Minutes

Southern Nevada District Board of Health Meeting
Thursday, January 26, 2006 - 8:00 a.m.

625 Shadow Lane
Las Vegas, NV 89106
Clemens Room

Board Chair Stephanie Smith called the meeting of the District Board of Health to order at 8:03 a.m. and the Pledge of Allegiance was held. She noted that she had been provided with the Affidavits of Posting and Mailing of Agenda meeting notices, as required by Nevada’s Open Meeting Law. The Affidavits will be incorporated into the Official Minutes.

Board Members Present:

Stephanie Smith Chair, North Las Vegas
Donna Fairchild Vice Chair, Council Member, Mesquite
Karla Burton Council Member, Boulder City
Lynette Boggs McDonald Commissioner, Clark County
Tom Collins Commissioner, Clark County
Susan Crowley At-Large Member, Environmental Specialist
Robert Eliason At-Large Member, Business/Industry
Joseph Hardy, MD At-Large Member, Physician
Mary Jo Mattocks, RN At-Large Member, Registered Nurse
Gary Reese Councilman, Las Vegas
Lawrence Weekly Councilman, Las Vegas

Absent:

Jim Christensen, MD At-Large Member, Physician
Steven Kirk Secretary, Councilman, Henderson

Executive Secretary:

Donald S. Kwalick, MD, MPH

Legal Counsel:

Stephen R. Minagil, Esquire

Staff: Karl Munninger, Sylvia Claiborne, Dr. Lawrence Sands, Patricia Rowley, Sheniz Moonie, Bonnie Sorenson, Mary Ellen Harrell, Jody Bellis, Veronica Morata-Nichols, Alice Costello, Jim Osti, Ann Markle, Angus MacEachern, Glenn Savage, Ed Wojick, Dennis Campbell, Steve Goode, Rory Chetelat, Deborah Williams, Jennifer Sizemore, Dave Tonelli, Susan Eiselt, Diana Lindquist, Shelli Clark, Leo Vega, Jerry Boyd

Attendance:

Dr. Kwalick and the Board of Health congratulated Karl Munninger on 30 years of service with the health district. He received a commemorative clock and lapel pin. Dr. Kwalick thanked Mr. Munninger for his loyalty and dedication to his job. Mr. Munninger thanked both the board and Dr. Kwalick for their support during his years of service.

Chair Smith stated that she has approved committee to address board bylaws and at large member selection. This committee consists of the following board officers and members: Chair Stephanie Smith, Vice Chair Donna Fairchild, Secretary Steven Kirk, Member Dr. Jim Christensen and Member Gary Reese.

Oath of Office

The oath of office was taken by Commissioner Lynette Boggs McDonald, Clark County representative. Commissioner Boggs McDonald replaces Rory Reid as Clark County representative.

I. Consent Agenda:

These are matters considered to be routine by the District Board of Health and may be enacted by one motion. Any item, however, may be discussed separately per Board Member request before action. Any exceptions to the Consent Agenda must be stated prior to approval.

1. Approve Minutes/Board of Health Meeting: 12/15/05
2. Approve Payroll/Overtime for Periods of: 11/19/05 - 12/02/05; 12/03/05 - 12/16/05; 12/17/05 - 12/30/05
3. Approve Accounts Payable Registers: #1003: 12/01/05 - 12/07/05; #1004: 12/08/05 - 12/14/05; #1005: 12/15/05 - 12/21/05; #1006: 12/22/05 - 12/29/05; #1007: 12/30/05 - 1/04/06
4. Petition #01-06: Approval of Members to the Family Planning Advisory Council
5. Petition #02-06: Award of Bid for Generator and Installation of Generator for Public Health Laboratory
6. Petition #03-06: Resolution #01-06: Approval of Proposed Adjustments to FY 2005-2006 Appropriations
7. Petition #04-06: Approval of Revision of CCHD Personnel Code in accordance with the new union contract. Change pay scale for managers from Schedule 28 ($67,177 - $93,704) to Schedule 29 ($70,782 - $98,598)
8. Petition #05-06: Approval to Proceed with Lease for Relocation and Expansion of the Henderson Public Health Center
9. Petition #06-06: Approval of Revised Classification Specification for Regional Trauma Coordinator (Formerly District Trauma Coordinator) – Recommended Schedule 26 ($60,648 - $84,620)
10. Petition #07-06: Approval of New Classification Specifications for Project Specialist – Recommended Schedule 22 ($49,439 - $68,929) and Planner I/II – Recommended Schedule 20/22 ($44,661 - $68,929) and Senior Planner – Recommended Schedule 24 ($54,733 - $73,369)
11. Petition #08-06: Approval of Reclassification of the Senior Janitor – Recommended Schedule 18 ($40,285 - $56,160) and Security Specialist – Recommended Schedule 18 ($40,285 - $56,160)
12. Petition #09-06: Approval of New Classification Specification for Safety Officer – Recommended Schedule 23 ($52,000 - $72,537)
13. Petition #10-06: Approval of New Classification Specification for Public Information Manager – Recommended Schedule 29 ($70,682 - $98,598) and Revised Classification Specification for Public Information Officer – Recommended Schedule 23 ($52,000 - $72,537)

A motion was made by Member Reese to approve all consent items, seconded by Member Mattocks and was unanimously approved.

No Public Hearings Scheduled

III. Report/Discussion - Items on which action may be taken

1. Update on Trauma System Development – EMS
   
   Mr. Rory Chetelat, EMS Manager, gave an update on trauma system development. The trauma system plan is completed and it is anticipated it will be presented to the Board next month.
   
   He then gave a PowerPoint presentation which addressed the issue of mental health patients who displace ED (emergency department) patients. This issue impacts both the hospitals and EMS. Mr. Chetelat began by stating that in July 2004 there was a county emergency declaration based on the number of mental patients holding in the EDs. At that point there were over 104 mental health patients in EDs and there were 103 beds for mental health patients. Currently, there are 181 beds and with a new hospital opening that number will increase to 217 by August 2006. This represents a 36 bed increase from where it is today.
   
   Despite this increase, the problem continues to grow and the solution is more complex than the number of beds. Total hospital ED visits were over 553,000. EMS delivered approximately 142,000 of those total patients or just slightly above 25 percent. The best that could be done would be to divert 15 percent of patients to locations other than EDs. This would only represent an approximate 4 percent drop in total volume to EDs.
   
   There are approximately 325 to 345 ED beds in the entire community. This is not a solid number because hospitals are able to fluctuate up and down slightly by adding beds in the hallways and other locations. The average ED patient spends approximately 4.5 hours in an ED bed. The system has a potential to see approximately 1500 patients per day based on the number of beds available. The average stay of the mental health patient is 72 hours in the ED or the equivalent of 16 ED visits. If you calculate the 75 mental health patients that are averaged every day, we are displacing over 1200 potential ED visits. The 75 mental health patients in ED beds are displacing more than 400 potential ED visits per day.
   
   EMS delivers approximately 390 patients a day, less than the total number of ED patient visits displaced by mental health patients. This demonstrates there is some surge capacity if a solution can be found to this very dire problem. EMS delivery is really not the solution.
   
   Member Eliason stated this does not take into consideration EMS personnel who are transporting patients and remain out of system during delivery of patients to the ED.
   
   Mr. Chetelat stated there is a long delay in the off load process and that has caused us to examine a variety of impacts on the system. It is felt that when the new mental hospital is completed, the system will still not be able to handle the load. We need to have an additional facility to medically clear and triage patients to Southern Nevada Adult Mental Health Services (SNAMHS), or other treatment options rather than hospitalization. We must continue to work with partners to solve this issue.
   
   Member Weekly asked if there have been meetings with other entities to discuss this issue. Mr. Weekly relayed a personal situation where his daughter was in an accident on campus and was transported by EMS. EMS personnel stayed with his daughter at the hospital for seven hours until she was treated. He stated his appreciation for their efforts, yet he was aware that those EMS personnel remained away from their duties during that time.
   
   Mr. Chetelat stated there are a variety of activities going on. Part of Senate Bill 458 allows for data gathering which will address the drop time issue. The software is now at all the hospitals and we are in the process of gathering data on what the wait times really are. From the EMS perspective, a variety of different solutions are being examined. There is a meeting next week to look at options such as alternative destinations for transporting patients. The facilities advisory board will be meeting in two weeks and will work on potential solutions. This is a huge problem, and unfortunately, a very common one. This problem has been addressed for a number of years, but there is no simple solution. There is a capacity issue as well and hospitals are not built very quickly. Dr. Kwalick stated this problem has been going on for decades and is impacted by the health care worker shortage that exists in this community. This is a problematic issue. The wait times in the EDs also are due to the massive number of patients who inappropriately access the EDs. They should be in a primary care setting.
   
   This is a complicated issue which requires increased staffing. SB458 stated there is to be a 30 minute drop time to transfer the patient to hospital staff. If all of the ambulances are being taken up by wait times, we cannot respond to a 911 situation. On the New Year’s weekend, there were times when 100 percent of the ambulances were tied up in EDs or responding to calls. Dr. Kwalick stated that he responded with a message that we may have to impose the 30 minute rule within certain guidelines. There has to be full participation by all agencies.
   
   Member Mattocks stated there have been mental health patients who have remained in the hospital ED in Mesquite for up to 96 hours before they are transported to Las Vegas.
   
   Dr. Kwalick stated that a solution is to ready a mental facility for those patients as well as to implement a primary care medical care network for these underinsured or uninsured persons.
   
   Member Boggs McDonald stated that after speaking to hospital CEOs, there is a disincentive to expand those services due to the low reimbursement rate from Medicaid and Medicare for mental health services and that we need to make this issue part of the equation.
   
   Dr. Hardy asked if this information will be presented to the governor’s newly formed access to care committee as well as the legislative interim health care committee. Mr. Chetelat responded that he hasn’t had an opportunity to present to any entity other than the Board; however, he would be happy to share it. Staff is also working to educate these groups on public health is stressing that public health is not publicly funded medical care.

Chair Stephanie Smith invited any individuals to speak under the Citizen Participation portion of the agenda.

Diana Daniels, CCHD SEIU Vice president spoke to the Board of Health. She stated she believed that employees are happy with the new contract and are pleased that CCHD administration and employees are working together.

Dr. Kwalick briefed the board on HDtv (Health District television) which has been created to inform the community about public health and related issues. It can be viewed on cable channels 2 and 4. Board members were also given ‘Take a Bite Out of Smoking’ two-for-one coupon books.

VI. Informational Items

Adjournment

There being no further business to come before the Board, Chair Smith adjourned the meeting at 8:32 a.m.

Submitted for Board Approval

Donald S. Kwalick, MD, MPH, Chief Health Officer
Executive Secretary

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