#  Collaborating for Positive Environmental Public Health Outcomes

# 2007 - 2008 

# 

#  Environmental Public Health Leadership Institute Fellows:

#  

**Larry Bergner, RS**

*Public Health Specialist Supervisor, NE Region*

Oklahoma State Department of Health

*111 NE 1^st^ Street, Pryor, OK 74361*

*918.636.9830*

[*Larryb@health.ok.gov*](mailto:Larrtb@health.ok.gov)

**Ray C. Hankins, CPA, MPH**

*Chief Financial Officer*

Oklahoma State Department of Health

*1000 NE 10^th^ Street, Oklahoma City, OK 73117-1299*

*405.271.4042*

[*RayH@health.ok.gov*](mailto:RayH@health.ok.gov)

**Tressa Madden, MPH, REHS**

*Director of Consumer Protection*

Oklahoma State Department of Health

*1000 NE 10^th^ Street, Oklahoma City, OK 73117-1299*

*405.271.5243*

[*tressam@health.ok.gov*](mailto:tressam@health.ok.gov)

**Richard McDaniel, BS, REHS**

*Group Manager*

Oklahoma Department of Environmental Quality

*707 N. Robinson, Oklahoma City, OK 73101*

*405.702.6188*

[*Richard.mcdaniel@deq.state.ok.us*](mailto:Richard.mcdaniel@deq.state.ok.us)

**Debbie C. Watts, MPH, REHS**

*Supervisor, Consumer Protection Division*

Tulsa Health Department

*4616 E. 15^th^ Street, Tulsa, OK 74112*

*918.595.4305*

*<dwatts@tulsa-health.org>*

# Mentor:

### **Mark Miller, RS, MPH**

*Captain, US Public Health Service*

Senior Environmental Health

Center for Disease Control and Prevention

National Center for Environmental Health

Environmental Health Services Branch

# Acknowledgements:

-   **Tribal Governments and Facilities Visited**

Cheyenne Arapaho Nation -- Lucky Star Casino, El Reno, OK

Chickasaw Nation -- Riverwind Casino, Norman, OK

Iowa Tribe -- Cimarron Casino, Perkins, OK

Potawatomi Nation -- Firelake Casino, Shawnee, OK

-   **Fan Robinson, Director, Indian Health Services, Oklahoma City,
    OK**

-   **Danny Walters, Indian Health Services, Oklahoma City, OK**

-   **Our respective supervisors and organization management for their
    allowance of time and support to complete this project**

Linda Axley, Administrator, Mayes County Health Department, OSDH

Gary Collins, ECLS Division Director, ODEQ

Monty Elder, Emergency Response Coordinator, ODEQ & EPHLI fellow

Ted Evans, former Consumer Health Service Chief, OSDH & EPHLI fellow

David Freede, Assistant Director -- ECLS Division, ODEQ

Rocky McElvany, Chief Operating Officer, OSDH & former EPHLI fellow

Elizabeth Nutt, Consumer Protection Division Director, Tulsa Health
Department

Tim Tallchief, Deputy Commissioner, Administration Services, OSDH

> ![](media/image1.jpeg){width="1.3756944444444446in"
> height="0.6368055555555555in"}

# EXECUTIVE SUMMARY:

Tribal nations have expanded operations into the gaming industry in
Oklahoma at an impressive rate. Concerns regarding consumer safety in
several environmental public health areas have resulted. Sovereignty
provides Tribes with the right to self govern. Tribal gaming facilities
operate outside the standard regulatory controls that currently oversee
other food service, water and wastewater, solid waste handling, vector
control and other environmental concerns within the State of Oklahoma.
Key stakeholders at the Oklahoma State Department of Health, Tulsa
City-County Health Department, and the Oklahoma Department of
Environmental Quality and others hope through collaborative efforts to
encourage consistent application of public health and environmental
public health oversight across all jurisdictions within the state.

Through the development and application of a collaborative model, key
stakeholders were identified and included in discussions aimed at the
adoption of uniform public health codes across all jurisdictions. A
"systems thinking" approach was utilized to identify and include all
stakeholders, to develop an understanding of the current reality, to
create a shared vision among stakeholders and to craft possible
solutions around these issues. Further goals of this collaborative
effort include the development of consistent approaches to training on
the uniform codes as well as exploring the possibilities and advantages
of sharing resources for training and other methods of assuring improved
public health and environmental public health outcomes across Oklahoma.

Site visits and stakeholder meetings were conducted at key facilities.
Great care was taken to ensure that tribal sovereignty was respected.
Apprehension related to governmental agency involvement created certain
barriers and concerns were noted. The result was the formation of
positive alliances and agreeable outcomes. Contacts were developed and
networking opportunities were planned. During a recent state
environmental public health meeting, 13% of the attendees were from
tribal jurisdictions, compared to 3% from the previous year.

The team was able to establish a positive working relationship with
several of the tribal jurisdictions in Oklahoma. Through diligent
networking, active listening, and the desire by all to better serve the
public, we feel that we have opened a door that was previously closed.
The first steps in building partnerships that improve communications
have been accomplished.

# INTRODUCTION/BACKGROUND:

The specific goals of the group project are tied closely to an issue not
unique to Oklahoma but certainly impacting our communities more so than
other areas across our nation. Indian or Tribal Gaming establishments
have been and are being constructed throughout Oklahoma at an impressive
rate. As of December 2001, twenty three tribes owned and operated 55
gaming facilities within Oklahoma.[^1] By the end of 2006, the number of
gaming facilities within the state had grown to 97 with over 45 thousand
individual gaming machines representing over 5% of the nations
gaming.[^2] Only two states have larger market share within this growing
industry.

Along with the expansion of gaming and the growth in the number of
facilities, certain environmental public health problems present
themselves. Many of these facilities operate food services ranging in
size from smaller canteen operations to much larger high volume buffets
and even up-scale restaurants. Combined, these facilities serve large
numbers of patrons within Oklahoma. The larger facilities make available
lodging to patrons along with swimming pools and other amenities. Each
have certain needs in relation to clean water supplies, sewage systems,
solid waste management, building and plumbing codes and other issues
normally regulated by public health or environmental public health
agencies.

These facilities exist and operate primarily on tribal or Indian trust
lands and are not subject to regulation by governmental agencies that
regulate similar matters on non-Indian lands. Jurisdiction and authority
to regulate such matters on tribal lands and thereby assure the
protection of the public's health is not vested in any single
governmental or non-governmental entity. Some tribes contract with the
Indian Health Service for regulation and oversight of these matters
while others have developed their own environmental services programs.

**The 10 Essential Public Health Services**

This project, "Collaborating for Positive Environmental Public Health
Outcomes", addresses many of the 10 Essential Services including:

●Diagnose and investigate health problems and hazards

●Inform, educate and empower people about health issues

●Mobilize community partnerships to identify and solve health problems

●Develop policies and plans that support individual community health
efforts

●Enforce laws and regulations that protect health

●Assure a competent workforce

As environmental health hazards and problems are diagnosed and
investigated, we are able to begin mobilizing partnerships with tribal
entities and state and local agencies. Through exchange of information,
education, and empowerment, we are able to push for development of
policies and plans that support community health efforts. As we look to
coordinate joint training opportunities with tribal entities and state
and local agencies, we assure a competent workforce that will be able to
effectively enforce laws and regulations that protect public health.

> ![](media/image2.wmf){width="3.627083333333333in"
> height="2.7090277777777776in"}
>
> Figure 1: Ten Essential Public Health Services, Carl Osaki (1995)

# PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES:

####### ***Program Goal***

The primary goal of our EPHLI group project is to attempt to address the
issue of providing consistent regulation of these establishments through
the implementation of a collaborative model attempting to ensure that
the protections provided citizens on tribal lands are the same as those
provided on non-tribal lands. Food services probably provide the most
obvious example. Retail food service establishments on non-tribal lands
are periodically inspected by public health officials, have certain
design requirements and are required to operate in compliance with
statutory requirements.[^3] The inspection process and compliance
requirements, set forth in the applicable regulations, exist primarily
for the protection of the public's health and to ensure the application
of basic sanitary principles. Currently, no such regulation exists for
similar facilities on tribal lands. This is not to imply that basic
sanitation is ignored in tribal facilities simply that such facilities
are not regulated in the same manner as non-tribal facilities.

####### ***Health Problem***

The current reality of the potential environmental public health issues
presented by the expansion of tribal gaming facilities throughout
Oklahoma is obvious. The gaming facilities on tribal lands present
jurisdictional issues for the regulatory authorities within the public
health and environmental public health agencies of state, county and
city-county governments. They operate independent of normal regulatory
constraints because of the sovereign status tribes have been granted
under treaties with the federal government.

Tribal gaming facilities across our state range in size from relatively
small establishments with minimal facilities and demands to much larger
facilities offering services comparable to resort hotel casinos in other
states operated on private versus tribal properties. Just as these
facilities vary in size, so do the demands they place on existing water
supplies, sewage systems and other infrastructures. The larger
facilities operate buffets, restaurants and other canteen operations
serving upwards of 1000 citizens per day. Providing basic public health
protections in these areas can not be assured in the absence of some
consistently applied form of regulatory oversight and control.

####### ***Outcome Objective***

To create collaboration among state, local, and tribal entities while
working towards agreements for uniform code adoptions, joint training
ventures, and open communications between these entities.

####### ***Determinant***

In Oklahoma, there is no agreement among tribal entities and state and
local agencies to use uniform codes. There is currently a lack of
communication among tribes and state and local agencies in determining
which codes are applicable and who has jurisdiction.

####### ***Impact Objective***

Develop networking opportunities that will bring all stakeholders
together so that collaboration and cooperation can improve to bring
about positive outcomes in regards to Environmental and Public Health.

####### ***Contributing Factors***

▪ The complexity of jurisdictional issues between tribal entities and
state and local agencies.

▪ Lack of resources committed to the purpose of building partnerships
among tribal entities and state and local agencies.

▪ Leadership and contact changes in tribal entities and state and local
agencies.

▪ A history of non-collaborative relationships between tribal entities
and state and local agencies.

####### ***Process Objectives***

We sought to improve communication between tribal entities and state and
local agencies to begin a process of collaboration and cooperation
statewide. We also sought to present opportunities for sharing resources
to provide joint trainings and networking opportunities which will lead
to partnership building among tribes and state and local agencies.

  ---------------- ---------- -------- -------------- -- --------- ------------------ -------- -- ---- -- --------
                                       **Leadership                                                       
                                       Project Plan**                                                     

                                                                                                          

                                                                                                          

  **Goal**                                                                                                

  Protection of                                                                                           
  the citizens of                                                                                         
  Oklahoma from                                                                                           
  potential                                                                                               

  detrimental                                                      **Health Problem**                     
  health outcomes                                                                                         
  emanating as a                                                                                          
  result of                                                                                               

  the expansion of                                                 Due to issues of                       
  tribal gaming                                                    sovereignty,                           
  facilities                                                       tribal gaming                          
  within the                                                                                              

  state.                                                           facilities within                      
                                                                   the state operate                      
                                                                   outside                                

                                                                   the regulatory                         
                                                                   controls                               
                                                                   established which                      

  **Outcome                                                        oversee various                        
  Objective**                                                      environmental                          
                                                                   public health                          

  Consistent                                                       concerns. The                          
  application of                                                   potential exists                       
  best practices                                                   that                                   

  relative to                                                      detrimental health                     
  environmental                                                    outcomes result                        
  and public                                                       from the                               

  health issues -                                                  absence of                             
  prevention                                                       regulatory                             
  focused                                                          oversight or                           

  food service,                                                    inconsistent                           
  water, waste                                                     oversight of these                     
  water, vector                                                    issues.                                

  control, built                                                                                          
  environment                                                                                             

                                                                   **Determinants**                       

  **Impact                                                         Inconsistent or                        
  Objective**                                                      absent uniform                         
                                                                   system of                              

  By July 2008,                                                    regulating the                         
  through                                                          various                                
  collaborative                                                    environmental                          
  efforts, seek                                                    public                                 

  adoption of                                                      health concerns                        
  uniform                                                          associated with                        
  standards                                                        the                                    
  (public health                                                                                          
  code) of                                                                                                

  regulation for                                                   expanding nature                       
  food service,                                                    of tribal gaming                       
  public water                                                     facilities.                            
  supply, waste                                                                                           

  water, solid                                                     These concerns                         
  waste                                                            include; food                          
  management,                                                      service,                               
  vector control                                                                                          
  and                                                                                                     

  built                                                            public water                           
  environment                                                      supply, waste                          
  issues by tribal                                                 water, solid                           
  entities                                                                                                
  engaging in                                                                                             

  the construction                                                 waste, vector                          
  and operation of                                                 control, building                      
  gaming                                                           code,                                  
  facilities                                                                                              

  throughout                                                       plumbing code,                         
  Oklahoma.                                                        swimming pools and                     

                                                                   recreational                           
                                                                   waters.                                

                                                                                                          

  **Process                                                        **Contributing                         
  Objective**                                                      Factors**                              

  Improve                                                          Multi agency                           
  Communications                                                   responsibility for                     
                                                                   oversight,                             

  Implement                                                        Multiple                               
  consistent                                                       jurisdictions                          
  training                                                         involved, Tribal                       
  programs                                                                                                

  Create                                                           sovereignty &                          
  collaborative                                                    apprehension                           
  training                                                         related to                             
  schedule                                                                                                

  Create a                                                         governmental                           
  Decision Tree                                                    intervention,                          
  for                                                              Issues of diverse                      
  Environmental                                                                                           
  Health issues                                                                                           

  Standardize                                                      scale, Issues of                       
  registration                                                     rapid expansion                        
  requirement                                                                                             
  guidelines                                                                                              

  Agree upon                                                       Varied economic                        
  professional                                                     resources and                          
  credentialing                                                                                           
  criteria                                                                                                

  Agreeing upon                                                    Issues of                              
  standards of                                                     conflicting                            
  practice                                                         priorities                             

                                                                                                          

                                                                                                          

  **Activities**                                                   **Events**                             

  Identify                                                         OSEPH Meeting,                         
  appropriate                                                      October 2008                           
  parties to                                                                                              
  involve                                                                                                 

  Create                                                           Stakeholder                            
  communication                                                    Meetings, Ongoing                      
  opportunities                                                                                           

  Create schedule                                                  EPHLI Team Member                      
  of meetings                                                      Meetings, Ongoing                      

  Draft policy of                                                  Site Visits to                         
  cooperation                                                      Facilities                             
  agreement                                                                                               

  Agree on overall                                                 Professional                           
  objectives                                                       Organization                           
                                                                   Meetings                               

  Send letters of                                                                                         
  intent for                                                                                              
  involvement                                                                                             

  Clearly state                                                                                           
  and communicate                                                                                         
  project goals                                                                                           

                                                                                                          
  ---------------- ---------- -------- -------------- -- --------- ------------------ -------- -- ---- -- --------

# METHODOLOGY AND RESULTS:

####### ***Events and Activities***

The reality of the problems or potential problems presented by the
expansion of tribal gaming facilities within Oklahoma are predominantly
a result of a fragmented system of oversight and regulation. The system
is fragmented due to the number and variety of public and other entities
involved. The jurisdictional issues previously discussed and varieties
of public and environmental public health concerns further complicate
the current reality. Our response to the problem or problems was the
development of a collaborative model (Figure 2) aimed eventually at the
adoption of uniform public health codes across all jurisdictions. A
"systems thinking" approach was utilized to identify and include all
stakeholders, to develop an understanding of the current reality, to
create a shared vision among stakeholders and to craft possible
solutions around these issues.

## **Figure 2**

##  **The Collaborative Model**

Further goals of this collaborative effort include the development of
consistent approaches to training on the uniform codes as well as
exploring the possibilities and advantages of sharing resources for
training and other methods of assuring improved public health and
environmental public health outcomes across Oklahoma. The abstract
developed as part of the group project attempts to concisely state our
approach in the "Methodology Used" section.

Although the abstract describes our approach, much of the detail of the
work of the group occurred behind the scenes. Behind the scenes, a
project model was developed and timelines were established for the
accomplishment of specific tasks. A "systems thinking" causal loop or
"archetype" was identified which best portrayed the scenario and helped
group members understand the dynamics of the current reality and how the
regulatory entities within Oklahoma could be "Accidental Adversaries" of
the various tribal organizations building and operating gaming
facilities within the state. The "Accidental Adversaries" archetype is
presented in template form in Figure 3 and again in completed form in
relation to the stated problem. The completed template describes the
problem from our perspective in Figure 4. In the completed template "A"
represents the regulatory agencies and "B" represents the various tribal
organizations.

#### Figure 3

#### Accidental Adversaries Template

![](media/image3.png){width="7.625in" height="5.485416666666667in"}

# RESULTS:

1.  General text

The exterior loop of the template describes and leads to optimal
outcomes for both A and B. The interior loo

The exterior look of the template describes and leads to optimal
outcomes for both A and B. The interior loops describe a more
adversarial relationship between the parties and deter the success of
both parties. The interior loops are representative of the situation
prior to the collaborative efforts of the group. We are hopeful that the
actions of both parties, which inhibit overall success, the interior
loops, can be minimized through genuine collaborative efforts which
accept the current reality and acknowledge a shared vision of optimal
public health outcomes.

**Figure 4**

**Accidental Adversaries -- Completed in relation to the problem**

![](media/image3.png){width="6.874305555555556in"
height="4.945138888888889in"}

# CONCLUSIONS:

General Text

# LEADERSHIP DEVELOPMENT OPPORTUNITIES:

####### ***Larry Bergner***

In the completed template, the regulatory agencies and other
stakeholders desire to maintain collaborative efforts which respect the
sovereign status of the tribes and creates or reinforces their desire to
invest in positive public health outcomes.

Again, the inside loops present something more in line with the current
reality. Presently the regulatory agency's desire to implement
consistent application of public health codes is seen as infringement on
the sovereign status of tribes. That infringement leads to resistance to
intervention in tribal business operations and potentially to negative
health outcomes.

Closer observation of the interior loops describes the results and
unintended consequences of each party's isolated fixes. The regulatory
agency's desire to implement consistent code is seen as success for them
and as infringement by the tribes. The tribes' resistance to
intervention appears to maintain their sovereign status but may not
ensure optimal public health outcomes. Only through collaborative
efforts and a shared vision will the positive aspects of the outside
loop come to fruition.

The group conducted site visits at four tribal gaming facilities across
central Oklahoma. We chose to visit two small facilities and two large
facilities. Obtaining invitation or permission for these visits was a
first step in a collaborative process that is the basis of our project.
Identifying contacts within the facilities chosen and obtaining the
appropriate permissions was an interesting process. Contacts at the
Indian Health Service and Mr. Tim Tall Chief of the health department
assisted in providing contact information and arranging visits. Cultural
sensitivities played a part in this as well in that invitations were not
granted without being channeled through and approved by the Chief or
Chairman of the tribe owning or operating the facility.

The group conducted visits at two larger facilities, the Firelake Grand
Casino in Shawnee and the Riverwind Casino in Norman. Both are
impressive operations, serving large numbers of patrons. Their food
service operations employ hundreds of staff and operate multiple
commercial kitchens at each location. At one location, vendors rent food
service space inside the facility and operate independent of the casino
owned food services that function out of separate kitchens. Additional
visits were made to two smaller facilities in Concho and Perkins.
Although these facilities operate much smaller food service operations,
our concerns are consistent regardless of facility size.

The site visits were simply a means of gaining introduction to the
persons responsible for the food service and physical plant operations
within each of the facilities and to develop a better understanding of
the possible environmental concerns at each site. Additionally, we used
these visits as an opportunity to explain to potential partners the
goals of our project and our desire to collaborate for positive health
outcomes. Before making these site visits, the group constructed mental
models of possible conversational scenarios around the completed
archetype and practiced in an effort to prepare for the meetings. We
were mindful of the issues of jurisdiction and wanted the visits to
serve primarily as a means to open communications with stakeholders.

What we found in our visits were that the primary concern of a public
health or environmental public health nature surrounds the food services
provided in these gaming facilities. Not that other concerns do not
exist but that the food service concerns were the most prominent and
immediate.

The facilities visited have tied into municipal water and sewage systems
and as a result our concerns are less immediate in those areas. Aside
from impacting local systems from a demand standpoint additional
sanitary concerns appear minimal if proper plumbing considerations were
addressed. One facility even went as far as financing a wastewater lift
station for a local community that increased capacity in the area. We
saw this as an excellent example of where tribal gaming initiatives were
impacting Oklahoma in a positive fashion.

The group had concerns originally about how these facilities are
constructed and whether or not building codes, plumbing, electrical and
mechanical codes and others were adhered to in the construction process.
Smoking is prevalent in the gaming facilities and proper air exchange
rates, ventilation and fire safety systems are obviously public health
concerns at some level both for the patrons and employees of these
establishments. Some of the larger facilities provide swimming pools and
we have concerns regarding their design, construction and operation. In
these areas, just as with our concerns related to food services, tribal
entities are not bound by the regulatory processes required of similar
facilities on non-tribal lands. Although concerns remain in these areas
we chose not to focus on them in the initial stages of the collaborative
process.

Again, the concerns surrounding the food service operations appear to be
the most immediate. According to notes from one visit, the Fire Lake
Grand Casino employs over 400 staff in food service operations, serves
upwards of 1000 meals daily through 7 separate commercial kitchens with
some operating 24 hours a day. In such large operations the potential
for food borne outbreaks is a reality and some level of protection must
be provided through basic sanitary practices. Without oversight and
regulation of these facilities similar to that provided for non-tribal
enterprises we are uncertain of how the public's health is protected.

What we found is that in both the larger and smaller facilities the
Indian Health Service (IHS) either does periodic food service
inspections or coordinates with tribal environmental specialists in
relation to their own environmental program. Representatives from IHS
indicated that the services they can provide are limited due to resource
constraints. They operate through contracts with the tribes for these
services and funding is simply inadequate to provide sufficient
oversight. The rapid expansion of these facilities has placed additional
burden on IHS resources in this area. The result is less frequent or
non-existent visits to observe environmental health issues at individual
sites. These facts emphasized the need for a collaborative approach to
the overall problem.

**CONSULSIONS:**

Through the contacts made and the opening dialogue we believe seeds have
been planted which will eventually grow into the collaborative model we
envision. Identifying stakeholders and seeking their involvement in the
process was a first step and appears to have produced results in the
short term. At a recent professional association meeting, attendance
from tribal entities was up substantially. Tribal representation at the
annual Oklahoma Society of Environmental Health Professionals (OSEHP)
meeting held recently was much improved over the previous year. Thirteen
percent (13%) of attendees at this meeting represented tribal interests
where only three percent (3%) did so the previous year. It is hoped that
our project and involvement has increased their interest and
participation. This professional organization, although made up of
individuals from other stakeholder entities will play a significant role
in the collaborative initiative we envision.

In keeping with the systems thinking approach, we believe our response
to this problem is taking shape. Identifying and involving key
stakeholders was the obvious first step. Assuring that all involved
understand the current reality (defining and agreeing on the problem) is
the next step and we feel that is being accomplished. Creating a shared
vision and seeking long-term versus short-term solutions comes next. We
are hopeful that over time all these things will be accomplished and
more consistent protections of the public's health can be provided
across all jurisdictions in Oklahoma.

**LEADERSHIP DEVELOPMENT OPPORTUNITIES:**

***Larry Bergner***

I am proud to have been able to work with such wonderful people as those
who have spent this past year in EPHLI. This has been a rigorous, yet
rewarding adventure. I have learned to be a systems thinker which has
broadened my skills as a District Supervisor in Oklahoma. The institute
allows for an opportunity to brainstorm with other professionals and
create a network of friends with a common goal, that is, to improve
public health. The institute has taught me to think "big picture" rather
than just locally. I am grateful for the opportunity and want to thank
all of the EPHLI staff for making this a very productive year.

***Ray Hankins***

Involvement in EPHLI has been an interesting and challenging experience.
My educational background and work experience in Public Health varies
somewhat from the other members of my EPHLI group. My experience has
been primarily in the financial and business affairs of a large state
public health agency. My exposure to Environmental Public Health issues
prior to this program was minimal and I believe I learned a great deal
from the curriculum and exposure to other group members and fellows.
Training in various leadership skills, the systems thinking approach,
the 360 degree evaluation and other aspects of the program should
benefit me greatly when applied in both business and personal settings.
I enjoyed immensely the opportunity to participate in the program.

***Tressa Madden***

The experience of this program and what it has done for my professional
and leadership skills have moved my career to a new level, it has been
very rewarding. It has challenged my abilities on system thinking and
given me new ideas and approaches toward enhancing a program I oversee
during times of limited resources. The team aspect and the encounters
that were involved to complete the project were challenging. I look
forward to the continued work we have planned and the collaboration with
all the other government agencies that have developed throughout this
past year. I have enjoyed meeting and developing friendships throughout
the nation. I thank EPHLI for the opportunity and the challenges you
have given me.

***Richard McDaniel***

This has been a wonderful experience to be a part of EPHLI. It has been
an eye opening experience for me to see how I perceive myself and my
leadership skills and how I am perceived by others. I have learned ways
to look at things that allow me to see beyond what I think are problems
and see how it can affect others. I have made many friends and contacts
through this program that I believe will be valuable resources for years
to come. I feel that some of the leadership skills that I have developed
from this class and the assignments we have worked on will be of great
benefit to me personally and also to the agency that I work for. I am
very thankful for the opportunity to work with my team members and the
staff of EPHLI.

***Debbie Watts***

The guidance and information provided by the EPHLI has enabled me to
expand my knowledge base and develop new leadership skills. Through the
introduction of the various personality assessment tools, I was able to
better understand myself, my work habits, and my project approaches. It
has enabled me to become more efficient and effective in my job. The
networking opportunities with peers throughout the country, as well as
with the mentors and seminar speakers, has assisted with the interchange
of ideas and sharing of materials to improve my local program and better
serve the public. In maintaining these new contacts, I hope I can
continue to grow and improve myself and my community.

# ABOUT THE EPHLI FELLOWS

**Larry Bergner**

Larry Bergner has been employed as a Public Health Specialist since
1992. He began his career with the Oklahoma City/County Health
Department and then transferred to Enid, Oklahoma in 1996 with the
Oklahoma State Department of Health. Since 2002 he has held the position
of the NE Region Public Health Specialist Supervisor covering 18
counties in Northeast Oklahoma.

**Ray Hankins**

Raymond C. Hankins (Ray) has been employed by the Oklahoma State
Department of Health for over twenty-two years, serving in various
administrative and financial functions of the department. He has served
as the Chief Financial Officer for the department since February 2000
and reports to the Deputy Commissioner of Health for Administrative
Services.

Ray is a Certified Public Accountant, a Certified Procurement Officer,
holds a Bachelor of Science in Accounting from Oklahoma State University
and has recently obtained his Masters in Public Health in Occupational
and Environmental Health at the University Of Oklahoma College Of Public
Health.

Ray's current position and responsibilities include oversight of the
accounting and budgetary functions of Oklahoma's state health department
with an annual operating budget of over 360 million dollars. He is
responsible for communicating the financial condition of the department
to the leadership, the department's governing board, the state
legislature and other partners and interested parties. Policy
development, strategic planning, program evaluation and other leadership
functions are recurring aspects of his role within the department.

**Tressa Madden**

Tressa is the Director of the Consumer Protection Division at the
Oklahoma State Department of Health. She has been employed with the
Department for 21 plus years. Ms. Madden is responsible for supervising
a multifunctional program in the Consumer Health Division that include,
local restaurants, hotel/motel, swimming pools, complaints, nuisances,
rabies prevention, mobile, seasonal and special events that are handled
from each county. Programs that are handled from the state level include
Consumer Product Safety Commission, bedding, body piercing/tattooing,
bottled water, drugs, medical devices, health fraud, food manufacturing,
wholesale foods, salvage foods, water vending, medical micropigmentation
and Department of Corrections Facility inspections. Certifications and
registrations include being commissioned as an officer of the DHHS-Food
and Drug Administration, Consumer Product Safety Commission, Better
Processing Authority, FDA Standardized and a Registered Environmental
Specialist/Registered Sanitarian.

Professional Organizations include: Oklahoma Public Health Association
having served as Vice-President, Secretary, Treasurer, Councilor, and
Section Chair; Oklahoma Society of Environmental Health Professionals
having served as President-Elect, Vice-President, Secretary, Treasurer,
Regional Delegate and currently serving as President; Mid-Continent
Association of Food and Drug Officials, currently serving as
Vice-President; Member of the National Environmental Health Association;
and Member of the Association of Food and Drug Officials. Ms. Madden is
also a member of the Conference for Food Protection and has been chosen
to set on three committees that include: Sanitizer Committee, Food
Recovery and Plan Review Committee. She has become a Fellow of the Class
of 2005 Oklahoma Public Health Leadership Institute.

**Richard McDaniel**

Richard began his career with the Oklahoma State Health Department in
1990. Job duties at this time entailed performing food, water,
wastewater, daycare, swimming pool and barber shop inspections.

In 1993, the Oklahoma Department of Environmental Quality was formed and
he transferred to the new agency. The DEQ performs regulatory functions
for water, wastewater, solid waste and air quality facilities. Richard
is now a District Manager for the western half of the state and is over
the Storm water Program for Environmental Complaints and Local Services
(ECLS).

Duties at the DEQ include working with the New Employee Training Program
as well as overseeing debris management for disasters that seem to occur
all too often in Oklahoma.

**Debbie Watts**

Debbie holds a BA degree from the University of Tulsa, and a Master's
Degree in Public Health in Health Administration and Policy from the
University of Oklahoma. She also attended East Central University where
she obtained her biology and chemistry background. She has been with the
Tulsa Health Department over 10 years, starting out as an inspector and
food handler instructor, then food handler program coordinator, before
becoming a Field Supervisor in 2003, the position she currently holds.
Debbie assists with training for new employees, is an FDA
Standardization Officer, and coordinates the Plan Review and
Construction program for Tulsa County.

Professionally, Ms. Watts is a member of the National Environmental
Health Association, the Oklahoma Society of Environmental Health
Professionals, where she is currently the president-elect, the Oklahoma
Public Health Association, the Mid-Continent Association of Food and
Drug Officials, and the Conference of Food Protection. She is currently
serving on several committees with the Conference for Food Protection
and will serve on Council II during the upcoming meeting.

# REFERENCES

[^1]: Kenneth W. Grant, Katherine A Spilde, Jonathan B. Taylor, Social
    and Economic Consequences of Indian Gaming in Oklahoma, Joint
    Occasional Papers on Native Affairs, No. 2003-04, p. 2, available at
    <http://www.jopna.net/pubs/JOPNA04_Okla.pdf>

[^2]: Gaming sees big growth, News Article, Newsok.com, October 13,
    2007, available at <http://newsok.com/article/3147041/1192247659>

[^3]: Oklahoma Administrative Code, Title 310, Chapter 257, Food Service
    Establishments, available at
    <http://www.health.state.ok.us/program/cpd/257Food2006.pdf>