Board Meeting Minutes - November 2008 - Southern Nevada District Board of Health

Southern Nevada District Board of Health Meeting
November 20, 2008 - 8 a.m.

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

Chair Giunchigliani called the meeting of the Southern Nevada District Board of Health to order at 8:01 a.m. and led the Pledge of Allegiance. Chair Giunchigliani noted that a quorum was present. Stephen F. Smith, Esq., Legal Counsel confirmed the meeting had been noticed in accordance with Nevada’s Open Meeting Law.

Board Members Present:

Chris Giunchigliani — Chair, Commissioner, Clark County
Steven Kirk — Vice Chair, Councilman, Henderson
Ricki Barlow — 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
John Onyema, MD — Alternate At-Large Member, Physician
Gary Reese — Councilman, Las Vegas
Barbara Ruscingno, RN — Alternate At-Large Member, Registered Nurse
Bubba Smith — Councilmember, Mesquite
Linda Strickland — Councilmember, Boulder City
Lawrence Weekly — Commissioner, Clark County

Absent:

Robert Eliason — Councilman, North Las Vegas
Joseph Hardy, MD — At-Large Member, Physician
Mary Jo Mattocks, RN — At-Large Member, Registered Nurse

Executive Secretary:

Lawrence Sands, DO, MPH

Legal Counsel:

Stephen F. Smith, Esq.
Shaun Haley, Esq. Fisher & Phillips

SNHD Lobbyists:

Bryan Gresh
Gary Milliken

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

Other SNHD Board of Health Members/Alternates Not Present:

Travis Chandler — Councilmember, Boulder City Alternate
Tom Collins — Commissioner, Clark County Alternate
Frank Nemec, MD — Alternate At-Large Member, Physician
Steven Ross — Councilman, Las Vegas Alternate
Gerri Schroder — Councilwoman, Henderson Alternate
Stephanie Smith — Councilwoman, North Las Vegas Alternate

Staff: Scott Weiss; John Middaugh, MD; Angus MacEachern; Glenn Savage, Bonnie Sorensen; Stephanie Bethel; Jerry Boyd; Mary Ellen Britt; Dennis Campbell; Rory Chetelat; Sylvia Claiborne; Alice Costello; Steve Goode; Mary Ellen Harrell; Forrest Hasselbauer; Dale Klabacha; Angela Jones; Eddie Larsen; Brian Labus; Ann Markle; Patricia O’Rourke-Langston; Christina Madison; Kieawa Mason; Naim Qazi; Walter Ross; Patricia Rowley; Jane Shunney; Leo Vega, Jennifer Sizemore; Jorge Viote; Leisa Whittum; Deborah Williams; Linda Zielinski; Valery Klaric and Shelli Clark, recording secretary

Attendance:

Name	Representing
George Anderson	Self
Leroy Anderson	Self
Michael Biel	Kafoury, Armstrong and Company
Stephanie Bruning	CNLV
Jerry Ernst	Self
Randy Erwin	AAEQ
Katie Fellows	Jones Vargas
Murat Gunes	Student Pharmacist
Melissa Gullickson	Mass Media Corporate Communications
Ashley Isom	Student Pharmacist
Tami Miramontes	Kafoury, Armstrong and Company
Bob Motis	A-1 Organics
Chris Salm	SEIU
Tracy Scott	City of Las Vegas
Cheng T. Shih	City of Las Vegas
Rob Tidwell	Republic Services
Chuck Wilson	A-1 Organics
Bob Yost	A-1 Organics

Recognition:

Aid for AIDS of Nevada: Sue Kulkrep, NR – Senior Public Health Nurse / Lourdes Yapjoco, RN – Community Health Nurse II-Case Manager

2008 Silver Syringe Awards

In the interest of time and as the employees to be recognized were not present at the meeting, Chair Giunchigliani asked that the two recognition items be continued to the December 18, 2008 Board of Health meeting.

I. Closed Session - To Be Held at Beginning of Meeting

Meeting of 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 Member Kirk to close the meeting at 8:02 a.m. The motion was seconded by Member Strickland and was unanimously approved.

Closed Session

The meeting recessed for the Southern Nevada District Board of Health to meet in Closed Session. Chair Giunchigliani reconvened the open session at 8:45 am.

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.

Approve Minutes / Board of Health Meeting: PDF 678KB 10/23/08

Approve Payroll / Overtime for Periods: 10/04/08 – 10/17/08 and 10/18/08 – 10/31/08

Approve Accounts Payable Registers: #1149: 10/02/08 – 10/09/08; #1150: 10/10/08 – 10/16/08; #1151: 10/17/08 – 10/23/08; #1152: 10/24/08 – 10/29/08; #1153: 10/30/08 – 11/06/08

Petition #32-08: PDF 52KB Approval of Amendment Number 1 to an Interlocal Agreement with Clark County Social Service (CCSS): Tuberculosis Test Services CCSS Employees for FY 09

Petition #34-08: PDF 2.2MB Approval of Interstate Interlocal Contract with Nevada Department of Health and Human Services for the Food Stamp Nutrition Education Program Also Referred to as the Nevada Supplemental Nutrition Assistance Program (SNAP)

Petition #35-08: PDF 289KB Approval of Interstate Interlocal Contract with Nevada State Division of Environmental Protection for Local Underground Storage Tank Program (Four Year Renewal)

Petition #36-08: PDF 154KB Approval of Revised Classification Specifications for Senior Public Health Preparedness Planner (formerly Senior Biopreparedness Planner), Recommended Schedule 24 ($58,919 - $82,204) and Public Health Preparedness Planner I/II (formerly Biopreparedness Planner I/II), Recommended Schedule 20/22 ($48,071 - $67,007 / $53,216 - $74,196)

Petition #37-08: PDF 70KB Approval of Revised Classification Specification for Financial Services Manager, Recommended Schedule 29 ($76,078 - $106,132)

Chair Giunchigliani asked if there were any changes to the Consent Agenda or discussion on specific items; seeing none she called for a motion to approve the Consent Agenda.

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

III. Public Hearing / Action

Memorandum #07-08: PDF 1.4MB Application for Approval for A-1 Organics Nevada, LLC to Operate a Solid Waste Management Facility – Compost Plant, Located at 9325 South Jones Blvd., Las Vegas, Nevada 89139 (APN 176-23-701-009, 176-23-801-002, 176-23-801-011 and 176-26-501-003, SNHD Control No. CP002-XXX-01 Continued from October 23, 2008 meeting

Chair Giunchigliani declared the public hearing open.

Naim Qazi, plan review manager, spoke relative to this matter. Mr. Qazi said that A-1 Organics has met all requirements for a compost plant as specified in Subsection 1 of NAC Chapter 444.670. Staff recommends approval based on the final inspection based on conditions as outlined including requesting a variance to Subsection 2 of NAC 444.670 regarding land use approval requirements and obtaining a variance within six months from Clark County in reference to the buffer zone requirement of at least 500 feet from the adjoining property and 1,000 feet from any public roads. Bob Yost, representing A-1 Organics, was present to answer questions of the Board.

Chair Giunchigliani asked Mr. Yost if he understood and was in agreement with the conditions as outlined. He responded affirmatively.

Member Weekly asked Mr. Yost if he was familiar with conditions recently placed into an ordinance dealing with gravel batch and compliance with county regulations for residential adjacency, noise and hours of operations. Mr. Yost responded that he was familiar with the ordinance and stated that their operation is located within the gravel facility, but is separate, and located there as they have like-use issues.

Member Crowley inquired about the plan of action if the variance was not granted and Mr. Yost responded that the parcels they are contained within have the potential for future movement within the facility and would involve parts of the gravel operation lines. Walter Ross, environmental health engineer/supervisor, stated that this condition is conditional on the permit and if the variance was not approved and the operation was unable to move the required distance the permit would be rescinded. Composting odors are controlled by technologies and methods developed and they use plastic sleeve technology for items creating a nuisance condition which would be contained within the in-vessel system. All public hearings and notices have been completed.

Chair Giunchigliani asked if anyone from the public wished to speak to this matter. No one came forward to speak and Chair Giunchigliani closed the public hearing.

A motion was made by Member Crowley to approve the application as submitted with the conditions outlined in the memorandum; seconded by Member Strickland and was unanimously approved.

Memorandum #16-08: Application for Approval for Las Vegas ARC International to Operate a Solid Waste Management Facility – Recycling Center, Located at 4606 Andrews Street, North Las Vegas, NV 89031 (APN 140-06-510-002) Application withdrawn by applicant

Memorandum #15-08: PDF1.2MB Application for Approval for the City of Las Vegas West Maintenance Yard to Operate a Solid Waste Management Facility – Transfer Station, Located at 2870 Ronemus Drive, Las Vegas, NV 89128 (APN: 138-15-201-002), SNHD Control No. TR008-XXX-01 Continued from October 23, 2008 meeting

Chair Giunchigliani declared the public hearing open.

Naim Qazi, plan review manager, spoke relative to this matter. Mr. Qazi said that City of Las Vegas has met all requirements to operate as a transfer station as specified in Section 4 of the Transfer Station Regulations and satisfied all the land use approval requirements for Clark County. Staff recommends approval based on conditions and final inspection. Tracy Scott, representing the City of Las Vegas was present to answer questions of the Board.

Member Barlow noted that he intended to abstain, but in reviewing the documents he noted that Member Weekly voted on this item so he can proceed to vote.

Member Crowley stated that although the Board of Health is the solid waste management authority, it is different than setting up the business of collecting trash and having actual transfer stations – that is the responsibility of Clark County. She said that Republic Silver State has a franchise that also covered transfer stations. Chair Giunchigliani indicated there are only seven transfer stations referenced in their franchise agreement; the City would need additional approval. Approval is for permitting of the facility and an additional business license is not required.

Chair Giunchigliani asked if anyone from the public wished to speak to this matter. No one came forward to speak and Chair Giunchigliani closed the public hearing.

A motion was made by Member Crowley to approve the application as submitted with the conditions outlined in the memorandum; seconded by Member Strickland and was unanimously approved.

Memorandum #17-08: PDF 1MB Application for Approval for AAEQ Manufacturers and Recyclers to Operate a Solid Waste Management Facility – Recycling Center, Located at 2580 N. Commerce Street, North Las Vegas, NV 89030 (APN 139-15-801-001 & 139-15-701-003), SNHD Control No. RC026-XXX-01

Chair Giunchigliani declared the public hearing open.

Naim Qazi, plan review manager, spoke relative to this matter. Mr. Qazi said that AAEQ Recycling has met all requirements to operate as a recycling center as specified in Section 4 of the Recycling Center Regulations and satisfied all land use approval requirements for Clark County. Staff recommends approval based on conditions and final inspection. Randy Urban, representing AAEQ Manufacturers and Recyclers was present to answer questions of the Board.

Chair Giunchigliani asked Mr. Urban if he agreed with the conditions as outlined and in agreement. Mr. Urban responded affirmatively. He reported that they accept steel, copper, metals and some engines, which they break down and rebuild as reusable cores. Chair Giunchigliani asked if they maintained a log book for monitoring collection of copper. Mr. Urban replied that they utilize Scrapdragon system to log the collection, and also take a fingerprint scan prior to purchase in addition to collecting photo identification – they were one of the first companies to begin using this software. The system currently prints a bar code that the customer takes to their 24/7 camera-monitored Brinks ATM that scans the bar code for payment.

Chair Giunchigliani asked if anyone from the public wished to speak to this matter. No one came forward to speak and Chair Giunchigliani closed the public hearing.

A motion was made by Member Crowley to approve the application as submitted with the conditions outlined in the memorandum; seconded by Member Weekly and was unanimously approved.

IV. Report / Discussion / Action

Due to the interest of time and the possibility of losing a quorum, Chair Giunchigliani took the following items out of the posted order.

Recommendation to EMS Staff Concerning Emergency Measures if Paramedic Strike Should Occur

Rory Chetelat, EMS & trauma system manager, spoke relative to this item. There has been a great deal of information in the media of late concerning this potential strike. Mr. Chetelat reviewed the role of EMS – staff is responsible for licensing and certifying individuals working in the permitted agencies, as well as permitting the agencies themselves. EMS is not part of the franchise agreement, but staff does attend meetings to gather information and to answer questions about our role. If a strike should occur, we will wait for the state, city or county to seek assistance in certifying out-of-state personnel. Mr. Chetelat has been in lengthy discussion with Las Vegas Fire & Rescue, who will feel the largest impact, as AMR is the majority of the franchise. There are strong contingency plans in place in the event a strike occurs and are confident they can handle the additional capacity immediately. The county fire department’s area is covered by AMR by roughly half. They also have contingency plans in place and they believe they can handle to additional load for a short period of time. Henderson and North Las Vegas fire departments will not be directly impacted by a strike; however they are also developing contingency plans if any impact occurs. Everyone is prepared. As of yesterday, AMR is also developing plans for those individuals they believe would be available to staff units. They are confident the issues can be resolved, but will have contingency plans ready.

If there were a request to bring in personnel from out-of-state, our regulations currently require 120 hours of reciprocity on our ambulances to learn protocols. There are no requests at present and most feel the issues will be resolved before the strike date.

Chair Giunchigliani said NLRB has been asked for assistance. She asked if the city can charge for services; the county is unable to do so. Mr. Chetelat verified the city can charge for services.

Member Weekly said that in discussions with the fire chief, a strike will place everyone in a precarious situation. We need measures in place to ensure the safety of the public. He is hopeful that this will be resolved before the holidays.

Chair Giunchigliani said that even though the county is the first responder, they cannot bill for services – other companies must come in.

Member Weekly thanked staff for the presentation. He wanted to be clear that the health district is not responsible for this and the role of the health district is limited. It is not Dr. Sands’ place to make a statement on this issue – it is the responsibility of the jurisdictions. He wants to ensure that everyone is on the same page with the same message.

Chair Giunchigliani said that no matter what occurs, the safety of our citizens is the foremost priority.

Petition #39-08: PDF 301KB Approval of Revision of Family Planning Fee Schedule

Scott Weiss, director of administration, presented on this item. He indicated that there were no fee increases at this time – the item was brought forward to correct some generic brand names and clarify some of the CPT and IC9 codes for the actual drugs for billing purposes.

A motion was made by Member Barlow to approve the revision to the fee schedule as presented; seconded by Member Christensen and was unanimously approved.

Petition #40-08: PDF 244KB Approval of Two Additional Positions of Disease Data Collection Specialist/Interviewer, Recommended Schedule 14 ($35,350 - $49,331)

Mary Ellen Harrell, community nurse manager, spoke relative to this item. Member Barlow asked if the new positions would be filled via the grant or health district funding. Ms. Harrell said they are grant positions through Ryan White Part A to help Clark County Social Services, the grantee of the Ryan White grant, conduct continuous quality management activities. This will allow us to begin showing whether there are good medical outcomes with Ryan White monies. The recruitment will specify that the positions are grant funded.

Dr. Sands clarified that if the funding goes away, and other positions are available staff could be moved into open positions.

Member Barlow said that some individuals feel that even though their positions are grant funded that they are district employees and should retain employment after a grant ends. Ms. Harrell confirmed that if the grant ends, and there are vacancies in the same classification, the displaced employee can be transferred. Employees selected for these two particular positions will sign an acknowledgement that this is a grant-funded position.

A motion was made by Member Kirk to approve the new positions as submitted; seconded by Member Barlow and was unanimously approved.

Memorandum #24-08: PDF 34KB Approval of Fiscal Year 2007-2008 Audit Report by External Audit Firm Kafoury, Armstrong & Co.

Scott Weiss and Sylvia Claiborne, financial services manager, presented this item. Mr. Weiss said that this audit report went before the Audit Committee on Monday, November 17, who subsequently recommended full approval to the Board of Health.

Chair Giunchigliani asked for clarification on the auditors’ two recommendations for internal control issues (attachment #1). Michael Biel of Kafoury, Armstrong & Co. replied that there was a question of use of fixed assets software and accumulated appreciation from the prior year. Reconciliation has begun and staff are in the process of fixing the software issues. The second issue sought the establishment of written procedures and policies for the IT department, in the event of an employee absence and someone filling in for that individual so workflow could continue. A further recommendation was the establishment of quarterly changes on security passwords and certain user information – as of December 1 quarterly changes will be necessary to user passwords.

Member Jones, chair of the audit committee, said that the recommendations were not material to the quality of the overall operation but more continuous improvement recommendations.

A motion was made by Member Strickland to approve the audit report for FY08 as presented; seconded by Member Smith and was unanimously approved.

Mr. Weiss noted that Ms. Claiborne is leaving the district. He thanked her for her service and noted that under her leadership the district has received a CAFR award for four years running. Chair Giunchigliani also thanked Ms. Claiborne for her service and professionalism and wished her good luck in her future endeavors.

Receive Report on Inspection of Pools and Spas in Clark County; Direction to Staff

Glenn Savage, environmental health district, Angela Jones, environmental health/plan review supervisor, and Naim Qazi, plan review manager, presented this item to the Board.

Mr. Savage said that staff was here to address the concerns raised by Gerald Ernst at the last Board meeting (attachment #2). Ms. Jones will also update the Board relative to the Virginia Graham Baker Act, which affects both public and residential pools in Clark County.

Mr. Qazi said that staff researched the information presented by Mr. Ernst, as well as met with him to see if his concerns could be resolved. Mr. Qazi said that after discussions with legal counsel it was determined that we cannot accept Mr. Ernst’s full requests for the following reasons: increasing the temperature of spas to a range of 102° to 140° will limit the amount of time citizens can spend in the water; having a heated swimming pool to have an operating temperature of 82° - 87° will have an impact on the pool operators/managers and can be very costly and not energy conscious; allowing for public access of maintenance records is not in the best interest of the public or public health as management is not protected for those who are not health inspectors to view records – records are for the view of inspectors; there is no need to change the definition of public bathing areas as NAC 444.058 addresses the points described by Mr. Ernst – mobile home park pools are considered public bathing areas. In order for the Board to consider these changes, there is a formal process, including public hearings, in order to make the proposed changes. Staff recommends Mr. Ernst work with the pool managers on these issues.

Chair Giunchigliani clarified that the information in dark print on the handout are Mr. Ernst’s requests.

Mr. Ernst said this has been a problem since 2003 and he first addressed the Board at the time, and was directed to work with Dr. Kwalick. At that time, the pool and spa at the park were closed for a week, and Mr. Ernst contacted Mr. Savage for assistance. Steven Goode was put in charge of the meetings, however no action was taken nor was there resolution – the meetings generated solely general conversation. The citizens are concerned that not only should the pool and equipment need to be maintained properly but that this could be a recurring problem in the manufactured home community. He said these are retirement communities where seniors live – not trailer parks. He would like to have the inspection reports made available to the general public who use the bathing areas. There is concern about infections and rashes resulting from the chemicals used and the temperature of the water. He said seniors are using the bathing areas for therapeutic use and would like to see the temperatures raised to more comfortable levels. He feels that the Board of Health should take action to assist the residents of these communities.

Chair Giunchigliani asked for clarification on the pool closure. Mr. Ernst said that the pool was too cold for certain activities and when asked, management said the pool only needs to be heated to 70°. He would like to add the word “spa” to the definition of a public bathing area.
Member Crowley said that the Board of Health is restricted to regulating health-related issues. Unless there is a health-related requirement to have a pool heated to 85°, there is no reason for the Board to do anything different. The Board of Health does not regulate comfort – they regulate what is healthful. Staff is obligated to base decisions on health, not comfort or what is desired.

Mr. Ernest said this was explained to him early on and the possibility of temperature adjustment was negligible. He said that the health district should inspect the issues of skin rashes and infections incurred by citizens using the bathing areas. When calls are made to the health district, inspectors are sent out and adjustments are made. He feels more inspections are necessary and the public should be able to see the reports.

Member Barlow asked the physician members if citizens could have rashes and infections from bathing in these areas. Member Christensen said it is possible, but all other sources need to be considered as well. Member Onyema said that there is no relationship to incidences of vaginal infections due to the temperature of a pool.

Chair Giunchigliani said that posting the use of chemicals will help in explaining the rashes. Member Barlow said that it appears that Mr. Ernst was trying to make a correlation between the pool temperatures and skins rashes/infections. Mr. Ernst said that the water temperature is the driving factor as this is not addressed in the spa category of NAC 444.

Chair Giunchigliani said that Member Crowley was correct in stating what the role of the Board was; however she felt that there should be standard for water temperature. She asked for the reasons pools are closed.

Ms. Jones said that pools are not required to have a temperature range; spas are required to be heated between 70° - 104°, which is specified in the operational section of the regulations and NAC. Pools are closed for not having self-latching gates, gates not closing properly, chlorine levels exceeding acceptable limits, depth markers missing, inadequate life-saving equipment and such. The documentation is provided to the pool operator and violations are reviewed so corrective action can be taken. If fees need to be paid clients may do so at the closest public health center. Re-inspections are completed to ensure all violations have been corrected. There is no law requiring inspection records to be posted in visible areas at the site. The records are available for public inspection in the Environmental Health Office. There is nothing in place prohibiting making the records available at the place of operation.

Member Jones asked what resolution came from talking with management and pool operators about citizens having more input and participation. Mr. Ernst said that their situation is very unique and that management is looking into the concerns.

Chair Giunchigliani asked if the crux of the issue was having access to the records – she felt there was compromise available on this issue. Member Jones said that the regulations require the pool operator to manage the conditions of the pool and the facility is owned by the mobile home park. The residents need to have an effective relationship with the pool operator to have access to the records.

Mr. Ernst said the residents solely want access to the information. Currently only inspectors are able to read the information. The people using the facility are not able to view the records. By seeing the records each day, the residents would have more confidence in the work being done in maintaining the pools.

Mr. Savage said that over the years staff has called the management group and offered to work with them in providing the pool records. Mr. Savage said that he would consider his request a public information request and send a copy of the records each time an inspection occurred. Mr. Ernst and the residents were also able to provide information to the health district to monitor pool maintenance and the management group was not open to this idea either. There are logistical issues in posting the records, but they are matters of public record and available upon request.

Chair Giunchigliani said the Board could focus on item #3 and post the records. Mr. Savage said that in the course of an inspection the pool is closed, and residents are not aware of the reasons for closure unless they speak with a supervisor. Member Crowley said the public can always call and receive a copy of the report – it does not have to come from the management office.

Member Jones said that hotels could keep the pool records at the desk for review; however he does not feel that this could be regulated. Chair Giunchigliani said that posting NAC providing a written record for facilities that apply for use by two or more permanent residents in a gated or association community would cover the parks, and put this forth as a motion. Member Strickland seconded the motion.

Member Crowley asked for clarification on what the vote would be on. Chair Giunchigliani said that the motion is in reference to item #3 on Mr. Ernst’s request to add the NAC language to clarify that this only pertains to facilities in use for two or more permanent residents in a gated or association community. Member Crowley said that the Board of Health cannot change NAC. She said that the district has regulations resultant of NAC. Mr. Smith said that this issue would need to be opened up for discussion between the pool industry operators and there could be different points of view. This is a record-keeping issue and would involve SNHD if there were to be amendments. Do we want the health district involved in disputes about record-keeping, posting and draining its resources rather than doing inspections and acting on complaints?

Chair Giunchigliani asked why this issue was brought to the Board. She said that she will talk to Assemblyman Manendo about a BDR to make some of these changes and accommodations. Mr. Ernest said that the Board of Health can make changes at any time and did not have to go to the legislature for changes. Chair Giunchigliani said she will meet with Mr. Ernst on an individual basis and bring information back to the Board for discussion. Dr. Sands said that staff will meet and provide recommendations about what we can do and work with our partners at the state level to make any regulatory changes if needed.

Mr. Savage said that the state has given the district carte blanche to work on rewriting the regulations to include various issues, including the Virginia Graham Baker Act, and bring it before the Board of Health and the State Board of Health.

Member Crowley asked for the statute which stipulates a local board of health can amend NAC. Mr. Ernst referred to NRS 444.070 which reads: “The health authority shall supervise the sanitation, healthfulness, cleanliness and safety of public swimming pools and bathhouses and the State Board of Health or local board of health may adopt and enforce such rules and regulations pertaining thereto as it deems necessary to carry out the provisions of NRS 444.065 to 444.120, inclusive.” Member Crowley said that the Board can establish regulations for themselves; however we cannot change NAC, as those are state-based rules provided by the legislature.

Chair Giunchigliani said this issue will come back as an agenda item for discussion. Staff will bring forward some recommendations, as well as copies of the NRS and NAC for review. The Board sets regulations for how to implement the NAC.

Member Jones also said that the pool records are one day in time – conditions change rapidly. We can provide access to the information, but it may be quickly out of date.

Mr. Savage said that the Board has directed staff to have a workshop process and public hearings in order to make changes.

LeRoy Anderson addressed the Board in support of Mr. Ernst’s comments. He said that he would like to see all senior parks be treated the same and focus on all issues facing the seniors.

Member Crowley said that we must exercise caution about setting regulations that may be problematic for others involved. Making information available to those using facilities makes sense but requiring posting of legible records can be difficult; making it available is a different story.

Ms. Jones offered clarification on the Virginia Graham Baker Act, which is effective December 19, 2008 and requires all public and residential pools to use ASME/ANSI covers on all suction outlets, including main drains, booster lines, water features, play parks, etc. The Consumer Product Safety Commission is the enforcing agency as this is a federal law. Staff is advising people on the Act. CPSC stipulates that any pool not in compliance by December 19, 2008 should be closed until in compliance. Fines range from $1.2 - $15 million for someone found operating a non-compliant pool. If a complaint is filed with CPCS, the agency must respond and investigate the complaint.

Member Barlow said his pool has been closed up to 45 days because he is unable to find the drain cover. Ms. Jones said many are experiencing this same problem. The items are not on the market as yet, and CPSC will not change the compliance date. Those taking steps to come into compliance will not be held liable. CPSC expects to have more products available soon. There are only 117 employees to enforce this federal law and CPSC will be meeting with local partners to seek assistance in enforcement. Currently staff is providing education, not enforcement. Member Barlow said he does not want to receive a fine where there are no products available to make his pool compliant. The fines go to the federal government.

Receive Report on Legislative Planning for 2009 Session; Direction to Staff

Jennifer Sizemore, public information manager, and SNHD lobbyists Bryan Gresh and Gary Milliken presented this item to the Board. Staff has been working on various issues we need to track and a report was provided to the Board (attachment #3). Ms. Sizemore indicated that the information provided is the foundation for the reports which will be done on an ongoing basis. Staff has identified our top priorities, which include funding issues, and what might ultimately affect the health district and the funding we receive. Other issues include children’s health issues which encompasses immunizations and Vaccines for Children; another item are the recommendations put forth as a results of the hepatitis C outbreak; lastly staff is looking at items affecting the Nevada Clean Indoor Air Act and tobacco control programs. Staff is tracking current BDRs which fall under these main categories. We have cast a wide net to ensure we do not miss any bills which may potentially affect the health district – in the past bills have gone forward that adversely affected environmental health. This is a work in progress and updates will be provided to the Board as the session progresses.

Member Crowley asked to have updates on a regular basis. Ms. Sizemore said that she will capture any testimony presented and a monthly report in the Board book will be provided; other information will be sent via email as it occurs. Both Mr. Gresh and Mr. Milliken will be in Carson City full-time when the session begins.

Mr. Gresh said they will continue to represent the district in coordination with other entities represented by the Board, as well as other interested parties. There is ongoing dialogue with each entity and they will continue to meet and discuss issues as opportunities arise. They will reach out to lawmakers on a continual basis and take advantage of that time to promote the health district, our needs and agenda. Recently they met with Dr. Sands and Ms. Sizemore along with three state senators and an assemblyperson at a United Way function.

Mr. Milliken said there is a weekly update of BDRs that comes out and some do not pertain to the health district. Some do not have language or a legislator assigned yet – these are turned over the Legislative Counsel Bureau (LCB) to be written. In addition, our lobbyists follow both the Ways and Means Committee as well as the Finance Committee as funding is a large issue this session. They will also monitor the health division for their budget proposals and see if anything will be passed to the health district resulting in a larger financial burden to the district and Clark County. There will be a special session in December resultant of the special meeting on December 1. Any economic issues addressed are for the current biennium.

Member Barlow asked who sets the agenda for the health district as it pertains to the agenda for the legislative session. Dr. Sands said that input from both the executive and senior management teams was received relating to various programs. This information was then discussed in executive team to define the priorities and overall issues we need to address. Chair Giunchigliani asked if any BDRs have been prepared by the health district. Dr. Sands said none have been at present. She said that the Board should be able to determine their legislative priorities as well. Ms. Sizemore said that is why they are before the Board today. Chair Giunchigliani asked for this item to be agendized at the next meeting to provide further direction to staff. She said that she does not understand why the County solely funds the health district and why other municipalities do not participate. She asked if Mr. Gresh and Mr. Milliken could provide a history on that funding.

Member Barlow asked how many BDRs can be presented by the health district. Mr. Gresh said we have no BDRs – this must be done through a legislator or local government. The health district is not assigned any BDRs. Because of our relationships with various legislators we would have no problems in finding a sponsor if needed.

Dr. Sands said that the purpose of preparing the information today was to seek input from the Board and to ensure everyone is on the same page, including staff. We do not want staff representing the district on an issue that has not been approved.

Member Barlow said he would like to have conversation with staff and the Board regarding this issue. The Board should have had more input in preparation of this initial document. Chair Giunchigliani said once the session is underway we’ll have a better idea of where things are going.

Mr. Gresh said that he was not presenting this information to the Board – the Board is presenting information to him. He said the Board sets the agenda for our legislative planning and staff will listen to the Board’s needs; he and Mr. Milliken are very in tune with the happenings in Carson City and have a feel for what is going on. Ms. Sizemore has been instrumental in gathering information and keeping everyone informed. Chair Giunchigliani commended Ms. Sizemore on the information presented. Revision dates will be included on future updates, as well as staff’s thoughts on different issues. The Board is in agreement that the four key priority issues are on target.

Review/Implement Policy/Procedures for Health District Acceptance of Checks/Credit Cards; Direction to Staff (Chair Giunchigliani requested item)

Chair Giunchigliani said she had been contacted by a constituent regarding personal check acceptance and credit card acceptance. His ID did not match his credit card and the payment was not accepted. She asked for clarification on acceptable methods of payment for services.

Mr. Weiss said that in reference to the kiosk suggestion from the previous meeting, our needs do not match the service. Kiosks are used when there is no need for interaction with persons whereas our services require interaction. An ATM machine is available and almost $408,000 has been taken from the machine. A cash system is available when needed. A bank fee is charged for use, and approximately $10,000 comes back to the district.

Member Crowley said she was approached by someone that told her he could not pay fines at the Henderson Public Health Center and had to come to the main facility. Ann Markel, health records manager, verified that fines can be paid at any public health center. Monies are brought to the main facility on a daily basis. There could have been a specific issue with that payment that warranted coming to the main office.

In regard to personal checks, Mr. Weiss said that acceptance of personal checks ceased due to the number of returned checks – this policy was put into effect several years ago. Chair Giunchigliani said in her research it was found that all other entities accept personal checks. We have received $8 million dollars in checks received and $44,000 of that was dishonored. Personal checks are not accepted; however business checks are accepted for fees and fines. Over the last five years, there were over $300,000 in dishonored checks. Staff was able to recover a significant portion, but this does not account for staff time.

Member Barlow said that there is technology available that clears checks immediately and holds the funds. He suggested looking at adding this technology to better accommodate clients’ needs. Member Smith said that these types of machines can be received for free. Mr. Weiss said that staff will look into this technology.

In reference to credit card acceptance, the issue is not having the names matching on the identification and credit cards. There has been only $2,000 of dishonored credit cards, and this is insignificant. Staff’s recommendation is to require a second form of identification and if the second form matches, the credit card will be accepted. Staff will track this activity for the next six months and report back to the Board. At that time, staff will re-evaluate the process of requiring the second ID and impact on staff.

V. Public Comment:

Public Comment is a period devoted to comments by the general public, if any, and discussion of those comments, about matters relevant to the Board’s jurisdiction will be held. No action may be taken upon a matter raised under this item of this Agenda until the matter itself has been specifically included on an agenda as an item upon which action may be taken pursuant to NRS 241.020.

Shelli Clark, district employee addressed the Board. Mrs. Clark is a confidential employee, neither represented by management nor the union and therefore has no voice in the negotiations process. She expressed her concern with the health insurance selection process. Union members are not seeking input from confidential employees. Her family has been on the County insurance plans, both the PPO and HMO, through her husband’s employers in the past. Both plans resulted in exuberant costs to her family – premiums and co-payments were cheaper in the front end, but fees and costs were very high in the end. Lab fees, x-rays and childhood vaccinations for children over the age of two are not covered. She attended an open enrollment meeting and learned that vaccinations can be covered under a wellness benefit with $150 allowance annually. She expressed her concern over paying more money out-of-pocket to keep her children vaccinated because insurance will not cover the immunizations. She also learned that retirement benefits cover retirees who live within 100 miles of Clark County. Her former employer had a benefits committee who met annually to review the insurance plans; when changes were to occur surveys were distributed to management, confidential employees and labor to gain input as far as deductibles, co-payments, vision and dental coverage. As a district employee, Mrs. Clark feels that her voice should not be silent because she is a confidential employee – the union should speak to all employees, not just a few key employees. Health insurance affects all employees and everyone should have a voice.

Chair Giunchigliani thanked Mrs. Clark for her comments and asked if a survey was currently in place. Dr. Sands said there is no survey at present. She asked that in the future this be a standard practice going into insurance discussions to receive input from all staff.

Chair Giunchigliani, as an aside, commended Mrs. Clark for her efforts in completing the meeting minutes – she said the minutes were the best in the state. She said she is trying to have the SNHD minutes format adopted as a standard in the County. She commented on the ease of reading the minutes, that they are concise and comply with the law. She said taking the minutes is a difficult job and thanked Mrs. Clark for her efforts.

Member Barlow asked for clarification on what constitutes a “confidential employee.” Dr. Sands said that in the union contract there are certain employee classifications that are included that are eligible to be part of the union, there are other employees considered confidential, who work in Administration or other sensitive areas, such as HR, that are not eligible to be part of the bargaining unit. Chair Giunchigliani said in the school district anyone working for top management was considered confidential, or those working with the city or county manager. She acknowledged that their input should be solicited.

Dr. Sands said he supports doing a survey and the technology is available. Chair Giunchigliani said the committee could do a solicitation of input from staff in what they are looking for. There are different impacts with different employees. She noted that all surveys are public records.

Member Jones asked if the insurance investigation was done internally or if a broker or third party had been contacted. Mr. Weiss said that management wanted to have due diligence in looking for a new insurance plan because there are several employees that have voiced concern about going to the County plan. The bargaining unit wants the county, but due diligence is necessary. The initial plan was to do an RFP with the health insurance committee and have brokers provide proposals. The ultimate plan was to have a presentation open to all employees without names attached to the plans and do a benefit-by-benefit analysis. This would allow for staff input and get a true feedback as to what the staff is looking for. Mr. Weiss will take the survey suggestion back to the committee because it can be a very valuable tool to get overall feedback versus the people in the negotiating room. This would allow for brokers to come forward and present their information, including the County.
Chair Giunchigliani said the survey could provide talking points; but since SEIU is negotiating, it would need to be tailored to their recommendations.

Ann Markle, district employee, addressed the Board concerning the negotiation process. Mrs. Markle said management’s feedback is also not sought by the union. Her concern is that her fifty-five employees are not receiving information from the union concerning the negotiation process. They are invited to the meetings, but because the meetings last so long, employees are not willing to sacrifice their personal lives to attend the meetings. In the past, separate meetings were held to keep the membership apprised of what is occurring in negotiations. Employees are leaving the union due to the lack of communication.

Chair Giunchigliani said that the message needs to go back to the union.

Chair Giunchigliani asked if anyone else wished to address the Board. Seeing no one, Chair Giunchigliani closed the Public Comment portion of the meeting.

VI. Health Officer & Staff Reports

SNHD Employee Service Awards/Holiday Dinner
Dr. Sands reminded Board members of the annual Employee Service Awards/Holiday Dinner on December 13th at the “Top of the Riv” at the Rivera. He asked that Shelli Clark be notified if Board members wish to attend.

Health Disparities Conference
Dr. Sands noted that Board members had received copies of information for the Health Disparities Conference being held on December 11th. He said this meeting will be very informative and builds on the successful PBS program entitled “Unnatural Causes” and focuses on significant health disparities throughout the country. This conference will bring people together to continue that dialogue in how to address health disparities in Clark County.

Congenital Syphilis Update: John Middaugh, MD, Director of Community Health
Dr. Middaugh presented a PowerPoint on the current congenital syphilis outbreak in Clark County (attachment #4) and acknowledged the tremendous work and extraordinary amount of clinical case management performed by STD Nursing and EPI staffs to treat those infected and determine the status of syphilis among newborns. He described complications experienced determining when the mother was infected and stated that the clinical status of the mother directly impacts the newborn and appropriately diagnosing and treating the child.

Dr. Middaugh’s presentation showed that from 2006 through the present 101 reported cases of congenital syphilis met the surveillance case definition with 33 actual presumptive cases of syphilis in the mother and child and two children have died. Each had to be managed by staff and involved huge amounts of investigate work not contained in a single source making it necessary for staff to get medical, birth certificate, laboratory records, deal with clinicians for both the mother and child to sort out how to properly care and manage these children. Nevada leads the nation in congenital syphilis rates and has the largest outbreak of congenital syphilis in the United States, which is a symptom of catastrophically poor access to prenatal care and occurs at a time when most states eradicated it years ago due to a national program for the elimination of syphilis.

He reviewed slides showing the following information:

Case Classification

Racial composition

Ethnic composition

Gestational age

Mother’s marital status

Age of mother at time of delivery

Age of mother by marital and case status

Prenatal care status

Number of prenatal care visits if known

Congenital syphilis cases (presumptive including stillbirths) and non-cases by date reported

Possible recommendations:

All pregnant women should have a serologic test for syphilis during the 1st and 3rd trimester and at the time of delivery

All pregnant women with a positive test result should be immediately reported to the SNHD and receive expert consultation on clinical management and treatment

Access to prenatal care is essential

Increased efforts to detect syphilis and respond with aggressive DIS activities are warranted

Dr. Middaugh hopes to target a subpopulation of people at great risk and have an effective intervention to target preventive activities effectively. Definitive recommendations will be ready in the next few weeks. He stated that this is a major public health challenge, but one more area that shows that Nevada has really not taken public health seriously whether it’s child immunization, leading the nation in congenital syphilis or in supporting preventive public health transfer of proven science to prevent preventable diseases. He is dedicated to doing everything to bring this message to our policymakers and stakeholders.

Dr. Sands stated that there are long waits to get into prenatal care which results in mothers not having access to care during the first trimester, and by the time they can see a provider many providers don’t want to accept them as patients because of their high risk status. A child exposed to syphilis during the first trimester is at more risk than during the third trimester.

Chair Giunchigliani thanked Dr. Middaugh for his presentation.

VII. Informational Items - Duly Noted

A.	Chief Health Officer and Administration:
	1.	Monthly Activity Report, Mid-October 2008 – Mid-November 2008PDF 130KB
	2.	Financial Data: Revenue and Expenditure Report for General Fund, Capital Reserve Fund and Public Health Laboratory Fund for the Month of October 2008
		a.	Grant and Agreement Tracking Report, as of November 3, 2008
	3.	Public Information Monthly Report, Mid-October 2008 – Mid-November 2008 PDF 2.3MB
		a.	Letter of Appreciation from the International Association for Public Participation to Jennifer Sizemore
		b.	Letter of Congratulations to Jennifer Sizemore Concerning the Nomination of the “Fight the Flu!” Commercial for a Silver Syringe Award

B.	Community Health:
	1.	Monthly Activity Report, October 2008 PDF 842KB
		a.	Polo Towers Guest Letter and Legionellosis Frequently Asked Questions (FAQ)
		b.	October 2008 Disease Statistics

C.	Environmental Health:
	1.	Monthly Activity Report, October 2008 PDF 638KB
		a.	Email from Caesars Palace to Dennis Campbell concerning EHSs Donna Houston, Barbara Johannessohn, Lori Luces and Diane Meyer
		b.	Note from Mayor Goodman to Keith Zupnik, CLPPP project coordinator
		c.	Email from Aqua Plans to Lorraine Forston regarding EHS Joy Clark
		d.	Letters from Vegas Drive HOA to Angela Jones, Sr. EHS and James Modico, EHS
		e.	Letter from Paragon Pools to Lorraine Forston, Sr. EHS
		f.	Letter from Regional Transportation Commission to Steven Goode concerning Linda Centeno, administrative assistant
		g.	Email from Green Valley Ranch HOA to Paul Klouse concerning Brenda Dyess, administrative assistant

D.	Clinics and Nursing:
	1.	Monthly Activity Report, October 2008 PDF 307KB
		a.	Monthly Statistical Report – October 2008
		b.	In-service Calendar
		c.	Letters of Appreciation

VIII. Adjournment

There being no further business to come before the Board, Chair Giunchigliani adjourned the meeting at 10:49 a.m.

SUBMITTED FOR BOARD APPROVAL

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

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