Minutes

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

Thursday, June 26, 2008 - 8 a.m.

Chair Kirk called the meeting of the Southern Nevada District Board of Health to order at 8:01 a.m. and 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:

Steven Kirk — Chair, Councilman, Henderson
Gary Reese — Secretary, Councilman, Las Vegas
Jim Christensen, MD — At-Large Member, Physician
Susan Crowley — At-Large Member, Environmental Specialist
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
Bubba Smith — Councilmember, Mesquite
Stephanie Smith — Councilwoman, North Las Vegas Alternate
Linda Strickland — Councilmember, Boulder City
Lawrence Weekly — Commissioner, Clark County

Absent:

Chris Giunchigliani — Vice Chair, Commissioner, Clark County
Ricki Barlow — Councilman, Las Vegas
Travis Chandler — Councilmember, Boulder City Alternate
Tom Collins — Commissioner, Clark County Alternate
Robert Eliason — Councilman, North Las Vegas
Joseph Hardy, MD — At-Large Member, Physician
Frank Nemec, MD — Alternate At-Large Member, Physician
Steven Ross — Councilman, Las Vegas Alternate
Gerri Schroder — Councilwoman, Henderson Alternate
Debra Toney, RN — Alternate At-Large Member, Registered Nurse

Lonnie Empey — Alternate At-Large Member, Environmental Specialist

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: Mike Walsh; Angus MacEachern; Glenn Savage; Jennifer Sizemore; Bonnie Sorenson; Jo Alexander; Kara Bennis; Mark Berghtoldt; Stephanie Bethel; Jerry Boyd; Rory Chetelat; Sylvia Claiborne; Alice Costello; Mary Ellen Harrell; Forrest Hasselbauer; Paul Klouse; Brian Labus; Ann Markle; Veronica Morata-Nichols; Robert Newton; Gwen Osburn; Shannon Randolph; Patricia Rowley; Jane Shunney; Leo Vega; Jorge Viote; Leisa Whittum; Deborah Williams; Keith Zupnik; Valery Klaric and recording secretary Shelli Clark

Attendance:

Chair Kirk asked Dr. Sands if there were changes to the agenda. Dr. Sands confirmed there were no changes.

I. Meeting of the Board of Health as governing body of a local government employer with its management representative(s) – CLOSED SESSION pursuant to NRS 288.220

A motion was made by Chair Kirk to close the meeting at 8:03 a.m. The motion was seconded by Member Smith and was unanimously approved.

CLOSED SESSION

II. 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 645 KB 5/22/08
   
   
2. Approve Payroll / Overtime for Periods: 5/03/08 – 5/16/08 & 5/17/08 – 5/30/08
   
   
3. Approve Accounts Payable Registers: #1127: 5/01/08 – 5/07/08; #1128: 5/08/08 – 5/14/08; #1129: 5/15/08 – 5/21/08; #1130: 5/22/08 – 5/28/08; #1131: 5/29/08 – 6/04/08
   

4. Petition #20-08: PDF 226 KB Approval of Interlocal Agreement, Amendment #1 with Clark County Social Service (CCSS): HIV/AIDS Evaluation Services to CCSS Clients for FY 2009
   

5. Petition #22-08, Resolution #02-08: PDF 735 KB Approval of Adjustments to FY 2007-2008 Appropriations
   

A motion was made by Member Reese to approve the Consent Agenda as presented; seconded by Member Crowley and was unanimously approved

III. Public Hearing / Discussion / Action
       No Public Hearings scheduled

IV. Report / Discussion / Action

1. Petition #17-08 PDF 369KB : Approval of New Classification Specification for Associate Attorney, Recommended Schedule 26 ($65,281 - $91,087) Continued from May 22, 2008 meeting
   
   Michael Walsh, director of administration, spoke relative to this item. Angus MacEachern, human resources administrator, was also available to answer questions. Mr. Walsh indicated that the additional information requested by the Board at the May 22, 2008 meeting was provided in the Board books. Mr. Walsh stated that over the last two years the demands on the attorney have greatly increased, especially with the additional needs of the environmental health division. It is a good business decision to hire an associate attorney at a lower rate than the hourly rate required by a contracted attorney ($40/hour versus $250 - $400/hour).
   
   Chair Kirk indicated that Mr. Minagil has tendered his resignation, which is effective at the end of August and it is critical to maintain continuity in the legal department. Chair Kirk asked if all questions brought forward by Member Giunchigliani were addressed. Dr. Sands replied that Glenn Savage, director of environmental health, had provided the requested information to her before she left last month’s Board of Health meeting, and in a separate meeting with Dr. Sands Member Giunchigliani indicated that she would be comfortable moving forward with the position.
   
   Chair Kirk asked if there were any additional questions. Seeing none he called for a motion.
   
   A motion was made by Member Smith to approve the Associate Attorney position as presented; seconded by Member Crowley and was unanimously approved
   
   
2. Petition #21-08 PDF 443KB : Approval of Revision of District Administrative Services Fee Schedule, Emergency Medical Services Fee Schedule, Family Planning Fee Schedule, Medical Procedures Fee Schedule and Professional Services Fee Schedule Bonnie Sorenson, director of clinics and nursing services, and Alice Costello, community health nurse manager, were present to answer questions of the Board.
   
   Chair Kirk asked if there were any comments or questions on this item. Seeing none he called for a motion.
   
   A motion was made by Member Reese to approve the revisions to the fee schedules as presented; seconded by Member Crowley and was unanimously approved.
   
   
3. Memorandum #14-08PDF 443KB: Proposed Fee Schedule Change for the Office of Emergency Medical Services (EMS) & Trauma System
   
   Rory Chetelat, EMS & trauma system manager, spoke relative to this item.
   
   Chair Kirk asked the Board if there were any questions or comments, or if Mr. Chetelat had additional information to provide. Mr. Chetelat said that with the migration to national registry testing staff is no longer certifying all applicants; however there are more applications being received, but no fees collected. This is creating additional work for staff and it would be more beneficial to collect an application fee at the beginning of the process and not require additional fees upon certification. Chair Kirk expressed his agreement with this concept.
   
   A motion was made by Member Reese to approve the proposed fee schedule change as presented; seconded by Member Christensen and was unanimously approved.
   
   
4. Committee Report/Recommendation PDF 263KB : At-Large Member Selection (Committee: Chair Kirk, Members Giunchigliani, Hardy and Vigilante)
   
   Chair Kirk provided the committee’s recommendation which was to keep the current at-large members in place due to their institutional knowledge which is valuable and of great benefit to the district. All current at-large members expressed interest to continuing serving on the Board. Dr. Sands read the names of the current at-large members: Jim Christensen and Joe Hardy as the physician members; Susan Crowley as the environmental specialist member; Mary Jo Mattocks as the registered nurse members; and Tim Jones as the regulated business/industry member.
   
   Mr. Minagil stated that only the elected members of the Board would be voting on the motion, specifically Chair Kirk, Members Reese, Stephanie Smith, Robert Smith, Weekly and Strickland.
   
   A motion was made by Chair Kirk to appoint the at-large members as presented; seconded by Member Reese and was approved unanimously.
   
   
5. Committee Report/Recommendation PDF 210 KB: Nominees for Southern Nevada District Board of Health Officers for FY 2008-09 (Committee: Chair Kirk, Members Giunchigliani, Hardy and Vigilante)
   
   Mr. Minagil indicated that this item was for discussion only and would be put before the Board for action at the July meeting. This action would occur after the new at-large members are seated.
   
   Chair Kirk stated that the committee was recommending the following members to serve as officers for FY 2008-09: Chris Giunchigliani as Chair; Steven Kirk as Vice Chair and Ricki Barlow as Secretary.
   
   Mr. Minagil said that Mrs. Clark, recording secretary, indicated the alternate at-large members were not included in the motion for item #4. Mr. Minagil stated that the item needed to be recalled.
   
   A motion was made by Member Reese to recall item #4 and reconsider the motion; seconded by Member Mattocks and carried unanimously.
   
   Dr. Sands read the names of the alternate at-large members as recommended by the committee: Frank Nemec and John Onyema as physician members; Lon Empey as the environmental specialist member; Jimmy Vigilante as the regulated business/industry member; and Barbara Ruscingno as the registered nurse member.
   
   A motion was made by Member Reese to appoint the alternate at-large members as presented; seconded by Member S. Smith and was approved unanimously.
   

V. Public Comment:

Public Comment 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. No one came forward and Chair Kirk closed the Public Comment portion of the meeting.

VI. Health Officer & Staff Reports
Chief Health Officer Report
Dr. Sands reported that the first collective bargaining session is scheduled for July 9th at 5:00 p.m. He also noted that Mr. Minagil is resigning to return to private practice. Additionally, Michael Walsh, director of Administration, announced his retirement for the end of August. Dr. Sands hopes to have both positions filled before their departures to ensure smooth transitions.

Dr. Sands also announced that Dr. John Middaugh is joining the health district as the new director of community health effective July 7th. He has served thirty years in public health, and is board certified in preventive medicine and internal medicine. He most recently served as state epidemiologist in Alaska and most recently in Florida.

Dr. Sands also expressed his appreciation to Rory Chetelat who has served as the acting director of community health for the last seventeen months. He has done a remarkable job building the division as well as managing the day-to-day operations. He has also served as the chair of the senior management team during this time and played a critical role in the strategic planning process. Dr. Sands said he deserves much recognition and accolades for his performance.

Employee Satisfaction Survey
Dr. Sands indicated that all Board members received copies via email of the first employee satisfaction survey, which was a project of the joint Labor/Management Committee. Results showed that more than 90% of those responding are satisfied or very satisfied with the areas of work they do, their immediate supervisor and co-workers, as well as benefits. More than 80% indicated satisfaction or being very satisfied with how they are treated by division management. There are always areas for improvement, including communication between divisions, consistent application of personnel policies, how performance problems are handled and customer satisfaction. The Executive Team has reviewed the results and all comments and is developing strategies for addressing these issues and ensuring consistent application of policies. Dr. Sands will report back to the Board on progress and maintaining focus on improvement. Dr. Sands expressed his appreciation to the Labor/Management Committee for their efforts in rolling out the survey. He also thanked those employees who participated in the survey.

Hepatitis C Investigation Update: Brian Labus, Senior Epidemiologist
Dr. Sands said invited Brian Labus to brief the Board relative to the hepatitis C investigation on events since the announcement concerning the Burnham Clinic investigation. Mr. Labus said that there is not much information to report since the press release went out three weeks ago. Basically our investigation showed reuse of propofol, but there was no evidence of reuse of syringes. The district made a soft recommendation for patients to be tested; however many patients had already been tested on their own accord. The press release also announced the launch of the hepatitis C exposure registry. The registry was created due to the inability to obtain correct contact information from medical records and lab results. Registry forms were sent to 53,000 people two weeks ago and to date 3,200 enrollment forms have been received. The Board will be updated as the analysis begins.

Member Jones asked if clients have been asking for guidance and treatment as a result of the registry. Mr. Labus said the initial announcement was cause for concern and our stance has been to direct patients to speak with their physicians directly who can then provide treatment. The call center does provide some information, but again directs patients to contact their individual providers.

Environmental Health Updates: Glenn Savage, Director of Environmental Health

Dr. Sands invited Glenn Savage to brief the Board relative to the annual high risk itinerant permits and illegal mobile vending. Joining Mr. Savage were Paul Klouse and Mark Bergtholdt, environmental health supervisors. Mr. Savage said that some individuals have asked for special consideration, especially for those selling kettle corn. After some research, the state indicated that special considerations are not in statute and therefore not a possibility. Adding a special section to the fee schedule was not approved by legal counsel. After this, it was determined that individual businesses need to submit their business plans and the district will hold public workshops to consider implementation of the new business plans. It is hoped that the information provided by these clients will be acceptable to all interested individuals and can be built into the fee schedule to be brought before the Board for consideration in the near future.

Chair Kirk said it is important to listen to the affected businesses and take their input into consideration.

Mr. Savage briefed the Board regarding some illegal mobile vending sweeps done by staff in recent weeks. There is great concern from permitted businesses who are competing with those not permitted. Last week numerous venders were caught and their operations were closed. Mr. Savage also informed the Board of trafficking operations where minors are purchased in Mexico and brought to Los Angeles and later Las Vegas and made to sell fruit to pay their handlers for room and board, and to pay the debt for their purchase. Staff was able to place one minor with Child Haven and another was sent back to Los Angeles to be with his family.

Member S. Smith said that there are these types of operations in her neighborhood and she is not sure if she should turn them in or not. Mr. Savage said that it needs to be reported and Metro will provide assistance. Currently FBI and Metro are involved with the human trafficking problem we are seeing in the community. The products being sold can be contaminated or harmful for consumption and the health district needs to be notified when illegal vending is occurring due to public health concerns.

Member Smith also asked about businesses such as Windsor Farms doing home delivery for food and offering samples. Mr. Savage said that home delivery of food needs to be permitted and both Windsor Farms and Schwan’s have been permitted. To offer samples they should also be permitted, but sometimes the businesses do not comply with that aspect of the regulations.

Chair Kirk asked for the procedure to follow when we witness people selling fruit on the corner. Mr. Savage said that when the health district is notified, staff goes out to confiscate the food products and conduct interviews. If the vendor is underage, Metro is notified for assistance. Staff offers water and transportation if needed. Chair Kirk asked what the public should do. Mr. Savage said to call the health district or Metro. Chair Kirk asked for this number to be placed on the front page of the health district’s website. Mr. Savage said he is working with Jennifer Sizemore to have this done. Dr. Sands said that HDtv will also have a segment on illegal mobile vending. Highlights of this segment will be used as a time filler between shows on channels 2 and 4

Disposal of Medications: Christina Madison, Pharm.D., Pharmacist
Dr. Sands asked Christina Madison to make a presentation to the Board as a result of many questions about proper disposal of medications and recent reports of pharmaceuticals in the water supply.

Dr. Madison shared a PowerPoint presentation (attachment #1 PDF 340 KB) in addition to two handouts containing information regarding proper disposal of medication (attachment #2 - 1 PDF 90 KB, 2 PDF 44 KB).

Education regarding proper disposal of medications is important to protect our water supply, prevent exposure to wildlife and illicit use of medications by others. There are no official disposal programs in southern Nevada other then the federal guidelines which were distributed to Board members. Some pharmacies take back unused or expired medications, but this is not highly publicized. Federal guidelines instruct patients to remove leftover or expired prescription medications from the original containers and mix with an undesirable substance, such as used cat litter or coffee grounds, place the mixture in a non-descript container and placing in another sealed container and putting it in the trash. Some medications are approved for flushing in the toilet, including transdermal medications.

Dr. Madison discussed take back programs in other areas of the country as examples of possible solutions for Clark County. Some areas have take back programs in police stations, local pharmacies and nursing homes; sample collection containers were also shown. When medications are collected, someone must be deputized or have proper authority to collect them. In the absence of a formal collection program education can be provided to inform consumers of the proper methods of disposal based on federal guidelines.

The state board of pharmacy’s regulations do not address these issues and are excited that this topic is being discussed. There is a concern about collection of schedule II medications (certain narcotics) and this must be addressed.

Dr. Madison stressed the need in the community for education for proper disposal of medications. She hopes that we will have a well-defined program in the future, but it starts with education.

Member Jones said that the resort industry finds numerous medications in hotel rooms. Dr. Their procedure is to place in red bio-hazard bags and dispose of them in that manner. Dr. Sands said that Republic Services provides a quarterly toxic waste pick-up which could be an option for consumers. Currently Republic Services does not offer disposal services for medication. Member Christensen said that we need to partner with the state board of pharmacy in developing a plan and possibly the legislature.

Chair Kirk asked that a quarterly update be provided to the Board on the progress of this program. There is a strong need to have a program in place and we need to come together and develop a plan. Funding issues will be worked out at a later time.

VII. Informational Items - DULY NOTED

VIII. Adjournment

There was no further business to come before the Board and Chair Kirk concluded the meeting at 9:14 a.m.

SUBMITTED FOR BOARD APPROVAL

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

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