Southern Nevada District Board of Health
Chief Health Officer Review Committee Meeting
June 9, 2009 - 3:30 p.m.

Administration Conference Room #1
625 Shadow Lane
Las Vegas, NV 89106

Chair Chris Giunchigliani called the meeting of the Chief Health Officer Annual Review Committee to order at 3:38 p.m. Stephen F. Smith, Esq., Legal Counsel confirmed the meeting had been noticed in accordance with Nevada’s Open Meeting Law and that a quorum was present.

Committee Members Present:

Chris Giunchigliani — Chair, Commissioner, Clark County (telephonically)
Jim Christensen, MD — At-Large Member, Physician
Lonnie Empey — Alternate At-Large Member, Environmental Specialist
Linda Strickland — Councilmember, Boulder City Committee

Members Not Present:

Robert “Bubba” Smith — Councilman, Mesquite

Executive Secretary:

Lawrence Sands, DO, MPH

Legal Counsel:

Stephen F. Smith, Esq.

Staff:

Angus MacEachern — Human Resources Administrator
Ann Markle — Health Records Manager
Gwen Osburn — Public Health Nurse Manager
Bonnie Sorenson — Director of Clinics & Nursing Services
Scott Weiss — Director of Administration
Shelli Clark — Executive Assistant and recording secretary

Public Attendance:

There were no members of the public in attendance

II. Discussion - Action

1. Approval of Minutes

Chair Giunchigliani noted that the minutes were from last year, which is the last time the Committee met. She asked if there were any changes to the minutes presented. Seeing none, she called for a motion to approve to the minutes of July 24, 2008 meeting.

Member Christensen made a motion to approve the minutes from the Chief Health Officer Annual Review Committee Meeting held July 24, 2008; seconded by Member Empey and carried unanimously.

2. CHO Report of Accomplishments and Progress in Achieving Previously Agreed upon Goals

Packets were provided to Committee members (attachment #1) PDF 5MB which included the accomplishments of the Chief Health Officer (CHO), letters and recognitions, a recruitment and retention report, the employment agreement for the CHO and the CHO evaluation process document.

Chair Giunchigliani made reference to the Nevada Clean Indoor Air Act, which was changed by the legislature. She also noted the successes of the refugee program.

Member Christensen said he has sat on many review committees over the years and this was the most comprehensive packets he has seen. Chair Giunchigliani said the new format is working well and was helpful to Dr. Sands. Member Empey agreed with the other committee members but indicated he would like to see more work done in the bioterrorism area. Chair Giunchigliani also suggested that the involvement of environmental health staff with county programs be noted.

Dr. Sands said that packet was to provide an overview of the performance of the health district under his leadership and obtain feedback on his strengths as a leader as well as where improvements are needed, both for the health district and his performance. He said he is not seeking a merit raise at this time due to the current economic situation.

Dr. Sands expressed his sincere appreciation and respect for the exceptionally fine team of highly dedicated and talented professionals at the health district – he said he feels fortunate to be able to lead this team through such difficult times. The hard work of every member of the health district team resulted in the district’s success in achieving much over the past year. He noted that everyone should be proud of the numerous accomplishments and progress made in several areas this year.

Staff makes continued efforts to develop and execute a comprehensive strategic plan, which has resulted in a stronger, strategically-aligned and results-oriented district. The emphasis on reaching out to partners in the community to form collaborations and build strategic alliances continues to strengthen the public health system in Southern Nevada while enhancing the district’s capacity to deliver essential public health services to the community, advancing the health district’s mission. He expressed his pride in staff’s performance as a team across the various programs and divisions to respond to the novel H1N1 influenza virus in a calm, measured and decisive manner.

Dr. Sands highlighted some to the accomplishments of which he is most proud, including:

• Building and strengthening the health district’s leadership team by working with the Board to recruit highly qualified and experienced professionals to fill three key leadership positions – John Middaugh, MD, community health director; Scott Weiss, director of administration; and Stephen Smith, our in-house attorney.
• Improving employee relations and promoting a positive work environment by taking actions based on the results of the 2007 employee satisfaction survey and the findings and recommendations of an external assessment of the human resources function. Dr. Sands referenced his efforts to increase his visibility and contact with employees. He expressed appreciation to Mr. Weiss and members of the executive team for their efforts in working together to build a collaborative and collegial relationship with union representatives to improve communication, and avoid conflict and resolve issues directly.
• Providing leadership for the district’s continued response to the 2008 hepatitis C outbreak, including working with the legislative health care committees on key legislation passed this session, and working with the state and local healthcare leaders, along with members of Nevada’s congressional delegation, to restore trust in the our local healthcare system. He noted Brian Labus’ contribution to the investigation and, along with Jennifer Sizemore, in providing input to the legislative process in this area.
• Developing and executing the health district’s legislative agenda for the 2009 session, in collaboration with the Board, and advocating for legislation initiated by the district. Ms. Sizemore, along with our lobbyists Bryan Gresh and Gary Milliken, management staff and Board members contributed to the many successes of the past legislative session.
• Improving communications with Board of Health members and enhancing collaboration with the Board of Health, including seeking advice and counsel of Board members as necessary. He thanked Shelli Clark and Ms. Sizemore for their assistance and support, as well as the executive team for providing current information and responding to Board members’ inquiries.
• Building and strengthening our relationships and ability to work collaboratively with the state and local health authorities as well as key local officials from the various jurisdictions, health profession education programs, professional organizations and service agencies.

Dr. Sands said he learned much over the last year and expects to continue to grow as a leader as the health district faces new challenges. He shared some challenges before the district and public health in the coming year:

• continuing operations in an out-dated and inadequate main campus facility, and in some areas, with reliance on out-dated and inadequate information management systems;
• maintaining core public health services as the health district faces revenue reductions due to the declining economy, legislatively-mandated reallocations of county property tax revenues, and reductions of federal grant dollars allocated to the district by the state;
• preparing for the potential threat of a more virulent H1N1 influenza virus during the upcoming influenza season; and
• continuing to respond to the aftermath of the hepatitis C outbreak as a result of ongoing litigation and efforts to restore public trust in the health care system Dr. Sands shared his plan for meeting these challenges, in collaboration with the leadership team:
• Partner with the Board of Health to build support and seek resources needed to commence building a new facility, while proceeding with preparation of engineering plans and blue prints to achieve “shovel ready” status;
• Collaborate with staff to identify and implement cost containment measures while pursuing new grant opportunities and revenue sources;
• Collaborate with staff to make improvements to the district’s strategic planning process to better assess the return on investment of district programs and ensure alignment with current community health needs and health status assessments;
• Reach out to various community partners to develop and coordinate plans and activities to ensure an organized and cohesive community response in the event of a more virulent H1N1 influenza virus during the upcoming flu season; and
• Mobilize staff to ensure completion of the hepatitis C outbreak investigation report, and ensure effective collaborations with state and local partners to pilot the Safe Injection Practices Campaign in Nevada.

Chair Giunchigliani asked for comments and questions from those in attendance. Seeing none, she asked for further explanation of the Nurse Family Partnership program. Dr. Sands said this is an evidence-based program where a team of public health nurses enroll and follow first-time mothers during pregnancy and through the first two years of the newborn’s life. This is a national program taking place in different communities throughout the country. The program focuses on prenatal care, immunizations, healthy lifestyle behaviors and ensures participants are connected to different resources in the community. Research has demonstrated that there is a large positive impact on the child’s ability to learn upon entrance into school and there is less demand for special resources/services at the school; there is also a reduction in juvenile delinquency and drug use. Parents have a higher potential to be gainfully employed. Participants enrolled to date are low-income and under the age of 17. Fifty percent of the nurses working in this program are bilingual. Gwen Osburn, public health nurse manager noted that the program is designed to reach first-time mothers before they turn to social services for assistance – they try to enroll mothers in their first trimester. The home visitation program works closely with CPS and DFS. This program is a redesign of the maternal child health and community health nurse programs. Member Christensen said he uses the assistance of public health nurses to follow HIV positive children – these patients are more prepared, they are educated and diligent in their course of treatment; they also touch on parenting skills and elements of healthy lifestyles. He noted what an advantage the nurses are to his practice.

Chair Giunchigliani suggested an upcoming goal for the childhood lead poisoning prevention program could be to work with the Healthy Homes program in looking at ensuring homes are healthy and prepared for habitation before new families move in. Dr. Sands said this is already happening and partners are involved with the Strategic Advisory Coalition, which meets later this month. Staff is looking at new grants with the Healthy Homes project to leverage funding with the weatherization program to continue moving forward. The passage of AB249, which sets up a hearing officer process for nuisance landlords and rental properties, provides a foundation for the Healthy Homes project as well.

Lastly, Chair Giunchigliani suggested a continued focus on improving the immunization rate in Clark County.

3. Discussion of Report and Any Additional Clarifying Data or Information Needed to Supplement CHO’s Draft Report

Dr. Sands distributed his draft goals both for himself and the district. He noted that his goals are more strategically focused and those for the district are operational in nature. Goals for the chief health officer include:

1. Continue to build support and seek resources for a replacement facility for Ravenholt Center.
2. Collaborate with staff to identify, implement and evaluate cost containment measures necessary in response to changes in projected revenue.
3. Collaborate with staff to identify and pursue new grant opportunities and other revenue sources.
4. Initiate assessment of environmental health department to identify organizational and operational efficiencies and ensure fees reflect actual costs and value provided to industry and the community.
5. Collaborate with staff to prepare for 2009-2010 influenza season and sudden surge and/or change in severity of novel H1N1 virus.
6. Continue to support and make improvements to the district’s strategic planning process and further strengthen linkages to annual budget planning and preparation.
7. Continue initiatives directed at promoting and strengthening employee relations and a positive work environment, to include but not limited to:
   • administering bi-annual employee satisfaction survey and reporting results as a collaborative project of the Joint Labor-Management Committee
   • implementation of recommendations resulting from 2008 HR external review
   • continuing to meet with employees through “Bagels with the Boss” meetings and regularly scheduled visits to satellite sites and employee team meetings
8. Continue to meet with community partners and organizations and maintain working relationships with state and local officials.
9. Continue to maintain and enhance communication with BOH members and strengthen working relationships.
10. Participate in Great Basin Public Health Leadership Institute and Nevada’s project team.

It was noted that employees’ response to “Bagels with the Boss” has been very positive; Board members have also received positive comments. The program is very casual and has served to break down walls, in addition to establishing two-way communication and transparency. It was suggested that the name be changed to “Donuts with the Doc” for the coming year.

Chair Giunchigliani suggested that as a result of interim legislation being passed to look at health delivery systems and possible co-locations with UMC and other programs. Dr. Sands said he is trying to set up meetings with Kathy Silver and Nancy McLane to find areas of collaboration.

III. Public Comment:

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

Chair Giunchigliani asked if any member of public wished to be heard.

Ann Markle said that Dr. Sands has made a concentrated effort to get involved and know what the employees want. He has also gotten more involved with clients. He has made good effort to do what was asked and demonstrated progress. Chair Giunchigliani expressed her agreement with these comments

Gwen Osburn said the district has weathered two difficult storms, one being the H1N1 virus. It is a matter of pride that the district responded in an evidence-based manner and not reactionary as other public health departments across the country did. Chair Giunchigliani noted not overreacting to the situation and the calm response helped everyone get through the situation.

Member Christensen said Dr. Sands has weathered several storms and more are on the horizon with looming budget cuts, antiquated information systems and a non-functional building. He said that we need to come up with creative ideas to replace these systems and the building. Chair Giunchigliani said there is broadband money from the stimulus dollars, and Kathy Silver is setting up workgroups with hospitals – she asked Dr. Sands to get involved in this project. UMC is looking at grants to establish electronic medical records throughout the valley.

Dr. Sands said that electronic medical records are important; but replacing the VAX is a high priority. Chair Giunchigliani said there could be funding sources available in the electronic medical records grant for this project. Dr. Sands said that once an entire medical community has electronic medical records, a regional health information organization to share information between providers and organizations, would help facilitate the exchange of data needed for our surveillance systems.

Chair Giunchigliani asked if anyone else wished to address the Committee. Seeing none, she closed this portion of the agenda.

4. Schedule Time and Date of Next Committee Meeting

Member Giunchigliani said she felt the process is much improved and will look at implementing a similar structure at the county. Member Empey said this process has improved immensely.

The Committee agreed that a second meeting is not necessary. Chair Giunchigliani called for a motion to accept the goals, accomplishments and the discussion today and report back to the full Board of Health at the next meeting.

Member Christensen motioned to accept the goals and accomplishments as present and to bring this report before the Board at the June meeting; seconded by Member Empey and carried unanimously.

IV. Adjournment

There being no further business to come before the committee Chair Giunchigliani adjourned the meeting at 4:14pm.

Respectfully Submitted,

 

Chris Giunchigliani, Committee Chair

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