Board of Health

Contact Information (702) 759-1201 board.of.health @snhdmail.org

Minutes

Southern Nevada District Board of Health Meeting
April 26, 2007 - 9 a.m.

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

Chair Donna Fairchild called the meeting of the Southern Nevada District Board of Health to order at 9:02 a.m. and the Pledge of Allegiance was held. She also noted that she had been provided with the Affidavits of Posting and Mailing of Agenda meeting notices, as required by Nevada’s Open Meeting Law. The Affidavits are incorporated into these Official Minutes.

Board Members Present:

Donna Fairchild — Chair, Council Member, Mesquite
Susan Crowley — At-Large Member, Environmental Specialist
Chris Giunchigliani — Commissioner, Clark County
Timothy Jones — At-Large Member, Business/Industry
Mary Jo Mattocks, RN — At-Large Member, Registered Nurse
John Onyema, MD — At-Large Member, Physician Alternate

Absent:

Steven Kirk — Vice Chair, Councilman, Henderson
Gary Reese — Secretary, Councilman, Las Vegas
Karla Burton — Councilwoman, Boulder City
Jim Christensen, MD — At-Large Member, Physician
Joseph Hardy, MD — At-Large Member, Physician
Stephanie Smith — Councilwoman, North Las Vegas
Lawrence Weekly — Commissioner, Clark County
Robert Eliason — Councilman, North Las Vegas, Member Alternate
Lon Empey — At-Large Environmental Specialist Alternate
Frank Nemec, MD — At-Large Member, Physician Alternate
Steven Ross — Councilman, Las Vegas Alternate
Debra Toney, RN — At-Large Member, Registered Nurse Alternate

Executive Secretary:

Lawrence Sands, DO, MPH

Legal Counsel:

Stephen R. Minagil

Other SNHD Board of Health Attendees:

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

Staff: Mike Walsh; Bonnie Sorenson; Glenn Savage; Dennis Campbell; Mary Ellen Harrell; Paul Klouse; Jane Shunney; Rory Chetelat; Jim Osti; Patricia Rowley; Deb Williams; Veronica Morata-Nichols; Jo Alexander; Ann Markle; Brian Labus; Jennifer Sizemore; Julie Hurd; Rayleen Earney; Stephanie Bethel; Susan Eiselt; Sylvia Claiborne; Jerry Boyd; Angus MacEachern; Bob Gunnoe; Mark Bergtholdt; Jorge Viote; Margaret Patterson; Leo Vega; Forrest Hasselbauer; Recording Secretaries: Shelli Clark and Diana Lindquist

Attendance:

Chair Fairchild recognized the children in the audience as part of “National Take Your Sons and Daughters to Work Day.” She acknowledged that no quorum was present when the meeting was called to order and asked to proceed with the presentations.

Recognition
Dr. Sands introduced the Great Basin Public Health Leadership Institute graduates for 2007. Dr. Sands and the Board members congratulated the graduates.

Great Basin Public Health Leadership Institute Graduates 2007

• Dennis Campbell – Environmental Health
• Sylvia Claiborne – Finance
• Mary Ellen Harrell – Nursing & Clinics
• Bonnie Sorenson – Nursing & Clinics
• Deborah Williams – Chronic Disease Prevention & Health Promotion

Dr. Sands invited Sylvia Claiborne to discuss the graduates’ project for the year. Ms. Claiborne reported that the scholars chose to review the budgeting process. Previously there was no budgeting software in place, and the process was manual involving numerous spreadsheets. In order to implement the annual budgets, the scholars determined that software was necessary. Sage is the new software and allows for an online process which enables staff to see only their programs. The software is a roll-up process that starts at the overall district, down to divisions, to programs and finally to projects. The budget process begins at the project level and rolls up to the district as a whole, which was presented to the Board in March. Staff is able to see revenues, capital and input expenditures. Forty staff members have been trained in the software, and the overall feedback was very positive. There are some issues to be resolved, but the overall perception is that the new software makes the budgeting process much easier.

Member Jones asked if staff or financial staff input expenses into the software. Ms. Claiborne explained that staff manually entered the expenditures into the appropriate column. Member Giunchigliani asked about project codes on the accounts payable registers and why it wasn’t reflected in the software. It was clarified that users enter the information directly in the project area, which are the sub-categories outlined on the registers. Chair Fairchild commented that the software appears to be user friendly, which is beneficial to staff.

Dr. Sands said that scholars are trained as leaders, but come together as a team to work in concert on a project that will be of benefit to the district. Dr. Sands also introduced the Great Basin Public Health 2008 scholars. Dr. Sands and the Board recognized and congratulated them.

Great Basin Public Health Leadership Institute Scholars 2008

• Stephanie Bethel – Public Information
• Veronica Morata-Nichols – Nursing & Clinics
• Jim Osti – Community Health
• Glenn Savage – Environmental Health
• Jorge Viote – Public Information

Presentation - Public Health Hero Awards

The first week of April was Public Health week, and numerous events were held which are noted in staff reports. The Public Health Hero award honor individuals and organizations that make contributions that positively affect the health and well-being of our community. Dr. Sands introduced the 7th annual Southern Nevada Public Health Hero awardees:

Adult Diabetes Education & Management Support (ADEMS) Group: Chris Moore & Theresa LeBlanc Moore

Chris and Theresa Moore are Valley Hospital nurses, nominated by the office of chronic disease prevention and health promotion. The Moores were recognized for their advocacy and volunteer efforts for diabetes education. The Moores are the Las Vegas Valley’s only master trainers for the Stanford University’s Chronic Disease Self-Management Program, which started in 1999. They have spent many years training diabetes self-management leaders and teaching classes for the public about how to manage the disease. Their work has benefited many diabetics and their families in the community. Some of their accomplishments include: facilitating the monthly Adult Diabetes Education and Management Support Group (ADEMS) to share education, resources and skills for diabetes management; producing a weekly online podcast that hosts diabetes experts and covers many topics about the disease; and coordinating a diabetic health fair where patients gain information about the latest pharmaceuticals, support groups and community agencies. The Moores exemplify two very important components of public health: to inform, educate and empower people about health issues and to link people with needed health services.

UMC Information Services Department: Ernie McKinley, Dan Pacleb and Jim Poulos

The UMC Information Services (IS) Department earned its nomination from the health district’s office of epidemiology for its willingness, responsiveness and quick turnaround to health district requests. Since 2001, the UMC Information Services department has been instrumental in the development of several health district surveillance systems to provide data to monitor, identify and track diseases and other health hazards in Southern Nevada. Most recently, the department worked closely with the health district to implement technology that has allowed UMC to become one of the first hospitals to participate in the Centers of Disease Control & Prevention (CDC’s) BioSense program, a system to improve the nation’s ability to detect serious public health situations such as an outbreak. Other programs that SNHD and UMC IS staff worked together include developing a near real-time syndromic surveillance system that provides essential data to SNHD; UMC is the first Clark County hospital to provide such information; developing a program that allowed UMC Information Services to pull data about patterns of antibiotic resistance in the community and provide the information to SNHD for a report about the problem in Southern Nevada. UMC Information Services still participates in this program and routinely provides data to the health district. The UMC IS department was recognized for its past and current efforts to assist the health district in its mission to better the health of the community and to continue to assist the district in its efforts to monitor the health status of Southern Nevada.

Sunrise Hospital & Medical Center: Mary Jo Foreman, Infection Control Practitioner

Mary Jo Foreman received a nomination from the health district’s office of epidemiology (OOE) for her continued commitment to public health programs. As an infection control specialist, Ms. Foreman supports the first essential public health service which is monitoring health status to identify community health problems. She notifies the health district about diseases and illnesses that are reportable to the health district and the state health division. Her proactive disease reporting activities assist SNHD to identify communicable disease cases, control outbreaks and tract the scope of illnesses in our community. Ms. Foreman has volunteered to report cases of nationally notifiable illnesses that are not required to be reported to the State of Nevada. She has helped the health district track community-acquired MRSA infections which have been seen in emergency room patients in recent years, and hospital-acquired infections. Ms. Foreman also served as the chair of the infection control/surveillance subcommittee of Nevadans for Antibiotic Awareness, which is a statewide task force of more than 60 state and local public and private agencies committed to reducing the spread of antibiotic resistance.

In recognition of their support of public health objectives in the community, Dr. Sands and the Southern Nevada District Board of Health congratulated and thanked all of the 2007 Public Health Hero Awardees. Chair Fairchild remarked that in today’s world where there is so much negative, it is refreshing to see so many striving to make our world a better place to live and thanked the recipients again for their service.

As there continued to be no quorum, Chair Fairchild asked Dr. Sands to proceed with health officer and staff reports.

I. Health Officer & Staff Reports

National Infant Immunization Week

Dr. Sands reported that in addition to Public Health Week, this week is observed as National Infant Immunization Week. Dr. Anne Schuchat, the Assistant U.S. Surgeon General from the Centers of Disease Control & Prevention, oversees the Center for Immunization and Respiratory Services and visited SNHD earlier this week. Currently Nevada has one of the lowest immunizations rates in the country and is currently ranked 49 out of 50, with a state immunization rate of 63%. Dr. Sands invited Bonnie Sorenson, director of clinic services & nursing, and Veronica Morata-Nichols, public health nurse manager, to update staff on activities. Mrs. Sorenson said that her staff has been very busy over the last week preparing to make the community more aware of the immunization rates. Mrs. Morata-Nichols reported that staff has worked to make the NIIW a good experience for the community. Locally the event is called National Childhood Immunization Week, which is an annual observance to promote the benefits of immunization and to focus on the importance of immunizing infants against vaccine preventable diseases by age 2. This year NIIW is being held in conjunction with the Pan American Health Organization's Vaccination Week in the Americas This program has been in place since 1994 providing an opportunity for local and state health departments, national partners, healthcare providers and community leaders to highlight the positive impact of immunization on the lives of infants and children. There are currently seventeen vaccine preventable diseases, with three new vaccines added last year. Last Friday, the health district partnered with Covering Kids at J.T. McWilliams Elementary School. Commissioner Weekly and Senator Horsford were guest speakers at the event where sixty children were immunized and a total of two hundred immunizations were administered. On Saturday, we participated in the La Oportunidad Expo, sponsored by the Latin Chamber of Commerce, as well as an afternoon event at Red Rock Station with the American Academy of Pediatrics sponsored by “Every Child by Two.” Local pediatricians discussed immunizations, as well as best practices, recommendations, reminder recalls, provider outreach, reducing missed opportunities, vaccine shortages, immunization documentation, and state-wide immunization registries. The district’s community health nurses have formed a “walk-able communities” project where approximately 11,000 children not in daycare or Headstart are found and offered immunizations, as many of these children have not received recommended vaccinations. Outbreaks are a plane ride away and ensuring children have received the proper immunizations can help prevent an outbreak of vaccine preventable disease. Ms. Morata-Nichols asked for a commitment from the Board; she asked for each Board member to speak to four people before Sunday; the Southern Nevada Immunization Coalition thanked each member by giving them a t-shirt.

Mrs. Sorenson added that Jorge Viote was instrumental in helping the district become involved with the Hispanic community and a workgroup has been formed. Senator Reid read into the congressional record wording for the Las Vegas Hispanic Latin Chamber of Commerce. Their main objective is to work with the public sector and improve the immunization rate. Mr. Viote has worked diligently to improve relationships with diverse populations.

Commissioner Giunchigliani asked about the walk-able community project and how vaccinations are offered. Mrs. Sorenson said that depending upon what immunizations have been given previously a child may need as many as five or six shots, or no shots may be needed. The district uses an immunization registry that is very effective including reminder calls and allows staff to view areas by zip code with low immunization rates. Personal phone calls are made to ensure contact is made. The overall immunization rate is 80% for the district; private providers have concerns with vaccine reimbursement which pulls the compliance rate down. Staff plans to meet with private providers to have “lunch and learn” sessions to discuss current rates, schedules and proper coding for reimbursement. Commissioner Giunchigliani also asked about the reminder calls. Ms. Morata-Nichols clarified that phone calls are made to each person who comes to the district for immunizations; Hope for Worldwide Nevada is a volunteer program where once a month calls are made to parents notifying them of clinics and necessary vaccinations. Commissioner Giunchigliani expressed concern about the number of community members with no phone. Staff verified that numerous languages and tele-interpreters are provided for non-English speaking clients. Member Jones asked if this information were available for private worksites. Ms. Morata-Nichols said that kits were available and staff will work with a worksite to answer questions. Commissioner Giunchigliani asked about working with the registrars at the middle and high schools to make sure that all family members have received necessary immunizations. Kindergarten Roundup is held annually to ensure that all kindergarteners are immunized before school begins. Mrs. Sorenson said that children cannot be registered in school until proof of immunizations are received, and having a state-wide registry would aid in ensuring that all children are up-to-date with vaccinations. Commissioner Giunchigliani said that she will follow up with the registrar at her school and see if referrals can be made to the school nurse to speak with the health district about vaccination opportunities.

West Nile Virus Surveillance

Dr. Sands said that environmental health staff has begun working on West Nile Virus prevention and mosquito-borne illness control. Board members were provided with a copy of the Zoonotic Infectious Disease Surveillance report (attachment #1). Glenn Savage, director of environmental health, and Mark Bergtholdt, environmental health supervisor gave a presentation to the Board concerning West Nile Virus surveillance for 2007 (attachment #2). Mr. Bergtholdt provided an update of final counts of West Nile Virus for 2006 and what is being done in 2007 to combat mosquito-borne illness. In 2006, Clark County had three cases of West Nile Virus; northern counties had higher instances, particularly along border counties. Staff follows up on citizen complaints concerning green pools. Pools with larvae are treated with adulticide and pupicide, or larvicide, which is a growth regulator that prevents larvae from continuing to the pupa stage. Staff responded to 1,052 complaints in 2006 across Clark County. Staff treats the pool, sends the owner a notice of abatement to drain the pool, and follows up to ensure the pool is drained; if it is not drained, it is treated again to ensure no adults emerge from that pool. To date in 2007, staff has responded to more complaints than in previous years; most properties with green pools are on foreclosed properties. Staff does routine treatment in various areas having a year round supply of water, such as ditches and streams. Staff work with the agencies responsible for these areas and to remove accumulated vegetation or solid waste. Water may be treated with mosquito fish if engineering controls are not effective. Surveillance is performed on certain species of dead birds. Specimens who have been dead less than 24 hours are tested for West Nile Virus, St. Louis encephalitis and Western Equine encephalitis, all of which have been found in Clark County. Last summer one dead bird tested positive for St. Louis encephalitis; in 2007 five dead birds were tested, all of which tested negative. In Clark County, mosquito surveillance is also done routinely. In 2006, 704 traps were set, catching over 17,000 mosquitoes, with 265 mosquitoes from 17 traps tested positive for West Nile Virus. Surveillance began in April for 2007 and to date 100 mosquitoes have been caught and test results are pending. Staff, as part of the Enhanced Laboratory Capacity (ELC) grant, also perform surveillance in the southern part of Nevada. Last year $97,000 enabled staff to set 167 traps, test over 8,000 mosquitoes and find positive results for West Nile Virus in five mosquitoes from five traps; five additional mosquitoes from one trap tested positive for Western Equine encephalitis. Due to reduction in ELC grant dollars for 2007, Nye County Emergency Management Department is testing mosquitoes in Nye County.

Commissioner Giunchigliani asked if all green pools should be reported, considering some are drained once someone says something. Mr. Savage responded that all pools should be reported so the information can be entered into the database for tracking purposes and to find repeat offenders. Commissioner Giunchigliani commended staff for responding quickly to her call about a different situation that could have been a mosquito breeding ground. She also asked about clogged drainage ditches and who should be contacted to investigate the situation. Mr. Savage responded that staff will work with Public Works to remove sediment and open drains to allow water flow. Mr. Bergtholdt said that many areas of surveillance are in storm drains. If water stands for more than three weeks, staff should be notified to see if water can be drained working with the appropriate agency – mosquito fish and other controls can also be used. Chair Fairchild said that Flood Control is asking for notification of clogged storm drains to resolve these issues. Mr. Savage said that staff can go to rural areas for presentations and education if needed.

Dr. Sands commented that staff’s early surveillance assists in ensuring there is not a problem with mosquito-borne illnesses later in the year. Member Jones asked about coordination with the Lake Mead area. Mr. Savage responded that staff has worked with the National Park Service and have not found large number of mosquitoes in their 2006 surveillance. Staff will assist if a problem occurs.

Nevada Clean Indoor Air Act (NCIAA)

Dr. Sands announced that Steve Minagil has joined the District full time as in-house counsel and is devoting much of his time to enforcement of the Nevada Clean Indoor Air Act. Mr. Minagil said that the district is about to enter the judicial enforcement phase. To date, staff’s approach has been education and discussion first, making sure that all business and establishments in Clark County know the requirements of NCIAA, as well as continuing discussions with businesses daily about compliance issues and how their individual establishments can come into compliance. Many establishments rather than deciding to advise patrons that the establishment is non-smoking as food is served have opted to keep smoking customers and terminate food service or wall off areas of food service to have two separate establishments. Staff in Environmental Health has been tracking complaints of violations of the Act. Correspondence has been sent to nine particular establishments who have received the most complaints. Staff has verified violations, meaning unannounced visits by inspectors, with cameras, documenting how the particular establishments violate or undermine the Act. Once the citizen complaints are verified, a letter is sent under his signature stating that the Act has been violated and documenting the method used to undermine the Act. The establishment is invited to meet with staff and confirm that the activity will cease. If the establishment fails to meet with staff and confirm that they have abandoned this method of undermining the Act, they will be the subject of a civil action being filed. Of the nine letters sent to verified violators, staff has met with two establishments and they have agreed with staff’s interpretation of their obligations under the Act, they will comply by removing ashtrays and posting signs as well as instructing their staff to advise patrons that the establishment is non-smoking. Staff will meet two more establishments in the next few days. Communication has been received from one establishment that they will not comply with the Act. They have invited the District to sue them. The first judicial action will be filed in District Court next week against that establishment. Staff is prepared to file the same lawsuit against other establishments who decline affirmatively to comply with the Act; if they choose to comply, staff will perform follow up visits to ensure compliance; if they do not comply, a civil action will be filed. Staff in Environmental Health has been very active in educating the public and businesses and maintaining an open door policy with businesses affected by the Act. The District is now at the end result of the process which is to file a judicial action against establishments that intentionally and willfully choose not to comply with the Act. Notice of filing will be in the press next week; we are continuing to try and work with establishments, discuss compliance issues, invite them to speak with us, and ensure they are not violating the Act.

Member Crowley asked if we are successful in the lawsuit, what will that mean to the establishment that is not successful. Mr. Minagil explained that there are two matters we are seeking from the lawsuit: first, the Act provides for a monetary penalty of $100 which goes to a state education fund; second and more importantly we would like orders from the Court that 1) declares this particular type of activity is in violation of the Act; and 2) restrains the establishment from continuing to operate in this particular manner. This order can be enforced with contempt of court proceedings.

Member Jones asked if there is any leverage or privilege with liquor licenses as a point of action. Mr. Minagil responded that we must exercise the power we have at this time – we have no power over gaming and liquor licenses; perhaps some of the other jurisdictions will take action. The health authority has the obligation to enforce the Act and this is the method we’ve chosen as this point.

Chair Fairchild agreed with Member Jones and suggested that staff contact the jurisdiction involved; if the jurisdiction could have a show-cause hearing and find that an establishment is in violation of their licenses, if those licenses are pulled, there will be a financial impact. She asked that staff keep jurisdictions involved and notify each jurisdiction of upcoming lawsuits, this will help maintain a solid working relationship and bring establishments into compliance. Mr. Minagil said that we plan to do this, and are optimistic that the approach we are following with meeting with establishments will help to resolve issues and bring them into compliance.

Member Crowley said that the Act specifies that the legislature cannot take action on smoking related issues until the 2009 session. She inquired how far local jurisdictions can go if the legislature cannot take action. Mr. Minagil said that the Act provides that local jurisdictions have the authority to pass particular ordinances; it is only at the legislative level where action cannot occur.

Member Giunchigliani asked if the name of the establishment being sued can be released. Mr. Minagil replied that he would rather wait to release this information when the suit is filed. She also asked if the District has a budget for legal issues. Dr. Sands responded that the legal budget is for Mr. Minagil’s salary. Member Giunchigliani clarified that there is no liability budget or contingency fund for legal actions. Dr. Sands said that was one of the many benefits of having in-house counsel. Our expectation is that we will only have to file suit a few times, and it will not become a regular activity. Dr. Sands also informed the Board that an enforcement page will be added to the NCIAA section of our website, where all legal activities will be posted as well as the correspondence sent to non-compliant establishments. Inspection reports will also be posted as they occur in terms of NCIAA. Member Giunchigliani asked if restaurant grades will include smoking violations. Dr. Sands clarified that we are not using a ranking system in regard to NCIAA; there is a simple inspection form showing that establishments are in compliance with NCIAA by removing ashtrays, posting signs, etc. Dr. Sands said that we have over 16,000 permitted establishments and since November we’ve received over 2,000 complaints, representing about 600 businesses.

Chair Fairchild noted that a quorum was not present. She asked to proceed with citizen participation.

II. Citizen Participation:

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

Chair Fairchild asked if any other member of the audience wished to speak. No one came forward and the citizen participation portion of the meeting was closed.

As no quorum was present, Chair Fairchild asked that all items requiring action be brought back before the May meeting of the Southern Nevada District Board of Health. (See items below)

III. Consent Agenda:

Tabled until May 24, 2007 meeting due to lack of quorum

Items for action to be considered by the Southern Nevada District Board of Health which may be enacted by one motion. Any item may be discussed separately per Board Member request before action. Any exceptions to the Consent Agenda must be stated prior to approval.

1. Approve Minutes / Board of Health Meeting: 3/22/07
2. Approve Payroll / Overtime for Periods: 2/24/07 – 3/09/07 & 3/10/07 – 3/23/07
3. Approve Accounts Payable Registers: #1067: 3/01/07 – 3/08/07; #1068: 3/09/07 – 3/14/07; #1069: 3/15/07 – 3/21/07; #1070: 3/22/07 – 3/28/07; #1071: 3/29/07 – 4/04/07
4. Appointment of Nominating Committee for Fiscal Year 2008 Board of Health Officers (Chair Fairchild, Members Kirk & Reese)
5. Petition #12-07: Approval of Family Planning Title X 2007 Fee Schedule for CT (Chlamydia) & GC (Gonnehrea) Laboratory Services

IV. Public Hearing / Action

Tabled until May 24, 2007 meeting due to lack of quorum

1. Variance Request to Operate a Food Establishment not in Compliance with the District Board of Health Regulations 1996 Governing the Sanitation of Food Establishments (APN #162-03-301-002). Petitioner: Anita Jankovics, President, Little Tiny Diner, Inc., 365 Apple River Court, Las Vegas, Nevada. (Postponed from March 23, 2007 meeting)
   
   
2. Variance Request to Operate a Public Bathing Place not in Compliance with the Nevada Administrative Code (NAC)444, Public Bathing Places, NAC 444.204 (APN #179-18-802-008). Petitioner: City of Henderson Parks & Recreation, Dominick Casey, Acting Superintendent.

V. Report / Discussion / Action

Tabled until May 24, 2007 meeting due to lack of quorum

1. Memorandum #17-07: Appointment of Robert Schmidt as Emergency Medical Services Hearing Officer
   
   
2. Petition #11-07: Approval to Seek Funding for New Main Campus

VI. Informational Items - Duly Noted

VII. Adjournment

There being no further business to come before the Board, Chair Fairchild adjourned the meeting at 10:01 a.m.

Submitted for Board Approval

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

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Attachment #1: Zoonotic Infectious Disease Surveillance Annual Report 2006 PDF (879 KB/11 pages)

Attachment #2: Mosquito Control and West Nile Virus Surveillance 2006 Review & 2007 Update PDF (2.1 MB/27 pages)