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The sanitary regulations for riding stables, academies, and show rings shall be as follows: Separate toilet rooms for men and women shall be installed on the premises of all riding stables, academies and show rings. The equipment and maintenance of such shall comply with State and County health regulations. The water supply which is available on the premises shall comply with State and County health regulations. Manure and used bedding shall be kept in a fly-tight compartment and in such other manner to meet with the requirements of the State and County Health Departments. The floors of the stable shall be constructed in such a manner to drain properly. Manure and bedding shall not be allowed to accumulate, but shall be removed daily.

The regulations contained in this Section for immunization shall apply to all children enrolled in the public schools of the County in the elementary grades. No person shall be allowed to remain as a pupil in any public elementary school in the County, unless he submits satisfactory evidence of adequate protection or immunization against diphtheria, acceptable to the Health Department, within a reasonable period of time after registration; provided, that certain children may be exempted from this requirement upon certification by a licensed, registered physician that the physical condition of the child precludes such immunization. Such exemption from this requirement may also be obtained if the person or his natural or legal guardian provides a written statement to the public school which he expects to attend, that he objects to the inoculation required by this Section on the basis of a religious belief. If it found that the parents cannot afford to take their child to a private physician for the necessary immunization, this service will be rendered free of charge by the Health Department with the written consent of a parent or guardian. The principal of every public elementary school shall be responsible for advising the parent or guardian of the requirements of this Section. He shall be responsible for notifying the Health Department within a reasonable time, not to exceed thirty (30) days after registration of the child, of any failure to comply with this Section. Any parent or guardian who fails to comply with this Section, either willfully or through neglect, within a reasonable time after registration of the child, but in no case more than one (1) month, shall be guilty of a violation of this Code. A continued failure to comply after conviction shall constitute a separate offense.

The regulations contained in this section shall apply to all "Free Standing Clinics" in Prince George's County. A "Free Standing Clinic" is a medical facility offering medical treatment of a convenience nature which is physically separate from a hospital or hospital grounds and which is not a hospital, or administratively part of a hospital, or related institution as defined in the Health Article of the Maryland Annotated Code. No Free Standing Clinic shall use in its title or in advertisement of its service words which may lead the public to believe the clinic can provide emergency medical treatment unless the requirements set forth in Subsection (c) of this Section are met. This shall include use of the words "emergency," "urgent," or other words clearly indicating the availability of medical treatment for immediately life threatening medical conditions. The following are basic requirement for all free standing clinics in Prince George's County offering or advertising emergency services as described in Subsection (b): Well marked facility and entrance; Stretcher and wheelchair entrance; Separate approach specifically identified and maintained for emergency vehicles; 24 hour staffing, including: physician(s), nurse(s), radiology technician(s), laboratory technician(s), and all clinic signs, streets signs, or advertisement of any kind shall state the exact hours such clinic services are available; Physician and nursing staff trained in emergency care (ACLS certified or preferably Board Eligible for certification in Emergency Medicine); Resuscitation equipment including: monitor, defibrillator, cardiac medications, intubation equipment, and intravenous line equipment; Specific defined role in local emergency medical services system with appropriate radio/tel. communication; Operations according to approved local protocols for stabilization and transportation of patients requiring hospitalization or other more definitive care; On-premises radiologic services; Availability of services to all persons regardless of ability to pay. Those Free Standing Clinics which offer or advertise emergency services and are administratively a part of a hospital and open less than twenty-four (24) hours a day must indicate on all clinic signs, street signs and advertisement of any kind the exact hours such clinic services are available.

Definitions. The following definitions shall apply: Citizen means an individual who resides or is employed in this County for at least ninety (90) consecutive days. Insurer means an insurance company that is authorized to provide insurance in this State that includes medical insurance, catastrophic health insurance, and nursing home care insurance. Responsibility of County Executive. The County Executive is authorized to: Identify an insurer to provide to any citizen medical insurance at an affordable rate; and Provide sufficient notice to citizens of the availability of the medical insurance plan. Pre-existing conditions. A contract provided under this section will be subject to the insurer's regulations in covering pre-existing medical conditions of the citizen.

As used in this Division: Business building shall mean any structure, whether public or private, regardless of the type of material used in its construction, located within the jurisdiction of the County, that is adapted to occupancy for transaction of business, whether vacant or occupied, for the rendering of professional services, for the display, sale, or storage of goods, wares, or merchandise or for the performance of work or labor, including hotels, rooming houses, apartment houses, beer parlors, office buildings, public buildings, theaters, stores, markets, restaurants, warehouses, grain elevators, abattoirs, work shops, factories, and all public or private structures where domestic or other animals are kept. Opening shall mean any opening in the foundation sides or walls, ground, or first floor, basement, and roofs, including chimneys, eaves, grills, windows, ventilators, sidewalk grates, and elevators, and around any pipe, wire, or other installation connecting with a building, through which a rodent may enter. Premises shall mean all business buildings, sheds, barns, animal pens or shelters, garages, docks, wharves, piers, grain elevators, and abattoirs, whether public or private, used in connection with the operation of any business building. Rodent harborage shall mean any condition which provides shelter or protection for rodents, thus favoring their multiplication and continued existence in, under or outside of a structure of any kind. Rodent-stoppage or rodent-proofing shall mean a relatively inexpensive form of rodent-proofing to prevent the ingress of rodents into business buildings from the exterior or from one building or business establishment to another. It consists essentially of the closing or protection of all openings in the exterior walls, ground, or first floors, basements, roofs, and foundations with material impervious to rodent gnawing in such a manner as to prevent rodents from gaining entrance.

No person shall construct within the County any business building or curb or farmer's market, unless such construction renders the structure rodent-proof in accordance with the regulations prescribed by this Division.

For the purpose of preventing rodents from entering business buildings and other structures on the premises through actual or potential openings in their walls, roofs, first or ground floors, foundations and basements, and to prevent their passage from one business building or one establishment in the same building to another, when this latter procedure is practicable, the specifications or regulations for rodent-proofing contained in this Division will be followed, unless they are modified by direction of the Health Officer as may be necessary for the rodent-stoppage of conditions not contemplated in this Division or to apply more effective methods than specified.

The Health Officer shall approve all materials and the method of installation.

Solid sheet metal, expanded metal and wire cloth specified in these regulations shall have a rust-resisting covering, preferably galvanized.

The exterior walls of basements or cellars of all business buildings shall be constructed of cement or masonry impervious to rodents at their junction with the ceiling or floor above, and all existing or potential openings in such walls through which rodents may gain entrance from the exterior or pass from one building to another, as those caused by defects in the wall construction, those around drains, pipes, wires or other installations and those of any other nature not used for passage, light or ventilation, shall be closed with cement, mortar, masonry, metal of twenty six (26) gauge or heavier or other suitable material as directed by the Health Officer. When there is evidence of rodent infestation of the basement or cellars of business buildings having floors constructed in part or all of wood, the Health Officer may require that such wood floors be completely removed and that they be replaced with a cement floor three (3) inches or more in thickness, or if there is no basement floor the Health Officer may require that a suitable cement floor be installed. All open pipes or drains in basements or cellars through which rodents may pass are required to be capped with a perforated iron or metal cover that is securely fastened in place, preferably by a hinge. Any breaks, cracks or other openings in cement floors of basements through which rodents may pass shall be closed with cement mortar. Basements or cellars of business buildings are required to be kept free of rubbish at all times and all merchandise or other materials stored in basements or cellars shall be kept so that such merchandise or other materials will not afford harborage for rodents as directed by the Health Officer.

As the requirements for rodent-proofing of the first or ground floor of buildings depend on the type of construction and its condition, the presence of a rodent-proof basement under it, the depth the foundation extends below the surface of the ground, the nature of the business establishment, the degree of rodent infestation, the results of measures to eradicate rodents and other factors, the Health Officer shall prescribe and require such corrective measures as he deems necessary for each business building, being guided as far as possible by the following specifications: If the first or ground floor of a business building is constructed of cement, tile, or other material impervious to rodent gnawing and does not have a basement or cellar under the entire floor area which can be satisfactorily rodent-proofed, the Health Officer will require that all actual or potential openings through which rodents may gain entrance, such as those around pipes, wires, or other installations, those caused by defects of any kind and those where the floor and side walls join, shall be properly sealed with cement, mortar, masonry, metal collars, metal flashing of twenty-six (26) gauge or heavier, or any other suitable material as indicated, and that open drains or pipes through which rodents may pass shall be securely capped with perforated iron or other metal having openings not greater than one-half (1/2) inch in diameter; Whenever rodents are found to be harboring under wooden platforms or secondary wooden floors built over cement floors the Health Officer may require the complete removal of such wooden platforms or floors or that they be lowered to a distance not exceeding one-half (1/2) inch above the cement floor; and, If the first or ground floors of business buildings are constructed of wood, and do not have basements or cellars extending under their entire area that can be satisfactorily rodent-proofed, the Health Officer may require whichever of the following procedures he deems necessary: That all actual or potential openings in the floor through which rodents may gain entrance be sealed with metal of twenty-four (24) gauge or heavier. That the junction of the floors with the sidewalls be flashed with twenty-four (24) gauge or heavier metal which shall extend six (6) inches or more on the floor and four (4) or more inches upon the sidewalls. That all drains or open pipes through which rodents may pass be capped with perforated iron or other metal having openings not greater than one-half (1/2) inch in diameter. That if buildings are built on piers so that the distance between the ground and lower surface of the joists is less than eighteen (18) inches, or the foundation of the building is not impervious to rodent gnawing, or the foundation does not extend thirty-six (36) inches below the ground surface, a cement curtain will be installed around the entire periphery of the building. This curtain wall shall tie in tightly with the foundation or side wall of the building. It shall be at least four (4) inches thick and extend thirty-six (36) inches below the surface of the ground, or it shall be constructed in the form of an L with the vertical portion eighteen (18) inches or more below the ground surface, and the lower horizontal and extending outwards eight (8) or more inches from the vertical section. That when part of the ground or first floor is constructed of wood and part of cement, it may be required that the wooden portion be replaced with cement. That when the condition of the floor and the degree of rodent infestation warrant, it may be required that wood flooring be replaced by properly installed cement or other form of flooring impervious to gnawing by rodents. That in lieu of curtain walls and other measures necessary to rodent-proof wooden floored buildings the responsible person may elect to replace the wooden floors with properly installed cement or other suitable flooring.

When there is evidence of rodents harboring in or entering built-in ice boxes or refrigerators, all openings used by rodents are required to be sealed with twenty-six (26) gauge or heavier metal, and if necessary the junction of the ice boxes with the floor and walls shall be flashed with twenty-four (24) gauge or heavier metal. If the built-in iceboxes or refrigerators rest on the surface of the ground the Health Officer may require that curtain walls be installed around the periphery in the same manner as those used for imperfect foundations of buildings.

All wood doors and door jambs or frames, serving as front, side, or rear entrances to the ground or first floors, and those on upper floors having exterior stairways, as well as any other doors accessible to rodents outside of buildings or between buildings and different business establishments shall be treated in each case according to the following specifications as directed by the Health Officer: Solid, strong doors constructed of hardwood or metal that fit snugly in their frames and on their thresholds or sills so that rodents can not gain entrance through them and that do not present irregular surfaces or cracks for rodents to gnaw through them may be passed without any treatment, at the discretion of the Health Officer; Doors in such disrepair or in such a poor condition that they cannot be satisfactorily rodent-proofed are required to be replaced by new ones or repaired to the extent that they can be satisfactorily rodent-stopped and they shall swing smoothly and easily on their hinges; All doors on the sides and rear of a building that are constructed of soft wood, any doors that show evidence of rodent gnawing or have any irregularities, cracks, or small openings along their lower margin or sides that offer potential sites for rodents to gnaw and doors that have any openings over three-eighths (3/8) inch wide between the door and door sill or threshold are hereby required to be fortified and rodent-proofed by using either metal channels of twenty-four (24) gauge or heavier or to be flashed with twenty-six (26) gauge or heavier metal, as directed by the Health Officer in the following described manner: A metal channel shall be applied when it is necessary to extend the lower edge of the door downwards or when the wood along the lower edge of the door is too soft to hold nails firmly in place, a metal bending brake shall be used in making the channels so that they will have sharp edges and sides at right angles to each other. The side pieces of the channel shall not be less than eight (8) inches in length and three (3) inches in width, on their exterior surface, and two (2) inches in width on their interior surface. The width of the lower part of the channel extending from one (1) side piece to the other will depend on the distance it extends beyond the lower margin of the door and condition of the wood. The lower arm should not be less than two (2) inches wide on its exterior surface and one (1) inch wide on the interior surface. When the condition of the door permits, and there is no necessity to extend its lower margin, metal flashing on the exterior surface shall be used with side pieces not less than eight (8) inches long by three (3) inches in width, and the lower piece extending from one (1) side piece to the other not less than two (2) inches in width. Metal flashing should not extend beyond the margin of a door at any place. If it is necessary to extend metal around the side of bottom edges of doors, metal channels should be used. After the application of either metal channel or flashing the door should swing smoothly without any binding. Wooden door frames are required to be flashed with twenty-six (26) gauge or heavier metal to the same height as the door flashing whenever there is a crack or other defect between them and their doors that may be utilized by rodents for gnawing through the frame; Irregularities or defects in wooden door sills are to be corrected by flashing the sills with twenty-four (24) gauge or heavier metal; Any irregularities or defects in door thresholds constructed of cement or masonry which produce any openings under doors three-eighths (3/8) inch or greater shall be corrected by pointing up with cement, mortar, or other suitable material or by constructing a new threshold of similar material as directed by the Health Officer; Sliding wooden or metal doors and swinging metal doors that have any spaces greater than three-eighths (3/8) inch wide between them and their sills or thresholds are required to have either rigid or movable sliding strips of twenty (20) gauge metal or equivalent material fastened to their lower margins so that spaces under such doors when closed will not exceed three-eighths (3/8) inch in width; Mail slits in the lower part of doors that are accessible to rodents shall be fitted with covers that cannot be raised by rodents from the outside; Other openings in exterior doors used as vents or for other purposes shall be fitted with iron grill work having no openings larger than one-half (1/2) inch in diameter or wire cloth of the same mesh of nineteen (19) gauge or heavier; and, All exterior doors on the sides and rear of business buildings are required to be kept closed at night and during the day unless protected by screen doors with automatic closing devices.

All windows of business buildings through which rodents may gain entrance, such as those having sills less than thirty (30) inches from the ground, or those that may be accessible to rodents from the roof of the same buildings or adjacent structures, and those that rodents may gain entrance to by climbing the walls of the building or by means of vines, trees, wires, pipes, or any other installation, are required to be rodent-proofed if the windows are liable to be left open during the night or day, unless the Health Officer is satisfied that they are already appropriately protected by screening, grills, or wire cloth. Windows shall be rodent-proofed by covering their entire surface with nineteen (19) gauge or heavier wire cloth having a mesh not greater than one-half (1/2) inch. The wire cloth is to be securely fastened to wood frames that are to be installed so that they may be readily removed in order to clean the windows or for other purposes. The edge of the wire cloth along the entire outer margin of the frames should be covered with metal strips approximately one (1) inch wide; provided, that there is scrap metal available for this purpose. At the discretion of the Health Officer, when appropriate situations arise a metal rodent guard of twenty six (26) gauge or heavier metal may be substituted for the wire cloth covering of windows. The metal guard shall be approximately eighteen (18) inches wide, or its upper margin thirty (30) inches or more above the surface of the ground below the window. Its upper outer margin will extend out nine (9) inches from the window frame while the lower margin will extend downward and inward to within three-eighths (3/8) inch of the outer edge of the sill. The sides should fit tightly against the outer margin of the window frame on each side. If necessary to prevent the accumulation of trash, the space between the upper margin of the guard and the window should be capped with wire cloth.

All vents or openings for light or ventilation in the side walls, foundations or roofs of business buildings which may be accessible to rodents, from the ground or other surface or by climbing, are required to be rodent-proofed by the installation of iron or steel grills having no openings large enough to insert through them a cylinder over one-half (1/2) inch in diameter, or by securely fastening into place expanded metal of eighteen (18) gauge or heavier, or wire cloth of nineteen (19) gauge or heavier having a mesh of one-half (1/2) inch or smaller. The metal may be sealed in place with cement, or mortar or it may be installed on a tightly fitting wooden or metal frame. If a wood frame is used the edges of the wire cloth should be covered by strips of scrap metal approximately one (1) inch wide.

Unless closed by a metal grill having no openings that will allow the passage of a cylinder over one-half (1/2) inch in diameter, all sidewalk vents and light wells of business buildings are required to be rodent-proofed by one of the following methods as prescribed by the Health Officer: By covering the opening in the side wall or foundation of the building with wire cloth of nineteen (19) gauge or heavier having a mesh of one-half (1/2) inch of less, which will be securely fastened in place with cement mortar or on a tight fitting frame. If it is necessary to gain entrance to the well for any purpose a frame should be installed that can be easily removed, or the frame may be attached by hinges. By partially closing the openings in the foundation or wall of the building with masonry and treating the remaining opening as in Subsection (a)(1) of this Section; In lieu of the above described procedures for the rodent-stoppage of light wells and sidewalk vents the following method may be used in suitable instances: A wire cloth basket should be constructed of nineteen (19) gauge or heavier wire cloth having a mesh of one-half (1/2) or smaller which conforms to the dimensions of the light well or sidewalk vent with sides not less than twelve (12) inches deep. In the case of large baskets, the edges and corners should be reinforced with twenty-four (24) gauge or heavier metal and cross supports of the same material used if necessary. The wire basket should be securely fastened to the edges of the light well or vent so that it can be removed to empty accumulated trash when necessary. When agreeable to the person in charge of the business building, the openings of sidewalk vents or light wells may be entirely closed with cement mortar; and, If deemed necessary the Health Officer may require that the bottom and sides of light wells shall be rodent-proofed with cement or masonry, making at least one (1) hole per square foot in the bottom one-half (1/2) inch in diameter for drainage.

Meter boxes and any other installations sunk into sidewalks or in the ground near buildings from which conduits or pipes pass to business buildings are required to have their sides and bottom surfaces sealed with cement mortar or other suitable material. Drainage should be provided when necessary.

Openings of any type in the foundations, walls and roofs of business buildings such as those caused by defects in construction, those resulting from disrepair or deterioration of the building, those around wires, pipes, conduits and any other installation through which rodents may directly enter a building or gain access to the space between double walls from the exterior, and are not used for ventilation or lighting, are required to be sealed with metal of twenty-six (26) gauge or heavier, used as collars or flashing, with cement mortar, masonry or any other suitable material as directed by the Health Officer.

Openings of any character in party walls between business buildings are required to be rodent-proofed in the same manner as those in walls having a free exterior surface, and when feasible the walls dividing an establishment in which food is sold or stored from other establishments in the same building shall be rodent-stopped in the same manner as exterior walls, if so ordered by the Health Officer.

The walls of elevator shafts are required to be repaired and rodent-proofed in the same manner as prescribed for basement walls and exterior walls of buildings when considered necessary by the Health Office.

All outhouses, sheds, barns, garages and other structures on business premises are required to be rodent-proofed in the same manner as prescribed for business buildings, or the person having custody over such premises may have structures of this type torn down instead of having the rodent-stoppage work done.

In order to protect buildings on business premises from climbing of roof rodents no person shall permit poles, ladders or any other object not in actual use to lean against the sides of buildings. No person shall permit vines to grow up the sides of business buildings. All trees near business buildings are required to be kept trimmed and cut so that no part of any branch or any part of such tree shall be closer than four (4) feet from the sides of any business building and shall under no circumstances overhang the roof of the building.

Curb or farmers' markets in which fruits, vegetables, meats or any other food products are exposed or offered for sale, on racks, stands, platforms and in vehicles outside of business buildings, shall have floors paved with concrete, asphalt or other material impervious to rodents, for the entire surface area of the market. Display racks, stands or platforms on which any foods are displayed or offered for sale are required to be at a distance of not less than eighteen (18) inches from the floor and be constructed so that rodents cannot hide or harbor in or under such structures.

After business buildings and premises have been rodent-proofed or rodent-stopped as prescribed in this Division, or have previously complied with the specifications for rodent-stoppage, the occupant of each business building or premises, or any part or fraction thereof in which there is evidence of rodents, shall immediately take steps to free such buildings or premises thus occupied of all rodents. They shall keep the buildings or premises they occupy in a rodent-free and rodent-proof condition. The person having custody of a vacant business building or premises, or the vacant portion of a business building, shall be responsible for carrying out all the measures prescribed in this Subdivision for keeping such vacant building or portion thereof in a rodent-free and rodent-proof condition. Immediately upon receipt of a written notice from the Health Officer that there is evidence of rodent infestation, or that a leak or break has developed in the rodent-proofing of a business building or other structure on the premises, the person designated in this Section as being responsible for correcting the conditions reported by the Health Officer shall take immediate steps to abate the condition. The eradication of rodents and sealing of leaks or breaks by which rodents may enter buildings shall be carried out under the general direction of the Health Officer. If the proper corrective measures are not under way within seven (7) days following delivery of the notice to abate the condition, or if the necessary procedures are not being properly carried on and achieving satisfactory results fourteen (14) days after the notice was issued, the Health Officer is authorized to take over the work of rodent eradication or rodent-proofing and to make a charge against the responsible person which will cover the costs of labor, materials, use of equipment and overhead.

The Health Officer, or his designee is authorized to make frequent and unannounced inspections of existing business building within the County for the purpose of determining signs of rodent infestation, and order by written notice either the owner, occupant, agent or any other person in custody of a business building showing any evidence that rodents have been present, to have such building rodent-proofed immediately, regardless of the need for remodeling of or repairs to such buildings. He shall also order that such rodent control measures as may be deemed necessary by him to eradicate all rodents present on the premises be undertaken immediately, and to maintain them free of rodents. The written notice or order shall specify the time, in no event less than fifteen (15) days, for completion of the rodent-stoppage work. Unless such work and improvements are completed in accordance with the written order or notice by either the owner, whether an individual, partnership, corporation, or the occupant, agent or any other person in custody of the business building and, therefore responsible for the upkeep or repair of the building, within the time so specified, or within the time to which a written extension may have been granted by the Health Officer, such owner, occupant, agent or other person shall be in violation of this Division. The Health Officer is authorized to make inspection during the course of and upon completion of any construction, repair, remodeling or installation of rodent control measures to business buildings to insure compliance with the provisions of this Division. No person shall interfere with or refuse to permit such inspection. If the construction, repair, remodeling or installation fails to comply with the standards of this Division, they will have to be altered according to the directions of the Health Officer.

In order to alleviate the general unsanitary conditions associated with the rodent infestation of business buildings the Health Officer is directed to make or cause to have made periodic inspections of all rodent-stopped buildings at intervals of not less than once every forty-five (45) days in order to determine whether or not such buildings show any evidence of rodent infestation and locate any breaks or leaks that may have developed in the rodent-proofing.

No contractor, public utility or other person shall make any alterations or repairs of a business building or install any wires, conduits, pipes or make installation or for any other reason remove existing rodent-proofing, and not restore the rodent-proofing in a proper condition. No such person shall make new openings by which rodents may enter business buildings from the ground, or by climbing or burrowing.

All food or feed kept within the County for feeding chickens, cows, pigs, horses and other animals shall be kept and stored in rodent-free containers, compartments or rooms unless the entire building is rodent-stopped.

The occupants of all business buildings and private residences shall provide an adequate number of covered containers of a type prescribed by the Health Officer according to existing conditions in which all garbage, litter, or refuse, including waste vegetables or animal matter of any kind and all small dead animals, that may serve as food for rodents, shall be placed and stored so that such items are not accessible to rodents until removed from the premises by the garbage collectors. No person shall dump or place on any land or in any waterway within the County any dead animals, butchers' offal, or any waste vegetable or animal matter or any other food product whatsoever. All establishments where employees eat lunches on the premises are required to provide a sufficient number of suitable covered containers in which the employees shall cause to be placed any remnants of such lunches so that they will not be accessible to rodents at any time. Whenever there is evidence of rodent infestation of any moving picture theater or other place of amusement wherein the audience eats peanuts, popcorn, or other foods, the Health Officer may require that all particles of or all such foods be removed from the floors of the place of amusement immediately after the last performance each evening. The owner and/or operator of every commercial business establishment and the owner and/or operator of any vending machine where readily consumable food items are offered for sale shall be responsible for providing an adequate number of covered containers for the disposal of garbage, litter, and refuse at locations in front of each such establishment or machine, or at such locations as otherwise approved by the County Health Officer, and reasonably accessible to the establishment's clientele. Said owners and/or operators shall also be responsible for the routine maintenance and disposal of the contents of said containers. The responsibilities assigned in this paragraph shall not apply where otherwise prohibited by law. Any person found in violation of this Section 12-160 shall be liable to a civil fine not to exceed Five Hundred Dollars ($500.00). Each day of violation shall constitute a separate violation. The County Attorney shall be authorized to prosecute a violation of this Division by instituting a civil proceeding in a court of competent jurisdiction. The court, upon a finding of a violation, may impose a civil fine, in addition to the granting of any other relief authorized by law.

No garbage, litter, rubbish, trash or manure shall be placed, left, dumped or permitted to accumulate or remain in buildings or premises in the County so that it shall or may afford food for a harborage, shelter, or breeding place for rodents. No person shall permit any premises, improved or unimproved, and all open lots and alleys within the County to accumulate lumber, boxes, barrels, bricks or stones, and similar materials that may be permitted to remain thereon, unless the same shall be placed on open racks that are elevated not less than eighteen (18) inches above the ground or not less than six (6) inches above a weed-free surface on property improved by a one or two-family dwelling, and evenly piled so that these materials will not afford a shelter or harborage for rodents.

It is hereby declared that the County Council of Prince George's County, Maryland, has found that the use of pesticides in the County to control common pests of lawns, golf courses, recreation areas, and similar areas is widespread. The County Council is further concerned that health problems may exist for certain individuals sensitive to pesticides and may arise in other individuals who may inadvertently come into contact with a treated area. The Council further finds and declares that requiring public notice before and after pesticide application is necessary to protect and promote the public health, safety, and general welfare.

The following definitions shall apply in this Subdivision: Custom applicator means any person, and his employees, who is engaged in the business of applying, by air, ground, hand, or mechanical equipment, pesticides to property; Customer means any person who has entered into an agreement for a custom applicator to apply pesticides for the care of property; Pest means any insect, snail, slug, rodent, nematode, fungus, weed, or any other form of terrestrial or aquatic plant or animal life or virus, bacteria, or other microorganism (except viruses, bacteria, or other microorganisms, on or in living man or any other living animal), which normally is considered to be a pest or which the Secretary of the Maryland Department of Agriculture declares to be a pest. Pesticide means any substance or mixture of substances intended: For preventing, destroying, repelling, or mitigating any pest; For use as a plant regulator, defoliant, or desiccant; and To be used as a spray adjuvant such as a wetting agent or adhesive. Private Applicator means any person who applies pesticides by air, ground, hand, or mechanical equipment to his privately owned or leased property, or property which he otherwise occupies or uses by consent of the owner, and further includes any corporation, partnership, sole proprietorship, other business association, condominium association, agency of Prince George's County, Maryland, or any of the municipalities within Prince George's County, Maryland, and similar entities which utilizes its own employees to apply by air, ground, hand, or mechanical equipment, pesticides to property owned or managed by said entity. Property means land located in Prince George's County, Maryland, and the water, vegetation, and airspace upon and above said land, but does not include structures or other improvements or areas of land used exclusively for agriculture or commercial forest production. Residential Applicator means a private applicator who applies a pesticide for any purpose on any property where he/she resides, excluding such property as may comprise the common area of a multifamily dwelling or associated group of dwellings.

Sign prior to pesticide application. For at least twenty-four (24) hours prior to each application of pesticide by a custom applicator, the customer shall post signs visible from all streets fronting or providing principal access to the property. The sign(s) will be developed or approved by the Health Officer for the purpose of notifying the public of the pending property treatment and will be supplied to the customer by the custom applicator. At least twenty-four (24) hours prior to each episode of pesticide treatment by a private applicator, or a residential applicator, the applicator shall either post signs visible from all streets fronting or providing principal access to the property, said sign to be substantially in the form and content as described in paragraph (1) of this Subsection and may be obtained pursuant to Section 12-161.05 of this Subdivision. This requirement shall not apply to emergency situations as may be defined by regulation or in which treatment is necessary to protect property or structures from immediate damage from an existing pest. The Health Officer shall further have the right, from time to time, to exempt certain properties, such as, but not exclusively, golf courses and public utility rights-of-way, when it is shown that access to the property is sufficiently restricted and proximity to other properties which may be affected by or receive drifting chemicals from the pesticide application is sufficiently removed so as to eliminate the need for prior posting. The signs required under this Subsection shall remain posted until replaced by the signs required by Subsection (b) of this Section. Sign after pesticide application. Immediately after pesticide application, the applicator shall post a sign or signs on the treated property. Such sign or signs shall: Be clearly visible on the treated area and from all streets fronting or providing principal places of access to the property. If there are more than one principal places of access to the property, a sign shall be placed so as to be visible from each. Be of such size and bear such language as developed, approved, or directed by the Health Officer. The signs shall remain in place for at least three (3) days, and in no event more than seven (7) days, following application of the pesticide. The Health Officer may from time to time exempt certain types of property, such as, but not exclusively, golf courses and public utility rights-of-way, in which access is sufficiently restricted and proximity to other properties which may be affected by or receive drifting chemicals from the pesticide application is sufficiently removed, from the requirements of this Subsection, providing such exempted property has an alternative method of providing the notification set forth in this Subsection to members of the public who may come into contact with the treated area. The Health Officer shall provide to the public in a manner deemed appropriate, information which explains the notice provisions. The Health Officer shall compile and make available to the public, upon request, specific information and safety precautions for those lawn pesticides determined by the Health Officer to be most commonly used.

Immediately after application of a pesticide, the custom applicator shall give each customer a brief written statement as set forth in this Section. The language of such statement shall be developed or approved by, and revised as necessary by, the Health Officer but shall include, at a minimum: Current government agency phone numbers for consumer complaints, further technical information and medical emergencies; A list of general customer safety precautions applicable to most pesticide applications; and A statement notifying the customer that each custom applicator applying pesticides must be licensed by the Maryland Department of Agriculture and have its employees follow safety precautions. As a part of such statement, the custom applicator shall, in addition to the foregoing, list the trade and generic name of each pesticide which is used and any customer safety precautions specific to any of the individual pesticides.

Every vendor of a pesticide or material containing a pesticide shall be encouraged to display and make available to the buyer with each sale signs for pre- and post-treatment posting and other informational material provided by or approved by, the Health Officer, said informational material to provide, at a minimum, the information required by Section 12-161.04(b)(1) and (2).

Upon the showing by the Washington Suburban Sanitary Commission, Maryland-National Capital Park and Planning Commission, and the Prince George's County Department of Public Works and Transportation that the potential for any adverse effect from pesticide application upon the public or to adjoining property is minimal or that compliance with the terms of this Subdivision is excessively burdensome or impractical, the Health Officer may exempt said agencies from the requirements of this Subdivision. The Board of Health may adopt by resolution such regulations and establish such exemptions as may be necessary to carry out the intent of this Subdivision.

Each violation of this Division shall constitute a civil violation subject to a civil fine of Fifty Dollars ($50.00) in accordance with the procedures of Division 3, Subtitle 28, Prince George's County Code.

As used in this Division: Perishable food shall mean any food or drink, or food or drink ingredient capable of supporting the growth of any microorganism which is pathogenic to man or capable of producing preformed toxins, or which will promote the growth of coliform organisms when held at incubation temperatures. Vending machine shall mean any automatic self-service device offered for public use which, upon insertion of a coin, coins, token or by similar means dispenses unit-servings of food and beverage, either in bulk or in package, without the necessity of replenishing such device between each such vending operation. Vending machine location shall mean the space under one (1) roof or an outside location involving a consolidated single enclosure, space or area under one (1) proprietor where one (1) or more vending machines are installed and operated and offered for public use.

No person shall establish or maintain a vending machine location for the sale of food or beverages to the public without a valid permit from the Health Officer. Subsection (a) shall not apply to: The sale of beverages which are sealed, canned or bottled carbonated beverages, or pasteurized dairy products; Machines commonly known as gumball machines; or, Any food or drink which is not perishable.

Any person desiring to establish a vending machine location under Section 12-163 shall make application for a permit to the Health Officer upon forms to be supplied by the Health Officer. No new permit shall be necessary for additional machines to be added to an established vending machine location of the same permittee. Permits shall be issued for a period not in excess of one (1) year, expiring December 31 of each year, and may be renewed for periods not to exceed one (1) year. The Health Officer shall provide for the issuance of any permits which are required pursuant to this Division. If the permittee has complied with the provisions of this Division and any State laws or regulations pertaining to food and drink vending machines, shall be entitled to a permit.

The Health Officer may suspend any permit issued pursuant to this Division if any violation of this Division or any State laws or regulations pertaining to food and drink vending machines has been committed by the licensee by sending a notice of such suspension or revocation to the address of the licensee as it appears upon his application. A licensee whose license has been suspended may request a hearing before the Health Officer. The suspension shall remain in effect pending any hearing. The Health Officer may rescind or sustain its determination of suspension after such hearing. Upon receipt of any new application for a new permit for the same location a permit for which has been previously suspended, the Health Officer shall make an inspection to determine whether there has been satisfactory compliance with this Division and any State law or regulation.

For every vending machine location permit issued, a fee as prescribed in the Table of Fees shall be paid before the issuance of any permit. A duplicate permit will be issued, on request, at a charge as prescribed in the Table of Fees.

All readily perishable foods, as determined by the Health Officer, shall be coded with the date of processing, or with or in addition to any other system acceptable to the Health Officer. All such coding systems shall be subject to the approval of the Health Officer.

County Building shall mean any building that is: Owned, leased, or managed by the County; or Used to house a branch of government; or Used by County employees for the purposes of employment; or Open to the public for the purpose of accessing services rendered by the County. This definition excludes all property owned or managed by the Prince George's County Board of Education. Lactation Room shall mean a private and hygienic place, other than a bathroom, where a nursing mother may express breastmilk and/or breastfeed. Portable Lactation Room shall mean a prefabricated, portable structure designed for nursing mothers to express breastmilk and/or breastfeed in a private and hygienic space.

All County Buildings shall contain a Lactation Room or Portable Lactation Room accessible to all County employees during their work hours as well as members of the public during hours of operation. Each lactation room shall require: Clear indicative signage; and Access without traveling through a bathroom, locker room, or other similar facility; and A door that locks from the inside, and is accessible only to emergency personnel; and A table, countertop, or other sturdy workspace; and Adequate seating; and Adequate lighting; and At least one duplex electrical outlet; and At least one multi-user hospital grade breast pump, and each user shall provide their own collection equipment; and Adequate trash collection receptacles; and If designed for multiple users at one time, then individual user privacy screening; Reasonable access to a refrigeration storage unit; and Reasonable access to a sink with hot and cold water. Mandatory Minimum Dimensions. Single user Lactation Room shall be, at a minimum, a space of 6' × 8' or 7' × 7'; or Multi-user Lactation Room shall be, at a minimum, a space of 12' × 16'.

The Maryland State Department of Health and Mental Hygiene Regulations Governing Assisted Living Programs as set out in the Code of Maryland Regulations (COMAR 10.07.14), and as they may be amended from time to time, are hereby adopted by reference as the County regulations governing assisted living programs and made part of this Subtitle, with the additions, insertions, and changes prescribed in this Division. The Health Officer shall at all times maintain and keep current one (1) set of such State regulations for public inspection.

The following additions, insertions, and changes are hereby made to the Maryland State Department of Health and Mental Hygiene Regulations Governing Assisted Living Programs adopted by reference herein as the County regulations governing assisted living programs.

In addition to the definition of terms contained in the State regulations adopted by reference in this Division, the following definitions and terminology shall apply and are applicable to such provisions adopted by reference: Approving Authority means the Prince George's County Health Officer. Assisted Living Program means a residential or facility-based program that provides housing and supportive services, supervision, personalized assistance, health-related services, or a combination of these services to meet the needs of residents who are unable to perform, or who need assistance in performing, the activities of daily living or instrumental activities of daily living, in a way that promotes optimum dignity and independence for the residents. Assisted Living Program does not include a Nursing Home, a Hospice facility, services provided by family members, services provided by a licensed residential service agency or licensed home health agency in an individual's own home, or emergency, transitional, and permanent housing arrangements for the homeless and/or victims of domestic violence. Department means the Prince George's County Health Department. Health Officer means the Prince George's County Health Officer or the Health Officer's designee. Household Member means an individual living in an assisted living facility who is not a resident or staff and does not require assisted living or skilled services from the facility staff. Secretary of Health and Mental Hygiene means the Secretary of the Maryland Department of Health and Mental Hygiene.

It shall be unlawful for any person to operate an assisted living program without a valid license issued by the Health Officer. Any person desiring to operate an assisted living program shall make written application to the Health Officer for a license to operate the program. A separate license shall be required for each program location. Application for an assisted living program license shall be on a form approved by the Health Officer. In the case of new facilities, or facilities materially altered, the application must be accompanied by plans and specifications for the proposed facility.

When, upon review of the application form and following a complete inspection of the assisted living facility, the Health Officer is satisfied that the program and the facility complies with the provisions of this Division, the appropriate requirements of the Secretary of Health and Mental Hygiene, and the State and County health laws, a license to operate shall be issued. If the program and/or facility does not meet the foregoing requirements, the Health Officer shall deny a license to operate an assisted living program. Final denial shall be in writing.

The license issued by the Health Officer shall be prominently posted in public view within the assisted living facility. The license shall be valid for a period not in excess of two (2) years, expiring on the date designated by the Health Officer. The license fee shall be Two Hundred Dollars ($200.00) per year with an additional Ten Dollars ($10.00) per bed for all beds above eight (8). At the time of submitting plans to the Health Department for a new or remodeled assisted living facility, a fee of Two Hundred Dollars ($200.00) for new facilities or a fee of One Hundred Fifty Dollars ($150.00) for remodeled facilities shall be paid. A fee of an additional Twenty-five Dollars ($25.00) shall be paid for each resubmittal of plans after the first resubmittal. An additional Twenty-five Dollars ($25.00) shall be paid for each reinspection after the first reinspection required prior to the approval to operate. A fee of Twenty-five Dollars ($25.00) shall be paid for prospective inspections, consultations, and equipment evaluations. Any holder of a license issued pursuant to this Section who is required to pay for said license and who fails to submit to the Health Officer an application for renewal of the license, together with the required fee not later than five (5) days following the expiration date of the existing license, shall be assessed an additional fee of Twenty Dollars ($20.00) per day for each day following the expiration of the existing license. A duplicate license will be issued, on request, at a charge of Fifteen Dollars ($15.00)

A licensee or employee of an assisted living program who believes that a resident has been subjected to abuse, neglect, or exploitation shall report the alleged abuse, neglect, or exploitation within twenty-four (24) hours to the Prince George's County Health Department Division of Adult and Geriatric Health in addition to complying with COMAR 10.07.14.27.

In cases where there is a serious violation of the regulations adopted herein, the requirements of the Secretary of Health and Mental Hygiene, or the State and County health laws which, in the sole discretion of the Health Officer, creates a serious and immediate danger to the public health, the Health Officer shall deliver a written notice suspending or revoking the program's license subject to a hearing held at the request of the operator.

A fee of One Hundred Dollars ($100.00) shall be charged for administrative/ enforcement hearings held pursuant to this Division. The operator will not be obligated to pay the fee for the scheduled hearing if a request to cancel or reschedule is received at least twenty-four (24) hours in advance of the scheduled hearing.

The Health Officer shall make inspections of assisted living programs to determine compliance with this Division, the appropriate requirements of the Secretary of Health and Mental Hygiene, and the health laws of the State and County. The Health Officer shall be permitted access to all parts of assisted living facilities during all hours and shall be permitted to inspect all resident records.

The manager of the assisted living program shall ensure that all employees follow "standard precautions" as stated by the Centers for Disease Control and Prevention when handling used syringes, needles, or items contaminated by body fluids. If caring for patients with communicable disease, including, but not limited to, Methicillin-Resistant Staphylococcus aureus (MRSA), Vancomycin-Resistant Enterococcus (VRE), C-Difficile, Scabies, Lice, Shingles, appropriate infection control policies and procedures must be available and in use by all caregivers.

All sanctions, civil penalties, and criminal penalties as outlined in COMAR 10.07.14.48-10.07.14.50 will remain under the authority of the Secretary. All variance requests dealing with levels of care will remain under the authority of the Secretary. All certification training for medication management shall remain under the authority of the Secretary.

Aggregate means a mixture of rocks, pebbles, sand, or similar hard, inert materials used for such purposes as construction, erosion control, road-building, or making of concrete or mortar. Asbestos means any of the following group of minerals: actinolite, amosite, anthophyllite, chrysotile, crocidolite, or tremolite. The use of aggregate containing evidence of asbestos content greater than one hundred parts per million by volume is prohibited for any purpose. Each supplier of aggregate in this County shall be conclusively presumed to warrant it to be free of asbestos-bearing content greater than one hundred parts per million by volume.

In this Division the following words have the meanings indicated. Distribute means to: Give away, sell, deliver, dispense, or issue; or Offer to give away, sell, deliver, dispense, or issue; or Cause or hire any person to give away, sell, deliver, dispense, or issue or offer to give away, sell, deliver, dispense, or issue. Electronic cigarette means any electronic device that can be used to deliver nicotine or other substance to the person inhaling from the device, including, but not limited to, an electronic cigarette, cigar, cigarillo, or pipe, or any cartridge or other component of the device or related product. Electronic cigarette does not include any product approved by the Food and Drug Administration for sale as a drug delivery or medical device. Employee means an individual employed by an owner. Minor means an individual under the age of eighteen (18). Owner means a person engaged in the business of selling or otherwise distributing tobacco products or electronic cigarettes for commercial purposes. Tobacco product means any substance containing tobacco, including cigarettes, cigars, smoking tobacco, snuff, or smokeless tobacco. Unpackaged cigarettes means any cigarette not contained within a sealed original package of at least twenty (20) cigarettes that are designed and intended to be sold or distributed as a unit.

An owner or an employee shall not: Distribute any tobacco product or electronic cigarette to a minor, unless the minor is acting solely as the agent of the minor's employer who is engaged in the business of distributing tobacco products or electronic cigarettes; Distribute cigarette rolling papers to a minor; or Distribute to a minor a coupon redeemable for tobacco products or electronic cigarettes. A person, who is not an owner, shall not: Buy for or sell to a minor any tobacco product or electronic cigarette; or Buy for or sell to a minor cigarette rolling papers. This Section does not apply to the distribution of a coupon which is redeemable for any tobacco product or electronic cigarette when the coupon is contained in a newspaper, a magazine, or any other type of publication in which the coupon is incidental to the primary purpose of the publication, or sent through the mail. A person has not violated this Section if: The person examined a driver's license or another valid identification issued by an employer, a governmental entity, or an institution of higher education; and The license or other identification identified the buyer or recipient of a tobacco product or electronic cigarette as being at least 18 years old. If a minor bought a tobacco product from a vending machine, this Section does not apply to the owner of the vending machine or any other person with control over the vending machine.

An owner shall display or store the tobacco product or electronic cigarette in a manner which by the design demonstrates the owner's intent that the tobacco product or electronic cigarette is inaccessible to the buyer without the intervention of the owner or the owner's agent. Designs that demonstrate an intent that the tobacco product or electronic cigarette is inaccessible to the buyer without the intervention of the owner or the owner's agent shall include storing or displaying the tobacco product or electronic cigarette as follows: Behind the sales counter in a manner which places the tobacco product or electronic cigarette beyond the physical reach of the buyer in the absence of extraordinary extension beyond the sales counter; or In a display case which requires seller assistance to gain access to the tobacco product or electronic cigarette contained therein; or In an overhead merchandising rack that is mounted more than six feet above the floor at the lowest point and from which access to the tobacco product or electronic cigarette is provided only on the side facing away from the buyer; or In any place that is inaccessible to buyers of the tobacco product or electronic cigarette without the intervention of the owner or the owner's agent.

Notwithstanding any other provision of law, a retailer or wholesaler may not purchase unpackaged cigarettes from a tobacco manufacturer or sell, resell, distribute, dispense or give away unpackaged cigarettes to any person.

Definitions. In this Section the following words have the meanings indicated: Child resistant packaging means packaging that is designed or constructed to meet the child-resistant effectiveness standards set forth in 16 C.F.R. § 1700.15(b)(1) when tested in accordance with the protocols described in 16 C.F.R. § 1700.20 as in effect on the date of enactment. Liquid nicotine container means a container that is used to hold liquid containing nicotine in any concentration. Child resistant packaging required. No person shall sell, resell, distribute, dispense or give away: any liquid or gel substance containing nicotine unless the substance is in child resistant packaging; or any nicotine liquid container unless the container constitutes child resistant packaging. Exceptions. This section does not apply to a liquid nicotine container that is sold, marketed, or intended for use in an electronic cigarette if the container is prefilled and sealed by the manufacturer and not intended to be opened by the consumer.

This Division shall be enforced by the Health Officer or Health Officer's designee. The Health Officer or designee may issue a citation to any person who violates Sections 12-202, 12-203 or 12-204 of this Division. The citation shall serve as notification to the person that a civil violation has been committed and in accordance with the provisions of Division 3, Subtitle 28 of this Code shall be subject to the monetary civil fine as provided in Subsections (b) and (c) of this Section, subject to his right to elect to stand trial pursuant to Section 28-257 of this Code. An owner who violates this Division is subject to a civil penalty of not more than Three Hundred Dollars ($300.00) for the first violation and not more than One Thousand Dollars ($1,000.00) for subsequent violations. An employee who violates this Division is subject to a civil penalty of not more than Fifty Dollars ($50.00) for the first violation and not more than One Hundred Dollars ($100.00) for subsequent violations. For the purposes of this Division, subsequent violation means a separate and distinct incident at a different time and occasion.

Definitions. "Tanning device" shall mean any equipment that emits radiation used for tanning of the skin, including sunlamps, tanning booths, or tanning beds. "Tanning facility" shall mean any place where a tanning device is used for a fee, membership dues, or other compensation. Prohibition. An owner, employee, or operator of a tanning facility shall not allow a minor under the age of 18 years to use a tanning device. Warning signs. A tanning facility must post a warning sign in any area where a tanning device is used. At a minimum, the sign must state that it is a violation in Prince George's County for a person under the age of 18 to use a tanning device and that the use of a tanning device may cause skin cancer and burns to the skin and eyes. The warning required by this section must be in conspicuous and legible type, printed in all capital letters, and printed in a size and manner so as to be clearly legible to customers. Verifying documentation. The owner, employee, or operator of a tanning facility shall require appropriate documentation to verify the age of an individual before allowing the individual access to a tanning device. Civil penalty. The Health Department shall impose on a person who violates this section, civil penalties under Section 28-268 of the County Code. Right of Entry The Health Department may inspect any tanning facility whenever it is open to the public for business to determine whether the tanning facility meets the requirements of this section.

As used in this Division. Vending machine shall mean a self-service machine offered for public use that, on insertion of a coin, paper, currency, token, card, or key, or by optional manual operation, dispenses servings of food or beverages in bulk or in packages, or prepared by the machine, without the necessity of replenishing the device between each vended operation Packaged shall mean bottled, canned, securely bagged, or securely wrapped, whether packaged in a food establishment or a food processing plant. Healthy Food Or Beverage Choices shall mean a packaged food or beverage that meets the requirements to be a healthy food choice or a healthy beverage choice established in Section 12-211. County Property shall mean any property owned, operated or managed by Prince George's County. County Property does not include property owned or managed by the Prince George's County Board of Education.

This Division applies only to packaged food and beverages sold through vending machines located on County Property. This Division shall be implemented in accordance with federal, state, and local laws. The requirements of this Division shall apply 24 hours a day. If a food and beverage machine located on County Property has been leased to a private entity, the Health Department shall encourage the tenant to meet the requirements of this Division.

The following criteria must be met by all items offered in vending machines. Any packaged food and beverage item offered shall contain no more than: 0.5 grams of trans-fat per serving; and 200 milligrams of sodium per package. Any beverage container offered shall contain no more than: 250 calories; and 20 fluid ounces.

Healthy Food Choices shall meet the following specifications: Individual Healthy Food Choices offered in vending machines must meet the following criteria: No more than 200 calories per package; Less than 35% of total calories from fat except for foods containing 100% nuts or seeds with no added fats; Less than 10% of calories from saturated fat; and No more than 35% of calories from total sugars except for 1%, 2%, or non-fat dairy products, non-dairy milk products, fruits and vegetables. At least one healthy food choice offered must meet the Food and Drug Administration's definition of "low sodium" (<140 milligrams per serving). Sugarless chewing gum and mints also meet healthy food choices specifications. Healthy Beverage Choices shall meet the following specifications: Individual Healthy Beverage Choices offered in vending machines must contain fewer than 40 calories per serving unless specified below. The following beverages also meet Healthy Beverage Choices nutritional standards even though they exceed 40 calories per serving: Fat-free milk; 1% low fat dairy milk; Calcium or vitamin D fortified soy milk with less than 200 calories per container; packages containing 12 ounces or less of 100% fruit juice, vegetable juice or fruit juice combined with water with no added caloric sweeteners and no more than 200 milligrams of sodium per container. Vegetable juice must contain <230 milligrams of sodium per serving.

All new vending machine service contracts and all vending machine service contract renewals entered into by covered entities in Section 12-209(a) on or after July 1, 2017 must require that at least 50% of the food and beverage items offered in vending machines meet the requirements listed in Section 12-211. Upon recommendation of the County Executive and approval by County Council resolution, all new vending machine service contracts and all vending machine service contract renewals entered into by covered entities in Section 12-209(a) on or after July 1, 2019 must require that at least 65% of the food and beverage items offered in vending machines meet the requirements listed in Section 12-211. The County Purchasing Department will ensure that Prince George's County municipalities can use any resultant contract that the County enters into for vending services thereby extending the contract's pricing, terms, and conditions to help facilitate easy compliance with this Division.

Healthy Food or Beverage Choices shall: Be displayed in a way that is easily distinguishable from food and beverages that do not meet Healthy Vending Standards listed in Section 12-211; and Be stocked in positions with highest selling potential. Water without added caloric sweeteners is required to be stocked in beverage machines. Beverages that do not meet the Healthy Vending Standards listed in Section 12-211 shall be placed in positions with the lowest selling potential.

Food and beverage items that meet the Healthy Vending Standards in Section 12-211 must be comparatively priced or less expensive than products that do not meet the standards. All vending machines shall display nutritional labeling that, at a minimum, complies with the standards for nutritional labeling set forth in 21 CFR, sections 101 and 109, as may be amended from time to time.

From time to time but at least once every five (5) years, the Department shall review, and if necessary, suggest updates to the Healthy Vending Standards in Section 12-211 to reflect advancements in nutrition science, dietary data, new product availability, and/or updates to the Dietary Guidelines for Americans.

It is hereby declared by the County Council of Prince George's County, Maryland that in order to foster healthy environments where families live, learn, work, and play in Prince George's County, it must engage in the promotion of healthy lifestyles through innovative approaches. The 2017 Prince George's County Health Report found that over 30% of high school students in the county were either overweight or obese, exceeding the state's prevalence at 26.4%. The 2020 RAND Corporation Report to the Prince George's County Board of Health found that Latino high school students have the highest rate of overweight and obesity in the County. Obese children are at least twice as likely as nonobese children to become obese adults. Sugar-sweetened beverages or sugary drinks are leading sources of added sugars in the American diet and are associated with an increased risk of type 2 diabetes, heart disease, obesity and other chronic diseases. The County Council finds that consuming such drinks, including fruit drinks with added sugar, sports drinks, energy drinks, and soda pose a real health risk to children. The American Heart Association recommends that children over the age of 2 have no more than one 8-ounce sugary drink a week. Yet children today are consuming as much as 10 times that amount with nearly two-thirds of children living in the U.S. consume at least one sugary drink daily. This equates to an average of 30 gallons of sugary drinks per year. Children in low-income families consume 2½ times more sugary drinks than their peers in higher-income families this may be due, in part, to some of the marketing initiatives by the beverage industry. People living in the U.S. consume about 34 pounds of added sugar every year just from sugary drinks. Every year, 40,000 cardiovascular deaths in the U.S. are attributed to overconsumption of sugary drinks. The County Council finds that diet-related health conditions have serious economic costs. The medical burden of obesity in the United States is approximately $147 billion annually, or almost 10 percent of all medical spending. Roughly one-half of these costs are paid through Medicare and Medicaid, which means that taxpayers are responsible for much of the bill. Medicare and Medicaid spending would be reduced by 8.5 percent and 11.8 percent, respectively, in the absence of obesity-related spending. A 2016 study commissioned by MedChi, the Maryland State Medical Society, showed that Medicaid annual spending per enrollee with diabetes ($24,387) is more than double the spending per enrollee without diabetes ($10,880). In 2017, The National Association of Black County Officials passed a resolution of measures in order to reduce the rising rates of chronic diseases and obesity. Nationwide, American children eat 19 percent of their calories at fast food and other restaurants. Children eat almost twice as many calories when they eat a meal at a restaurant as they do when they eat at home. A 2013 study that examined the nutritional quality of children's meals sold at 18 of the most profitable fast food restaurant chains in the United States found that only three percent of the 3,494 meal combinations assessed met the expert nutrition standards for children's meals. The beverage industry spends millions each year in targeted marketing to communities of color, such that African-American children and teens see more than twice as many television ads for sugary-drinks than their white peers, lower income neighborhoods have more outdoor ads for sugary drinks than either lower-income or higher-income white neighborhoods, and 80% of food-related ads viewed by Latino children and teens on Spanish-language TV were for sugary drinks, snacks, and candy. Many restaurants and beverage companies have taken steps to help citizens address obesity by introducing lower and no-calorie options, displaying calorie information, encouraging citizens to drink more water, removing full-calorie beverages from schools, and reducing calories from many of their products. The Prince George's County Council is the Legislative Branch of Prince George's County Government and sits as the Board of Health to govern and guide County health policy. The County Council as the Board of Health is authorized to develop solutions to public health issues that can manifest in the form of legislation or policies promulgated by the County Council for the protection and promotion of public health. The purpose of this statute is to support parents' efforts to feed their children healthfully by ensuring healthy meals are readily available to children in restaurants and that offering healthier children's meals will improve the overall health and well-being of children and families living in Prince George's County.

Child Friendly Restaurant means any Covered Food Service Facility offering Healthy Children's Meals. Children's Meal means a combination of food items and beverage that is: prepared by and offered for purchase at a food service facility as a unit at a single price; and represented to be or otherwise primarily intended for consumption by a child. It shall not include a combination of food items that has been prepackaged by or at a facility other than the food service facility offering the prepackaged combination for purchase. Covered Food Service Facility means any food service facility as defined by Section 12-104(a)(7) of the County Code. Default Beverage means the beverage automatically included as part of a children's meal, absent a specific request by the purchaser of the children's meal for an alternative beverage. Default Healthy Side means the healthiest side option available as part of a Healthy Children's Meal. Healthy Children's Meal is a Children's Meal that contains not more than: 550 calories; 700 milligrams of sodium; 10 percent of calories from saturated fat; 15 grams of added sugars; and 0 grams of trans fat; that includes at least a half (½) cup of non-fried fruit or non-fried vegetables (excluding white potatoes, juices, condiments, and spreads) including: Servings in the specified amounts from at least two of the following five food groups, at least one of the two food groups must be a fruit or vegetable: Fruit: greater or equal to a half (½) cup (100% juice cannot be used as a fruit substitute); Vegetable: greater or equal to a half (½) cup; Non/low-fat dairy: greater or equal to one (1) cup; Meat or meat alternate: includes meat, poultry, seafood, eggs, legumes (beans and peas), soy products, and nuts and seeds: greater or equal to one (1) ounce. Whole grains: a half (½) serving must provide greater or equal to eight (8) grams of whole grains and meet at least one of the following: First ingredient a whole grain; or greater or equal to fifty percent (50%) whole grains by weight of product; or fifty percent (50%) whole grains by weight of grains. Healthy Drink; where, if a children's meal includes a beverage, that beverage shall be one of the following: water, sparkling water, or flavored water with no added natural or artificial sweeteners; nonfat or one percent milk or a nondairy milk alternative containing no more than 130 calories per container or serving as offered for sale; or 100 percent fruit and/or vegetable juice or fruit and/or vegetable juice combined with water or carbonated water, with no added sweeteners in a serving size of not more than eight ounces.

In a multi-year tiered approach, each Covered Food Service Facility that sells children's meals shall: Offer the Healthy Drink as the default beverage as defined by Section 12-216(f)(2) in Years 1-2 and thereafter. Offer the Default Healthy Side in all Children's Meals in Years 2-3 and thereafter. Offer at least one children's meal that is a Healthy Children's Meal as defined by Section 12-216(f) in Years 3-4 and thereafter. Beginning in Year 5 and thereafter, enforcement will commence. Children's Beverage Requirement Each Covered Food Service Facility shall make the default beverage for children's meals a Healthy Drink option as defined in Section 12-216(f)(2), and the options provided there shall be displayed on menu boards.

Nothing in this Section prohibits a Covered Food Service Facility's ability to sell, or a customer's ability to purchase, a substitute or alternative beverage instead of the default beverage offered with a children's meal, if requested by the purchaser of the children's meal. The Health Department, in conjunction with the Department of Permits and Inspections, and Enforcement shall administer and enforce this chapter. These departments may issue rules and regulations as necessary to carry out the purposes of this chapter consistent with existing enforcement, recordkeeping and fine structures, and the State Regulations adopted in Subtitle 12, Subdivision 1 as amended by Subdivision 2 of the County Code in all manner of enforcement except as provided in Subsection (d)(3)(A) of this Section.

It is hereby declared by the County Council of Prince George's County, Maryland that a healthy restaurant program shall be established. Communities are trying to address the health effects of restaurant food in a variety of ways. By establishing a healthy restaurant program, local governments can support and give incentives to restaurant owners who are willing to offer healthier foods. Restaurants apply to the program, agree to meet certain standards, and, in exchange, receive benefits, including free publicity and help implementing healthy changes.

Healthy Meal Options shall mean food items deemed "healthy" by the Health Department's Prince George's Healthcare Action Coalition. Healthy Restaurant Program (the "Program") shall mean a voluntary healthy restaurant incentive certification program whereby the County provides grants, loans, and other incentives including free promotions to restaurants carrying healthy food and drink options on their menus. Promotions shall mean publicity, advertising, marketing and signage promoting the restaurants under the Healthy Restaurant Program.

Restaurants, as a condition of participating in this program, shall: Provide a menu of options whereby 40% of their total number of entrees are deemed healthy by the Prince George's Healthcare Action Coalition and includes at least one healthy plant-based meal. Participate in periodic program promotions and celebrations such as County-sponsored "Restaurant Weeks" and other such events. Renew their membership every two years on the condition that the restaurant continues to satisfy the requirements of subsection (a) of this Section.

The Prince George's Healthcare Action Coalition will work with a hired dietician who will approve applications and collaborate with restaurants to analyze menu meals and recommend healthy options at no cost to the restaurant, ensuring that no "healthy" entrées exceed the Prince George's Healthcare Action Coalition's specified levels of total fat, saturated fat, cholesterol, or sodium permitted. The Prince George's Healthcare Action Coalition will work with a hired compliance coordinator that will ensure that participating restaurants are in compliance with the Healthy Restaurant Program. The Economic Development Corporation shall provide free promotions for the restaurants certified under the Program. The Economic Development Corporation shall provide zero-interest loans for the restaurants certified under the Program. In terms of promotions, the County shall: promote restaurants certified under the Program and the Program itself on the Prince George's County website and on local government channels or programming. The Experience Prince George's office shall work the Prince George's Healthcare Action Coalition to: Engage with local media outlets to announce new healthy restaurants under this Program; and create promotional materials and provide a list of healthy restaurants to local elected officials, government commissions, committees agencies, local hospitals, colleges, universities, parent associations, large employers, local YMCAs, gyms, health clubs, local schools, and affiliated parent associations and encourage them to order food from participating restaurants; and set up a Program website with information about the healthy restaurants under this Program with links to menus; and promote Healthy Restaurants during annual "Restaurant Weeks" or similar events.

The Health Department shall administer and enforce this chapter. The Health Department may issue rules and regulations as necessary to carry out the purposes of this chapter consistent with the State Regulations adopted in Subtitle 12, Division 2, Subdivision 1 as amended by Division 2, Subdivision 2 of the County Code in all manner of enforcement except as provided in Subsections (b), (c), and (d) of this Section. Failure of the restaurants to comply with the requirements under Section 12-221(a), shall constitute a breach of that condition and shall result in revocation of those restaurants from the Healthy Restaurant Program, which, in turn, shall result in all zero interest loans disbursed to the restaurants converting to interest bearing loans calculated at the market rate existing at the time of the breach. The revocation in subsection (b) of this Section shall be for one year. If the restaurant satisfies the repayment requirements under subsection (b), they may be reinstated under the Program and the original loan shall revert back to a zero-interest loan. The restaurant may voluntarily withdraw from participation in the Program without being subject to subsection (b) if they can demonstrate economic hardship to the satisfaction of the Economic Development Corporation.

This Act shall be known and may be cited as the "Prince George's County Food as Medicine Health Program Act of 2025."

The Prince George's County Department of Health ("Department") shall establish and administer a Food as Medicine Health Program ("Program") to plan, implement, expand, and evaluate medically supportive food and nutrition interventions to improve public health outcomes. The Program shall prioritize serving residents experiencing food or nutrition insecurity and those diagnosed with or at risk for diet-related chronic conditions, such as hypertension, diabetes, or cardiovascular disease and shall develop and implement an educational component of the Food as Medicine Health Program to serve these residents.

The Department may contract or partner with: public and nonprofit healthcare providers, including community health clinics and Federally Qualified Health Centers (FQHCs); and nonprofit groups, such as food banks, food pantries and meal delivery organizations; and grocery stores; and health insurers; and local farms, food hubs, and agricultural cooperatives; and socially disadvantaged, minority-owned, or community-based food producers; and academic and research institutions for data collection and evaluation; and neighboring jurisdictions as a part of a collaboration seeking funding, in whole or in part, from the Washington Metropolitan Council of Governments. The Department shall encourage use of locally or regionally sourced foods grown using organic, regenerative, or culturally appropriate sustainable practices.

The Program may support the following interventions, as prescribed by healthcare professionals: medically tailored meals to meet individual needs aligned with evidence-based dietary guidelines; and produce prescriptions redeemable at grocery stores, food hubs, farms, farmers markets, or farm stands, prioritizing partnering with authorized farms that accept nutrition benefits such as Supplemental Nutrition Assistance Program (SNAP); and nutrition and health coaching, culinary education, including hands-on cooking or cook-along classes, or group medical visits; and food delivery or pick-up services tailored to health needs; and range of foods that are often included in FAM programs, such as healthy shelf stable goods, fresh and frozen proteins, and minimally processed local produce, in addition to fresh produce.

Established. There shall be established a Food as Medicine Health Program Workgroup ("Workgroup"). Powers and Duties of Workgroup. The Workgroup shall have the power and duty to: Advise the Prince George's County Department of Health, the County Executive and the County Council on issues and recommendations regarding the format and scope of the Program. Advise the Prince George's County Department of Health, the County Executive and the County Council on issues and recommendations regarding the Food as Medicine Health Program partnerships, education, eligible interventions, use of funds, Department reporting and implementation, technical assistance, and funding. The Workgroup can request assistance from other experts on an as needed basis to achieve its goals and objectives. Workgroup Composition; Term; Officers. The Workgroup shall be composed of twenty-one members (21) nominated by the County Executive and confirmed by the County Council. The twenty-one members (21) shall represent each of the following: One member shall be the Council Member who sponsored this legislation, and shall serve as Chair. Two members from Federal Qualified Health Care Centers (FQHCs) based in the County. One member of a County-based nonprofit serving frequently underserved communities who utilize Federal Qualified Health Care Centers (FQHCs). One member from the County Health Department. One member from the Office of Food Security of the Department of Social Services. One member from the Department of Family Services. One member from the Office of Management and Budget. One member from the Prince George's County Public Schools. Two members from County-based hospitals and medical systems. One member of the County's Soil Conservation District. One member who is an owner or operator of a County-based farm. One member who is a Community Health Program Manager or equivalent position from a grocery store chain operating within the County. One member who is a County-based registered dietitian. One member from the Prince George's Food Equity Council. One member from a health insurance provider that provides wellness incentives, such as lifestyle medicine programs, to their clientele. One member from the Health, Wellness and Hospitality Division of the Prince George's County Community College. One member who is a County-based chef or culinary instructor. One member who is a nutritionist. One member from the community. Meetings. The Workgroup shall meet in public session monthly and upon call of the Chair. The public meetings may be held in person or virtually. Reports. A first report containing the Workgroup's recommendations regarding the format and scope of the Program shall be made to the Department, the County Executive and the County Council one year after the first meeting of the Workgroup. The report should also include any recommendations or requests it deems appropriate to further the public purpose of the Program. Twelve (12) months after the transmittal of the first report, the Workgroup shall submit to the Department, the County Executive and the County Council an annual report on its functions, activities, accomplishments, plans and objectives. The annual report should also include any recommendations or requests it deems appropriate to further the public purpose of the Workgroup.

Program funds may be used to: develop and expand eligible interventions; and provide grants or reimbursements to community-based organizations and healthcare providers; and build infrastructure for food distribution and delivery; and support administrative functions, including staffing, reporting, and evaluation.

Within three years of the actual start of the Program, the Department shall issue a public report evaluating: program impacts on health outcomes and healthcare utilization, including emergency room visits, hospital admissions, and medication adherence; and changes in participant food security and dietary behaviors; and community economic development, especially related to local food producers; and recommendations for future improvements and funding needs. Data, including qualitative data, shall be disaggregated by geography, race/ethnicity, age, and income, where feasible.

The Department shall coordinate technical assistance for local food producers and distributors, prioritizing partnering with authorized farms that accept nutrition benefits such as Supplemental Nutrition Assistance Program (SNAP), seeking to participate in the Program. Priority shall be given to small, minority-owned, and socially disadvantaged producers implementing regenerative, organic, or culturally appropriate agricultural methods.

The Department shall issue annual guidance regarding: eligible participant criteria and referral pathways; and nutrition intervention standards and dosage; and provider and vendor eligibility; and integration with existing Medicaid Managed Care Organizations and other County health initiatives.

The County shall seek federal, state, and philanthropic funding to support implementation and evaluation of the Program. The County shall encourage commitments to multi-year funding. The County Executive may include funds for the Program in the annual budget.