Community Development

Board of Health

Deborah Farnsworth, Chair
Jack Henderson
Dr. Susanna Bedell
Ann Snow, RN
David Burgess

The Board of Health is responsible for the overall stewardship of the public health of the Town. It promotes, enacts, and enforces health rules and regulations in accordance with local bylaws and state law. There are five members of the Board, appointed for three-year terms by the Town Manager.

Public Hearings

In addition to voting on the septic variance requests shown on the following table, the Board of Health held 4 hearings under the Food Code, 2 hearings for recreational camps for children, 2 appeals of letters from staff, 2 building reviews, and 1 underground storage tank variance.

Mosquito Control Program

In recent years, communities throughout eastern Massachusetts have experienced an increase in two mosquito-borne illnesses: West Nile Virus (wnv) and Easter Equine Encephalitis (eee). After a Concord horse tested positive for eee in 2005, the Board of Health and the East Middlesex Mosquito Control Project (emmcp) restructured Concord's mosquito control program to include mosquito surveillance, larval control of eee and wnv mosquito vectors, and public education.

Mosquito surveillance is conducted in Concord by trapping adult mosquitoes at four different locations. Disease-vector species are submitted to the Mass. Dept. of Public Health laboratory for testing. No evidence of eee or wnv was found in 10 mosquito trap collections made on 6 different nights between July and September on 2006.

Concord's larval mosquito control program relies on the larvicides Bacillus thuringiensis var. israelensis (Bti) and Bacillus sphaericus, which are classified by the epa as relatively non-toxic. From July through September, emmcp field crews inspected 16 wetland sites and applied Bti to 8.25 wetland acres when high densities of Aedes vexans larvae were found breeding in stagnant water. During the summer, emmcp personnel applied Bacillus sphaericus to control Culex mosquito larvae in 2,697 roadside catchbasins. As part of an effort to develop an eee vector control response that uses aerial Bti applications, 33 wetlands were surveyed to identify likely Aedes vexans habitats.

The public education program developed by the Board of Health and emmcp is designed to develop awareness within the public and the private sectors as to their roles in mosquito control. emmcp serves as a resource to residents, municipal officials and the local media on controlling mosquitoes, breeding sites and mosquito-borne diseases. A web page (www.town.sudbury.ma.us/services/health/emmcp) provides residents with information on mosquitoes, control programs and related topics.

Health Division

Michael Moore, Public Health Administrator
Karen Byrne, Administrative Assistant
Stanley Sosnicki, Environmental Health Inspector
Gabrielle White, Public Health Inspector

The Health Division enforces State statutes and regulations relative to the protection of public health, the control of disease, the promotion of sanitary living conditions, and the protection of the environment from damage and pollution. Environmental and sanitary codes enforced by the Health Division include: septic systems, food establishments, swimming pools/bathing beaches, summer camps, indoor ice skating rinks, housing and lead paint. Administrative staff is responsible for immunization programs, rabies control, and maintenance of databases for the issuance of 15 types of annual licenses/permits issued by Health Division. Approximately 9% of total staff hours in the Division (596 hours in fy06) is committed to providing staff support for the Boards of Health in Lincoln and Carlisle under inter-municipal agreements. Approximately $227,000 in revenue was collected for services provided under these inter-agreements since 1996.

Permits & Licenses

The Health Division issued the following operating licenses in 2006: 123 Food Service/Retail Food; 20 Tobacco Sales; 43 Permits to Keep Farm Animals; 20 Bathing Beaches/Swimming Pools; 43 Hazmat; 20 Massage Therapy Establishments; 10 Recreational Camp Sites; 2 Tanning Facilities; 57 Massage Therapists; 77 Disposal System Installers; 15 Septage Haulers; 12 Rubbish Haulers; 4 Funeral Directors.

Vaccine Program

The Administrative Assistant for the Health Division is responsible for maintaining and distributing vaccines to Concord Health Care providers who are enrolled in the Massachusetts Department of Public Health Immunization Program. On a monthly basis, administrative staff places and packages vaccine orders for 19 physicians, Emerson Hospital, New England Deaconess Nursing Home, Walden Rehabilitation Center, Concord Health Center, and mci Concord. The Health Division staff acts as a liaison between local health care providers and the Mass. Department of Public Health, providing the support needed to maneuver through continually-changing policies and procedures set by the State.

In addition to monthly vaccine management, the Health Division organizes the annual distribution of influenza vaccine provided by the mdph to local health care providers. During the 2006-2007 flu season, mdph staggered administration of vaccine over a several month period beginning in early September. Although this made it difficult for some providers to coordinate their influenza clinics, most were able to purchase vaccine directly from the drug manufacturer to accommodate their patients. All influenza vaccine was distributed to participating physicians by the beginning of December.

Thankfully, Concord seniors were not affected by this delay in distribution, and staff was able to coordinate with Emerson Hospital Home Care to provide the annual influenza clinic in mid-November. Over 400 residents aged 65 or older participated in the clinic held at the Harvey Wheeler Community Center.

Rabies Control Program

The Health Division quarantined 21 dogs and cats due to contact with potentially-rabid animals. Fourteen animals that bit humans were quarantined and monitored by the Health Division. The rabies vaccine was administrated to 54 dogs and 15 cats during the Health Division's annual rabies clinic in March 2006.

9 animals were tested for rabies (2 bats, 2 cats, 2 dogs, 2 squirrels, and 1 raccoon); only the bats and raccoon were positive for the rabies virus. The table of data collected since 1992 shows that raccoons are the primary carrier of the virus in Concord, and that dogs and cats are protected from the disease by the rabies vaccine.

Public Health Nurses/Communicable Disease Control

Emerson Hospital Home Care provides public health nursing services, staffs the annual influenza vaccination clinics, conducts telephone consultations and home visits, and investigates communicable disease reports. Cases of communicable diseases are reported to the Health Division for inclusion in statistical reports prepared by the Massachusetts Department of Public Health to identify outbreaks and track trends. This confidential information is maintained by the Division and conveyed to the public health nurses and mdph for appropriate follow-up action.

Results for 2006 are included on the following table and chart that illustrate how some diseases numbers change over time, while others remain relatively constant.

The Public Health Inspector responded to the increase in Lyme disease by creating a fact sheet on ticks and the virus some of them carry. The information was distributed to residents out of the Health Division office, on the Board of Health webpage, and at various popular hiking locations in Concord. The Lyme disease fact sheet was also forwarded to the Concord Journal as part of a press release for National Public Health Week.

Food Inspections/Temporary Food Events

The Public Health Inspector conducts bi-annual food inspections at 154 establishments in Concord, 23 in Lincoln and 9 in Carlisle. On average, for every full inspection there is one re-inspection. The 177 temporary food events that were reviewed and permitted included the Nashawtuc Golf Classic, Art in The Park, Drumlin Farm Fall Festival, Memorial Day Festivities, West Concord Family Festival, the Agricultural Fair, and the Fourth of July Parade. Each facility and temporary event was reviewed as required by the Food Code to identify and remove any food safety risk factors and help the program to protect the public health.

Recreational Camps for Children

The 26 camp programs reviewed by the Public Health Inspector served 4,201 children at 9 sites in Concord, and 1,560 children at 3 sites in Lincoln. Prior to licensing, each program was reviewed for compliance with regulatory requirements, including: background checks on staff, health records, training records, medical and emergency protocol, and safety checks on all facilities and high risk activities.

In order to meet the State definition of a camp, a program must operate for greater than 2 hours per day, and for at least 5 days over a two week period, or advertise itself as a camp. Programs which do not meet this definition are not inspected and licensed by the Health Division because the Board of Health has no regulatory oversight in those instances.

Swimming Pools

There are 13 sites in Concord which hold recreational pool permits and 1 in Lincoln. There are currently 4 general purpose pools, 13 lap pools, 6 children's pools, 3 special purpose pools and 1 diving well. The Public Health Inspector conducts water tests at each pool as well as monitors safety equipment and trained personal for each site.

Indoor Ice Skating Rinks

The Public Health Inspector also reviews the indoor air quality control program that state law requires for indoor ice rinks. Ice resurfacing equipment that is powered by combustible fuels produce carbon monoxide and nitrogen dioxide. Rinks are required to test and maintain their indoor air quality as needed to protect the health, safety and well being of the public.

Bathing Beach Water Quality

The Public Health Inspector tested 5 bathing beaches for E. coliform during the summer, and obtained test results from the state for Entercocci tests conducted at Walden Pond. This table lists all the data collected this summer, and rank orders all swimming area by overall water quality.

One sample collected by the Town exceeded the action level for E coli. (Kennedy Pond on 8/15/06), that resulted in the closure of the beach for one day. White Pond had the highest overall water quality in 2006.

Animal Inspections

The Animal Inspector conducts sanitary inspections of 56 properties that hold a Permit to Keep Farm Animals. The facilities are inspected for sanitary conditions, health of the animals, and potential conditions presented by storage of manure. The following table shows how the animal population in Concord changed from 2004 to 2006. Sadly, the inspector will no longer be able to visit the miniature horses that used to be stabled in Concord because all 50 have moved to Littleton. Happily, Don Quixote, Concord's oldest donkey is still alive.

Septic Program

The Health Division issued 98 permits to construct septic systems, and reviewed 219 structures that were obtaining building permits for renovations. In addition to reviewing proposed renovations to buildings on septic systems, the Environmental Health Inspector also reviews renovations to buildings on Town sewer in order to calculate the Sewer Improvement Fee (sif) to be charged by cpw.

The Board of Health adopted a local septic regulation in 2004, and the number of requests for variances to this local regulation continued to drop in 2006. As is illustrated by the following chart, only 4% of the septic permits issued in 2006 required one or more local variances from the Board of Health. Variances or other waivers from Title 5 were needed for 12% of the septic permits issued in 2006, and 12% of all permits issued since 2002 have needed one or more waivers from Title 5.

Since the original rewrite of Title 5 in 1995, the Health Division has processed 1,661 system inspection reports from Concord residents who were either selling or renovating their homes. Of these 1,661 inspections: 1,408 (85%) passed; 165 (10%) failed; and 88 (5%) either conditionally passed or needed further evaluation. Similar rates were observed for the 137 system inspection reports filed in a 12-month period in 2006: 120 (88%) passed; 11 (8%) failed; and 6 (4%) conditionally passed.

Emerson Hospital Home Care Services

Jamie Stier, Director

Emerson Hospital Home Care is a Medicare Certified, Joint Commission Approved provider of home health services in Concord, as well as surrounding towns. The mission is to provide the highest quality, cost effective services to all our patients. These services include; skilled nursing, physical, occupational and speech therapy, psychiatric nursing, maternal-child health nursing, home health aide, and medical social work.

Home Care receives referrals for services from Emerson Hospital, many other local and Boston hospitals, physicians, nursing homes and rehabilitation facilities. Members of the community have contacted Home Care directly for services for themselves or family members. Home Care services assist community members of all ages to receive services at home after hospitalization, or during a prolonged illness. The goal of home care services is always to promote the highest state of wellness and independence, and to assist in planning for the continuum of care. Home Care also provides community health and communicable disease follow up in accordance with our Board of Health contract.

Although Emerson Hospital no longer has a hospice program, we continue to work closely with several hospice providers serving this area. The Home Care department has provided end of life care for those patients who have decided not to enroll in a hospice program. Our focus has continued to be provision of care focused on symptom management and dignity for patient and family at end of life.

The Mental Health Team continues to provide a much needed service. This multi-disciplinary approach has allowed for more comprehensive care being offered to our patients with mental health needs, including the elderly. The Team is often instrumental in identifying the need for psychiatric intervention or further evaluation of dementia in the elderly. As the staff of the Team has expanded, so has our capacity to respond to mental health needs of the community. There is close collaboration between the in-patient Psychiatric service of Emerson, and the Home Care Mental Health Team to facilitate transitions between hospital and home.

Home Care continues to participate in the Complimentary Therapies program at Emerson Hospital, and has begun to offer some of these modalities such as Reiki and Therapeutic Touch as part of the care plan for some of our patients.

Using our "Disease Management Program," the Home Care Department continues our success in decreasing emergency department visits, hospitalizations and lengths of stay in several diagnostic groups, especially chronic lung disease and congestive heart failure. This year the department has participated in a nationwide effort by cms to reduce unnecessary acute care hospitalizations from home care providers.

Home Care continues to care for several residents of Concord Park, Newbury Court, Everett Gardens and Peter Buckley Terrace. Through Medicare and other insurers, we are able to provide "home care" services for these individuals who now call these sites their "home." This has allowed these residents to successfully age in place.

The contract with the Town of Concord includes communicable disease follow-up. The contract also allows Home Care to make home visits to ill individuals who have no source of payment to cover much needed services. As Medicare and other insurers are limiting their coverage, this becomes a more important aspect of our work with the Board of Health.

As in previous years, the Flu Vaccine Clinics served many of Concord's residents and employees. The following numbers present the breakdown of specific vaccinations:

As some of the vaccine was delivered late again this year, many individuals received their immunization through their own physicians.

Emerson Hospital Home Care works with the Board of Health and other providers of health services in Concord to identify and implement new plans or programs which will benefit the members of the community.

2229 Main Street
Oversight Committee

Kerry Diskin
Deborah Farnsworth
Len Rappoli
Pam Rockwell
Fred Seward
Candace Wight

The 2229 Main Street Oversight Committee was formed to monitor the cleanup at Starmet, formerly Nuclear Metals, Inc. (nmi), a former defense contractor that is now a superfund site. In 2006, two major activities were happening at the site: a remedial investigation of contamination outside the buildings and removal of barrels of waste material that were stored inside the buildings.

The Environmental Protection Agency (epa) is managing the cleanup and overseeing the Remedial Investigation and Feasibility Study (ri/fs). The investigation will determine the extent of the contamination at the site and the pathways by which the public may be exposed. The feasibility study will develop possible cleanup strategies. The epa has hired the consulting firm de maximis inc. to conduct the ri/fs.

The second round of soil and water samples were taken and evaluated this year. This site is known to be contaminated with depleted uranium, beryllium, and other laboratory chemicals. There are also pcbs located in most of the areas where there is uranium contamination in surface soil, which means that these areas will definitely trigger a remediation action. (These areas are all close to buildings and enclosed by fences.) The major plume of uranium in the ground above the bedrock has also been identified heading from the former holding basin, under the buildings, and towards the Assabet River. Additionally, some high levels of natural uranium have been found in some bedrock wells, and more samples are being collected to determine if this is caused by other chemicals used at the site, such as lime or nitrates.

The Committee felt that the data suggested that some off-site soil sampling for uranium might be useful, however the epa disagreed and did not request these samples be taken. Citizen's Research and Environmental Watch (crew), a local watchdog group, has decided to collect and evaluate off-site soil samples for depleted uranium. The Town is allowing crew to collect samples on Town property and committee member Fred Seward has been observing the sampling. The first round of samples was taken in December and the results will be presented and discussed in 2007.

This summer, the Committee reviewed and commented on the Screening Level Environmental Risk Assessment (slera) for the site. The purpose of this document is to make sure that any threat to the environment from contamination at the site is tested for. In addition to further testing for contaminants in soil and sediments, the slera also lays out plans for toxicity testing and surveys of the animals at risk at the site. In addition to the adjacent river, wooded areas, and cooling pond, the site contains a sensitive habitat: a sphagnum bog. The challenge is to be able to sample and clean up the bog without destroying it in the process. The Committee provided ideas about how to find a reference bog, not on the site, to compare the toxicity and animal surveys. The Committee also recommended a sediment study that had been done on the Assabet River in 2004 upstream of the site to be used for comparison. The Committee also noted that the epa has a renowned expert overseeing the environmental risk assessment, and has confidence in the epa's oversight of this part of the process.

The epa has also mentioned to the Committee that it is time to start thinking about what the site will be used for once the cleanup is over, since things like future uses and zoning are taken into account during the next phase of the ri/fs: the human risk assessment. epa has continually made the point that the site is zoned for industrial uses, not residential ones. While the Committee has pointed out that there are residential buildings and a children's camp located on Forest Ridge Road in Concord, which has the same zoning as 2229 Main Street, the epa is not convinced that the site might ever be used that way. The committee feels strongly that our Town needs to take every opportunity to make the point to epa that we want to have the most thorough cleanup possible at the site, so that it can be used for residential or mixed use functions. We are starting by having Town Counsel write a letter to epa to remind them of the residential use possibilities under the current zoning. crew has also proposed changing the zoning to make residential uses even easier and they plan to submit an article to Town Meeting to that effect. The Committee supports such action in principle, although we want to be sure that the Planning Board and other Town boards are comfortable with the changes. The Committee feels that crew has enough support in the Town to be successful with their effort to change the zoning, so that it is important to be involved in their process now. In this way, other Town boards can help craft the best possible language in whatever zoning change might be enacted.

Another important part of the cleanup this year was the removal of 3,700 drums of uranium waste that were stored inside the Starmet buildings. As of March, the drums and barrels were gone. The Massachusetts Department of Environmental Protection (dep) contracted with Envirocare to package, transport, and dispose of the barrels and containers of depleted uranium waste. The drums and containers were packaged into special transport containers inside the building and then tested to be sure that no radiation or contamination got out of the transport package. The packaged drums were loaded into trucks and disposed of in Utah. The committee was particularly pleased with the close contact that the Concord Fire Department maintained with the contractors during this process. We felt that this attention contributed greatly to the safe completion of this waste removal. Currently, the dep is using the leftover money in the budget to dispose of other chemicals and waste left in the building.

The Committee has been informed of epa's plans to remove the buildings at the Starmet site. De maximus has been allowed into the buildings to evaluate what needs to be done. There is radioactive contamination in all parts of the buildings, including offices, due mostly to a leaky roof and standing water. In some areas, water is above the level of the electrical outlets. In April, the Committee expects that demolition plans will be released and can be finalized quickly. We would like to see flammable materials and electrical hazards removed from the buildings immediately, and we hope that the Concord Fire Department will be participating at the same high level that they participated during the removal of buried drums in 2005 and stored drums in 2006.

More information about the Starmet cleanup can be found at the following websites. The Committee does not manage the content of these sites:

• www.nmisite.org is the website created by the contractor de maximis. It includes a list of the current activities at the site, including data and maps from the sampling that has been completed.

• The epa also has a website with historical information (search for "Nuclear Metals").

• www.crewconcord.org is the website for the environmental advocacy group crew.