Minutes

Southern Nevada District Board of Health Meeting
May 24, 2007 - 9 a.m.

Clemens Room
Southern Nevada Health District Ravenholt Center
625 Shadow Lane
Las Vegas, Nevada

Notice

Chair Donna Fairchild called the meeting of the Southern Nevada District Board of Health to order at 9:00 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
Steven Kirk - Vice Chair, Councilman, Henderson
Karla Burton - Councilwoman, Boulder City
Jim Christensen, MD - At-Large Member, Physician
Chris Giunchigliani - Commissioner, Clark County
Timothy Jones - At-Large Member, Business/Industry
Lawrence Weekly - Commissioner, Clark County
Lon Empey - At-Large Environmental Specialist Alternate
John Onyema, MD - At-Large Member, Physician Alternate
Steven Ross Councilman, Las Vegas Alternate
Debra Toney, RN - At-Large Member, Registered Nurse Alternate

Absent:

Tom Collins - Commissioner, Clark County Alternate
Susan Crowley - At-Large Member, Environmental Specialist
Robert Eliason - Councilman, North Las Vegas, Member Alternate
Joseph Hardy, MD - At-Large Member, Physician
Mary Jo Mattocks, RN - At-Large Member, Registered Nurse
Frank Nemec, MD - At-Large Member, Physician Alternate
Gary Reese - Secretary, Councilman, Las Vegas
Stephanie Smith - Councilwoman, North Las Vegas

Executive Secretary:

Lawrence Sands, DO, MPH

Legal Counsel:

Stephen R. Minagil

Other SNHD Board of Health Attendees:

Jimmy Vigilante Alternate At-Large Member, Regulated Business/Industry

Staff: Mike Walsh; Sylvia Claiborne; Glenn Savage; Dennis Campbell; Mark Bergtholdt; Paul Klouse; Ellen Spears; Stanley Jensen; Bonnie Sorenson; Mary Ellen Harrell; Jodi Brounstein; Judith Slaney; Rory Chetelat; Mary Ellen Britt; Jim Osti; Angus MacEachern; Deborah Williams; Kay Godby; Nancy Gerken; Jennifer Sizemore; Stephanie Bethel; Linda Verchick; Brian Labus; Leo Vega; Forrest Hasselbauer; Recording Secretaries: Shelli Clark and Diana Lindquist

Attendance:

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: 3/22/07 & 4/26/07
2. Approve Payroll / Overtime for Periods: 2/24/07 – 3/09/07; 3/10/07 – 3/23/07; 3/24/07 – 4/06/07; 4/07/07 – 4/20/07
3. Approve Accounts Payable Registers: #1067: 3/01/07 – 3/08/07; #1068: 3/09/07 – 3/14/07; #1069: 3/15/07 – 3/21/07; #1070: 3/22/07 – 3/28/07; #1071: 3/29/07 – 4/04/07; #1072: 4/05/07 – 4/11/07; #1073: 4/12/07 – 4/18/07; #1074: 4/19/07 – 4/25/07; #1075: 4/26/07 – 5/02/07
4. Appointment of Nominating Committee for Fiscal Year 2008 Board of Health Officers (Chair Fairchild, Members Kirk & Reese)
5. Petition #12-07: Approval of Family Planning Title X 2007 Fee Schedule for CT (Chlamydia) & GC (Gonnehrea) Laboratory Services
6. Petition #13-07: Approval of Interlocal Agreement with Clark County Social Service: HIV/AIDS Evaluation Services to CCSS Clients for FY 2008
7. Petition #15-07: Approval of Contract with Nevada Division of Environmental Protection for Administration of the Federal Safe Drinking Water Act in Southern Nevada
8. Petition #16-07: Approval of New Classification Specification and Position for Vector/Entomologist Supervisor, Recommended Schedule 26 ($62,922 - $87,794)

A motion was made by Member Giunchigliani to approve all consent items; seconded by Member Burton and was unanimously approved.

II. Public Hearing / Action

1. Variance Request to Operate a Food Establishment not in Compliance with the District Board of Health Regulations 1996 Governing the Sanitation of Food Establishments (APN #162-03-301-002). Petitioner: Anita Jankovics, President, Little Tiny Diner, Inc., 365 Apple River Court, Las Vegas, Nevada.
   
   Paul Klouse, environmental health supervisor, presented a variance request from Little Tiny Diner. The establishment is a fully enclosed trailer on the owner’s property under a separation corporation that will serve as an employee dining facility outside the main facility. A list of specified conditions was agreed upon that would allow the establishment to operate safely. Staff recommends approval of the variance with the specified conditions as outlined in the memorandum. Robert Jankovics and Jennifer Adams were present on behalf of the applicant.
   
   Chair Fairchild asked if the applicants agreed to comply with staff’s recommendations. Both applicants replied in the affirmative.
   
   Member Giunchigliani asked to verify the address of the establishment and asked which residential properties were close to the business. Mr. Jankovics said that there are no residential properties in the area. Chair Fairchild asked if there were any other questions.
   
   Chair Fairchild opened the public hearing and asked if anyone wished to speak. No one came forward and Chair Fairchild closed the public hearing.
   
   A motion was made by Member Giunchigliani to approve the variance request with specified conditions; seconded by Member Onyema and was unanimously approved.
   
   
2. Variance Request to Operate a Public Bathing Place not in Compliance with the Nevada Administrative Code (NAC)444, Public Bathing Places, NAC 444.204 (APN #179-18-802-008). Petitioner: City of Henderson Parks & Recreation, Dominick Casey, Acting Superintendent.
   
   Member Kirk stated that he would need to abstain from voting on the item.
   
   Paul Klouse, Environmental Health Supervisor, stated representatives from the City of Henderson were unable to attend the meeting and requested a postponement of the public hearing to the June Board of Health meeting.
   
   Chair Fairchild opened the public hearing. No one came forward to speak and Chair Fairchild closed the public hearing.
   
   A motion was made by Member Giunchigliani to postpone the public hearing to the June meeting; seconded by Member Christensen and was unanimously approved.
   
   
3. Memorandum #12-07: Application for Approval for City of Las Vegas East Maintenance Yard to Operate a Solid Waste Transfer Station located at 3144 E. Bonanza, Las Vegas, Nevada 89101. Withdrawn by staff
   
   
4. Variance Request to Operate a Transfer Station not in Compliance with the District Board of Health Regulations 2004 Governing Transfer Stations, Public Waste Storage Bin Facilities, and Construction and Demolition Waste Short Term Storage Facilities. Petitioner: City of Las Vegas, 3144 E. Bonanza Road, Las Vegas, Nevada 89101. Withdrawn by staff
   
   
5. Memorandum #13-07: Application for Approval for Republic Services of Southern Nevada to Operate a Public Waste Storage Bin Facility at the Overton-Logandale-Moapa Convenience Center at 5205 N Moapa Valley Blvd, Moapa Valley, Nevada 89021. Withdrawn by staff
   
   
6. Variance Request to Operate a Public Waste Storage Bin Facility at the Overton-Logandale-Moapa Convenience Center not in Compliance with the District Board of Health Regulations 2004 Governing Transfer Stations, Public Waste Storage Bin Facilities and Construction and Demolition Waste Short Term Storage Facilities. Petitioner: Republic Services of Southern Nevada, 5205 N Moapa Valley Blvd, Moapa Valley, Nevada 89021. Withdrawn by staff
   
   
7. Memorandum #14-07: Application for Approval for C&D Construction Services, Inc. dba Liberty Salvage Materials and Recycling to Operate a Materials Recovery Facility located at 130 West Owens Avenue, North Las Vegas, Nevada, 89030.
   
   Dennis Campbell, environmental health manager for solid waste management and compliance, addressed the Board and presented an application for a materials recovery facility. The applicant has met all requirements of a materials recovery facility as specified in Section 4 of the Materials Recovery Facilities Regulations. Staff recommends the permit to operate a materials recovery facility be granted with the conditions as outlined in the memorandum. Tony Salazar was present on behalf of the applicant.
   
   Mr. Salazar said that his company had worked hard to obtain the permit and are in compliance with all requirements.
   
   Chair Fairchild asked Mr. Salazar if he agreed to comply with the conditions as outlined. Mr. Salazar agreed to the conditions.
   
   Chair Fairchild opened the public hearing. No one came forward to speak and the public hearing was closed.
   
   A motion was made by Member Burton to approve the application with conditions listed; seconded by Member Onyema and was unanimously approved.
   
   
8. Memorandum #15-07: Application for Approval for Wolfe Drop Box Services, Ltd. to Operate a Materials Recovery Facilities located at 5375 E. Cheyenne Avenue, Las Vegas, Nevada 89156.
   
   Dennis Campbell, environmental health manager for solid waste management and compliance, addressed the Board and presented an application for a materials recovery facility. The applicant has met all requirements of a materials recovery facility as specified in Section 4 of the Materials Recovery Facilities Regulations. Staff recommends the permit to operate a materials recovery facility be granted with the conditions as outlined in the memorandum. Betty Wolfe, the owner/manager, was present.
   
   Chair Fairchild asked if Ms. Wolfe agreed to comply with the conditions as outlined. Ms. Wolfe agreed to the conditions.
   
   Member Giunchigliani asked Ms. Wolfe if a special use permit had been issued from Clark County that expires in two years. Ms. Wolfe said that a permit had been issued and was contingent upon construction of a facility being completed. There was no opposition from the neighborhood. Member Kirk asked if approved materials recovery facilities are required to do separation at the job site or at the facility itself. Mr. Campbell said that separation is done at the facility – drop boxes are available at the job site, which are brought to the facility and subsequently separated. Member Kirk asked if materials are taken to the Apex Landfill. Ms. Wolfe confirmed that materials are taken to Apex.
   
   Chair Fairchild opened the public hearing. No one came forward and the public hearing was closed.
   
   A motion was made by Member Kirk to approve the application with conditions listed; seconded by Member Giunchigliani and was unanimously approved.
   
   
9. Memorandum #16-07: Application for Approval for Republic Services of Southern Nevada to operate a Materials Recycling Facility located at 333 W. Gowen Road, North Las Vegas, Nevada. Withdrawn by staff
   
   
10. Memorandum #18-07: Adoption of the Clark County Trauma System Regulations
    
    Rory Chetelat, EMS manager introduced Mary Ellen Britt, regional trauma system coordinator. Ms. Britt presented the proposed regulations. In accordance with NRS 450B.237 the Board of Health is required to adopt regulations to establish standards for the designation of hospitals in Clark County as centers for the treatment of trauma. The Office of Emergency Medical Services & Trauma System, in collaboration with the Regional Trauma Advisory Board, developed the regulations presented for adoption. The regulations were created following a review of the 2006 Trauma Model System Planning and Evaluation document published by the US Department of HHS, the final recommendations of the 2004 American College of Surgeons Committee on Trauma consultation visit to Clark County, and the current regulations from several other states with mature trauma systems. Consideration was also given to ensure the consistency of existing state trauma regulations. Dialogue occurred between with Alex Haartz, Administrator of the State Health Division, Lisa Jones, Acting Bureau Chief of The Bureau of Licensure & Certification, and Fergus Laughridge, EMS & Trauma Program Manager. The RTAB unanimously endorsed the draft. Regulations are divided into four sections: definitions; administrative activities; process for authorization of trauma centers; and structure and function of the RTAB.
    
    Member Giunchigliani said that the issue of diversion continues to come about in the community, particularly UMC. She said that the definitions did not include diversion and wanted to ensure that an audit trail exists to ensure patients are not diverted based on ability to pay. Ms. Britt said that patients are transferred to trauma centers based on the catchment areas defined by the Clark County Trauma System Plan. Facilities are able to go on trauma overload when an internal disaster occurs, as agreed by all medical directors. Times may occur when systems are severely overloaded, and to ensure patient safety a patient may be diverted to another trauma center. This is documented and a committee exists to review all instances that occur.
    
    Member Kirk confirmed that diversions occur due to capacity issues and not ability to pay. Mr. Chetelat said that structural issues could also cause offloading of patients. He further stated that diversion is not recognized in Clark County any longer other than in instances of internal disaster or trauma overload.
    
    Member Jones said that editing needs to occur on page 7, 300.500 III: “it” should be changed to “the Board.” Further in that paragraph “it” should again read “the Board.” Ms. Britt noted that the changes will be incorporated.
    
    Chair Fairchild opened the public hearing. No one came forward and the public hearing was closed.
    
    A motion was made by Member Christensen to adopt of the Clark County Trauma System Regulations; seconded by Member Jones and was unanimously approved.
    
    
11. Memorandum #19-07: Adoption of Proposed Environmental Health Division Permit and Plan Review Fee Schedule; Consideration of Business Impact Statement
    
    Mike Walsh, director of administration and Glenn Savage, director of environmental health, addressed the Board relative to the proposed fee schedule.
    
    The following is a verbatim transcription of the public hearing concerning Memorandum #19-07.
    
    Glenn Savage: Environmental Health is proposing to increase our permit and plan review fees to continue to provide our essential services within our community and all the seventeen, eighteen specific programs we have within our community. You might recall about four years ago we were here before you setting up our fee schedule. At that time Environmental Health was asked to become self sufficient. We tried to do so without using any county tax dollars. We did do that, we were successful in doing so. What is changed in those three years, and Mr. Walsh can better explain that, has to do with being, running a business, doing it correctly and coming up with the monies to be able to run our organization which includes the direct costs we incur in Environmental Health and also indirect costs. In the process we public noticed the community of workshops in Mesquite, Laughlin and here in Las Vegas. We have received just one written document from a gentleman who runs a mobile vending business, and works with temporary, in temporary events. We’ve had two meetings, one with the Nevada Restaurant Association, one with the Resort/Motel Association which Mr. Jones also attended. So we have gained some information and comments from the community. I believe there are other members of the public that are here today to express their interest, issues or concerns with the proposed fees. Again we have noted the information for you in the Board book as far as any written documents and also we have an economic impact statement that is also in the documents before you today. We feel again that we need to continue providing the services, we continue to grow in the needs in our community, whether it’s now an apartment complex issues that we continue to work with, and recently staff had a meeting with the City of Las Vegas to take care of an issue we have with some slum landlord which is something new and different in our community that we’re getting involved in; Metro and business license, code enforcement has asked us to get more involved more with the massage parlor industry in our community; we’re looking at putting together those regulations which will address those concerns. Environmental Health continues to grow and continue to have more concerns placed on our plate, we’re asking for the Board to consider to increase the fees to allow us to do the job that you ask to do.
    
    Chair Fairchild: Mr. Jones, you need to disclose . . .
    
    Member Jones: I do need to disclose that I am employed by MGM Grand Hotel, a property of MGM-Mirage, and we will be impacted by the fee schedule.
    
    Chair Fairchild: Mr. Walsh?
    
    Mike Walsh: If I may, I’d like to touch on the concept, or the shift in the concept of setting the rates. I think I touched on it a bit when we did the budget presentation, but what we were looking at was…prior to this change the Environmental Health people were asked to set a rate structure so that they could cover all of their direct costs of operation. In looking at the budget for this year and trying to make sure that we could meet the growing demand for services in all the different services that we provide, we saw an opportunity to cost out the indirect cost overhead that all the different divisions get. So we took administration and facilities, information services, human resources, and we look at them as overhead departments. So what we did is I constructed a spreadsheet that would allow the allocation of those indirect costs based on some significant statistics, that being the number of computer devices being used, or the number of employees that the different divisions have allocated to HR expenses for example. So based on that, the amount that was allocated to the Environmental Health people was about $2.3 million overhead. And so with that, Glenn and his people sat down and tried to incorporate that overhead allocation into their fee structure which accounts for most of the increase that you’re seeing over the previous year and that’s listed there on the fee schedule. The issue was that prior to that, the overhead was being supported by the property tax dollars from Clark County, and several of the other divisions had a significant need because of the growth and their demand. In nursing, for example, didn’t have the wherewithal to through their own fee structure to recover those costs, so we tried to set this up so that those property tax dollars that were unassigned could then be used by the divisions that didn’t have the wherewithal to generate or cover their own costs, and it was to allow us to do some new things in nursing and community health that we wouldn’t otherwise be able to do because we have had to allocate those property tax dollars to the overhead, covering the overhead for the Environmental Health division.
    
    Chair Fairchild: Very good. Are there any questions? Go ahead.
    
    Member Weekly: I’d just like to ask how were these workshops noticed or advertised. That’s one question I have. And I have two more.
    
    Glenn Savage: Yeah, we advertised through local newspapers, and the RJ here. We also posted the notices in government facilities. We also did send out notices to groups who have worked with us in the past such as the different Chambers of Commerce throughout the community and other interested parties.
    
    Member Weekly: OK, because I know Mr. Nevarez who sent in the letter is probably one of several small businesses that I’ve been contacted by who have some serious concerns as it relates to the fiscal impact it will have on their personal businesses and their livelihoods. I guess one of the other questions I wanted to ask is on the business impact statement on page 2, statement #5 where you talked about the seventeen new staff members…
    
    Glenn Savage: Yes …
    
    Member Weekly: . . . that are being proposed it relates to approximately how much we would generate from this annually. What does this mean? I mean this is just for my own understanding here. There is no additional cost contemplated for enforcement for the proposed scheduled. Explain that to me please.
    
    Steve Minagil: Excuse me, Member Weekly and Madam Chair. That particular statement, that’s a requirement of the law, Nevada Revised Statutes that describe how to prepare a business impact statement.
    
    Member Weekly: Mm-hmm.
    
    Steve Minagil: The business impact statement must have that particular provision in there, whether there will be a cost for enforcement. So we had to say, we had to make that statement, that these particular fees do not have that kind of component.
    
    Member Weekly: So with the seventeen new staff members, proposed staff members, there is no additional enforcement contemplated with the annual fees generated.
    
    Steve Minagil: That’s correct.
    
    Member weekly: OK. So then where would you make up that difference at? How would that come into play? If we’re dealing with the amount, if we’re dealing with growth, the last increase was January of ’06…
    
    Glenn Savage: Yes…
    
    Member Weekly: …OK, and we’re looking at a proposed increase here with possibly seventeen new employees, but there is no enforcement here. It’s almost like, when I was with the City I always had a concern with, we impose these ordinances, but there’s no enforcement. How does this work? It’s just what I’m trying to figure out here. How do you bring on seventeen new people with no enforcement?
    
    Glenn Savage: You mean as far as enforcing regulations?
    
    Member Weekly: Yes, sir.
    
    Glenn Savage: Oh, of course that’s part of their job duties. They will be doing enforcement. The job duties and responsibilities they would have would include enforcement of regulations concerning food facilities, mobile home parks, public accommodations, you know everything that is on our books right now to enforce, solid waste facilities, I mean, you know, we would continue as we’re doing now.
    
    Member Weekly: OK.
    
    Glen Savage: And I just might add, the growth continues here in our community. Just in our food programs alone, we’re averaging somewhere between 800 and 1,000 new facilities a year. Our pool/plan review program is looking about 300 new pools and modifications that happen. So growth continues. We look down at the properties down on the Strip and City Center and we’re having meetings with the engineers and the MGM people that are telling us about all the new permits that are going into that facility. We might be faced with assigning one person just to work that entire property because of the amount of permits necessary to run that operation. So…
    
    Member Weekly: Madam Chair, just one more question please. Do we believe we have done an adequate enough job in noticing the public on this proposed fee increase?
    
    Glenn Savage: Mr. Weekly, I always question myself with that. You know we try the best we can. We try to get the information out through all the venues we can: business, again Chambers of Commerce, people who have worked with us in the past with personal calls and/or letters. But apparently we don’t get to everyone, and that’s probably the sad part about public noticing, two months from now there will be someone who will come forward and say why didn’t you guys get a hold of us personally? And I guess that’s a failure of the system. But we did give opportunities for people to submit emails, letters, attend the meetings so we could address their concerns.
    
    Member Weekly: OK. Thank you, sir. Thank you, Madam Chair.
    
    Chair Fairchild: You bet. Any other questions? Go ahead, Chris.
    
    Member Giunchigliani: Thank you. I have several questions. Glenn, what’s the budget currently? Is there a reserve? We don’t have our budget in our book.
    
    Mike Walsh: I didn’t bring a copy of the budget with. In this year’s budget, the ’07 budget, the expense that was budgeted for the Environmental Health operation was fairly close to a break even, which was the directive that was given to Environmental Health in terms of the budgeting in prior years, which was to set their fees at a rate that would cover the direct costs of operating the division. And what we put in this year’s budget, well what we proposed in the budget and what we’re trying to accomplish is adding to that direct cost the indirect cost that’s attributable to the support that that division gets from IS and HR, and all the other departments that are not part of the Environmental Health division directly.
    
    Member Giunchigliani: I’ll come back, but I think he has a follow-up question.
    
    Member Empey:What you’re saying is then, that Environmental Health division is paying for the other services that you just said, spoke of.
    
    Mike Walsh: No, that’s not what I’m saying. What I’m saying is they receive services form those departments that are not part of their division. And now we’re allocating that cost to them to build into their fee structure.
    
    Member Empey:That’s what I just said. If they buy new trucks for their division…
    
    (Speaker): And they use them…
    
    Member Empey: …and they use them they have pay you guys to use them, is that right?
    
    Mike Walsh: Not if they buy them.
    
    Member Empey: What are we doing with the surplus money, if there’s any surplus money in Environmental Health, where does it go?
    
    Mike Walsh: Well, based on what I’ve seen, there isn’t. The amount of overhead that is, if you will, consumed by the Environmental Health division, is in excess of the revenue that they generate in excess of their direct costs.
    
    Member Empey: So what do we do with that excess?
    
    Mike Walsh: Well the excess goes to covering the overhead.
    
    Member Empey: There’s not any leftover that goes to any other division?
    
    Mike Walsh: No. Not when you consider the support that they get from departments that aren’t part of their division.
    
    Member Empey: I agree that there needs to be a fee increase. And that the Environmental Health division, and I speak from experience, real close experience, the demands on that service is going up; it’s not going down, it’s going up. And they need the support. But I get the impression that the Environmental Health division is going to foot the bill for everybody else, and that means the public. I can’t agree with that.
    
    Mike Walsh: Well, that’s not the case, OK.
    
    Member Empey: Clear it up for me.
    
    Mike Walsh: Pardon me?
    
    Member Empey: Clear it up for me. Because I’m concerned.
    
    Mike Walsh: It’s a relatively complex issue, but I certainly will try again. OK. They have direct costs: their labor, the benefits, the supplies that they use in the Environmental Health division. Those are their direct costs. And in the past was what they were asked to cover. In the new budget we’re asking them to not only cover those costs, but their fair share of the in direct costs that are attributable to operating the health district, but aren’t directly part of the Environmental Health division. I guess maybe as an analogy, if you were to look at the Environmental Health division as a separate entity. If it were a separate entity, it would need accounting staff; it would need HR staff; it would need information services people and equipment; it would probably have some advertising costs, or public relations costs; and then the general administration of the department, that would be the leadership and liability insurance premiums, those kinds of things. Well in this current configuration, they don’t get allocated those costs; those costs are part of the administration division, but all of those departments within the administrative division support that program like they support the community health program and they support the nursing program. So they’re providing support, personnel, equipment, the facilities themselves are costs that aren’t part of the Environmental Health division directly; so what we’re doing is we’re allocating, I’m allocating those indirect costs to the other divisions, or other departments, that have the ability to generate revenue to try to cover those costs, which in the past weren’t being covered by any fees, they were being covered by the property tax revenues from the County.
    
    Member Giunchigliani: So to kind of follow up on that, so you’re creating a cost allocation plan for the indirect costs.
    
    Mike Walsh: That’s correct.
    
    Member Giunchigliani: OK, kind of not having a budget in front of us is kind of frustrating because you can’t quite compare what we have (comment) and I also don’t quarrel that we need a fee increase, but I want to back up one of Commissioner Weekly’s points. It’s been about a year in workings, and then you have your public workshop when, in early May I believe.
    
    Glenn Savage: Yes.
    
    Member Giunchigliani: Public notices have always been a frustration thing because we’re required of statute for certain places. To me it would make sense, and maybe it’s not for this time, to but learn from this is over that year as you’re working through that as you’re out inspecting people, give them a letter and say we’re going to be looking at rate increases by this date so at least people have some additional awareness. You don’t even have to attach the fees yet because you won’t have that as you’re building the budget for the fee suggestion, but that just might be a better way to reach out to our customers, so to speak. I had, is it 26.7% or 27.6% across the board in each area so everybody was treated exactly the same within this fee schedule? Because that’s the way it’s outlined in that column for ’07 and then it goes to 8.75%...
    
    Glenn Savage: There’s a yellow column…
    
    Member Giunchigliani: Right…
    
    Glenn Savage: …or noted in yellow, which is other change which could be more than 27.6.
    
    Member Giunchigliani: OK. Is there a way to get a break out of how much more that was? Is it 100%?
    
    Glenn Savage: Well, for instance on page 2, massage parlors, mobile massage vendors, mattress refurbishing companies, that’s brand new so we had nothing to really go by. We established a fee so that’s different than just 27.6%. Two other areas, one is in the public accommodations area under category 51/52 on page 2, which is a substantial increase for hotel/motel, for the annual fee going from $250 to $320; the per unit going from $2.85 to $6 per unit; and then there used to be a cap of $3,750 for hotels to pay, now the proposal was not to have a cap at all – that has been part of the discussion that we have had with industry. Mr. Van Heffner has been part of that; Mr. Jones has been part of that, and others. We’re trying to come with a solution to that. They might not be able to, having an open cap is necessary. They’ve also asked in the last few days to try to come back with some other information about how much time and effort that we spend in the larger facilities concerning that cap. I did get some figures this morning. I was in Utah at a Leadership seminar, just got back and kind of putting together some of that information. So…
    
    Member Giunchigliani: So, for example, tattoo parlors, body piercing, you have nothing there, those are just all included in that section? Do you delineate them differently or, that’s on page 3 of 5.
    
    Glenn Savage: OK, 3 of 5. OK the top, tattoo and body piercing, that would have been a 27.6% increase from $200 up to $256 for the proposed in ’07 and then an additional 8.75% increase for the following year.
    
    Member Giunchigliani: OK, so then the body piercing underneath body art, body art vehicle, those are all considered part of that component; that’s why there’s no about figure there.
    
    Glenn Savage: Right.
    
    Member Giunchigliani: OK, so it’s just a further breaking out of what they’re called and what would be put in that…
    
    Glenn Savage: And I might want to add for the Board’s information is that in the past we tried to work with businesses to break out these fees to the best that we can, and kind of notes what their business is, try again to work with them. So in the past you’ve seen…of work with some mobile vendors, the temporary event people, the farmers’ market folks that come forward with concerns, and so we keep trying to break that out. Today you saw Mr. Wolfe and Mrs. Wolfe come in, and we’re breaking out the MRF requirements and the amount of fees. So we keep trying to do that, and try to get better at doing that each time we make these proposals.
    
    Member Giunchigliani: And so how many staff were added last year?
    
    Glenn Savage: I believe zero.
    
    Mike Walsh: In the current fiscal year?
    
    Member Giunchigliani: For current fiscal year ’07. ’06?
    
    Glenn Savage: I believe it was somewhere around fifteen.
    
    Member Giunchigliani: And so seventeen is what you’re proposing now, but we don’t really have documentation to show us. I’m assuming that’s low, you just have that much more business-wise opening up, but…
    
    Glenn Savage: But quite frankly without having any new staff hired last year that kind of put us behind. We probably should have hired seven, eight, nine people last year…
    
    Member Giunchigliani: Personally, I’d always rather see that so that we don’t have this huge bump that comes (comment)
    
    Glenn Savage: And in the discussions we had at that time with Mr. Munninger, he was in charge of our administration, he had concern about that amount of fees that were going to be coming in, he proposed that we would wait until later on in the year to make up the difference by hiring staff later on in the year, that didn’t happen, so that is reflected now in this year’s need for seventeen instead of eight.
    
    Member Giunchigliani: OK, so what’s your turn around time once you post for a position?
    
    Glenn Savage: Well, Mr. MacEachern is here with us. I wish our turn around was tomorrow, but with the…it could be upwards to a couple months, two to three months to get someone hired.
    
    Member Giunchigliani: So, all seventeen would not be anticipated to come on board…
    
    Glenn Savage: Probably not.
    
    Member Giunchigliani: …immediately. And just there’s, because I grabbed Alex briefly in the parking lot, because there was an article in the paper the other day that the fees have been re-added into the State budget for the Health Division who also assesses a lot of these similar businesses. And we don’t know if that’s going to stay in the budget or not, but I think we have to be cognizant of fee increases there plus our fee increase, and it could be quite large on a lot of businesses. And so, while I believe you need more staff and don’t argue that, I’m wondering what our process would be if we have more public discussion now, get some additional numbers based on what the State may do, what those impacts are going to be on the businesses to compound the problem possibly, and then the June meeting actually do whatever we need to do to enact, and that’s more to the Chairwoman. But just, I think we need to anticipate that, because if there’s a 50% increase at the State plus our 27%, that may need just phasing some things in. Because this takes place, anticipates July 1 of ’07, don’t want to stranglehold the department in any way, because I do think we need to move forward on some of these, but I think we may need to flush a little bit more out. And that’s just a proposal.
    
    Member Jones: Would you think that many of these businesses would have a State permit as well as a Health District permit?
    
    Glenn Savage: I would really doubt it, Tim.
    
    Member Giunchigliani: Alex is nodding his head no. Sorry.
    
    Member Jones: I don’t think we’re going to get hit twice.
    
    Member Giunchigliani: That’s good to know.
    
    Glenn Savage: However, again from what we’ve heard there are concerns with businesses and small businesses concerning minimum wage, gasoline prices, gas prices, power prices, insurance – we have heard some of that. I wish some folks would have put that on a piece of paper which would have allowed us more input and information, but we have heard that being discussed.
    
    Chair Fairchild: And there has been apparently a request from the restaurant group and some of the other groups to continue to next month to allow them time to meet with staff for further discussion and consideration on some of these fees. So…
    
    Member Jones: Madam Chair?
    
    Chair Fairchild: Tim has a question.
    
    Member Jones: I’d just like to bring up some of the concerns in terms of what the fee structure is. I think there’s no qualm on my part for the total amount of revenue that’s necessary to run the enterprise here. But when we look at it on a large business side of the world, I can tell you that permit fees for a large hotel are probably going up about 65%. For the hotel I work at, looking at fees going up from $65,000 to $107,000 for the year. If we take a look at the total revenue improvement necessary to move the revenue from $13 million to $17 million a year, a $4 million rise, which is 30% change in revenue versus the hotels seem to be paying about 65% more in fees than may have been paid in previous years. If we just look at the room structure piece of it, 135,000 rooms in Southern Nevada and $6 a room, we did the arithmetic at the meeting and $810,000, well that’s about 20% of the fee increase just based on rooms. So the bottom line point for me is that if we really have a good understanding of the resources that have to go into a specific type of permit and cost that permit based on what resources are needed to issue that permit as opposed to a cost of one. And at the end of the day maybe a large hotel pays the same amount of fees we would have paid otherwise. But I think that if we are at the point where each fee, each permit has a background of what it costs essentially to issue that permit that might better be reflected in the permit fee.
    
    Chair Fairchild: I should think it would also make sense, still telling what Tim just said, is perhaps a tiered schedule for hotels that have 100 rooms or less, and then 100 to 500, and then 500 to 2,500 and over 2,500. It would probably cost out better, I mean if you’ve got a 4,000 room facility versus someone who’s got 25 rooms…
    
    Member Jones: I don’t know but it takes a whole lot more resources to come and inspect public accommodations for a 5,000 room hotel than what it takes to take care of a 500 room hotel. Maybe I’m wrong…
    
    Glenn Savage: I was just involved with an investigation we did of a 45 room motel and in all total was spent close to, well we will have spent close to $2,000 in time and effort in ridding this hotel or motel of things such as bed bugs, rodents, mold, other issues, sewage issues, and that, and they pay I believe it’s somewhere around $400 a year for their permit. Again, Mr. Jones might pay $3,750 for their permit. We spent a great…I did the numbers this morning. So far this year Tim you spent almost $1,800 on your permit for the MGM and certain inspections and trainings that we’ve done. I’ve also got some more information we did some other public nuisance-type training with your staff, so it’s probably going to be close to $2,000. My point is that depending upon the compliance and how the facility runs sometimes these fees just don’t quite fit. The other thing I’ve got to remind the Board is that four years ago, there’s certain programs we do in Environmental Health that we don’t charge a fee for: vector control, such as rodent investigations, Hantavirus, Norovirus, we can’t charge anyone again for those. So I believe at that time the Board and people in the public said you know it’s OK for you guys to provide some of those other services; you can’t charge a fee to try to make sure that our community is not the Norovirus capital of the world; the Hantavirus capital of the world; the West Nile Virus capital of the world. Make sure you get out there and do apartment inspections to try to help people with need to make sure that they have HVAC systems, and air conditioning and they don’t have raw sewage in their apartments. Again those are things currently we’re not charging for, but in the overall scheme of what EH does, that is part of our things that we do and part of the money we spent to provide services.
    
    Member Giunchigliani: Madam Chair, to follow up on that then. Have we ever contemplated a fee schedule similar to what we have, or whatever, but looking at an enforcement or compliance factor for those that choose not to take care of those properties, that they have to pay then to offset that cost. I think that would then reward those that are good businesses and go after the ones who are not bothering to take care of their job. And you’ve documented that very well – I’d keep sending them the bill or give them a “you will close” notice” if that’s the case. And that might be something we could anticipate or at least have for discussion purposes. EH is absolutely a critical care, whether people think of it, I mean your folks came out and looked at roof rats at my house. I would willingly pay but I understand the issue there is how to get rid of them or eradicate them and work through that process. Because I notice even on some of your’s you do an initial inspection, there’s no charge, but when you have to come back out, you hit them with a charge.
    
    Glenn Savage: Right.
    
    Member Giunchigliani: That makes sense to me, because that’s a compliance issue or enforcement piece. What, will this generate $2.3 million, is that what you said, or did I, or is that over and above…
    
    Mike Walsh: That was the amount of the overhead that was allocated to Environmental Health that was a component of trying to raise the fees.
    
    Member Giunchigliani: OK, so what would this, what did you anticipate this raising then in the ’07 year, dollar-wise?
    
    Mike Walsh: You mean in the current fiscal year?
    
    Member Giunchigliani: Correct. No, with fee increases.
    
    Member Kirk: ‘07/’08.
    
    Mike Walsh: Oh, it was just a little short of $4 million of additional revenue, but that was both the current cost inflation plus the 21% was the percentage of the overhead cost that was allocated. It’s actually 21% of their direct costs.
    
    Member Giunchigliani: Of their direct costs. Thank you.
    
    Member Christensen: Madam Chair, it’s clear that EH bears the burden and I would love for all the businesses to pay their proportionate share; but with the Norovirus outbreak, we spent tremendous amounts of time and money, and the bottom line is on there if we get a Norovirus outbreak or a bioterrorism outbreak, everyone in this city pays. And they pay big. And so, yeah I would like to see everyone pay their fair share, but sometimes we’re going to have to, other people are going to have to foot the bill because if we go down with a big outbreak and some event, tourism’s going to suffer. And there’s a huge liability and a huge risk in this department.
    
    Member Kirk: Madam Chair, I have something. I wanted to comment. The comment I have is on the large projects when you’re talking about allocating one certain health inspector to cover multiple projects. We have found that the developers are more willing, they’re very willing to pay to have somebody out there on site daily, if necessary, to make sure that their inspections are done on time. And so even if there has be someone assigned and hired maybe in a temporary way just to cover those projects while they’re constructed, I think that the development community would be more than happy to cover that because it would cost them a lot more money in delays and everything else if we’re not able to get those done on time. Secondly, I’m a little concerned about the kind of small business man. I mean, he’s a, for example, I’m seeing the pool service vehicle goes up $47 per truck, so about a 33% increase. You know, if I have one or two trucks, not a big deal; I have a fleet of trucks, it costs me a lot of money, and I’m not so certain that you know a six or eight percent increase to cover increased, you know, cost of living increases is, maybe that’s appropriate. My question is to you, is how do we talk to the small business man that owns a pool service company and tell him that this year, or this coming year over last year you require 33% more services from the Health District when he hasn’t increased anything? How do we justify that to the small business man when he maybe hasn’t grown his business. Are we asking him to foot the bill for the rest of the community to cover these other outbreaks? If we are, let’s just tell him that’s what it’s going for. But if it’s going to cover other departments for other services, then those other services should be charging more and these guys should be charged less. And my question is how did we determine these rates? I mean was it, well, increase everybody by x% and that seems fair? Well, it doesn’t seem fair to me. If there is a bigger drain on environmental health services in one segment of our industry in our valley, they should pay for it. If another segment, if it’s service, like the pool service industry, they have not had an increase in their requirement, you haven’t allocated more people to cover what they do, they shouldn’t be paying more. They should be paying maybe the increase the COLA, you know the cost of living increase, but to burden them with an increase that essentially equals a subsidy of another department, I’m not so sure I’m comfortable with that. And so I’d like to know how we came up with these fees and I’m just really concerned about how we came up with these numbers.
    
    Glenn Savage: A few years ago we put together a business plan to figure out about how many hours it would take to do a plan review or an inspection. At that time we figured out, even with our own internal overhead, since it’s an administrative cost, it cost out about $65 per hour. And so that was our basis four years ago and we’ve used that as a number, and continue to do so. As far as adding additional staff which was in plan review, we’ve added additional staff in both our food and pool plan review programs. We gone from two pool plan reviewers up to four now. We’ve added at least three new food plan reviewers in just this past year. So I’ve actually had to take some staff resources that are actually in our operational inspection program and put them into the plan review program because of the needs of the contractors and developers because you have to be issued a permit first before you can start operating. We had to do that without putting in new staff to do those operational inspections. So that’s what’s suffered on the end; that’s why were looking at adding additional field staff to go out now and do the operational inspections.
    
    Member Kirk: Glenn, those are…we’re adding seventeen new staff members in ’08?
    
    Glenn Savage: They’ll be operational people; ones who go out and inspect the facility for compliance after a permit has been issued, further permit per the regulations. That’s where the seventeen people are going to go.
    
    Member Kirk: My issue is not that.
    
    Glenn Savage: OK.
    
    Member Kirk: Because I think what you just described, at least in my mind, is a growth issue. It’s a new construction, it’s a growth paying for growth kind of what we all say, but we wonder if it really works there. What I’m saying is I have a business of twenty trucks, I’ve had twenty trucks for the last three years – haven’t grown and I’m not doing anything different, and yet my fees are going up 33%. Doesn’t seem fair to me, doesn’t feel right. How do I stand in front of my constituents and say, well that’s the cost of doing business, you know? A 33% increase. I don’t know, that just doesn’t feel right. I know we have to pass it on in some respects, but I think we ought to be passing it on to, where, we need to identify the areas where the, I mean they run this like a business, that was your comment early on. I think we ought to look at these fee increases as a business would look at them. I mean if there is not an impact in a certain area, we should increase them just a small amount. If there is a large increase, if it’s a construction issue, if we’re adding more people because of growth, then they should pay more. But I feel, the growth issue, I mean that’s a whole other discussion. But my problem is the small business man. I cannot look at him as a member of this Board and in my heart feel good about saying to him, you haven’t grown your business at all in the last two years, and yet we’re going to increase your fees by 33%, the health district. So I’d just like to work with you a little bit more on understanding that. I didn’t get briefed on these – I read them, but I didn’t get a briefing. I think each of us have questions we’d like to ask the staff in more detail because I think the reason we make up such a good Board is that each of us have our own little area of concern. And so I’d like to continue these for 30 days, that’s not a motion yet, but I’d like the Board to consider that.
    
    Chair Fairchild: OK.
    
    Member Jones: One piece, if I’m understanding this right, the fee increase is not only the fact that it costs more to do the operation in 2007 than what it costs in 2006; I mean you’re also going to pay 100% of the operating costs of EH in your counter fees. Whereas previously some of that percentage was paid for out of the general funds, if you want to call it that versus now all of it is shifting to our fee schedule. So for everybody’s, everybody will pay . . .
    
    Member Kirk: Then when we meet, I’d like to read the budget, too. I mean I just don’t want to look at this, I don’t know, I’d like to look at the line item budget and see where these fees impact, where some of the money came from last, where it’s going to come from this next year. I don’t have that for backup. I’d like that.
    
    Chair Fairchild: OK. Obviously, Steve brings up good points, we all have more questions and more concerns, hear me out. Why don’t we go ahead and open the public hearing. We’ll hear from the public and then once we have everybody on the record, make the recommendation to come back next month. This gives Glenn and his staff time to sit down and chat with people that want to have contact. It allows all of us to some of our questions answered, as Steve pointed out with the budget to compare. Maybe if we could get the Board books out a little bit early for the June meeting, that way we’d have the budget and we’d have the fee schedule and then we could just have a little more study time and really grasp this issue because it is extremely important.
    
    Glenn Savage: Also, my suggestion would be if the individual Board members would like to have a meeting I would be more than happy to sit down as we’ve done in the past and discuss these matters so there is a better understanding.
    
    Member Weekly: Madam Chair, I think that would be important simply because from an elected official standpoint, you know we get a lot of phone calls, and Dr. Sands, I didn’t call you, I just kind of (comment) with our county managers, and you know we decide on them and the county started receiving phone calls on this issue here, and I know that you and I have both have been thrusted into new roles in ’07 and we’re both busy, but I would like, it’s extremely important to have, we have to meet on this so that we’re able to adequately address those concerns coming in to me. So I would appreciate that very much.
    
    Chair Fairchild: I would just ask of the Board members, if you wish to meet with Mr. Savage, please contact him via email and allow him to set up meetings with you.
    
    Glenn Savage: And if several members would like to meet in a joint meeting, that would be with both members of Henderson and the County or City, we’ll came out to Boulder City.
    
    Member Kirk: Mr. Minagil, how many of us can get together and have a meeting with him without forming a quorum? I mean is that permissible?
    
    Steve Minagil: Because you’re not determining…it’s a briefing, and you’re not making any, you’re not engaged in a decision-making process. I’ll re-look at that and if looking at the law changes my opinion I’ll so advise.
    
    Chair Fairchild: Six or less would be…
    
    Steve Minagil: It’s the purpose of what you’re doing, I think, is the key and not the number. So I look at it right now, it’s briefing; it’s not part of the determination process. It’s providing you information. If my opinion changes after this meeting, I’ll advise and we’ll set it up in a way that we’re not violative of the Open Meeting Law.
    
    Dr. Sands: Madam Chair:
    
    Chair Fairchild: Oh, I’m sorry. Go ahead, Dr. Sands.
    
    Dr. Sands: I mean, I appreciate all the input. It’s good discussion for us to have, and gives us better direction. I think these briefings will be able to give us the chance to share information. Just two observations, two comments I wanted to be sure we’re clear about. One of the issues has been, it’s come up a couple of times (comment) in this meeting here is that a perception that fee revenue that’s generated through Environmental Health is somehow used to support other activities in the district, and, I assure you that does not happen. The fee revenue generated through Environmental health fees are not supporting the nursing program or the epidemiology program, or whatever. We can’t do that statutorily – the fees we collect have to be directly related to the costs of delivering a specific service. And what we’re doing in this case, the larger share of the percent of the increase is due to the fact that we are now building in the indirect cost, the overhead cost which we are also doing with other programs at the same time. So as we get grants and other contracts, we’re also making sure we’re taking advantage of every opportunity of recovering those indirect costs because it’s great to get a grant, it’s great to get a contract, a revenue source, but it still costs us to hire new people, to house people and all of that. We have to recover that. So I just hope that that assures, allays any perceptions that people may have about where the fee revenue goes, or that the revenue goes outside of Environmental Health. And the other is we’re sympathetic of the same issues as businesses, whether it’s small business, large business, is that we have the same issues. Our personnel costs go up, our fuel energy costs go up, you know we’re hit by the same increases as everybody else. And we reflect that in recovering those costs, whether direct cost or indirect costs as well. I just want to be sure everybody’s clear about this issue.
    
    Chair Fairchild: And one thing we have to be cognizant about is the federal and state funding is drying up. Every year we have less and less money coming in from other sources – we have to be more self reliant and everything else. So that’s kind of a catch up situation as well and I think that’s why we see these bows every once in a while is because the federal funding’s going away, the state funding’s going away, but our costs aren’t going away – they’re the same. So, it’s been a difficult situation for all of the divisions. OK, let’s go ahead and open the public hearing. If you’d like to speak, come up to the microphone. We do need your name and address for the record. And you will have three minutes.
    
    Edward Lepere: Ladies and gentleman, good morning. Thank you for the opportunity speak this morning. My name is Edward Lepere and I’m representing the Nevada Restaurant Association this morning. We presented earlier a letter of testimony (attachment #1) PDF (20 KB) that I would like to over with you. If I may read it for the record, and then make some comments as a restaurateur on my own and how this proposal would affect us. “The Nevada Restaurant Association, on behalf of 5,200-plus eating-and-drinking places statewide, generating 8.2 billion in sales and providing more than 150,000 jobs, appreciates the opportunity to comment on this proposed fee schedule by the Southern Nevada Health District. Our comments reflect not only our concerns for our members and their employees, but are, in some instances, in direct response to SNHD’s request for information. As a leading member of the hospitality industry, we are keenly aware of the fact that without a sound health inspection division, our member restaurants could fall victim to a foodborne-illness outbreak that could ruin establishments’ reputations and even force them to close their doors. Food safety is non-negotiable and a critically important part of restaurant-and-foodservice operations. The Clark County restaurant industry firmly recognizes the need for a strong oversight division such as SNHD that is fully staffed, fully trained and fully supported. Our community is undeniably fortunate to have served billions of meals to people from all over the globe with very few incidences of verified food borne illnesses. But we as tax payers also realize that, despite the sharp and consistent increase in costs everywhere, growth does not always pay for growth. The business community has finite resources to deal with escalating costs and a competitive marketplace that dictates how much the consumer ultimately can bear in the way of menu price increases. As a result, NvRA’s members, who hail from every facet of the food service industry, cannot support increases that exceed the cumulative cost of living going back four years, as well as going forward into the future. Our biggest concern relates to how the complicated county budgeting process is configured. Further, we have concerns regarding how the increase in property values in Southern Nevada, coupled with the growth in health permit revenues from new applications, has not to a greater degree offset the need for increased fees. As a result, the NvRA community wants to support the increase, as it has supported increases over the past 10 years, but only in the same percentages as inflation and the cost-of-living index. Going forward, the NvRA is interested in joining forces with the SNHD to innovate programs that will further the education of industry operators and their employees with the ultimate goal of making the inspection and evaluation process less problematic. Done successfully, this could yield an environment where operators are more highly skilled and the inspectors serve more as teachers instead of enforcers. This should lead to a decrease in cost increases, since problem operations cost more time, energy and money to administer. Restaurants have a long-standing commitment to food safety and ensuring food safety is a shared responsibility. We thank you for the opportunity to comment on this significant proposed fee increase and sincerely look forward to working with you on this matter.” That presentation is on behalf of the restaurant association. As a restaurateur in the city, let me tell you a little history of Lawry’s restaurants alone.
    
    Chair Fairchild: Sir, I’m going to ask you to wrap very quickly, because, you know, we do have a lot speakers, and we’ve limited it to three minutes.
    
    Edward Lepere: It will be my pleasure. I’ll wrap it up quickly.
    
    Chair Fairchild: Thank you, sir.
    
    Edward Lepere: At this moment, we have two service bars in the restaurant - $146 permit for each one of them. Combined that together, separate. By 2008 that will be going up to $194. We have one permit for the restaurant itself which includes the entire kitchen. With training and education our health inspectors recommended breaking all of those permits in the kitchens into separate areas. The reason is the restaurateur can get points down in one particular area in the kitchen could end up losing his “A” rating down to a “B” rating very easily. If I break all of the areas in the kitchen into separate permits, my fees are going up very, very high. Right now I pay $1,430 in yearly fees; in ’07 it moves to $1,725; in ’08 it moves to $1,865. That’s one particular area – 38.9% increase by ’08. If we look at other particular areas for portable bars, it’s a 41% increase in the next two years. If you look at temporary food service, the temporary food service very often in this city has to do charity events in which restaurants dedicate everything they have in food and labor into those events. Moving over the next two years, for a one to five day event is a 38.9% increase. That’s not helping the charities in any particular way; it’s not helping the restaurants. Based on what’s said today, and I fully agree with Dr. Christensen, that we have to do the best possible to protect health in the area, and we do have a huge liability and risk, but it must be addressed. I would like to suggest a continuation for thirty days and let the Nevada Restaurant Association to be fully involved with meetings that go on and let us help in finding the solution. Let us participate in the process.
    
    Chair Fairchild: Thank you, sir. One other question: what percent of your total cost overhead are the permits?
    
    Edward Lepere: I can’t tell you that.
    
    Chair Fairchild: Is it 1%; is it 5% of your total cost? I mean, you talk about 34% increases, but what percentage of your entire cost of doing business is impacted by the permits?
    
    Edward Lepere: You know, I’d be more than happy to break that out and report back if that’s what you’d like, but I don’t have that information.
    
    Chair Fairchild: I think that would be helpful to keep it in perspective because it’s not a 34% increase your total cost of doing business as a restaurant; it’s a 34% over three years of one or two percent maybe of your total cost. That would be very helpful, if you don’t mind.
    
    Edward Lepere: The way we look at it as restaurateurs is each individual permit, breaking this down, these kind of increases that we have are just making business more and more difficult all the time. So if a restaurant wants to associate, we don’t want diseases, we do want inspections, we do want training and education, but we firmly believe that as was said today those companies that are in default need to be fined heavier so they come into compliance. Thank you.
    
    Chair Fairchild: Thank you, sir. The public hearing is still open. Come on up.
    
    Martin Nevarez: My name is Martin Nevarez, owner and operator of Martine BBQ & Mex-Grill. This fee hurts us. We are the littlest guys in the food and beverage industry. We do special events all around town, charity events, like the restaurants. We pay per event. I’ll give you an example: I got a permit yesterday for an event I’m going to do next week and the event is only two hours. And we pay $126 three, four times a month. So our fees per year average $2,000. And we are inspected, well twenty times, every time we get a permit. And we are inspected maybe three to five minutes, so we see the inspector for the whole year under two hours. And we pay over $2,000. And we are high risk, but we have no violations. Me and my constituents, we have a certain group of us that are very compliant. We have everything that a restaurant has and more. It’s like we’re moving a restaurant to a different location every week, but we have the same menu, same staff. It just seems the increase would hurt us the most when we are actually more compliant, cleaner than any free-standing building. We don’t have time for a rodent build-up, there’s no roaches, there’s no ants, there’s nothing. We come in, we bang it out and we’re done. And when the inspector actually sees us serving meals, it’s a natural relief to them. They come, they look and they know we have the same equipment; we see the same inspectors every week. And they’re like, OK sign and they’re out of there – two to three minutes. And I represent the food concession business. The fees going up and promoters raising, it’s, we’re breaking even. We’re not making millions out there, we’re not even, we’re pretty much the lowest on the totem pole of the food/beverage industry and to raise our fees up, and in 2008. For example my liability insurance, I have no claims so my insurance is going lower. So it should kind of be the same way here. I mean, I’m the cleanest one out there, all of us are, and they’re going higher with you guys. I’d like to work a little more, talk a little more about this. That’s it.
    
    Chair Fairchild: And thank you for your letter. You know one of the concerns you expressed in the letter is not only the fees of the Southern Nevada Health District, but the fees that are charged to you by promoters, by cities. So, again it’s not just one component – there are multiple components. So I can understand your frustration, but perhaps all of the cities and the county that have events need to cognizant of this, as well. It has a very high impact on small businesses and we all need to look at it in our own backyards as well. Is there anyone else from the public who’d like to speak? Of course.
    
    Van Heffner: Madam Chair, I’m Van Heffner. I’m the president and CEO of the Nevada Hotel and Lodging Association also Chief Executive Officer of the Nevada Tourism Alliance, also Commissioner of Tourism. I’d had some very informative meetings with the staff of the health district and I would ask on behalf of our members, we represent 120,000 hotel rooms statewide, and public accommodations, we, well as the other parts are very, very I would say concerned for us. We want to maintain the quality environment for tourism and keep tourism healthy. Dr. Christensen said it very well. We have to maintain that image, exactly what we’re doing throughout the world, and a critical part of this is the environmental health division of the health district. We have a very favorable relationship working with them and I would ask for continuance of this decision for at least thirty days to allow some other members to discuss the detail because needless to say with everything that’s going on in the legislature to these and the staff was very courteous to us because we could not meet at any of the noticed public hearings. And just a quick call and we were able to have very favorable meetings with them. I’m more than willing to answer any questions about any of the comments that you received if you need additional input from the private sector.
    
    Chair Fairchild: Any questions for Mr. Heffner: Lonnie?
    
    Member Empey: Mr. Heffner isn’t your organization responsible or tries to be responsible for public accommodations within its membership, and don’t those inspectors come in and spend time, lots of time, on every incident they are required to inspect?
    
    Van Heffner: Yes, they do.
    
    Member Empey: I’m asking that question because having been in the trenches with them for twenty-five years, I know what they go through and what they face. I’ve had police officers say you guys go in there without any weapons. Yeah, we do. And I have commend staff for what they’re doing and what they’re trying to do and I agree with the fact that Dr. Christensen said, we have to look, Environmental Health staff have to look at every incident that comes along, whether it’s one or a thousand, and there’s a need for a fee increase. And I agree with you, I think this discussion needs to go further.
    
    Van Heffner: Well, at the same time, I think (comment) it’s not my job to either micromanage the staff and be part of it. I think globally we need to look at the overall goal of where we’re going as well as to have the informational data, the fees as well as the expenditures of each category. For instance public accommodations and Mr. Savage did it very well where a 46-room property may in fact cost well over $2,000 where in fact Luxor with over 4,000 maybe is paying a tremendous amount but with a randomized block design the inspectors can very rapidly inspect and a very world class resort and will not have to spend the amount of time. However in case of any outbreak whichever that might be, and I’m really very proud of the relationship we have the health district because whatever we need, for instance when we had cholera outbreak potential, we were immediately able to address that issue. And that tie, that bond between us has been maintained. Us in the private, or someone who probably lost more on the tables than a white diamond ring but is complaining because oh my god, I received this food and I’m so ill so I’m going to sue this restaurant even though that’s the only claim that was filed. But at the same time this entire department, the entire department of environmental health has to evaluate every single thing to make certain they are adequately researching what needs to be, checking out medical records and so forth to see if there is a case of any incident that needs to be addressed or if it’s just some scam, a sham that somebody’s trying to move forward with. I think that this Board, and I give it to the staff, has to determine what sort of re-inspection fees must be made. I mean Commissioner Giunchigliani said very well that maybe they need to charge for that or they get their closure papers. And it doesn’t matter the size of the property, we have to maintain that because it’s not about us. It’s about tourism; it’s about travel; it’s about the entire package that is what we’re sending out. So this next month I will make myself available and also meet with staff with any of our members, and we represent most of the major members, including small properties to large ones. It’s something that we want that relationship, and you as the Board would do due diligence in questioning. Commissioner Weekly, you ask some good questions, and you need to ask those all the time. But in same way with staff, it’s not our job to micromanage them. I mean I could go in and say, Glenn why are you spending 2.6% in this area instead of 7% over in this. Because they are the experts there. Globally we have to have the entire package and if there’s some HR services, as we go forward in the next three years we’ll have 45,000 more, additional rooms, we will need 213,000 employees alone to work directly in these resorts, the retail, all the other things that are there, or once they remove that delivery the goods or delivery or whatever they might me and the health district is part of that. They have to pay for recruiting, because we’re probably going to recruit some of your employees and they’ll probably recruit many of our employees. But, so it’s, we’re all in this together, and so one more month would assisting giving you directions, as I’m commissioner in tourism I have to make some really hard cutting decisions sometimes. The more information you have the more educated decision you can make. So, I come before you, and if you have any questions feel free to talk together, give me a call and I have a very favorable with every single one of these staff. They do a good job for us. Thank you.
    
    Chair Fairchild: Thank you Mr. Heffner. Perhaps it’s also time to look at a fine schedule. How long has it been since we’ve reviewed the fines?
    
    Glenn Savage: Well there are certain ways the Board can consider re-inspection fees, closure fees, things like that that we could make proposals on. If it would be new to this fee schedule, we would have to go back and notice that, do the workshops, gather that information; but again if the Board would direct for us to go in that direction, I believe staff and I personally would be all for that. Even if that were to happen further down the line, let’s say within this calendar year, if the Board would give direction for us to do so, again that would work out for the benefit of the district and the community, again we would be in support of that.
    
    Chair Fairchild: Well, it just makes more sense because if most people have brought up, the problem is the 45-room hotel opposed to the 4,000 room hotel, that’s what taking the time and the person-power and everything else, then they need to pay their fair share of having to come back and having to mitigate whatever it is that infesting the room or whatever instead of a 4,000 room hotel that is absolutely spotless and there’s never been any problem. So those are considerations we need to look at.
    
    Glenn Savage: Let me answer that. Sometimes the larger facilities have their own issues or concerns or whatever, not that the Venetian’s having such, but in the last two weeks we’ve been working with the Venetian staff, sending health card staff down there, nurses have gone down for vaccinations and we have put together a process, an education process for the people in housekeeping and the bellman who handle maybe drinks and ice, and how they handle it, so we’ve kind of worked with them to give them partnering and put together a specific program for their needs. So we wanted to do that and that’s different from going out and doing room inspections. But I know our costs to do that are well over $1,000, so of the $3,750 that the Venetian paid us for the year we’ve already spent over $1,000 of it just putting that together, that EH put together in that education process. So each group has kind of their own needs and we’re trying to create models that will address that.
    
    Chair Fairchild: Tim, you have a comment?
    
    Member Jones: I guess my expectation that there is income from the fee schedule beyond the cost of operating EH, it would stay within EH going forward.
    
    Mike Walsh: That’s correct.
    
    Member Weekly: I guess I just want to say that I’m hearing that there’s a possibility of that we’re going to continue this discussion on for however, I guess thirty days or so. I’m not sure if we have a motion. I guess what I’m also hearing is that it is necessary for a possible fee increase but also I’m hearing something from this Board that our EH staff is strapped and that their case loads are probably extremely loaded and needs some relief. So I’m totally in support of that but I’m also concerned with how we would structure this fees here because again when you look at the gentleman who spoke here today is here, of course that will be a huge fiscal impact on him and of course that would pass that on to the general public. And they go in and participate in (comment) and events that North Las Vegas event they just had, there will be a booth increase fee and then they’ll pass that on to the public, and so I’m just real concerned about how we will structure these fees. Definitely let’s do something to help the staff out because I know that they are probably strapped.
    
    Member Giunchigliani: That’s where I was going to go. Mike, when we adopted the budget at the last meeting, did we have any staff allocated yet in that budget for EH?
    
    Mike Walsh: Yes, the budget allowed for forty-three additional staff district-wide, seventeen and a half of which were for Environmental Health.
    
    Member Giunchigliani: My only question would be is there a way, regardless of the fees, because we do apparently have a Board policy to off-set those costs in the fee structure, at the June meeting, or you appellate already to start your hiring piece, because I think that’s what Commissioner Weekly was feeling. If not, then maybe we could ask for an agenda item to at least allow that to start moving forward regardless of what we do with the fee structure so that at least they’re starting to get their staff in the next, if that’s how you do business, and I don’t know your budget well enough to know.
    
    Mike Walsh: Well in the approved budget theoretically we wouldn’t be able to start filling until the new budget year starts, which is July 1st. You can ramp up by starting to advertise to kick start the process so that in July you could move forward with the actual hiring.
    
    Member Giunchigliani: And I, maybe it’s the suggestion I’m making, and I don’t think any of us quarrel, your department is very well managed, your staff are excellent I’ve ever dealt with. And maybe the ramping up needs to start while we’re in this mix of discussing how we fee, finance anything so at least you’re not behind the curve ball anymore than you already are. And I don’t know if that has to properly agendized or how we handle that part. It’s probably just policy-wise. OK.
    
    Member Ross: Thank you, I’m trying to keep my mouth shut. I’m sorry, Commissioner.
    
    Member Giunchigliani: No, go ahead.
    
    Member Ross: I just, I’m looking at this in a simplistic way and I may be way off. But I mean we’ve already got structured fees for these businesses and these inspections and some require more man hours than others. Why aren’t we charging by the hour? I mean, if the Luxor needs 80 man hours a month to get out there and do inspections, why aren’t we charging and having those customers pay for what they’re getting instead of just structuring around a flat fee or a percentage? I know in businesses, the business that I’m in it’s per hour. It’s going to cost you x amount of dollars for me to send someone over to visit with you and that’s what it’s going to be plus materials. So I’m looking at it simplistically. I don’t know if you care to do that but the small operator and make him pay, and I’m with Commissioner Weekly, I can see you guys are strapped but I think it could actually do better, and you guys are professionals at this. But I think you can do better by charging a flat fee for the permits and then charging an hourly rate and if it took a bunch of man hours to go to that 45-room hotel and there was an outbreak of something, whether it was bed bugs or something else, why are you charging them for it? I’m just looking at it in a simplistic way because that’s how I’ve got to look at it. This is complicated and I don’t think it’s fair to all the players and those that deserve to pay for it need to pay for it. If they’re in violation, the fines and the re-inspection fees, for crying out loud. Make them pay for it. If they’re not in compliance with the rules and regulations then they need to pay for it. So, thank you.
    
    Member Giunchigliani: I was going to ask when we do the budget again, have it agendized, I would personally like to see just if you could break out what our general, what we formerly allocate general fund-wise plus fees so that at least we know what our obligation is then as we move in this changing direction of fees offsetting the costs, and then if there are other revenue sources that come into EH, grants or federal dollars, that we ought to making sure that they are, is there a way to delineate the number of licensees based on tattoo parlors, 156 or whatever so that for the next meeting we can take a look at that.
    
    Glenn Savage: We can have it all broken down.
    
    Member Giunchigliani: That would be great. I would think for the next meeting to take a look at that part of it. And just a side question when you have schools here, for example. Is that for the cooking area or is that the plans review?
    
    Glenn Savage: What page are you on?
    
    Member Giunchigliani: 4 of 5.
    
    Glenn Savage: That’s probably in the general plan review.
    
    Member Giunchigliani: It’s plan review.
    
    Glenn Savage: So yeah, that’s our plan review page.
    
    Member Giunchigliani: Detention facilities, jails, and so forth.
    
    Glenn Savage: And with schools we do a plan review of the facilities, and their kitchens. Approve that and once it becomes operational, twice a year inspection. I believe the state instituted a twice a year inspection program where we’re involved in that. And we also do at least once a year a facility search, check into the maintenance area, the auto shop or whatever, and make sure they’re handing materials correctly.
    
    Member Giunchigliani: Do you get a materials list of what they’re using? Like in the old days they used to use bat glue that made everybody sick.
    
    Glenn Savage: We ask for MSDS sheets and ask for (Comment)
    
    Member Giunchigliani: Alright thank you. Those are just some things information wise that I think would be helpful as we anticipate this.
    
    Chair Fairchild: Now the public hearing is still open. Is there anyone else that wanted to speak on this matter? We’ll go ahead and close the public hearing.
    
    Member Kirk: Madam Chair, can I ask one question?
    
    Chair Fairchild: Yes.
    
    Member Kirk: I don’t understand this. Is the budget and the hiring of seventeen people contingent upon this fee increase?
    
    Mike Walsh: Yes it is. The budget that was presented to the Board was effectively a break even budget; I think that it was about $120,000 surplus…
    
    Member Kirk: OK.
    
    Mike Walsh: …budgeted for next year, so any downward adjustment in the fees would create a deficit for us in our operating budget which would then cause us to have to look at either reducing expenses or increasing other revenues or both to try to make ends meet, or to just dip into the fund balance of our organization…
    
    Chair Fairchild: Or not hire all forty-three positions that are budgeted.
    
    Mike Walsh: Yeah, that’s what I mean by looking at expenses. What we would do to compensate for any kind of a change in the fees, the actual revenue.
    
    Member Kirk: Can I ask you a question? The next time we anticipate a fee increase that we see this along with the budget at the same time, maybe even the same meeting, because now we approved the budget that’s contingent on something we do today and that’s not…
    
    Mike Walsh: I did talk about it briefly during the budget…
    
    Member Kirk: Right, right. But not in the detail that we’re at now and it seems like we have done this in a bass-ackwards sort of way. I would to see this before we adopt the budget. But we are where we are and I think the break out sessions we had talked about will help. Thank you.
    
    Chair Fairchild: Tim?
    
    Member Jones: I do recall that what I thought we were going for was the 27% across the board increase, now we’re coming back to look at what makes up that 27% increase. Some are higher and some are lower. So that was my perception what we were passing at that point in time.
    
    A motion was made by Member Christensen to continue the matter to the next regularly scheduled Board of Health meeting; seconded by Member Giunchigliani and was unanimously approved.

III. Report / Discussion / Action

1. Memorandum #17-07: Appointment of Robert Schmidt as Emergency Medical Services Hearing Officer retroactive to May 1, 2007.
   
   Mr. Minagil said that the district is requesting appointment of an Emergency Medical Services Hearing Officer, as provided in the Emergency Medical Services & Trauma System Regulations. Staff requests that Robert Schmidt, who currently serves as a hearing officer for the Solid Waste Management Authority area, has a working knowledge of arbitration law, with his qualifications set forth in the memorandum, be appointed as an EMS Hearing Officer retroactive to May 1, 2007.
   
   Chair Fairchild asked if members of the Board had any questions. There were none, and Chair Fairchild asked for a motion.
   
   A motion was made by Member Giunchigliani to approve the appointment of Robert Smith as an Emergency Medical Services Hearing Officer retroactive to May 1, 2007; seconded by Member Christensen and was unanimously approved.
   
   
2. Petition #11-07: Approval to Seek Funding for New Main Campus
   
   Mike Walsh said that at the March Board of Health meeting the architects presented the conceptual design for a new main campus and staff wanted direction at that time to seek funding for the new main campus. As that request was not agendized the matter was brought back to the Board for discussion and direction.
   
   Chair Fairchild said that federal community block grants may be a possible source of funding as the district provides community services. She asked for suggestions from other Board members.
   
   Member Giunchigliani mentioned that discussions with George Stevens from the County occurred about receiving financial assistance for funding. She said that an idea came forward to relocate the UMC Wellness Center within the new facility, but not under the jurisdiction of the health district. She asked this information be brought forward publicly as this discussion may continue. Mr. Walsh said that exam rooms in the new design are for existing services and their future expansion, not for partnering with other entities for space. Member Giunchigliani said that this will be a discussion, and hoped that it would not affect the square footage dollar amount.
   
   Mr. Walsh said that in his discussions with Mr. Stevens there was mention of cost-share on potential funding. The dedicated funding stream from property tax dollars included a quarter cent increase that was to be dedicated to capital. Based on current tax revenues for the district, that equates to $1.7 million currently used for operations, that would need to be redirected. Member Burton asked to clarify that the decision to allocate the money for operational costs was internal. Mr. Walsh said that the district cannot manage the financing ourselves, and with the good faith and credit of the County the district would contribute as much as possible without compromising operations.
   
   Chair Fairchild asked if a grant writer were researching available federal and state grants currently. Member Giunchigliani agreed that grant monies would be a worthwhile source of funding. The district is currently recruiting for this position, and this will be a task for the incumbent once hired.
   
   Mr. Walsh also said that the cap on the property tax has inhibited the district in such that an additional $9 million would have been allocated to the district which could have been used to fund a building if the cap were not in place.
   
   Chair Fairchild asked for additional recommendations from the Board. She asked Mr. Walsh if he felt comfortable with the direction received. Mr. Walsh responded affirmatively. Chair Fairchild called for a motion.
   
   A motion was made by Member Giunchigliani for staff to be directed to look at seeking funding for a new main campus; seconded by Member Empey and was unanimously approved.

IV. Citizen Participation:

Citizen participation is a period devoted to comments by the general public about matters relevant to the Board's jurisdiction. Items raised under this portion of the Agenda cannot be acted upon by the Board of Health until the notice provisions of Nevada's Open Meeting Law have been complied with. Therefore, no vote may be taken on a matter not listed on the posted agenda and any action on such items will have to be considered at a subsequent meeting.

Chair Fairchild invited any individuals wishing to address the Board on matters under their jurisdiction and wishing to speak to come forward. No one came forward and the citizen participation portion of the meeting was closed.

V. Health Officer & Staff Reports

Nevada Clean Indoor Air Act (NCIAA)

Steve Minagil provided an updated the Board relative to NCIAA, including the district’s involvement with three legal actions.

One action is the initial lawsuit filed by Fame Operating, which resulted in Judge Herndon’s decision to eliminate the criminal provisions of the Act – the Attorney General’s office has appealed that part of the decision; the plaintiffs have also appealed allowing the civil penalties to remain in place, which the district is currently enforcing.

The second action is the action regarding the retail tobacco store – an establishment in the Forum Shops sued the district to prevent enforcement of the Act as it applies to them. An enforcement injunction against the district is in effect; the matter is headed toward a trial date in the future, where the health district will assert the position that the exception for retail tobacco stores is limited and does not extend outside the confines of the store into the patio area of the Forum Shops despite the establishment leasing that particular area.

The third action is an enforcement action the district filed against a local tavern that specifically said they would not comply with the obligations of the Act to remove all ashtrays and all other smoking paraphernalia. The outreach to businesses where most complaints are received and inspectors have gone out to verify complaints; letters have been sent under Mr. Minagil’s signature asking them to meet with staff and discuss compliance. Twelve letters have been sent and all have agreed to abandon all methods of undermining the Act with the exception of the one establishment which is the subject of the enforcement action. A preliminary injunction hearing is set for June 6th; the district is seeking an injunction to make the establishment, under court order, remove ashtrays and all other smoking paraphernalia. Staff continues to meet with business almost daily; the number of complaints has subsided and there is a great degree of compliance with the Act.

Dr. Sands said that the district’s website has a section devoted to enforcement of the NCIAA, where all enforcement activities is detailed for the public’s view, including letters which have been sent to non-complying establishments. Dr. Sands welcomed feedback from Board members.

Public Health Week

Dr. Sands reported that Public Health Week occurred in April, and the underlying theme was public health preparedness; the district focused on preparedness for special populations. He introduced Kay Godby, senior biopreparedness planner, who gave a presentation (attachment #2) PDF (99 KB) on the district’s progress of working with special populations in regard to preparedness activities .

Mrs. Godby shared a packet of information that was given to members of special populations. She also gave Board members a booklet detailing how to get your family prepared. The theme for Public Health Week was “Preparedness and Public Health Threats – Addressing the unique needs of the national’s vulnerable populations.” The aftermath of Hurricane Katrina showed that special needs populations were ignored and the main focus of the grants for this year looked at special needs populations.

The American Public Health Association (APHA) has sponsored Public Health Week since 1995, and has identified five different focus groups that may need assistance preparing for emergencies. Each day of Public Health week, a different group was the focus: mothers with children at home; schools serving K-12, food banks, hourly workers, and people with chronic illnesses.

SNHD chose to focus on people with chronic illnesses and those individuals with disabilities. Mrs. Godby shared a brief video from APHA designed for public health agencies. Mrs. Godby and Nancy Gerken appeared on local morning newscasts and spoke on the importance of preparedness; staff also participated in radio broadcasts and there was an article in the Las Vegas Review-Journal. Advertisements (attachment #3) PDF (116 KB) appeared in various publications, both in English and Spanish.

A special needs forum was held at the health district, which was attended by several agencies from throughout the community. Thirty-four agencies that provide advocacy as part of their services were invited to participate. Sixteen agencies attended, including the state, county, Paiute tribe, the cities of Henderson and Las Vegas, Easter Seals, Southern Nevada Centers for Independent Living, American Alzheimer’s Association, Muscular Dystrophy Association, and the Nevada Disability Advocacy and Law Center. Staff encouraged preparedness information to the group. A needs assessment survey was completed to see how they convey information to their clients and how information comes back to them. Results indicated that television was the mode used to convey information most often.

Staff is involved with an evaluation project, including a workshop next week. This will assist in assessing needs of public health and the special needs population, including Braille materials for the blind populations, and information for the hearing impaired.

The Yale Center for Public Health Preparedness (attachment #4) PDF (125 KB) highlighted the Southern Nevada Health District’s preparedness website on their newsletter. Mrs. Godby encouraged Board members to have a family disaster plan and disaster supply kits. If family members have chronic illnesses, medical supplies should be stored; families with pets need to store supplies for pets as well.

In southern Nevada, the largest threats are infectious disease and biological incidents. The community needs to plan for a possible pandemic, which could include quarantine and shelter in place. In case of a disaster, Board members may be called upon for assistance and their homes need to be in order as well. SNHD staff was queried in October about their own disaster plans – approximately 55% of staff responded that they had plans in place and kits prepared.

Chair Fairchild congratulated staff on the recognition on Yale’s website. Member Kirk made a comment about his nephew in Hawaii, and when an event occurred the ATM did not work. Member Kirk encouraged staff to keep cash on hand. Mrs. Godby said that the preparedness website does encourage community members to keep cash on hand, but not a specific amount. She also said that our community does not have a large supply of food on hand, as everything is imported, which furthers the need for community members to be prepared.

Chair Fairchild asked that advertisements in local papers, including rural areas, as not everyone takes the Review-Journal or watches Las Vegas channels, and thanked Mrs. Godby for her presentation.

Duly Noted

VI. Informational Items