Southern Nevada District
Board of Health Meeting
September 24, 2009 - 8:30 a.m.
Clemens Room
Ravenholt Public Health Center
625 Shadow Lane
Las Vegas, Nevada
Vice Chair Strickland called the meeting of the Southern Nevada District Board of Health to order at 8:31 a.m. and led the Pledge of Allegiance. Vice Chair Strickland noted that a quorum was present. Stephen F. Smith, Esq., Legal Counsel confirmed the meeting had been noticed in accordance with Nevada Revised Statutes 241.020(2) and (3).
Board Members Present:
Linda Strickland — Vice Chair, Councilmember, Boulder City
Tim Jones — Secretary, At-Large Member, Regulated Business/Industry
Stavros Anthony — Councilman, Las Vegas
Ricki Barlow — Councilman, Las Vegas
Kathleen Boutin — Councilwoman, Henderson
Susan Crowley — At-Large Member, Environmental Specialist
Robert Eliason — Councilman, North Las Vegas
Donna Fairchild — Councilmember, Mesquite
Joseph Hardy, MD — At-Large Member, Physician
Lawrence Weekly — Commissioner, Clark County
Absent:
Chris Giunchigliani — Chair, Commissioner, Clark County
Jim Christensen, 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
Karl Gustaveson — Councilman, Mesquite Alternate
Debra March — Councilwoman, Henderson Alternate
Frank Nemec, MD — Alternate At-Large Member, Physician
John Onyema, MD — Alternate At-Large Member, Physician
Steven Ross — Councilman, Las Vegas Alternate
Barbara Ruscingno, RN — Alternate At-Large Member, Registered Nurse
Anita Wood — Councilwoman, North Las Vegas Alternate
Staff: Scott Weiss; John Middaugh, MD; Angus MacEachern; Glenn Savage, Jennifer Sizemore; Bonnie Sorensen; Jo Alexander; Stephanie Bethel; Jerry Boyd; Dennis Campbell; Rory Chetelat; Alice Costello; Arta Faraday; Steve Goode; Mary Ellen Harrell; Forrest Hasselbauer; Brian Labus; Eddie Larsen; Ann Markle; Dante Merriweather; Veronica Morata-Nichols; Gwen Osburn; Mars Patricio; Walter Ross; Patricia Rowley; Jane Shunney; Leo Vega; Deb Williams; Valery Klaric and Shelli Clark, recording secretary
Attendance:
| Name |
Representing |
| Petya Balova |
LEA |
| Fred Couzens |
Las Vegas Tribune |
| Tom Davis |
Justice & Associates |
| Craig Erskine |
Self |
| Bill Fairchild |
Self |
| Jeff Gerber |
PGAL |
| L. E. Hawley |
NCII |
| Marty Johnson |
Silver Dollar Recycling, Inc. |
| Mason Joseph |
JACO Environmental Inc. |
| Dana Moss |
PGAL |
| Fidanis Ndokama |
Touro University |
| Rolando Posado |
EK Recycling |
| Scott Schlabsz |
ESCI/JACO Environmental Inc. |
| Cliff Vellinga |
Silver Dollar Recycling, Inc. |
Oath of Office:
Southern Nevada District Board of Health Elected Members and Alternates
Vice Chair Strickland asked Stephen F. Smith, Board Legal Counsel to proceed with administering the Oath of Office to the elected members and alternates present. Mr. Smith administered the Oath of Office to Robert Eliason – City of North Las Vegas.
I. Consent Agenda: These are matters considered to be routine by the Southern Nevada District Board of Health and may be enacted by one motion. Any item, however, may be discussed separately per Board Member request before action. Any exceptions to the Consent Agenda must be stated prior to approval.
- Approve Minutes / Board of Health Meeting: 08/27/09 PDF 1.5MB
- Approve Payroll / Overtime for Periods: 7/25/09 – 8/07/09; 8/08/09 – 8/21/09; 8/22/09 – 9/04/09
- Approval Voluntary Furlough Program Reports for Periods: 6/29/09 – 8/07/09; 8/08/09 – 8/21/09; 8/22/09 – 9/04/09
- Approve Accounts Payable Registers: #1192: 8/06/09 – 8/13/09; #1193: 8/14/09 – 8/20/09; #1194: 8/21/09 – 8/27/09; #1195: 8/28/09 – 9/03/09
- Petition #30-09: PDF 867KB Approval of Interlocal Contract with Nevada Division of Environmental Protection for Administration of Federal Safe Drinking Water Act in Southern Nevada
Vice Chair Strickland asked if there were any discussion on the items brought forward on the Consent Agenda. Seeing none, she called for a motion to approve the Consent Agenda as presented.
A motion was made by Member Fairchild to approve the Consent Agenda as presented; seconded by Member Jones and was unanimously approved.
II. Public Hearing / Action
- Memorandum #19-09: PDF 1.2MB Application for Approval for EK Recycling to Operate a Solid Waste Management Facility – Recycling Center, Located at 4545 N. Lamb Boulevard, North Las Vegas, NV 89081 (APN: 140-06-610-023)
Vice Chair Strickland declared the public hearing open.
Walter Ross, environmental health supervisor/engineer, and Dante Merriweather, environmental health specialist II, spoke relative to this matter. Mr. Ross said that EK Recycling has met all requirements for a Recycling Center as specified in Section 4 of the Regulations governing Recycling Centers.
Staff recommends approval based on conditions as outlined in the memorandum and a final inspection. Rolando Posada of EK Recycling and Petya Balova of LEA Engineering were present to answer questions of the Board.
Vice Chair Strickland asked the applicant if he understood and agreed to the conditions as outlined in the memorandum; Mr. Posada responded affirmatively. The facility will recycle metals.
Vice Chair Strickland asked if anyone else wished to testify on this item. Seeing none, she closed the public hearing.
A motion was made by Member Crowley to approve the application with the conditions as outlined; seconded by Member Hardy and was unanimously approved.
- Memorandum #21-09: PDF 2MB Application for Approval for Silver Dollar Recycling, LLC to Operate a Solid Waste Management Facility – Recycling Center, Located at 3870 Losee Road, North Las Vegas, NV 89030 (APN 139-12-104-011)
Vice Chair Strickland declared the public hearing open.
Walter Ross, environmental health supervisor/engineer spoke relative to this matter. Mr. Ross said that Silver Dollar Recycling, Inc. has met all requirements for a Recycling Center as specified in Section 4 of the Regulations governing Recycling Centers.
Staff recommends approval based on conditions as outlined in the memorandum and a final inspection. Cliff Vellinga of Silver Dollar Recycling and Tom Davis of Justice & Associates were present to answer questions of the Board.
Vice Chair Strickland asked the applicant if he understood and agreed to the conditions as outlined in the memorandum; Mr. Vellinga responded affirmatively.
Vice Chair Strickland asked if anyone else wished to testify on this item. Seeing none, she closed the public hearing.
Member Crowley asked how financial assurance is determined for closure and suggested staff bring the information back to future meeting. Mr. Vellinga said that he had to determine how much material was on site, and if the facility were to vacate the premises, what the expense would be to remove the materials and clean up the land – buildings would remain intact. Cost is calculated and a bond would be given to the submitted sufficient to cover those expenses.
Mr. Ross said cost estimates vary with facility and scenarios. Each business has a different financial assurance mechanism, such as a bond. Financial assurance must be in place prior to the issuance of the permit.
Scott Weiss, director of administration, said staff is looking at updating the financial assurance process, including a business’ processes over time, and financial assurance could increase or decrease – all costs should be consistent with today’s dollars. Environmental health staff is providing a list of all permitted facilities to Mr. Weiss, including financial assurances and when determined, to ensure all information is up-to-date and consistent with current operations.
Glenn Savage, director of environmental health, said at least once a year permit holders will work with their inspector to update the financial assurance documents.
A motion was made by Member Crowley to approve the application with the conditions as outlined; seconded by Member Fairchild and was unanimously approved.
- Memorandum #22-09: PDF 1.5MB Application for Approval for JACO Environmental to Operate a Solid Waste Management Facility – Recycling Center, Located at 2711 E. Craig Road, Ste. C&D, North Las Vegas, NV 89030 (APN 139-01-301-002 ptn)
Vice Chair Strickland declared the public hearing open.
Walter Ross, environmental health supervisor/engineer, and Arta Faraday, senior environmental health specialist, spoke relative to this matter. Mr. Ross said that JACO Environmental has met all requirements for a Temporary Permit to Operate a Recycling Center as specified in Section 4 of the Regulations Governing Temporary Permits To Operate Solid Waste Disposal Sites. JACO Environmental is the first solid waste facility to receive a temporary permit.
Staff recommends approval based on conditions as outlined in the memorandum and a final inspection. Mason Joseph, representing JACO Environmental Inc., was present to answer questions of the Board.
Vice Chair Strickland asked the applicant if he understood and agreed to the conditions as outlined in the memorandum; Mr. Joseph responded affirmatively.
Four categories had not been complied with at time of application. Mr. Joseph said all paperwork has been submitted; the only outstanding piece is the financial assurance will be submitted once the application is approved.
The facility is currently leasing the land where the business is located. The operations will move to a larger facility on the same property around the first of the year – the lease agreement has been signed. A full permit will be sought once the move is complete. As no special use permit was required, the City administratively approved the application – operations will be completely indoors.
Member Weekly would like to have seen all items prior to administrative approval. He said the business could have better landscaping outside the facility, particularly around the buffer by the street.
Vice Chair Strickland asked if anyone else wished to testify on this item. Seeing none, she closed the public hearing.
A motion was made by Member Crowley to approve the application with the conditions as outlined; seconded by Member Fairchild and was unanimously approved.
III. Report / Discussion / Action
- Memorandum #23-09: PDF 355KB Contract with Medical Resources Staffing Services
Scott Weiss, director of administration presented this item and noted the NRS citation on the memorandum should read 332.112 (2). Temporary staffing may be necessary due to demands of the H1N1 influenza outbreak and vaccination campaign. The district currently contracts with Medical Resources Staffing and the existing agreement was amended to accommodate for H1N1 planning purposes. Ordinarily this type of contract would go out for bid, but due to the federally declared public health emergency, staff was able to sign a contract and bring the information to the Board for acceptance. The budget for this program is under phase III of the Public Health Emergency Response (PHER) grant, which was just approved, which is designated for implementation of mass vaccination programs.
Medical Resources Staffing placed a newspaper add to recruit RNs. We do not have an exclusive agreement with this company as we may recruit staff from other agencies as the need arises. Bonnie Sorenson, director of clinics & nursing services, reported that fifty RNs have already been recruited. We are requesting drug screens and background checks to be performed on each recruit. This recruitment affords nurses in the community the opportunity for additional employment. Nurses are not prohibited from working with other agencies during their off-hours at hospitals/clinics.
Vice Chair Strickland thanked Mr. Weiss for the information noted that the report was accepted.
- Petition #31-09: PDF 298KB Approval of a Revised Voluntary Unpaid Furlough Program for Employees of the Southern Nevada Health District, Effective through June 30, 2010
This item was originally approved by the Board in April 2009 as a cost savings measure. A revised program is coming back to the Board for consideration to be consistent with recent changes to NRS.
Since the program was implemented the District has seen savings of approximately $9,000 (attachment #1 PDF 53KB). The request is to extend the program through June 30, 2010.
SB243 allows for PERS contribution to be maintained up to 96 hours. The program needs to be revised to reflect this amendment, in addition to increasing the number of hours staff may request during the fiscal year. The intent of SB243, under Section 4, allows employees to take up to 96 hours of furlough leave and be held harmless, whether in the case of mandatory furloughs at the state level, or voluntary furloughs at the local level, to help local jurisdictions with financial needs.
Member Weekly inquired about possible implementation of a voluntary separation program. Angus MacEachern, human resources administrator, reported that staff has looked internally at the number of years of service credit employees have versus cost of replacement, and there is no solid number available at present. Potential savings are incumbent upon an individual’s status of retirement – an employee’s retirement is based on the highest salary over the last thirty-six months. Further loss of institutional knowledge poses a major loss to the district – training replacements could be very expensive. Design of a potential program is critical to ensure the District does not incur extra costs. If the District were to consider a voluntary separation program, mechanisms will be in place to address former employees and potential re-employment on a contractual basis.
Furlough leave is subject to approval and cannot result in a negative impact on services. All job classifications have a clause that under emergency conditions staff may be called back to work and be reassigned duties due to the nature of the emergency.
A motion was made by Member Fairchild to approve the revised voluntary furlough program as submitted; seconded by Member Boutin and was unanimously approved.
- Receive Report from the Replacement Facility Committee; Direction to Staff
Member Jones reported the Replacement Facility Committee met on September 17th. Previously the Board approved moving forward with obtaining engineering plans for the new facility to be “shovel ready” in anticipation of any stimulus funding. The architects reviewed cost saving measures, including a new location or structural changes. Jeff Gerber and David Moss, architects from PGAL, noted that the current replacement facility yields $81.7 million in total project costs. The main problem with the current location is maintaining operations during construction, which adds to the project expense. A significant portion of the expense is protecting for risks that would potentially be in place to protect the public, including off-site parking for patrons and staff, and safe ways to construct a building while the public is on site. Discussion about potential new locations ensued, which will allow for faster construction and reduced costs.
Member Barlow noted that staff was very concerned about construction costs at the last committee meeting. Staff also took into consideration the Board’s direction to receive information from each jurisdiction regarding available land and facilities to offset the cost of the building. Mr. Weiss said the district does not have the ability to generate debt, we would need to work with the County for a bond. Currently the district has a bond reserve for replacement building expenses, which would offset the total bond amount. Originally the projection was fifteen years of County-funded support, and the district would pay back the debt service for fifteen years. The last calculation with cost increases showed an increase to twenty-two years of county-funded support. Following the last committee meeting staff ran new projections, as well as figuring in potential Build America bonds allowing for reduction in cost of bonds, based on estimates the fund balance would allow the district to fund the debt for seven years and the county would need to supplement the debt service for the next thirteen years. No other jurisdictions currently are contributing to the expense of the new building, other than monies collected through property taxes.
Member Barlow recommended a parcel in the Enterprise Park, at Lake Mead and Martin Luther King, as a potential new location. Maps were displayed of Enterprise Park (attachment #2 PDF 304KB). Parcel 14, designated as “Urban Chamber,” is being offered as a potential location by the City of Las Vegas, which is only 2.5 miles from the current main facility. A widening and landscaping project for Martin Luther King Blvd. will be completed soon, due to the large amount of commuter traffic; bus lines also run along the boulevard.
The project cost could be reduced to $69.4 million, including a contribution to land costs projected at $6.8 million. The timeframe for the project would also be reduced to fourteen months down from the original thirty-three months. Square footage costs would be reduced 10% as well; however there could be additional savings of 20-30% due to reduction in construction costs in today’s dollars.
If the main facility were to move to this proposed location, potentially the clinic at Lake Mead and McDaniel could be relocated to this new location, saving approximately $200,000 annually in lease expenses. Additionally leased space at the 400 Shadow Lane building would no longer be necessary as staff would be relocated back to the main facility, which is another $500,000 in annual savings. In total the district would be looking at a potential $20.7 million in savings with the relocation of the main facility.
Member Barlow noted he presented this idea to the Mayor and City Council and they are supportive of this proposal to be partners with the health district and share the expense of a new building by making land available. This change would require county approval before plans could go forward. He hopes that the other jurisdictions would also be able to provide assistance in support of the regional health district and board, versus having the county be responsible for the entire project. The City is ready to move forward if the Board and the County agree with the proposed changes.
Dr. Sands said the main facility is but one component of the district’s facility program – a central main facility for administration and services is key, but the district will continue to operate public health centers and offices in outlying areas to best serve the needs of the community. The most mitigating need presently is replacing the main facility, as it does not meet today’s standards and we have outgrown the capacity for which it was designed.
Mr. Weiss said that from a process standpoint, if the Board agrees with the changes, staff will work with Real Property Management and County Management to provide updated figures and ensure there is support from the County Commission for funding contribution, as well as the land contribution from the City of Las Vegas. Once approved, the project will need to go to Debt Management for consideration as well.
Member Jones suggested that an agenda item be brought forward to address the change of location. Member Fairchild commended the City of Las Vegas for stepping up to the plate in these difficult economic times. She also commended staff for the recent updating of the Clemens Room. Member Weekly also commended Members Jones and Barlow for their creative efforts in moving the replacement facility forward. He encouraged Board members to do all they can to help the health district – the health district is a first responder. Vice Chair Strickland also commended the City of Las Vegas for offering land to the health district and noted the spirit of cooperation shown.
A motion was made by Member Weekly to follow the Committee’s direction and agendize a Board item for further discussion and potential action; seconded by Member Fairchild and was unanimously approved.
Member Weekly asked to be excused from the meeting and complimented Vice Chair Strickland for her performance in chairing the meeting.
Dr. Sands referenced the handout before the Board, which provides the information sought regarding space needs, as requested at the August Board of Health meeting. The district would like to continue partnerships with each jurisdiction and develop public health centers in different regions of the county to ensure easy access to needed services. The district does offer limited services in both Mesquite and Laughlin. The Henderson Public Health Center serves the southeast region, including Boulder City. The Laughlin office offers environmental health services only, as well as health cards.
- Receive Report on FY10 Budget Reductions; Direction to Staff
Dr. Sands reported revisions to the budget approved in March were made as a result of the 2009 legislative session and the subsequent reallocation of property tax revenue in both Clark and Washoe Counties to the state general fund. Staff has worked diligently to restructure programs in a tiered approach to accommodate the loss of property tax funding. Dr. Sands recognized staff for their efforts in generating cost savings and finding ways to maintain services to the community.
Mr. Weiss presented a PowerPoint on the lease allocation breakdown, cost saving activities and FY10 budget reductions impact (attachment #3 PDF 1MB). He also expressed his gratitude to division directors and staff for working together unitedly with this difficult task. The impacts were done with a realistic approach, however as situations arise, any changes will be brought back to the Board.
Mr. Weiss briefly shared information regarding the lease allocation and space needs. The City of Mesquite offered space at a reasonable rate for office space at the hospital. Clark County also renegotiated the lease for the Cambridge Community Center, which is at a much lower rate. Maps for each individual location were also provided.
In preparing the FY10 budget staff developed a tiered approach to budget reductions in anticipation of declining revenues for future fiscal years, which resulted in $1.6 million of pre-identified reductions in tiers I-III. With the passage of AB543, the district ultimately faced a loss of almost $3.2 million in funding. Cost saving activities implemented to date include:
- FY10 supply budget reduced by 5%
- Initiation of analysis of all health district programs and a tiered reduction plan of cuts based on the projected impact on public health services to the community
- Initiation of a review process to approve filling vacant positions and/or creating new positions – currently there are 46.5 open positions and a vacancy rate of 7.8%
- Implementation of alternate work weeks and schedules to reduce overtime – current YTD savings of $45,910; voluntary furlough program – current YTD savings of $8.639; increased use of online training to reduce payroll and travel expenses
- Full review of all facility leases – negotiated 17.8% reduction for the Spring Valley location
- Additional collaboration opportunities – UMC Laughlin will provide immunization services for health card applicants in Laughlin
- Planned implementation of paperless Board of Health meetings
- Replacement of local printers with multi-function printers, generating $4,000 monthly in maintenance and supply expense; staff has also been asked to print in grayscale
- Investigating ways to reduce record storage and/or maintenance costs by converting to an electronic management system
- Review of energy usage, including temperature adjustments at each facility and looking at NV Energy’s rebate program
It is anticipated that property tax valuations will be down 10-12% for the coming year, and possibly even higher. FY11 budget reductions will even more drastic.
As environmental health is self-sufficient, the division was not included in the program impact evaluation. For the administration, community health and nursing divisions the primary cuts were to travel, training and reduction of overtime. All vacant positions have been defunded as well, resulting in $800,000 cost savings. Immunization inventory will be kept at a lower level, to be more consistent with the demands for vaccine in past years and due to the fact that some vaccines are widely offered in the community – if demand increases vaccine will be acquired immediately. Participation in health fairs, program and client incentives including for outreach activities, redistribution of job duties, reduction of x-ray costs, reduction in remodels, elimination of twenty-five district cell phones and freezing the technology refresh program round out other budget reduction activities. Budget reductions per division equate to: Administration - $1,733,794 (55%); Nursing - $1,106,016 (35%); and Community Health - $312,197 (10%). Total reductions from the FY10 budget amount to $3,152,005.
The Board commended staff for the reductions implemented as well as cost savings efforts. Dr. Sands also thanked staff for their willingness to make changes and sacrifices. With all budget reductions in place, services must maintain at current levels – we are unable to take on new projects at this time unless another program is reduced or eliminated if no new funding sources are available. If the budget situation continues to worsen, other cost containment strategies may need to be considered, such as offering some services on certain days of the week and not others, or reducing the number of clients served in some programs. The district will receive funding for H1N1 activities, but restrictions may prevent their use to sustain infrastructure. An announcement for available funding from the Recovery Act will assist with chronic disease and health promotion efforts if we are successful in securing this grant.
Additional cuts may be necessary dependent upon property tax valuation, and any potential legislative action. Seeking other funding opportunities is critical to maintain the services we provide to the community.
Member Boutin suggested appointing a committee to review jurisdictional budget cuts and contingency plans. The City of Henderson opted to avoid cuts to services, but reduced employee incentives, such as elimination of travel, tuition reimbursement and reduction to cost of living adjustments. Dr. Sands said the district has been monitoring budget activities at the local level and how reductions are addressed – the voluntary furlough program was instituted based on its success enjoyed in other jurisdictions. Mr. Weiss noted that the nursing division is submitting an application for a Healthy Start grant, which will provide much needed funds for that division. Service levels are consistent even with the budget reductions; however staff may need to come back to the Board for direction if the economic situation continues to plummet, resulting in the need for more drastic measures.
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. Vice Chair Strickland asked if anyone wished to address the Board. Seeing none, she closed the Public Comment portion of the meeting.
V. Health Officer & Staff Reports
Safe Injection Practices Campaign
Nevada State Health Division (NSHD) had submitted a grant application to CDC in partnership with UNLV and the health district to receive funding to evaluate a safe injection practices campaign in Nevada. The award was approved in the amount of $250,000, and the bulk of the award will go to UNLV for the evaluation efforts. Two months ago there was no financial support for this program and today there is close to $1 million in funding to promote this important campaign, including the earmark with support from Senator Reid to assist in our ongoing response to the hepatitis C outbreak. The Safe Injection Coalition also received funding from the CDC Foundation to help produce and develop materials in piloting and implementing a safe injection practices campaign. Dr. Sands will keep the Board informed as the project progresses.
Immunization Program Update – Bonnie Sorenson, Director of Clinics & Nursing Services; Veronica Morata-Nichols, Public Health Nurse Manager
Dr. Sands invited Bonnie Sorenson, director of clinics & nursing services, and Veronica Morata-Nichols, public health nurse manager, to update the Board on the immunization program efforts to raise our immunization rates in light of continuing funding cuts from the state. Dr. Sands recognized Members Barlow and Weekly for their support of the immunization program and providing outreach opportunities for the underserved populations in their respective areas. Recently Nevada moved to 46th in the nation in terms of childhood immunization rates.
Ms. Sorenson echoed her appreciation to Members Barlow and Weekly for their support. She said that staff is actively pursuing numerous grant opportunities. Family planning received $170,000 applied to the Title X grant to provide services to the community. This is especially important as some women are finding themselves with no insurance for the first time and our services are greatly needed by the community. The United Way provided $92,000 for an immunization initiative with 100 Black Men, who also received $92,000.
Back-to-School events were very successful and approximately 10,000 students were immunized by the health district. Ms. Sorenson said in terms of Nevada’s ranking of 46th nationally is based on data that is two years old. Last year providers had an immunization rate of 62% in their offices – this year that number fell to 56.8%. People do not have insurance and are not visiting doctors and receiving immunizations. We need to continue promoting immunizations as best we can with the limited resources we have.
Currently staff is seeing 200 people daily for seasonal flu vaccine. The community is also seeking the H1N1 vaccine, which is not available at present. Staff recently completed the campaign to immunize middle school students with the Tdap vaccine in partnership with Clark County School District, which result in a 90% completion rate. Taking vaccines into the schools has a positive impact and yield tremendous results. Two nurses are auditing day care center records and finding that there is lack of enforcement of immunization laws – if a child’s immunizations are not current they are to be excluded from day care. Last year the day care immunization rate was 29% and this year the rate has increased to 69.8%.
Ms. Morata-Nichols reported that October 24th is being celebrated as “Make a Difference Day” and staff, along with 100 Black Men of Las Vegas, will coordinate a Shots 4 Tots event at Lorenzi Park (attachment #4 PDF 156KB). The target population will be ages 6-months through 4 years of age, and caregivers of infants less than 6 months of age. H1N1 vaccine will be offered that day, depending upon availability. All immunizations administered at this event will be free of charge due to the grant received from the United Way. Staff will walk the neighborhood on October 22nd and 23rd in preparation of this event. Neighborhood walks yield extremely positive results. All Board members are invited to attend this important event. Newsweek and USA Today have been invited to this event. Penn and Teller are hoping to attend.
Ms. Sorenson said stimulus money was made available for vaccine purchase in Nevada in the amount of $917,000 for a two-year period. Vaccination shortfalls are in the fourth Tdap, Prevnar and Hib, which are due when children are 18-months old. Staff is using the stimulus money for campaigns and vaccine purchase to improve the immunization rate for this category, which will then provide free vaccination for these particular immunizations.
NSHD recently notified staff that as of January 1st the district’s allocation of the state’s federal immunization grant budget will be reduced by $250,000. This affects 2.5 FTEs assigned to the VFC program in the nursing division. Dr. Sands is working with the state to try and resolve this issue. All three local health authorities in the state were affected by this announcement. Over the last three years federal funds received by the district’s immunization program has decreased from over $900,000 to just over $500,000 due to more of the federal grant dollars remaining at the state level. The state provides services to the rural and frontier areas, as well as the quality assurance component, and provides support to the different immunization coalitions.
Ms. Sorenson noted that the health reform package there will be money to fund home visitations programs for evidence-based practice models – the district participates in the nurse-family partnership program and some monies could be used to fund these positions. The informatics position has been filled and will be in place beginning in January, which will assist in looking for available grant dollars.
Vice Chair Strickland asked if there is a penalty for day care centers for failure to enforce immunization requirements. Ms. Sorenson said a license could be revoked. Forums for day care providers were held in cooperation with environmental health staff, with over 150 attendees. It was stressed that their licenses could be in jeopardy for not enforcing this important requirement. Each day care facility also holds a business license and Dr. Sands encouraged Board members to address this issue in their respective jurisdictions. Staff will also alert business licensing of a day care’s failure to comply with statutory requirements.
Member Fairchild noted the importance of this information and it was given at the request of Board members. She expressed concern that two-thirds of the Board have left the meeting and noted her frustration. She asked if reports could be made sooner or ensure that Board members stay for the entire meeting. Mr. Smith, legal counsel, noted that quorum was lost when Member Boutin left the meeting some twenty minutes earlier. Dr. Sands noted the information is captured in the minutes for Board members to review, but that is no substitute for a face-to-face discussion.
Novel H1N1 Influenza Virus Update: John Middaugh, MD – Director of Community Health
Dr. Sands said we will continue to provide updates on Novel H1N1 Influenza in southern Nevada, as well as funding. Staff is transitioning from a planning committee to an incident command structure, as some vaccine could be available in the next two weeks.
Member Barlow noted he was late for a senior health fair and asked to be excused. He said he will read the update in the minutes.
John Middaugh, director of community, said H1N1 is widespread over the country; New York City has over 1 million affected with virus alone. The National Association of Colleges and Universities reported that more than half of the 162 participating institutions have reported outbreaks. The good news continues to be that the illness is mild and the hospitalization rate is low. The virus continues to be stable since the initial mutation in April, and remains sensitive to the antiviral agents. Most older adults are still spared by the virus. Over 85% of adults over the age of 60 have existing antibodies protecting them from the new H1N1 strain.
The weekly reports will provide more comprehensive information on the occurrence of the virus in the community. Staff is working diligently to discuss and come to a uniform agreement with the state on all policy issues, including school closure and use of facial masks, as well as vaccine distribution plans. The state and local health officers met this week and unanimously agreed to adopt the CDC’s new guidelines on school closure. The partnership with the school district continues to excel in terms of electronic communication with parents, staff and students as well as implementation of vaccine clinics.
Seasonal flu vaccine is being administered and we are encouraging the community to be immunized right away – vaccine is plentiful. Once the H1N1 vaccine is available, clients can receive both vaccines at the same time. The first bolus of H1N1 vaccine, FluMist, will be in Nevada the first week of October – there will be 3 million doses available nationally and Nevada will receive 26,000 doses of which between 15,000 and 18,000 doses will come to the health district. 46 million doses will be available nationwide in mid-October. The health district will focus primarily on healthcare workers and first responders with our first allocation of vaccine. Once additional shipments arrive, we will target the other high-risk groups. We have no knowledge when the additional shipments will arrive. The largest challenge will be to educate the community about the targeted high-risk groups and the limited vaccine amounts initially. Eventually there will be ample vaccine for whomever is seeking it. Clinical trials are showing that one dose is showing immunity in adults; however children through age 10 will need two doses.
We continue to partner with the state health division to phase in clinics for high-risk target groups, and as vaccine becomes more plentiful we will support distribution widely to those providers who wish to administer vaccine, including pharmacies. We are hopeful that anyone who wants vaccine will be able to receive it and we’d like to vaccinate everyone.
Some early reports show the outbreak could peak in October, thereby alleviating the need for mass vaccination; other reports say it may not peak until late in the flu season. The vaccination campaign is a six-month vaccine program to ensure that we provide vaccine rapidly in anticipation of a peak in the outbreak, as well as providing a sustained vaccination effort. Even with the large number of tourists in town over the weekend for the boxing event we are not seeing a surge in illness at this time. Even those who may receive the vaccine in March or April 2010 will be protected for the following flu season.
There continues to be conflicts about use of masks and respirators. Some clinics have staff in full protective gear, which is against the current recommendation. There needs to be a comfort level with our own stakeholders, physicians, healthcare providers, first responders and law enforcement and that they trust the health district and the information we provide. Once the initial high-risk target groups have been vaccinated we will provide vaccine to anyone seeking it, pending availability of vaccine.
FluMist is a modified live virus; the injected H1N1 vaccine is an inactivated virus. There are some injected vaccines that are live viruses. FluMist cannot be used in pregnant women, children under the age of 2, or anyone with certain medical conditions. Reports of influenza in the community have been reported throughout the summer, at a higher rate than in the past and they continue to be high. Illness is mild and those infected recover rapidly. Hospitalization rates are low as well.
VI. Informational Items - Duly Noted
- Chief Health Officer and Administration:
- Monthly Activity Report, Mid-August 2009 – Mid-September 2009 PDF 493KB
- Financial Data: Revenue and Expenditure Report for General Fund, Capital Reserve Fund and Public Health Laboratory Fund for the Month of August 2009
- Grant and Agreement Tracking Report, as of September 14, 2009
- Public Information Monthly Report, August 2009 PDF 2.75MB
- Community Health:
- Monthly Activity Report, August 2009
PDF 1.5MB
- Swine Flu Update #8
- EPIS Report
- August 2009 Disease Statistics
- Environmental Health:
- Monthly Activity Report, August 2009
PDF 1.75MB
- Letter of Appreciation
- Clinics and Nursing:
- Monthly Activity Report, August 2009 PDF 1.7MB
- In-service calendar
- Letters of Appreciation
- Academic Pharmacy Magazine Article
VII. Adjournment
There being no further business to come before the Board, Vice Chair Strickland adjourned the meeting at 10:51 a.m.
SUBMITTED FOR BOARD APPROVAL
Lawrence Sands, DO, MPH, Chief Health Officer
Executive Secretary
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