My world changed when I was a pediatric resident in 1997. I was working in the Pediatric Intensive Care Unit at Boston Medical Center, and I admitted a child with a terrible asthma attack. As we pumped IV medicine and continuous aerosolized medicine into her lungs to avoid having to intubate her, we were racing to figure out why she had the asthma attack in the first place. Her asthma had been in control. As I pored over her chart and sat with the family asking questions, the answer came to me. The family had recently acquired a cat, and she was allergic to cats. When I asked they got one, the family looked down and talked about the mouse they had found in her bed. They were desperate to get rid of the mice, and their landlord was ignoring their pleas for help. I realized that no amount of medicine I could give this young child would make it safe for her to go home. The prescription I wanted to write was for a healthy home.
Since then, many of us in Boston have worked hard to make healthy homes more of a reality. In 2006, the Breathe Easy at Home Program bagan, a collaboration between Boston’s Inspectional Services Department, Boston Public Health Commission, and such hospitals as Boston Medical Center, to make it easy to refer patients for housing code enforcement visits directly when they are seeing their doctor. This collaboration has won many national awards and cited as a model for how health care can work with public health and housing.
But the reality is that this is a reactive system, one that relies on patients being sick first before they get the inspections, and one that only serves the patients who come forward with complaints. A much better system would be one that is proactive, and gets to the problems first and prevents the asthma attack in the first place.
The good news is that the Boston City Council passed a revision to the Rental Registration and Inspection Ordinance in 2012. Under the previous ordinance, landlords only needed to list a post office box as a contact point, which sometimes resulted in weeks to months before a landlord could be served with a notice to fix problems, resulting in infestations or mold continuing to make patients sick. Landlords were only required to have a rental inspection when a unit changed occupants, a requirement that was often ignored and extremely difficult to enforce.
The new ordinance makes much more sense. It requires a contact number and out-of-state landlords to have an agent in state so city officials can reach them easily. It requires landlords to have their units certified as being in compliance with the housing code every five years to proactively ensure healthy housing. Landlords with a track record of poor compliance would be targeted first for compliance and landlords with excellent histories could apply for waivers. I was part of the meetings with city councilors who negotiated the ordinance along with the Greater Boston Real Estate Board and Small Property Owners Associations, and these compromises were fair and agreed to by all.
But the ordinance is now under attack, and a measure before the City Council would revert back to the old ordinance.
It is time to give the ordinance a chance to be fully implemented to reach its public health potential. Let’s put the story of a child struggling to breathe in our past and fully implement this ordinance to write the healthy home prescription for the residents in the City of Boston.
Dr. Megan Sandel is a pediatrician at Boston Medical Center.