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 Room, 1001 East Ninth Street, Reno, Nevada. 

1. Call to Order, Pledge of Allegiance

Chair Smith called the meeting to order at 1:02 p.m. 

Dr. Hess led the pledge to the flag.

______________________________________________________________________________

2. Roll Call

The following members 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, Administrative Health Services Officer, AHS

Randall Todd, DrPH, Director, EPHP 

Daniel Inouye, Air Quality Supervisor, AQM

Yann Ling-Barnes, Environmental Engineer 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. Public Comment

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 - Senior 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 professional 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 Registered 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 proclamation and presented it to Ms. Goatley-Seals. 

Councilmember Ratti moved to adopt 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 Tahoe 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% match) 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 support of the Centers for 

August 28, 2014 Washoe County District Board of Health Meeting Minutes Page 3 of 10
Disease 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. Inouye 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 current 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 the 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-Attainment Area.” Dr. Humphreys 

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

______________________________________________________________________________

10. 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 reduction 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 the new 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 10
Dr. 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 explained 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 the 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 population 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 another 

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. 

______________________________________________________________________________

11. 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 compliance 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 July, 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 10
percent. Priority One response for Zones, B, C and D combined was 93 percent and 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 

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

Councilmember Ratti asked if Zones 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 incorporated 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-todate 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 strategic 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 responsible for compiling the data from 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 explained 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 able 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 program 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 10
Staff 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, noting 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 manual as part of that. 

Mr. Dick stated staff was looking for feedback 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 members, they were welcome to take advantage of one or both. The first is 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 discuss 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 the manual 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 Board 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 Sparks Finance Director 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 decide on. 

Chair Smith reiterated the manual and training opportunities had originated from a

Fundamental Review recommendation so that one had been completed. He opined it 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 10
Councilmember 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. 

______________________________________________________________________________

14. 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 quality 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 contacted the local hospitals to 

notify them the positions would be available 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 stated 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 

represented, 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 could vote from among potential candidates. Dr. Hess 

suggested they ask each of the hospitals to nominate one of their physicians. 

Mr. Dick explained he had met with the CEOs 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 that 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 the 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 10
Dr. 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 offer 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. 

______________________________________________________________________________

16. 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 it is. He explained a tool that physicians are using to assist them in 

choosing effective antibiotics. This approach helps combat resistant strains. 

B. Director, Community and Clinical Health Services 

Mr. Kutz reported the special outreach clinics had immunized 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 acknowledged 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 asbestos abatement projects have 

never been charged a fee, so those fees will go into 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 Medical 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 recommended 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 the 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 10
Northern Nevada counties. Through the process, staff has learned 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 redirected to help the counties build capacity. The state has 

been involved but their participation has declined. 

______________________________________________________________________________

17. Board Comment

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

______________________________________________________________________________

18. Emergency Items

None.

______________________________________________________________________________

19. *Public Comment

None. 

______________________________________________________________________________

20. Adjournment

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 September 25, 2014.

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