Return to Board Meeting Minutes
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Minutes 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:
Absent:
Executive Secretary:
Legal Counsel:
Other SNHD Board of Health Members/Alternates Present:
Staff: Mike Walsh; Angus MacEachern; Glenn Savage; John Middaugh, MD; Jennifer Sizemore; Bonnie Sorenson; Stephanie Bethel; Jerry Boyd; Mary Ellen Britt; Dennis Campbell; Rory Chetelat; Sylvia Claiborne; Mary Ellen Harrell; Forrest Hasselbauer; Brian Labus; Eddie Larsen; Ann Markle; Veronica Morata-Nichols; Patty O’Rourke-Langston; Patricia Rowley; Leo Vega, Deborah Williams; Valery Klaric and recording secretary, Shelli Clark Attendance:
Chair Kirk asked if there were any changes to the agenda and Dr. Sands confirmed the agenda as presented. Chair Kirk asked Mr. Minagil to proceed with administering the Oath of Office to the at-large and alternate at-large members present. Oath of Office: Stephen Minagil, Board Legal Counsel, administered the Oath of Office to the following at-large members and alternates: Jim Christensen, MD – physician representative; Susan Crowley – environmental specialist representative; Joe Hardy, MD – physician; Tim Jones – regulated business/industry representative; Lon Empey – environmental specialist representative alternate; and Barbara Ruscingno – registered nurse representative alternate. 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.
A motion was made by Member Strickland to approve the Consent Agenda as presented; seconded by Member Giunchigliani and was unanimously approved. Chair Kirk turned the balance of the meeting to newly elected Chair Giunchigliani. Oath of Office: Stephen Minagil, Board Legal Counsel, administered the Oath of Office to the new Board of Health Officers for FY 2008-09: Chris Giunchigliani – Chair; and Steven Kirk – Vice Chair. Newly elected Chair Giunchigliani thanked everyone for their support and acknowledged the good team with which the Board has to work. She also thanked Vice Chair Kirk for his efforts and support. II. PUBLIC HEARING / ACTION III. REPORT / DISCUSSION / ACTION
IV. PUBLIC COMMENT: 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 Giunchigliani invited any individuals wishing to address the Board on matters under their jurisdiction to come forward. Al Sang, an environmental health specialist with the district, expressed his concerns about changes to the mileage reimbursement policy. Jacqueline Raiche-Curl, an environmental health specialist with the district, expressed her concern with changes to the mileage reimbursement policy. Chair Giunchigliani asked that this matter be agendized for discussion and possible action at the August meeting. She also asked for a copy of the policy. Member S. Smith stated that the Board does not address personnel issues and suggested the employees address their concerns to their supervisors and the union. She further suggested that staff be given direction and report back to the Board; she would like to be of assistance but refrain from personnel issues. She also asked for a copy of the policy to review what has transpired. Member Strickland asked for a count of environmental health specialists in attendance at the meeting and twelve employees raised their hands. Member Jones asked for the mileage reimbursement rate and if the district conforms to the current IRS rate of 58.5 cents per mile. It was confirmed that the district does follow this rate. Chair Giunchigliani asked Dr. Sands to look into the matter and brief Board members concerning his findings. Dr. Sands responded that the Employee Satisfaction Survey yielded concern about the consistent application of policies. This particular issue recently came to management’s attention and is under review. Member S. Smith asked if employees are required to do a certain number of inspections. Inspections are assigned to employees who typically cover that area in the course of their regular duties; if an employee is unable to do special events due to scheduled time off, the employee is responsible for finding coverage for the event. There can be as many as sixty-nine scheduled special events on a given weekend or holiday, and some areas host more events than others. Member Kirk indicated he would like a report from staff before venturing further into this item. He suggested that staff provide additional details and report back to the Board. Member Crowley suggested a review of work schedules due to the large number of inspections required on the weekends. Member Hardy expressed his concern about discussing an item that has not been properly noticed. Chair Giunchigliani again stated for the item to be agendized for the next meeting; if administrative action is taken beforehand, staff can continue to bring a report back to the Board. She then invited Mr. Savage forward to answer some of the questions raised in the discussion. Glenn Savage, environmental health director, echoed employees’ concern with the change in the mileage reimbursement policy and stated he recently learned that environmental health was applying the policy differently than other divisions within the district. He suggested there be no change in application of the policy for environmental health staff. Chair Giunchigliani asked Mr. Minagil for counsel in regard to proper procedure for today’s meeting. Mr. Minagil counseled that no action or deliberation could occur without the item being properly agendized; however Board members are free to ask questions of staff. Diane Freeman, SEIU Vice President, indicated this issue was brought before the joint labor/management committee and there was concern about a precedent being set. She indicated this issue can be taken care of in that venue and committee members should be able to share their feelings and exchange ideas in betterment of the district and the clients served. She further stated that Article 37 of the collective bargaining agreement states that employees will receive mileage reimbursement for use of personal vehicles in accordance with district policies and procedures. Diana Daniels, SEIU Steward, provided some history of this issue to the Board and indicated that the nursing division was following the policy as currently written. Staff would like the policy to be applied fairly across the district. Dan Slater, senior environmental health specialist addressed the Board and stated his concerns about the change in the mileage reimbursement policy and the potential problem in staffing events. Member Jones suggested contacting other agencies to see how these issues are handled, and specifically referred to fire agencies, building departments and social services. Member S. Smith asked if this change would be reflected in employees’ current pay checks and suggested a freeze on implementing the policy until a full review is completed. Dr. Sands said that if we are going forward with this application it would apply; however as the change was not well communicated a freeze can be considered. He said that staff needs to review what has transpired and agreed that the joint labor/management committee is the venue for this discussion. Tom Jarred, environmental health specialist serving Mesquite, addressed his concerns about the change in the mileage reimbursement policy. There were no other comments and Chair Giunchigliani closed the Public Comment portion of the meeting.V. HEALTH OFFICER & STAFF REPORTS Introduction of Director of Community Health: John Middaugh, MD Chair Giunchigliani welcomed Dr. Middaugh and said that we have a great staff and great employees. She said his expertise is welcome in dealing with the dynamic nature of the issues we face in Southern Nevada. Update on Hepatitis C Investigation: Brian Labus, Senior Epidemiologist To date approximately 6,000 enrollment forms have been received for the exposure registry, of which about 4,000 have been entered into the registry. Enrollment forms continue to come in daily. Information is being verified against clinic records and insurance records. By the next Board meeting, Mr. Labus is hopeful to have more detailed information available. Mr. Labus indicated that some further test results were received from the Centers for Disease Control & Prevention (CDC) and he provided a background on the hepatitis C virus to better understand the results. In order to fully understand what occurred at the clinic, the focus is on the genetic material inside the protein of the virus and the genome being studied is comprised of nine different genes. Small changes within the protein capsule can have a large impact on a virus. Staff is looking at the surface proteins which interact with the immune system and are constantly under attack by antibodies. There are generational changes that occur and some proteins change more than others. The mutation rate for HCV is very high in comparison to other viruses. When looking at the evolution of the virus, the changes to the virus not only exist in different individuals, but also within one person it can mutate enough to have fifteen to twenty different viruses in one person, which results in a quasi-species or a swarm. The challenge comes in matching specific patterns from a potential source to other individuals. Virus information was available from source cases, known cases and background cases which document the family tree of those viruses. This allows for comparison in the mutation from virus to virus found in different individuals. The data is only for the clusters at present. Regarding the July 25, 2007 cluster, there is one acute case identified and the source has been identified. There is a 98.6% genetic match between the source patient and the patient infected. A perfect match is not expected due to the mutation rate and over time there is less similarity between the viruses. Testing a case from 2005 or 2006 is not possible because of the mutation rate. Member Crowley suggested that Mr. Labus’ presentation be done on HDtv to help the public understand that testing of hepatitis C is not as easy to test as salmonella and the like, as well as have a better understanding that over time the mutations make the virus less easy to trace. Member Christensen said it would help the public also understand that the investigation is still a priority and a long process. Member Weekly asked if requests for records were still high. Mr. Labus said that any requests are forwarded to the Las Vegas Metropolitan Police Department. Member Weekly asked if we had sought any updates and Mr. Labus replied that a meeting scheduled for that week had been canceled. Both the call center and the health district’s website have information regarding requests for records. Member Hardy indicated that there is optimism for some people who have made it past the six month mark where symptoms present themselves and no new sources or potential sources have been identified. Mr. Labus replied that there could have been exposure every day at the clinic but the genetic testing is not available. The two days in question brought the situation to light and patients were put at risk. July 11, 2008 marked six months since identifying and correcting the problem. Within the next week, if no new acute cases are reported, we can say this part of the investigation is complete in regard to acute cases. Member Ruscingno asked about the families of the hepatitis C patients. Mr. Labus said that transmission of the disease occurs mainly through exposure to blood. Family members have been encouraged to receive testing; however staff does not anticipate a large number of secondary infections. As part of acute investigations patients are counseled to receive hepatitis A and B vaccinations and how to protect both themselves and their family members. Chronic infections are managed in the medical community. Mr. Labus reported that 15-20% of people infected with acute diseases are symptomatic right away; most people infected with the chronic disease either have no symptoms or they may develop later in life. This is why managed care is so important to someone with a chronic infection, as someone chronically infected can transmit the disease to others as it what occurred at the endoscopy centers. Member Hardy asked to clarify if the source patient in September 2007 was a known chronic hepatitis C carrier before the procedure on the medical record known to both the clinic and the patient and Mr. Labus confirmed this information. Member Hardy said in the day of universal precautions, everyone is treated as if they have a communicable disease; yet at the clinic a known carrier of a disease was not treated with universal precautions. He asked if there have been any new cases of HIV or hepatitis B diagnosed as a result of the procedures done at the clinic. Mr. Labus said no cases have been identified at this time. Member Hardy said this would be called good news. At present it is not known if the July 2007 patient was aware of being a chronic hepatitis C carrier. Member Christensen asked if other viruses were considered in testing the patients. Mr. Labus said that all patients were tested for hepatitis B, C and HIV. No other diseases, such as CMV, were tested for as the three we tested for are the most likely to be transmitted and are found most frequently in the population. Member Strickland asked if patients who receive counseling sign any type of document to show they were consulted. Mr. Labus said that interviews are conducted via telephone; however staff does include documentation in the interview notes. Member Ruscingno asked if the source patients were the first patients of the day. Mr. Labus said that approximately sixty patients were seen on the days in question and the sources were not the first patient – there were several before and after. With the new information, we can put more of the puzzle together. Chair Giunchigliani asked public information staff to work with Brian to have the presentation put on the local government channels and HDtv as an educational piece. Terrorism Injuries: Information, Dissemination and Exchange (TIIDE) Project: Mary Ellen Britt, Regional Trauma Coordinator (continued from January 2008 meeting) Current TIIDE partners include the American College of Emergency Physicians, American Medical Association, American Trauma Society, National Association of County & City Health Officials, and the National Association of Emergency Medical Service Physicians. Ms. Britt gave a brief overview on the different projects with which each partner is involved. CDC also worked to develop the “Bombings: Injury Patterns and Care” curriculum, “In a Moment’s Notice: Surge Capacity for Terrorist Bombings” planning document and new blast injury facts sheets for clinicians. “Bombings: Injury Patterns and Care” is an interactive scenario-based training designed in collaboration with the American College of Emergency Physicians to provide the latest clinical information regarding blast-related injuries from terrorism. The facts sheets have been distributed world-wide and are available in Spanish; Chinese and French translations will be available soon. The facts sheets are available on the CDC’s website. Member Barlow asked if the VAX System and potential new software compare with the TIIDE project. Dr. Sands said these are two separate systems and relate to two entirely different programs. The TIIDE Project was a good fit due to our emergency medical services system and the coordination of the regional trauma system. This project allows for coordination between the data systems of the trauma centers, response agencies and the health district into one central database to better communicate with all players and assess what needs exist. Member Kirk asked if the grant allowed for hiring of personnel. Ms. Britt said that existing staff is being used; some of the grant monies are being used to train existing personnel and the grant is non-matching. Chair Giunchigliani thanked staff for the presentations. As Member Barlow had arrived late in the meeting, Chair Giunchigliani asked if the Oath of Office could be administered to him on the record. Oath of Office: Stephen Minagil, Board Legal Counsel, administered the Oath of Office to the new Board of Health Officer for FY 2008-09: Ricki Barlow – Secretary. VII. Informational Items - Duly Noted
VIII. Adjournment There was no further business to come before the Board. Chair Giunchigliani adjourned the meeting at 9:20 a.m. SUBMITTED FOR BOARD APPROVAL
Lawrence Sands, DO, MPH, Chief Health Officer /src attachments Minutes amended August 28, 2008 per request of Member Hardy and the hepatitis C investigation update. |
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