Minutes

Southern Nevada District Board of Health Meeting
Thursday, March 23, 2006 - 8:00 a.m.

625 Shadow Lane
Las Vegas, NV 89106
Clemens Room

Board Chair Stephanie Smith called the meeting of the Southern Nevada District Board of Health to order at 8:02 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, Council Member, North Las Vegas
Karla Burton Council Member, Boulder City
Jim Christensen, MD At-Large Member, Physician
Donna Fairchild Vice Chair, Council Member, Mesquite
Robert Eliason At-Large Member, Business/Industry
Mary Jo Mattocks, RN At-Large Member, Registered Nurse
Gary Reese Councilman, Las Vegas
Lawrence Weekly Councilman, Las Vegas

Absent:

Lynette Boggs McDonald Commissioner, Clark County
Tom Collins Commissioner, Clark County
Joseph Hardy, MD At-Large Member, Physician
Steven Kirk Secretary, Councilman, Henderson
Susan Crowley* At-Large Member, Environmental Specialist

Executive Secretary:

Donald S. Kwalick, MD, MPH

Legal Counsel:

Stephen R. Minagil

*Chair Smith and the members of the board acknowledged Member Crowley who participated in the meeting via telephone.

Staff: Karl Munninger, Sylvia Claiborne, Dr. Lawrence Sands, Glenn Savage, Bonnie Sorenson, Zona Hickstein, Jo Alexander, Vickie Swanson, Debbie Martin, Jim Osti, Veronica Morata-Nichols, Synthia Metzger, Stephanie Joens, Nicole Samaniego, Carole Mankey, Alice Costello, Patricia Rowley, Linda Verchick, Deborah Williams, Angus MacEachern, Lonnie Empey, Dennis Campbell, Keith Zupnik, Robert Newton, Mike Bernstein, Mary Ellen Britt, Jennifer Sizemore, Dave Tonelli, Julie Hurd, Susan Eiselt, Forrest Hasselbauer, Diana Lindquist, Shelli Clark, Leo Vega, Jerry Boyd, Ann Markle

Attendance:

Presentation – Public Health Hero Awards Dr. Kwalick introduced the 6th annual Southern Nevada Public Health Hero awardees:

County Multi-Agency Response Team (CMART)

Dr. Kwalick introduced CMART (County Multi-Agency Response Team). Commissioner Mryna Williams accepted the award on behalf of CMART. Her vision launched this partnership several years ago. CMART brings local and state governmental agencies together to identify blighted and dilapidated properties within unincorporated as well as incorporated areas of Clark County using a team approach for compliance with public health and safety issues. This is accomplished through joint inspections and investigations of targeted properties such as unmaintained apartments, abandoned buildings and vacant lots. CMART has improved living conditions for Clark County residents by securing those buildings and subsequently preventing and reducing crime, assuring that fire and building codes are met and compelling property managers to bring their substandard facilities into compliance with health and safety regulations. This agency also ensures that abandoned swimming pools are maintained or filled in to prevent drowning and to prevent the spread of West Nile virus. This year National Public Health Week focuses on designing healthy communities and raising healthy kids. CMART helps to accomplish this by helping to ensure we live in a safe and healthy environment. Commissioner Williams accepted the award from Dr. Kwalick and the Board of Health in recognition of her support and vision. Commissioner Williams thanked all those involved and stated the award belongs to the men and women of CMART.

Nevadans for Antibiotic Awareness (NAA)

Dr. Kwalick introduced Nevadans for Antibiotic Awareness as a statewide taskforce of over 60 state and local public and private agencies committed to reducing the use of antibiotics and preventing the spread of antibiotic resistance. Since the year 2000, the taskforce has educated the medical community and general public about decreasing inappropriate antibiotic use. This non-profit organization consists of four subcommittees chaired by volunteers. These efforts have been successful in reducing the number of antibiotic prescriptions as physicians become more judicious in their use of antibiotics and their efforts have also increased the public’s understanding of when they should and should not use antibiotics. Dr. Bill Berliner accepted the award on behalf of the Nevadans for Antibiotic Awareness and thanked everyone for this honor. Dr. Berliner indicated that by using data from the four major managed care organizations, there has been a steady decline in the number of prescriptions written for antibiotics in the state of Nevada. As medical director of Health Insight, he is an executive committee member. Dr. Berliner introduced Dr. Christine Peterson who is also a member of the executive committee, chair of the NAA public awareness committee, and vice president of medial affairs for Sierra Health Services.

Clark County Deputy Fire Marshall Joe Noble and Mrs. Lonnie Noble

Dr. Kwalick introduced Mr. and Mrs. Noble who lost their child to drowning and have since donated their time and efforts to the Southern Nevada Health District’s Child Drowning Prevention Program. A member of the Drowning Prevention Committee knew of a Deputy Fire Marshall at the Clark County Fire Department that had lost a young child to a drowning. The Nobles agreed to share their personal tragedy in an effort to reduce the incidence of drowning in Clark County. They have graciously donated their time at press conferences as well as in media campaigns designed to educate parents and protect young children. They agreed to use their story in a commercial designed to help prevent the same tragedy from happening to another family. These commercial videos were shown during the meeting. As a result of their continuous involvement, the average death rate for children 4 years of age and under has decreased by more than 50 percent over the last five years and is now less than the national rate. Dr. Kwalick presented the Nobles with the 2006 Public Health Hero Award.

In recognition of their support of public health objectives in the community, Dr. Kwalick and Southern Nevada District Board of Health congratulated and thanked all of the 2006 Public Health Hero Awardees.

I. Consent Agenda:

These are matters considered to be routine by the Southern Nevada 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: 2/23/06
2. Approve Payroll/Overtime for Periods: 1/28/06 - 2/10/06; 2/11/06 - 2/24/06
3. Approve Accounts Payable Registers: #1012: 2/02/06 - 2/08/06; #1013: 2/09/06 - 2/15/06; #1014: 2/16/06 - 2/22/06; #1015: 2/23/06 - 3/01/06
4. Petition #12-06: Approval of Interlocal Contract with Clark County on Behalf of Clark County Social Services for Funding to Provide Ryan White Title I Services
5. Petition #14-06: Approval of Revised Classification Specification for Director of Administration – Recommended Schedule 36 ($101,148 - $141,142)
6. Petition #15-06: Approval of Revised Classification Specification for Human Resources Administrator (formerly Human Resources Manager) – Recommended Schedule 31 ($78,305 – $109,216) and a New Position and Classification Specification for Human Resources Supervisor – Recommended Schedule 26 ($60,648 - $84,620)
7. Petition #16-06: Approval of Revised Classification Specification for Information Technology Manager (formerly Computer Systems Manager) – Recommended Schedule 29 ($70,682 - $98,598)
8. Petition #17-06: Approval of Revised Classification Specification for Geographic Information Systems Technician I/II – Recommended Schedule 19 ($42,404 - $59,151 and Schedule 21 ($46,997 - $65,497)
9. Memorandum #05-06: Approval of Moratorium on Dry Camping Cease and Desist Order in Laughlin
10. Petition #18-06: Approval of Amended Southern Nevada District Board of Health Bylaws A motion was made by Member Eliason to approve all consent items, seconded by Member Mattocks and was unanimously approved.

1. Memorandum #03-06: Adoption of Two Proposed 2006 Environmental Health Division Permit Fees – Inactive Permit Fee and Annual Itinerant Permit Fee.
   
   Glenn Savage, environmental health director, stated that in reviewing the fee structure, it was determined that two areas needed to be addressed. One was an inconsistency in the fee amount and the other was work that was being performed with no fee charged. Mr. Savage stated that staff is required to inspect, on an annual basis, all inactive facilities to determine whether the facility is open or closed. Historically, there has not been a fee for this service and the time and cost for this inspection is not currently accounted for in the Environmental Health Division’s fee schedule.
   
   The second fee involved low risk vendors who travel throughout the community and provide services at itinerant events. It was determined that the fees charged were too high. Public workshops were held, information gathered and a new annual fee was implemented which would allow low-risk itinerant event vendors to travel throughout the community on a yearly basis and remain in compliance with an annual permit fee.
   
   Chair Smith asked if there was any public comment on this issue. No citizen came forward.

A motion was made to approve the fees by Member Reese with conditions listed, seconded by Member Burton and was unanimously approved.

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

1. Petition #13-06, Memorandum #4-06: Approval of Fiscal Year 2006-2007 Tentative Budget
   
   Karl Munninger, director of administrative services, presented the tentative budget. Despite positive economic news, this is a very tight budget for the Health District. The budget is presented with a double digit cost of living increase (COLA). This budget reflects the current COLA approved in December 2005 and the negotiated COLA for the new fiscal year.
   
   Additionally, new space has been acquired to meet the unrelenting demand for services in the community. It was recently learned from Clark County finance office that the District is not able to use the assessed valuation of 3.5 cent per $100 because of the 3 percent and 8 percent tax caps. We will have to use the actual tax roll in our calculations. This results in an amount of $123,000 less than what was calculated by our staff. This reduction is not reflected in the document distributed to members. A PowerPoint presentation outlining the details of the proposed FY2007 budget was given by Sylvia Claiborne. A copy of this presentation is attached. Final thoughts on the proposed budget include:
   
   FYI 2007 personnel expenditures will be 5.1% higher than FY 2006 estimates
   FY 2007 overall expenditures will be 1.5% higher than FY 2006 estimates
   FY 2007 services and supplies will be 5.8% less than the FY 2006 estimates
   
   The Health District is working to increase federal funding including a review of state grant funding formulas. The Health District is also working with Clark County to relocate the main campus because the existing facility has become too costly to maintain.
   
   Member Weekly asked if the Health District has a federal lobbyist and if it was possible to tap into the federal lobbying efforts of the county or the cities. Most of the entities have federal lobbyist that look for federal funding sources. Dr. Kwalick responded the District had a federal lobbyist in the past, but due to budget concerns, retaining a lobbyist was not cost effective. Dr. Kwalick stated we can investigate this.
   
   Chair Smith indicated that perhaps it would be advantageous to work with the city and county managers. Member Weekly stated the budget proposal indicated there was no new staff, yet the population in this area is increasing. Member Weekly indicated that the Health District is once again doing a whole lot with even less which was exacerbated by the lack of space. Dr. Kwalick indicated that it was due in large part to an extremely tight budget as well as the lack of space. Perhaps the Board could consider establishing a facilities committee who would work with the various jurisdictions, including the county. The Health District property is owned by the county except for the public health laboratory which is owned by the District. This is very valuable land considering all the discussions revolving around the academic health center being housed in this area. The Health District needs space for general management staff who should remain in the center city area, but clinical services such as STD’s, health cards, immunization services and family planning are also needed in the core area. It is not cost effective to maintain the current facility. New space is needed now. Staff will be returning to the Board with possible options and will need the Board’s assistance in locating a structure that will meet the needs of the community, the county and its jurisdictions for the next 25 to 30 years.
   
   Member Burton and Member Weekly asked about the discontinuation of the foot clinic and the status of that service. Dr. Kwalick indicated that Alice Costello, public health nurse manager, will address this in the staff updates.

A motion was made by Member Reese to accept the budget as presented, with funds used from contingency reserves to balance the county’s reduction, seconded by Member Burton and was unanimously approved.

IV. Citizen Participation

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

No one came forward and the citizen participation portion of the meeting was closed.

Dr. Kwalick turned over the discussion of the lead candy situation to Glenn Savage, director of environmental health. There was a concern in the 1990’s over candies produced in Mexico which contained lead. Orange County, California initially started doing sampling and testing and working with the state and the FDA. Information from this testing resulted in these candies being labeled “toxic treats.” The Health District went to stores in search of these candies and tried to remove them from shelves during this time. More recently, UNLV has determined that these candies have reappeared on store shelves. These candies are still being distributed locally. The samples tested indicated that lead was present, not always in the candy itself, but in the sticks, the spoons, ceramic pots, wrappers, the dye and the ink of the wrappers and also in the seals around the tops of the containers. The candy manufacturers have since offered a testing program and provided the district with information from this testing. The major candy manufacturers have indicated they have all made appropriate changes and there should not be a concern about the candy itself. The Health District is still finding lead contamination in accompanying products. The FDA is only concerned with the food product itself. The major candy manufacturers have outsourced all of the manufacturing processes. The smaller manufacturing companies in Mexico do not necessarily adhere to the same quality assurance methods.

Dr. Kwalick stated we will be issuing periodic news releases warning parents that the candy itself may be safe, but children should discard the wrappers, etc. Dr. Christensen indicated that staff may wish to contact the Food Allergy Network. They are an independent watchdog group and people do listen to this organization.

Dr. Kwalick indicated that advertising for the at-large members of the board will begin in Sunday’s paper and will run on Sundays and Wednesdays for three weeks with a closing date of April 14. The board committee will meet near the end of April to make recommendations for the at-large seats. The application process forms are in the board books. Those recommendations will be given to the full board in May or in June so the newly selected members may be seated for July’s Board of Health meeting.

Dr. Kwalick introduced Alice Costello, public health nurse manager. She confirmed that the District will no longer be providing foot clinic services and that seniors who have heard this message are reacting to it. She indicated to Board members that when they receive complaints from the community, it is a sign of faith and trust in our service delivery. It is difficult for seniors to change and they are concerned about staff and the excellent relationships they have built with those staff. Nevada Health Centers (NHC) is expected to begin offering these services and the District staff has been providing NHC with the protocols currently being utilized to provide these services. NHC anticipates providing foot care services in Henderson and Boulder City. They also intend to continue service at the low-income senior housing projects that have been established by the District and serve seniors who have no transportation or who are disabled. NHC primary location for the provision of service will be at the new senior center at 9th and Bridger Avenue in Las Vegas. This center will be dedicated to senior services and will enable seniors to receive enhanced services that could not be provided at the District. Because the grant has not been formally approved by the Division of Aging, District staff has not been at liberty to release the name of the provider or any particulars. Each of the locations has received a letter informing them that services will not be provided by the District after June 30th, 2006 and that another agency will assume service responsibility. Flyers have also been distributed to program participants with a similar message and instructions to contact the District Senior Foot Clinic phone number for additional instructions regarding the opening of the new locations and phone numbers to schedule appointments.

Members of the Board received a copy of “talking points,” or Q&A to assist them in responding to the issues or concerns of seniors. Member Weekly thanked Mrs. Costello for that information and he will distribute it to members of the public who contact him.

Mrs. Costello indicated she will accept any calls from constituents of the members of the board.

Dr. Kwalick indicated that each board member received an invitation to the Health District Public Health Week employee breakfasts commencing Friday, March 31. All members are invited to attend at the Ravenholt Center or at any of the satellites.

VI. Informational Items

Adjournment

There being no further business to come before the Board, Chair Smith adjourned the meeting at 8:55 a.m.

Submitted for Board Approval

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

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