Southern Nevada District Board of Health Meeting
April 23, 2009 - 8:30 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 8:35 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
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
Bubba Smith — Councilmember, Mesquite
David W. Steinman — Councilman, Las Vegas
Linda Strickland — Councilmember, Boulder City
Lawrence Weekly — Commissioner, Clark County

Absent:

Ricki Barlow — Secretary, Councilman, Las Vegas
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.

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
Barbara Ruscingno, RN — Alternate At-Large Member, Registered
Nurse Gerri Schroder — Councilwoman, Henderson Alternate
Stephanie Smith — Councilwoman, North Las Vegas Alternate

Staff: Scott Weiss; John Middaugh, MD; Angus MacEachern; Glenn Savage, Jennifer Sizemore; Bonnie Sorensen; Jo Alexander; Patricia Armour; Maria Azzarelli; Kara Bennis; Stephanie Bethel; Phillip Bondurant; Jerry Boyd; Dennis Campbell; Rory Chetelat; Nicole Chacon; Robert Clarke; Alice Costello; Dr. Tony Fredrick; Kay Godby; Steve Goode; Mary Ellen Harrell; Forrest Hasselbauer; Julie Hurd; Amy Irani; Vicky Legaspi; Eddie Larsen; Brian Labus; Ed Larsen; John Lewis; Christine Madison; Ann Markle; Tina McMahon; Veronica Morata-Nichols; Patricia O’Rourke-Langston; Gwen Osburn; Mars Patricio; Vivek Raman; Rick Reich; John Roberts; Walter Ross; Jane Shunney; Vickie Swanson; Marlo Tonge; Leo Vega, Jorge Viote; Ken Wirtz; Leisa Whittum; Deb Williams; Luis Zepeda; Valery Klaric and Shelli Clark, recording secretary

Attendance

Name	Representing
Peter Angulo	OCG & D
Kevin Arnold	USAF
Veronica R. Balbsko	USAF PH
Chris Benjamin	USAF
Patrick Browning	USAF
Thressa Burtey Bell	USAF Public Health
Monique Cantrell	USAF PH
Mandy Clark	Self
David Cunningham	USAF
Jack Davis	USAF PH
Tom Davis	Justice & Associates
Dr. Galen Eversole	Quest Diagnostics
Andrea Fish	USAF PH
Scott Hanse	Boulder City
Paul Harasim	Las Vegas Review Journal
Michael Jennerman	USAF PH
Phillip Johnson	Silver Dollar Recycling
Carrie Johnson	USAF PH
Mike Keller	Jones Vargas
Erika King	USAF
Cameron Kirk	Self
Stacie Kirk	Self
William Murphy	USAF PH
Renee E. Osborne	USAF
Kimberly Owens	USAF Public Health
Sherry Suggs	COME (Community Outreach)
Lung Thach	USAF PH
Alex Turner	USAF PH
Dr. Carol VanDerHarten	Quest Diagnostics
Cliff Vellinga	Silver Dollar Recycling
Doc Wiest	USAF
Bree Williams	USAF
Penny Williams	Quest Diagnostics

Chair Giunchigliani noted that there was a possibility of losing quorum and opted to take the Consent Agenda prior to recognitions.

I. Consent Agenda: 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: PDF 5.5MB 3/26/09
2. Approve Payroll / Overtime for Periods: 3/07/09 – 3/20/09 & 3/21/09 – 4/03/09
3. Approve Accounts Payable Registers: #1170: 3/06/09 – 3/11/09; #1171: 3/12/09 – 3/19/09; #1172: 3/20/09 – 3/26/09; #1173: 3/27/09 – 4/01/09
4. Petition #19-09: PDF 298KB Recommendations for Appointment of Members to the District’s Nurse Family Partnership Program’s Advisory Board

Chair Giunchigliani asked if there were any further 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 Crowley to approve the Consent Agenda as presented; seconded by Member Christensen and was unanimously approved.

Chair Giunchigliani asked that all in attendance please silence their cell phones.

Dr. Sands noted that the district is participating in the National Take Your Sons and Daughters to Work Day and there were several children in attendance. This is an opportunity for children to learn about the health district and public health.

Recognition:

March Women’s History Month

As Councilman Barlow was not present at the meeting, this item will be held to the next meeting.

National STD Awareness Month

Dr. Sands introduced Patricia O’Rourke-Langston, public health nurse manager. Kara Bennis, public health nurse supervisor noted staff has been promoting STD awareness throughout the month. A video presentation was shown, compiled by a Jewish Community Center in Florida, depicting awareness of STDs in the senior population, which is currently being shown in the clinic. Chlamydia and gonorrhea rates are the rise in Clark County. Rates are highest in young women, African Americans, males who have sex with other males and those with limited or no access to health care. Rapid testing has been available all month in partnership with the HIV/AIDS clinics, and clients receive a “lifesaver condom,” as well as stickers depicting the GYT campaign (Get Yourself Tested), which is sponsored by CDC, MTV and the Kaiser Foundation. STD clinical staff introduced themselves and shared examples of services provided in the clinic to help treat and stop the spread of STDs, including education, testing and ensuring access to treatment. Dr. Robert Mull provides clinical oversight for the clinic. Dr. Sands commended the excellent staff that work in the clinic for their efforts.

Great Basin Public Health Leadership Institute Graduates 2009

Dr. Sands introduced and congratulated the fifth cohort of Great Basin Public Health Leadership Institute graduates:

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

Ms. Godby thanked the Board and management for allowing staff to participate in this experience. The institute is a nationally recognized best practice site for public health leadership and the recent graduates recommend the district continue to participate in the trainings. The scholars’ presentation was recognized by Dr. James O. Mason at the recent graduation ceremony due to the need to market to the public the value of public health to the community and how public health services the community daily. Ms. Godby shared the project summary with the Board (attachment #1) PDF 265KB. The focus was to raise awareness of public health services in southern Nevada – the project was based on a campaign conducted by the New York City School of Public Health entitled “This is Public Health.” The project provides insight into the programs and services within the health district. DVDs in varying length were prepared for use with the general public, new hires, community organization, state and local service agencies, funding sources and the legislature. The scholars sought to raise awareness of effective regional public health services in an economic downturn, which can affect positive outcomes in general health and well-being.

Dr. Sands said this project had been discussed for some time and thanked the team for bringing the project to fruition. Chair Giunchigliani noted that the support of colleagues was important during the process. She thanked the scholars for their leadership.

Great Basin Public Health Leadership Institute Scholars 2010

Dr. Sands also introduced the Great Basin Public Health 2010 scholars. This year’s program will focus on top agency officials and community leaders. The sixth cohort will include:

Scott Weiss – Administration
Lawrence Sands, DO, MPH – Administration
Jim Christensen, MD – Board of Health
Ricki Barlow – Board of Health

The program will commence May 11, 2009. Dr. Sands noted that updates to the Board will be provided as the project progresses.

Public Health Hero Awards

The first week of April was Public Health week, and numerous events were held to recognize the work of employees throughout the District. The theme of Public Health week was “Building a Foundation for a Healthy America,” which fits well with the district’s vision of “healthy people in a healthy southern Nevada.” The Public Health Hero award honors individuals and organizations outside the health district that make remarkable contributions to further and advance public health in our community. Dr. Sands introduced the 9th annual Southern Nevada Public Health Hero awardees:

Public Health Flight – 99th Aerospace Medicine Squadron, US Air Force, Nellis AFB

The Squadron was nominated by the Office of Epidemiology. The Squadron participates in preparedness drills and exercises with the health district. Additionally, the Squadron tested, counseled and managed more than 2,500 active duty service members, their families and retirees during the 2008 hepatitis C outbreak, as well as assisting the health district during large-scale illness outbreaks such as the 2004 Norovirus outbreak, and administering flu shots during large immunization clinics. The Squadron attends monthly surveillance meetings to share information and approaches to investigation and control of infectious diseases. Public Health Flight is committed to serving our community and shows is support of public health by working closely with epidemiology, TB, STD and vector control teams to investigate or control outbreaks and support the district’s mission to “protect and improve the health, environment and well being of southern Nevada residents and visitors.”

Chair Giunchigliani thanked and congratulated Public Health Flight and invited the commanding officers to say a few words. Colonel Christian Benjamin thanked Brian Labus for the nomination and noted the appreciation of the partnership between the health district and Public Health Flight. They are proud to be a part of the public health network. He recognized the hardworking Squadron staff. Lieutenant Rob Gudgel, on behalf of the Mike O’Callaghan Hospital, said they take seriously the obligation to be good members of the community. The cooperation between epidemiology and Public Health Flight are but one endeavor to push forward this commitment. Chair Giunchigliani asked Public Health Flight staff to introduce themselves for the record: Kevin Arnold, Veronica R. Balbsko, Chris Benjamin, Patrick Browning, Thressa Burtey Bell, Monique Cantrell, David Cunningham, Jack Davis, Andrea Fish, Robert Gudgel, Michael Jennerman, Carrie Johnson, Erika King, William Murphy, Renee E. Osborne, Kimberly Owens, Lung Thach, Alex Turner, Doc Wiest, Bree Williams.

Vice Chair Kirk recognized the value of the air force base to the community. Dr. Sands noted that Nellis AFB has the support of the health district and thanked the Squadron for their efforts.

Quest Diagnostics Laboratories of Las Vegas

Quest Diagnostics was nominated by the Office of Epidemiology and the Southern Nevada Public Health Laboratory. Quest was recognized for its willingness to partner with the health district and SNPHL. Its greatest assistance came during the 2008 hepatitis C outbreak by putting together a team to create customized testing panels to assist patients and ensure they received the most efficient testing. Quest also reported to the health district statistics on the number of HIV and hepatitis tests performed during the three month period following the initial announcement. Additionally for eight months in 2007 and 2008, Quest provided daily reports of all mumps testing to assist the district in controlling an outbreak, and during an investigation at a long-term care facility. The labs’ rapid turnaround enabled the health district and CDC to offer quick guidance to the facility necessary to remediate the situation. Also in 2008, Quest’s informatics department helped to create a unique report to assist in the Legionella investigation in Clark County. By searching their databases from 2007 and 2008, Quest was able to identify the total numbers of Legionella tests ordered and verify the number of positive Legionella pneumophila serogroup 1 test types identified during that time period. As another example of its continued partnership, Quest is currently the only southern Nevada laboratory that provides reportable test results electronically to the health district daily, which allows our team to identify and take steps to end a potential outbreak both more quickly and efficiently. Dr. Carol VanderHarten stated that she appreciates the award and looks forward to further collaboration between the health district and Quest Laboratories. Chair Giunchigliani expressed gratitude on behalf of the Board, and acknowledged Quest for utilizing electronic record submission.

Rubin Saavedra, MD – Community Outreach

Dr. Rubin Saavedra, medical director of the Community Outreach Medical Center, received his nomination from the nursing department. Dr. Saavedra helped manage the syphilis outbreak by providing assistance in 2008. He worked with staff to provide HIV and syphilis testing, referrals and discharge planning with the Clark County Detention Center, and the City of Las Vegas and North Las Vegas jails to ensure that patients with HIV and STDs receive appropriate counseling, treatment and follow up. Dr. Saavedra is an advocate for patients community wide and is supportive of the health district’s outreach programs. He provides medical service for the district’s new Refugee Program, which helps protect the community from infectious diseases that might be endemic in countries around the world. He provides care to these patients who are at risk for carrying infectious diseases that can spread to others in our community. Sherry Suggs extended her appreciation, on behalf of Dr. Saavedra, for this award. She thanked the health district for the continuing partnership.

Dr. Sands noted that Ms. Godby shared information about the importance of having knowledge of all aspects of public health. Stephanie Bethel, public information officer, coordinated a “Do My Job” program in conjunction with Public Health Week where staff members were able to shadow other employees for a day. Ms. Bethel shared a short video with the Board depicting experiences of staff with this program. Feedback from all participants was very positive and we plan to continue this program next year.

Chair Giunchigliani asked that the Public Hearing item be taken next due to the possibility of losing quorum.

II. Public Hearing / Action

1. Memorandum #07-09: PDF 8.5MB Application for Approval for Silver Dollar Recycling, LLC to Operate a Solid Waste Management Facility – Recycling Center, Located at 5850 N. Nellis Blvd., North Las Vegas, NV 89115 (APN #128-28-301-003, 005 and 006) – SNHD Control No.: RC013-XXX-01
   
   Chair Giunchigliani declared the public hearing open.
   
   Walter Ross, environmental health engineer/supervisor spoke relative to this matter. Mr. Ross said that Silver Dollar Recycling Cleaning Company has met all requirements for a recycling center as specified in Section 4 of the Regulations governing recycling centers and satisfied all special use permits require by Clark County.
   
   Staff recommends approval based on conditions as outlined in the memorandum and a final inspection. Cliff Vellinga, Tom Davis and Phillip Johnson, representing Silver Dollar Recycling were present to answer questions of the Board. Chair Giunchigliani asked the applicants if they understood and accepted the conditions as outlined on the memorandum; the applicants responded affirmatively.
   
   Chair Giunchigliani asked what items would be recycled. The facility will recycle metals, including automobiles. There is an auto shredder and they will process not only the iron but all non-ferrous materials (brass, die-cast, stainless steel). The only by-products are dirt, foam and plastics. All fluids and hazardous materials must be removed from the vehicles before they arrive on site.
   
   Member Jones asked if there is recycling of copper or other items. Non-ferrous materials are incidental to the business. The facility maintains a working relationship with Metro and they are invited on site often. Metro is notified of suspect items and it is subsequently taken care of. Metro emails the facility when suspect materials may be on the market as well. They have worked with the legislature and state law enforcement to develop bills to improve the recycling process and that only legitimate items are accepted.
   
   Member Weekly asked if a buffer between the property and the railroad was required in the site plan. Union Pacific runs through the property – Silver Dollar owns the property on both sides of the railroad. The facility has their own spur where rail cars are loaded.
   
   Member Kirk said the triangular piece in the photograph denotes property used for truck storage and storage of boxes. No recycling is done on this property. Mr. Ross noted that the application includes the three parcels – the full property was shown on the map and in the photos. Chair Giunchigliani asked that the parcels be outlined in red on future applications.
   
   Chair Giunchigliani asked if anyone from the public wished to speak on this issue. Seeing none, the public hearing was closed.
   
   A motion was made by Member Weekly to approve the application as submitted with the conditions outlined in the memorandum; seconded by Member Strickland and was unanimously approved.

II. Closed Session - To be held at beggining of meeting

Meeting of Board of Health as governing body with its attorneys regarding existing/potential litigation – Closed Session pursuant to NRS 241.015.2(b)(2).

A motion was made by Chair Giunchigliani to close the meeting for the Board of Health as a governing body to meet with its attorneys regarding existing/potential litigation at 9:26 a.m.

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 10:27 a.m.

III. Report / Discussion / Action

1. Receive Report on Legislative Planning for 2009; Direction to Staff
   
   Jennifer Sizemore, public information manager, spoke relative to this item. The proactive legislation, including West Nile Virus and the Healthy Homes initiative, to allow a process for rental properties, are proceeding nicely – no opposition has been expressed and Washoe County has also rendered support of the bill, as a result population will be expanded for Washoe County to be part of the process. SB372 is also of interest, which will dramatically alter the Nevada Clean Indoor Air Act (NCIAA). We are focusing on getting local control put back in the legislation. The health district would then have authority to enforce the Act; however it would continue to be an unfunded mandate. Staff is working on developing a citation process but there is no way to recover costs for the district.
   
   Member Weekly said he heard where some taverns were allowing smoked as long as patrons were over the age of twenty-one. Dr. Sands said this is what is being proposed by SB372, to create an adults only stand-alone bar. A new provision would allow food service as long as no patrons are under the age of twenty-one. We understand that we will not get everything we want into the bill, so our focus will be on retaining local control.
   
   SB397 established provisions for use of certain plastic bags – this bill originally had a different title when first introduced. The bill would requires our environmental health inspectors to audit the books of any retail outlet using plastic bags and put a ten cent tax or fee on the use of these bags. This would apply to many retail outlets that do not hold permits and require staff to go into businesses we do not currently regulate. Staff has put together information for our lobbyists to demonstrate how many more establishments staff would be required to frequent. The fee would go into the general fund. We are looking to limit this to grocery stores and outlets we currently regulate. This bill would have a major impact on our environmental health staff.
   
   Dr. Sands said that things have moved rapidly as of late and staff is doing an excellent job of keeping everyone informed and ensuring that our positions are made known. Chair Giunchigliani acknowledge Ms. Sizemore for her efforts. Dr. Sands referenced the press release (attachment #2) PDF 159KB from UNLV regarding the economic study done demonstrating that overall there was no economic impact on industry due to NCIAA.

IV. 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.

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

VI. Health Officer & Staff Reports

Dr. Sands asked Bonnie Sorenson, director of clinics & nursing services to brief the Board about the transfer of the airport clinic from the health district to another vendor. Ms. Sorenson said that the airport approached staff approximately eighteen months ago about the possibility of using a different vendor as a means to generate revenue. Currently injured travelers are brought to the public health nurses for treatment, including worker’s comp issues, which is not a service we provide. The health district will finish out the current contract and provide assistance in setting up a new vendor for the airport. No staff will be displaced as a result of the clinic closure. Travel immunizations are offered at the main public health center (PHC) as well as the Henderson PHC.

National Infant Immunization Week: Veronica Morata-Nichols, Public Health Nurse Manager

Dr. Sands asked Veronica Morata-Nichols to discuss National Infant Immunization Week. Ms. Sorenson thanked Member Weekly for his support and testimony regarding the importance of immunizations. Both Members Barlow and Weekly do much to promote vaccinations in the community. Ms. Morata-Nichols echoed her appreciation for their support. National Infant Immunization Week runs April 25 to May 2, which is an annual event to promote the importance of protecting infants against vaccine preventable diseases, as well as to celebrate the achievements of immunization programs and partners in promoting healthy communities. This year’s motto is “Love Them, Protect Them and Immunize Them.” All partners have been challenged to share immunization information with new mothers (attachment #3) PDF 381KB. One early event at Wal-Mart resulted in 100 children being immunized in under four hours – administrative fees were paid by Nevada Covering Kids for those unable to pay. Ms. Morata-Nichols also thanked Chair Giunchigliani and Member Weekly for the proclamation for National Infant Immunization Week.

Chair Giunchigliani asked if the Board could be sent information about upcoming events to include in their respective newsletters.

Southern Nevada Health District Accomplishments

Dr. Sands referenced a handout for Board members depicting the accomplishments of health district staff over the last year (attachment #4) PDF 210KB. Dr. Sands shared these accomplishments with staff at the public health week recognitions earlier this month. Some highlights include the establishment of a public health center in Mesquite, working toward a new main facility, advancing our preparedness programs and health promotion programs particularly in the areas of tobacco control and childhood lead poisoning prevention. New programs such as the Nurse Family Partnership and the Refugee Program have been launched to provide service to specific communities. Staff and programs have received recognition at the local and national level and staff has also been invited to present at various conferences and workshops. An annual report to the community will be produced in June. Brian Labus is finalizing the hepatitis C investigation report, which will be presented to the Board in the coming months.

West Nile Virus and Vector Control Update: Vivek Raman, Vector Control Supervisor

Dr. Sands introduced Vivek Raman to update the Board on West Nile Virus and vector control activities. Dr. Sands commended staff for their efforts and proactive approach in prevention. Mr. Raman shared a PowerPoint presentation (attachment #5) PDF 3MB with the Board. Vector control staff is responsible for natural breeding source treatment, West Nile Virus surveillance and human case investigations, in addition to plague and hantavirus surveillance. Staff takes each citizen complaint seriously and responds to each call. In 2008 there were 2,854 complaints logged; to date in 2009 802 complaints have been received, which is a 65% increase over last year at the same time. There could be over 4,700 green pool complaints by the end of the year. When staff responds to a green pool complaint, staff attacks the larvae before it emerges as an adult. The pool is assessed, treated and a note is left on the door of the resident; a letter is also sent to the homeowner of record, which is also posted on the door. In 2006 the Board of Health approved a $117 treatment fee, which was implemented in December 2007. Since that time, staff has issued $180,000 worth of invoices, and recovered only $22,447. Staff may visit a residence up to seven times to find that there continues to be no compliance with draining a pool. One strategy sought this year was to gain permission to drain a pool and place a lien on a home for cost recovery. This was done by seeking to amend NRS 439 language to allow the health district is take all necessary steps to prevent mosquito breeding from reoccurring, meaning drainage of a pool, and placing a lien against a property. AB249 went to the Assembly Health & Human Services Committee in early April, and passed to the Senate for further action. Staff is also looking at cost containment and is using minnows (mosquito fish) more frequently as a means to treat green pools. Staff are also using microbial larvicides, which are less expensive chemicals.

Staff surveils over 100 sites in the Las Vegas valley, Logandale, Overton, Mesquite, Bunkerville, Laughlin for possible breeding areas. Staff works closely with code enforcement authorities in each jurisdiction. Environmental management is encouraged within the respective jurisdiction to assist staff with treatment and control measures. Last year staff set 321 mosquito traps, and trapped over 15,000 mosquitoes. Only 346 tested positive for West Nile Virus.

The district receives a portion of the CDC Epidemiology Laboratory Capacity (ELC) grant for surveillance in southern Nevada, including White Pine, Lincoln and Nye counties. In 2009, the grant was increased to $83,000 to continue surveillance activities. Staff has also worked to develop our lab capacity with the grant funding, including a new computer and an ultra-low freezer to keep samples at -85° to maintain their integrity for shipment. Staff would like to obtain mobile data management systems for all staff to work hand-in-hand with the computer system, which would save time and paperwork.

Mr. Raman said it is a pleasure to represent the vector control staff, who work diligently each day, often in the high heat, to keep the public safe and healthy.

Chair Giunchigliani commended Mr. Raman and staff for their efforts. She asked where hantavirus samples are tested. Our samples are sent to the University of New Mexico, as the state lab no longer provides this service. Staff responds to rodent complaints at schools as well. In 2008 there were only thirteen cases of West Nile Virus in Clark County, the majority of which were locally acquired.

VII. Informational Items

A.	Chief Health Officer and Administration:
	1.	Monthly Activity Report, Mid-March 2009 - Mid-April 2009 PDF 471KB
		a.	Card Expressing Appreciation from the Institute of Real Estate Management to Dr. Lawrence Sands
		b.	Letter of Appreciation from Senator Harry Reid to Dr. Lawrence Sands
	2.	Financial Data: Revenue and Expenditure Report for General Fund, Capital Reserve Fund and Public Health Laboratory Fund for the Month of March 2009
		a.	Grant and Agreement Tracking Report, as of April 13, 2009
	3.	Public Information Monthly Report, Mid-March 2009 - Mid-April 2009 PDF 7.4MB
B.	Community Health:
	1.	Monthly Activity Report, March 2009 PDF 1.7MB
		a.	2009 1st Quarter Disease Statistics
		b.	March 2009 Disease Statistics
C.	Environmental Health:
	1.	Monthly Activity Report, March 2009 PDF 1.6MB
		a.	Annual Child Care Licensing Offices Certificate to Larry Rogers, environmental health specialist
		b.	Card Expressing Appreciation from the Institute of Real Estate Management to Glenn Savage
		c.	Letter of Appreciation from Silverado High School to Mark Gillespie, senior EHS
		d.	Letter of Appreciation from the CCSD Curriculum & Professional Development Division to Mark Gillespie, senior EHS
D.	Clinics and Nursing:
	1.	Monthly Activity Report, March 2009 PDF 945KB
		a.	In-service calendar
		b.	Correctional Health Care – Editorial
		c.	Letters of Appreciation

VIII. Adjournment

There being no further business to come before the Board, Chair Giunchigliani adjourned the meeting at 11:00 a.m.

SUBMITTED FOR BOARD APPROVAL

 

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

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