Kenneth E. Davis, President
Board of Commissioners

Dear Commissioner Davis,

It is my pleasure to forward to you the 1998 Annual Report of the Township of Lower Merion Board of Health. This was another busy and productive year for the Board.

Oversight of the Volunteer Medical Service Corps of Lower Merion/Narberth, ElderNet and the Montgomery County Emergency Services continued. All agencies were felt to be doing a very fine job and continued funding at the 1997 level was recommended to the Board of Commissioners.

ElderNet continued to receive many calls from first time users for information and access to its many helpful services. A Nursing Home Guide for institutions located in Montgomery, Chester, Delaware and Philadelphia counties was produced and placed on the Township web site. Work on a Senior Directory of Services was begun. To increase awareness of this organization, multiple presentations were made by Miss McCabe and her staff to community organizations and schools. New initiatives for fund raising and the establishment of an endowment fund were undertaken.

The Volunteer Medical Service Corps welcomed a new director, James Dougherty. A quality improvement committee was formed under the guidance of Dr. Edward Dickinson of the Emergency Medicine Department of the University of Pennsylvania. A new paramedic responder/command vehicle was purchased to further expedite services in emergency situations. Wheelchair transport became an available service. Billing procedures were revamped to enhance revenues. Members of the VMSC presented multiple programs to the community during the year.

Montgomery County Emergency Service continued to provide invaluable assistance to the Lower Merion Township Police and to the community.

There was further improvement in communications with the Montgomery County Health Department. Members attended three of our meetings. A frank exchange of ideas and constructive criticisms occurred at each and led to a much better understanding of the problems faced by both organizations. Board member, Dr. Brian Strom, began a study of available data on the incidence of breast cancer in Lower Merion. This data, when available, will be reviewed with the Board of Health, Health Commissioner, David Sonenshein and subsequently with the Montgomery County Board of Health.

In February, Gail Wallace Wright, Regional Director of Community Services of Main Line Health-Jefferson Health System, updated the Board of Health regarding the wide range of health initiatives offered by the system. Regular meetings are planned with Ms. Wright to keep us aware of current health programs being offered by this organization to Lower Merion citizens.

Ann Danish’s departure after 10 years of exceptional service was a real loss to the Board, and left it with no direct means of communications with Main Line Health. Hopefully, this gap will be bridged by Mr. Ken Hanover’s appointment of Richard Wells to serve as a liaison. We are looking forward to working with Ann’s replacement, Dr. Matthias Genser, D.V.M., a Gladwyne veterinarian.

Oversight of health reports from the Health Department indicated no significant problems. This absence of serious community health problems is largely due to the proactive stance taken by John Messa and his staff. To be better informed about reportable diseases in Lower Merion, a new disease form was designed and monthly data is obtained from the Bryn Mawr and Lankenau Hospitals’ microbiology laboratories.

A priority of the Board remained the goal of decreasing the number of our youth who smoke. This was felt to be best accomplished through education and the enforcement of existing laws. Educational packets were distributed to all local merchants selling tobacco products and our police department carried out compliance checks. Deficiencies in compliance were below the national goal of 20%. Additionally, individual members of the Board and their families continue to observe merchants to see whether they are selling tobacco products to minors. Education regarding the use of tobacco is carried out through various school programs sponsored by the Community Service arm of Main Line Health and other organizations such as the American Heart and Lung Associations. There are also multiple smoking cessation programs available to community members.

A rabies clinic was held for the first time in the Township on October 3^rd. Local veterinarians and animal technicians gave generously of their time, but community turn out was less than expected with only nine animals being vaccinated. With two rabid animals found in Lower Merion last year, more public awareness is needed. Additional ways of notifying residents of the availability of this valuable service will be tried in 1999.

Awards were again given to those establishments in the community with superior sanitation records during the preceding year. These included: the Guard House in Gladwyne, McDonald’s Restaurant in Rosemont; Lankenau Hospital Food Services in Wynnewood; Super Fresh in Gladwyne; Peche Mignon in Bryn Mawr; and the Southwest Prime/Ultimate Bake Shop in Narberth.

The Board of Health Annual Message to the community included articles on: Cardiovascular Disease, Breast Cancer, Domestic Violence and Adult Immunizations, as well as a list of important phone numbers for obtaining information on topics such as Lyme disease, Aids and travel immunizations. To inform the community about important health issues in a more timely fashion, the Board plans to make use of the government access cable channel for Lower Merion, the Township’s web page and one page written health alerts during the next year.

Sincerely,

Abigail A. Silvers, M.D., President
Lower Merion Township Board of Health

THE TOWNSHIP OF LOWER MERION BOARD OF HEALTH

ANNUAL REPORT 1998

TABLE OF CONTENTS

Personnel

Board Meetings

Organization Chart of the Board of Health

Vital Statistics

Resident Deaths, Live Births, Fetal Deaths, Infant Deaths - Township of Lower Merion, 1976-1997

Communicable Disease Control

Report of Diseases from March 13, 1908 to December 31, 1998 - Township of Lower Merion

Public Health Education

Lyme Disease Food Safety

Cigarette and Tobacco Sales

Clinics & Health Care

Annual Health Message

Environmental Concerns

Public Health Laboratory

Environmental Sanitation

Eating and Drinking Places

Retail Food Stores

Temporary Food Service

Milk Sanitation

Sample Collection in the Township

Vending Vehicles

Vending Machines

Private Refuse Collectors

Public Swimming Pools

Schools

Public Health Nuisances

General

Rodent Control

Assistance Calls

Health and Social Services

ElderNet of Lower Merion Narberth

Volunteer Medical Service Corps of Lower Merion and Narberth

Staff Training

Training Courses

Organizational Affiliations

Township of Lower Merion Department of Health Financial Statement for 1998

Cost of Health Protection

THE TOWNSHIP OF LOWER MERION BOARD OF HEALTH
NINETY-FIRST ANNUAL REPORT

The members of the Board of Health of the Township of Lower Merion who served during the year of 1998 were:

The Health Department staff included:

Consultants:

Board Meetings: There were 11 regular meetings held by the Board during 1998.

ORGANIZATION CHART
BOARD OF HEALTH

DIRECTOR OF HEALTH

DIRECTOR OF LABORATORY

SANITARIAN I
* RESTAURANTS
* SAMPLING
* COMPLAINTS
* SCHOOLS
* REFUSE TRUCKS
* SWIMMING POOLS

LABORATORY TECHNICIAN

SANITARIAN
* FOOD STORES
* SAMPLING
* COMPLAINTS
* VENDING
* RODENTS
* SWIMMING POOLS

STUDENT INTERN
* VENDING
* SWIMMING POOLS
*REFUSE CONTAINERS

1998 STATISTICS
VITAL STATISTICS

The Pennsylvania Department of Health, Division of Health Statistics and Research, supplied statistics on resident deaths and infant deaths in the Township of Lower Merion for the year 1997. Compilation of these data for 1998 will not be completed until the end of 1999.

These data were supplied by the State Health Data Center, Pennsylvania Department of Health, Harrisburg, PA. Any analyses, interpretations or conclusions based on this information are solely those of the user, and the Pennsylvania Department of Health specifically disclaims responsibility for any such analysis, interpretations or conclusions.

The table below lists the cases of disease reported to the Board of Health from the time of its origin on March 13, 1908 to December 31, 1998. Since 1990, this data has been supplied by the Montgomery County Health Department.

One hundred and fifteen cases of communicable disease were reported in 1998. In the number of cases reported, Lyme Disease ranked first with sixty-four cases, Girardia

was second with eleven cases, Chlamydia was third with twelve cases and Salmonella was fourth with eight cases.

The decrease in the so-called childhood diseases is to be expected considering the changes in state regulations and the availability of vaccines. Measles, Mumps, German Measles, and Pertussis are preventable through immunization. Chickenpox and respiratory streptococcal infections (Scarlet Fever), and other common childhood diseases are no longer reportable under state law, although exclusion from school by school authorities for specified periods is still required.

Regulations of the Pennsylvania Department of Health require all students, kindergarten through grade twelve, to provide proof of immunization against or immunity to Diphtheria, Tetanus, Polio, Measles, German Measles and Mumps prior to admission to school. This legislation is being strictly enforced by school administrators.

Animals capable of transmitting rabies inflicted injuries on ninety-one Township residents in 1998. When the animal owner was a resident of the Township, the owner was instructed to confine the animal for ten days, then submit a veterinarian's examination report, certifying that the animal was free of any evidence of rabies.

The Township Health Department submitted twelve animal specimens to the Pennsylvania State Laboratories in Lionville or Harrisburg for examination. Two bat specimens proved positive for rabies. Stricter regulations regarding the quarantine and examination of animals inflicting injuries on humans, as well as a prohibition on cats running at large, were continued for another year. These requirements have been in effect since May 1992.

This data was information furnished by the Montgomery County Health Department.

Lyme Disease remains the number one reportable disease in the Township of Lower Merion with 64 cases confirmed during the year. The Health Department issued flyers reminding residents and persons who work outdoors to take precautions against ticks in both the Spring and the Fall peak season. Lyme Disease information was disseminated through the Public Information Officer, Main Line Health/Jefferson Health System, Public Works Department, and the six Township Libraries. Information is also posted on the Township website as well as on the Government Access Channel, Cable Channel 7.

A new vaccine, LYMErix®, was released this year and requires three doses over the course of one year. The series should be started in early spring so that immunity peaks prior to the next year start of the tick season. As the vaccine is not 100% effective, persons need to continue to take precautions against ticks. The vaccine will not protect against other tick borne illnesses such as Rocky Mountain Spotted Fever, Ehrlichiosis and Babesiosis. As the vaccine is new, the Board of Health recommends that persons considering the vaccine first consult their family physician.

The Health Department wishes to acknowledge those establishments that take proactive steps in the area of food safety. Recognition Awards were presented in April by the Board of Health. This years award winners were: The Guard House Inn - Gladwyne, McDonald’s Restaurant - Rosemont, Lankenau Hospital Food Services, SuperFresh Supermarket - Gladwyne, Peche Mignon - Bryn Mawr, and Southwest Prime/Ultimate Bake Shop at Albrecht's Market in Narberth.

Due the large turnover among food service personnel, the Health Department Staff began onsite education programs designed to integrate better sanitation in the workplace. These sessions are particularly useful at new establishments which often utilize untrained persons.

The Director of Health, working with the Police and County, developed "Merchant Education Packets" which contained copies of regulations on cigarette and tobacco sales along with information on smoking and health. The Police Bike Patrol distributed these packets. Each storeowner was asked to sign a pledge not to sell to minors and also have their employees sign similar pledges. Compliance checks started in February utilizing existing State Law. A total of 119 compliance checks resulted in the issuance of citations against 17 persons who sold to underage youth. Letters were sent out to all store managers informing them of the results of the compliance check. The number of violations observed falls within Federal Guidelines to reduce sales to youth to less than 20% by the year 2003. Compliance checks were continued under federal regulations requiring tobacco retailers nationwide to verify, by photo ID, anyone attempting to buy cigarettes or smokeless tobacco who appears twenty-six years of age or younger. Under Federal Law the storeowner is liable for his employees. Escalating fines and the loss of license to sell cigarettes and tobacco products may result.

The Board of Health and Health Department work closely with the medical community and health care providers. Four locally available flu clinics were conducted at no charge for senior citizens and high-risk individuals. Others are available throughout the County. The Health Department conducted two low cost rabies vaccination clinics targeting unvaccinated animals or animals in need of revaccination. Health screenings are routinely conducted through senior and community centers in the Township. We are grateful to Main Line Health/Jefferson Health System and area veterinarians for giving their time so freely to the community. Eldernet developed a resource guide to nursing homes in the area. This, as well as other health facts and advisories, are now available through the Township Website.

Members of the Board of Health contributed their time and talent in the development of their annual message, Partners in Health. The message was distributed to all public, private and parochial schools in the Township, as well as distribution through the local newspaper. Copies of the Annual Message and Board of Health Annual Report are available at the Health Department office and all libraries in the Township.

The Director of Health, on behalf of the Township, signed up as an Ozone Action Partner. A committee was formed consisting of members from Planning, Information Services, and Fleet personnel. Educational posters for employees were created to keep air quality in focus as an ongoing issue for this region. Approximately 750 brochures, from the Ozone Action Partnership, were made available to the public at Township facilities and the Library system. Notification as to air quality forecasts was accomplished on the Township Website by a direct hyperlink to the Delaware Valley Regional Planning Commission. During the summer, the partnership called for Ozone Action Days on 6 occasions. This was one less day than the previous year. Much of the time period in between fell in the moderately unhealthy range signifying the poor air quality in this area. The Township has been doing their part through employee education, the installation of vapor recovery systems on fueling stations, and proceeding with plans for alternative fuels under the Compressed Natural Gas program. Pollution in the Delaware Valley is increasing and will be an ongoing problem which may result in further Federal regulation. Mass transit, carpools, and the selection of new energy efficient engines as replacements for lawnmowers and chain saws are things that people should look at in future years.

The Township of Lower Merion Public Health Laboratory examined the following samples in 1998:

The Laboratory is certified by the Pennsylvania Department of Agriculture for the examination of milk and dairy products.

Eating and drinking places for which licensing is required include restaurants, bars, soda fountains, snack bars, cafeterias, kitchens and dining rooms of schools, hospitals, nursing homes, child care centers and industrial plants. Food is inspected to insure products are clean, wholesome and free from spoilage. Refrigerators and freezers as well as ovens, grills and steam equipment are checked and tested for maintaining proper temperature.

In 1998, one hundred and sixty-six licenses were issued to eating and drinking places. Sixteen new establishments were licensed, seven closed, and five changed ownership. Inspections totaled 678. Laboratory examinations were performed on 78 swabs taken on 312 multi-use utensils. All swab tests must have bacteria counts less than 100 colonies per cubic centimeter to be acceptable.

As required by the Township Code, thirty plans were submitted and reviewed on all new construction and alterations, and on new equipment and its installation before approval is given.

A retail food store permit is required for supermarkets, grocery stores, bakeries and retail bakery outlets, ice cream and candy stores, cooked food take-out stores, caterers, gourmet shops, bulk food for self service or any place where food or beverage for human consumption is sold or offered for sale and not consumed on the premises.

Retail food stores are inspected on a bi-monthly basis. Inspections are unannounced. Some of the critical items checked are temperature control, hand washing facilities and sanitization programs. Federal shell fish regulations are enforced as well as those on bulk and potentially hazardous food for customer self-service.

One hundred and seventy-two retail store permits were issued for 1998. Fourteen new stores were licensed, sixteen closed, and nine changed ownership. There were 1,110 food store inspections.

A permit is required for churches, synagogues, civic and business organizations to serve food in connection with a charitable event or celebration, not exceeding 14 days. All regulations governing food protection, cooking, handling and temperature controls must be maintained the same as restaurants and stores. Thirty-one permits were issued in 1998.

Milk surveillance has been an important function of the Health Department since 1922. Although the Pennsylvania Department of Agriculture has sole enforcement authority over milk and milk products since an act of state legislature in 1972, the Health Department has kept a watchful eye over the dairy products distributed in the Township. Routine laboratory analyses of samples, careful observation of the expiration codes and the handling and refrigeration methods in restaurants and food stores, enable the Department to monitor the quality of milk sold in the Township. The "sell by" date had been extended from 10 to 12 days by the Department of Agriculture.

The Health Department Laboratory provides invaluable back up in food service inspections. The Sanitarians throughout the month take samples of milk products, waters and foods for microbiological analysis. Swab samples are also taken from dishes, cups, glasses and other equipment to determine the efficiency of the dishwashing and cleaning process and subsequent handling of these items.

If the analyses disclose excess bacterial counts, the department notifies store or restaurant personnel as well as food dealers and state agencies where appropriate. The cooperation of these parties has helped in pinpointing sources of bacterial contamination so that they can be eliminated.

The Township Code requires the annual licensing of vehicles from which food products are sold. In 1998, seven food vending vehicles were inspected prior to the issuance of licenses. The vehicles are examined for general cleanliness, approved food products and proper temperature control in both the hot holding units and the refrigeration.

Two hundred and thirty-nine vending companies operating vending machines in the Township were issued licenses in 1998.

Nine hundred and twenty-eight inspection of machines were made for general sanitation and the kinds of foods and beverages dispensed. Citations were issued to those companies who were operating without a permit.

Samples of milk and potentially hazardous food products are collected routinely from the machines for laboratory examination.

Thirteen private refuse collection companies were registered with the Township and received permits to operate seventy-one collection vehicles in the Township in 1998.

The Township Code requires an annual inspection before issuance of permits of all vehicles used by private collectors for the collection of garbage and rubbish in the Township. Trucks are inspected for overall cleanliness, company identification on sides of vehicle, clean-up equipment and any leaking seals on the body of the truck. A new ordinance requires permits for refuse containers such as dumpsters and compactors placed within the Township. The units are inspected to ensure that drainage plugs are in place and that there are no holes that would allow leakage. Lids or covers must also be provided to prevent material from being blown on neighborhood properties. A total of three hundred and sixty-nine containers were inspected.

There were fifty-three public swimming pools operating in the Township in 1998. The eleven indoor pools, seventeen whirlpools, and the twenty-five outdoor pools, including the Township pools in Ardmore and Belmont Hills, were under surveillance during their period of operation.

Inspections totaled 250 for the year. Each inspection included a survey of general sanitary conditions and health and safety factors in the pool area and locker room. A sample of water was examined at poolside to determine the amount of pH and chlorine residual. In addition, a sample was collected from each pool and brought to our laboratory for bacteriological examination.

The responsibility for enforcing state rules and regulations pertaining to health and sanitation in public schools in the Township was delegated to this department by the State Department of Environmental Resources. The annual inspections of the school buildings include: general cleanliness of the interior, a check on heating and ventilation, toilet facilities, equipment construction, refuse storage, insect and rodent control, and light measurements in all rooms, halls, and stairways.

Copies of the inspection reports were sent to each school principal and to the superintendent's office.

Milk samples were collected monthly and delivered to our Laboratory for bacteriological examination. Likewise, the school cafeterias were inspected monthly, and swab tests taken on multi-use utensils were collected routinely for examination.

Investigations of nuisance complaints by staff totaled 166 for the year.

There were one hundred and thirty investigations of nuisance complaints relative to conditions which were considered offensive and/or prejudicial to public health.

Improper or careless storage of garbage and refuse, both on private and commercial properties, was a major problem. Many complaints were received concerning trash containers with overflowing trash, lids not secure and leaky compartments.

The Township has a "Pooper Scooper" Ordinance which requires owners to clean up after their dogs to avoid prosecution for a nuisance condition. The Ordinance allows the offended party to seek redress from the Courts after notification to the offender and the Health Department.

There were thirty-six investigations of rodent complaints. Improperly stored garbage in containers without lids, or in plastic bags, at residences and at commercial establishments was the chief attraction for rodent infestation. Also, bird feeding and fruit trees were implicated in several rodent complaints.

The Health Department will investigate rodent complaints to determine if a nuisance situation exists. The Township does not bait, trap or treat any property for rodent infestation. This is the responsibility of the property owner.

In addition to routine inspections and complaint investigations, the staff provided assistance to Township residents 1,419 times during 1998. The majority of these calls involve analysis of the resident's problem and referral to the appropriate government agency. Examples include: the procurement of birth and death certificates, and regulations enforced by State and Federal agencies.

In 1998, ElderNet of Lower Merion and Narberth continued to serve needy and disabled persons aged 18 to 59 years, as well as older adults.

Information and Referral - 6,303 calls from 1,901 persons were answered with information or help with problems of older or disabled young adults. ElderNet also publishes booklets on nursing homes and personal care homes.

Volunteer Services - 8,044 hours of service were given by 210 volunteers to 166 frail or disabled clients. Services included transportation, friendly visiting, odd jobs, shopping, reading and paperwork help for blind clients, and help with emergency problems. ElderNet also coordinated the distribution of 163 holiday food baskets for needy families.

Escort Transportation - 1,759 escorted round trips were provided for older, frail, or disabled clients to medical or other necessary appointments, to the bank, or to do grocery shopping.

Emergency Assistance - 105 persons were given financial assistance, including rental help, shelter, and respite care, homemaker service, or other emergency aid.

Telephone Reassurance - 24 clients were called daily, including weekends and holidays, by 20 trained volunteers who report daily to ElderNet staff.

Housing Assistance - Direct help was provided through emergency funds and housing counseling. Indirect help was provided through collaboration with agencies such projects as the Lower Merion Affordable Housing Corporation.

Advocacy - ElderNet acts as an advocate on issues benefiting elderly, needy or disabled adults.

The Eldercare Campaign brings businesses, religious, and educational groups together to address the problems of older adults. Eldercare programs serving the community in 1998: Gatekeepers/Carrier Alert: Postal carriers are trained to recognize problems of elderly customers and to refer them to ElderNet for help. Odd Jobs: Volunteers help elderly homeowners with small repairs and yardwork. Vial of Life: Emergency aid personnel have easy access to medical information. Telephone Reassurance: Volunteers call frail clients every day, and check on their well being.

100 agencies cooperate to provide options for persons with long-term care needs. Consortium goals are to improve delivery of long term care and to lessen duplication of services.

29% of ElderNet’s funding is from state and county funds; 26% from Lower Merion Township and Narberth Borough; 13% from foundations, and 32% from business, civic, or religious organizations, and community residents.

In 1998, the Volunteer Medical Service Corps (VMSC) continued to provide transportation of emergent and non-emergent patients to and from health care facilities. Ambulance services included basic and advanced life support, critical care interfacility transportation and wheelchair van transportation.

VMSC staffs its ambulances with volunteer and paid staff consisting of Emergency Medical Technicians and Paramedics. Both types of personnel are trained to meet the National Standard Curriculum of patient care and are credentialed by the Commonwealth of Pennsylvania. In addition, the staff is trained in Advanced Cardiac Life Support, Pediatric Life Support and Prehospital Trauma Life Support.

VMSC also provides medical coverage to special community events in Lower Merion.

Members of the staff attended meetings and conferences relating to public health and environmental sanitation.

The Director of Health attended the Annual Educational Conference, sponsored by the National Environmental Health Association. Local meetings conducted by the Central Atlantic States Association of Food and Drug Officials were attended by the Sanitarians. Prior to assuming, the Health Intern attended a pool management course sponsored by the Pennsylvania Recreation and Park Society. Sam Conti, Sanitarian for the Health Department, attended the Pennsylvania Vector Control Association Training Conference. Information was presented by officials from the Pennsylvania Department of Agriculture, Penn State University and leading pest management companies.

American Public Health Association
Association of Food and Drug Officials
Central Atlantic States Association of Food and Drug Officials
Environmental Health Association of Southeastern Pennsylvania
National Environmental Health Association
Pennsylvania Environmental Health Association
Pennsylvania Public Health Association

FINANCIAL STATEMENT FOR 1998

* Code Books, Temporary Food Permits, Photocopies

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