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 otherjurisdiction 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 ofwhich was placed on file for the record . Dr. Hess stated that if he is looking at the correctfee, 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 ofWashoe 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 thei r 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 ofthe Washoe County Health District. In the lasttwo 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. 

### Page 2

### 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 forthat but at this point we have questions regarding that process. We want to be able to . communicate the reasoning beh ind 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. Page 

## 3

### 5.



### 6.

7. 

### 8. Approvall AdditionslDeletions to the Minutes ofthe January 

### 24, 2013 Regular Meeting

Recognitions

Proclamati. ons ConsentAgenda 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 ofthe January 

### 24, 2013 Regular Meeting be approved as presented. MOTION CARRIED



### Page 4recovery 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. Staffrecommends 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 5project 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 1There 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 ofthe 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

### 1 1. C. Presentation regarding REMSA's Healthcare Innovation Grant



### Inter-Hospital Coordinating Council ("IHCC") Presentatio· n Regarding Accomplishments CommissionerJungclarified 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 thatthose assets are worth $33 Million . REMSA's liabilities are worth $14 Million . Those dollars change on the budget sheet each month, but is reflective ofthat 2.3% to 1 % asset to liability ratio. 

### CommissionerJung 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 ofwhich presentation was placed on file for the record . 

### CommissionerJung 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. 

### CommissionerJung asked Ms. Staffan to find out that information and bring it back to the DBOH
. 

### CommissionerJurig 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 ofwhich 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 ofwhich 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 ofAdequacy."

Presentation ofAir 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 airquality 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 ofthis I-SIP Demonstration ofAdequacy 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 ofwhich was placed on file for the record. Dr. Humph reys 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. ofTransportation . 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 ofwh ich was placed on file for the record. . Mr. Robert Sack, Director, Environmental Health Services, presented his monthly Division Director's Report, a copy ofwhich was placed on file for the record . Mr. Kevin Dick, Division Director, Ai r Quality Management, presented the monthly DiVision Director's Report, a copy ofwhich 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 asthe 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 ofwhich 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 ofthe 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 ofthe Board packets still not being printed double-sided ; CommissionerJung expressed her displeasure in the length ofthe 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 r p . 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 . CommissionerJung 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 CommissionerJung, that the meeting be adjourned. MOTION CARRIED The meeting was adjourned at 2:45 

### p.m.

# ~4~do~ PEGG'V**Lb 'NEIL** **b.,** 

### ( .' ',j' 

### RECORDING SECRETARY



### Page 11