Wash oe County 

Health D i strict 

Agenda I t em No.5. 

Washoe County District Board of Health 

Meeting Minutes 

June 28, 2012 

PRESENT: Mr. Matt Smith, Chairman, George Furman, MD; George Hess, MD; Dr, Denis Humphreys; Commissioner Kitty Jung; 

Councilwoman Ratti; and Councilman Gustin 

ABSENT: None; Councilwoman Jung excused herself at approximately 3:15 pm. 

STAFF: 

4. 

5. 

Dr. Joseph Iser, District Health Officer 

Kevin Dick, Director, Air Quality Management 

Robert Sack, Director, Environmental Health Services 

Steve Kutz, Acting Director, Community and Clinical Health Services 

Lori Cooke, Fiscal Compliance Officer, AHS 

Curtis Splan, Department Computer Application Specialist 

Peg Caldwell, RN1 , EMS Program, EPHP 

Phil Ulibarri, Public Inf9rmation Officer 

Bev Bayan, WIC Program Manager, CCHS 

Mary Kandaris, Assistant District Attorney 

Peggy F. O'Neill, Recording Secretary 

Chairman Smith 

Ei leen Stickney , Administrative Health Services Officer 

Randall Todd, DrPH, Director, Epidemiology and Public Health Preparedness 

Tony Macaluso, Environmental Health Speciallst Supervisor, EHS 

Patsy Buxton, Fiscal Compliance Officer, AHS 

Stacey Akurosawa, EMS Coordinator, EMS Program, EPHP 

Daniel Inouye, Air Quality Supervisor, AQM 

Charlene Albee, AQM Enforcement Branch Chief 

l aurie Griffey, Admin Assistant I, AHS 

Nicole Mertz, Public Health Nurse II , CCHS 

Janet Piette, Community Health Nutritionist, CCHS 

Michael Wolf, Environmental Engineer 11 , AQM 

Meeting Called to Order, 

Pledge of Allegiance and 

Roll Call 

led by Councilwoman Ratti. Roll call was taken and a quorum 

Approval/Deletions -

Agenda -June 28, 2012 

Approval/Deletions -

Minutes - Regular Meeting 

of May 24, 2012 

was 

any deletions to the Agenda June 28, 2012 

Or. Humphreys moved, seconded by Councilman Gustin, that the DBOH Agenda 

be approved as revised. 

Chairman II any 

May 24,2012 Regular Meeting. 

or 

approved as presented. 
Proclamations 

Board Comment 

i 

New employee, Michael Wolf, 

Air Quality Management 

B. Promotions· None 

C. Years of Service Recognition -

1. Mary Olga Rodriquez - WIC - 5 Years 

2. Janet A. Piette - WIC - 15 Years 

3. Nicole J. Mertz - CCHS - 20 Years 

C. Proclamatians - Nane. 

D. RecagnitionsI i 

I Engineer II, 

1. Jeanne Rucker, Retirement· 32+ Years, Enviranmental Health Services 

2. Mary-Ann Brawn - Service as Divisian Directar and Interim Health Officer 

Cauncilman Gustin questioned the difference in the settlement amaunts and haw 

thase amounts were determined. Charlene Albee responded to. Cauncilman 

Gustin that the difference in the fine amaunts related to. the timeliness of the 

respanse to. the Natice af Vialatian. Thase that take more time and follow up are 

generally nego.tiated at a higher amaunt. The Inspector General has issued 

guidelines for fine impasitian which are determined by haw quickly campliance is 

abtained and the gravity af the affense. 

1. Unappealed Citatians to. the Air Pallution Cantral Hearing Baard: 

a. Narthtawne Shell, Case No.. 1080, Unappealed Citatian No. 5014-

Staff reparted Citation No. 5014, Case No.. 1080, was issued to 

Ncrthtcwne Shell an April 27, 2012, far failure to. maintain gasaline 

dispensing equipment in gaad warking conditian in compliance with 

Permit to. Operate #L0305GS, Canditians (3) and (6). Operating 

cantrary to. permit canditians is a majar vialatian af Sectian 030.2175 

af the DBOH Regulatians Gaverning Air Quality management. Staff 

recammends the citatian be upheld and a negatiated fine in the 

amaunt af $2,500.00 be levied. 

b. Reno Seven Seas, Inc., Case No.. 1081, Unappealed Citatian 

No.. 5102 - Staff reported Citaticn No. 5102, Case No. 1081, was 

issued to. Rena Seven Seas, Inc., an May 8, 2012, far failure to. 

perfarm required static pressure decay testing an undergraund fuel 

starage tanks, in vialation of Sectian 030.2175 af the Washae 

Page 2 
County DBOH Regulations Governing Air Quality Management. 

Staff recommends the citation be upheld and a negotiated fine in the 

amount of $1,000.00 be levied. 

c. Chottu Inc. - Arco Station #83438, Case No. 1083, Un appealed 

Citation No. 5113 - Staff reported Citation No. 5113, Case 

No. 1083, was issued to Arco Station #83438 on May 17, 2012, for 

failure to perform required static pressure decay test on a gasoline 

dispensing facility. Failure to have the test performed 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 negotiated fine in the amount of 

$500.00 be levied. 

2. Recommendation for Variance: None. 

B. Sewaae. Wastewater & Sanitation Cases' Recommendation to Approve 

Variance Case(s) Presented to the Sewage, Wastewater & Sanitation 

Hearing Board. There are no variance case requests this month. 

C. Budget Amendments Iinteriocal Agreements: 

1. Proposed retroactive approval of District Health Officer Acceptance of 

Grant Agreement Assistance Amendment #1 from the U.S. Environmental 

Protection Agency (EPA) for funding increase of $109,450 ($57,200 

available for drawdown) for total funding of $109,450 ($57,200 available 

for drawdown) for the period 4/1/12 through 3/31 /13 for the Air Quality 

Management, EPA Air Pollution Control Program, PM 2.5 Program, 10 

10021. 

2. Proposed retroactive approval of the District Health Officer's acceptance 

of Subgrant Amendment #1 from the Nevada Department of Health and 

Human Services, Health Division for the period January 1, 2012 through 

December 31, 2012 in the amount of $193,208, bringing total CY 2012 

funding for the Immunization Program Grant (lOs 10028 & 10029), to 

$290,727. 

3. Retroactive Approval of Acting District Health Officer Acceptance of Notice 

of Subgrant Award from the Nevada State Health Division to provide 

funding in the total amount of $113,000 for the period 03/29/12 through 

03/28/13 for the Tobacco Education and Prevention Program Grant. 10 

10010. 

ACTION ITEMS: 

Letters to Northtowne 

Shell, Reno Seven Sea, 

Inc., and Area Station 

regarding fines and due 

dates. 

SINGLE, CONSENT 

AGENDA MOTION -

CARRIED: Citations 

upheld and fines levied as 

recommended; retroactive 

~pproval of District Health 

Officer Acceptance of 

Grant Agreement 

Assistance Amendment 

#1, retroactive approval of 

the District Health Officer's 

Page 3 
8. 

9. 

10. 

. Air Pollution Control 

Hearing Board Cases 

Regional Emergency 

Medical Services Authority 

A. Review and Acceptance 

of the Operations and 

Financial Report - April 

2012 

B. Updale of REMSA's 

Community Activities 

Since April 2012 

Review - Acceptance -

Monthly Public Health 

Fund Revenue and 

Expenditure Report - May 

2012 

4. Authorize the permanent decrease in full-time hours for position control 

number 70002136 (1.0 FTE to .55 FTE); Authorize the permanent 

decrease in part-time hours for position control number 70002192 (.95 

FTE to .75 FTE); Approval of amendments totaling a decrease of $15,000 

in both revenue and expense in the FY13 Family Planning Title X Grant 

Program, 10 10025. 

Councilman Gustin moved, seconded by Councilwoman Ratti, that the Consent 

Agenda Items be accepted as presented. 

None. 

No report presented this month. Both May and June will be presented at next 

month's meeting. 

Ms. Eileen Stickney, Administrative Health Services Officer, reported that staff 

recommends that the District Board of Health accept the Report of Revenues and 

Expenditures for the Health Fund for May FY1 2. 

Ms. Stickney reported that by close of year end, the entire Transfer will be 

received by the Health Fund. Staff further reported that there were no significant 

issues to bring to the Board at this time. At this time of year, Staff is diligently 

working on year end close out projects, including inventory, grant billing, external 

audits, etc. 

acceptance of Subgrant 

Amendment #1 ; 

Retroactive Approval of 

Acting District Health 

Officer Acceptance of 

Notice of Subgrant Award; 

and Authorize the 

permanent decrease in 

full-time hours for position 

control number 70002136 . 

Page 4 
F~~"'=li.~~~~~;;;j~~~~~Fc~~~~~~;"§ i on , 

which was addressed previously, or address it at a future meeting, which she 

agreed to do at the September meeting since she is on leave in August. 

11 . of FY 13 

Budget Update 

Board Comments 

Dr. Humphries questioned the difference in Projected and Actual Revenue for Vital 

Records. Ms. Stickney reported that the actual numbers of records requests are 

higher, along with higher fees, which has generated more revenue. 

Dr. Iser reported that the Health District is about to implement Vital Check, which 

is an online portal that will allow clients to order records online and the revenue 

come to the Health District. 

Dr. Hess moved, seconded by Dr. Humphreys, that the Health Fund Revenue and 

Expenditure Report for May 2012 be accepted as presented. 

i Officer, reported that 

in the Board's are copies of the Project Accounting Sheets and the 

Reduction Templates. Placed at your seats today is a comparison between the 

Proposed and WC Recommend FY 13 Budget. 

Ms. Stickney reported that the Reduction Templates are presented to the Board 

today to answer Councilwoman Ratti's questions as to the story about how the 

budget cuts have impacted the programs and services of the Health District. We 

chose this format to tell the story from FY07 - FY 13. 

Councilwoman Ratti expressed her appreciation for the work presented in the 

Reduction Templates, but stated her real need is an Executive Summary which 

she can convey to her constituents which will tell the effects upon the Health 

District. She expressed her hope that this product is helpful to the staff in recalling 

the process of the reduction, but restated her need for a higher level review of the 

reductions. 

Ms. Stickney asked for additional clarification on exactly what issues 

Councilwoman RaUl would like Staff to be responsive to, and suggested that 

Councilwoman Ratti and Dr. Iser discuss in depth the product she desires. 

Councilwoman Ratti reiterated her request for a recapitulation of high level events 

that have impacted the Health District over the last five years and capped with 

FY13, and specifically, what have the citizens of Washoe County lost in terms of 

overall service in the last five years with the budget reductions. 

Ms. Stickney will address 

the $850,000 variance in 

the September meeting. 

MOTION CARRIED: 

Health Fund Revenue and 

Expenditure Report for 

May, 2012 accepled as 

presented. 
12 PUBLIC HEARING: 

Proposed approval and 

adoption of the revisions_ 

to the "Washoe County 

Portion of the Nevada 

Dr. Iser suggested that with Councilwoman Ratti's and the Bo~rd's permission, 

they could work together to craft the Executive Summary that she desires. 

Councilwoman Ratti stated that she does not feel it is an urgent need, but that it is 

certainly an ongoing need that needs to be addressed. 

Dr. Hess presented a prospective budget document to the Board and asked that 

the Board speak to it. Chairman Smith stated that this matter needs to be 

addressed, but it should be tabled at this time so that it can be properly agendized 

for the August meeting if Dr. Hess so desires. Ms. Jung stated that Dr. Hess can 

place any item he wishes for the Board to consider on the agenda at any time. 

Items must be properly agendized. Dr. Iser suggested that Dr. Hess forward the 

information to him so that the matter may be addressed by the Board. 

Councilman Gustin stated his agreement with Councilwoman Ratti in the need for 

an Executive Summary. It is imperative to provide proper context and 

understanding for a prospective and retrospective analysis for our path forward. 

Councilwoman Ratti reiterated her concern that the Executive Summary focus 

more or services and less on lack of personnel, that that is where impact is to the 

public. 

Ms. Stickney presented the comparison between the FY13 Proposed Budget and 

FY13 Recommend which was approved by the BCC. Ms. Stickney reported that a 

significant amount of the variance is in the realignment of the Retirement 

Calculation dollars. 

Councilman Gustin stated that to him it is obvious that that is the majority of the 

variance. Councilwoman Ratti stated that while she does not feel that a line item 

report is helprul to the process, a high level review and narrative of the process is 

imperative to the dialog. These decisions are made at a high level, and the 

strategy and methodology utilized needs to be reported to the Board in an 

Executive Summary rather than so much detail. 

Councilman Gustin moved, seconded by Dr. Humphreys, that the Budget Update 

for June 2012 be accepted as presented. 

Mr. Dan Inouye presented the proposed revisions to the ·Washoe County Portion 

of the Nevada Infrastructure State Implementation Plan for the 2006 PM2.S 

National Ambient Air Quality Standard." 

ACTION ITEMS: 

Dr. Iser will work with 

Councilwoman Ratti to 

formulate the Executive 

Summary requested by the 

Board. 

Dr. Hess will forward 

information to Dr. Iser to 

agendize if he wants the 

Board to address this issue 

prospectively. 

MOTION CARRIED: 

Budget Update for June 

2012 accepted as 

presented. 

Mr. lnouye 

Page 6 
13. 

14 

15. 

Infrastructure State 

Implementation Plan for 

the 2006 PM2.S National 

Ambient Air Quality 

Standard" 

Presentation regarding 

Change in Leading 

Mortality Rates Among 

Washoe County Residents, 

1998 - 2010, by Heidi 

lengdorger, MPH, 

University of Nevada, Reno 

Presentation - "Autism 

and Ultr.asound A Public 

Health Issue" 

Presentation and possible 

approval of a special 

meeting of the DBOH in the 

afternoon on J uly 24, 2012, 

or the morning of July 25, 

2012, to facilitate the 

presentation of th~ TriOata 

report to the DBOH, and 

authorize payment of nonemployee travel 

expenditures, if necessary. 

Mr. Inouye reported that this is an administrative requirement by the EPA There 

would be no change to the way business is conducted. 

Councilman Gustin moved, seconded by Councilwoman Ratti, that the revisions to 

the Washoe County Portion of the Nevada Infrastructure State Implementation 

Plan for the 2006 PM2.5 National Ambient Air Quality Standard be adopted as 

presented. 

Ms. Lengdorger (recipient of the first OeOH scholarship) made the Change in 

Leading Mortality Rates Among Washoe County Residents, 1998 - 2010 

presentation to the District Board of Health. 

The Board thanked Ms. Lengdorger for her presentation, and stated that she was 

obviously deserving of the scholarship. 

Or. Furman made the -Autism and Ultrasound A Public Health Issue~ presentation 

to the District Board of Health. 

The Board thanked Dr. Furman for his presentation. 

Dr. Iser requested that the Board consider the approval of a special meeting of the 

DBOH to facilitate the presentation of the TriData report. Discussion ensued 

regarding the availability of the members. Several were not available on the 

suggested dates, but more were available on the date of the regular meeting, 

July 26. Dr. Iser suggested that the Board have the presentation at the regular 

meeting and pay approximately $500 for Dr. Cohen's additional expenses to stay 

over. 

Councilwoman Ratti asked if the presentation to the DBOH would be the same as 

that to the Washoe County BCC, and if so, could the Board not just watch the 

presentation. Dr. Iser confirmed that the presentation would be identical, but the 

questions and concems that the OBOH would have would be quite different than 

that of the BCC. 

MOTION CARRIED: 

Revisions to the Washoe 

County Portion of the 

Nevada Infrastructure 

State Implementation Plan 

for Ihe 2006 PM2.5 

National Ambient Air 

Quality Standard adopted 

as presented. 

Action Item: Send 

presentation to DBOH 

Members. 

Action Item: Send 

presentation to DBOH 

Members. 

Page 7 
16. 

approval of date 

for the August 23, 2012, 

regularly scheduled DBOH 

Meeting 

Board Comments 

Presentation of the 

Washoe County Health 

Status Report 

Evaluation of District 

Health Officer 

Board Comments 

i 

facilitate the in this current fiscal climate. Dr. Iser stated that he had 

that concern also, and that the Chairman had decided that he would forego the 

NALBOA Annual Conference in order to pay the difference in his expenses for the 

presentation to the Board. 

Dr. Humphreys motioned, seconded by Dr. Furman, to authorize payment of nonemployee travel expenditures, if necessary, to facilitate the presentation of the 

TriData report by Dr. Cohen. 

i i to j on 

Title X Family Planning grant on the date of the next DBOH meeting, August 23, 

and questioned whether the Board would like to change the date of the meeting so 

that he could attend or if he should simply have the Acting DHO attend the 

meeting. 

Discussion ensued about the necessity for Dr. Iser to travel and that it would be an 

opportunity for professional development for whomever will be Acting DHO on that 

date, The board stated that the Acting DHO should cover the meeting for Dr. tser. 

Dr. tser presented the Washoe Health Report to the Dr. Iser 

stated that the calendar format allowed us to share a little bit of Health Status· 

and a tittle bit of advice. Dr. tser reported that the St. Mary's Health Status Report 

will be a much more comprehensive Health Status Report. 

Councilman Gustin questioned whether the District had received photo releases 

from anyone who took the photos included in the Report. Phil Ulibarri, PIO, 

confirmed that the Health District has received photo releases on everything used. 

Health Officer evaluation results ensued. The majority of the responses in each of 

the categories quarried in Survey Monkey indicated "Meets or Exceeds 

Expectations." Dr. Iser received very high marks in almost every category. 

Chairman Smith stated that comments regarding Dr. Iser's exploration of a 

standalone health district are understandable, but that direction has come from 

him and the Board. Dr. Furman stated that he had nothing in addition to add. 

Councilman Gustin stated that he is very pleased with Dr. tser's performance and 

MOTION CARRIED: 

Payment of non-employee 

travel expenditures (Dr. 

Cohen) is authori zed in the 

amount of $500. 

Page 8 
19. Staff Reports and Program 

Updates 

A Director - Epidemiology 

and Public Health 

Preparedness 

B. Director - Community and 

Clinical Health 

Preparedness 

level of expertise. Dr. Hess stated that he has been very pleased with Dr. Iser's 

performance. Dr. Humphreys stated that he believes that Dr. Iser has done an 

exceptional job and is very pleased with Dr. Iser's performance. Councilwoman 

Ratti stated that she is pleased with Dr. Iser's perforlT!ance also. Chairman Smith 

stated that Dr. Iser had done a great job from his perspective. Retention is 

desired. 

Areas for Professional Development - Desire more formal and long term strategic 

plan; the relationship with the county and choosing when to be fierce and when to 

be diplomatic. 

Discussion ensued regarding wage and benefit concession and adjustments in line 

with the BCC's approval of Department Head and management salary 

adjustments. 

Chairman Smith moved, seconded by Dr. Humphreys, to approve Item 16(c), 

wage and benefit concession adjustments from 5% to 4.5% continuing through 

June 30, 2013 and discontinue health cost benefit contributions for the District 

Health Officer as presented 

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 reported that an additional individual has contracted Pertussis which will 

require continued surveillance and contact notification. 

Councilman Gustin questioned the age of the persons referenced in Dr. Todd's 

reports who died due to influenza. Dr. Todd stated that he did not know for sure, 

but he would guess older age individuals. 

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

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

file for the record. 

MOTION CARRIED: 

Approve item 18(c), 

wage and benefit 

concession adjustments 

from 5% to 4.5% 

continuing through June 

30,2013 and 

discontinue health cost 

benefit contributions for 

the District Health 

Officer, as presented. 

Page 9 
Director - Environmental 

Health Services 

Board Comments 

Director Air Quality 

Management 

E. Administrative Health 

Services Officer 

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. Sack reported that we've received notice from California that a few birds in 

South Lake Tahoe have tested positive for West Nile, and the vast majority of 

them are Robins and Sparrows, which is unusual. 

Councilman Gustin stated he was so disappointed to read in the report that there 

are grant dollars out there that we are hesitant to pursue since we don't know if we 

will have the staff to implement any award. 

Dr. Furman expressed his frustration with the grants review process at the federal 

level. 

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 reported that AQM issued a press release to announce the beginning of 

the summer ozone season, and on June 18, a Monday, we had our first 

exceedance of the eight hour ozone standard. We hit 76 parts per billion, and the 

standard is 75. The peak came closer to midnight so we think what we got was 

transport out of California. 

The Title X Major Source Permit that we have a meeting for on Monday is related 

to the Sparks Energy Plant which is designed to supply power to the data storage 

facilities there. Mr. Dick congratUlated Ms. Albee on her work in this area. 

Ms. Stickney, Administrative Health Services Officer, presented her report, a copy 

of which was placed on file for the record. 

Dr. Joseph Iser, District Health Officer, presented his monthly District Health 

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

Page 10 
20 

JOSEPH P. ISER, MD, DrPH, MSc 

DISTRICT HEALTH OFFICER 

on iii i 

with the UNR PH program so that we will increase our chance of being 

in the future in this program 

Dr. Iser reported that REMSA applied for and was awarded a CMS Innovations 

Grant. The award is approximately $10 Million. The grant is designed to give 

REMSA the flexibility to triage a patient and decide jf there are other care options 

available rather than just the emergency room. Maybe even transport to a dOctor's 

appointment. It should have significant effect on the cost of health care and it will 

be a tremendous asset for REMSA and our community. 

Councilman Gustin thanked Dr. Furman for his presentation today. 

Councilman Gustin also applauded NY Energy on their quick trimming of trees In 

the downtown area during the heavy winds. Some of the branches were already 

burning due to arcing next to the electric lines. They are to be commended. 

Councilwoman Ratti thanked the team again for putting the program reports 

together. 

No public comment was presented. 

come was 

adjourned. 

Councilwoman moved, seconded by Dr. Hess, that the meeting be adjourned. 

was 

adjourned at 3:45 p.m. 

PE~~ {)1(wd RECORDING SECRETARY 

Page 11