MIIA News

Certified Playground Safety Inspector Course Offered March 3rd - 5th, Boston, MA

Are your playgrounds safe? According to the Consumer Product Safety Commission, 200,000 children are treated annually for playground accidents. Of these, 70 percent, or 140,000 occurred at public parks and schoolyards.

Sponsored by the NRPA National Playground Safety Institute and Massachusetts Recreation and Park/Boston Park and Recreation Department this course is the most comprehensive training program on playground hazard identification and risk management methods offered. Advanced reading and 10 hours of training will prepare you for the Certified Playground Safety Inspector Exam scheduled at the culmination of this certification course.

This course is eligible for reimbursement through the Loss Control Grant Program. Only one person per MIIA member. When registering, use the "member level" fee selection. See flyer for more information here.

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Strategies for preventing costly sewer backups

Sewer backups and overflows, which have become more frequent in the past decade, create huge headaches for local officials. Backups can result in a homeowner or business with “dirty water” in their basement or, worse, in occupied rooms. Backups have a serious impact on the people whose property is affected, raise questions about who is responsible, and require a swift and effective remedy. The reasons for the increase in backups include aging, undersized pipes with inadequate hydraulic capacity, failure of pipes due to wear and tear or structural deficiencies, mechanical or electrical failures, and blockages from tree roots, construction, miscellaneous debris, and fats, oils and grease.

About 25 percent of sewer blockages can be attributed to fats, oils and grease that are discharged directly into the sewer system or through the disposal of food waste, according to Weston and Sampson Engineers. Local officials can make a big difference in the problem by raising public awareness and encouraging proper disposal of fats, oils and grease.

For larger commercial facilities, such as hospitals, nursing homes and restaurants, a fats, oils and grease (FOG) management program should include locally mandated installation of grease traps as well as requirements for continuing upgrades, maintenance and inspections. Procedures for enforcing these regulations must be established, and tracking of compliance by these institutions is critical to success. Another important piece of a FOG management system is cooperation among local boards of health and other municipal entities such as public works departments and building departments. A strong sewer-use ordinance or bylaw can set a high standard for the way in which the water/sewer utility operates, manages and maintains the system.

Structural defects in aging or poorly installed sewer systems are another major cause of sewer backups and overflows. According to Weston and Sampson, groundwater can infiltrate sewer systems through joints and cracked or broken pipes. All sewer systems should have an active and ongoing rehabilitation program based on information collected during routine maintenance or as a result of a planned inspection program.

Structural defects can often be identified by means of closed-circuit television inspections. When structural defects are identified, repairs should be a priority. Known problem areas should be inspected more frequently. A Department of Environmental Protection publication, “Guidelines for Performing Infiltration/Inflow Analyses and Sewer System Evaluation Surveys,” is available at http://www.mass.gov/dep/water/wastewater/wastewat.htm

Another significant cause of sewage backups and overflows is damage resulting from the failure of mechanical and electrical systems. Regular maintenance and inspection of pump stations is an important component of the operating program for water and sewer systems. Preventative maintenance can reduce the cost of emergency repairs while improving reliability.

Specialized electrical, hydraulic and mechanical expertise is usually required for the proper operation and maintenance of pump stations. Pump stations should always be equipped with alarms that are hard-wired to telephone systems connected to personnel who are trained to react to system failures. Supervisory and data-tracking systems should also be used to record system performance and provide details about system failures.

Despite the best operation and maintenance program, system failures will occur. Written protocols and policies should be understood and readily available in the event of a backup or overflow. The plan should include information on containment, mitigation, and, in particular, clean up. Procedures for reporting problems to local, state and federal authorities should be clearly stated, with current names and phone numbers.

In a situation where residents or business owners are affected by sewerage on their property, a controlled response including prompt and precise information is absolutely necessary. Weston and Sampson recommends that the emergency response plan include the following:

Description of the sewer system
Listing of known sewer back up and overflow locations
Description of the water/sewer department/utility organization
Primary response personnel, including names, titles and contact information
Other important telephone numbers
Backup personnel
Step-by-step protocol for responding to backups and overflows
Local, state and federal reporting procedures
A public notification and education component

In consultation with Weston and Sampson, MIIA has developed a Sanitary Sewer Overflow Prevention Program to assist members with maintenance and management of their sewer systems. For more information about the program, contact Loss Control Manager Jeff Siena at MIIA (ext. 259).

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Reading develops staph-prevention bulletin

In response to recent incidents of a staph infection called MRSA in public schools, the Reading School Department prepared and distributed an informational bulletin for parents. The bulletin explains that methicillin-resistant staphylococcus aureus (MRSA) may not respond to routine treatment with common antibiotics, but it can respond to other antibiotics. Mild infections may look like a pimple or boil and can be red, swollen, painful or have pus or other drainage. The only way to determine if an infection is caused by MRSA is through laboratory testing ordered by a physician or other health provider.

Staph can be passed from person to person through direct contact with skin or contaminated items. The main ways to prevent staph infection are by washing hands and caring for wounds properly. The bulletin advises parents to:

Clean wounds and cover them with a clean, dry bandage
Urge children to wash their hands regularly and use hand sanitizers placed throughout the schools
Be sure family members use antibiotics properly
Make sure that students who participate in sports take a shower after each practice or game and don’t share equipment, uniforms, towels, or other personal items

The bulletin also informs parents of the precautions the Reading Public Schools are using to help prevent MRSA. Schools are cleaned daily with cleaners that kill a variety of bacteria and viruses, including MRSA. Students with open wounds are sent to the nurse for cleaning and bandaging. The school nurse will encourage the parent and students to see a physician if a student has a wound that appears to be infected. If a student has a diagnosis of MRSA, the Reading Health Department will be contacted for guidance.

The bulletin was prepared in cooperation with the Reading Health Department, the Reading Public School’s physician, the Massachusetts Department of Public Health, and the American Association of School Administrators.

More information about MRSA can be found on the Department of Public Health’s Web site (www.mass.gov/dph).

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Employers can take steps to prevent costly medical errors

Between 44,000 and 98,000 people die each year due to preventable medical errors in U.S. hospitals, according to a 1999 study by the Institute of Medicine. The numbers were higher than the annual death toll from motor vehicle accidents, breast cancer or AIDS.

The under-use and misuse of medical services also wastes 30 cents of every dollar spent on health care, according to a 2002 study by the Chicago-based Midwest Business Group on Health. When indirect costs such as lost workdays are factored in, the cost to employers is between $1,700 and $2,000 per covered employee per year.
A more recent study by the American Medical Association showed that progress is being made, but the pace of change is slow.

Medical errors happen not just in hospitals but in nursing homes, pharmacies and elsewhere. Most errors result from the complexities of the medical care system, but they may also happen when patients and providers don’t communicate effectively.

It is estimated that at least 1.5 million preventable adverse drug reactions occur in the United States each year. One study found that each such reaction in a hospital added about $8,750 to the cost of the hospital stay. Dr. Mary Jane England, president of the Washington Business Group on Health, said, “The impact of medication errors will appear as higher benefit costs for prescription drugs, but also for health care and disability.”

Medical errors may also contribute to hospital-acquired infections – estimated at 45,000 cases per year in Massachusetts, nearly 2,000 of them resulting in deaths.

The Mass. Coalition
The Massachusetts Coalition for the Prevention of Medical Errors was formed in 1998 in response to the rising human and financial costs associated with medical errors. The MIIA Health Benefits Trust is one of the coalition’s more than 50 members, which include health plans such as Blue Cross Blue Shield of Massachusetts, medical associations, hospitals, educators, employers, researchers and policymakers. Funding comes from the Massachusetts Hospital Association and the Department of Public Health.
As a member of the coalition, MIIA has the opportunity to get updates on patient-safety activities and to influence programs that could have an impact on health costs.
The coalition can obtain educational materials to help subscribers and their family members be less likely to experience a medical error. Patients who are responsible consumers and are actively involved in making decisions about their health care are more likely to have good outcomes.
In cooperation with the Massachusetts Medical Society, the coalition has created a medication list that patients and their families can carry to medical visits. Another resource, “Improving Medication Safety: Actions for Prescribers” (available at www.macoalition.org) describes activities that can reduce the likelihood of medical errors.
The coalition is also working with health care providers, patients and families to help prevent infections. One aim is to educate patients to be sure to ask health care providers to wash their hands and wear gloves.

Strategies for employers
Municipalities can take several steps to help improve health care safety.
1. Insist on excellence from your health plans.
Demand quality ratings. Ask specifically about information technology systems, recordkeeping, online links between providers, electronic medical records, medical decision support, electronic capabilities for prescribing systems, and medication alert systems.
2. Take advantage of what your health plan administrator and health plans offer.
Stay in close contact with your health plan account executives. Depending on the size of your group, they can make available reports such as claims utilization reports. Ask what mechanisms your health plan has in place to better manage claims. The bottom line in claims management is to help ensure that participants are getting the right care, from the right provider, at the right time.
3. Expand and update employee education.
Many people take more care in purchasing a car than they do in choosing their health care. Encourage employees to ask questions and to keep organized records of their doctors’ visits and their medications. There are many opportunities for employee education: open enrollment; new employee orientation; management training; wellness presentations; and literature distribution. Take advantage of the extensive resources available at your health plan’s Web site, such as safe medication guidelines. Provide self-care books. [MIIA’s Wellness program offers presentations on patient safety.]
4. Become more informed.
Consult helpful resources such as Leapfrog Group (www.leapfroggroup.org), an association of 78 large health care purchasers. Among Leapfrog’s safety initiatives is an effort to link the ordering of medication to software that prevents prescribing errors. [The Brigham & Women’s hospital in Boston reported a 55 percent reduction in serious medication errors and a 17 percent reduction in adverse drug events as a result of its computerized prescriber order entry system. As of 2004, however, 70 percent of Massachusetts hospitals did not have this error-reducing technology.]
Other organizations of note include the Agency for Healthcare Research and Quality, the National Patient Safety Foundation, and the Joint Commission on Accreditation of HealthCare.

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Schools need to be prepared for emergencies

Emergency operations are a significant departure from day-to-day activity at local schools. Fires, shootings, information systems security breaches (“cyber attacks”), and a host of potential natural disasters can suddenly throw local school officials into emergency mode.

Such a departure can strain a school’s ability to effectively manage the emergency, the post-disaster recovery plan, and the resulting media storm.

For example, what should a teacher do when she notices a trash can smoldering, the result of student pranksters? This is a critical decision-making point.

In one all-too-real case, the teacher quickly reached for a fire extinguisher about 10 feet away. While her back was turned, however, the trash can suddenly became fully engulfed. The teacher squeezed the trigger, but the force of the extinguisher knocked over the trash can, and the fire spread to an art project depicting an apple tree. In a flash, the fire spread along the walls, which were covered with student art work. As panic gripped the students, two overturned desks resulted in a pileup of trapped children. The teacher and all but one student perished that day.

What decision-making error was made?

The first priority must always be the preservation of life, followed by preservation of the environment, and lastly that of property.

Emergencies happen without notice. School emergency planning should be an ongoing activity.

Planning

The first step is for the school committee and superintendent to make a commitment (resolution) to the project.

School officials must then take an objective look at the potential areas of vulnerability and the department’s readiness to respond to emergencies related to them.

Local fire and police departments are good sources of information for both natural and man-made risks in the area. Local hazard mitigation plans, other public documents, and the municipal insurance carrier can also provide important information.

The Farmington River Regional School District, serving students in Otis and Sandisfield, recently contacted MIIA to conduct a hazard assessment and to assist in developing an Emergency Operations Plan. Superintendent Jo Ann Austin understands the importance of emergency preparation, particularly in rural schools, which may experience delays in assistance from emergency response professionals. Her experience provides the leadership necessary to drive the emergency preparedness project.

In Shutesbury, Police Chief Thomas Harding is an active participant on the Shutesbury Elementary School’s Safety Committee, made up of a cross-section of school and community members. Harding understands the importance of the local public safety department’s involvement in the planning and evaluating process.

“Outsiders” are a key resource. The Shutesbury Safety Committee recently asked MIIA for a security evaluation related to access control and a review of emergency response procedures. The Safety Committee now has a better understanding of some of the issues that were stalling the process of safety preparedness.

Implementation

Implementation is the true test of a school’s commitment to emergency preparedness. It takes more effort than just a simple stroke of the pen to implement policies and procedures. Training, personnel, resources, time management, and media relations take on enormous significance. School officials must make their commitment clear. In regional districts, they must work with officials from the other towns to ensure a seamless response plan for the district.

Drills are a critical element of any school’s emergency response program. In addition to required fire drills, schools should consider drills that may prove helpful to their local situation (e.g., lockdown drills, “hazmat” drills).

Drills are the only way to determine if staff understand their duties during an emergency. Table top exercises are useful tools for administrators, particularly when held with local police and fire officials.

An objective evaluation should be made of written plans as well as drill activities. Shutesbury Elementary School Principal Robert Mahler is working with MIIA in reviewing his school’s written plans.

The local police and fire departments should be invited to observe drills and asked to provide constructive feedback on how to improve the response. A drill report should be completed for reference and to address any deficiencies in the program.

An honest evaluation gets the school department ready to implement changes and practice. The cycle doesn’t end; it continues to improve.

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MIIA marks 25 years … and counting

This year the MMA and MIIA mark the 25th anniversary of the formation of MIIA.
MIIA was formed in response to a real crisis. In the late 1970s and early ’80s, the private insurance industry, notoriously fickle when offering workers’ compensation insurance to cities and towns, had put Massachusetts municipalities in a difficult situation, offering limited products at extremely high premiums. An alternative was badly needed, and thus the MMA began the process to form MIIA.

As a 1986 article in The Municipal Forum, an early publication of the MMA, states, “From today’s perspective the idea seems so straightforward – cities and towns can cooperate to provide themselves with better insurance services at the lowest possible cost. …” As with most new ideas, however, it wasn’t easy.

First, special enabling legislation was required to allow an insurance “pool” to be formed. The insurance industry strongly opposed the formation of the pool, and the industry’s powerful lobby was ultimately able to block it.

MIIA then took a different route and organized a group of towns that would purchase insurance collectively. As the Municipal Forum reported, “This enabled the members of the group to enjoy the benefits of economies of scale and provided a mechanism for a group approach to loss control.” Old Republic Insurance Company, an early leader in the “alternative markets” field of insurance, agreed to work with MIIA. The key factor in securing the Old Republic partnership was the group’s plan to implement a dynamic program aimed at loss control and reducing claims leading to lower premiums. In order for the early program to get off the ground, however, Old Republic required a minimum premium of $1 million as of the program inception date, July 1, 1982. It was a tough challenge, but when July 1 arrived, MIIA had 58 group members and premiums of $1.2 million.

Still, there was opposition. The Professional Insurance Agents of New England tried to block the competition that MIIA presented. (MIIA markets its products directly, not through insurance agents.) The PIA filed a civil suit against MIIA and a complaint with the insurance commissioner. After working out a new set of procedures and state requirements with the commissioner, MIIA was off and running. Finally in 1985, MIIA was able to pass enabling legislation allowing the formation of a true insurance pool. And on July 1, 1986, MIIA was in business on its own. Old Republic, a critical bridge to MIIA’s independence, bowed out of the workers’ compensation program. In 1987 MIIA began operation of a property and casualty pool. Since that time, the Workers’ Compensation and Property and Casualty programs have grown steadily. On July 1, 1998, the two pools merged, bringing even greater financial strength to both groups.

New Programs
In the late 1980s and early ’90s, health insurance costs were just beginning to show the insatiable budget appetite that has today become a major fiscal issue for cities and towns. In response to this growing concern, MIIA saw another opportunity to serve local governments and, on July 1, 1992, MIIA launched its third major program, the MIIA Health Benefits Trust.

The trust started quietly, with just four charter members. In the 15 years since, it has grown to become one of the largest municipal health insurance pools in the country. MIIA constantly fights to hold health insurance premiums down through control of administrative costs and, consistent with the MIIA philosophy, reduced claims through a strong emphasis on wellness.

MIIA’s WellAware program has become a major force within the Massachusetts municipal employee community. The WellAware staff organizes and promotes a wide range of programs that promote healthier and more balanced lifestyles, including improved diet and exercise habits, and stress reduction and emotional well being. Today, the Health Benefits Trust is by far the largest of the MIIA entities and continues to leave no stone unturned in its drive to control health care costs and improve the health and well being of its subscribers.

Throughout the 1990s the MIIA insurance pools continued their growth and innovation. In 2002, MIIA Property and Casualty welcomed 67 new members due to the failure of a major insurance competitor. The following year, Health Trust membership grew by 25 percent.

Today, the three MIIA programs have a membership of nearly 400 public entities, and premiums for fiscal 2007 totaled nearly $280 million. Wellness, MIIA Rewards and many other loss control programs have continued to evolve and improve. Not a day passes without MIIA making significant efforts to educate its members on wellness, health, safety and loss control. MIIA representatives travel throughout the state bringing new ideas every day.

In 1982 the driving motivation to form MIIA was the desire to fill a critical need and provide a necessary service. In 2007, that is still the clear and fundamental theme underlying all MIIA operations. It is also MIIA’s biggest competitive edge.

The MIIA story continues to build on a solid foundation of innovation and, most importantly, service to members. Governed by a board composed of local officials, MIIA provides quality insurance products at the most competitive price possible. That’s the mission that has sustained MIIA for 25 years and will continue to be the driving force as MIIA steps into the next 25 years.

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