Cape & Islands Health Agents Coalition Meeting


Cape & Islands Health Agents Coalition Meeting


Cape & Islands Health Agents Coalition Meeting

Friday, September 24, 2010

9:30 AM –12:00 Noon

Dennis Police Department

90 Bob Crowell Road SouthDennis, MA


  • Introductions
  • Approval of Minutes from August 27, 2010.
  • No motion to approve minutes due to no quorum at this meeting.


George Heufelder, BCDHE, Lynn Mulkeen-Perry, BCDHE, Amy L. Wallace, BCDHE, Brian Baumgaertel, BCDHE, Bob Collett, BCDHE, Nancy Ellis-Ice, Brewster HD, Pat Pajaron, Truro, HD, Donna Lazorik, MDPH, Judith Giorgio, Chatham HD, Carl Lawson, Yarmouth HD, Matt Poole, Edgartown BOH, Diane Brown-Couture, MDPH, Angela Waldron, Wampanoag Health, Hillary Greenberg-Lemus, Wellfleet HD, Robbie Hendricks, MWT, Brenda Richerson, MWT, Terry Hayes, Dennis HD, Sean O’Brien, BCDHE, Thomas McKean, Barnstable HD, Katie Mueller, Cape Cod Volunteers, Bob Canning, Orleans Health, Jennifer Flood, Dennis Health, Carrie Furtek, Bourne BOH (some attendees did not sign in today).

Fall, 2010 Flu Vaccine Update:

Donna Lazorik, RN, MS – Immunization Program, Bureau of Infectious Diseases

Mass Department of Public Health

  • Donna is here to discuss updates on the flu season and has mostly good news to share.
  • Vaccine will come through this October and is recommended for ages 6 months and older.
  • 40 million more doses will be available than in the past.
  • Manufacturers predict that 60% will be out by the end of September.
  • MDPH purchased 1 million doses.
  • Starting last week, DPH began allocating vaccine to local HDs.
  • Next week, they will promote it out to schools.
  • Two groups that are at increased risk for influenza are native Americans, Alaskans and morbidly obese.
  • These must have access to vaccine.
  • Only a handful of confirmed cases representing all three strains have been detected in Mass.
  • It is hard to predict what we will be seeing this year.
  • Handouts are on the table in back.
  • There are three reimbursement projects available.
  • Medicare roster billing – for 65 and older Medicare beneficiaries.
  • Medicare reimburses for more than $25 per dose, allowing for revenue in your town.
  • Senior Advantage plans also get reimbursed as the same rate as Medicare.
  • Younger than 65 and children. Commonwealth Medical developed contracts with insurers and towns that wanted to participate.
  • One page form. Submitted to Commonwealth Medicine, which sent it out to the appropriate health plans.
  • The health plans were reimbursing at a rate of $13.76 per dose.
  • George: Was this an open subscribership?
  • Donna: Yes, across the state.
  • There is going to be a webinar coming up and I will make sure the information gets out.
  • We are encouraging towns to participate in these reimbursement projects.
  • Towns that have been doing this awhile to generate money for their revolving funds and general funds when they go up to request their budgets.
  • If you are not doing it, you are leaving a significant amount of money on the table.
  • There is a flyer from Public Sector Partners take a commission on claims successfully reimbursed.
  • George: Does the reimbursement have to go to the town or can it go to the VNA or for reimbursing contracted nurses.
  • Donna: It can’t go to commercial vaccinators. It can go to the towns (for the young child reimbursement).
  • George: Can it go to the County to pay for vaccinator nurse services?
  • Diane: From our point of view it can, but it is an agreement between you and the town.
  • George: We experienced last year we used different vaccinators per diem. It might be reimbursable in this mechanism so we can keep serving the towns.
  • Donna: We started planning this during H1N1 and schools would be very important. Last year there was PHER funding, and this year the Bureau of Emergency Preparedness is trying to use this for flu season, and whether or not this can be used to cover all your expenses – I don’t know.
  • Towns were able to use the PHER funding for their H1N1 flu clinics.
  • As of right now, MDPH has taken their concerns to the CDC. The CDC is aware of the issue of using PHER funding for what is reimbursable. We don’t know if we will be able to use it for seasonal flu clinics.
  • But, for school clinics, the reimbursable funding looks good.
  • Dennis: We have been doing the roster billing for the past five years and the revolving account helps us buy vaccine and run the clinics.
  • Donna: Who will do school based clinics?
  • Edgartown, Falmouth may and one is scheduled in Chatham.
  • Donna: If you ordered flu mist you will get it but now we are out for future orders. More than 70 K doses were ordered but it all went.
  • The 2009 H1N1 strain is included in this year’s vaccine with the seasonal flu.
  • There is no strain dominating this year.
  • It is likely that we will see all three.
  • Matt: The doses for children are the standard?
  • Donna: We still have thymerisol free doses. Most are .5 single dose vials.
  • You can request those specifically if you want those.
  • Donna is thanked by the Coalition for attending with this update.

Regional Tobacco Control Update

Bob Collett, Director – BarnstableCounty Regional Tobacco Control

  • During the past, the FDA had passed a set of its own regulations for specifically cigarettes at retailers and how they can be marketed.
  • They prohibited terms like “light” and “mild”.
  • These will be removed from shelves because as of June 22nd, manufacturers are not allowed to make items with these descriptors.
  • Smokers are under the misconception that these were safer to smoke than regular.
  • “Light” cigarettes are no safer than regular.
  • Science shows that smokers inhale these types of cigarettes deeper and get as many toxins in their system. Your level of addiction increases.
  • You will not see these in your towns.
  • The level of inspections has increased lately. I have only found a few of these items because they can see down the road what they have to do with them.
  • Most of these regs will be supplemental to the regs at the local level – and yours are more stringent.
  • They are not going to enforce the 30 days, they will let them sell these products down (and not hurt the retailers too much).
  • Question: So, will they stop producing or take the name off?
  • The pack looks exactly the same. Now, they will label it “medium” instead of “light”.
  • There are loopholes in this law. This is prohibiting the cancellation of the term “medium” at this time.
  • They are getting around the law.
  • The misconception was out there widely, since the first Surgeon General report. Since 1965, light cigarettes have been out on the market.
  • There is a ban on vending machines. There is one left in Oak Bluffs.
  • The sale of cigarettes and smokeless tobacco is banned in establishments that are not 18 and older.
  • There are a few southern states that do not ban smoking entirely (indoors).
  • There is smoking and non-smoking sections in some restaurants in southern states.
  • The vending machine piece is pretty self explanatory under local regs.
  • Tobacco retailer training programs are covered on the next sheet (this is a reference document Bob is using to guide everyone through the new regulation changes).
  • This is all stuff that we have on our local regs. 27 or under, you should ask for ID.
  • 27 is consistent with what was used for alcohol (under 30).
  • The health effects of tobacco use must also be displayed. There is a pending lawsuit in NYC and it may require graphic warning labels in the future. They do this in Canada and in some places in Europe.
  • When people come in to buy cigarettes, they are coming in to buy newspapers and other miscellaneous stuff. When you can suspend a tobacco retailer’s license for repeated underage sales, you really hit them in the pocketbook.
  • If a guy has three sales in two years. The BOH suspends their license for 2-3 days. That is about $10K in revenue.
  • It can stop the problem immediately as it is very effective. The thirty cents on the pack of cigarettes they earn is not the issue; it’s the other items the smoker is buying that hits the store hard.
  • There are three FDA offices working to do random checks in our towns from year to year. The FDA will be around to issue a first violation. The first penalty is a training program, then a training program with a $250 fine and then $250 and $500 fines on up for continued violations. On up to $5K.
  • We are limited in Massachusetts by the amount of fines that we can charge. It is maxed out at $300.
  • But the feds are not under these restrictions and they can charge and charge again.
  • They have their own training program.
  • Question: Is there any chance that they will be in an establishment five times in three years?
  • Bob: They will communicate with me at the local level.
  • They keep the tracking and communication system consistent to follow the violators. They are current or former NTCP employees. They are leaving Mass Tobacco Control to go the FDA.
  • There is really a huge disincentive now for retailers to sell to kids and the FDA will come down hard.
  • There is a permanent suspension piece in most of your regulations.
  • On the next piece, restricting the sale of smokeless tobacco. Cigars are not covered. This includes e-cigarettes, blunts, flavored tobacco products that I brought to show you last time.
  • Bourne: How do you enforce this? Generally they use items like e-cigarettes in bars.
  • Bob: When someone violates, we get a phone call. If someone smokes in a restaurant, we get a call. The e-cigarette emits vapor. Some would complain because they see a vapor.
  • E-cigarette: It looks like a cigarette. You purchase a small cartridge or nicotine and artificially lights and sends a vapor into the air. Some towns have banned them.
  • Some of the other components on the sale of distribution is the ban on marketing and merchandising of free stuff. Coupon redemption is permitted as long as Massachusetts laws are followed.
  • Things like Marlboro miles will now go away.
  • Tents at festivals in towns (similar to a wine tasting). They would have to establish that it is “adults only” and they would have to get a local permit. On a national basis it might be easier.
  • Cigar booths would have to get a DOR permit and a local permit.
  • Bourne: We have a new establishment coming in and he is doing cigars and tobacco and it doesn’t say anything about cigarettes.
  • Bob: A tobacco permit is needed from the town.
  • During our inspections, I have come across vendors with no DOR permit. I report it to the DOR. In re-permitting your establishments, they should be showing you a copy of their permit each year. And it needs to be current.
  • These are good for two years. They are renewing now. They expire in even numbered years.
  • In Wareham, there is something noteworthy to mention. The state is testing the waters for limiting localities such as CVS, who sell tobacco products behind the counter.
  • Limiting the number of tobacco permits you issue is another item coming up. Like liquor permits that get issued. If you place a higher value on the permits, you may get more responsible retailers.
  • George: In the towns that have done this, are they developing the information on what will result.
  • Pharmacies and grocery stores don’t rely on the same traffic as convenience stores.
  • In speaking with some of the pharmacists, they get it. They know the impact of tobacco, but they don’t call the shots in terms of retail.
  • Relative on recent inspections, we did a survey on what is out there. The compliance checks this past quarter covered about 80% of the stores.
  • The cigar products keep changing and coming out with new items.
  • Mass Health does cover cessation services.
  • Another topic that the state is looking at taking on is addressing the problem of second hand smoke in public housing. We have been waiting to see where this is going to go. Many phone calls from residents complaining about neighbors. There is a person at the state that is specifically working on this project. I can take care of calls on this type of complaint if you refer the problem to me.
  • HUDD gave permission to all of their facilities to prohibit smoking if they want to. Condo associations can do this too. There is one in Orleans.
  • The smoking rate among young adults is down to 15% in Massachusetts – I am glad to announce this. We are marketing the right message to them.
  • The goal the state has come up with is to reduce smoking 5% by 2022.
  • This is ambitious. Materials are here for you to display in your offices on the subject of smoke free homes.
  • Not trying to demonize a smoker but to take it outside instead.
  • Maybe take these to the Headstart office of WICC offices.
  • There are more available through the Mass Tobacco clearing house. I can order for you or you can order on your own.
  • The people in the lower socioeconomic demographic are the heaviest smokers (and drinkers and gamblers, etc.). That is why HUDD is getting involved and pushing the word out there.
  • They are so overwhelmed with the other problems that exist there, they don’t look at this as a big problem.
  • The smoking rate in the western suburbs of Boston, it is about 45. In the city, it is much higher.
  • Tom: Have they found any correlation in the higher priced cigarettes? In New Hampshire, they are cheaper.
  • Bob: For every 10% increase in cost of cigarettes, it results in a 4% decrease in usage. Taxing is not liked, but the most effective strategy.
  • So, if prices go up, enrollment in cessation classes also goes up.

Cape Cod Volunteers

Katie Mueller, AmeriCorps-VISTA, Volunteer Initiative Coordinator

Cape Cod Volunteers is an initiative of the Cape Cod Foundation in partnership with Barnstable County and

  • We provide a one-on-one service that helps community members identify their own interests and passions and then match them with meaningful opportunities to serve Cape Cod. Cape Cod Volunteers also promotes volunteering in general to engage more people in service to their community.
  • To make it easier to get involved in volunteering, our website ( launched in July 2010, serves as a database for Cape Cod Volunteer activities.
  • Many volunteers have asked:

Q: Where do I start? Before Cape Cod Volunteers, there was no comprehensive database of volunteer opportunities. Many people found volunteer opportunities through neighbors or friends, but reported dissatisfaction: perhaps the experience wasn’t meaningful, or it did not fit the volunteer’s schedule, lifestyle, or interests. So we launched the Cape Cod Volunteers website ( in July 2010 to act as a searchable database of local volunteer activities. Users can use the site to search for volunteer opportunities based on their skills, interests, location, and however much or however little of a commitment they want to make.

The other question that came up in the assessment was Q: What if it’s not the right fit for me?

People are naturally afraid to commit to something they might not like. Because they don’t know how to leave a volunteer position, they may stop themselves from getting involved and miss out on all that volunteering has to offer. Cape Cod Volunteers helps individuals:

•identify their skills,

•figure out the best way to put those skills to use in the community,

•and guide them through the sometimes-overwhelming process of finding a meaningful volunteer opportunity. We want to work with the volunteer until the right match is made.

•Whether it’s showing people how to try out volunteer opportunities or walking them through the process of leaving an opportunity that isn’t a proper fit, we can provide the support that prospective volunteers need to figure out how they can have the most impact in our community.

•We hear this question from many people. You can be sure that we are here to stay because we have done the research and put three and a half yearsof development into this organization. We have established that our top priority must be to match volunteers with meaningful volunteer opportunities. We took the time to evaluate ‘what worked’ and ‘what didn’t’ in prior attempts. We have developed a sustainable volunteer network model to avoid being distracted by fundraising. Moreover, the development of the Cape Cod Volunteers model was informed by a 2006 community assessment in which 200 community members participated.

•Our top priority is to match volunteers with meaningful volunteer opportunities. By taking the time to get to know prospective volunteers and by working with them to find appropriate placements, we can point volunteers to places where their talents and interests will have the most impact, thereby strengthening your corps of volunteers; saving you resources; and ultimately building your capacity to further your mission. When you register with us, we learn about your services, and later, when those perfect volunteers come along,we will know where to send them.