Washoe County 

Health District 

Agenda Item No.5. 

Washoe County District Board of Health 

Meeting Minutes 

February 28, 2013 

PRESENT: Mr. Matt Smith, Chairman, Commissioner Jung, Vice Chair, Dr. George Hess, Dr. George Furman, Dr. Humphreys, and 

Councilwoman Zadra 

ABSENT: Councilwoman Ratti 

STAFF: 

3. 

Kevin Dick, Acting District Health Officer, Division Director, Air Quality 

Management 

Eileen Stickney, Administrative Health Services Officer, Administrative 

Health Services 

Robert Sack, Division Director, Environmental Health Services 

Charlene Albee, Branch Enforcement Chief, AQM 

Lori Cooke, Fiscal Compliance Officer, AHS 

Phil Ulibarri, Public Information Officer, AHS 

Leslie Admirand, Deputy District Attorney 

Erin Dixon, Public Health Educator 

Nicole Mertz, Public Health Nurse II 

Janet Smith, Administrative Secretary 

Peggy F. O'Neill, Recording Secretary 

\"Cllleu to _ ......... , 

Steve Kutz, Division Director, Community and Clinical Health 

Services 

Randall Todd, DrPH, Division Director, Epidemiology and Public 

Health Preparedness 

Daniel Inouye, Air Quality Supervisor, AQM 

Patsy Buxton, Fiscal Compliance Officer, AHS 

Steve Fisher, Department Computer Application Specialist, AQM 

Peg Caldwell, Registered Nurse I, EPHP 

Diane Freedman, Public Health Nurse 

Christina Conti, Public Health Emergency Response Coordinator 

Katy Hill, Office Assistant II 

Tony Macaluso, Environmental Health Specialist Supervisor 

Paula Valentin, Administrative Assistant I 

Pledge of Allegiance and Roll 

Call 

Allegiance led by Commissioner Jung. Roll call was taken and a quorum 

noted. 

Public Comment Chairman Smith stated prior to Public Comment that Agenda Item No. 12 will 

be pulled from this agenda. Dr. Hess requested that Chairman Smith not pull 

the item from the agenda. Ms. Admirand confirmed that it is within the 

Chairman's discretion to pull an item. 
done so for the past 23 years . . He is in attendance to speak in opposition to 

the proposed fee increase for instructors. He stated that the last tim.e he 

came to oppose a fee increase itwas a proposed $700 increase, and the 

DBOH agreed with the instructors that we were doing our part in the · 

community. 

Dr. Hess questioned Mr. Allen about what the particular fee is and where it is 

referred to in the schedule. 

Mr. Allen further stated that there is no other jurisdiction in the state of 

Nevada or as far as he knows in the state of California that has any such fee 

for private contractor instructors. Instructors are constantly fighting a cycle of 

increasing fees here at the Health District. The State of Nevada charges no 

fees and is happy to have us in the field teaching so that they do not have to 

provide this service. Mr. Allen directed to the DBOH to the handouts he 

provided, a copy of which was placed on file for the record. 

Dr. Hess stated that if he is looking at the correct fee, it is only $44; it went 

from $27 to $44. 

Mr. Allen stated that it increased from $225 to $271, even though the DBOH 

had in the past recommended a possible decrease in the fee. 

Chairman Smith stated that the Board will take that into consideration. 

Mr. Alan Cook, Assistant Executive Chef at John Ascuaga's Nugget. He has 

b~en instructing Food Service Sanitation for about 20 years. We as 

instructors provide a service for Washoe County. We are working as 

subcontractors. We do not operate without the approval of Washoe County. 

We have permits from the County to operate. Why are we continuously 

charged fees to do the job they don't want to do. According to their figures, 

for them to teach a class, it costs over $860. We incur expenses to teach a 

class. We are not subsidized by the Washoe County Health District. Why are 

we charged by the Health District when we generate revenue for the District? 

For every person that we certify, there isa minimum of $32 that goes into the 

coffers of the Washoe County Health District. In the last two months, he has 

certified 25 people. According to the Health District's figures, we certify about 

825 people per year. That is a significant amount of money. 

Dr. Hess questioned staff if the fee is only charged every five years, and it 

was confirmed, the fee is essentially $54 per year. 

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4. Approval/Deletions - Agenda . 

- February 28, 2013 

Peter Rathmann withdrew his Public Comment Card. 

Fred Turnier, Community Development Coordinator for the City of Reno,. read 

a letter from the City Manager of Reno to the DBOH into the record. The 

letter was placed on file for the record. The City OT Reno is requesting that 

Health District staff and City of Reno Staff work together on this issue. 

Dr. Hess asked Mr. Turnier which particular fees they are concerned about, 

and Mr. Turnier replied that it would be the entire section related to 

Environmental Health Services, but specifically the City charges a fee for 

Master Plan Amendments, changing a designation from Professional Office to 

Industrial, and there is no development associated with that it is just a land 

use change. We charge $205 for the Health District. So from an applicability 

standpoint, how does that action of the City impact the action of the Health 

District? There may bea simple answer for that but at this point we have 

questions regarding that process. We want to be able to .communicate the 

reasoning behind it to our customers. 

Chairman Smith closed the pl,lblic comment. 

Chairman Smith called for any deletions to the Agenda of the February 28, 

2013 DBOH Meeting. 

Chairman Smith stated that he would like to pull Item No. 12 from the 

agenda. 

Dr. Humphreys moved, 

seconded by Councilwoman 

Zadra (with a note), that the 

February 28, 2013, Agenda 

be approved as modified. 

Note: Councilwoman 

Zadra stated that we need 

extensive public outreach 

on this matter. Sh_e wants 

to know the impacts of 

these fees. She would like 

distinction and clarity on 

how the multipliers were 

determined. She would like 

a full explanation of how 

that is determined. 

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5. 

6. 

7. 

8. 

Approvall AdditionslDeletions 

to the Minutes of the 

January 24, 2013 Regular 

Meeting 

Recognitions 

Proclamati.ons 

Consent Agenda 

Chairman Smith called for any additions or corrections to the minutes of the 

January 24,2013 Regular Meeting. 

Mr. Dick and Chairman Smith made the following recognitions: 

A. Introduction of new employee(s) - Genine Wright, AQM - Air QUqlity 

Specialist I -

B. Promotions - None. 

C. Years of Service - Diane A. Freedman - CCHS - 20 years 

D. Recognitions-

(1) Certificate of appreciation to the Washoe County Health District from 

the United States War Dog Association for the support and generosity of 

your staff - presented to Janet Smith 

(2) Medical Interpreter Certification - Maria Magana 

E. Retirements - Katie Hill, CCHS - 22.5 years 

None. 

A. Air Quality Management Cases: 

1. Unappealed Citations to the Air Pollution Control Hearing Board: 

a. Jackson Food Store #134 - Case No. 1110,Unappealed 

Citation No. 5234 - Staff reported Citation No. 5234, was 

issued to Jackson Food Store on December 13, 2013, for 

failure to comolete the reauired reoairs to the Phase II vaDor 

Opposed: Hess 

MOTION PASSED 

Dr. Hess moved, seconded 

by Commissioner Jung, 

that the minutes of the 

January 24, 2013 Regular 

Meeting be approved as 

presented. 

MOTION CARRIED 

Page 4 
recovery equipment within the specified timeframe, which is a 

major violation of Section 030.2175 of the Washoe County 

DBOH Regulations Governing Air Quality Management. Staff 

recommends the citation be upheld and a fine in the amount of 

$1,500.00 be levied as a negotiated fine. 

2. Recommendation to Uphold Citation Appealed to the Air Pollution 

Control Hearing Board: None. 

3. Recommendation for Variance: None. 

B. Sewage, Wastewater & Sanitation Cases: None. 

C. Budget Amendments Iinteriocal Agreements: 

1. Staff recommends approval of Notice of Subgrant Award 

(continuation award) from the Nevada Department of Health and 

Human Services, Health Division, Sexually Transmitted Disease 

(STD) Prevention and Cohtrol Program, for the period January 1, 

2013 through December"31, 2013 in the amount of $119,023 in 

support of the STD Program, 10 10014; and authorize the Chairman 

of the Board to sign; 

2. Staff recommends approval of Grant Agreement #A-00905413-0 

(continuation agreement) from the U.S. Environmental Protection 

Agency (EPA) for partial funding in the amount of $524,508 for the 

period 10/1/12 through 9130/13 for the Air Quality Management, EPA 

Air Pollution Control Program, 10 10019. 

3. Staff recommends approval of Notice of Subgrant Award 

(continuation award) from the Nevada Department of Health and 

Human Services, Health Division for the period January 1, 2013 

through December 31 , 2013 in the amount of $99,223, for the 

Immunization Program Grant (lOs 10028 & 10029), and authorize the 

Chairman of the Board to sign. 

4. Staff recommends ratification of Interlocal Agreement between the 

Washoe County Health District (WCHD) and theBoard of Regents of 

the Nevada System of Higher Education on Behalf of the University 

of Nevada Cooperative Extension to utilize WCHD facilities for the 

"All 4 Kids©: Resiliencv in the ObesoQenic Environment: research 

ACTION ITEMS: (1) Letter 

to Jackson Food Store 

regarding fines and due 

dates; and (2) Letter to Ron 

Anderson regarding reappointment to SWS 

Control Hearing Board. 

Page 5 
project for the period upon approval by all parties through June 30, 

2013, unless extended by the mutual agreement of the Parties; in n.o 

event shall this agreement extend beyond June 30, 2018; and if 

approved, authorize the Chairman to execute. 

5. Staff recommends approval of donation of one 50 gallon tank with 

boom to the Churchill County Mosquito Vector and Weed Control 

District with a current market value estimated at $200. 

D. Staff recommends re-appointment of Ronald Anderson, P.E., to the 

Sewage, Wastewater and Sanitation (SWS) Control Hearing Board. 

9.1 Air Pollution Control Hearing 1 There were no cases heard this month. 

Board Cases Appealed to the 

District Board of Health. 

10. 1 Regional Emergency Medical 

Services Authority: 

A. Review and Acceptance of 

the Operations and 

Financial Rep9rts for 

January, 2013; and 

B. Update of REMSA's 

Community Activities Since 

January, 2013 

Mr. Jim Gubbels, Vice President of REMSA, reported that the DBOH 

members have been provided with a copies of the January 2013 Operations 

and Financial Reports; overall emergency response times for Priority One 

compliance was at 92%; in the 8-minute zone, it was 96%; for the15-minute 

zone, it was 94%; for the 20-minute zone it was 93%. For Priority Two 

compliance it was 96%. Advised the overall average bill for air ambulance 

service to date is $7,550, and overall average bill for ground ambulance 

services to date is $1,026. 

Commissioner Jung questioned Mr. Gubbels about the financial disclosures 

she had asked for at the February 11, 2013 jOint meeting. Mr. Gubbels stated 

that he will address those issues under the Community Activities portron of 

the report. 

Mr. Gubbels presented REMSA's community service activities since 

December, 2012. 

Mr. Gubbels stated that in response to Commissioner Jung's question at the 

February 11 , 2013 meeting about the asset to liability ratio, he has 

researched that issue, and currently REMSA is at 2.3% assets to 1 % liability. 

Councilwoman Zadra 

moved, seconded by 

Commissioner Jung, that 

the Consent Agenda be 

approved as presented in a 

single motion. 

MOTION CARRIED 

Commissioner Jung 

moved, seconded by 

Councilwoman Zadra, to 

accept the REMSA 

Operations and Financial 

Report for January 2013 as 

presented. 

MOTION CARRIED 

Page 6 
11. 

C. Presentation regarding 

REMSA's Healthcare 

Innovation Grant 

Inter-Hospital Coordinating 

Council ("IHCC") 

Presentatio·n Regarding 

Accomplishments 

Commissioner Jung clarified that she actually asked what REMSA's debt 

payments in dollars are each month. She believes that is information the 

DBOH needs ona regular basis due to the structure of the. Franchise 

Agreement since the DBOH would be successor in interest of all of REMSAs 

debt. For that reason she would like a clear statement and representation of 

that debt amount in the monthly operations report. 

Mr. Gubbels stated that those assets are worth $33 Million. REMSA's 

liabilities are worth $14 Million. Those dollars change on the budget sheet 

each month, but is reflective of that 2.3% to 1 % asset to liability ratio. 

Commissioner Jung again clarified that her question is what is the monthly 

debt service, along with REMSAs assets and liabilities? Commissioner Jung 

requested that amount be reflected in the operations report each month going 

forward. 

Ms. Brenda Staffan, Innovation Grant Project Director, presented to the Board 

of Health on REMSA's Healthcare Innovation Grant, a copy of which 

presentation was placed on file for the record. 

Commissioner Jung questioned Ms. Staffan about how many applicants 

there were from Nevada, and Ms. Staffan responded that she does not know. 

She only knows there were 3,000 nationwide. There was at least one 

awarded in each state. Commissioner Jung asked Ms. Staffan to find out 

that information and bring it back to the DBOH. Commissioner Jurig 

questioned Ms. Staffan about the requirement that REMSA transport only to 

hospital emergency departments and Ms. Staffan stated that that is due to 

current Medicare reimbursement policy. 

Dr. Hess questioned what mode of transportation will be used to transport 

patients to other facilities under the grant, and Ms. Staffan stated that is part 

of the grant's objectives to explore. 

Dr. Randall Todd, Division Director of Epidemiology and Public Health 

Preparedness, gave explanations of the Division and funding mechanisms for 

Public Health Preparedness, and then introduced Ms. Christina Conti who 

presented on in Inter-Hospital Coordination Council's accomplishments, a 

copy of which was placed on file for the record. 

Page 7 
13. 

14. 

15. 

Presentation and Adoption of 

the Washoe County Health 

District Refund Policy. 

Board Comment 

Review and Acceptance of 

the Monthly Public Health 

Fund Revenue and 

Expenditure Report for 

January, 2013. 

Board Comment 

Discussion and Possible 

Direction to Stctff Regarding 

FY 14 Health Fund Budget 

Lori Cooke, Fiscal Compliance Officer, presented the proposed Washoe 

County Health District Refund Policy, a copy of which was placed on file for 

the record. 

Commissioner Jung requested an example of how this policy would be 

applied across all of the Division, and Ms. Cooke provided same. 

Dr. Hess questioned if credits could be carried forward, and Ms. Cooke stated 

yes. 

Eileen Stickney, Administrative Health Services Officer, presented the 

Monthly Public Health Fund Revenue and Expenditure Report for January 

2013, stating that Staff recommends the Board accept the report. 

Dr. Humphreys questioned Ms. Stickney about GL No. 460523, and Ms. 

Stickney stated she would research that bring that back to the Board. 

Mr. Sack suggested that the variance may be due to the high turnover in 

restaurants, which lends to higher numbers of permits. 

Dr. Humphreys moved, 

seconded by Dr. Hess, to 

approve the Refund Policy, 

as presented. 

MOTION CARRIED 

Commissioner Jung moved, 

seconded by Councilwoman 

Zadra, to accept the Health 

Fund Revenue and 

Expenditure Report for 

January, 2013. 

Dr. Humphreys questioned Ms. Stickney about the Worker's Compensation I MOTION CARRIED 

and Unemployment categories, and Ms. Stickney responded that those items 

are billed by finance and by the end of the fiscal year they will balance out. 

They are based on our actual FTEs. 

Eileen Stickney, Administrative Health Services Officer, stated that there is 

nothing new to report at this time, but that that Health Fund Budget meeting is 

scheduled for next week, March 7 at 1 :00 pm. In light of today's fee item 

being pulled, there might be some revisions which will be given to you at that 

meeting. 

Page 8 
17. 

18. 

PUBLIC HEARING: Proposed 

Approval and Adoption ofthe 

Revisions to "The Washoe 

County Portion of'the Nevada 

State Implementation Plan for 

the 2008 Ozone NAAQS: 

Demonstration of Adequacy." 

Presentation of Air Quality 

Management Division 

Accomplishments and 

Strategic Plan. 

Review and Acceptance of. 

the 2013 Legislative Activity 

Report. 

19. I Staff Reports and Program 

Updates 

A. Director - Epidemiology and 

Public Health Preparedness 

The EPA establishes health-based National Ambient Air Quality Standards for 

6 criteria pollutants including Ozone. 

When these standards are revised, Section 11 0(a)(2) of the Clean Air Act 

requires air quality agencies to develop plans demonstrating the ability to 

implement, maintain, and enforce the standard. The Ozone standard was 

most recently revised in 2008. 

This Infrastructure State Implementation Plan, or I-SIP, is a summary of air 

quality regulations and programs demonstrating the Health District's ability to 

meet these Clean Air Act requirements. 

Staff is recommending adoption of this I-SIP Demonstration of Adequacy and 

forwarding it to EPA through the Nevada Division of Environmental Protection 

as a revision to the Washoe County portion of the Nevada Ozone State 

Implementation Plan. 

Kevin Dick, Division Director, Air Quality Management Division, presented the 

Division's Strategic Plan and its accomplishments, a copy of which was 

placed on file for the record. 

Dr. Humphreys questioned Mr. Dick about the new monitoring site and how 

the data is being integrated and reviewed. . 

Kevin Dick,. Division Director, Acting Health Officer, presented the District's 

2013 Legislative Activity Report and made comments regarding the Smog 

Check legislation which has been introduced by the Dept. of Transportation. 

Dr. Hess questioned Mr. Dick about the proposed fee structure and its 

implications. 

Dr.. Randall Todd, Director, Epidemiology and Public Health Preparedness, 

presented his monthly Division Director's Report, a copy of which was placed 

on file for the record. 

Dr. Humphreys moved, 

seconded by Dr. Hess, to 

adopt the Revisions to the 

Washoe County Portion of 

the Nevada State 

Implementation Plan for the 

2008 Ozone NAAQS: 

Demonstration of 

Adequacy, as presented. 

MOTION CARRIED 

Councilwoman Zadra 

moved, seconded by Dr. 

Humphreys, to accept the 

2013 Legislative Activity 

Report, as presented. 

MOTION CARRIED 

Page 9 
20. 

Director - Community and 

Clinical Health Services 

c. Director - Environmental 

Health Services 

D. Director - Air Quality 

Management 

E. Administrative Health 

Services Officer 

F. District Health Officer 

Board.Comment - Limited to 

Announcements or Issues for 

Future Agendas 

Mr. Steve Kutz, Director, Community and Clinical Health Services, presented 

his monthly Division Director's Report, a copy of which was placed on file for 

the record. . 

Mr. Robert Sack, Director, Environmental Health Services, presented his 

monthly Division Director's Report, a copy of which was placed on file for the 

record. 

Mr. Kevin Dick, Division Director, Air Quality Management, presented the 

monthly DiVision Director's Report, a copy of which was placed on file for the 

record. 

Mr. Dick made a correction on page 4 of his report, "Asbestos Assessments 

and Asbestos Demo and Removal" should reflect an Annual Total of 1,138 

. rather than 160 as presented. 

Mr. Dick also reported on unknown effects of federal sequester. Dr. Hess 

asked for an update as soon as the impacts are known. 

The Administrative Health Services Officer's Reports for this month were 

addressed in other agenda items. 

Ms. Stickney acknowledged Mr. Splan and Mr. Fisher and their efforts in 

supporting the Health District. 

Dr. Iser, District Health Officer, presented the monthly District Health Officer 

Report, a copy of which was placed on file for the record. 

Councilwoman Zadra stated that she was unaware of next week's Budget 

Meeting and has a conflict on that date. 

Chairman Smith announced that the next regular meeting of the District 

Board of Health on March 28, 2013, will be held in the Board ofCounty 

Commissioner's Chambers. 

Commissioner Jung stated her displeasure with portions of the Board 

packets still not being printed double-sided; Commissioner Jung expressed 

her displeasure in the length of the minutes, which for the last meeting were 

.24 oaaes. Commissioner Juna also exoressed her disoleasure with the 

Page 10 
21. I Emergency Items 

22. Public Comment 

23. Motion to Adjourn 

d>~I?VJOSEPH rp . ISER, MD, DrPH, MSc 

DISTRICT HEALTH OFFICER 

format of the Agenda; she had addressed this issuei with Dr. Iser previously, 

and the format has been changed, but it is still not to her liking. 

Commissioner Jung requested that the member's names be bolded in the 

minutes. 

Dr. Humphreys questioned when the fee issue would be addressed, and 

Chairman Smith stated that it would be addressed next week. 

No public comment was presented. 

There being no further business to come before the Board, the meeting was 

adjourned. 

Dr. Humphreys moved, 

seconded by 

Commissioner Jung, that 

the meeting be adjourned. 

MOTION CARRIED 

The meeting was adjourned 

at 2:45 p.m. 

PEG

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RECORDING SECRETARY 

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