Minutes

Southern Nevada District Board of Health Meeting
625 Shadow Lane
Las Vegas, Nevada
Clemens Room

Thursday, January 24, 2008 - 8 a.m.

Chair Steven Kirk called the meeting of the Southern Nevada District Board of Health to order at 8:05 a.m. Stephen Minagil, Legal Counsel confirmed the meeting had been noticed in accordance with Nevada’s Open Meeting Law and that a quorum was present. Chair Kirk led the Pledge of Allegiance.

Board Members Present:

Steven Kirk Chair, Councilman, Henderson
Tom Collins Commissioner, Clark County Alternate
Susan Crowley At-Large Member, Environmental Specialist
Robert Eliason Councilman, North Las Vegas
Tim Jones At-Large Member, Regulated Business/Industry
Mary Jo Mattocks, RN At-Large Member, Registered Nurse
John Onyema, MD Alternate At-Large Member, Physician
Robert “Bubba” Smith Councilmember, Mesquite
Linda Strickland Councilmember, Boulder City
Lawrence Weekly Commissioner, Clark County

Absent:

Ricki Barlow Councilman, Las Vegas
Travis Chandler Councilmember, Boulder City Alternate
Jim Christensen, MD At-Large Member, Physician
Chris Giunchigliani Vice Chair, Commissioner, Clark County
Joseph Hardy, MD At-Large Member, Physician
Frank Nemec, MD Alternate At-Large Member, Physician
Gary Reese Secretary, Councilman, Las Vegas
Steven Ross Councilman, Las Vegas Alternate
Gerri Schroder Councilwoman, Henderson Alternate
Stephanie Smith Councilwoman, North Las Vegas Alternate
Debra Toney, RN Alternate At-Large Member, Registered Nurse

Executive Secretary:

Lawrence Sands, DO, MPH

Legal Counsel:

Stephen R. Minagil

Other SNHD Board of Health Members/Alternates Present:

Lonnie Empey Alternate At-Large Member, Environmental Specialist
Jimmy Vigilante Alternate At-Large Member, Regulated Business/Industry

Staff: Jo Alexander; Jerry Boyd; Mary Ellen Britt; Dennis Campbell; Rory Chetelat; Sylvia Claiborne; Alice Costello; Diana Daniels; Ed Larsen; Angus MacEachern; Ann Markle; Mary Ellen Harrell; Lance Johnson; Patty O’Rourke-Langston; Veronica Morata-Nichols; Gwen Osburn; Patricia Rowley; Glenn Savage; Jennifer Sizemore; Jane Shunney; Bonnie Sorenson; Nicole Truax; Leo Vega; Mike Walsh; Leisa Whittum; Deborah Williams; Keith Zupnik; Diana Lindquist, Recording Secretary: Valery Klaric

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: (164 KB) 12/13/07
2. Approve Payroll / Overtime for Periods: 11/17/07 - 11/30/07; 12/1/07 – 12/14/07; 12/15/07 – 12/28/07
3. Approve Accounts Payable Registers: #1105: 11/30/07 – 12/05/07; #1106: 12/06/07 – 12/12/07; #1107: 12/13/07 – 12/19/07; #1108: 12/20/07 – 12/26/07; #1109: 12/27/07 – 1/02/08
4. Petition #01-08: (895 KB) Approval of the Interlocal Agreement with Clark County Social Service: Tuberculosis Test Services to CCSS Employees
5. Petition #04-08: (1012 KB) Request for Approval of New Classification Specification for Public Health Preparedness Supervisor, Schedule 26 ($65,281 - $91,087) and Revised Classification Specification for Public Health Preparedness Training Officer, Schedule 23 ($55,975 - $78,081)
6. Petition #05-08: (524 KB) Funding Recommendation for HIV Prevention Service Awards
7. Petition #06-08: (1.6 MB) Request for Approval of Revised Classification Specifications for Database Administrator, Schedule 26 ($65,281 - $91,087), Disaster Recovery Specialist, Schedule 22 ($53,217 - $74,196), Information Technology Systems Administrator I/II, Schedule 20 ($48,073 - $67,007) / Schedule 22 ($53,217 - $74,196) and New Classification Specification for Network Administrator Specialist, Schedule 22 ($53,217 - $74,196)
8. Memorandum #05-08: (484 KB) Request for Approval of Full Authorization of University Medical Center as a Level I Trauma Center and Pediatric Level II Trauma Center
   
   Chair Kirk asked Dr. Sands if there were changes to the agenda. Dr. Sands confirmed there were no changes. Chair Kirk called for a motion to approve the Consent Agenda as presented.
   
   A motion was made by Member Mattocks to approve the Consent Agenda as presented; seconded by Member Crowley and unanimously approved.

II. Public Hearing / Action

1. Memorandum #01-08: (16.8 MB) Application for Approval for Gemark Services of Nevada, Inc. to Operate a Recycling Center, Located at 6120 N. Hollywood Blvd., Ste. 107, Las Vegas, NV 89115 (APN 123-26-201-001)
   
   Chair Kirk declared the public hearing open.
   
   Dennis Campbell, Solid Waste Compliance Manager, spoke relative to this item. Mr. Campbell stated that Gemark Services of Nevada, Inc. has met all requirements to function as a recycling center as specified in section 4 of the Recycling Center Regulations. At this time, staff recommends approval for this permit based on final inspection with the conditions as outlined in the memorandum. Richard Donovan, Gemark Services of Nevada, Inc. Recycling, was present to answer questions of the Board.
   
   Chair Kirk asked Mr. Donovon if he understood the conditions as outlined and he responded affirmatively. Chair Kirk declared the public hearing open and asked if anyone from the public wished to speak to this matter. No one came forward to speak and Chair Kirk closed the public hearing.
   
   A motion was made by Member Eliason to approve the application as submitted with the conditions outlined in the memorandum; seconded by Member Strickland and unanimously approved.
   

III. Report / Discussion / Action

1. Discussion of Southern Nevada District Board of Health Audit Committee and Possible Appointment of Committee Members
   
   Michael Walsh, Director of Administration, discussed formation of the Audit Committee, which would be a Board of Health subcommittee charged with meeting directly with our external auditors, who would report to the committee during the audit process. The Audit Committee Toolkit was distributed to Board of Health members and they were polled asking for participation on the committee prior to today’s meeting. The following people volunteered to serve: Dr. Christensen, Susan Crowley, Timothy Jones, Mary Jo Mattocks and Robert Smith.
   
   The Audit Committee Toolkit suggests committee members have an understanding of generally accepted accounting principles and it was noted that many Board of Health members are involved with multi-million dollar budgets in their positions. The committee may bring full autonomy to the auditing process and can bring other issues, problems, and questions to the forefront. Additionally, operational items may be identified enabling the committee and Board to address them immediately as the Board has the fiduciary responsibility for the operation of the organization.
   
   At the first meeting the committee would elect the committee chair and establish the meeting schedule. One of the first duties of the committee discussed at the December Board of Health meeting was a Request for Proposals (RPF) for auditing firms for the SNHD, however, due to the time constraints and the need to start the bid process for auditing firms, Mr. Walsh stated that this needs to be accomplished immediately and he distributed a draft of the RFP containing criteria for the auditors and after discussion it was agreed to move forward with the bids. The committee will be charged with reviewing the applications and making a recommendation to the Board to select an independent auditing firm.
   
   After extensive discussion it was suggested that the Audit Committee be established for a period of one year at which time the Board of Health would evaluate whether or not the committee should continue or disband and that Dr. Sands work with members to set-up the committee’s first meeting. It is important that value is added to the process.
   
   A motion was made by Member Weekly, seconded by Member Crowley and unanimously approved to form the Audit Committee, for a one year period with review at the end of the 12 month period to determine whether or not to continue the committee and assign members with Dr. Sands working with them to set the first meeting and to move forward with the RFP to solicit bids for auditors.
   
   
2. Receive a Report and Provide Direction to Staff on a Proposed Plan to Generate Additional Funds for District Operations Through Fundraising Activities
   
   Mr. Walsh reported that a Grant Research and Development Specialist position was approved in last year’s budget for the purpose to find funding sources, particularly grants, and to assist in matching grants with the strategic initiatives to move the public health process forward in Southern Nevada. He introduced Leisa Whittum, who filled this position stating that she also has a background in fundraising, which may provide an opportunity for us to obtain funds to avoid cutting back on under funded programs, i.e., immunization program, which is a impacted by shrinking funds. Ms. Whittum explained that we have experienced reductions in federal, state and local government funding opportunities. We plan to submit grant proposals in strategic areas. The public sector and various partnerships have been receptive to our programs and we are looking to take a more organized approach to acquire funds. Research indicates that partnering with community organizations and foundations may tap into private sector funding to contribute to public health programs, resulting in additional funds, and partnering with individuals, organizations, foundations and trusts to be able to provide immunizations for people who do not have other resources.
   
   Chairman Kirk expressed his support for fundraising and grants. He requested that regular reports be made to the Board on the status of the grants and fundraising and suggested that elected officials that may be able to assist on the governmental levels.
   
   Decreased state and federal monies make it necessary to find other sources to generate funds and federal grants are very specific regarding fund usage. Dr. Sands stated that we are ready to send solicitation letters to potential funders to begin establishing foundation fund accounts and asked for the Board’s support.
   
   A motion was made by Member Kirk, seconded by Member Jones and unanimously approved to follow the recommendation of supporting the Grant Specialist in fundraising efforts and activities to private organizations and partnering with individuals, organizations, foundations and trusts.
   

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 Kirk invited any individuals wishing to address the Board on matters under their jurisdiction to come forward.

Mr. Shaundell Newsome, Newsome Marketing, 424 Pinewood Drive, spoke in support of the Childhood Lead Poisoning Prevention Program. Mr. Newsome works with children affected by lead living in west Las Vegas through several organizations including 100 Black Men of Las Vegas, who helped build a charter school. He and members of the community met to discuss the lead issue and want to ensure that action is taken on discussion of the lead program discussed at the December 13, 2007 Board of Health meeting. He cited statistics showing the need for the program to place a greater emphasis on primary prevention activities for identifying and eliminating sources of lead in the community and discussed an article in the New England Journal of Medicine providing new evidence that lower levels of exposure can result in harmful effects and that no level of exposure can be considered safe and expressed the need to take this issue seriously. Children under 6 years old are especially vulnerable as their brains and central nervous system are still being formed and very low levels of exposure can result in reduced I.Q., learning disabilities, attention deficit disorder, behavioral problems, impaired hearing, kidney damage and juvenile delinquency has also been associated with lead poisoning. One of the major functions of the 100 Black Men of Las Vegas is to deter criminal behavior and work with children who have special education needs and the group is very concerned about lead poisoning. The Office of Minority Health has worked to reduce health disparities within the minority community. Mr. Newsome thanked the Board of Health for the opportunity to express his concern about lead poisoning.

Member Weekly reported meeting with 15 community organizations concerned about lead poisoning to share information and concerns and stated that representatives at today’s meeting included the Urban Chamber of Commerce, Urban League and a local physician. He would like to arrange to meet with Dr. Sands and Chairman Kirk to determine the direction the Health District is taking in this matter and stressed the importance of using lead grant funds in the affected communities stating that it is our responsibility to provide services to everyone utilizing the grant funds. Mr. Weekly thanked Dr. Sands for meeting with him to discuss the issue and Dr. Sands responded that he was committed to the Childhood Lead Poisoning Prevention Program that is intended to protect all children in Clark County against the risk of lead exposure and welcomed continuation of dialogue and partnering with community groups as well as communicate better about the grant and project accomplishments and goals. Mr. Jones suggested providing an executive-style report on the process to date taken from the strategic plan describing past, present and future plans. Mr. Weekly will be in touch when availability of the participants is determined. Chairman Kirk thanked Mr. Weekly for bringing this critical issue to the forefront to identify lead poisoning as an important issue needing attention and thanked the community representatives for their attendance.

V. Health Officer & Staff Reports

• Update on Nevada Clean Indoor Air Act (NCIAA) Regulations - Steven Minagil, Esq.
  Mr. Minagil discussed the NCIAA stating our plan is to resolve questions and interpretation of enforcement within the Nevada Clean Indoor Act through development of regulations. The Health District took a lead working with partners in Carson City, Washoe County and the State of Nevada to develop and draft regulations sending them to partners throughout Nevada and received no objections regarding the proposed regulations. The State Health Division will submit the draft regulations to the Legislative Counsel Bureau (LCB) for review to ensure they meet the requirements of law and await final revisions and once the LCB signs off, the proposed regulations will be sent to public workshops throughout the state before presentation to the State Board of Health. Adoption by the State Board of Health will provide one set of rules for the entire state.
  
  
• Update on Revised Environmental Health Fee Schedule – Michael Walsh, Director of Administration
  Dr. Sands stated that the Board of Health requested an update on the status of the Environmental Health Division fee schedule revision effective July 1, 2007, as well as the status of the seasonal mobile food vendor fees and noted that staff was directed to work with these vendors to establish an appropriate fee schedule. Mr. Walsh distributed information and reviewed the financial operation of the division stating that a significant change was made to costing out the program that included adding indirect costs into the equation using a traditional healthcare approach to allocate indirect costs. Indirect costs using 2006 audited financial statements were at 20.8% compared with 2007. Using the same calculation and 2007 audit, the overhead allocation is 23.2%. In summary, while the revenue appears to be going up 32% the volume is going up over 11%, so new business represents about 11% and the price increase about 20%. Of note is last year’s calculations, looking at the bottom line is a deficit. The direct surplus generated was less than the fully loaded cost of the program. Based on estimates and looking at last year’s trends, it would appear that the deficit is switching from $1.7 million to an estimated surplus of approximately $1.1 million. In last year’s budget 17 additional positions were approved, but many of the positions were filled at a later date and due to increased volume the department is looking to add staff, which may result in a cost offset of surplus funds generated by the fee increase.
  
  Glenn Savage, Environmental Health Division Director, reported that approved positions were not filled during the past 13 months and calculations showed $4.5 million in expenses were not generated due to lack of the staff members. Projections were based on plan reviews and permits issued during the next 6 months and a 9 month check will be made to determine if there is a surplus. Productivity increased 11.5% for 6 months. Expansion within the community result in increased activity and population growth results in added services, restaurants, etc., with plans for budgeting additional positions due to the increased workload. Fees for the seasonal mobile vendors were not increased and allowing seasonal permits, low-risk annual permits, temporary permits, farmers’ market permits is working well with vendors satisfied. He recommended keeping the fees the same as the estimated loss of fees by not increasing this sector is approximately $14,000. High risk vendors need inspections at the time of their event due to the potentially hazardous food served. Overall, vendors, although not happy with fee increases, understand that it is part of the cost of doing business.
  
  Mr. Savage commented on the Childhood Lead Poisoning Prevention Program stating that Dr. Keith Zupnik exited the Board of Health meeting to meet with members of the community and is building interaction with them to get the program into the areas of need and discussed partnering with local hardware stores to assist in the program. UNLV is evaluating the effectiveness of an in-home lead test kit used in other parts of the country and usage here will be determined pending the outcome of their evaluation. Lead will continue to be an ongoing problem related to international trade. Bonnie Sorenson, Nursing Division, reported that we have blood lead analyzer protocols in place and are ready to go, but cannot do mass screenings in day care centers until they are licensed by the State Bureau of Licensing and Certification. SNHD will be involved in blood lead screening and have contracts with Head Start.
  
  
• New Immunization Mandates (455 KB) - Veronica Morata-Nichols
  Veronica Morata-Nichols reported on three unfunded immunization mandates; Adolescent, Daycare and University students. The adolescent mandate requires immunization of 24,000 Clark County middle school students and 6,000+ private middle school students. All sixth graders (11-12 year olds) are required to be updated with another dose of Tdap immunizations to comply with the mandate before the September 2008 school year; the mandate states before June 30, 2008. SNHD is partnering with Clark County School District and meeting with private and public sector community partners including pediatricians, hospitals and family physicians to provide information and education regarding the mandates. Clinics are being held once daily from now to June to facilitate the immunizations.
  
  Immunization mandates for the 544 licensed daycare centers in the county translate into 59,000 children attending daycares. Fees will be charged for those able to pay with free immunization provided to the 25-30% of our population that cannot afford to pay. We will work with the childcare providers to ensure their compliance and also provide lead screening along with the immunization program. Many daycare centers do not maintain updated immunization records. We are trying to develop a concept of having nurse consultants go into the daycare centers to assist the staff with understanding the immunization schedule.
  
  University student mandates impact us less and we are working with allied health services at UNLV to accomplish the mandate by September 1, 2008, requiring students under 23 years old enrolled as freshmen, who reside in on-campus housing to have proof of immunity to Neisseria meningitides. To make these mandates a reality the Immunization Department is moving at full speed to ensure that the immunizations are delivered by the due dates.
  
  
• Terrorism Injuries: Information, Dissemination and Exchange (TIIDE) Project
  Mary Ellen Britt, Regional Trauma Coordinator, reviewed the TIIDE Project, our second CDC Grant. She stated that terrorism and mass casualty events have the potential to seriously impact public health systems and emergency medical response capability and present unique triage, diagnostic, treatment and surgical challenges.
  
  The $70,000 per year grant for three years, beginning September 1, 2007 and continuing to August 31, 2010, was made available to us through a cooperative agreement between the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention.
  
  The purpose of the grant is to generate and disseminate critically needed information to prepare for and respond to terrorist events, especially explosions, and work collaboratively with the CDC and TIIDE partners to develop a field triage protocol for mass casualties, clinical references and mass injury training for health care professionals and best practice models for civilian injury care based on recent military experience.
  
  The TIIDE partners are the American Medical Association, American Trauma Society, American College of Emergency Physicians, National Association of EMS Physicians, National Association of County and City Health Officials and Southern Nevada Health District.
  
  We applied to enhance the community’s ability to assess current resources for our trauma system and plan for future needs, to link data sources to provide meaningful information to community partners, to share data to assist in revision and coordination of existing emergency management plans and strengthen daily operations of emergency medical services and trauma system and identify strategies to adapt the daily operations to manage a large influx of emergency patients.
  
  The goal for year one is to create automated linkages on identified data sources to provide timely access to the number and type of patients who access emergency medical care through EMS, emergency departments and trauma centers in Clark County.
  
  Year two goal will be to analyze that data obtained from the identified data sources to assess the baseline status of our EMS agencies, hospitals and trauma centers to manage the transportation and emergency care of trauma victims and in year three to develop and disseminate relevant, timely evidence-based information involving pre-hospital, hospital and trauma center capacity and capability to provide transportation and emergency care to multiple victims with traumatic injuries.
  
  We were funded because of our experience working collaboratively with partners in the emergency care, emergency management and public safety communities and we were identified by the CDC as a model community. We have experience dealing with real events and experienced with developing interoperability communications with our 800 megahertz radio system and experience with First Watch.
  
  The next step will be working with local emergency care and management partners to achieve our goals for the community as well as to collaborate with national partners to reach larger objectives.
  
  Mr. Kirk asked Mary Ellen Britt to return to the February, 2008 meeting for further discussion of this important topic.

VI. Informational Items - DULY NOTED

VII. Adjournment

There was no further business to come before the Board. Chair Kirk reported that the next meeting of the Southern Nevada District Board of Health will be held February 28, 2008. The meeting adjourned at 9:50 a.m.

SUBMITTED FOR BOARD APPROVAL

Lawrence Sands, DO, MPH, Chief Health Officer
Executive Secretary

/vjk