1. CITY OF NORTHAMPTON
MASSACHUSETTS
November 18,2010
Upon the Recommendation of Mayor Mary Clare Higgins and City Councilor Marianne L.
...... LaB.atge....................................................................................................................................................... .
Ordered, f~af
Whereas, The City of Northampton is a municipal Corporation of the Commonwealth of
Massachusetts, having been granted a city charter by act of the General Court, to-wit; Chapter 250
of the Acts ofthe 1883 Acts and Resolves of Massachusetts; and
WHEREAS, the election and appointment of certain positions in the City are determined by the
Charter and by certain special acts of the Legislature amending said Charter; and
WHEREAS, the City Council has determined that the Public Health needs of the City of
Northampton would be more effectively managed if the Board of Health was expanded to five
members and the members were appointed by the Mayor and subject to approval by City Council
as outlined in this proposed Special Act; therefore
BE IT ENACTED THAT THE CHARTER OF THE CITY OF NORTHAMPTON BE
AMENDED TO REMOVE THE BOARD OF HEALTH MEMBERS FROM THEIR
STATUS PROVIDING FOR AN ELECTION BY THE CITY COUNCIL AND CHANGED
TO BOARD POSITIONS THAT IS ARE APPOINTMENTS BY THE MAYOR AND
SUBJECT TO THE CONFIRMATION BY THE CITY COUNCIL. THE FOLLOWING
SECTION OF THE CHARTER OF THE CITY OF NORTHAMPTON SHALL BE
AMENDED AS FOLLOWS:
Delete
Section 27 -Board of Health Generally
The City Council first elected under this act shall, as soon as may be convenient after its
organization, elect by concurrent ballot three persons, legal voters of said City, to constitute a Board
of Health, to serve one for three years, one for tvo years, and one for one year from the first
Monday of March then next ensuing, and until their respective successors are elected and qualified;
and thereafter the City Council shall annually in the month of February elect in the same manner
one person, a legal voter of said City, to serve as a member of said Board for the term of three years
from the first Monday of March then nmct ensuing, and until his successor shall be elected and
qualified. Elections shall be so made that one member, at least, of said Board shall be a physician.
Any vacancy occurring in said Board may be filled by concurrent ballot of the City Council at any
time. The City Council may at any time remove any member of said Board. The members of said
Board shall serve ';vithout compensation.

2. Add
Section 27- Board of Health Generally
There shall be established in the City of Northampton a Board of Health, hereinafter
called the board, to consist of five members, who shall be legal voters of the city, to be appointed
by the mayor subject to confirmation by the city council; and a Health Department which shall
be under the direction and control of the Director of Health. The members of said board shall
serve without compensation.
The first appointments under this Act shall be made by the Mayor and referred to the Council at
the first Council meeting after this act has been approved by the Legislature and the first
appointees shall assume the duties of his/her office immediately following appointment by the
City Council. The current Board of Health members shall serve out their terms.

3. Committee recommendations: Northampton Health Department Structure
Submitted: May, 2010
Members:
Lucy Hartry (chair), Chris Norris, Karen Jarvis-Vance, Councilor Maria1me LaBarge, Jeff
Harness, Dom1a Salloom (BOH member), Kitty Jerome
Introduction:
Mayor Clare Higgins formed an ad hoc committee to address the governance and structure of
Northampton's Board of Health and Health Department. At the Mayor's request, the committee
was convened by Ms. Hartry. The committee was charged with recommending a structure for
Northampton's Board of Health (BOH) and Health Department. The committee met on February
3, February 18, March 3, March 29, April15, and May 5, 2010. Following, please find the report
respectfully submitted to Mayor Clare Higgins and the Northampton City Council.
Recommendation:
The committee recmmnends that the Board of Health (BOH) structure be maintained and that the
membership be increased from the current three, to five.
The committee further recmmnends that:
• The title of the Health Agent be changed to Health Department Director or Director of
Health.
• To be consistent with other city boards and committees, the BOH members be appointed by
the Mayor and confirmed by the City Council.
• The BOH structure remain compatible with regionalization efforts.
• The BOH, with input from the Mayor, City Solicitor and the Massachusetts Association of
Health Boards (MAHB), develop or document standard operating procedures (SOP) that
would include but not be limited to the following areas:
o Hiring, supervising and dismissing staff;
o Staff reporting mechanisms;
o Accountability to the Mayor;
o Conflict resolution;
o Appointing BOH members;
o Staff access to the City Solicitor; and
o Training expectations and requirements ofBOH and staff members.
Background:
The cmmnittee began by reviewing a resolution from September 3, 2009 that called for the
establishment of a health commission structure. Mayor Higgins infonned the cmmnittee that the
goal of the resolution had been to establish an ad hoc committee to study the health department
structure and make recommendations for possible changes. A charter change would be required
for changes to the structure.
The current structure includes a three person Board of Health with members appointed by the
City Council. The BOH, with the City Human Resources Department's involvement in
interviewing and final selection, hires a full-time Health Agent. The Health Agent, with one or
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more members of the Board of Health and the City Human Resources Department, interviews
and hires the staff.
In order to leam about the relevant issues, the conm1ittee requested a presentation by Cheryl
Sbana, staff attomey for the MAHB. The cmmnittee also requested that Mayor Higgins, Health
Agent Ben Wood, and public health nurse Trish Abbott, a Health Department employee, attend
our meeting for a question and answer session. Ms. Sbarra attended the 2/18 meeting, and the
Mayor, Mr. Wood and Ms. Abbott presented separately to the ad hoc committee on March 3.
The committee deliberated based on the review of the resolution, presentations and our
investigation into models used by comparable size conununities across the state.
In order to arrive at a consensus recommendation, the ad hoc cmmnittee explored the two BOH
structures available in Massachusetts. A discussion of the pros and cons as detennined by the
committee follows.
Structures considered: Health Commission model
Overview:
In the Health Commission model, the mayor appoints a commissioner, who has the sole authmity
to promulgate health regulations. An advisory committee is also appointed, but does not have
policy-making authority.
Discussion:
The health cmmnission structure allows for quick decision-making and direct accountability to
the Mayor (an elected position). From the perspective of a mayor, this structure provides a
balance of public accountability, with authority to act and eliminates the problem of open
meeting law requirements. The health cmm11issionmodel strengthens the Mayor's role in
accountability for health department services.
In this model, the Cmm11issioner has the sole authority to promulgate regulations, but in practical
application it appears that work typically falls to the city council. The reason is that most
Cmmnissioners have found it difficult to make public health decisions based on scientific merit
rather than political considerations. Instead of universally making those regulations, a
Commissioner can side-step the issue and let a city council, where individual decisions by
elected officials are buffered by the number of members voting, take on ordinance passage.
This model limits decision-making to one person. There is also no mechanism to resolve conflict
between a Mayor and a Commissioner. The potential for a Mayor (as the highest elected official
in the city) to pressure a Cmmnissioner on decisions, would appear to be high. Two neighboring
cmmnunities, Holyoke and Pittsfield, switched to a health cmmnission model, and then back to a
BOH model in recent years. One cmmnunity perceived the cmmnission model as allowing too
much interference from the Mayor.
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Structures considered: Board of Health Model
Overview:
In the Board of Health model, the BOH is an independent board, with members appointed by the
city council. Authority for the BOH is given by the Massachusetts legislature. The BOH may
delegate its authority to staff. Chapter 111, section 27 gives the BOH hiring and firing authority
for staff (unless the city charter says otherwise).
Discussion:
The BOH model provides checks and balances in decision-making because staff report to an
independent board. Therefore staff are somewhat insulated from political interference.
In this model the mayor is accountable to the citizens for city operations, yet does not have
authority over the health department. The public is likely to call the mayor's office when
problems arise. The model makes it very difficult, if not impossible, for the mayor to act in
situations where the health department is not functioning well. The mayor has no supervisory
role over the health agent and his staff, even though they are city employees. To mitigate this
disadvantage, the committee discussed the process for BOH member appointments and the need
to make the process more consistent with other city boards and committees.
The committee also discussed the size of the BOH. There are currently three members. Because
there are only three, any occasion for two members ofthe BOH to communicate (by email,
phone or in person) is subject to open meeting law because two members form a quorum. On a
practical level, this eliminates the possibility of subcommittee work and even simple exchanges
of information. Because the BOH meets monthly and all discussion has to occur at that meeting,
having three members can result in less productivity, efficiency and responsiveness. As Ben
Wood noted in his presentation to this committee, Board of Health quorum challenges "are
sometimes a barrier to timely resolutions of issues".
A three-member BOH also may present a barrier to attracting qualified volunteers to serve on the
board because of the heavy workload. Increasing the number of members could allow for more
issues to be addressed as the workload could be divided among more members. It could also lead
to more breadth and depth of expertise on the board.
The committee reviewed the advantages and disadvantages of a seven-member board. This
model would offer options for subcommittees and would help spread the work load. A
disadvantage to a seven member board is it might lead to "diffusion of responsibility". In other
words, people might be less likely to step up and address a situation if they think others will act.
It also might present a problem in terms of recruiting volunteers to fill available seats on the
board. In addition, subcommittees would increase the burden on staff to attend additional
meetings, create minutes, and other ancillary functions.
Conclusion:
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Northampton Ad Hoc Committee to recommend structure for the Health Department
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6. The ad hoc committee recommends retaining the Board of Health model and increasing
membership from three to five. The decision is unanimous by ad hoc committee members and
follows several hours of investigation and discussion. The committee has concluded that the
Health Conunission model has not worked well in other similar communities. Although the
structure appears to strengthen the staffleader's role, the ad hoc committee believes it may
actually weaken the commissioner's power because of the possibility of political considerations
from the mayor as well as the public.
The Board of Health model is not entirely satisfactory because it does not allow the mayor to
take a more direct role in ensuring accountability ofthe department. Nevertheless, the ad hoc
conunittee believes that the BOH model is the stronger structure of the two models. The ad hoc
committee also believes that the challenge of increasing the mayor's oversight of the department
can be mitigated by having the mayor appoint the BOB members (with City Council confinning)
and by the creation of Standard Operating Procedures that specifically address the mayor's role
vis-a-vis the health department.
Given key public health and safety issues addressed by the Northampton's Health Department,
this committee finds it notable that the general public is relatively unaware of the "ten essential
services" provided by the department. We believe anything that can increase the visibility of the
Board of Health and the Health Department's role would be positive. This visibility could serve
to increase engagement in and interest in seats on the Board of Health, thus benefiting the city as
diversely qualified individuals come to serve on the Board. This would be particularly true if the
Board opens two additional seats tlrrough the recommended structural changes.
The task force was explicitly directed not to allow budget considerations to influence our
recommendation. However we found it hard to ignore the budget in our review of health
department functions. Northampton's Health Department, as compared to similarly sized cities,
is woefully under-funded, and that greatly limits the work the Department can accomplish.
In smmnary, this cmmnittee reco111111ends retaining the current board of health structure,·
increasing the membership from three to five, and creating Standard Operating Procedures to
address the important accountability issues that led the Mayor to form this cmmnittee. Standard
Operating Procedures should be developed by the Board of Health as soon as possible, utilizing
existing examples from other departments in the city (i.e. fire and police) as well as expert advice
fi:om MAHB, the Mayor and the City Solicitor.
Given the cmm11on themes we heard from the Mayor, the health agent and public health nurse, in
concert with what we leamed fi:om the MAHB attomey, we feel this recommendation is the best
model to address the public health and safety needs of the City ofNorthampton.
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Northampton Ad Hoc Committee to recommend structure for the Health Department
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