## WASHOE COUNTY
DISTRICT BOARD OF HEALTH
MEETING MINUTES

Members Thursday, August 28 , 2014
Matt Smith , Chair 1:00 p .m. Kitty Jung , Vice Chair
Dr. Denis Humphreys
Neoma Jardon Washoe County Administration Complex
Julia Ratti Health District South Conference Room Dr. George Hess 1001 East Ninth Street
David Silverman Reno, NV

______________________________________________________________________________

The Washoe County District Board of Health met in regular session on Thursday, August 28

, 2014, in the Health Department South Conference R oom, 1001 East Ninth Street, Reno, Nevada.

1. Call to Order, Pledge of Allegiance

Chair Smith called the meeting to order at 1:0 2 p .m.

Dr. Hess led the pledge to the flag.

______________________________________________________________________________ 2. Roll Call

The following m embers and staff were present:

Members present: Chair Matt Smith
Dr. Denis Humphreys Dr. George Hess
Julia Ratti (arrived at 1:05 p.m.)
David Silverman
Neoma Jardon

Members absent: Vice Chair Kitty Jung

Staff present: Kevin Dick, District Health Officer
Leslie Admirand , Deputy District Attorney Charlene Albee, Division Director , AQM Steve Kutz, Division Director , CCHS Bob Sack, Division Director , EHS
Anna Heenan , A dministrative Health Services Officer, AHS
Randall Todd

, DrPH, Director, EPHP Daniel Inouye, Air Quality Supervisor, AQM Yann Ling

- Barnes, Environmental Engin eer II, AQM Kelli Goatley

- Seals, Health Educator Coordinator, CCHS Dawn Spinola, Administrative Secretary/ Recording Secretary

Post Office Box 11130, Reno, NV 89520

- 0027

– 1001 E. Ninth St., Reno, NV 89512 Telephone: 775.328. 2415

– Fax: 775.328. 3752 www.washoecounty.us/ health /3. P ublic C omment
As there was no one wishing to speak, Chair Smith closed the public comment period

.

______________________________________________________________________________

4. Approval/Deletions to Agenda

Councilmember Jardon moved to approve the agenda for the August 28 , 2014
, District
Board of Health meeting. Mr. Silverman seconded the motion which carried six in favor and none against

.

______________________________________________________________________________ 5. Approval of Draft Minutes

Dr. Hess moved to approve the minutes of the July 24 , 2014 District Board of Health regular meeting as written

. Councilmember Jardon seconded the motion which carried six in favor and none against

.

______________________________________________________________________________ 6. Recognitions Presented by Mr. Dick and Chair Smith

A. Years of Service

1. Jeffrey Brasel, 20 years, hired 8/22/94

– EHS

Mr. Dick congratulated and thanked Mr. Brasel and presented him with a Certificate of Appreciation

. 2. Michael Ezell, 20 years, hired 8/22/94

– EHS

Mr. Dick congratulated and thanked Mr. Ezell and presented him with a Certificate of Appreciation

.

B. Promotions

1. Anna Heenan

– Finance

- S enior Fiscal Analyst to Health

- Administrative Health
Services Officer 8/4/2014

Mr. Dick introduced Ms. Heenan , stated he has been very impressed with her work thus far and briefly reviewed her profes sional background

. 2. Latricia Lord

– From EHS Environmental Health Trainee II to Environmental Health Specialist 8/11/14

Mr. Dick congratulated Ms. Lord and explained she had received the promotion due to the fact she had earned her certificate as a Registe red Environmental Health Specialist.

3. Elizabet Munoz

– From CCHS Intermittent Hourly Community Health Aide to Permanent Full Time Community Health Aide

Mr. Dick congratulated Ms. Munoz

. Ms. Stacy Hardie noted Ms. Munoz had been the lead applicant for the position and CCHS was very happy to have her.

C. Transfers

1. Nicole Alberti, transfer from Health Educator II (EPHP) to Health Educator II (CCHS)
effective 6/30/14

Mr. Dick congratulated Ms. Alberti.

August 28 , 2014 Washoe County District Board of Health Meeting Minutes Page 2 of 10_______________________________________________________________________________ 7. Proclamation Presented by Mr. Dick and Chair Smith

A. Healthy Living Day

Mr. Dick read the p roclamation and presented it to Ms. Goatley

- Seals

. Councilmember Ratti moved to ad opt the proclamation. Councilmember Jardon seconded the motion which was approved six in favor and none against.

_____________________________________________________________________________ 8

. Consent Agenda

Matters which the District Board of Health may consider in one motion. Any exceptions to the Consent Agenda must be stated prior to approval.

A. Air Quality Management Cases Staff Representative: Ms. Albee

1. Recommendation to Uphold Citations Not Appealed to the Air Pollution Control Hearing Board

a. Payless Car Rental

– NOV No. 5430, Case No. 1162 1395 Airmotive Way, Reno, NV 89502

b. Ryder Homes

– NOV No. 5419, Case No. 1163 750 Arrow Creek Parkway, Reno, NV 89511

c. KDH Builders

– NOV No. 5359, Case No. 1164
10625 Double R Blvd, Reno, NV 89521

B. Budget Amendments / Interlocal Agreements:

1. Approval of the Washoe County Smoke Management Program Memorandum of Understanding with the United State Department of Agriculture, U.S. Forest Service, Region 4, Humboldt

- Toiyabe National Forest, and Region 5, Lake Ta hoe Basin Management Unit ; and if approved, authorize the Chairman to execute

. Staff Representative: Ms. Erin Dixon

2. Approval of Notice of Subgrant Award from the Division of Public and Behavioral Health in the amount of $255,322 (with $25,532.20 or 10% ma tch) for the budget period July 1, 2014 through June 30, 2015 (BP3) in support of the Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program; and if approved authorize the Chairman to execute. Staff Representative: Ms. Patsy Buxton

3. Approval of Notice of Grant Award dated May 22, 2014 from the Department of Health and Human Services Public Health Service for the period June 30, 2014 to June 29, 2015 in the amount of $799,800 in support of the Family Planning Program,
IO 10025. Staff Representative: Ms. Patsy Buxton

4. Approval of Notice of Subgrant Award from the Division of Public and Behavioral Health in the total amount of $685,505 (with $68,550.50 or 10% match) for the budget period July 1, 2014 through June 30, 2015 in suppor t of the Centers for

August 28 , 2014 Washoe County District Board of Health Meeting Minutes Page 3 of 10Disease Control and Prevention (CDC) Public Health Preparedness Program; approve amendments totaling an increase of $24,049 in both revenue and expense to the FY15 CDC Public Health Preparedness Federal Grant Program, IO 10713; and if approved
authorize the Chairman to execute. Staff Representative: Ms. Patsy Buxton

Dr. Humphreys moved to approve the consent agenda as presented

. Dr. Hess seconded the motion which was approved six in favor and none against.

______________________________________________________________________________ 9. Public Hearing

– Adoption of the “Redesignation Request and Maintenance Plan for the
Truckee Meadows 24

- Hour PM10 Non

- Attainment Area” Staff Representative: Mr. Inouye

Mr. In ouye presented the staff report. He explained during the 1980s and 1990s Washoe County frequently exceeded the PM10 standard. AQM staff had developed and implemented successful strategies to reduce emissions. Currently Washoe County’s air quality meets the
national ambient standard.

A similar redesignation request and maintenance plan was adopted by the Board in 2009 and submitted to the Environmental Protection Agency (EPA). EPA had informed AQM that
additional documentation would be required . The c urrent plan addresses EPAs comments and demonstrates continued attainment of the PM10 standard through 2030. There is no fiscal impact as the plan is the same but more documentation is being provided.

As there was no one wishing to speak, Chair Smith closed the public comment period

. Chair Smith congratulated th e AQM staff. Councilmember Ratti noted it was good news.

Councilmember Ratti moved to adopt the “ Redesignation Request and Maintenance
Plan for the Truckee Meadows 24

- Hour PM10 Non

- Attainmen t Area

. ” Dr. Humphreys seconded the motion which was approved six in favor and none against.

______________________________________________________________________________ 1 0

. Public Hearing

– Adoption of the “Second 10

- Year Maintenance Plan for the Truckee
Meadows 8

- Hour Carbon Monoxide Attainment Area” Staff Representative: Ms. Ling

- Barnes

Ms. Ling

- Barnes presented the report, explaining that during the 1970s and 1980s Washoe County frequently exceeded the Carbon Monoxide (CO) standard. Non

- attainment areas are required by the Clean Air Act to develop a State Implementation Plan for attainment.

AQM identified and applied redu ction strategies that successfully reduced emissions from the largest wintertime CO contributors. Air quality standards were attained in 1995. In 2005 AQM submitted a redesignation request and maintenance plan demonstrating attainment of the
CO standard. EPA redesignated the CO standard in 2008. Since then, Washoe County has been consistently 2/3 below the standard.

The plan will provide for the maintenance of the 8

- hour CO standard through 2030 . The current plan is effective through 2018, and th e ne w plan is being prepared and submitted early in order to align transportation conformity analysis years with the PM10 plan.

August 28 , 2014 Washoe County District Board of Health Meeting Minutes Page 4 of 10Dr. Hess asked what would happen if Washoe County had more than the allowed one episode
of exceedance . He opined 2030 was a long time to project out , particularly in light of increasing population and associated pollution

.
Ms. Ling

- Barnes noted technology was improving and vehicles were being upgraded to
reduce emissions. Fuels are also cleaner than they used to be. Mr. Inouye e xplained the CO plan contained a contingency plan which allowed them to revisit the categories and determine which
ones could be reduced more. He provided examples that included t he woodstove program

, which could be expanded

, some types of exemptions reduced and the smog check program made more stringent. He noted the plan provided them flexibility for the future.

Mr. Inouye went on to explain the forecasts for 2030 include planning assumptions used as a region. AQM is required to use the same popu lation estimates as the Regional Transportation
Commission (RTC) and the cities.

Chair Smith asked what categories of pollutants were associated with fires. Mr. Inouye stated they contained PM10, PM2.5, CO and ozone. EPA considers those as exceptional events with respect to attainment or non

- attainment and excludes them when calculating Washoe County’s air quality levels compared to standards.

Councilmember Jardon asked if electric cars and changes in driving habits were factored into the predictions. Mr. Inouye explained the basis of the predictions is an EPA

- developed and
endorsed model. The main things considered are employment, population and vehicle miles
traveled. RTC develops a transportation model and that information is combined with anothe r model to calculate emissions

. As there was no one wishing to speak, Chair Smith closed the public comment period

. Dr. Humphreys moved to adopt the “ Second 10

- Year Maintenance Plan for the
Truckee Meadows 8

- Hour Carbon Monoxide Attainment Area

. ” Councilmember Ratti seconded the motion which was approved six in favor and none against

.

______________________________________________________________________________

1 1

. Regional Emergency Medical Services Authority Presented by Jim Gubbels, President , REMSA

A. Review and Acceptance of the REMSA Operations Reports for June, 2014

Mr. Gubbels presented the report. Priority One compliance was 92 percent and Priority Two compliance was 96 percent. 8

- minute response zone co mpliance was at 92 percent, 15

- minute response zone was at 97% and 20

- minute response zone was at 100%.
Average Care Flight bill for the month was $7,732, which brought the year

- to

- date average to $7,994. The average Ground Service bill for the month was $1,068, which brought the year

- to

- date ground average to $1,067.

Councilmember Jardon moved to accept the REMSA operations report for June 2014. Dr. Hess seconded the motion which was approved six in favor and none against.

B. Review and Acceptance of the REMSA Operations Reports for Ju ly, 2014

Mr. Gubbels explained the July report format was different, reflecting the changes enacted under the new Franchise Agreement. Priority One compliance for Zone A is 93

August 28 , 2014 Washoe County District Board of Health Meeting Minutes Page 5 of 10percent. Priority One response for Zones, B, C and D combined was 93 percent a nd is required to be 90 percent or better. An average response time will be reported, which is currently 5:41 for all zones. Required response times are as follows: Zone A, 8:59; Zone B, 15:59; Zone C, 20:59, and Zone D, 30:59.

The second section reports statistics by jurisdiction. Priority One for Reno is 5:07, Priority Two is 6:33. Priority One for Sparks is 5:59, Priority Two is 6:55. Priority One for

u nincorporated Washoe County is 8:34, Priority Two is 9:53.

Councilmember Ratti asked if Z ones B, C and D were unincorporated Washoe County. Mr. Gubbels replied that was correct, with the exception of the fact that Sparks has 15:59 exceptions for the Priority One calls. Those will be an ongoing study area to see if they can
be converted from the 15 : 59 to the 8 :59 response zone times.

Councilmember Ratti requested further clarification, asking if Priority One Zone A was incorporated Reno and Sparks. Mr. Gubbels stated that was correct. He opined he should report that Zone A is the 8:59 zone within the service map. He noted the next segment of the report listed averages by jurisdiction which included all of i ncorporated Sparks . He stated it
includes both the 8:59 and 15:59 areas. Councilmember Ratti clarified the bottom numbers of the graph were by city boundaries and the top numbers were driven by the maps.
The average Ground Service bill for the month was $1,069, which brought the year

- to

date ground average to $1,069. He pointed out the allowed ground average bill for the current fiscal year did receive the Consumer Price Index (CPI) increase so will now be at $1,076. The increase was .84, which is the lowest CPI index ever received.

Councilmember Ratti asked if the new data

- gathering systems would allow for reports that would help strateg ic planning for the region and how the Board would receive the data. Mr. Dick explained the reporting would come from the Emergency Medical Services ( EMS ) program staff, so it would be separate from the REMSA report. The EMS program staff would be respon sible for compiling the data f rom the Fire EMS agencies and REMSA, doing the analysis and presenting the information to the Board.

Councilmember Ratti asked if there will still be an annual franchise review and when it would be held. Mr. Gubbels explain ed the normal process was that the Health District reports that information to the Board in January for the previous fiscal year.

Dr. Humphreys moved to accept the REMSA operations report for July 2014.
Councilmember Ratti seconded the motion which was approved six in favor and none against.

C. Update of REMSA’s Community Activities Since June , 2014

Mr. Gubbels introduced J.W. Hodge, the manager of Educational Services for REMSA and Care Flight. Mr. Hodge discussed their latest accreditation through the Commission on Allied Health Education Programs. All paramedic education programs must be accredited
for students to be a ble to take the national examination. New paramedics in Nevada must have national certifications to be licensed by the state. REMSA’s three

- year average success rate on the national paramedic examination is 100% and they have produced 63 students. The p rogram is one of only four in Nevada.

______________________________________________________________________________ 12. Acknowledge receipt of the Health District Fund Financial Review for Fiscal Year 2015 year to date July, 2014

August 28 , 2014 Washoe County District Board of Health Meeting Minutes Page 6 of 10Staff Representative: Ms. Heenan

Ms. Heenan provided an overview of the current fiscal status of the Health District. She offered to make any changes to the report format that the Board would like.

Dr. Hess asked how the District received the committed General Funds from the County. Ms. Heenan explained the majority of the County’s cash that comes in is from property tax and sales tax, so there is a lag at the beginning of the year. They hold payouts during that time so that they can cover their bills. The Health District did not need funds to get through the month of July but will receive them from the General Fund when it is necessary.

Dr. Humphreys complemented Ms. Heenan on the readable and understandable report. Councilmember Ratti agreed, noti ng the included analysis, which is helpful to her.

Ms. Heenan thanked the fiscal staff for their support.

Dr. Hess moved to accept the report. Councilmember Jardon seconded the motion which was approved six in favor and none against.

______________________________________________________________________________ 13. Presentation, Discussion and possible Direction to Staff regarding proposed District Board of Heath Orientation Manual and Program Staff Representative: Mr. Dick

Mr. Dick introduced the Orientation Manual

. He noted one recommendation from the
Fundamental Review had been to work on the onboarding and education process for the Board
members and had suggested an up

- to

- date ma nual as part of that

. Mr. Dick stated staff was looking for feed back regarding whether the manual captured the significant items regarding the Health District’s functioning and organization that the Board
members needed

. Mr. Dick went on to explain the proposed orientation program, composed of two options for
the mem bers, they were welcome to take advantage of one or both. The first i s to attend the New Employee Orientation (NEO) meeting, which is a three

- hour program comprised of the District Health Officer and each Division Director taking a half hour each to discu ss their respective programs. The second option was for the Board members to spend time with each of the division heads individually.

Councilmember Jardon explained she would value the one

- on

- ones and the NEO session

most. Councilmember Ratti opined th e m anual would be great for some and she would utilize it

as a resource when questions arose. She supported the idea of offering the two

- part training. Dr. Hess agreed and stated the manual was very well organized.

Councilmember Ratti requested more time to review the materials. Councilmember Jardon supported the idea of alerting new Bo ard members as to the first hot

- button items they would face, as well as a review of the basic operations of a meeting. Councilmember Ratti had spent time with the Sp arks F inance D irector learning about public funding and found that to be very helpful. Dr. Humphreys noted he had found it educational to go out with one of the restaurant inspectors , as that information was pertinent to some policies the Board must decid e on

. Chair Smith reiterated the manual and training opportunities had originated from a Fundamental Review recommendation so that one had been completed

. He opined i t was a great start but the best learning method was to spend time with division heads and other Board
members.

August 28 , 2014 Washoe County District Board of Health Meeting Minutes Page 7 of 10Councilmember Ratti moved to table any direction to staff until the next meeting. Dr. Hess seconded the motion which was approved six in favor and none against.

______________________________________________________________________________ 1 4

. Discussion and possible direction to staff regarding process for appointment of Regional Emergency Medical Services (EMS) Advisory Board Members Staff Representative: Mr. Smith

Chair Smith presented the staff report. He noted the EMS Advisory Board was part of the Interlocal Agreement.

Mr. Dick stated the EMS Advisory Board included the City Managers, the Washoe County Manager, the District Health Officer, and two Board of Health appointed positions, being an emergency room physician and a continuous quali ty improvement representative from a hospital.

Chair Smith reiterated that the topic was to discuss the process that the Board wished to follow to locate the two individuals in question. Mr. Dick had contac ted the local hospitals to notify them the positions would be avail able and to request that they contact the Health District if anyone was interested.

Dr. Hess asked if the Premedical Hospital Advisory Committee (PMAC) was still active.
Mr. Gubbels stat ed it was, but the members were uncertain of their role in the community. REMSA has requested their input for protocols. He explained the varied membership of the Committee. Dr. Hess clarified to say he had asked because if all of the hospitals were

rep resented, that would provide them with a group to possibly select from as well as a link to other medical professionals.

Chair Smith opined the best way might be to get the word out to the hospitals and see what kind of a response is received

. The Board c ould vote from among potential candidates. Dr. Hess suggested they ask each of the hospitals to nominate on e of their physicians.

Mr. Dick explained he had met with the CEO s of the hospitals and asked them to send information regarding anyone who qualifies that might be interested in participating. He will continue to work with them. Mr. Gubbels offered to find out who is the current president of PMAC and get th at person’s contact information to Mr. Dick.

Councilmember Ratti noted the Board may need to adjust its approach to recruitment based
on the number of candidates and the level of interest. She stated she was comfortable with leaving the process up to Mr. Dick.

Ms. Admirand suggested a motion be made to direct Mr. Dick to continue working with the hospitals to ascertain anybody’s interest in the two positions.

Chair Smith made the motion based on the language suggested by Counsel

. Councilmember Jardon seconded th e motion which was approved six in favor and none against.

______________________________________________________________________________ 15. Presentation

– Washoe County Chronic Disease Report Card Staff Representative: Ms. Goatley

- Seals

Ms. Goatley

- Seals presented the report.

[Councilmember Ratti left the meeting at 2:30 p.m.]

August 28 , 2014 Washoe County District Board of Health Meeting Minutes Page 8 of 10Dr. Hess noted Washoe County’s overall statistics were positive but the death rate was higher than the state average. He asked Ms. Goatley

- Seals if she could off er any explanation. She opined that this was the data that was available and that they were not able to attribute a cause at
this time.

______________________________________________________________________________ 1 6

. Staff Reports and Program Updates

A. Director, Epidemiology and Public Health Preparedness

Dr. Todd stated he had nothing to add but would be happy to answer any questions

. Dr. Hess asked if the Health District was collecting data on multi antibiotic

- resistant bacteria and Mr. Todd replied i t is. He explained a tool that physicians are using to assist them in choosing effective antibiotic s

. This approach helps combat resistant strains.

B. Director, Community and Clinical Health Services

Mr. Kutz reported the special outreach clinics had imm unized almost 400 students. The
Immunizations counter will be open five full days a week starting September 2. The next planned phase is to be able to book appointments and offer Wednesday evening clinics.

Mr. Kutz noted that staff had informed him the Governor’s office is interested in the Fetal Infant Mortality Review (FIMR) program. Additionally, the National FIMR program staff are happy with the progress and want to offer additional training.

C. Director, Environmental Health Services

Mr. Sack ackno wledged the hard work of staff during an extremely busy time period.

D. Director, Air Quality Management

Ms. Albee explained AQM has been involved in the regional license and permitting

program (Accela) and is now preparing for deployment. AQM has been doing business process reviews in preparation for conversion to the new system. Time accounting has also commenced. The process uncovered the fact that some a sbestos abatement projects have never been charged a fee , so t hose fees will go int o effect beginning October 1, 2014.

E. Administrative Health Services Officer

Ms. Heenan stated she had nothing to add.

F. District Health Officer

Mr. Dick reported that Truckee Meadows Fire Protection District Board had approved the Regional Emergency Medica l Services Interlocal Agreement. All other involved agencies had already approved it so it is now official.

He noted the Accela project was ramping up to implementation. It will kick off on September 2. The Community Health Assessment is still on track to be completed by the end of the year.

Mr. Dick pointed out that one of the Fundamental Review items had r ecommended the development of a performance management system. The Health District will be submitting an application for a grant to support this process. The Public Health Foundation has offered to work with the Health District to develop the performance management system.
Mr. Dick explained t he Robert Wood Johnson Foundation grant was originally provided
to review cross

- jurisdictional sharing of public health program services across the eight

August 28 , 2014 Washoe County District Board of Health Meeting Minutes Page 9 of 10Northern Nevada counties. Through the process, staff has le arned that most of these counties do not have a robust public health system and are served primarily by the state. They are not at a point to be able to engage in formal agreements regarding how to deliver public health
services. The project is being red irected to help the counties build capacity. The state has been involved but their participation has declined.

______________________________________________________________________________ 1 7

. Board Comment

Dr. Hess suggested changes to the Executive S ummary portion of the Board reports.

______________________________________________________________________________ 1 8

. Emergency Items

None.

______________________________________________________________________________ 1 9

. *Public Comment

None

.

______________________________________________________________________________ 20

. A djournment

At 2:53 p.m. , Councilmember Jardon moved to adjourn. Dr. Humphreys seconded the motion which was approved six in favor and none against

.

Respectfully submitted,

Kevin Dick

, District Health Officer Secretary to the District Board of Health

Dawn Spinola, Administrative Secretary Recording Secretary

Approved by Board in session on S eptember 25 , 2014.

August 28 , 2014 Washoe County District Board of Health Meeting Minutes Page 10 of 10