Roll Call 

Public Comment 

WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

Board Room - Health Department Building 

Wells Avenue at Ninth Street 

August 25, 2011 

ApprovaJlAdditions/Deletions - Agenda - August 25,2011 2 

Review - Approval of Minutes - Minutes of July 28,2011 2 - 3 

Recognitions 3 

Proclamation - "Obesity Awareness Day" 3 

Proclamation - "Clean Hands Montli' 3 - 4 

Consent Agenda - Empire Distributing - Case No. 1064, NOV No. 4612 4 - 5 

Consent Agenda - Budget Amendments/lnterlocal Agreements 

Retroactive Approval of District Health Officer's Acceptance of Assistance 5 

Amendment #1 from the US Environmental Protection Agency (EPA) to Increase 

Funding -Air Quality Management, EPA Air Pollution Control Program, 10 10019 

Approval- Notice of Subgrant Ward from the Nevada State Health Division in 5 

Support - Assistant Secretary for Preparedness and Response (ASPR) Hospital 

Preparedness Program; and Approval of Amendments Totaling an Increase - FY 

12 ASPR Hospital Preparedness Federal Grant Program, 10 10708 

Approval- Notice of Subgrant Award - Nevada State Health Division - Women, 5 

Infants, and Children (WI C) Clinic Program - Support of Salaries and Benefits; 

Travel and Training; and Operating Expenditures 

Regional Emergency Medical Services Authority 

A. Review and Acceptance of the Operations and Financial Report - June and 6 - 7 

July 2011 

B. Update - REMSA's Community Activities Since June 2011 7 

Presentation and Possible Approval of the Washoe County District Health 7 - 11 

Department's Franchise Compliance Report for the Regional Emergency Medical 

Services Authority (REMSA) for July 1,2009 Through June 30, 2010 

Acceptance of District Health Department Monthly Public Health Fund Revenue 11 

and Expenditures for July 2011 

Fiscal Year 12 Update 11 - 12 
WASHOE COUNTY DISTRICTBOARD OF HEALTH MEETING 

August 25, 2011 

Page 2 

Public Hearing - Washoe County District Board of Health Regulations Governing 

Public Bathing Places and Public Spas 

A. Presentation and Discussion of Proposed Additions of Section 010 

(Definitions); Section 020 (Public Swimming Pool and Spa Operator 

Requirements); and Section 030 (Enforcement Actions) 

B. Recommendation to Approve and Adopt Additions to the Washoe County 

District Board of Health Regulations Governing Public Bathing Places and Public 

Spas 

Public Hearing - Washoe County District Board of Health Regulations Governing 

Solid Waste Management 

A. Presentation and Discussion of Proposed Deletion of Section 090.000-

090.195, Inclusive (Land Disposal Facility); 

B. Presentation and Discussion of Proposed Additions to Section 010 

(Definitions), Specifically Section 010.010 (Active Portion); Section 010.022 

(Annular Space); Section 010.086 (Bird Hazard); Section 010.146 (Composite 

Liner); Section 010.278 (Face Amount); Section 010.438 (Lower Explosive Limit); 

Section 010.538 (Period for Repayment into Fund); Section 010.618 (Salvage 

Yard); Section 010.734 (Type I Error); Section 010.754 (Washout); Section 

010.762 (Waste Management Unit Boundary); and Section 090.001 - 090.557, 

Inclusive (Landfill/Municipal Solid Waste Landfill Unit); 

C. Presentation and Discussion of Proposed Amendments to Section 010 

(Definitions), Specifically Section 010.408 (Lateral Expansion); and Section 

010.428 (Liquid Wastes); 

D. Recommendation to Approve and Adopt the Additions, the Amendment and 

Deletions to the Washoe County District Board of Health Regulations Governing 

Solid Waste Management 

Public Hearing Washoe County District Board of Health RegUlations Governing 

Solid Waste Management 

Public Hearing - State Implementation Plan (SIP) 

A. Presentation and Possible Discussion of the Revision to the Washoe County 

Portion of the Nevada State Implementation Plan (SIP), Which Demonstrates the 

Washoe County Health District's Compliance with the Lead Infrastructure SIP 

Requirements of the Clean Air Act Section 110(a)(2) 

12 -18 

18 -20 

20 

20 - 21 
WASHOE COUNTY DISTRICTBOARD OF HEALTH MEETING 

August 25,2011 

Pagel 

B. Recommendation to Approve and Adopt the Revision to the Washoe County 

Portion of the Nevada State Implementation Plan (SIP), Which Demonstrates the 

Washoe County Health District's Compliance with the Lead Infrastructure SIP 

Requirements of the Clean Air Act Section 110(a)(2) 

Staff Reports 

Division Director - Epidemiology and Public Health Preparedness 

Division Director - Community and Clinical Health Services 

Division Director - Environmental Health Services 

Division Director - Air Quality Management 

Division Director - Administrative Health Services Officer 

District Health Officer 

Board Comment 

Public Comment 

Adjournment 

21 - 22 

22 

23 - 25 

25 - 26 

26 - 28 

28 

28-29 

29 

29 

30 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

AUGUST 25, 2011 

PRESENT: Mr. Matt Smith, Chairman; George Furman, MD; Councilman Dan Gustin; George 

Hess, MD; Denis Humphreys, 00; and Councilwoman Julia Ratti 

ABSENT: Commissioner Kitty Jung, Vice Chairman 

STAFF: Dr, Joe Iser, District Health Officer; Eileen Coulombe, Administrative Health Services 

Officer; Bob Sack, Director, Environmental Health Services Officer; Dr. Randall Todd, 

Director, Epidemiology and Public Health Preparedness; Mary-Ann Brown, Director, 

Community and Clinical Health Services; Kevin Dick, Director, Air Quality 

Management; Patsy Buxton, Fiscal Compliance Officer; Stacey Akurosawa, EMS 

Coordinator; Jeanne Rucker, Environmental Health Specialist Supervisor; Bryan 

Tyre, PE, Senior Environmental Engineer; Jim English, Senior Environmental Health 

Specialist; Noel Bonderson, Air Quality Specialist Supervisor; Dan Inouye, Air Quality 

Specialist; Mary Ames, Office Assistant II; Bev Bayan, WIC Program Manager; Bryan 

Wagner, Senior Environmental Health Specialist; Mark Dougan, Environmental 

Health Specialist; Kim Franchi, Environmental Health Specialist; Krista Hunt, 

Environmental Health Specialist; Wes Rubio, Environmental Health Specialist; Steve 

Fisher, Department Computer Application Specialist; Amber English, Environmental 

Health Specialist; Phil Ulibarri, Public Information Officer; Kelli Seals, Public Health 

Nurse; Peg Caldwell, RN; Peggy Quinlan, Environmental Health Specialist; Lee 

Salgado, Environmental Health Specialist; Janet Smith, Recording Secretary; and 

Leslie Admirand, Deputy District Attorney 

At 1 :05pm, Chairman Smith called the Washoe County District Board of Health meeting to order, 

followed by the Pledge of Allegiance, led by Councilman Dan Gustin, member of the Washoe 

County District Board of Health, 

ROLL CALL 

Roll call was taken and a quorum of the Board noted, Mrs, Janet Smith, CPS, Recording 

Secretary, advised that Commissioner Kitty Jung, Vice Chair, was excused, 

PUBLIC COMMENT 

There was no public comment presented, 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 2 

APPROVAL/DELETIONS - AGENDA - AUGUST 25,2011 

Chairman Smith stated item 7.CA. Consent Agenda - Ratification of Interlocal Contract with the 

State of Nevada, Department of Motor Vehicles, for the DMV Excess Reserve Grant Program, 10 

TBD has been withdrawn. 

Chairman Smith advised, Item 15. Public Hearing -- Washoe County District Board of Health 

Regulations Governing Solid Waste Management, specific to the definition of garbage has been 

withdrawn and will be rescheduled for the Board's October 27,2011 meeting. 

Chairman Smith called upon anyone wishing to make a statement regarding the Public Hearing for 

the Solid Waste Management Regulations, specific to the definition of garbage. There was no one 

present wishing to make a public comment. 

Ms. Ratti 

Stated, the Sparks City Council will have Council workshop sessions to "discuss and educate the 

Council members on specific issues; that she would question if the Board should consider 

scheduling such a session to discuss the complexities of this issue. Or if the Board members 

should attend a workshop session." Stated, "as there isn't an interest to have a Board workshop 

session, she would request notification regarding the public workshop sessions." 

MOTION: Dr. Humphreys moved, seconded by Mr. Gustin, that the agenda of the 

District Board of Health August 25, 2011, meeting be approved as 

amended. 

Motion carried unanimously. 

APPROVAL/ADDITONS/CORRECTIONS - MINUTES - JULY 28,2011 

Chairman Smith called for any additions or corrections to the minutes of the July 28, 2011 meeting 

of the Washoe County District Board of Health. 

Dr. Humphreys 

Stated, the date on the Table of Contents should be corrected to July 28,2011. 

MOTION: Mr. Gustin moved, seconded by Dr. Humphreys, that the minutes of the 

District Board of Health July 28, 2011 meeting be approved as received, 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 3 

with the noted correction to the Table of Contents. 

Motion carried unanimously. 

RECOGNITIONS AND PROCLAMATIONS 

Chairman Smith and Dr. Joseph Iser, District Health Officer, recognized Ms. Mary Ames for 

earning her International Association of Administrative Professionals (lAAP) - Certified 

Professional Secretary (CPS) level of certification. 

PROCLAMATION -SEPTEMBER 8, 2011-"OBESITYAWARENESS DAY' 

Dr. Iser read the Proclamation declaring September 8,2011, as "Obesity Awareness Day" (a copy 

of which was placed on file for the record). Chairman Smith and Dr. Iser presented the 

Proclamation to Ms. Kelli Seals, Community Health Nurse. 

MOTION: Mr. Gustin moved, seconded by Dr. Furman, that the Proclamation 

declaring September S, 2011 as "Obesity Awareness Day" be approved 

and adopted as presented. 

Motion carried unanimously. 

PROCLAMATION - SEPTEMBER 2011 - "CLEAN HANDS MONTH" 

Dr. Iser read the Proclamation declaring the month of September 2011, as "Clean Hands Month" (a 

copy of which was placed on file for the record). Chairman Smith and Dr. Iser presented the 

Proclamation to Mr. Bryan Wagner, Senior Environmental Health Specialist; Mr. Mark Dougan, 

Environmental Health Specialist; and Ms. Kim Franchi, Environmental Health Specialist. 

Mr. Bryan Wagner, Senior Environmental Health Specialist 

Stated, the Proclamation is through the efforts of the Nevada Food Safety Task Force to "further 

increase the safety of food." Advising, the Centers for Disease Control and Prevention (CDC) has 

been determined "hand washing is the 'first line of defense' in preventing illness and the single 

most important means of preventing the spread of infection." 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 4 

Advised this year's efforts are focused on teaching children proper hand washing, as children 

"learn by example; and develop new habits through repetition, accompanied with positive 

reinforcement." Advised both influenza and norovirus are frequently transmitted by individuals who 

fail to properly wash their hands; that Staff frequently investigate outbreaks at childcare centers 

directly related to poor hand washing techniques. Advised some Washoe County School Districts 

experience a::1 0% rate of absenteeism due to influenza outbreaks. 

Ms. Kim Franchi. Environmental Health Specialist 

Presented a graph depicting the number of outbreaks of confirmed and suspected cases of 

norovirus and influenza investigated by the District Health Department Epi Team, from 2007 

through 2011 (to-date), advising, these represent "reported cases only, as the vast majority of 

cases go unreported." Advised from 2007 through 2009, Staff noted an increase in the number of 

cases; that there was a marked decrease in 2010, which Staff attributes to the Health District's 

public outreach educational efforts. Stated, as Mr. Wagner indicated, the Health District "has 

targeted children in these efforts, as children are notoriously known for being poor hand-washers; 

that teaching children how to properly wash hands develops and fosters a life-long learning habit." 

Ms. Franchi reviewed Staff's previous efforts in educating children in proper hand washing 

techniques. Advised October 15th is Global Hand Washing Day; that globally, diarrheal diseases 

and acute respiratory infections case 3.5 million deaths of children under the age of five (5) every 

year. Stated the goal of "Clean Hands Month" is to decrease the spread of infectious diseases; 

that "the simple act of hand washing with soap and water is the key." 

MOTION: Dr. Humphreys moved, seconded by Dr. Hess, that the Proclamation 

declaring September 2011 as "Clean Hands Month", be approved and 

adopted as presented. 

Motion carried unanimously. 

CONSENT AGENDA - AIR QUALITY MANAGEMENT CASE - EMPIRE DISTRIBUTING - CASE 

NO. 1064, NOV NO. 4612 

Staff advised that Citation No. 4612, Case No. 1064 was issued to EMPIRE DISTRIBUTING, on 

June 16, 2011, for failure to file the required proper change of ownership paperwork with the Air 

Quality Management Division, in violation of Section 030.2175 (Operations Contrary to Permit) of 

the Washoe County District Board of Health Regulations Governing Air Quality Management. Staff 

advised Empire Distributing was advised of the right to appeal; however, no appeal was filed. Staff 

recommends Citation No. 4612, Case No.1 064 (Empire Distribution) be upheld and a fine in the 

amount of $200 be levied as a negotiated settlement for a major violation. 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25. 2011 

Page 5 

In response to Mr. Gustin 

Regarding the violation, Mr. Noel Bonderson, Air Quality Supervisor, stated there was a change in 

the ownership of Empire Distributing. Advised, after several attempts by Staff to have the new 

owners submit the required paperwork for that change of ownership with no response, Staff issued 

a Notice of Violation. 

MOTION: Mr. Gustin moved, seconded by Ms. Ratti, that Citation No. 4612, Case 

No. 1064 (Empire Distributing), be upheld and a fine in the amount of 

$200 be levied as a negotiated settlement for a major violation. 

Motion carried unanimously. 

CONSENT AGENDA - BUDGET AMENDMENTSIINTERLOCAL AGREEMENTS 

The Board was advised Staff recommends retroactive approval of the District Health Officer's 

acceptance of Assistance Amendment #1 from the US Environmental Health Protection 

Agency (EPA) to increase funding by $258,225 for the total funding amount of $699,331 for the 

Air Quality Management, EPA Air Pollution Control Program, 10 10019, for the period of 

October 1, 2010 through September 30, 2011. 

The Board was advised Staff recommends approval of the Notice of Subgrant Award from the 

Nevada State Health Division in the amount of $404,044 (with $40,404 or 10% match) in 

support of the Assistant Secretary for Preparedness and Response (ASPR) Hospital 

Preparedness Program, for the period of July 1, 2011 to June 30, 2012; and approval of 

amendments totaling an increase of $35,814 in both revenue and expense to the FY 12 ASPR 

Hospital Preparedness Federal grant Program, 1010708. 

The Board was advised Staff recommends approval of Notice of Subgrant Award from the 

Nevada State Health Division for the Women, Infants and Children (WIC) Clinic Program in 

the total amount of $1,071,998 in support of Salaries and Benefits, Travel and Training, and 

Operating Expenditures. for the period of October 1, 2011 through September 30, 2012. 

MOTION: Ms. Ratti moved, seconded by Mr. Gustin, that the retroactive approval 

of the Health Officer's acceptance Assistance Amendment #1; and the 

Notices of Subgrant Awards, with the corresponding budget amendment, 

be approved as presented, and the Chairman authorized to execute on 

behalf of the Board where applicable. 

Motion carried unanimously. 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 6 

REGIONAL EMERGENCY MEDICAL SERVICES AUTHORITY 

A. Review and Acceptance of the Operations and Financial Report - June and July 2011 

Mr. Jim Gubbels, Vice President REMSA 

Advised the Board members have been provided with a copy of the June 2011 Operations and 

Financial Report; that the overall emergency response times for life-threatening calls in June 2011 

was 91 % and 94% for non-life threatening calls; that within the eight (8) minute zone it was 91 %; 

within the fifteen (15) minute zone it was 100%; and within the twenty (20) minute zone it was 97%. 

The overall average bill for air ambulance for June was $6,783, with a year-to-date average of 

$7,026. The overall average bill for ground ambulance service for June was $905, with a year-todate average of $968. 

Advised the Board members have been provided with a copy of the July 2011 Operations and 

Financial Report; that the overall average emergency response time for life-threatening calls in July 

was 91% and 95% for non-life threatening calls; that within the eight (8) minute zone it was 91%; 

within the fifteen (15) minute zone it was 95%; and within the twenty (20) minute zone it was 97%. 

The overall average bill for air ambulance for July was $7,711, which is the year-to-date average. 

The overall average bill for ground ambulance service for July was $988, which is the year-to-date 

average. 

In response to Dr. Humphreys 

Regarding the allowable average bill for air and ground ambulance, Mr. Gubbels advised at the 

end of the Fiscal Year, REMSA is allowed the Consumer Price Index (CPI), which changes the 

average allowable rate REMSA can charge. Stated, if REMSA exceeds the allowable average bill 

from the previous year, REMSA "then subtracts the difference for the new allowable average." 

Advised the allowable average for Care Flight was $6,939; however, at the end of the Fiscal Year 

the average bill for air ambulance services was $7,026; therefore, the $87 difference is subtracted 

from the allowed CPI increase to determine the allowable monthly average of $7,089 for the new 

Fiscal Year. 

Advised the allowable average for ground ambulance service was $966; however, at the end of the 

Fiscal Year the average bill for ground ambulance service was $968; therefore the $2 difference is 

subtracted from the allowed CPI increase to determine the allowable monthly average of $1 ,002 for 

the new Fiscal Year. 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 7 

In response to Chairman Smith 

Regarding negative customer comments, Mr. Gubbels advised that last month the Board members 

were provided with "a pie chart of the comments received for the quarter, depicting the percentage 

of positive and the negative comments; the percentage of neutral and non-responses; and clinical 

comments. Stated the monthly comments are listed in each monthly report; that it was the 

consensus of the Board the pie chart would be submitted on a quarterly basis. Advised, "piecharting the comments received was the recommendation of the ambulance accreditation service 

that reviewed REMSA in February." 

Advised for the last Fiscal Year less than .2% of all the comments received were "clinical concerns; 

that the return rate for the comment cards is 6.55%, which is a good return rate." 

MOTION: Ms. Ratti moved, seconded by Dr. Hess, that the Operations and 

Financial Report for the months of June and July 2011 be accepted as 

presented. 

Motion carried unanimously. 

B. Update of REM SA's Community Activities Since June 2011 

Mr. Gubbels 

Advised, next month, Ms. Melissa Krall, Director for Community Outreach, will present the Cribs for 

Kids Program to the Board. 

PRESENTATION - WASHOE COUNTY DISTRICT HEALTH DEPARTMENT'S FRANCHISE 

COMPLIANCE REPORT - REGIONAL EMERGENCY MEDICAL SERVICES AUTHORITY 

(REMSA) - JULY 1,2009 THROUGH JUNE 30 2010 

Ms. Eileen Coulombe, Administrative Health Services Officer 

Advised the Board members have been provided with a copy of the Washoe County District Health 

Department's Franchise Compliance Report for the Regional Emergency Medical Services 

Authority (REMSA) for the period of July 1, 2009 through June 30,2010 (a copy of which was 

placed on file for the record.) 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25,2011 

Page 8 

Stated she would commend Ms. Stacey Akurosawa, EMS Coordinator; and Ms. Peg Caldwell, RN 

in the EMS Program, for "their significant input in reviewing the data and preparing the Compliance 

Report. 

Advised Staff recommends the District Board of Health determine REMSA to be in compliance with 

thirty (30) of the thirty-one (31) performance requirements for Fiscal Year 2009/2010; and in 

sUbstantial compliance with Section 2. Board Meetings, of the performance requirements. 

In response to Dr. Humphreys 

Regarding Section 23., which was repealed, Ms. Coulombe advised Section 23., was repealed in 

August 2003; therefore, it would not be reviewed for compliance. 

Ms. Ratti 

Stated, she would commended Staff "for the level of detail in this year's Compliance Report; that 

Staff's efforts are apparent." Stated, as she previously advised, "from a systems approach she is 

concerned as to the District Board of Health's ability to fulfill its oversight role regarding the 

Franchise. The Compliance Report is for FY 09/10, and this is August 2011." Stated, she 

acknowledges the EMS Coordinator position was vacant for an extended period of time; that there 

is a new Health Officer and there have been a number of other issues; however, "it is incumbent 

upon Staff to ensure the Reports" are submitted. 

In response to Ms. Ratti 

Regarding when the FY 10/11 Compliance Report will be submitted, Ms. Coulombe advised "the 

Compliance Report is based on the Fiscal Year; that there "is the close-out of the Fiscal Year and 

the completion of the external audit." Advised, all of the documentation is provided to the Health 

Officer and Administrative Health Services Officer for review and utilized in determining compliance 

with the Franchise Agreement. Advised, "the responsibility for compliance is (usually) ninety (90) 

days after the close-out and completion of the external audit; therefore, the Compliance Report for 

FY 10/11 would be March 2012." 

Ms. Ratti 

Stated, "there will always be vacancies within the Department within the foreseeable future; that it 

is necessary to determine how to complete annual compliance reports." Stated, the Compliance 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25,2011 

Page 9 

Report for the ambulance franchise is the "most meaningful oversight process for the Franchise 

Agreement." 

In response to Ms. Ratti 

Ms. Coulombe acknowledged "that this [Compliance Report] is a priority;" that the Compliance 

Report for FY 10/11 will be submitted on time. 

Ms. Ratti 

Stated, she "feels there should be improvements to several Sections of the Franchise Agreement, 

as she has concerns regarding Section 5. Periodic Competitive Bid Requirement; and obtaining 

sufficient information to ensure the prices are being kept as low as possible for the citizens of the 

community served by the Franchise Agreement." 

Stated she has concerns regarding Section 9. Response Requirement of Eight (8) Minutes 90% of 

the Time, "as to the level of data to which the Board has access; and being able to make decisions 

to help the other jurisdictions in making decisions on the other facets of the emergency medical 

systems." 

Stated, she has concerns regarding Section 28. REMSA's Exclusive Right to Operate; that "the 

Agreement renews automatically 'unless there is material and adverse failure', which does not 

allow for the opportunity to make some of the amendments to the Franchise Agreement she 

believes need to be made, unless it is mutually agreed upon." Stated, she would question "how to 

get to the point of mutually agreed upon improvements to the Franchise Agreement?" 

Stated, she has concerns regarding Section 29. Any Future Service Agreements with Other 

Political Entities. Stated, the Board has been advised REMSA is "doing no other work that would 

impinge upon the service levels provided to Washoe County; however, as a Board member she 

does not feel as though she has the information necessary to explain that to her constituents." 

Stated, she has concerns regarding Section 30. Assumption of REMSA Central Facility by a Future 

Contractor, "and the assumption of these assets and debts." Stated, as a Board member "she 

does not know what financial decisions are being made to take on debt and assets; and should that 

[REM SA] fail then those debts and assets come back on the Board of Health and ultimately the 

jurisdictions." 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25,2011 

Page 10 

Stated, "these are the majDrfive (5) SectiDns for which she has concerns; that there is a clause, 

which allDws for mutually agreed upon amendments to the Franchise Agreement." Stated, 

"between now and March 2012 when the Compliance RepDrt is presented, perhaps there can be 

discussiDns as to any opportunities to open dialogue with the Franchisee to Dbtain that 

information." 

Dr. Hess 

Stated, "regarding the CDncern specific to debts and assets; that as the Health Officer receives the 

annual repDrt from the agency and the 990," he would question if this infDrmation "is shared with 

the BDard of Health members." 

In response to Dr. Hess 

Ms. CoulDmbe advised "that information is provided to the District Health Officer; and REMSA has 

an annual external audit performed every year." 

In response to Dr. Hess 

Regarding the 990 "not being provided to the Board Df Health members", Ms. Leslie Admirand, 

Deputy District Attorney, advised her legal opinion is "there are documents which are public record 

and other documents, which contain proprietary business infDrmation that is not part Df the public 

record. Ms. Admirand advised, when information contains proprietary [business] infDrmation it is 

confidential; that this information is cDnfidential by law; and therefore, nDt available to the public." 

In response to Dr. Hess 

Chairman Smith 

Advised the Health Officer and the Administrative Health Services Officer "are privileged to the 

information of the audit and the 990, and review if for the BDard of Health"; that the Health Officer 

and the AHSO then advise the Board of Health as to the cDmpliance with the requirements of the 

Franchise Agreement. 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 11 

Dr. Iser 

Stated, he will confer with Ms. Admirand and representatives of REMSA to discuss "what formation 

could possibly be provided to the Board of Health members. 

MOTION: Dr. Hess moved, seconded by Dr. Humphreys, that the Washoe County 

District Health Department's Franchise Compliance Report for the 

Regional Emergency Medical Services Authority (REMSA) for July 1, 

2009 through June 30, 2012, be approved. 

Motion carried unanimously. 

REVIEW - ACCEPTANCE - MONTHLY PUBLIC HEALTH FUND REVENUE AND 

EXPENDITURE REPORT - JULY 2011 

Ms. Coulombe 

Advised the Board members have been provided with a copy of the Health Fund Revenue and 

Expenditure Report for the month of July 2011. She reviewed the Report in detail advising Staff 

recommends the Board accept the Report as presented. 

MOTION: Me. Gustin moved, seconded by Dr. Humphreys, that the District Health 

Department's Revenue and Expenditure Report for July 2011 be accepted 

as presented. 

Motion carried unanimously. 

UPDATE - FISCAL YEAR 12 - POSSIBLE DIRECTION TO STAFF 

Dr. Iser 

Advised Staff has submitted the District's 10% budget reduction plan to the County; that Staff does 

not anticipate any additional budget reductions specific to the County transfer. Stated, the Board of 

County Commissioners made the determination not to approve a 1 % increase to the motor vehicle 

license fee to "help fund the Incline Village refunds." Stated, the County has indicated monies from 

a discretionary fund will be utilized to pay for the refunds; that the County will then "request 

reimbursement from the other taxing entities." Stated, there is a level of disagreement among the 

County Commission members and the other taxing entities as to who should pay the interest due. 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 12 

Ms, Coulombe 

Advised, the 10% budget reduction plan presented to the Board of Health last month is the plan, 

which was submitted to the Board of County Commissioners, Stated, Staff had anticipated the 

request for a reclassification within the Air Quality Management Division, from a Public Information 

Officer (PIO) to an Air Quality Specialist, would be on the BCC agenda for August 23rd ; however, it 

was not. 

Stated, the 10% budget reductions plans will be presented by the various County Departments at 

the Board of County Commissioners September 27, 2011 meeting; that Staff will have that update 

available for the Board's October Strategic Retreat. 

Dr, Hess 

Stated, he has met with three (3) of the five (5) Division Directors for his orientation; that "for as 

bad and depressing as the [budgetary] news is, he has been very impressed with the level of 

enthusiasm" and the strategies for providing services with reduced funds, 

No action was taken, 

PUBLIC HEARING - WASHOE COUNTY DISTRICT BOARD OF HEALTH REGULATIONS 

GOVERNING PULIB BATHING PLACES AND PUBLIC SPAS 

1 :OOp,m,: This being the time set in a Notice of Public Hearing, heretofore published in the Reno 

Gazette Journalon May 20,23, and June 1,2011, to consider the additions to the District Board of 

Health Regulations Governing Public Bathing Places and Public Spas, 

A. Presentation and Discussion of Proposed Additions to Section 010 (Definitions), Section 020 

(Public Bathing Places and Spa Operator Requirements): and Section 030 (Enforcement 

Actions) 

Mr. Bryan Tyre, PE, Acting Senior Reqistered Engineer 

Advised the Environmental Health Services Staff conduct all of the inspections for the public pools 

and spas within the County; that Staff conduct approximately 1200 inspections annually. Advised, 

Staff can manage the 1200 required annual inspections; however, there are "a number of 

unanticipated return 'Inspections due to complaints or lack of compliance to the Regulations, 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 13 

resulting in the closure of pools and multiple inspections." Advised, Staff prepared draft 

Regulations requiring operators of public pools and spas to have a Certified Pool/Spa Operator 

(CPO) on staff. 

Mr. Wes Rubio, Environmental Health Specialist 

Advised, it was the consensus of Staff it was a necessary to address the issue of public health and 

safety in regard to public swimming pools and spas; that within the past twelve (12) months it has 

been necessary for Staff, on multiple occasions, to close the pools and/or spas at three (3) of the 

major casinos to protect the public health. 

Advised, Southern Nevada has successfully required a CPO (Certified Pool Operators) program for 

all pool and spa operators for "the last twenty (20) years"; that he reviewed Southern Nevada's 

CPO Program and adapted it for Washoe County. Advised the requirement for a CPO ensures an 

individual has a minimum level of education; and extends the level of responsibility for operating a 

pool or spa to the permit holder/management company ensuring there is an individual certified in 

the proper management and maintenance of a public pool or spa. Stated, the proposed provisions 

requiring a CPO will benefit the community, the Health District, and the permit 

holders/management companies. 

As indicated there were two (2) options available to Staff - additional inspections resulting in 

increased permit fees to pay for the necessary additional staffing; or achieving a greater level of 

compliance through requiring Certified Pool Operators for each facility. Advised the Regulations 

specify a three (3) year recertification program for the CPOs. 

Advised, Staff recommends the Board approve and adopt the proposed additions to the 

Regulations as presented. 

In response to Mr. Gustin 

Regarding "a percentage of repeat offenders compared to the 1200 inspections per year", Mr. 

Rubio advised Staff does not have that information; that it would require the assistance if IT to 

determine those percentages. Mr. Rubio advised the "re-inspections are not just from complaints; 

that a percentage are the result of Staff inspections determining the pool or spa is not in 

compliance. Mr. Rubio reviewed the inspection process for annual and seasonal pools and spas. 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 14 

Mr, Bob Sack, Director, Environmental Health Service 

Advised, approximately ten (10) years ago Staff was conducting pool inspections "once a month"; 

that due to fewer Staff members, budget reductions and the increased number of pools and spas 

the District only has the capacity for two (2) annual inspections, Stated, with the decrease in the 

number of inspections, Staff has noted a correlated increase of approximately 100 complaints 

annually, Advised, Staff has noted "the same recurring complaints at a number of the same 

facilities; that a number of the complaints are the result of not having properly trained operators at 

the pools and spas," 

Advised, increased inspections "is not the answer as that results in Staff continually educating the 

individual operating the pool at that time"; that there are a couple of local companies which offer 

the national certification training for pool operators, Advised, upon submission of documentation, 

Staff will issue the three (3) year Certificate to the Pool Operator(s), Stated, the Certified Pool 

Operators (CPOs) "will then be responsible for the maintenance of the pools and spas at those 

facilities which contract with them," Stated, it is the consensus of Staff "this will decrease the 

number of complaints being received, thus reducing the number of repeat violations requiring 

repeat inspections," 

In response to Mr, Gustin 

Regarding the proposed requirement being for all facilities "rather than just the repeat offenders", 

Mr, Sack advised "what Staff has noted is an across-the-board drifting away of from the ability of 

these facilities to remain in compliance" throughout the season or annually, Advised, Staff is 

attempting "to reverse a noted trend for all pools and spas", which are inspected, 

In response to Mr. Gustin 

Regarding a difference in "saline pools versus the chemically treated pools", Mr. Rubio advised 

"both types of pools utilize the same type of sanitizer, which changes through a chemical process 

to chlorine," Advised, in regard to compliance, "the issues are the same; that the individual(s) 

operating the pools or spas don't always have the knowledge necessary to maintain the pool/spa in 

a sanitary manner, which will serve the community and not place other people at-risk," 

Mr, Sack 

Stated, to convert a commercial pool from chemical to saline requires "a dramatic change in 

equipment and sizing; that there are problems trying to convert as it requires a redesign to 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 15 

accommodate the cell generators," Stated, although there has been some interested indicated, 

Staff has not noted a number of commercial pools converting to saline; however, "ultimately the 

chemistry is the same," 

Mr, Gustin 

Stated, he would commend Mr, Rubio for assisting in "getting a pool at a major casino reopened 

during the Memorial Day weekend, after he, as a Reno City Councilman, had received a telephone 

inquiry about it." Stated, he is aware "Mr. Rubio and other Staff members made the extra effort 

when the facility in question was not in compliance; that Mr. Rubio's efforts were over and above 

what was required; that he appreciates those efforts," 

In response to Chairman Smith 

Regarding the difference between "saline pools versus chlorine pools", Mr, Rubio advised that 

saline pools will have "more total dissolved solids as solid salt is added to the water," Stated, the 

commercial saline pools of which he is aware, are adding fifty-five (55) pound bags of salt two (2) 

or three (3) times per week depending upon the level of usage, Stated, on "hot days of heavy 

usage of the pool the operator may be adding one-hundred (100) pounds every two (2) or three (3) 

days, which increases the total levels of solids resulting in the water becoming milky, This requires 

draining more frequently or shutting-down to treat it and maintain service," Stated, regardless of 

the type of system, "it depends on how good the operator is; that the proposed additions to the 

Regulations address these issues," 

Advised, Staff will continue to conduct two (2) inspections of every commercial pool and spa; that 

the proposed amendment will require a facility with a pool or spa to have a Certified Pool Operator 

(CPO), who will be responsible for the maintenance of the pool and/or spa, Advised, this Program 

will be similar to Certified Food Service Managers; that documentation will be provided to the 

Health Department that an individual successfully completed a national CPO training; the Health 

District will issue a badge identifying the individual as an authorized CPO, Advised the CPO will 

have the ability to obtain a form from the Health District website, which will be posted either in the 

pump room or somewhere on the premises, with the name and contact information should a 

problem occur and it is necessary for Staff to contact them; that this individual "will not be required 

to be on-site when Staff conducts the inspection(s)," Advised, this provides Staff "with a 

responsible party to contact when necessary," 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25,2011 

Page 16 

B, Recommendation to Approve and Adopt Additions to the Washoe County District Board of 

Health Regulations Governing Public Bathing Places and Public Spas 

Chairman Smith declared the Public Hearing open and called upon anyone wishing to speak either 

in favor of or opposition to the proposed additions to the Washoe County District Board of Health 

Regulations Governing Public Bathing Places and Public Spas, specific to the requirements for 

Certified Pool Operators, 

Mr, Doug Coulter, PE, Retired Senior Engineer 

Advised, "since 1974, the existing Regulations have required qualified staff to operate pools and 

spas; that the proposed addition establishes the standards for those qualifications," Stated, the 

proposed addition to the Regulation will result in "improving the efficiency of Staff in conducting the 

inspections without having to sacrifice the quality of the inspections," Advised, requiring a CPO will 

allow Staff to more immediately address an issue of non-compliance; and how and when that issue 

will be resolved, 

Advised, when the Health District had the capacity to conduct monthly pool inspections "it was a 

matter of operation by inspection -- Staff would provide a list of issues that had to be corrected and 

then return the following month to determine if the deficiencies had been corrected," Advised, with 

the reductions to two (2) annual inspections Staff determined "it was not enough contact with the 

operators; and there was concern as to what was occurring the remaining 363 days," 

Advised, the proposed addition is "modeled after the Certified Food Service Manager Program to 

ensure the pools and spas are operated properly 365 days a year," Stated, as Mr, Sack advised, 

previously when Staff conducted monthly inspections the EHS division would receive 

approximately a dozen complaints a year; that when it was reduced to two (2) annual inspections 

complaints increased to approximately 100 annually, with a marked increase every year. 

Mr. Coulter reiterated the approval and adoption of the additions to the Regulations "will improve 

Staff efficiency and ensure the public health, 

Mr, Richard Martinache, Vice President of Lee Joseph Pools and Swim Pool and Spa Consultants 

Advised, he is a CPO instructor in the community, certified by the National Swim Pool Foundation 

(NSPF); that his father, Mr. George Grukovic, has been offering the CPO program in the 

community since 1987, and has trained in excess of 2500 CPOs, Stated, the NSPF "has been the 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 17 

leader of the industry since 1974; that he would encourage people to visit the NSPF website for 

more information. Stated, NSPF fully supports the requirement of certifying and registering pool 

operators with the local health departments. Stated, "in regard to public safety he teaches the 

standard of having a safe pool is extremely important, as the public expects pools to be safe from 

disease, illness, and harm." 

Stated, Swim Pool and Spa Consultants offers four (4) certification classes per year in Reno and 

Las Vegas; that Swim Pool and Spa Consultants provide continuing education to the CPOs. 

Stated, he would commend Staff for proposing the addition to the Regulations; that "it will continue 

to keep the public safe." 

Mr. Sack 

Stated, he would commend Mr. Grukovic for his contribution to public safety in offering the pool 

and spa certification courses; that all EHS Staff have completed Mr. Grukovic's courses prior to 

inspecting swimming pools and spas. 

There being no one else wishing to speak either in favor of or in opposition to the proposed 

additions to the Regulations, the Public Hearing was closed. 

Dr. Humphreys 

Stated, he would question if there is a fee charged for re-inspections or a process for allowing a 

charge for re-inspections. 

In response to Dr. Humphreys 

Mr. Rubio 

Advised, the annual fee for the Permit to Operate includes the initial opening inspection for 

seasonal pools; and the secondary routine inspection; and the two (2) inspections for annual pools. 

Advised, there are provisions for billing for re-inspection fees; that a re-inspection fee cannot be 

levied if a pool or spa is not in compliance during the initial opening inspection and it is necessary 

for Staff to return to conduct a re-inspection. Advised, there have been facilities in which it was 

necessary for Staff to conduct "six (6) inspections during the operating period. There are facilities 

which have more than one (1) pool or spa; that, again, it then becomes an issue of education;" that 

if there is non-compliance with one (1) pool or spa there will (probably) be non-compliance with all 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 18 

of the pools and spas. Stated, "it becomes a continual problem; that it becomes an issue of having 

a minimal level of education and knowing how to properly operate the equipment and 

understanding the water chemistry." 

In response to Chairman Smith 

Regarding inspecting facilities with more than one (1) pool or spa, Mr. Rubio stated Staff does 

attempt to schedule the inspection of all the pools and spas at the same time for those facilities 

with more than one (1) water body. Advised, Staff has now classified pools and spas by zip codes 

to more efficiently conduct the opening and routine inspections resulting in saved Staff time and 

cost savings to the Department. 

In response to Ms. Ratti 

Regarding the majority of re-inspections being due to "failed inspections or a complaint", Mr. Rubio 

advised the majority have been due to failed inspections; however, the number of complaints has 

greatly increased; and Staff does respond to complaints. Advised, the majority of complaints are 

"the visibility of the water or the chlorine bleaching-out the swimsuits; that the public won't be 

aware'of chemical imbalances and improper levels." Stated, Staff's concern has been "the 

individuals operating these facilities being unaware these are issues of concern and pose a health 

threat;" that the proposed addition to the Regulations will address this and will result in the 

protection of the public. 

MOTION: Mr. Gustin moved, seconded by Ms Ratti, that the additions to the 

Washoe County District Board of Health Regulations Governing Public 

Bathing Places and Public Spas, be approved and adopted as presented, 

Motion carried unanimously, 

PUBLIC HEARING - WASHOE COUNTY DISTRICT BOARD OF HEALTH REGULATIONS 

GOVERNING SOLID WASTE MANAGEMENT 

A. Presentation and Discussion of Proposed Deletion of Section 090.000 - 090.195, Inclusive 

(Land Disposal Facility): 

B. Presentation and Discussion of Proposed Additions to Section 010 (Definitions), Specifically 

Section 010.010 (Active Portion); Section 010.022 (Annular Space); Section 010.086 (Bird 

Hazard); Section 010.146 (Composite Liner); Section 010.278 (Face Amount); Section 

010.438 (Lower Explosive Limit): Section 010.538 (Period for Repayment into Fund): Section 

010.618 (Salvage Yard): Section 010.734 (Type I Error); Section 010.754 (Washout); Section 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 19 

010.762 (Waste Management Unit Boundary); and Section 090,001 - 090,557, Inclusive 

(Landfill/Municipal Solid Waste Landfill Unit); 

C, Presentation and Discussion of Proposed Amendments to Section 010 (Definitions), 

Specifically Section 010.408 (Lateral Expansion); and Section 010.428 (Liguid Wastes) 

1 :OOpm: This being the time set in a Notice of Public Hearing, heretofore published in the Reno 

Gazetle Journal on July 12, 14, and 21, 2011 to consider the proposed deletions, additions and 

amendments to the Washoe County District Board of Health Regulations Governing Solid Waste 

Management. 

Mr, Jim English, Senior Environmental Health Specialist 

Advised, that the Board members have been provided with a copy "of a complete update to the 

landfill portion of the Washoe County District Board of Health Regulations Governing Solid Waste 

Management." Advised, "the proposed deletions, additions, and amendments are the complete 

revision of the Solid Waste Management Regulations, with the exception of the definition of 

garbage," 

Stated, the proposed Regulations parallel the State, and are easier for the public to comprehend; 

that Staff recommends the Board approve and adopt the proposed deletions, additions, and 

amendments to the Regulations be approved and adopted as presented, Stated, the approval and 

adoption of the proposed revisions will ensure the District's Regulations are as stringent as the 

State's, 

In response to Dr. Humphreys 

Regarding, "currently there being no fiscal impact to businesses", Mr, English advised the Health 

District does have the authority to charge fees for plan reviews and Permit to Operate; however, 

currently there are no landfills in the Washoe Health District. Stated, "Staff does not anticipate any 

landfills being designed or constructed in the Health District or County in the near future," 

0, Recommendation to Approve and Adopt the Additions, the Amendment and Deletions to the 

Washoe County District Board of Health Regulations Governing Solid Waste Management 

Chairman Smith declared the Public Hearing open and called upon anyone wishing to speak either 

in favor of or in opposition to.the proposed revisions to the Washoe County District Board of Health 

Regulations Governing Solid Waste Management. 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 20 

Mr. Greg Martinelli, Waste Management, Inc. 

Stated, he would commend Ms. Jeanne Rucker and Mr. Jim English, of Environmental Health 

Services; that "it was a pleasure working with them on developing the revisions to the Regulations." 

Stated, Waste Management, Inc. supports the adoption of the proposed revisions. 

There being no one else wishing to speak either in favor of or in opposition to the proposed 

revisions the Public Hearing was closed. 

MOTION: Dr. Humphreys moved, seconded by Dr. Hess, that the proposed 

deletions, additions and amendments to the Washoe County District 

Board of Health Regulations Governing Solid Waste Management, be 

approved and adopted as presented. 

Motion carried unanimously. 

PUBLIC HEARING - WASHOE COUNTY DISTRICT BOARD OF HEALTH REGULATIONS 

GOVERNING SOLID WASTE MANAGEMENT 

Chairman Smith advised this item has been withdrawn for further revision and will be rescheduled 

for the Board's October 27,2011 meeting. 

PUBLIC HEARING - STATE IMPLEMENTATION PLAN (SIP) 

A. Presentation and Possible Discussion of the Revision to the Washoe County Portion of 

the Nevada State Implementation Plan (SIP), Which Demonstrates the Washoe County 

Health District's Compliance with the Lead Infrastructure SIP Requirements of the Clean Air 

Act Section 11 O( a )(2) 

1 :OOpm: This being the time set in a Notice of Public Hearing, heretofore published in the Reno 

Gazette Journal on July 22; August 10 and 22, 2011, to consider the revisions to the Washoe 

County portion of the Nevada State Implementation Plan (SIP), demonstrating the Health District's 

compliance with the Lead Infrastructure SIP Requirements of the Clean Air Act Section 11 0(a)(2). 

Mr. Daniel Inouye, Air Quality Specialist 

Advised, the Clean Air Act mandates the US Environmental Protection Agency (EPA) established 

health-based National Ambient Air Quality Standards (NAAQS) for six (6) criteria air pollutants, 

including lead. 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 21 

Advised, nationwide average concentrations of Lead in the air have decreased by 94% since 1980; 

that the majority of this improvement was the result of the phase-out of Lead in gasoline, Advised, 

in 2008, EPA issued a final rule revising the Lead Standard, which initiated specific Clean Air Act 

requirements including the Infrastructure State Implementation Plan (i-SIP), 

Advised, the I-SIP is a summary of current air quality management elements in Washoe County's 

portion of the Nevada Lead SIP, which includes air quality regulations and programs, demonstrates 

the Health District's ability to comply with the requirements of the Clean Air Act, 

Advised, the EPA rule requires source-oriented ambient monitoring for non-airport Lead sources 

emitting 0,5 tons annually and airport sources emitting 1,0 tons per year. Advised, currently there 

are no sources in Washoe County which "meet those criteria; and the Division does not currently 

monitor for Lead, 

Advised, Staff recommends two (2) minor revisions to the I-SIP; including the Nevada Division of 

Environmental Protection (NDEP) recommendation to revise the title to read: "The Washoe County 

Portion of the Nevada State Implementation Plan to Meet the Lead SIP Requirements of the Clean 

Air Act Section 11 0(a)(2)," Stated, "specifying it is Washoe County's Portion of the SIP will assist 

the NDEP and US EPA as other areas of the state submit their portions," Stated, the second 

revision is specific to Table 1; that the threshold source-oriented monitoring "at airports is 1,0 ton 

per year"; however, this is incorrectly listed and will be corrected "on page 2, Element B, paragraph 

2, line 2; and on page 5, Element G, paragraph 1, line 3," 

Stated, Staff recommends approval and adoption of the Lead I-SIP, with the recommended 

revisions; that upon adoption and approval it will be forwarded to the NDEP, Stated, the NDEP will 

formally I-SIP to the US EPA as a revision to the Washoe County Portion of the Nevada Lead SIP, 

B, Recommendation to Approve and Adopt the Revision to the Washoe County Portion of 

the Nevada State Implementation Plan (SIP), Which Demonstrates the Washoe County 

Health District's Compliance with the Lead Infrastructure SIP Requirements of the Clean Air 

Act Section 11 0(a)(2) 

Chairman Smith declared the Public Hearing open and called upon anyone wishing to speak either 

in favor of or in opposition to the proposed revision to the Lead Infrastructure of the Washoe 

County Portion of the State Implementation Plan (SIP), There being no one the Public Hearing 

was closed, 

MOTION: Ms. Ratti moved, seconded by Dr. Humphreys, that the Revision to the 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25,2011 

Page 22 

Washoe County Portion of the Nevada State Implementation Plan (SIP), 

demonstrating Washoe County Health District's Compliance with the 

Lead Infrastructure (SIP) Requirements of the Clean Air Act Section 

110(a)(2), be approved and adopted as presented. 

Motion carried unanimously. 

STAFF REPORTS AND PROGRAM UPDATES 

A. Director -- Epidemiology and Public Health Preparedness 

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. Todd 

Advised the Board laboratory tests confirmed Washoe County's first case of West Nile Virus for the 

season; that "due to the unusually wet and protracted winter creating an ideal environment for 

mosquitoes." Stated, Staff had anticipated a "more severe WNV season"; however, "that has not 

occurred due to the effectiveness of the Vector Control activities." Stated, the Health District was 

advised of the confirmed case through the blood donor screening program; that this individual had 

traveled through Idaho, California and Nevada; therefore, it is not known where he may have 

contracted the Virus. 

Advised, Vector Control Staff have obtained mosquito samples in the "area adjacent to this 

individual's residence; that these mosquitoes have been tested; and the results are pending." 

Dr. Iser 

Advised, the Health District has issued a press release to inform the public of this case; and the 

protective measures to take for prevention of the West Nile Virus. 

Dr. Todd 

Stated, the press release was issued; that immediately prior to the meeting news Channels 2 and 8 

were on-site conduct interviews; that Dr. Furman indicated he heard the information on the radio on 

his way to the meeting. 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 23 

B, Director - Community and Clinical Health Services 

Ms, Mary-Ann Brown, Director, Community and Clinical Health Services, presented his monthly 

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

Ms, Brown 

Advised, each of the Board members was provided with the brochure/agenda for the Obesity 

Forum, scheduled for Thursday, September 8,2011; that she would invite the Board members to 

attend, Stated, Staff anticipates an increased attendance at this year's event. Stated, Dr, Iser will 

be providing the opening comments, 

Stated, Dr, Hess has completed his orientation with the CCHS Division; that she would thank him 

"for being very tolerant of Staff's passion for the Division Programs, Staff was very appreciative of 

his taking the time to learn about the Programs in CCHS," 

In response to Dr. Humphreys 

Regarding back-to-school immunizations and "if Staff anticipates an increase or a decrease in the 

number seeking immunizations, Ms, Brown stated, "for the past number of years Staff has 

attempted to a number of methods to engage the parents, the School District, and the community 

to be prepared for school entry, especially for 7th grade," Stated, Dr. Iser and Staff met with 

representatives last week to discuss the immunization requirements and were advised there were 

approximately 2400 students who had not yet been fully immunized for school entry, Stated, Staff 

is aware "there are systems issues, including the timely entry of immunization records into the 

WeblZ database; and the school district verifying those immunizations," Stated, the number of 

students who have not yet been immunized has been reduced, including approximately 600 

seventh graders, Stated, the Health District and the School District, through the media have been 

promoting the immunization clinics, "not only the Health District clinics, but others in the community 

as well." Stated, the Nevada Immunization Coalition "has been making personal telephone calls to 

parents reminding them of immunization requirements and those not in compliance will be 

excluded from school." Advised, the Health District will be conducting a walk-in clinic; that Saint 

Mary's has walk-in clinics; that UNR Medical School Clinic "has tried to fill the gap for the Orvis 

Nursing School Clinic; that there are other community sites conducting clinics; that the Nevada 

Immunization Coalition issued a press release yesterday listing the various clinic locations, 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25,2011 

Page 24 

Dr. Humphreys 

Questioned, "if it is the policy to exclude children from school if not properly immunized." 

In response to Dr. Humphreys 

Dr. Iser 

Advised, children not properly immunized will be excluded from school. Stated, with the 

implementation of the Tdap (Tetanus, Diphtheria, and Pertussis) requirement two (2) years ago for 

seventh graders, and at the request of the School District, the Health District allowed a period of 

exemption for those children who weren't in compliance to obtain the Tdap without being excluded. 

Advised, there will be no exemption period this year; that "it is the role of the Health District to 

protect the public health - protecting those who can't protect themselves." Stated, in his capacity 

as the Health Officer in Nevada County there was a thirty (30) day old infant who died from 

Pertussis. 

Ms. Brown 

Advised, the exemptions granted in the past two (2) years was in an effort "to achieve the mutual 

goals of ensuring all children were immunized to protect the public's health, while ensuring 

exclusions were minimized, as that has a detrimental effect as well." Stated, the community 

"worked collaboratively to ensure these dual goals were met - children being properly immunized 

and being in school." Stated, she and Dr. Iser "were in complete agreement as to this year's 

process." 

Dr. Iser 

Stated, immunization Staff "anticipates a full day tomorrow and a full day on Saturday, as Ms. 

Brown's Staff will be conducting a clinic tomorrow; that Staff anticipates a full day Monday, as 

children are excluded from school." 

Ms. Brown 

Advised, Saturday's clinic is a "walk-in clinic." 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 25 

Dr. Hess 

Stated, when Dr, Mary Guinan was the State Health Officer, an Immunization Advisory Committee 

was established through the State Health Division, which made the recommendation of school 

admission to ensure proper immunization, 

Ms, Brown 

Stated, "when the Tdap requirement for seventh graders was implemented, Southern Nevada 

excluded hundreds of children from school; that Staff attempted to work collaboratively with the 

School District and the community providers to achieve the dual goals," Stated, last year Staff was 

very pro-active in ensuring seventh graders received the Tdap, including "having strike teams go to 

the schools and immunize those children who were deficient; that there were approximately thirty 

(30) children who weren't immunized by the strike teams or through other efforts," 

In response to Dr, Humphreys 

Regarding the incident at a private school, Ms, Brown stated the incident at the private school was 

a response to an outbreak and not related to the Tdap immunizations efforts for seventh graders, 

Dr, Iser 

Stated, allowing personal exemptions from immunization requirements "sets-up the risk for 

significant outbreaks; that he appreciates being in an area that does not allow for personal 

exemptions," 

C, Director - Environmental Health Services 

Mr. Bob Sack, Director, Environmental Health Services, presented his monthly Division Director's 

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

Mr. Sack 

Stated, the upcoming week is "one of Staff's busiest weeks for special events; that Staff will be 

working the Rib Cook-Off; and the Burning Man event." Advised, the Vector Control Team 

continues to be "very busy, as there is a lot of water and a lot of bugs," 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 26 

Dr. Humphreys 

Stated, "a gentleman on the Red Hawk Golf Course complimented the Vector Staff indicating 'he 

had not had one mosquito bite this year'; that "that goes to Staff's efforts." 

Mr. Sack 

Stated, Staff is "working to control the populations; that Staff has noted mosquitoes in places where 

there previously wasn't any." 

D. Director - Air Quality Management 

Mr. Kevin Dick, Director, Air Quality Management, presented his monthly Division Director's Report 

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

Mr. Dick 

Advised, the Fundamental Review Report was presented to the Board of County Commissioners; 

that a recommendation in the Report indicated "as the Air Quality Management Division does 

permits and conducts inspections, the AQM Division should be combined with the Building 

Department and others which issue permits and conduct inspections." Stated, each month AQM 

Staff reports the number of permits issued and inspections conducted; however, he has not 

"explained what the permits are for or what the inspections involve." 

Advised, the permits issued by AQM are based "on one (1) of two (2) types of Regulations. The 

US EPA establishes National Ambient Air Quality Standards (NAAQS), which are designed for the 

protection of public health. When these Standards are issued AQM develop plans delineating how 

the District will attain and/or maintain that public health Standard. To achieve this Staff develops 

control measures, some of which are permit requirements for sources of air pollutants limiting the 

amount of emissions, which can be released into the ambient air that everyone breathes. These 

Regulations are established by the local ordinances through the State Implementation Plan (SIP) 

process, which are submitted to US EPA for approval; that the local Regulations then become 

federally enforceable Regulations." 

Advised, "the other type of permits issued by AQM are for Regulations developed at the federal 

level by US EPA for hazardous air pollutants or specific types of air pollution sources; that the US 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 27 

EPA then directly delegates the AQM District with the authority to regulate and permit those 

sources. The US EPA specifically empowers the AQM Division of the Washoe County Health 

District with the compliance and enforcement authority for these Federal Regulations. 

Advised, "the statistical permit information provided in the monthly Report relates to the permits 

issued by the AQM Division." Advised, "the majority of the more than 1200 annual permits issued, 

are Permits to Operate for continuous business operations and are not related to new construction 

and development activities. These businesses are outside the authority of Washoe County and are 

not regulated by the Washoe County Building Department, as 60% of the sources are located in 

Reno; approximately 30% are located in Sparks, with the remaining 10% in Washoe County." 

Advised, the inspections performed by AQM Staff, as noted on the bottom of page three (3) "are 

fundamentally different than an inspection performed by the Building Department. The Building 

Department schedules inspections with the contractor or developer of construction projects to 

determine if project is being constructed in accordance with building standards." Stated, when 

"AQM Staff conducts an inspection it is unscheduled and is for the purpose of observing how a 

business is operated and how harmful air pollutants, which are being emitted, are being controlled 

in accordance with the conditions stipulated in the Permit to Operate." Stated, Staff inspections 

review "how employees [of a source] are performing their jobs; if the employees have 

documentation of required training; the chemistry of the materials being handled in the business; 

the amount of chemicals being used; the equipment being used in the processes; operational 

hours; and the pollution control equipment that is in place ensuring it is installed properly and 

operating efficiently." 

Advised, the AQM inspectors are "highly trained on a number of various EPA Regulations and 

requirements. The inspectors have required medical monitoring and personal protective 

equipment training to be able to suit-up and enter contaminated air spaces when necessary." 

Advised the job functions "are fundamentally different than what a building inspector would do." 

Stated, page five (5) of the monthly Report delineates the various types of "complaint activity to 

which Staff responds." Advised, he continues to participate in "on-going discussions with the 

permitting and compliance departments to review streamlining efficiencies on how to best function 

together with the other Departments." 

Stated, the Fundamental Services Review referenced "proposed consolidation on efficiencies and 

how to reduce services in a way which would save money in the operations." Stated, a proposal 

was to made in the County compliance and permitting workgroup to eliminate "somebody 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 28 

answering the telephone having calls transferred to voice mail all day; and at the end of the day 

checking calls." Stated, AQM Staff "respond to complaints from citizens who feel they be being 

exposed to air pollution; that Staff attempt to respond within an hour of receiving the complaint." 

Staff investigates these complaints "and takes action as necessary and reports back to the 

complainant so the complainant knows Staff responded and what action, if any, was taken." 

Stated, "this is very important for people's peace of mind when there is a concern their health is 

being impacted by activities which are occurring." 

E. Administrative Health Services Officer 

Ms. Eileen Coulombe, Administrative Health Services Officer, presented her monthly 

Administrative Health Services Officer Report, a copy of which was placed on file for the record. 

F. District Health Officer 

Dr. Joseph Iser, District Health Officer, presented his monthly District Health Officer's Report, a 

copy of which was placed on file for the record. 

Dr. Iser 

Stated, he continues to meet with representatives of the various agencies and entities throughout 

the Cities and the County. Stated, his report delineates the various media contact and with which 

media the contact was. 

Stated, the Board members have been provided with a copy of his written response to the Board of 

County Commissioners and Ms. Simon, on behalf of the Health District, regarding the 

recommendations of the Fundamental Services Review. Stated, "in spite of Staffs best efforts they 

were unable to sway Management Partners from presenting recommendations to the 

Organizational Effectiveness Committee (OEC), which were presented to the Board of County 

Commissioners; that the Air Quality Management Division and Environmental Health Services 

transferred to the new Municipal Services Department." Stated, he provided the Board members 

with a copy of a newspaper article from the Reno Gazette Journal, regarding the proposed new 

County Department. Stated, he has explained "he does not have the authority to transfer these 

two (2) Divisions anywhere outside of the Health District without many levels of approval, first and 

foremost the approval of the District Board of Health." Stated, as "Mr. Dick indicated, [the Health 

District] has many regulatory agencies ensuring the Health District does its job, including the State, 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25,2011 

Page 29 

US EPA and other agencies. There would have to be an entire series of approvals after a 

determination by the Board of Health." 

Advised, the Board members have been provided with a graph, which delineates the status of 

completed evaluations for Health District Staff; that after evaluations are current, Staff has 

established a goal of 85% compliance. Stated currently the Health District has completed 

approximately 74% of the evaluations, improving from approximately 40%. 

Advised, the Board of County Commissioners have released the contract for a review of the "entire 

EMS system, including the pre-hospital care, in which REMSA "plays a major part and fire plays a 

part." Stated, he is in the process of "meeting with as many people as he can to obtain as much 

information as possible to develop his own beliefs regarding the EMS system." Stated, "he did 

volunteer to be a co-project officer on the EMS Study, for first responder and medicine, as a more 

neutral party because he is new to the County; and he has some experience in this area. He 

offered his services to Mr. Kurt Latipow, Fire Liaison with the County and Ms. Simon County 

Manager; that he as advised his services weren't needed as co-project officer; however, they 

would like him involved as he could." Stated, "he will remain as neutral an arbiter as he can in this 

process." Stated, the District Board of Health's function is "to oversee the Franchise Agreement 

and to ensure compliance with that Agreement." 

BOARD COMMENT 

There was no Board comment presented. 

PUBLIC COMMENT 

There was no public comment presented. 
WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING 

August 25, 2011 

Page 30 

There being no further business to come before the Board, the meeting was adjourned at 3:05pm. 

JOSEPH P. ISER, MD, DrPH, MSc 

DISTRICT HEALTH OFFICER/SECRETARY 

(?3~f,)~(~ .i;\SW;~\ JANET SMITH, CPS 

RECORDER