### Wash o e County

Health D i stri ct 

### Agenda I t e m No.5 . 

## Washoe County District Boa rd of Health Meet i ng M i nutes

June 28, 2012 PRESENT : M r. Matt S m ith , Ch a i rman, Geo rg e Fu rma n , MD ; Geo rg e H ess , MD ; D r , Den i s Hu m phreys ; Com m issio n er Kitty J u n g ; Cou n ci lwoma n Ra tti ; an d Cou n ci lm a n Gust i n ABSENT : N one ; Co un cilwoma n J un g excu s ed he rs e lf at approxim ate ly 3:15 pm . STAFF :



### 4 .



### 5 . Dr. Josep h I se r , District Health Officer Kevi n D ick , D ire cto r , Air Qua l ity Ma n age m ent Robe rt Sack , D i recto r , E nv i ronme ntal H ealth Services Steve Kutz , Act i n g D irector, Comm u nity and Clinical Health Services Lori Cooke , Fiscal Compliance Officer , AHS C u rtis Splan , D ep a rtme nt Computer Application Spe cia l ist Peg Caldwell, RN1 , EMS Prog ra m , EPHP P h i l Uli barri , Pu b l ic Inf9rmation Offi ce r Bev Bayan , W I C Program Ma na ger, CC H S M ary Kanda ri s , Assista nt District Attorney Peggy F. O'Neill , Recording Secretary

Chai rman Smi t h Ei leen Stickney , Admi n ist rat ive H ealth Services Officer Randall Tod d , DrPH , Director, Epidemiology and Public Health Preparedness T ony Macal u so , Environmental Health Speciallst Supervi sor, E H S Patsy B uxton , Fiscal Compliance Offi cer , A H S Stacey Aku rosawa , EMS Coo rd inato r , EMS Program , E P H P Da ni e l In o uye , Air Qu a lity Supervisor, AQM Ch a rlene Albee, AQM Enforcement B ranch Chief l auri e Griffey, Admin Assistant I , AHS Nicol e Mertz , Public Health Nu rse II , CCHS Janet P iette , Commun ity Healt h N utritionist , CCHS M ic h ae l Wo lf , Environmental E ng i neer 

### 11 , AQM



### Meeti ng Called to O rder, Pledge of Allegiance and 

### Roll Call led by Cou n c i lwo m a n Ratti. Ro ll ca ll was take n a n d a q uorum 

### Approval/Deletions - Agend a -June 28 , 2012 

### Approval/Delet i ons - Minutes - Regular Meeting o f May 24 , 2012 was a ny del et io n s to the Age nda J une 28, 2012 Or. H umphreys moved , seconded by Councilman Gustin , that the DBO H Agenda be approved as revise d . C h a irma n II any M ay 24 ,2012 R egular Meeting . 

### or a p proved as prese nted .

### Proclamations

Board Comment i New employee , M ic hael Wolf , Air Quality Management B. Promotions· None C. Years of Service Re cognition - 1 . Mary Olga Rodriquez - W I C - 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 settlem ent amaunts and haw thase amounts were determined . Charlene A lbee responded to. Cau nci lma n Gustin that the diffe rence in the fine amaun ts related to. the timeliness of the resp anse to. the Natice af V iala tian. Thase th at take more time and follow up are generally neg o.tiated at a highe r 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 A i r Pallution Cantral Hearing Baard : a. Narthtawne Shell , Case No. . 1080, Unappealed Citatian No . 5014- Staff 

### reparted Citation No. 5014 , Case No.. 1080, was iss ued to Ncrthtcwne Shell an April 27, 2012, far failure to. ma intain gasaline dispe n sing equipment in gaad warking cond iti an in comp lian ce with Permit to. Ope rate #L0305GS , Canditians (3) and (6). Operating ca ntrary to. permit can di tians is a majar vialatian af Sectian 030.2175 af the D BOH 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. Re na Seve n Seas, Inc., an May 8, 2012 , far failure to. perfarm required static pressure decay tes ting an undergraund fuel starage tanks, in via lation of Sectian 030 .2175 af the Washae 

### Pa ge 2County DBOH Regulations Governing Air Quality Management. Staff recommends the citati o n be upheld and a negotiated fine in the am ount 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 1 7 , 2012, for failure to perform require d static pressure decay test on a gasoline dispensing facility . Failure to have the test perfo rmed is a Major Violation of Section 030.2175 of the Washoe County DBOH Regulations Governing Ai r Quality Management. Staff recommends the citatio n be upheld and a negotiated fine in the amo u nt of $500.00 be levied . 2. Recommendation for Variance: None . 

### B. Sewaae. Wastewater 

### & Sanitation Cases ' Recommendation to Approve Va riance 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 approva l of District Health Officer Acceptance of Grant Agreement Assistance Amendment #1 from the U . S. Environmental Protection Agency (EPA) fo r 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 Ai r Quality Management, EPA Ai r Pollution Control Program, PM 2.5 Progra m , 10 

### 10021. 2. Proposed retroa ctive approval of the District Health Officer's acceptance of Subgrant Amendment #1 from the Nevada Department of Health and Human Services, H ealth D ivisio n for the period Ja n uary 1 , 2012 t h rough December 31, 2012 in the amount of $193,208, bring i ng 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 thro ugh 

### 03/28/13 fo r 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 Distri ct 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 decreas e 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 P ro gram , 10 10025. Councilman Gustin moved , seconded b y Coun cilwoman Ratti , that the Co nsent Agenda Items be accepted as presented . None.



## N

o re port 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 Boa rd of Health accept the Report of Reve nues and Expenditures for the Health Fund for Ma y FY1 2 . Ms . Stickney reported that by c lose of yea r end , the e nt i re Transfer will be rece ived by the Hea lth Fund . Staff further reported that there were no significant iss ues to bring to the Boa rd at this time . At th is time of year, Staff is diligently working on year end close ou t 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 A utho ri ze the permanent decrease in full-time hours for position control number 

### 70002136.

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# F~~"'=l**i.~ ~~~~;;;j~~~~~Fc~~~~~~;"§**  i on , which was addressed previously , or address it at a future meeting , which she agreed to do at the September meeti ng since she is on leave in August.



### 11 . 

### of FY 13 

### Budget Update

Board 

### Comments Dr. Humphries questioned the difference in Proje cted and Actual Re venue for Vital Records . Ms . Stickney reported that th e 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 onl ine and the revenue come to the Health District. Dr. Hess moved , seconded by Dr. Humphreys , that the Health Fund Reven ue 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 Te mplates . Placed at your seats today is a compariso n between t h e Proposed and WC Recommend FY 13 B udget. Ms . Stickney reported that the Reduction Template s 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 te ll 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 co nvey 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 redu ction , but restated her need for a higher level review of the reductions . Ms. Stickney asked for additional clarification on exactly what issues Councilwoma n RaUl would like Staff to be responsive to , and suggested that Councilwoman Ratti and Dr. Iser discuss in depth the product she desires. Cou n c ilwo man Ratti reiterated her request for a recapitulation of hig h level events that have impacted the Health District over the last five years and capped with FY13 , and specifically, what have the cit ize ns of Washoe Coun ty lost in terms o f overall service in the last five years with the budget reductions . 

### Ms . Stickney will address the $850,000 varia n ce in 

### the September meeting.
MOTION CARRIED: Health Fund Revenue and 

### Expenditure Report for May , 2012 accepled as presented.

### 1 2 PUBLIC HEARING: 

### Proposed approval and adoption of th e revisions_ to the " Washoe County Portion of the Nevada Dr. I ser suggested that with Councilwoman Ratti 's and the**Bo~rd's** permission, th ey could work together to craft the Exec utive 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 p rospective budget documen t to the Board and asked that the Board speak to it. Chairman Smith stated t hat this matter needs to be addressed , but it should be tabled at this time so that 

### it can be prope rly 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 t he matter may be addressed by t h e 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 forwa rd . Councilwoman Ratti reiterated her conce rn that the Executive Summary focus more or services and less o n lack of personnel, that that is where impact is to the publi c . Ms. Stickney p resented the comparison between t h e FY13 P ro posed 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 Calcu lation dollars . Councilma n Gustin stated that to him 

### it is obvious that that is the majority o f the variance. Counci lwo m an Ratti stated that while she does not feel that a l ine item report is he l pru l 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 E xe c utive 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 pres ented the proposed revisions to the · Washoe County Portion of the Nevada Infrastru cture State Implementation Plan for th e 2006 PM2 . S National A mb ie nt A i r Quality Standard . " 

### ACTION I TEMS : Dr. I ser will work with Coun cil woman Ratti to formu late the Executive Sum ma ry requested by th e Board . Dr . H ess will forward i nformation to Dr. Ise r to agendize if h e wan ts the Board to address this issue pros pective ly.

MOTION CARRIED: 

### Budget Update for June 2012 accepted as presented. 

## Mr. 

## lnouye
Page 6

### 1 3 .

14



## 15 . Infrastructure State Implementation Pla n fo r 

### th e 2006 PM2.S Nati on al Ambient Air Quality Standard "

Presentati on regarding 

### Cha nge in Leading Mortality Rates Among Washoe County Resi dents, 

### 1998
- 

### 2010 , by Heid i lengdorger, MPH , University of Nevada, Reno
Presentation - 

### "Autism and Ultr.asound A Public Health Issue " P resentati on and possible a pp roval of a special 

### meeting of the DBOH in the afternoon on J uly 24 , 2012 , or t h e morning of Ju l y 25 , 2012 , to facilitate t he prese n tation of**th~** 

### TriOata 

### report to t h e DBOH, and authorize payment of nonemployee travel ex p e nditures, if necessary . Mr. I nouye reported t hat th i s is an a d ministrative requirement by the E PA T he re would be no c hange to the way busi n ess is conducted . Council m an Gustin moved, se conded by Councilwoma n Ratti, t hat the revision s to the Was hoe Cou nty Portion of t he Neva d a I nfra st ructure State I m p le men tati on Pl a n for the 2006 P M2 . 5 National Ambi e nt Air Quality Standard 

### be a dopted as p re sented .

M s. Leng d o rge r ( re cipient of th e f i rst Oe OH schola rship) made th e Change in Leading Mortality Rates Among Washoe County Residents, 

### 1998
- 2010 presentation to th e Dist rict Board of Hea lth. T he Boa rd t hanked Ms . Lengdo rge r for her presentation, and sta ted tha t she was o bviously deserving of the sch o larshi p .

Or. Fu rm an m ade t h e -Autism an d Ultrasound A Public Health**Issue ~**  presentation to the D istri ct Board of Hea lth . T he Board thanked D r. Furm an for his p rese ntation. Dr . Iser requested that t he Board consi de r t h e app roval of a special meetin g of t he D BO H to f aci l itate th e presentat io n of t h e TriData report . D isc uss io n e n su ed re ga rd i n g th e ava i la b i l ity of the m em bers. Several were not available o n the su gg ested dates , bu t m ore w e re ava il a bl e on t he da te of th e regula r meeting , Ju ly 26. Dr. I ser s ug gested that th e Board have the presen tation at the re g ular meet ing a nd pay a pp roxim ately $500 fo r D r. Cohen's additio nal expenses to stay over. Co u ncilwom a n Ratti asked if t he p resentation to the DBO H would be th e sa m e as that to t h e Washoe County BCC, and if so, co ul d the Board not just watch th e presen tation . D r. Iser confirmed that th e p resen tati on wo ul d be ide ntica l , b ut t h e q uestions an d concems t hat the OBO H wo u ld have wou ld be quite d ifferent th an that of the BCC . 

### MOTION CARRIED : Revi s i ons to the W as h oe 

### Cou nty Portion of t he Ne va da 

### In frastru cture Sta te I mpl e me ntatio n P lan 

### for Ih e 2006 PM 2 .5 Nati o n al Am b ie nt Air 

### Qu ali ty Sta n da rd adopted as pre sented. 

### Action Item: S en d p re s entati o n t o 

### DBOH Membe rs .

Action Item: Send pre sentat ion to 

### DBOH M e m bers .

P ag e 7

### 16 . approval of date f or the August 23, 2012, regularly scheduled DBOH Meeting Board Comments
Presentation of the 

### Washoe County Health Status Report



### Evaluation of District Health Officer Boa r d Comments i faci l itate the in this curre nt 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 , seco nded by Dr. Furman , to authorize payment of nonemp loyee travel expenditures , 

### i f necessary , to facilitate the presentation of the TriData report 

### by D r . Cohen. 

### i i 

### to j 

### on Title X Family Plann i ng grant on the date of the next DBOH meeting , August 23 , and questioned whether the Board would l ike to change the date of the meeting so that he could attend or if he should simply have the Acting DHO attend the meeti ng . Discussion ensued about the necess ity for Dr. Iser to travel and that it would be an opportun ity for professional development for whomever will be Acting DHO on that date , The board stated that the Acting DHO should cover the meeti n g for Dr. tser . Dr. tser presented the Washoe H ealth 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 H ealth Status Report . Councilman Gusti n questioned whether the District had rece ived photo releases from anyone who took the photos included in the Report . Phil Ulibarri , P IO, co nfi rmed that the H ealth District has received photo releases on everything used.
Health Officer evaluation results ensued. T he majority of the responses in each of the categories quarried in Survey Monkey indicated "Meets or Exceeds Expectations ." D r. Iser received very high marks in almost every category . Chairman Smith stated that comments regarding Dr. I ser' s explorat ion of a standalone health district are understandab le , but that direction has come from him and the Board . Dr. Furman stated th at h e had nothing in additio n to add . Councilman Gustin stated that he is very pleased w ith 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 

### Upd ates A Director - Epidemiology 

### and Public Health Preparedness

B. Director - Community and Clinical Health P reparedness level of expertise. Dr. Hess stated that he has been very pleased with Dr. I ser's performance. Dr. Humphreys st ated that he believes that D r. Iser has done an exceptional job and is very pleased with Dr. Iser's performan ce. Counci lwoman Ratti stated that she is pleased with Dr. Iser's perfo rlT!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 fo r mal and long term strategic plan ; the re l ationship with the county and choosing when to be fierce and when to be dip lomatic . Discussion ensued regarding wage and benefit concession and adjustments in l i ne with the BCC's approva l of Department Head and management salary adjustments . Chairman Smith moved , seconded by Dr. Humphreys , to approve Item 16(c) , wage and benefit concessi o n adjustments from 5 % to 4 . 5% co ntinuing through June 30 , 2013 and discontinue health cost benefit contribut ions for the District Health Officer as p resented

Dr. Randa ll Todd , Director, Epidemiology and Pub l ic Health Preparedness , presented his monthly Divisi o n Director's Report , a copy of which was placed on file for th e record . D r . Todd reported that an additional individual has cont racted Pertuss is which will require continued surveillance and contact notification . Counci lm an 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 o lde r age individua ls . Mr. Steve Kutz , Acting Directo r, Comm unity and C l in ical Health Services, presen ted 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 adjustm ents 

### from 5% to 4 . 5% continuing t h roug h June 30,2013 and discontinue health cost benefit contrib uti ons 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 hes itant 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 wh ich was placed on file for the record. Mr. Di ck 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 exceeda nce 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 Energ y Plant which is designed to supply power to the data storage facilities there. Mr. Dic k congratUlated Ms . Albee on her work i n this area . Ms . Stickney , Administrative Health Services Officer, presented her report , a copy of which was placed o n file for the record . Dr. Joseph Iser, District Health Officer, presented his m o nthly District Health Office r Report, a copy of whic h was placed on file for the reco rd . 

## Page 10

## 20

JOSEPH P. ISER , MD , DrPH , MSc DISTRICT HEALTH OFFICER on iii i with the UNR PH program so that we w ill in c rease our chance of be ing in the fut u re in this program Dr. Iser reported that REMSA appl i ed for and was aw arded a CMS In novations Grant. Th e 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 emerge ncy ro om . May be even transport to a dOctor's appointment. I t should have sig n ificant effect on the cost of health c are and it will be a tremendo us asset fo r REMSA a nd our commun ity . Councilman Gusti n thanke d Dr. Furman fo r his presentati on today . Cou n cil m an Gustin also applauded NY Energy on their quick trimming of trees In the d owntown area during the h e avy winds. Some of the branches were already burning due to arcing next to the elect ri c lin es . They are to be co mmended . Coun cilwoman Ratt i thanked the team aga in for putt in g the progra m reports together . N o publi c commen t was presen ted . come was adjourned. Councilwoman moved, seconded by Dr. Hess , t hat the meeti ng be adjourned . 

### was 

### adjourned at 3:45 p . m .

# PE**~~ {)** **1(wd** RECORDING SECRETARY


### Page 11