Minutes

Southern Nevada District Board of Health Meeting
625 Shadow Lane
Las Vegas, Nevada 89106
Clemens Room

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

Secretary Gary Reese called the meeting of the Southern Nevada District Board of Health to order at 8:04 a.m. Chair Steven Kirk and Vice Chair Chris Giunchigliani were excused from the meeting. Mr. Reese led the Pledge of Allegiance. Stephen Minagil, Legal Counsel confirmed the meeting had been noticed in accordance with Nevada’s Open Meeting Law and that a quorum was present.

Board Members Present:

Gary Reese Secretary, Councilman, Las Vegas
Ricki Barlow Councilman, Las Vegas
Jim Christensen, MD At-Large Member, Physician
Tom Collins Commissioner, Clark County Alternate
Susan Crowley At-Large Member, Environmental Specialist
Robert Eliason Councilman, North Las Vegas
Joseph Hardy, MD At-Large Member, Physician
Tim Jones At-Large Member, Regulated Business/Industry
Mary Jo Mattocks, RN At-Large Member, Registered
Nurse Gerri Schroder Councilwoman, Henderson Alternate
Linda Strickland Councilmember, Boulder City
Lawrence Weekly Commissioner, Clark County

Absent:

Steven Kirk Chair, Councilman, Henderson
Chris Giunchigliani Vice Chair, Commissioner, Clark County
Travis Chandler Councilmember, Boulder City Alternate
Frank Nemec, MD Alternate At-Large Member, Physician
John Onyema, MD Alternate At-Large Member, Physician
Steven Ross Councilman, Las Vegas Alternate
Bubba Smith Councilmember, Mesquite
Stephanie Smith Councilwoman, North Las Vegas Alternate

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
Debra Toney, RN Alternate At-Large Member, Registered Nurse
Jimmy Vigilante Alternate At-Large Member, Regulated Business/Industry

Staff: Mike Walsh; Angus MacEachern; Glenn Savage; Jennifer Sizemore; Bonnie Sorenson; Stephanie Bethel; Mary Ellen Britt; Dennis Campbell; Rory Chetelat; Sylvia Claiborne; Mary Ellen Harrell; Ed Larsen; Ann Markle; Patty O’Rourke–Langston; Gwen Osburn; Jane Shunney; Deborah Williams; Jo Alexander; Brooke Doman; Susan Eiselt; Mark Gillespie; Kay Godby; Nancy Hall; Julie Hurd; Brian Labus; Christina Madison; Rae Pettie; Walter Ross; Adele Solomon; Linda Verchick; Jorge Viote; Leo Vega; Forrest Hasselbauer; Valery Klaric; and Recording Secretary, Shelli Clark

Public Attendance:

Oath of Office:
Secretary Reese indicated that the oath of office would be administered to Alternate Member Tom Collins, representing Clark County by Stephen Minagil, Legal Counsel. Member Collins was welcomed to the Board.

Recognitions:

Proclamation by the Governor: World TB Day in Nevada
Dr. Sands introduced Patricia O’Rourke-Langston, public health nurse manager, who presented a Proclamation from the Governor PDF concerning World TB Day in Nevada. Governor Gibbons declared March 24, 2008 as World TB Day in Nevada and recognized for the first time the work done for TB in our community.

Great Basin Public Health Leadership Institute Graduates 2008
Dr. Sands introduced and congratulated the Great Basin Public Health Leadership Institute graduates for 2008, which are individuals selected annually from the SNHD leadership teams. The program has been very successful, which partners public health agencies throughout Nevada and Utah.

• Stephanie Bethel – Public Information Office
• Veronica Morata-Nichols – Clinics & Nursing Services
• Jim Osti – Community Health
• Jorge Viote – Public Information Office
  

Great Basin Public Health Leadership Institute Scholars 2009
Dr. Sands also introduced and commended the Great Basin Public Health 2009 scholars.

• Rory Chetelat – Emergency Medical Services & Trauma System
• Tony Fredrick – Epidemiology
• Kay Godby – Public Health Preparedness
• Amy Irani – Environmental Health
• Vickie Swanson – Clinics & Nursing Services

Presentation – Public Health Hero Awards
The first week of April was Public Health week, and numerous events were held to recognize the work of employees throughout the District for the jobs they do in public health every day. The Public Health Hero award honors individuals and organizations outside the health district that make remarkable contributions to further and advance public health in our community. Dr. Sands introduced the 8th annual Southern Nevada Public Health Hero awardees:

JS Pest Control: George Botta
George Botta was nominated as a public health hero by the Spring Valley environmental health office. A certified pest control professional, Mr. Botta’s efforts allowed health district inspectors to identify a potential public health hazard. By alerting the health district, Mr. Botta launched an investigation that found a warehouse operating without the appropriate health district permits or businesses licenses from the county. Our inspectors issued a Cease and Desist order immediately, obtained delivery invoices and notified the warehouse’s customers not to accept any products from this company. The inspectors supervised the destruction of 22 tons of tainted food products, visited food facilities that had received products from the company and supervised the destruction of them as well, and finally notified the appropriate California health authorities about this company. Mr. Botta’s dedication, experience and commitment to protecting the health of the community allowed our inspectors to eliminate a potential health hazard for many people.

Mike Cushman, formerly of Boyd Gaming
Mr. Cushman was nominated by the office of epidemiology for his willingness and commitment to protect the health of his colleagues as well as Las Vegas visitors. Over the past several years, he has become a leader in the prevention of Norovirus outbreaks in the resort industry, including adopting the health district’s guidelines to assist the resort industry to prevent and control such outbreaks. His aggressive and thorough approach in responding to even individual reports of illness has been responsible for protecting many tourists and Valley residents. Mr. Cushman was nominated specifically for his efforts in controlling a Norovirus outbreak among inmates inside the Clark County Detention Center in 2007. Not only did Mr. Cushman provide guidance, he arrived at the detention center with the chemicals and equipment needed to conduct the environmental response to this type of outbreak. He trained the detention center staff and stayed with them for the entire evening working alongside them to clean the entire facility. Mr. Cushman’s quick response, his willingness to volunteer to provide assistance and his extra efforts in staying at the facility to work with the staff allowed for the quick containment of the outbreak and prevented countless other inmates and staff from getting sick. Mr. Mike Cushman is recognized for his commitment to keeping all of our residents and guests well and assisting the health district in its mission to maintaining a healthy community.

Venetian/Venezia and Palazzo: John Willian
John Willian, nominated by our nursing division for his ongoing commitment to public health issues in our community, adheres not only to industry standards but goes above and beyond to promote safety and public health standards. Within his organization, he has promoted hepatitis B vaccination for staff members and as a result almost 1,000 team members have received the vaccine. In addition he implemented a requirement that members of housekeeping, guest services, priority services and meeting services obtain a health card from the health district. Mr. Willian shares his “real-world” knowledge with engineering students, relating safety issues at resort properties with the field of engineering and providing information on the role of safety programs and response to chemical, biological and other emergency situations. He has been proactive in his response to Norovirus incidents by ensuring guests who are ill receive the necessary resources to self-isolate until they are well enough to return home and by placing team members on paid leave until cleared to return to work by a physician.

University of Nevada Las Vegas: Coach Lon Kruger
UNLV’S men’s basketball coach Lon Kruger was nominated by the office of chronic disease and health promotion for his efforts to encourage school-age children to adopt healthy eating habits and become physically active through a new program called The Coach’s Challenge. This new program was implemented for the first time this year in 63 elementary schools comprising 530 classrooms and more than 14,500 children who are encouraged to eat healthy and be physically active. The Coach’s Challenge has been the most successful school-based program we have implemented. Coach Kruger committed to the program and attended planning meetings, visited winning classrooms, wrote letters on the importance of physical activity and nutrition to the students who participated, and contributed UNLV resources to the program including 500 tickets to a UNLV game and posters for each participating classroom. Coach Kruger arranged for “special treatment” for a group of student participants from the Children’s Heart Center at a pre-season UNLV scrimmage and took time out of his schedule that day to talk to the kids about the importance of physical activity and healthy eating. He also took pictures with the kids and signed autographs. The fact that Coach Kruger is willing and eager to take on these additional responsibilities and make this type of commitment not only to public health, but also to the children in our community makes him a true Public Health Hero.

Secretary Reese recognized the children in the audience as part of National Take Your Sons and Daughters to Work Day. Secretary Reese, on behalf of the Board, congratulated those individuals recognized this morning.

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: PDF 818KB 3/27/08
   
   
2. Approve Payroll / Overtime for Periods: 2/23/08 – 3/07/08; 3/08/08 –
   3/21/08; 3/22/08 – 4/04/08
   
   
3. Approve Accounts Payable Registers: #1118: 2/28/08 – 3/05/08;
   #1119: 3/06/08 – 3/12/08; #1120: 3/13/08 – 3/19/08; #1121: 3/20/08 –
   3/26/08; #1122: 3/27/08 – 4/03/08
   
   
4. Petition #15-08: PDF 333KB Approval of Revised Classification Specification for Environmental Health Engineer/Manager, Recommended Schedule 31 ($84,289 - $117,561)
   

Secretary Reese asked Dr. Sands if there were changes to the agenda. Dr. Sands confirmed there were no changes. Dr. Sands noted that the first “Public Hearing” item would be continued to the next meeting to ensure the public has the opportunity to review the materials in their entirety. It was also noted that the Terrorism Injury: Information, Dissemination and Exchange (TIIDE) Project discussion would be tabled to the next meeting.

Member Weekly asked the minutes from the Chief Health Officer Annual Review Committee meeting minutes be amended, specifically referencing page 4 of 7, to read: “he felt that all men and women of the Southern Nevada Health District should be able to come to work and do what they love.” He asked that this be corrected for the record.

Secretary Reese called for a motion to approve the Consent Agenda as presented.

A motion was made by Member Eliason to approve the Consent Agenda as presented; seconded by Member Mattocks and was unanimously approved.

II. Public Hearing / Discussion / Action

1. Memorandum #11-08: PDF 720KB Adoption of Amendments to the Clark County Trauma System Regulations
   
   This item is continued to the next regularly scheduled meeting.
   
   
2. Memorandum #09-08: PDF4.4 MB Application for Approval for Lunas
   Construction Clean Up, Inc. to Operate a Materials Recovery Facility
   Located at 4830 Cartier Avenue, Las Vegas, Nevada 89115 (APN 140-17-
   701-006 & 140-17-701-007)
   
   Secretary Reese declared the public hearing open.
   
   Glenn Savage, environmental health district and Walter Ross, environmental health engineer/supervisor, solid spoke relative to this item. Mr. Savage stated that Lunas Construction Clean Up has met all requirements to operate as a materials recovery facility (MRF) as specified in section 4 of the Materials Recovery Facility Regulations. The facility operates 24 hours per day, 360 days per year. Approximately 45-50 trucks will enter the facility to bring in recyclable materials such as metal, cardboard, wood, and plastics. They will also remove gypsum materials from green waste, and will recycle concrete and asphalt. The new constructed facility will also provide for bailing for paper, cardboard, aluminum and plastic. At this time, staff recommends approval for this permit based on final inspection with the conditions as outlined in the memorandum. Victor and Roberto Madrigal were present to answer questions of the Board.
   
   Secretary Reese asked if there were questions. Member Schroder asked if the center would operate 24 hours per day. Mr. Norberto Madrigal verified that once at full capacity, the facility would operate 24 hours per day. She also asked about haul route and which route trucks would take to and from the facility. Mr. Madrigal responded that the trucks would travel north on Nellis and Las Vegas Boulevard straight to the Apex landfill.
   
   Member Collins said this facility was in his district and there were several concerns raised with the Clark County public response office, including waste on the street and necessary street improvement. He indicated that he would not support the application until all complaints from neighboring businesses were resolved with the public response office. He recommended holding the item until the next meeting, or issuing the application with a condition that all issues are adequately resolved. Mr. Savage responded that under III.3 of the recommendations, one condition stipulates that Lunas Construction Clean Up must maintain any approvals from Clark County concerning applicable land uses, business license, permits, air quality issues, code enforcement, and the like. Staff relies on sister agencies to ensure environmental concerns are addressed before, during and after the approval process and enforcement actions are taken when necessary. There have been concerns in the past and staff has worked with the facility to rectify all issues.
   
   Member Collins asked if this approval were necessary to obtain other approvals or do the issues need to be resolved before granting the application. Mr. Savage said that bringing the application before the Board of Health is contingent upon all permits and licenses being approved previously by Clark County.
   
   Walter Ross, environmental health engineer/supervisor, added that the land use permit was approved January 28th by Clark County. If there are continued concerns, both staff and Clark County Public Response can respond to complaints to ensure they are resolved, including looking at the land use permit being granted before coming before this Board for final approval. Member Collins expressed concern that not all information is always brought before the commission when an item is approved, and wanted to ensure that all necessary permits are in place before the health district grants approval for operation.
   
   Member Jones asked if there are dates for resolutions of the complaints or if they are outstanding. Member Collins replied that the issue is ongoing as the area is undergoing upgrades and other improvements including dry campers and reducing crime.
   
   Member Eliason disclosed that his company uses the services of Lunas on a daily basis, but there is no conflict of interest in his voting on this matter.
   
   Mr. Victor Madrigal stated that he was not aware of any complaints and have obtained all necessary permits. He said that they have worked with neighboring business and the community to improve the area, including cleaning the streets on a daily businesses. All complaints in the past have been addressed professionally and quickly resolved. Member Collins said that some issues have been resolved.
   
   Secretary Reese asked if anyone from the public wished to speak to this matter. No one came forward to speak and Secretary Reese closed the public hearing.
   
   Mr. Ross said that permitted periodic inspections are performed to look for any issues and to resolve complaints. Member Collins suggested that additional conditions be set with the approval. Member Schroder asked Member Collins is the complaints were specific to Lunas. Member Collins said there were several companies in the area and all businesses need to come into compliance. New businesses have made improvements as of late, and Member Collins would like to ensure that all businesses in the area do the same. Member Schroder asked Mr. Madrigal if their business is in compliance with all codes and ordinances. Mr. Madrigal replied that all improvements were done as early as 1993 and he is not aware of the issues raised by Member Collins. Mr. Madrigal said that the property has curbing and gutters, as well as a concrete driveway.
   
   Member Eliason said he would like to commend the County for making sure that these improvements are done and cleaning up that area of the community. Member Jones suggested that the Board books contain a better representation of the property, including curbside photographs versus a satellite image.
   
   A motion was made by Member Eliason to approve the application as submitted with the conditions outlined in the memorandum; seconded by Member Crowley with Member Collins abstaining. The application was approved with Member Collins abstaining.
   
   NOTE: On April 25, 2008 Member Collins issued a written apology (attachment #1 PDF) to all Board members and alternates as he had confused Lunas Construction Clean Up with another facility. Mr. Collins also expressed his verbal apologies to Lunas.
   

III. Report / Discussion / Action

1. Committee Report/Recommendation: PDF 413KB Chief Health Officer Annual Review and Compensation (Committee: Chair Kirk, Members Christensen, Giunchigliani, Hardy and Weekly)
   
   Member Hardy referred to the minutes in the Board book. During public participation, an employee shared some employee concerns. There was an employee driven survey conducted as well as an employee satisfaction survey prepared by the District and staff, both of which were not available at the time of the committee meeting. The employee driven survey ranked Dr. Sands’ performance at a 1.85 on a scale of 1-5, with 5 being the optimum rating. The key areas of concern were communication, issues with delegation, visibility, perception of caring, retention, employee morale, disappointment and discrimination. The committee reviewed both the health officer and health district accomplishments and goals, which are included in the Board books as well.
   
   The committee recognized the vibrant dynamics of the health district with the accompanying issues and challenges. The committee sought to see how goals can be met while ensuring an atmosphere of caring, competency and respect for employees and clients. The committee determined that an instrument should be developed to rank the health officer’s performance in order to justify a merit raise of up to 5%, and pending availability of funds in the budget. Again, the ranking would follow a scale of 1-5, with 5 being the best, and a composite score of at least 3.0 would warrant merit pay. The Board would then determine what the merit pay would be, if any. The chief health officer is entitled to the same cost of living adjustment granted to the employees.
   
   Member Weekly expressed his concern with the employee survey ranking of 1.85, and was not surprised to hear that employees felt Dr. Sands had not relationship with him. He was also concerned that difficult human resources decisions are left to the discretion of the Human Resources Administrator, who reports to the Director of Administration. The committee felt that the chief health officer should be making these types of decisions. The committee also felt that corrective action should occur. Member Weekly stated he felt morale was low and that employees feel intimidated. He said that that health district does not need a figure head, but a leader who can make tough decisions.
   
   Member Hardy reiterated the committee is seeking accountability for improvement. Perception of the employees, as well as Board members, needs to be joined to see significant improvement and better interaction with employees, Board members and individual jurisdictions. Secretary Reese rendered his support for the committee’s recommendations.
   
   Member Christensen indicated that he had been unable to attend the meeting and expressed his feelings that a 360º instrument be used that has been validated in other areas. He said everything should be open and transparent. There are instruments available where performance can be measured and obtain accountable increases.
   
   Member Collins appreciated the transparency of the cost of living adjustment and merit raises; however he was concerned with this position’s longevity being a percentage of salary versus a flat rate as employees receive.
   
   Angus MacEachern, human resources administrator, verified that the collective bargaining agreement stipulates a flat rate for longevity per year. The executive system for longevity is based on the county system, and is a percentage. Member Collins said he would prefer to see a flat rate for executive positions.
   
   Member Mattocks said that the employment agreement would need to be modified if changes to longevity occurred. Member Collins again said he would prefer to see uniform longevity for all employees.
   
   Secretary Reese asked if there were any additional questions. Seeing none, he asked for the committee’s recommendation.
   
   Member Hardy made a motion to conduct an objective survey among Board members and employees to assess Dr. Sands’ merit raise, which necessitates an approval rating of 3 or greater; the merit raise can be between 0 and 5% and would be retroactive to the start of the fiscal year. The survey will be conducted between now and the end of the year. This mechanism will be used for future reviews and merit raises. The motion was seconded by Member Crowley. There was no further discussion, and the motion was approved unanimously.
   

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.

Secretary Reese invited any individuals wishing to address the Board on matters under their jurisdiction to come forward. No one came forward and Secretary Reese closed the Citizen Participation portion of the meeting.

V. Health Officer & Staff Reports

• Hepatitis C Investigation Update: Brian Labus, Senior Epidemiologist and Stephanie Bethel, Public Information Officer
  Dr. Sands invited Brian Labus, senior epidemiologist and Stephanie Bethel, public information office, to address the Board. Dr. Sands said the district announced a seventh case of acute hepatitis C associated with the Endoscopy Center of Southern Nevada. The patient had a procedure performed in June 2005; after receiving the case report epidemiology staff reviewed medical records and consulted with the Centers for Disease Control and Prevention (CDC) to determine if the illness met the criteria for an acute case and rule out additional risk factors. The findings reiterate the importance of notifying patients based on the risk for exposure. There are now eight acute hepatitis C cases related to procedures at these endoscopy centers.
  
  Mr. Labus shared a PowerPoint presentation (attachment #2 PDF) with the Board. He explained the different between acute and chronic hepatitis C. Acute infections account for 20-30% of those infected with hepatitis C, who are symptomatic with jaundice, nausea and abdominal pain. If a person has no symptoms this person has a chronic infection, meaning the virus is present in that person’s body and will be there for the course of his or her life. Disease progression is from acute to chronic and not vice versa. Acute infections occur within six months prior to onset of symptoms; chronic infections could occur anytime during a person’s life.
  
  Staff only knows of a small percentage of those who have developed acute disease due to lack of reporting. This is resultant of the severity of the illness and access to care. Two of the recent confirmed acute cases were not reported by the patients’ physicians, but they came forward on their own. The cluster was found as a result of the physician not writing reports as required and imperfect reporting.
  
  The challenge is ascertaining what all the positive results mean at this point. Staff expects a 4% positive rate based on the background rate of disease among the age group of those attending the clinic and some percentage of those infected by the clinic accounts. Staff is trying to determine what percent of the clinic population is infected. For example, a finding of 6 and 10% would indicate a certain amount of disease transmission in the facility.
  
  Staff requested a list of patients who went to the clinic, and we know that the list was incomplete. In reviewing insurance claims staff learned that we are at least 10,000 people short on the list, which means that 50,000 people should have been on the list. From those on the list, some are local residents and can be tested and a percent will be tested. Though we would like everyone to be tested, it is unrealistic to expect 100% compliance. Staff receives positive lab results for hepatitis C and the results are not limited to just those patients of the endoscopy centers. Staff looks at the results to see if the name matches anyone on the list from the centers and not having a date of birth increases the difficulty in matching results with names on the patient list. Staff then tries to call the individual to verify information to determine a match – there are issues with incorrect phone numbers, incorrect contact information and people not wanting to answer questions just to name a few challenges.
  
  There are six major risk factors for hepatitis C which include blood transfusion and transplant recipients prior to 1992, receipt of clotting factors prior to 1987, dialysis patients, IV drug use and sexual contact with a known or suspected case of hepatitis C. If staff speaks with someone who recently tested positive and indicated a history of IV drug use, this patient may or may not have been exposed at the clinic. For those patients with no risk factors other than a visit to the clinic, this patient is then in a presumptive category.
  
  The goal of the interview process is to classify patients and obtain overall numbers concerning the outbreak. This process will take several months, as there is a six month delay in testing after a procedure. The cluster investigation has centered around clinical visits on September 21, which resulted in five cases, and one case each from July 25 and June of 2005. There is also investigation with the Burnham Clinic – staff is waiting for access to patient records to further evaluate if additional notification is necessary, for how many individuals and the timeframe. Metro has been cooperative in our requests for access to available records.
  
  Member Jones asked if there is a genetic match to the September 25 cases. Mr. Labus said that four of the five cases yielded a genetic match to the same source – staff is waiting for results from the fifth case. Member Jones asked to clarify the time frame between possible exposure and testing. Mr. Labus said that a patient typically becomes symptomatic after two months, and it can be as long as three months from initial exposure to obtain lab results and a diagnosis to be made. The clinic was asked to stop performing the procedure identified as the source of infection which put patients at risk as of January 11, 2008.
  
  Secretary Reese thanked Mr. Labus for his remarks.
  
  Stephanie Bethel, public information officer updated the Board of the Community Forum held April 19, 2008. The goal was to address health concerns for those affected as well as provide answers to questions and available resources. Speakers addressed how to deal with the diagnosis and potential legal issues. Commissioner Weekly was a speaker in addition to Dr. Sands, Brian Labus, Dr. Robert Gish who is a hepatologist, Drs. Tom and Evelyn McKnight who are the founders of HONOReform, which stands for Hepatitis Outbreak’s National Organization for Reform, Kathleen Risdon a local social worker, and Professor Robert Correales and Dr. Gary Marrone from the Boyd School of Law at UNLV.
  
  Booths were available to provide information from medical providers, pharmaceutical companies, counseling and laboratory information. There were 300 attendees between the two sessions.
  
  Member Weekly expressed his appreciation to staff for holding the forum and commended them on a job well done. He indicated that attendees were looking for answers from the state medical board and local government, including why the physicians were able to practice medicine at other locations when one clinic was closed. He said that there should have been more representation from the local entities to address these questions, and suggested that additional forums be held in the future.
  
  Secretary Reese said that the licensing issues are out of the local jurisdiction’s purview. It is up to the state to revoke the licenses. If the City of Las Vegas could revoke the licenses it would have been done.
  
  Member Weekly said he was impressed with the information available to the community as well as the assembled panel, which included someone infected with hepatitis C. He said that public wants action now. Dr. Sands said that staff is evaluating the information received from attendees and are planning a debrief to discuss outcomes. One item of discussion will be whether to hold another forum and who should participate, as there are many contributing factors that can deter some agencies from involvement, including legal and law enforcement.
  
  Member Weekly said the public is confused as to who is responsible for what. They understand there is an issue and they want answers. He listened to some of the attendees as they expressed their confusion over no one taking ownership of the situation. The forum provided vital information about transmission and living with hepatitis C, but there are still many questions answered. It is not the health district’s responsibility to answer questions about the physicians – the local jurisdictions needs to come together and address these concerns.
  
  
• Terrorism Injuries: Information, Dissemination and Exchange (TIIDE)
   Project (continued discussion)
  
  This item is continued to a future meeting.

VI. Informational Items

VII. Adjournment

Secretary Reese asked if there were further comments or questions. Seeing none, Secretary Reese concluded the meeting at 9:15 a.m.

SUBMITTED FOR BOARD APPROVAL

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

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