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Minutes Thursday, October 26, 2006 - 8 a.m.
Chair Donna Fairchild called the meeting of the District Board of Health to order at 8:02 a.m. and the Pledge of Allegiance was held. She also 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 are incorporated into these Official Minutes. Board Members Present: Donna Fairchild - Chair, Council Member, Mesquite Absent: Karla Burton - Council member, Boulder City Executive Secretary: Donald S. Kwalick, MD, MPH Legal Counsel: Stephen R. Minagil Staff: Mike Walsh, Dr. Lawrence Sands, Angus MacEachern, Edmond Wojcik, Glenn Savage, Jane Shunney, Jim Osti, Dennis Campbell, Bonnie Sorenson, Jennifer Sizemore, Stephanie Bethel, Stanley Jensen, Deborah Williams, Jo Alexander, Mary Ellen Britt, Mary Ellen Harrell, Veronica Morata-Nichols, Alice Costello, Dan LaRubio, Brian Labus, Rose Marie Lee, Dan LaRubio, Paul Klouse, Rory Chetelat, Diana Daniels, Diana Lindquist, Shelli Clark, Ann Markle, Susan Eiselt, Leo Vega, Forrest Hasselbauer Attendance:
Nevada Public Health Association Award – Lead Poisoning Prevention – Dr. Sands Dr. Sands informed the Board of an award received at the Nevada Public Health Association meeting held recently in Henderson in recognition of the SNHD childhood lead poisoning prevention program. A grant was received from CDC starting in July 2006 for a comprehensive childhood lead poisoning prevention program that provides approximately $500,000 per year for five years to prevent and eliminate childhood lead poisoning. The health district will be working with various community providers and stakeholders to develop the policies and protocols needed to address screening and testing, case finding, mitigation, and many other issues required to formulate a community plan. Several programs within the health district worked together to put the grant together in partnership with UNLV School of Public Health and Health Insight. Congratulations are in ordered for everyone in the district who worked on the grant; in particular Patricia Rowley, Wil Townsend and Dr. Sheniz Moonie from the Office of Epidemiology. Members of the Board congratulated staff on the award. 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.
A motion was made by Member Jones to approve all consent items; seconded by Member Crowley and was unanimously approved. II. Public Hearing / Action
III. Report / Discussion / Action
IV.Citizen Participation: Chair Fairchild invited any individuals wishing to speak to come forward. Mr. Gary Vause, 2301 West Charleston Blvd., Las Vegas, Nevada, owner of Lit’l Scholar Daycare & Preschool addressed the Board. Mr. Vause stated that a member of the health district staff inspected his facility at the Summerlin location and he was told he could not prepare food for kindergarten children without a commercial kitchen. Mr. Vause indicated that he could not operate this facility without the ability to distribute food to children. He stated he believed it was a misinterpretation of the law. He requested the Board allow this facility to continue to serve food to children. Dr. Kwalick indicated that he was unaware of the situation and stated that no action could be taken by the Board at this time. Dr. Kwalick indicated that further information needed to be obtained from staff; we will meet with Mr. Voss. Dr. Kwalick assured the Board the issue would be thoroughly investigated and staff will report back to the Board. Chair Fairchild indicated to Mr. Vause that he needed to address the issue through proper channels and that Dr. Kwalick would address the issue and report back to the Board. V. Health Officer & Staff Reports Update on New Facility – Mike Walsh, Director of Administration Mr. Walsh gave a brief update on the progress of the new facility. Under the contract approved by the Board last month, the architects had five representatives come and take measurements which will be used to create a baseline for each department based upon what space they currently occupy. A memo was sent to managers with a questionnaire which asked vital information about goals and objectives of the department with a request to return those responses to the architects by November 8. This information will be used in starting the design and space planning. On November 13, architects will meet with staff who will be involved in the process. This will be an overview meeting to kick off the actual work plan. After this meeting, each department will have the opportunity to meet with the architect to review their individual questionnaires. The strategic plan will also be incorporated into the planning model. It is anticipated there will be a plan presentation to the Board by the end of January, 2007. Chair Fairchild indicated she was pleased that there would be department heads involved in the process, but was concerned that there would be staff input in the planning process. Mr. Walsh stated that each department head will meet with their staff to work on plans. Mr. Walsh stated it would be best to avoid having a cast of thousands meeting with the architects. The managers and division heads will meet with the architects. Chair Fairchild asked that employees give their input to the respective managers and department heads. Mr. Walsh stated there will also be input from the public. Member Hardy asked if there were assurances that nothing in this building would make people ill. Mr. Walsh stated certainly, that will be taken into account as well as to make the building technically advanced and to make this a ‘green building.’ Dr. Christensen indicated his concern with air exchange rates through the HVAC. Member Weekly asked about the employee survey and the process to obtain feedback from employees. Mr. Walsh indicated that part of the process will be to obtain functional requirements; that is, what space is required for each employee to do their job. The architects and engineers will use national standards about employee space requirements to size individual work areas. Bonnie Sorenson, director of clinic and nursing services and Veronica Morata-Nichols, public health nurse manager - PINK project - Protect and Immunize Nevada’s Kids Mrs. Sorenson, director of clinic and nursing services, said the state of Nevada has very low immunization rates and of metropolitan areas surveyed Las Vegas is ranked the lowest. Mrs. Sorenson introduced Veronica Morata-Nichols, public health nurse manager, who gave an update on one the projects that has begun in Nevada as a joint initiative between the north and the south to try to educate parents about the importance of immunizations. The PINK project stands for Protect and Immunize Nevada’s Kids. This project emerged from the Healthy People 2010 goal to have 80 percent of 2 year olds properly immunized. Each year the CDC collects data from the national immunization survey from every state and some major metropolitan areas. The latest survey was 2005 and covered children aged 19 – 35 months and Nevada was among the five states with the lowest rates. Clark County had the lowest coverage among all the areas for the series of vaccinations measured by the survey. Based on the 2005 data, Nevada was 63.2 percent and Clark County was 58.8 percent. The remainder of the state, excluding Clark County, was 75.8 percent. The national average is 76.1 percent. In the year 2004, Nevada was ranked last. The rates are low do to a number of contributing factors. For Clark County, reasons include: high transient rates, high population growth, switching of care providers, lack of a statewide registry, inadequate number of immunization providers, lack of awareness of the importance of immunizations. However, immunization rates at school entry are above 90 percent. The PINK project includes the Southern Nevada Immunization Coalition and the Southern Nevada Health District which was formed three years ago along with several community partners and launched last May. PINK is currently being distributed to about eight birthing hospital and centers and the goal is to get all the hospitals, birthing centers and pediatricians and all physicians to have this PINK project in their offices. The goal is to have every family in the state of Nevada have a PINK project in their homes. Our target population at this time is newborns and mothers with the hopes that siblings will also be included. The PINK packet is a tool filled with information to educate families about immunizations and to raise awareness. In related activities, a Baby Fair was held at Lorenzi Park with fifteen community partners. There were 2,000 participants, 279 children received immunizations and over 700 vaccinations were given. During the event staff was also able to explain the need for a medical home to each family. Spanish speaking interpreters were also available for this event. Another method of outreach being utilized is the Never Miss a Shot radio campaign and outdoor advertising which targets parents, and print advertising which targets private physicians and providers. Currently, staff is working with a subcommittee of the Nevada chapter of the American Academy of Pediatrics, which has indicated their commitment in improving immunization coverage among its constituency. The Southern Nevada Immunization Coalition is also working on a child care mandate which will add Varicella or chicken pox, hepatitis A, hepatitis B and pneumococcal to the child care requirements. Staff is working with all Vaccine For Children providers so their office immunization rates will improve. There are a number of problem areas in this state, but Southern Nevada with its population growth has been hardest hit. Funding is needed that is stable, sustainable and able to provide services to children in our community. Member Hardy asked about pneumococcal vaccine which is not on the list of the vaccine series. Mrs. Sorenson responded that due to shortages and interruptions of service of that vaccine in the past, it was decided not to include it in the schedule because it would have skewed the results for all the states. Mrs. Sorenson also stated immunization rates for clients who come into the health district clinics as well as the WIC (Women Infant Children) clinics, and FQHC’s, (Federally Qualified Health Centers), are 80 percent. The private providers, unfortunately, are the ones in the 58 percent range. That is where the bulk of our efforts must occur. There are funds that will be requested to get the immunization registry functioning. Many people in the community have an interruption in their medical home. They have insurance for a couple of months, and then they do not have it. They often go back and forth between a private provider and public services. This is where registries in the community would greatly assist. Dr. Christensen asked about access to the registry. He stated that he wanted his patients to register with the health district – as a provider he needs to be able to access the registry. Dr. Kwalick stated that federal funds received by the state are not distributed appropriately. Mrs. Sorenson stated there is a low reimbursement rate to private providers as well. Chair Fairchild asked if parents were still receiving a wallet card with immunization dates. Mrs. Sorenson stated yes, however, they are often lost. Member Mattocks stated that issuing a wallet card with immunizations and parents losing those cards just makes a better case for a state immunization registry. Chair Fairchild congratulated Mrs. Sorenson and Mrs. Morata-Nichols on their excellent presentation. Proposed Non-communicable Disease Regulations – Brian Labus, Senior Epidemiologist Dr. Kwalick informed that Board members that proposed disease regulations will be brought before them at the November Board of Health meeting and he has asked Dr. Sands and Brian Labus, senior epidemiologist, to report on the proposed non-communicable disease regulations. See PowerPoint presentation (Attachment #1 PDF (489 KB/15 pages)). These regulations will include different health events that are not communicable disease events that are already being tracked. The proposed regulations resulted from discussions at a statewide epidemiology meeting which brought about the question of ‘how to we make lead poisoning reportable?’ Under existing Nevada law, there is no provision for non-communicable diseases, everything under NRS 441A and NAC Chapter 441A are specifically about communicable diseases. The chief health officer can make individual infectious diseases reportable, but does not have the same authority for non-infectious diseases. The Board of Health does have authority to adopt regulations to protect and promote the public health generally in the geographical area subject to the jurisdiction of the health district. It is felt that it is appropriate that the local health authority adopt regulations along with reportable conditions and allow non-communicable conditions to be reportable, at least at the local level which would cover most of the state as well. The proposed regulations are largely modeled after NAC 441A. The regulations expand the definition of "disease" in NAC 441A to cover non-communicable events. Health issues like lead poisoning would now be reportable under the definition of disease. The definition of exposure refers to chemical agents so that definition would be expanded as well for exposure to biological and chemical or radiological conditions and sudden health events. These are conditions that do not fall into diseases or exposures such as drowning, etc. The regulations that are being proposed have four different sections: general provisions, reporting requirements, duties and powers relating to the presence of disease and specific diseases, exposures, or sentinel health events to be reported and subsequent investigation by the health authority. Diseases to be made reportable:
Dr. Christensen asked about compliance from the laboratories. Mr. Labus responded that health district already receives electronic reporting from the major laboratories and does not anticipate any issues. Dr. Kwalick invited members of the Board to attend the new Henderson public health center open house on Tuesday, October 31, from 10 a.m. to 2 p.m. VI. Informational Items
VIII. Adjournment Chair Fairchild asked if there were any other reports. There were none. Chair Fairchild adjourned the meeting at 9:06 a.m. SUBMITTED FOR BOARD APPROVAL Donald S. Kwalick, MD, MPH, Chief Health Officer /se Attachment #1: Proposed Non-Communicable Disease Regulations Presentation PDF (489 KB/15 pages) |
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