Public Health Nuisances Identifying, Defining, Responding and Managing Joseph W. Jurusik, R.E.H.S. Supervising Environmentalist Hennepin County Human Services and Public Health Department (HSPHD) Interesting Aspects about Hoarding Prevalence estimated at 700,000 to 6 million people (USA Frost & Steketee 2010) 1 4% of the population: In Minnesota that translates to 53,000 212,000 individuals Covers all socio economic classes People who hoard are found on every continent except Antarctica Interesting Aspects about Hoarding Cont. Chronic condition typically begins in childhood around age 13 (Frost, 2005) People who hoard have often experienced traumatic life events such as a significant loss, death, rape, assault or other trauma. (Hartl, Duggany, Allen, Steketee and Frost, 2005) Runs in Families: Genetic disposition 80% report first degree relative with similar problem (Samuels, Shugart, et al., 2007) 1
Characteristics of Hoarding Hyper sentimental - beliefs that emotional comfort comes from objects Fear of losing something important Feelings of loss of self or identity Need for control No one can move possessions Characteristics of Hoarding Discarding is laborious so it is avoided Fear of waste Excessive responsibility to care for the environment Anxiety /Perfectionism 60% of people who hoard meet criteria for major depression (Samuels et al., 2002) Objectives What are Public Health Nuisances (PHN)? What are the different types and some examples? Who is involved (what agencies)? Where do they happen? Why are they a problem? When do I declare a site a PHN? (what to look for) How do I manage the case and clean-up? 2
Public Health Nuisances - Types Private Nuisances disputes between neighbors Public Nuisances concerns of cities, such as noise, junk cars, tall grass, etc. Public Health Nuisances concerns of a Board of Health, or other delegated Health programs with an ordinance Public Health Nuisance - Definitions What is a Board of Health? A city or county with the authorities granted under MN Statutes 145A. In Hennepin County there are five: City of Bloomington City of Edina City of Minneapolis City of Richfield Hennepin County HSPHD PHN Delegated Programs Non Board of Health Ordinances Many Local Health Departments in the State (Cities and Counties) that are not a board of health have their own ordinances. In Hennepin County there are: City of Brooklyn Park City of Minnetonka 3
Public Health Nuisance - Definitions What are the powers of a Board of Health Stat.145A, Subd. 8. Removal and abatement of public health nuisances. (a) If a threat to the public health such as a public health nuisance, source of filth, or cause of sickness is found on any property, the board of health or its agent shall order the owner or occupant of the property to remove or abate the threat within a time specified in the notice but not longer than ten calendar days. Public Health Nuisance - Definition MN Statutes, Chapter 145A states it is the act or failure to act that affects the public s health Only a board of health can determine and order abatement of a PHN using 145A Non-board of health departments write orders based on their local ordinance Must be abated within 10 calendar days Public Health Nuisance Definition Continued Notices must be handed to the violator, sent by certified mail or posted on the property Depending on the condition the property may need to be posted unfit for habitation and entry (i.e. for clean up) may be restricted Police may need to monitor to ensure it is not occupied Clearance inspection is needed for reoccupancy 4
Public Health Nuisance Practical Working Definition Has the potential to make people sick. Provides harborage or attracts vermin. Can cause injury to those directly exposed. Public Health Nuisance Local Ordinances Hennepin County has Ordinance #25 which includes sections on Meth Local Ordinances must be as strict as MN Statute 145A, but in many cases they are more stringent Public Health Nuisance Obvious 5
Public Health Nuisance Not so obvious Public Health Nuisance Examples Septic Problems (Bubbling Crude) Public Health Nuisance Examples Sewage Conveyance Problems 6
Public Health Nuisance Examples Feces Public Health Nuisance Examples Rodent/Animal Infestation Public Health Nuisance Examples Insect Infestation - Mosquitoes 7
Public Health Nuisance Noxious Weeds and Animal Harborage After the Trim! Public Health Nuisance Examples Flies, Bed Bugs & Roaches 8
What to Look for While Inspecting Blood spots, fecal stains Cast exoskeleton skins A sweet or musty odor Bugs! Public Health Nuisance Examples Insect Infestation - Bees & Fleas Public Health Nuisance Examples Dumping of Garbage/Haz. Waste 9
Who is involved? Police Child/Adult Protection Animal Control City Housing Officials HAZ MAT Team Drug Task Force Health Agencies (Social Services) Fire Department Septic Company's Cleaning Company's City Councils Medical Responders Media Utility Company's (Gas and Electric) Police Child/Adult Protection 10
Animal Control Animal Control - Too many pets Animal Control - Abuse 11
City Housing Officials & City Councils HAZ MAT Team Drug Task Force 12
Health Agencies (Social Services) Fire Department Septic Company 13
Cleaning Companies Medical Responder Media 14
Utilities Who Does This Happen to? Not Just The Poor Single people Couples Families Mentally Ill Poor Middle Class Wealthy Where do Public Health Nuisances Happen? Outdoors/Indoors 15
Why are Public Health Nuisances a problem? Service workers not able to safely perform their job Clear access for emergency personnel Infestations and vermin can migrate to neighbors property Child and vulnerable adult health and safety When do I declare a site a Public Health Nuisance (what to look for) Excess piled garbage inside and out Feces inside home No clear path to windows and doors Hoarding of items (sometimes new stuff) Animal/insect infestation, dead or alive Lack of running water Sewer or septic problems Harborage for vermin Are these Public Health Nuisances? 16
How do I manage the case and cleanup? Take a co-worker or go with the Police to every visit, NEVER go alone Many need a search warrant Document with notes Label and date all evidence Document with photos How do I manage the case and cleanup? continued Ask everyone you deal with for a business card for your records, and also give your card out Keep copies of everything (i.e. invoices) Keep a calendar to track dates and time involvement, in case costs need to be assessed back to the property taxes, or for court appearances How do I manage the case and cleanup? continued Evaluate the risk of personal injury Personal Protective Equipment (PPE) Tyvek suit Boots or shoe covers Niton 95 (N95) mask Head gear (hard hat) Eye protection 17
PHN Ordering property owner to clean-up Repeat, Repeat, Repeat, so there is a clear understanding Mental health issues = confusion Set clear expectations Leave orders in writing What if it is not clean after 10 days? Time may be extended (sometimes issues are beyond the control of the property owner) The Heath Agency may decide to clean the property and assess the property taxes Questions? Joseph W. Jurusik Hennepin County Human Services Department Public Health Protection/Environmental Health 1011 First Street South, Suite 215 Hopkins, Minnesota 55343 612-543-5213 joe.jurusik@co.hennepin.mn.us Thank You! Some slides borrowed from a PHN presentation given by Lynn Moore. Some photos borrowed from MDH Meth PowerPoint. Statistic s on slides 2 through 5 from The Hoarding Project slide presentation. 18