 23—Regulation for the Restriction of Drug Paraphernalia

15 The White House Office of National Drug Control Policy [Internet]. Synthetic Drugs (a.k.a. K2, Spice, Bath Salts, etc.). n.d. [cited 2016 July 19]. Available from https://www.whitehouse.gov/ondcp/ondcp-fact-sheets/synthetic-drugs-k2-spice-bath-salts

ARTICLE 22 REGULATION FOR RESTRICTION OF SYNTHETIC DRUGS

SECTION 22.1 AUTHORITY

This regulation is promulgated under the authority granted to the Needham Board of Health under Massachusetts General Laws Chapter 111, Section 31 which states that “boards of health may make reasonable health regulations”.

SECTION 22.2 PURPOSE

The Needham Board of Health has found that synthetic marijuana, consisting of plant or other material treated with various chemicals or other synthetic substances not approved for human consumption, may be marketed and sold as herbal incense in the greater Boston area, although they are being used in the same manner and for the same purposes as scheduled drugs. In addition, the use of these products has become particularly popular among teens and young adults.

Based on information and reports from hospitals, emergency room doctors, and police agencies, individuals who use these products experience dangerous side effects including , hallucinations, and dangerously elevated heart rates. This is evidence that synthetic marijuana products are harmful if inhaled or consumed, and present a significant public health danger. These synthetic compounds and others have a high potential for abuse and lack of any accepted medical use, these dangerous products, while not approved for human consumption, are marketed and sold in a form that allows for such consumption, putting at risk the individuals who come into contact with them.

Therefore, the Needham Board of Health adopts this regulation for the purpose and with the intent to protect the public health and safety of the Town of Needham and its residents from the threat posed by the availability and use of synthetic marijuana, synthetic stimulants, synthetic hallucinogens, and other dangerous products by prohibiting persons from trafficking in, possessing, and using them within the town.

SECTION 22.3 DEFINITIONS

Unless otherwise indicated, terms used throughout this regulation shall be defined as they are the federal Controlled Substances Act (21 U.S.C. Chapter 13 § 801et seq.) or in its Massachusetts analog (M.G.L. Chapter 94C). Act means the federal Controlled Substances Act (21 U.S.C. Chapter 13 § 801et seq.).

Board of Health means the Town of Needham Board of Health and its designated agents.

Board of Health Agent means the Director of Public Health and any town employee or contractor designated by the Director, which may include Public Health Department staff, law enforcement officers, fire officials, and code enforcement officials.

Chemical agent means any chemical or , substance, or agent that is not made, intended and approved for consumption by humans.

Consumable product or material means a product or material, that regardless of packaging disclaimers or disclosures that it is not for human consumption or use, is in a form that readily allows for human consumption by inhalation, ingestion, injection, or application, through means including but not limited to smoking, or ingestion by mouth with or without mixing with food or drink.

Controlled substance means a substance included as a controlled substance in schedules 1 through 5 of the Act or a substance temporarily scheduled or rescheduled as a controlled substance as provided in the Act.

Controlled substance analogue has the same meaning as defined in the Act, which is a substance, the chemical structure of which is substantially similar to that of a controlled substance in schedules 1 and 2 of the Act.

Dangerous product means a consumable product or material containing a dangerous substance, including, but not limited to, cannabinoids, stimulants, psychedelic hallucinogens, and synthetic chemical agents as outlined in the subsequent Prohibitions.

Director means the Director of Public Health Traffic and trafficking means to manufacture, distribute, dispense, sell, transfer, or possess with intent to manufacture, distribute, dispense, sell, or transfer.

Transfer means to dispose of a dangerous product to another person without consideration and not in furtherance of commercial distribution.

SECTION 22.4 PROHIBITIONS

It shall be unlawful to possess, sell, deliver, transfer, or attempt to possess, sell, or deliver these synthetic drugs within the Town of Needham.

1. A synthetic cannabinoid or any laboratory-created compound that functions similarly to the active ingredient in marijuana, (THC), including, but not limited to, any quantity of a synthetic substance, compound, mixture, preparation, or analog (including isomers, esters, , salts, and salts of isomers) containing a cannabinoid receptor agonist. The trade names of such synthetic cannabinoid compounds include, but are not limited to:

a) 2NE1; b) 5-bromopentyl-UR-144, 5-bromo-UR-144; 5-chloropentyl-UR-144, 5-chloro-UR-144; 5-fluoropentyl-UR-144, 5-fluoro-UR-144; c) A-796,260; A-834,735; A-836,339; AB-001; AB-034; AKB-48; AM-087; AM-356 (methanandamide); AM-411; AM-630; AM-661; AM-679; AM-694; AM-855; AM-905; AM-906; AM-1220; AM-1221; AM-1235; AM-1241; AM-1248; AM-2201; AM-2232; AM-2233; AM-2389; d) BAY 38-7271; e) Cannabipiperidiethanone; CB-13, SAB-378; CP 47,497 and its homologues; CP 50,556-1 (); CP 55,490; CP 55,940; CP 56,667; f) HU-210; HU-211 (dexanabinol); HU-210; HU-211; HU-243; HU-308; HU-331; g) JTE-907; h) JWH cannabinoid compounds from JWH-001 through JWH-424; i) MAM-2201; j) RCS-4, SR-19; RCS-8; k) STS-135; l) UR-144; fluoro-UR-144; 5-fluoro-UR-144; URB-597; URB-602; URB-754; URB-937 m) WIN 48,098 (pravadoline); WIN 55,212-2; n) XLR-11.

2. A synthetic or any compound that mimics the effects of any federally controlled Schedule I substance such as , , MDMA and MDEA, including, but not limited to, any quantity of a natural or synthetic substance, compound, mixture, preparation, or analog (including salts, isomers, and salts of isomers) containing central nervous system stimulants. The trade names of such synthetic stimulants include, but are not limited to:

a) 2-diphenylmethylpyrrolidine; 2-DPMP; 2-FMC; b) 3,4-DMMC; 3-FMC; c) 4-EMC; 4-FMC (); 4-MBC (); 4-MEC; 4-MeMABP; d) Alpha-PBP; alpha-PPP; alpha-PVP; , diethylcathinone, or diethylpropion; e) BZ-6378; ; bk-MBDB (); BZP; f) D2PM; ; DMBDB, bk-DMBDB, or dibutylone; DMEC; DMMC; g) Ephedrone; ; ethylethcathinone; ethylmethcathinone; ; ; h) Fluorococaine; fluoroethcathinone; fluoroisocathinone; i) HMMC; j) Isopentedrone; k) MaPPP, 4-MePPP, or MPPP; MBP; MBZP; MDAI; MDAT; MDDMA; MDMC; MDPBP; MDPPP; MDPV; MDPK; MEC; or 4-MMC; or N,N- DMMC; , bk-PMMA, or PMMC; , bk-MDMA, or MDMC; MOMC; MOPPP; MPBP; l) N-ethyl-N-methylcathinone; NEB; NRG-1 (); NRG-2; m) ; .

3. A synthetic psychedelic/ or compound that mimics the effects of any federally controlled Schedule I substance, including but not limited to, any quantity of a natural of synthetic material, compound, mixture, preparation, substance and their analog (including salts, isomers, esters, ethers and salts of isomers) containing substances which have a psychedelic/hallucinogenic effect on the central nervous system and/or brain. Trade names of such synthetic hallucinogens include, but are not limited to: -C, 2C-D, 2C-E, 2C-H, 2C-I, 2C-N, 2C-P, 2C-T-2, and 2C-T-4.

4. Any other substance which mimics the effects of any controlled substance (such as opiates, hallucinogenic substances, , MDMA, , PCP, cannabinoids, and ), including, but not limited to, “bath salts,” “plant food,” “incense,” or “insect repellant,” but excluding legitimate bath salts containing as the main ingredient the chemicals sodium chloride (sea salt) and/or magnesium (Epsom salts), or legitimate plant foods or insect repellant, or legitimate incense used as an odor elimination product.

5. or salvinorum A; all parts of the plant presently classified botanically as salvia divinorum, whether growing or not; any extract from any part of such plant, and every compound, manufacture, salts derivative, mixture, or preparation of such plant, its seeds, or extracts.

6. Any similar substances to the above which when inhaled, or otherwise ingested, may produce intoxication, stupefaction, giddiness, paralysis, irrational behavior, or in any manner, changes, distorts, or disturbs the auditory, visual, or mental process, and which has no other apparent legitimate purpose for consumers.

7. A product containing a substance that is defined herein, but not limited to the examples of brand names or identifiers listed within Exhibit “A” attached hereto and incorporated herein. Each year, or from time to time as may be required, the list of such substances may be redefined, so as to be representative of any products which may have been altered by the changing nature of chemicals in manufacture, and such lists will be available to the public. This list will be provided by the Director of Public Health in consultation with the Chief of the Needham Police Department (please see Appendix A).

8. Public display for the sale of such dangerous products in unlawful. It shall be unlawful for any store owner, store manager, store purchasing agent or any other person to publicly display for sale any natural or synthetic materials defined in this article. Any dangerous product housed within a facility, shall be assumed for sale, and shall constitute a separate violation of this Board of Health regulation.

SECTION 22.5 DANGEROUS PRODUCT EXEMPTION

The following shall be exempt from section 22.4 herein.

1. A physician, dentist, optometrist, veterinarian, pharmacist, scientific investigator or other person who is licensed, registered, or otherwise lawfully permitted to distribute, dispense, conduct research with respect to, or to administer a dangerous product as defined herein in the course of professional practice or research.

2. A pharmacy, hospital or other institution licensed, registered, or otherwise lawfully permitted to distribute, dispense, conduct research with respect to, or to administer a dangerous product as defined herein in the course of professional practice or research.

SECTION 22.6 RIGHT OF ENTRY The Chief of Police of the Town of Needham, the Director of Public Health and his designated agents may enter upon any privately owned property, which serves the public, for the purpose of performing their duties under this Board of Health regulation.

SECTION 22.7 ENFORCEMENT This regulation may be enforced by the Director and his/her designated agents, especially the Chief of Police for the Town of Needham and his law enforcement staff as well as other code enforcement personnel so designated by the Director.

In addition to the restrictions defined herein, the Director and his/her designated agents may consider these items as violations of this section.

a) Refusal to permit an agent of the Police or Public Health Departments to inspect the facility or any part thereof; b) Interference with an agent of the Police or Public Health Departments in the performance of their duty; c) A criminal conviction of the facility owner or employee in control of the facility, relating to the operation of the facility; d) Failure to pay assessed fines or penalties; e) The facility owner, operator, or employee’s failure to comply with this ordinance; f) Keeping or submitting any misleading or false records, documents, or verbally stating false information related to the possession or sale of dangerous products or paraphernalia.

Any resident who desires to register a complaint pursuant to this Regulation may do so by contacting the Board of Health, the Public Health Department, or the Needham Police Department.

SECTION 22.6 FINES FOR VIOLATIONS OF ORDERS AND SUSPENSIONS Any person or entity violating any term or condition of this Board of Health regulation, shall be subject to a fine of fifty dollars ($50) for the first violation and a fine of one hundred dollars ($100) for the second violation, and increasing for each subsequent violation up to the amount of three hundred dollars ($300). Each day that a violation continues shall constitute a separate and distinct offense.

This regulation shall be enforced pursuant to M.G.L. Chapter 40, section 21D, as a noncriminal offense, or may be punished under M.G.L. Chapter 111, section 31 as a criminal offense in which the criminal fine imposed shall not exceed $1,000.

SECTION 22.7 SEVERABILITY If any word, clause, phrase, sentence, paragraph, or section of this Board of Health regulation shall be declared invalid for any reason whatsoever, that portion shall be severed and all other provisions of this regulation shall remain in full effect.

SECTION 22.8 COMMUNITY PARTNERSHIP Any police officer, code enforcement officer, physician, nurse, or other concerned individual that has knowledge of the sale or possession of a dangerous product within the Town of Needham may inform the Needham Police Department Business Line (781-455-7570) or the Public Health Department Main Line (781-455-7500 x511) of the location of the dangerous product. Nothing within this subsection shall be enforced herein, but considered goodwill toward the betterment of the community.

SECTION 22.9 EFFECTIVE DATE This regulation shall take effect upon August 1, 2016. Public hearings and open meetings regarding this regulation were conducted on XYZ. This regulation was approved by a [unanimous] vote of the Board of Health on XYZ, 2016.

Exhibit A

2010 8-Ball Aztec Gold Aztec Midnight Wind Tezcatlipoca Back Draft Bad 2 the Bone Banana Cream Nuke Bayou Blaster Black Diamond Black Magic Salvia Black Mamba Blueberry Hayze Bombay Blue Buzz C3 C4 Herbal Incense Caneff Cherry Bomb Chill X Chronic Spice Cill Out Citrus Colorado Chronic DaBlock Dark Night II Demon Diamond Spirit Dragon Spice D-Rail Dream Earthquake Eruption Spice exSES EX-SES Platinum EX-SES Platinum Blueberry EX-SES Platinum Cherry EX-SES Platinum Strawberry EX-SES Platinum Fire Bird Ultimate Strength Cinnamon Forest Humus Freedom Fully Loaded Funky Monkey Funky Monkey XXXX G Four G Greenies Caramel Crunch Genie Gold Spirit Spice Green Monkey Chronic Salvia Greenies Strawberry Heaven Improved Heavenscent Suave Humboldt Gold Jamaican Gold K Royal K1 Gravity K1 Orbit K2 K2 (unknown variety) K2 Amazonian Shelter K2 Blonde K2 Blue K2 Blueberry K2 Citron K2 Cloud 9 K2 Kryptonite K2 Latte K2 Mellon K2 Mint K2 Orisha Black Magic Max K2 Orisha Max K2 Orisha Regular K2 orisha Super K2 Orisha White Magic Super K2 Peach K2 Pina Colada K2 Pineapple K2 Pineapple Express K2 Pink K2 Pink Panties K2 Sex K2 Silver K2 Solid Sex on the Mountain K2 Standard K2 Strawberry K2 Summit K2 Summit Wonk K2 Thai Dream K2 Ultra K2 Watermelon K3 K3 Blueberry K3 Cosmic Blend K3 Dusk K3 Grape K3 Heaven Improved K3 Heaven Legal K3 Kryptonite K3 Legal K3 Legal- Original (Black) K3 Legal- Earth (silver) K3 Legal- Sea (silver) K3 Legal- Sun (Black) K3 Mango K3 Original K3 Original Improved K3 Strawberry K3 Sun K3 Sun Improved K3 Sun Legal K3 XXX K4 Bubble Bubble K4 Gold K4 purple Haze K4 Silver K4 Summit K4 Summit Remix Kind Spice Legal Eagle Legal Eagle Apple Pie Love Potion 69 Love Strawberry Magic Dragon Platinum Magic Gold Magic Silver Magic Spice Mega Bomb Mid-Atlantic Exemplar Mid-Atlantic Exemplar (K2 Summit) Midnight Chill MNGB Almond/Vanilla MNGB Peppermint MNGB Pinata Colada MNGB Spear Mint MNGB Tropical Thunder Moe Joe Fire Mojo Mr. Smiley’s MTN-787 Mystery Naughty Nights New Improved K3 New Improved K3 Cosmic New Improved K3 Dynamite Blend New Improved K3 Kryptonite New K3 Earth New K3 heaven New K3 Improved New K3 Sea Improved New-Kron Bomb Nitro Ocean Blue P O W p.e.p. pourri Love Strawberry p.e.p. pourri Original p.e.p. pourri Twisted Vanilla Spearmint p.e.p. pourri X Blueberry Paradise Pink Tiger Potpourri Potpourri Gold Pulse Rasta Citrus Spice Rebel Spice Red Bird S1. S Werve Samurai Spirit Sativah Scope Vanilla Scope Wildberry Sence Shanti Spice Shanti Spice Blueberry Silent Black Skunk Smoke Smoke Plus Space Spice Artic Synergy Spice Diamond Spice Gold Spice Silver Spice Tropical Synergy Spicey Regular XXX Blueberry Spicey Regular XXX Spicey Ultra Strong XXX Strawberry Strawberry Spicylicious Spike 99 Spike 99 Ultra Spike 99 Ultra Blueberry Spike 99 Ultra Cherry Spike 99 Ultra Strawberry Spike Diamond Spike Gold Spike Maxx Spike Silver Stinger Summer Skyy Super Kush Super Summit Swagger Grape SYN Chill SYN Incense LemonLime SYN Incense Smooth SYN Incense Spearmint SYN Lemon Lime SYN Lemon Lime #2 SYN Smooth SYN Spearmint SYN Spearmint #2 SYN Swagg SYN Vanilla SYN Vanilla #2 Texas Gold Time Warp Tribal Warrior Ultra Cloud 10 Utopia Utopia- Blue Berry Voo Doo Remix (black Voo Doo Remix (orange Voodoo Child package) package) Voodoo Magic Voodoo Remix Who Dat Who Dat Herbal Incense Wicked X Winter Boost Wood Stock XTREME Spice Yucatan Fire Zombie World

ARTICLE 23 REGULATION FOR THE RESTRICTION OF DRUG PARAPHERNALIA

SECTION 23.1 AUTHORITY This regulation is promulgated under the authority granted to the Needham Board of Health under Massachusetts General Laws Chapter 111, Section 31 which states that “boards of health may make reasonable health regulations”.

SECTION 23.2 PURPOSE The Needham Board of Health has found that the availability and use of controlled substances are a threat to the public health and the community well-being of the Needham and that drug paraphernalia facilitates the use of controlled substances, chemical agents, and dangerous products in a manner that jeopardizes personal health. Therefore the Board of Health adopts this regulation for the purpose and with the intent to protect the public health and safety of the Town of Needham and its residents from the threat posed by the availability and use of drug paraphernalia by prohibiting persons from trafficking in, possessing, and using them within the town.

SECTION 22.3 DEFINITIONS Unless otherwise indicated, terms used throughout this regulation shall be defined as they are the federal Controlled Substances Act (21 U.S.C. Chapter 13 § 801et seq.) or in its Massachusetts analog (M.G.L. Chapter 94C).

Act means the federal Controlled Substances Act (21 U.S.C. Chapter 13 § 801et seq.).

Board of Health means the Town of Needham Board of Health and its designated agents.

Board of Health Agent means the Director of Public Health and any town employee designated by the Director, which may include Public Health Department staff, law enforcement officers, fire officials, and code enforcement officials, as well as contractors. Chemical agent means any chemical or organic compound, substance, or agent that is not made, intended and approved for consumption by humans.

Consumable product or material means a product or material, that regardless of packaging disclaimers or disclosures that it is not for human consumption or use, is in a form that readily allows for human consumption by inhalation, ingestion, injection, or application, through means including but not limited to smoking, or ingestion by mouth with or without mixing with food or drink.

Controlled substance means a substance included as a controlled substance in schedules 1 through 5 of the Act or a substance temporarily scheduled or rescheduled as a controlled substance as provided in the Act.

Controlled substance analogue has the same meaning as defined in the Act, which is a substance, the chemical structure of which is substantially similar to that of a controlled substance in schedules 1 and 2 of the Act.

Dangerous product means a consumable product or material containing a dangerous substance, including, but not limited to, cannabinoids, stimulants, psychedelic hallucinogens, and synthetic chemical agents as outlined in the subsequent Prohibitions.

Director means the Director of Public Health.

Drug Paraphernalia means all equipment, products and materials of any kinds that are used to facilitate, or intended or designed to facilitate, violations of the Controlled Substances Act, including planting, propagating, cultivating, growing, harvesting, manufacturing, compounding, converting, producing, processing, preparing, testing, analyzing, packaging, repackaging, storing, containing, and concealing dangerous products and injecting, ingesting, inhaling, or otherwise introducing dangerous products into the human body. “Drug paraphernalia” includes, but is not limited to, the following:

A. Kits for planting, propagating, cultivating, growing, or harvesting any species of plant which is a controlled substance or from which a controlled substance can be derived; B. Kits for manufacturing, compounding, converting, producing, processing, or preparing dangerous products; C. Isomerization devices for increasing the potency of any species of plant which is a dangerous product; D. Testing equipment for identifying, or analyzing the strength, effectiveness, or purity of dangerous products; E. Scales and balances for weighing or measuring dangerous products; F. Diluents and adulterants, such as quinine, hydrochloride, mannitol, mannite, dextrose, and lactose for mixing with dangerous products; G. Separation gins and sifters for removing twigs and seeds from, or otherwise cleaning or refining, any species of plant which is a dangerous product; H. Blenders, bowls, containers, spoons, and mixing devices for compounding dangerous products; I. Capsules, balloons, envelopes and other containers for packaging small quantities of dangerous products; J. Containers and other objects for storing or concealing dangerous products; K. Objects for ingesting, inhaling, or otherwise introducing dangerous products into the body, such as: i. Metal, wooden, acrylic, glass, stone, plastic, or ceramic pipes with or without screens, permanent screens, heads, or punctured metal bowls; ii. Water pipes; iii. Carburetion tubes and devices; iv. Smoking and carburetion masks; v. Objects, commonly called roach clips, for holding burning material, such as a marijuana cigarette, that has become too small or too short to be held in the hand; vi. Miniature cocaine spoons and cocaine vials; vii. Chamber pipes; viii. Carburetor pipes; ix. Electric pipes; x. Air-driven pipes; xi. Chillums; xii. Bongs; xiii. Ice pipes or chillers.

The following, along with all relevant evidence, may be considered in determining whether an object is drug paraphernalia:

a) Statements by the owner or anyone in control of the object concerning its use; b) Prior convictions of the owner or other person in control of the object for violations of controlled substances law; c) The proximity of the object to a violation of the Controlled Substances Act; d) The proximity of the object to a dangerous product; e) The existence of any residue of a dangerous substance on the object; f) The proximity of the object to other drug paraphernalia; g) Instructions provided with the object concerning its use; h) Descriptive materials accompanying the object explaining or depicting its use; i) Advertising concerning its use; j) The manner in which the object is displayed for sale; k) Whether the owner, or anyone in control of the object, is a legitimate supplier of like or related items to the community, such as a seller of tobacco products or agricultural supplies; l) Possible legitimate uses of the object in the community; m) Expert testimony concerning its use; n) The intent of the owner or other person in control of the object to deliver it to persons whom he knows or reasonably should know intend to use the object to facilitate violations of the Controlled Substances Act. (1981, c. 500, s. 1.) o) The sale of items, which singularly is lawful, but as a whole creates a legitimate hazard to the community by selling products that help the planting, propagating, cultivating, growing, harvesting, manufacturing, compounding, converting, producing, processing, preparing, testing, analyzing, packaging, repackaging, storing, containing, and concealing dangerous products and injecting, ingesting, inhaling, or otherwise introducing dangerous products into the human body.

Traffic and trafficking: means to manufacture, distribute, dispense, sell, transfer, or possess with intent to manufacture, distribute, dispense, sell, or transfer.

Transfer: means to dispose of drug paraphernalia to another person without consideration and not in furtherance of commercial distribution.

SECTION 23.4 POSSESSION OF DRUG PARAPHERNALIA It is unlawful for any person to knowingly use, or to possess with intent to use, drug paraphernalia.

SECTION 23.5 MANUFACTURE, SALE, OR DELIVERY OF DRUG PARAPHERNALIA: It is unlawful for any person to sell, deliver, possess with intent to deliver, or manufacture with intent to deliver, drug paraphernalia. Sale, delivery, possession with intent to deliver, or manufacture with intent to deliver, of each separate and distinct item of drug paraphernalia shall be considered a separate offense.

SECTION 23.6 ADVERTISEMENT OF DRUG PARAPHERNALIA: It is unlawful for any person to purchase or otherwise procure an advertisement in any newspaper, magazine, handbill, or other publication, or purchase or otherwise procure an advertisement on a billboard, sign, or other outdoor display, when he/she knows that the purpose of the advertisement, in whole or in part, is to promote the sale of objects designed or intended for use as drug paraphernalia.

SECTION 23.7 DRUG PARAPHERNALIA EXEMPTION Any patient or caregiver that possesses drug paraphernalia for lawful use of Medical Marijuana (pursuant to Chapter 369 of the Acts of 2012 An Act for the Humanitarian Medical Use of Marijuana and Massachusetts Department of Public Health Regulations 105 CMR 725.000) shall be exempt from sections 23.4 and 23.5 herein.

SECTION 23.8 RIGHT OF ENTRY The Chief of Police of the Town of Needham, the Director of Public Health and his designated agents may enter upon any privately owned property, which serves the public, for the purpose of performing their duties under this Board of Health regulation.

SECTION 23.9 ENFORCEMENT This regulation may be enforced by the Director and his/her designated agents, especially the Chief of Police for the Town of Needham and his law enforcement staff as well as other code enforcement personnel so designated by the Director.

In addition to the restrictions defined herein, the Director and his/her designated agents may consider these items as violations of this section.

a) Refusal to permit an agent of the Police or Public Health Departments to inspect the facility or any part thereof; b) Interference with an agent of the Police or Public Health Departments in the performance of their duty; c) A criminal conviction of the facility owner or employee in control of the facility, relating to the operation of the facility; d) Failure to pay assessed fines or penalties; e) The facility owner, operator, or employee’s failure to comply with this ordinance; f) Keeping or submitting any misleading or false records, documents, or verbally stating false information related to the possession or sale of drug paraphernalia.

Any resident who desires to register a complaint pursuant to this Regulation may do so by contacting the Board of Health, the Public Health Department, or the Needham Police Department.

SECTION 23.10 FINES FOR VIOLATIONS OF ORDERS AND SUSPENSIONS: Any person or entity violating any term or condition of this Board of Health regulation, shall be subject to a fine of fifty dollars ($50) for the first violation and a fine of one hundred dollars ($100) for the second violation, and increasing for each subsequent violation up to the amount of three hundred dollars ($300). Each day that a violation continues shall constitute a separate and distinct offense.

This regulation shall be enforced pursuant to M.G.L. Chapter 40, section 21D, as a noncriminal offense, or may be punished under M.G.L. Chapter 111, section 31 as a criminal offense in which the criminal fine imposed shall not exceed $1,000.

SECTION 23.11 SEVERABILITY If any word, clause, phrase, sentence, paragraph, or section of this ordinance shall be declared invalid for any reason whatsoever, that portion shall be severed and all other provisions of this Ordinance shall remain in full effect.

SECTION 23.12 COMMUNITY PARTNERSHIP Any resident, police officer, code enforcement officer, physician, nurse, or other concerned individual that has knowledge of the sale or possession of a drug paraphernalia within the Town of Needham may inform the Needham Police Department Business Line (781-455-7570) or the Public Health Department Main Line (781-455-7500 x511) of the location of the drug paraphernalia. Nothing within this subsection shall be enforced herein, but considered goodwill toward the betterment of the community.

SECTION 23.13 EFFECTIVE DATE This regulation shall take effect upon August 1, 2016. Public hearings and open meetings regarding this regulation were conducted on XYZ. This regulation was approved by a [unanimous] vote of the Board of Health on XYZ, 2016.

The Public Health Consequences of Marijuana Legalization

With the fast approaching election season and the decision to legalize recreational marijuana use in Massachusetts on the November ballot, the Needham Board of Health finds it important to communicate the threat to the public health and safety that such legalization would have on our community. As a local Board of Health we operate with the intent and purpose to protect the public health and safety of the Town of Needham and its residents. With this intent and purpose in mind, the evidence below outlines the public health and safety risks of recreational marijuana legalization so that Needham voters may make an informed decisions this November. ,

MARIJUANA USE POSES SIGNIFICANT RISKS TO PUBLIC HEALTH

Marijuana poses health risks not only to the user, but also their families and our greater community. Evidence tells us that marijuana use, particularly long-term, chronic use that begins at a young age, can i lead to dependence and addiction. We know from local data collection that youth in Needham and across the state use, and have used, marijuana, which makes the proposition of increased availability of the drug through legalization a serious concern.  In 2014, 32% of Needham 9-12 graders reported they had used marijuana in their lifetime and 22% reported use in the past 30 days. iiIn Massachusetts, high school students indicated that 41% had used marijuana in their lifetime and 25% reported use in the past 30 days.iii  Youth in Needham and in Massachusetts indicate a low perception of risk associated with marijuana use: • Less than half (38%) of Massachusetts high school students reported that they believe smoking marijuana occasionally would be a moderate or great risk to their health and 75% reported that it would be very easy or fairly easy for them to obtain marijuana. iv • In Needham, only 54% of high school students surveyed reported that there is a moderate or great risk of people harming themselves if they smoke marijuana one or two times a week. v  In 2011, approximately 4.2 million people nationwide met the diagnostic criteria for abuse or dependence on marijuana. vi vii viii ix  Marijuana use is associated with addiction, respiratory illnesses, and cognitive impairment. x  Marijuana is also the second leading substance for which people receive drug treatment and a major cause for visits to emergency rooms.xi xii  Studies also reveal that marijuana potency has almost tripled over the past 20 years, raising serious concerns about implications for public health – especially among adolescents, for whom long-term use of marijuana may be linked with lower IQ (as much as an average 8 point drop) later in life.xiii  Between 2010 and 2014 in Colorado, marijuana-related traffic deaths increased 92% while all other traffic deaths increased by only 8%. Additionally, such traffic deaths involving operators that tested positive for THC represented only 10% of all traffic fatalities in 2009 and by 2014 that number nearly doubled to 19.26% of all fatalities. xiv

INCREASED AVAILABILITY LEADS TO INCREASED HEALTH AND SAFETY COSTS

Scientific research shows us that increasing the availability of drugs can lead to increased use, and growth in the consequences of that use:

 Legality increases the availability and acceptability of drugs in the community, as we see with xv alcohol and tobacco – whose use far outpaces the use of illegal drugs.  Increased availability and acceptability of marijuana would likely lead to increased consumption xvi of the drug in Massachusetts. Since legalization in Colorado, teen use has jumped 20% and it has the dubious distinction of having the highest rate of teen marijuana use across all 50 states. xvii  Increased consumption leads to higher public health and financial costs for society. Addictive substances like alcohol and tobacco, which are legal and taxed, already result in much higher social costs than the revenue they generate. The cost to society of alcohol alone is estimated to be more than 15 times the revenue gained by its taxation.xviii

LEGALIZATION WILL NOT SOLVE PUBLIC HEALTH OR SAFETY CHALLENGES

Research also shows that policies that would make drugs more available would likely not eliminate the or improve public health and safety. Recent reports from the nonpartisan RAND Institute xix,xx found that the potential economic benefits from legalization had been overstated:  Marijuana legalization would not eliminate the black market for the drug.  And dramatically lowered prices could mean substantially lower potential tax revenue for states.

The data on legalizing recreational marijuana outlines a clear danger to the public health and safety to members of our community and outlines why voters should vote NO on Question 4.. The Needham Board of Health hopes that voters will remember this information when they submit their ballots later this fall.

REFERENCES

i Anthony, JC, Warner, LA, and Kessler, RC (1994) Comparative Epidemiology of Dependence on Tobacco, Alcohol, Controlled Substances, and : Basic Findings from the National Comorbidity Survey, Experimental and Clinical Psychopharmacology 2(3):244-268. Available: http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=1994-45545-001 ii Education Development Center, Inc. 2014 MetroWest Adolescent Health Survey Report. Waltham: MetroWest Health Foundation; 2015. iii The Commonwealth of Massachusetts, Massachusetts Department of Elementary and Secondary Education, and the Massachusetts Department of Public Health. Health and Risk Behaviors of Massachusetts Youth [Internet]. Massachusetts; Massachusetts Department of Elementary and Secondary Education; 2014 May [cited 2016 Aug 28]. 27 p. Available from: http://www.doe.mass.edu/cnp/hprograms/yrbs/2013report.pdf iv The Commonwealth of Massachusetts, Massachusetts Department of Elementary and Secondary Education, and the Massachusetts Department of Public Health. Health and Risk Behaviors of Massachusetts Youth [Internet]. Massachusetts; Massachusetts Department of Elementary and Secondary Education; 2014 May [cited 2016 Aug 28]. 27 p. Available from: http://www.doe.mass.edu/cnp/hprograms/yrbs/2013report.pdf v Education Development Center, Inc. 2014 MetroWest Adolescent Health Survey Report. Waltham: MetroWest Health Foundation; 2015. vi Substance Abuse and Mental Health Services Administration. Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings. U.S. Department of Health and Human Services. [September 2012]. Available: http://www.samhsa.gov/data/NSDUH/2k11Results/NSDUHresults2011.htm#Fig7-2 vii Anthony, JC, Warner, LA, and Kessler, RC (1994) Comparative Epidemiology of Dependence on Tobacco, Alcohol, Controlled Substances, and Inhalants: Basic Findings from the National Comorbidity Survey, Experimental and Clinical Psychopharmacology 2(3):244-268. Available: http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=1994-45545-001 viii Polen MR, Sidney S, Tekawa IS, Sadler M, Friedman GD. Health care use by frequent marijuana smokers who do not smoke tobacco. West J Med 158(6):596–601, 1993. Available at http://www.ncbi.nlm.nih.gov/pubmed/8337854 ix Meier et al., “Adolescent-onset and neuropsychological health.” Proceedings of the National Academy of Sciences. [August 27, 2012]. Available: http://www.pnas.org/content/early/2012/08/22/1206820109 x Substance Abuse and Mental Health Services Administration. Treatment Episode Data Set (TEDS), Substance Abuse Treatment Admissions by Primary Substance of Abuse, 2010. U.S. Department of Health and Human Services. [2012]. Available: http://wwwdasis.samhsa.gov/webt/quicklink/US10.htm xi Substance Abuse and Mental Health Services Administration. Highlights of the 2010 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. U.S. Department of Health and Human Services. [July 2012]. Available: http://www.samhsa.gov/data/2k12/DAWN096/SR096EDHighlights2010.pdf xii Mehmedic, Zlatko, et al., “Potency Trends for Δ9-THC and Other Cannabinoids in Confiscated Cannabis Preparations from 1993 to 2008.” Journal of Forensic Sciences, Vol. 55, No. 5. [September 2010]. Available: http://home.olemiss.edu/~suman/potancy%20paper%202010.pdf xiii Meier et al., “Adolescent-onset cannabis and neuropsychological health.” Proceedings of the National Academy of Sciences. [August 27, 2012]. Available: http://www.pnas.org/content/early/2012/08/22/1206820109 xiv Wong, K. & Clarke, C. The Legalization of Marijuana in Colorado: The Impact Volume 3 [Internet]. Rocky Mountain High Intensity Trafficking Area. Denver (CO); 2015 [cited 2016 Aug 16]. Available from http://www.rmhidta.org/default.aspx/MenuItemID/687/MenuGroup/RMHIDTAHome.htm xv Substance Abuse and Mental Health Services Administration. Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings. U.S. Department of Health and Human Services. [September 2012]. Available: http://www.samhsa.gov/data/NSDUH/2k11Results/NSDUHresults2011.htm xvi Kilmer, Beau, et al., Altered States? Assessing How Marijuana Legalization in California Could Influence Marijuana Consumption and Public Budgets. RAND Corporation. [2010]. Available: http://www.rand.org/content/dam/rand/pubs/occasional_papers/2010/RAND_OP315.pdf xvii Massachusetts Prevention Alliance. Marijuana: Know the Facts, Then You Decide [Internet]. MA: Massachusetts Prevention Alliance; 2016 May [cited 2016 Aug 28]. Available from: http://www.mapreventionalliance.org/wp- content/uploads/2012/01/Marijuana-Policy-Fact-Sheet_May-2016_FINAL-1.pdf xviii Ellen E. Bouchery, Henrick J. Harwood, Jeffrey J. Sacks, Carol J. Simon, Robert D. Brewer. Economic Costs of Excessive Alcohol Consumption in the U.S., 2006. American Journal of Preventive Medicine - November 2011 (Vol.

41, Issue 5, Pages 516-524, DOI: 10.1016/j.amepre.2011.06.045). Available: http://www.ajpmonline.org/article/S0749-3797(11)00538-1/fulltext xix Kilmer, Beau, et al., Reducing Drug Trafficking Revenues and Violence in Mexico: Would Legalizing Marijuana in California Help? RAND Corporation. [2010]. Available: http://www.rand.org/content/dam/rand/pubs/occasional_papers/2010/RAND_OP325.pdf xx Kilmer, Beau, et al., Altered States? Assessing How Marijuana Legalization in California Could Influence Marijuana Consumption and Public Budgets. RAND Corporation. [2010]. Available: http://www.rand.org/content/dam/rand/pubs/occasional_papers/2010/RAND_OP315.pdf

9/6/2016 Needham letter: Board of Health invites public comment ­ News ­ Needham Times ­ Needham, MA

Needham letter: Board of Health invites public comment

Wednesday Posted Jul 27, 2016 at 6:16 AM

Board of Health invites public comment

The Needham Board of Health is accepting public comment on three regulations that will be on the agenda at the board’s next meeting and public hearing. That meeting will be Friday, July 29, at 7 a.m. in the Charles River Room at the Town’s Public Service Administration Building at 500 Dedham Avenue; hearings begin at approximately 8 a.m. A second hearing is scheduled for Sept. 9.

The first regulation to be considered would ban the sale of synthetic drugs in Needham. Synthetic drugs are laboratory-made chemical compounds in the form of crystals, chemicals sprayed onto plant material, or liquids to be used in vaporizers. Such substances may be marketed and sold as “herbal incense” or “potpourri” and are often marked “not for human consumption.” However a study in the World Journal of Clinical Pediatrics found that these products are often used in the same manner and for the same purposes as scheduled drugs. According to the Office of National Drug Control Policy, these drugs are known to have unpredictable and intense effects on the user due to the variety of chemicals and concentration of chemicals used in the manufacturing process, which lacks quality controls and government oversight.

An accompanying regulation would also ban the sale and use of drug paraphernalia in Needham. Drug paraphernalia, which includes things like cocaine spoons, roach clips, bongs, and a variety of non-tobacco pipes, facilitates the use of controlled substances that are illegal or a threat to health, and often both. The regulation is careful to exempt the lawful use of items by medical

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marijuana cardholders, in accordance with both state and local regulations. Both the Synthetic Drug and the Drug Paraphernalia regulations would be cooperatively enforced by the Needham Public Health Division and the Needham Police Department.

The final regulation to be considered would update the board’s existing regulation on Body Art to include select modern techniques of temporary tattooing where a needle or multiple needles pierce the skin or the mucosa. The current regulations, which are intended to ensure safe and hygienic operations by licensed practitioners, do not encompass all modern techniques and have been largely unchanged since first enacted in 2001.

The Board of Health believes that all three proposed regulations will improve the health and wellness of the community. Residents, business owners, and other concerned parties are invited to attend the hearings to register their opinions on the proposed regulations.

Comments will also be accepted through Friday, Sept. 2 in writing via electronic or postal mail. Please send comments to [email protected] or to Public Health Department, 1471 Highland Avenue, Needham, MA 02492. Both regulations are available for interested parties to review on the Public Health Department’s website at www.needham.gov/health.

Edward Cosgrove

Stephen Epstein

Jane Fogg

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Needham Guest Column: Synthetic drugs - know the facts

Saturday Posted Jul 30, 2016 at 6:11 AM

By ByAngela Giordano, Catherine Delano and John Schlittler

You may have heard of laboratory-made synthetic drugs such as “bath salts” or synthetic marijuana, and as a parent or caregiver of a teen or young adult you might wonder what these substances are and the risks involved in their use. Here is important information for you to have in order to stay informed and up to date.

Synthetic drugs are chemical compounds created in laboratories and sold to replicate the effects of marijuana and other controlled substances. Concern about use of these drugs comes from their unpredictable and intense effects on the user, and from the varied concentration of chemicals from one product to the next. Much of what is known about the short and long-term effects of these substances on physical and psychological health comes from individual reports of use that crop up through emergency department visits, calls to poison control centers, and online forums. It is clear from the information collected on adverse reactions that synthetic drugs need to be a part of the substance use prevention conversation in Needham.

Teens and young adults in Massachusetts report use of two types of synthetic drugs: synthetic stimulants (“bath salts”) and synthetic cannabinoids (or synthetic marijuana, common street names include “K2,” or “Spice”) according to the Massachusetts Department of Public Health. The Centers for Disease Control and Prevention noted a substantial increase in calls to poison control centers for adverse reactions to synthetic cannabinoids in the same three-month study period during 2014 and 2015, which indicates that use of these drugs may be on the rise. http://needham.wickedlocal.com/news/20160730/needham­guest­column­synthetic­drugs­­­know­facts 1/3 9/6/2016 Needham Guest Column: Synthetic drugs ­ know the facts

Synthetic marijuana is a chemical that is sprayed onto plant material and sold in order to be smoked. It is also manufactured as a liquid to be vaporized and used in e-cigarettes. In order to mimic the high of marijuana, the chemical product in synthetic cannabinoids operates on the same brain cell receptors. Reported adverse effects of synthetic marijuana include, rapid heart rate, vomiting, violent behavior, suicidal thoughts, raised blood pressure, kidney damage, and seizures, according to the National Institute on Drug Abuse.

Synthetic stimulants (synthetic cathinones or “bath salts”) have an effect on individuals similar to cocaine and hallucinogenic drugs, such as LSD, MDMA, and/or methamphetamine. Despite their name, these are not the type of bath salts that are added to bathwater. Rather, the name “bath salts” is used to avoid detection by law enforcement or public health officials. Bath salts usually take the form of a crystalline powder and are typically swallowed, snorted, smoked, or injected. Reports of adverse effects of synthetic stimulants include paranoia, hallucinations, extreme agitation, and panic attacks.

Synthetic drugs are commonly available for purchase at gas stations, convenience stores, drug paraphernalia shops, and through the Internet. They are primarily marketed to young adults and teens with brightly colored foil packages, cartoon characters, and are sold under a variety of street names, such as Joker, Black Mamba, Kush, and Kronic. Though some versions of synthetic drugs are covered under the federal controlled substances act, new chemical compounds continue to be created as a work around to current bans, according to the CDC and NIDA. Efforts to keep new varieties off the market include local and federal legislation that ban these look-alike drugs, according to a study published in Governing magazine.

Initial inspections conducted by the Needham Police Department have not revealed any vendor that currently sells synthetic drugs in Needham, and if the Board of Health enacts its synthetic drug regulation at a public hearing it will soon be unlawful to sell any such products in Needham.

The documented adverse effects of synthetic drugs are cause for concern; they are unpredictable, intense, and in some instances include death. These outcomes, along with the ever-changing landscape of synthetic drugs, illustrate the need to equip ourselves with knowledge and a way to communicate the risks to the young people in our lives.

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The Town of Needham will continue to take active steps to address this trend in synthetic drug use and we invite you to be a part of this effort by educating yourself and others about this issue. You can find more information on our website by visiting www.needhamma.gov/health.

Angela Giordano is prevention specialist at the Needham Public Health Department. Catherine Delano is senior substance use prevention coordinator at the Needham Public Health Department. John Schlittler is chief of police for the Town of Needham.

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9/6/2016 Needham hearing on Board of Health regulations ­ News ­ Needham Times ­ Needham, MA

Needham hearing on Board of Health regulations

Tuesday Posted Aug 30, 2016 at 6:32 AM Updated Aug 31, 2016 at 6:00 PM

The Board of Health will is proposing new regulations on body art establishments, synthetic drugs and drug paraphernalia at a public hearing coming up Sept. 9 at 8 a.m. in the Charles River Room at the Town’s Public Service Administration Building at 500 Dedham Avenue.

The first regulation would ban the sale of synthetic drugs in town. Synthetic drugs are laboratory-made chemical compounds that can take the form of crystals, chemicals sprayed onto plan material or liquids to be used in vaporizers. Often sold as “herbal incense” or “potpourri,” at least one study has found the drugs are often abused in the same way as regular drugs.

The second regulation would ban the sale and use of drug paraphernalia, including cocaine spoons, roach clips, bongs, and a variety of non-tobacco pipes, in Needham.

Residents, business owners, and other concerned parties are invited to attend to register their opinions on the proposed regulations. This is the second public hearing on the regulations.

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The body art regulation would simply update the current regulation to include select modern techniques. Comments will also be accepted through Friday, Sept. 2 in writing via electronic or postal mail. Please send comments to [email protected] or to Public Health Department, 1471 Highland Avenue, Needham, MA 02492.

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