Michael Collins, RN - Alternate At-Large Member, Registered Nurse Doug Dobyne - Alternate At-Large Member, Regulated Business/Industry

Transcription

1 M I N U T E S Southern Nevada District Board of Health Meeting 495 S. Main Street, Las Vegas, Nevada City of Las Vegas Council Chambers Thursday, - 8:30 A.M. Chair Jones called the meeting of the Southern Nevada District Board of Health to order at 8:32 a.m. and led the Pledge of Allegiance. Annette Bradley, legal counsel, confirmed the meeting had been noticed in accordance with Nevada s Open Meeting Law. Chair Jones noted a quorum was present at the start of the meeting with Members Beers, Giunchigliani, Goynes-Brown, Jones, Litman, Smith, Tarkanian, Winchell and Woodbury seated. BOARD MEMBERS: (Present) ALSO ATTENDING: (In Audience) LEGAL COUNSEL: INTERIM EXECUTIVE SECRETARY: Bob Beers Councilmember, City of Las Vegas Chris Giunchigliani - Commissioner, Clark County Pamela Goynes-Brown - Councilmember, North Las Vegas Alternate Timothy Jones At-Large Member, Regulated Business/Industry Allan Litman Councilmember, City of Mesquite Stan Smith Alternate At-Large Member, Gaming Lois Tarkanian, Councilmember, City of Las Vegas Lori Winchell - At-Large Member, Registered Nurse Rod Woodbury Councilmember, City of Boulder City Michael Collins, RN - Alternate At-Large Member, Registered Nurse Doug Dobyne - Alternate At-Large Member, Regulated Business/Industry Annette Bradley, Esq. John Middaugh, M.D. STAFF: Rory Chetelat; Glenn Savage; Bonnie Sorenson; Tom Coleman; Bob Gunnoe; Jennifer Sizemore; Stephanie Bethel; Mary Ellen Britt; Adrian Brown; Dennis Campbell; Mee Kee Chong-Dao; Ray Chua; Alice Costello; Margarita DeSantos; Arta Faraday; Steve Goode; Amy Irani; Dan LaRubio; Dante Merriweather; Patricia O Rourke-Langston; Mars Patricio, Jr.; Rick Reich; Walter Ross; Jane Shunney; Deborah Williams; Nancy Williams; Timothy Ripp; Chris Strickland; Lance Johnson; Diana Lindquist and Valery Klaric, Recording Secretary

2 Board of Health Minutes Page 2 of 13 PUBLIC ATTENDANCE: NAME Ann Markle Carl Markle PUBLIC ATTENDANCE: (continued) Dr. Kathleen Peterson Paul Jucknath David Foster Thammarat Thammayarit Sripai Biadnok Pat Mulasastra Steve Liepman Scott Simon Orlando Sanchez Tenny Young Angelo Rosa John Wilson Kam Brian Mo Dennis Norberto Madrigal Nick DiArchangel Angus MacEachern Norine Clark Cara Evangelista REPRESENTING Self Self Self / Adjunct Professor Self WATSRI WATSRI WATSRI WATSRI Cannery Resorts CCR City of Las Vegas Rocky Mountain Recycling, LLC Rocky Mountain Recycling, LLC Rocky Mountain Recycling, LLC Par 3 Landscape Lunas Construction Lunas Construction SEIU Self SNHD / SEIU SNHD / SEIU RECOGNITIONS: BOARD OF HEALTH MEMBERS: Joseph Hardy, M.D to 2012 OATH OF OFFICE: The following members took the oath of office as At-Large Members for FY and City of North Las Vegas Alternate: Lori Winchell At-Large Registered Nurse Douglas Dobyne At-Large Alternate Regulated Business/Industry Pamela Goynes-Brown Alternate City of North Las Vegas I. PUBLIC COMMENT Public comment is a period devoted to comments by the general public on items listed on the Agenda. All comments are limited to five (5) minutes. Chair Jones asked if anyone wished to address the Board pertaining to items listed on the Agenda. Norine Clark, SNHD Chief Steward SEIU Local 1107, and Cara Evangelista, SNHD Vice President of SEIU, spoke thanked the Board of Health, Administration and employees during the long process in reaching a labor contract. They reported 97% of union employees voted in favor of the contract and stated they both are in support of the agreement. They reported significantly improved morale at the health district is supportive of Dr. Middaugh and the Division Directors. They stated the district is moving in the right direction.

3 Board of Health Minutes Page 3 of 13 Kam Brian, Par 3 Landscape, requested that Discussion/Action Item V.5: Proposed Changes to the Submission of Environmental Health Permit Applications for Board Approval, be moved to the Public Hearing portion of the agenda. Chair Jones with board concurrence agreed not to move the item and would solicit public comment on that item. The Chair asked if anyone had further comments and seeing no one the Public Comment portion of the meeting was closed. II. ADOPTION OF THE JULY 26, 2012 AGENDA The Chair called for a motion to adopt the agenda for the meeting as presented. A motion was made by Member Smith, seconded by Member Beers and carried unanimously to adopt the Board of Health meeting agenda as presented. 1. Receive Report from the Nomination of Officers Committee; Election of Southern Nevada District Board of Health Officers for FY : (Committee: Chair Jones, Members Beers, Litman, Vigilante) Chair Jones presented the Nomination of Officers Committee recommendations for Board of Health officers for the Fiscal Year : Chairman: Mary Beth Scow Vice Chairman: Sam Bateman Secretary: Lois Tarkanian Discussion followed regarding time requirements for the officers, primarily the chair, and the ability of those appointed to dedicate the necessary time required as more involvement is required than the monthly meeting. Other factors include upcoming legislative session, transition of the Chief Health Officer and potential conflict in light of the ongoing litigation with Clark County. Member Woodbury recommended that Tim Jones continue as chair as he has shown diligence and dedication in attending meetings, adding he was not questioning Member Scow s integrity. Annette Bradley, Legal Counsel, stated Nevada statute requires the board to elect a chair by July and if officers find they are unable to serve they have the option to withdraw from their positions and a new selection would occur using the same process. A motion was made by Member Giunchigliani seconded by Member Beers and carried unanimously to appoint the following officers of the Southern Nevada District Board of Health for FY ; Mary Beth Scow, Chairman, Samuel Bateman, Vice Chairman and Lois Tarkanian, Secretary. Member Tarkanian was the only newly appointed officer attending the meeting, took the Oath of Office and presided over the meeting. III. 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. 2. Approve Minutes / Board of Health Meeting: 6/28/ Approve Payroll / Overtime for Periods: to & to

4 Board of Health Minutes Page 4 of Approve Voluntary Furlough Program Reports for Periods: to & To Approve Accounts Payable Registers: #1362: to ; #1364: to Motion made by Giunchigliani, seconded by Member Jones and carried unanimously to approve the Consent Agenda as presented. IV. PUBLIC HEARING / ACTION: Members of the public are allowed to speak on Public Hearing/ Action items after the Board s discussion and prior to their vote. Each speaker will be given five (5) minutes to address the Board on the pending topic. No person may yield his or her time to another person. In those situations where large groups of people desire to address the Board on the same matter, the Chair may request that those groups select only one or two speakers from the group to address the Board on behalf of the group. Once the Public Hearing is closed, no additional public comment will be accepted. 1. Consider/Approve Variance Request Sripai Biadnok, Sole Owner of Buddhist Temple, to Permit One (1) Commercial Individual Sewage Disposal System to Serve Two (2) Separate Structures (Buildings) on a Property Served by Public Water Supply at 5929 Duncan Drive, Las Vegas, NV 89108, and/or take any other action deemed appropriate: Mr. Daniel Larubio, Environmental Health Engineer/Supervisor, Septic System Program and Adrian Brown, Environmental Health Engineer, Septic System Program, reported on the requested variance. Mr. Sripai Biadnok, sole owner of the Buddhist Temple, and David Foster, member of the Temple were present. A variance was requested to connect a second building to an existing commercial Individual Sewage Disposal System on a lot located at 5929 Duncan Drive, APN He plans to build a private residence for Buddhist monks and requested a variance to connect a second building to an existing commercial Individual Sewage Disposal System. He requested a variance from Section of the District Board of Health Regulations Governing Individual Sewage Disposal Systems and Liquid Waste Management (February 26, 2009 Revision) to connect the proposed private residence to the existing commercial ISDS installed to serve the Buddhist Temple and the existing 3,000 gallon septic take and 2,376 square feet leach field that has available capacity to treat sewage flows from the proposed building. After review, staff recommended approval of the variance in accordance with conditions outlined in the Memorandum. Chair Jones asked if the parties understood and were in agreement with the conditions as specified; the parties responded affirmatively. Chair Jones declared the public hearing open and asked if anyone from the public wished to testify on this item and seeing none closed the public hearing. Motion made by Member Giunchigliani seconded by Member Beers and carried unanimously to approve the variance requested by Sripai Biadnok, Sole Owner of Buddhist Temple, to Permit One (1) Commercial Individual Sewage Disposal System to Serve Two (2) Separate Structures (Buildings) on a Property Served by Public Water Supply as presented.

5 Board of Health Minutes Page 5 of 13 V. REPORT / DISCUSSION / ACTION 1. Petition #30-12: Approve the Three-Year Collective Bargaining Agreements (General and Supervisory) recently ratified by the District s SEIU Local 1107 Supervisory and Non- Supervisory Bargaining Units. Dr. Middaugh reported that a collective bargaining agreement was reached that is advantageous to all parties and introduced Bob Gunnoe, Human Resources Administrator, and Rory Chetelat, Acting Director of Administration. Mr. Gunnoe reported negotiations began approximately fifteen months ago and agreement was reached June, Membership overwhelmingly ratified the contract and it was also supported by the management bargaining team members. Mr. Gunnoe reported the agreement is a three year contract and since our contract expired June 30, 2011 we are already into one year of the contract term with two years remaining moving forward through Fiscal Year The contract consists of two units, Supervisory and General Contract, in conjunction with recent legislation. The agreement is conservative with no general salary increases, COLA s, frozen longevity, no insurance payment increases and we do preserve the ability to recognize newer employees service to the district with an annual step increase and agree to continue the contribution to PERS in regard to the employee s increase of 1.125% with the understanding that all increases in PERS from this day forward will be evenly split between employer and employee. Changes to the definition of the work day were made that enable us to better serve the public without overtime considerations. Rory Chetelat, Acting Director of Administration, presented the financial impact of the proposed contract: 1. The contract is a multi-year contract in effect until June 30, There are no general salary increases or longevity increases 3. The total fiscal cost of this three-year agreement is estimated to be approximately $2,762, the major elements of which are as follows: a. PERS We will continue to pay the 1.125% employee portion of the last PERS increase which we have paid on behalf of the employees up to this point. We will continue that for the term of the agreement resulting in a total cost of $1,183, Any future increases will be equally split between employee and employee. b. Step Increases - We will continue to pay step increases to employees on their postprobation anniversary date as has been the practice to this point. It should be remembered that the step increases for the Health District are only 2.5% which is a 50% reduction from prior years when most step increases were 5%. Step increases are only applicable to employees who have not reached the top of the salary scale (approximately 60% of the employees receive step increases) and the total estimated cost of continuing the step increases for the life of the contract is $1,578, Mr. Chetelat stated that management and union representatives recommend Board of Health approval. Motion made by Member Giunchigliani seconded by Member Beers and carried unanimously to Approve the Three-Year Collective Bargaining Agreements (General and Supervisory) recently ratified by the District s SEIU Local 1107 Supervisory and Non-Supervisory Bargaining Units as presented.

6 Board of Health Minutes Page 6 of Petition #31-12: Approve the Revision of the SNHD Personnel Code in Accordance With The New Union Contracts Bob Gunnoe, Human Resources Administrator, reported that over one-half of SNHD employees are members of the collective bargaining unit. The running rules for all of the district body are in the SNHD Personnel Code and when contract changes occur the code is changed to agree with the governing sections of the labor contract, which also covers non-union employees. Member Giunchigliani suggested a future agenda item regarding longevity of a flat rate instead of a percentage on the salary of those paid the percentage rate. Motion made by Member Giunchigliani seconded by Member Jones and carried unanimously to Approve the Revision of the SNHD Personnel Code in Accordance With The New Union Contracts as presented. 3. Petition #32-12: Approve the continuance of Southern Nevada Health District Chief Health Officer, Division Directors and Human Resources Administrator Compensation Plan for July 1, 2012 through Fiscal Year 2013 concerning the cost of PERS retirement contribution. Bob Gunnoe, Human Resources Administrator, explained that when the board met to consider whether or not the PERS increase in 2011 should be paid equally between employer and employee, at that time the Executive Team adopted a position showing leadership by putting forth a motion reducing their salaries by 1.25% in recognition of that PERS increase, approved May 26, The decrease anticipated that currently ongoing collective bargaining would stipulate to a sharing of increases between employer and employees from that point forward. The petition was approved through June 30, 2012 and salaries for those stipulated in the petition were set to resume their former levels which would return the 1.125% increase to base salaries, however, in this environment it is appropriate to propose that the period and rate of salary reduction continue until such time as future increase for PERS contributions are imposed. At that time it is proposed that we align with the employee groups in an equally shared contribution toward PERS contributions. Motion made by Member Jones seconded by Member Litman and carried unanimously to Approve the continuance of Southern Nevada Health District Chief Health Officer, Division Directors and Human Resources Administrator Compensation Plan for July 1, 2012 through Fiscal Year 2013 concerning the cost of PERS retirement contribution as presented. 4. Board of Health Policy - Ratify Temporary Waiver of Board Governance Policy-004, Paragraph 2, Committee Composition Limits Regarding the Chief Health Officer (CHO) Succession Committee, and/or take any other action deemed appropriate. Annette Bradley, Legal Counsel, discussed the Board Governance Policy-004 explaining that it permits committee membership with a minimum of three members and maximum of six. Current Chief Health Officer Succession Committee members are Members Scow, Tarkanian, Woodbury, Crowley, Beers and Jones. Member Jones suggested the committee should include a physician and because of this addition committee membership would increase to seven. She stated that a temporary waiver of the governance policy to allow for that added member was needed. The quorum would remain at four people. A comment was made that legislative changes may come forth changing the role of the Chief Health Officer requirement for a physician heading the district with two bill drafts at this time. Suggestions were brought forth for an ad hoc committee made up of managers to delineate job skills needed for the position. Historical data from previous recruitments is being coordinated by Human Resources.

7 Board of Health Minutes Page 7 of 13 Motion made by Member Litman, seconded by Member Giunchigliani to ratify the temporary waiver of Board Governance Policy to add a seventh member to the Chief Health Officer Succession Committee for this situation only. 5. Discuss and Approve Proposed Changes to the Submission of Environmental Health Permit Applications for Board Approval, and/or take any other action deemed appropriate. Glenn Savage, Environmental Health Director and Dennis Campbell, Solid Waste Compliance Manager, presented an overview of the revision of the solid waste hearing process and procedures. Mr. Savage reported the current process arose from improper handling of medical waste in North Las Vegas many years ago and the board asked that permitting applications be brought forward at that time in approximately 1996 and is well documented at that time. Currently discussions are underway to streamline the process and Mr. Savage and Campbell are presenting the proposed procedure. Staff will continue working with local jurisdictions including zoning and land use issues and business licenses would have to be received by the applicant during that process. Quality review will continue taking a look at design, construction, operational plans and ensuring all statutes and regulations and being adhered to during the application process. Mr. Douglas Dobyne has been in discussion with them and suggested bringing the principal or responsible party to the discussions and holding a public workshop and Mr. Savage stated they were in agreement with the suggestion. Public noticing and workshops for all applications will continue and they will develop a public notice system gathering addresses of all permitees (currently 96 in the community), local officials, chamber of commerce and other members serving on local solid waste association committees, engineering firms or anyone interested in the process. They would be notified of the public workshop and asked for comments. The existing process will continue, taking comments from the public at workshops as well as concerns sent by mail and for discussion at the public workshop and they will continue discussions regarding concerns with the applicant. He noted that they have been able to resolve concerns, e.g., traffic, odors, dust and processing and waste and other operational issues and if unable to resolve issues at their level they would involve the Chief Health Officer and Board of Health. Mr. Savage stated the community recycling committees will continue for discussion of processes and regulations and he is working with jurisdictions in defining solid waste and will continue working with them and the industry to assist jurisdictions. Southern Nevada Health District is by statute the solid waste authority and should assist local authorities with business licenses, zoning and land use by statute and regulations. In closing he stated streamlining the process by having staff issue permits versus the current process providing information to the Board of Health is expected to save businesses days. The process is consistent with current permitting processes used for hotels, restaurants, public accommodations, child care, schools, food facilities and tattoo and many more businesses are handled in this manner on an administrative level and Mr. Savage noted solid waste is the only permitting process brought before the board of health. Mr. Campbell added the proposed process is consistent with the other two solid waste management authorities in the state. Mr. Savage responded to questions stating that the system will be similar to liquor and gaming where they meet and talk with the principal and work with SNHD in agreeing to the permit conditions. Issues that cannot be resolved will be brought to the Board of Health as an agenda item and Member Giunchigliani requested that the item not be listed under the consent agenda in that circumstance. Mr. Savage reported the current processes will continue with fact sheets, documenting the public workshop as part of the record and findings of the workshop. Acting Chair Tarkanian declared the public hearing open and asked if anyone from the public

8 Board of Health Minutes Page 8 of 13 wished to testify on this item. Kam Brian, Par 3, thanked the board members for taking interest and agreed with the process and efforts to work with them in the past stating he was in agreement with the process, but would like to look at the specifics of the process before it is ratified. Douglas Dobyne, Lunas Construction Clean-Up, agreed with Mr. Brian and suggested that applications be put online for review instead of having to travel to the Environmental Health Department to review them, adding there is not enough time to review and absorb all of the information at the public hearing. He requested tabling a decision until the August meeting to enable industry members to meet with environmental health to review the process and provide input. Mo Dennis, Lunas Construction Clean-Up, was in agreement with the comments made and that industry would like to review the process and may have additional suggestions for the process. Dr. Middaugh summarized the goal of the new procedure. He stated that a huge proportion of the time of the board has been reviewing these applications with 90% of them approved with conditions already agreed to by the petitioner and the Environmental Health staff. The goal is to streamline the agenda and enable the board to have additional time to focus on other potential issues while totally protecting the process and enabling these discussions to occur at the workshop with proper notice and provide the opportunity for the petitioner to request their item be an agenda item to come before the board if there was not agreement. Much time would be saved for the petitioners, board, staff and public and if the consensus is agreed upon by the business and staff then our staff could issue that permit immediately enabling the business to move forward and he asked the board of assist facilitation of our responsiveness to the business community and protect the time of the board for having the opportunity to look at other public health problems and issues. In response to a question how the board would receive notice Mr. Savage stated the Board of Health would be part of the noticing process so they are aware of applications and a system established where the permit and conditions of the permit would be shared with the board members prior to issuance, which is currently done with the memorandums presented at the board meetings. Mr. Savage acknowledged the suggestions made in the public hearing and stated that additional forums for discussion would be welcomed. Industry and SNHD staff will meet to further review the procedure/process developed, finalized and brought before the board at the August 23, 2012 meeting. A motion was made by Member Giunchigliani and seconded by Member Beers to not take action on the proposed changes to the Environmental Health Permit Applications permitting industry to review and provide input in the process and present it at the August 23, 2012 meeting. 6. Discussion: Amending the Southern Nevada Health District Board of Health Bylaws to Include a Statement of Commitment Ensuring the Health District has Adequate Resources. (Requested by Member Menzel); and/or take any other action deemed appropriate. Annette Bradley, Legal Counsel, stated former member Menzel suggested this language change a few months ago and asked for the item to be placed on the agenda last month and it was inadvertently left off and added for the board s consideration this month. The bylaws according to article 7.1 it requires a majority vote of all members for change. Discussion followed and it was the opinion of the board that they could not guarantee secured funding and would not feel comfortable adopting something that cannot be enforced or controlled

9 Board of Health Minutes Page 9 of 13 and did not agree with use of the word ensure. Language could be changed to reflect the intent. If the bylaws will be reviewed the review of article 3.1 e was also suggested. Additions and deletions to the existing language was suggested to enable a review of existing and changed language. Changes to the Bylaws could be reviewed by the Bylaws Committee that can be addressed in the future. A motion was made to hold the amendment of the bylaws in abatement for review by the Bylaws Committee by Member Giunchigliani, seconded by Member Beers and unanimously carried. VI. BOARD REPORTS: The Southern Nevada District Board of Health members may identify emerging issues to be addressed by staff or by the Board at future meetings, and direct staff accordingly. Comments made by individual Board members during this portion of the agenda will not be acted upon by the Southern Nevada District Board of Health unless that subject is on the agenda and scheduled for action. Pamela Goynes-Brown, North Las Vegas Alternate Member, discussed the need to re-establish services and utilize the CP Squires Elementary Campus at no cost for one nurse to provide immunizations, healthy kids exams for physicals on a short-term basis, however that did not work out as planned. Space was located in a shopping center at Craig and Revere that will allow a clinic to be opened by September 1, 2012 and to meet the deadline and move forward she would like to direct staff to finalize the lease and bring it to the Board of Health for approval at the August meeting. The board directed staff to move forward with the lease to establish clinic services in North Las Vegas. Acting Chair Tarkanian responded that staff has the full support of the board to move forward. Dr. Middaugh thanked the board for their support that will assist with implementation. VII. HEALTH OFFICER & STAFF REPORTS Health Card Program and Hepatitis A Vaccine Requirements: Nancy Williams, M.D., presented information on this item. She reported that Clark County foodhandlers are required to have Hepatitis A vaccinations and that it is a good time to revisit this requirement as frequency of Hepatitis A has dramatically decreased both in Clark County and throughout the U.S. This mandatory requirement has been in place since 1999 and she noted that the only other major metropolitan area known to have a similar requirement is St. Louis, Missouri. CDC has never recommended vaccination of all food handlers. Hepatitis is a viral illness that causes inflammation of the liver and is most likely to be transmitted through contaminated food. The illness can last from weeks to several months with severity ranging from very mild to very severe. Dr. Williams reviewed a graph of the annual Hepatitis A case rate in the U.S. starting in 1952 noting that waves of Hepatitis A illness used to occur prior to about 1972 at which time a gradual decline in rates began. The initial decline was presumably related to better food-handling practices, improved sewage treatment, and processes of that nature. The recent, more dramatic decline is attributed to the development of a Hepatitis A vaccine. People with the greatest risk factors for contracting Hepatitis A have historically been: People visiting or living in countries with high Hepatitis A rates Men who have sex with other men Users of illegal drugs, and Close contacts of people with the disease. Being a food handler or a restaurant patron is not considered to be a significant risk factor, although on rare occasions, the source of Hepatitis A infection has been traced to an ill food-handler. Overall, transmission of Hepatitis A by a food handler is unlikely, even if a food handler is

10 Board of Health Minutes Page 10 of 13 diagnosed with the disease. Most restaurant patrons do not get sick when a food handler has Hepatitis A. Many people, particularly those in the high risk groups, benefit from protection against Hepatitis A. The vaccine was approved for use in 1995 and in 1996 formal recommendations were made to vaccinate people in the high-risk groups as well as children living in communities with the highest rates of Hepatitis A. The recommendations were broadened three years later, with the vaccine having become more available and its success demonstrated. At that time, Nevada children were included in the target group because of our high rates of Hepatitis A and, in 2006, the recommendation to vaccinate was extended to all U.S. children. Dr. Williams stated that Clark County s Hepatitis A rates were compared with the rates in ten other large metropolitan areas to determine what effect the vaccination of food handlers has had on Hepatitis A rates. She reviewed a graph showing Hepatitis A rates for all eleven of the metropolitan areas in The three metropolitan areas that had large outbreaks during the mid- to late 1990s were: Maricopa County, Arizona (Phoenix metro) in 1998 St. Louis, Missouri in 1993, and Clark County, Nevada in 1997 The two metropolitan areas that require vaccination of food-handlers had slightly more decline in rates initially, but by 2010, all of the metro areas rates of Hepatitis A had dropped so low that this advantage is no longer apparent. The CDC reported only five foodborne Hepatitis A outbreaks in the entire U.S. in 2010 and 2011, and over the last five years, the greatest number of individual Hepatitis A cases per year recorded in all of Clark County was ten. Dr. Williams pointed out several other factors to consider when deciding whether the food-handler Hepatitis A vaccination requirement is appropriate. Hepatitis A infection produces lifelong immunity to the disease. Once recovered, a person can never again contract Hepatitis A or transmit the virus to others. Therefore, there is no benefit of vaccinating any person who has previously been ill with hepatitis A. In Clark County, many food handlers come from countries where Hepatitis A rates are high. Therefore, many of them are likely to have been infected previously, meaning that they are already immune to Hepatitis A. We have no idea what proportion of health card applicants fall into that category, but it is likely that we have been vaccinating many people unnecessarily. Dr. Williams summarized and presented her conclusions: Hepatitis A rates are historically low both in Clark County and throughout the U.S. The main factor contributing to the decline in Hepatitis A illness rates in Clark County and throughout the U.S. was the issuing of vaccination recommendations for high-risk groups, including children. The food handler vaccination requirement is probably no longer serving much benefit. Today, foodborne outbreaks of Hepatitis A are unlikely to occur either in Clark County or anywhere in the US. Ray Chua, Health Cards Supervisor, reported that effective September 1, 2012 the movie will no longer be required and training can be done online and is offered at PBS (Public Broadcasting Station) and the Urban League office and we are looking to provide online training at the health district. The possibility of expanding these services to the libraries, welfare and WIC offices was suggested. Glenn Savage stated they were also looking at providing the certificates electronically to

11 Board of Health Minutes Page 11 of 13 employers. Food Safety Training is being refocused for those in these fields only, but is offered as an option for this training as people do work multiple jobs. Training will be provided in other languages as needs determine. They plan to do a financial analysis to break down components and make any proposals for change. Current cost of the card is $50.00 and has not changed and depending on what happens with Hepatitis A they will cost it out. Dr. Middaugh reported the current cost of a Hepatitis A dose is $ Pertussis Update: Dr. John Middaugh provided a pertussis update and reported that the Seattle, King County area, of Washington declared an emergency because of the pertussis epidemic. Identified cases in Clark County have doubled and he reported that a major pertussis campaign is being planned. Discussion followed regarding school based clinic programming and Member Giunchigliani recommended Bonnie Sorensen s participation. Bonnie reported that she participating with the state in a CDC grant funded statewide billing committee, which she participated in, so that we are able as part of the Affordable Healthcare Act to put the state of Nevada as a whole in a position to contract with Medicaid and private insurance companies and stated we will be one of the pilot sites for southern Nevada when they select a vendor to set up the program. We currently bill Medicaid and have a contract with the Culinary Union and have been recognized by United Healthcare on a limited basis and are looking to increase that in the near future. Bonnie Sorensen reported that SNHD will be providing back-to-school immunizations at the malls and large community events and at the Valley View facility and will run seven days during the last week. Last year a large campaign was conducted immunizing almost 15,000 students and data showed a 95% immunization rate in the middle schools. Audit of the 558 daycare centers for enforcement of rules and laws is a current focus, but a challenge with two staff members. For information Mee Kee Dao is the contact person. Process to Change NAC Annette Bradley, Legal Counsel, report that Member Beers requested that she bring information to the Board of Health regarding the mechanism to enact NAC provisions. She stated that the State Board of Health (SBOH) has the authority to adopt public health regulations for inclusion in the Nevada Administrative Code (NAC) and amend existing public health NAC provisions. As you know, a public notice and hearing is required prior to adopting or amending administrative regulations. Once adopted, if the SBOH wanted to have their new (versus amended) administrative regulations codified in the NAC, they would submit the regulations in the form of a bill draft during the next legislative session. If the SBOH wanted only to amend existing NAC provisions, they would work with the Legislative Counsel Bureau to draft the amendatory language for ultimate submission and codification. If the Health District wanted to have a regulation adopted, amended, or repealed, it could petition the SBOH by submitting a letter to the Secretary of the Board, accompanied by relevant data, views, and arguments. Building Update Rory Chetelat, Acting Director of Administration, provided an update on the Valley View facility. He commended the IT, Maintenance and Environmental Staff for their hard work to get the building ready. We are on track to make the first phase move of approximately employees by August 1, The building owners are required to bring the facility up to ADA standards and have the systems in place and on target to have the Certificate of Occupancy by August 1, 2012 and final changes are being made as some of the air conditioners are not functioning. The second phase move is planned for September 1, 2012 bringing staff relocation to 200 employees and they will

12 Board of Health Minutes Page 12 of 13 continue to plan completion of the remainder of the building and relocations. Acting Chair Tarkanian asked Member Giunchigliani about the offer made on behalf of Clark County offer to work on a methodology to withdraw the court cases and the county would step up construction. Member Giunchigliani stated the offer is on the table. HbA1c and Lipids: Dr. Middaugh reported that we developed our epidemiology disease surveillance system over the last 2-1/2 years, TriSano and our Public Health Informatics Scientist has equipped us with the capability of receiving disease reporting data from physicians and laboratories. Using this system we hope to require reporting of hemoglobin A1c and lipids. Hemoglobin A1c is a laboratory test and based on the proportion of hemoglobin can be used to diagnose diabetes. It is a reflection of how well diabetes is being controlled and a valuable surveillance tool to help understand how people with diabetes are being diagnosed and managed on population basis. Hemoglobin A1c is reportable in New York City and we have been in communication over the last year learning from their experience. Use of TriSano software enabled us to have laboratory reporting come into our offices for the last 1-1/2 years and over the last 6 months through the Homeland Security grant fourteen of the sixteen acute care hospitals are on board and are being certified to ensure all requirements were met to transmit their laboratory data to us. We hope to analyze these data to observe what is going on with diabetes, high cholesterol and high lipids among the population that we serve and are exploring our ability to do this. We hope to utilize this tool to equip us to respond to the epidemic of chronic disease and obesity in the country. We will report on the initial results at a future meeting. Dr. Tom Coleman, Director of Community Health Division, stated the data will be reviewed to determine where to prioritize and target interventions. It is critical to build our epidemiology capacity. He stated that epidemiology is really the science of public health, and is important to be able to collect, analyze and interpret data for use in building surveillance systems to impact the public health to build programs and allocate resources and community partners. The U.S. Department of Human Services rolled out a campaign focusing on hemoglobin A1c, blood pressure control, cholesterol management and smoking cessation and this will provide the start of surveillance systems for two of those components. It is a 5 year initiative to try to bring in more federal funding and prepares us to have the data that can be used to make stronger applications. Dr. Coleman responded to various questions presented stating the process is under development and has a learning process, but will have profound effects on our ability to measure and track the burden of cardiovascular disease in our community. In response to a question presented regarding barriers experienced in the past relative to gathering information from the state Dr. Middaugh responded that he was working with the Medicaid program to access Medicare data and we have been unsuccessful getting any support from the Medicaid program at this point. We are continuing that dialogue and he hopes to have access to Mr. Duarte and Mr. Willden to find a way to collaborate fully and take advantage of the Medicaid resources and their value to our community to assist with the community health status. Member Giunchigliani recommended presenting this information to the Legislative Committee on Healthcare and suggested that the Board add it as a future lobbying issue in the next session if it is not resolved. Dr. Middaugh would support that kind of initiative and reported that Richard Whitley, Nevada State Health Division, is supportive of the initiative. Member Giunchigliani will discuss with a few legislators.

13 Board of Health Minutes Page 13 of 13 VIII.INFORMATIONAL ITEMS - DULY NOTED IX. PUBLIC COMMENT: 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 Comments will be limited to five (5) minutes per speaker. Please step up to the speaker s podium, clearly state your name and address, and spell your last name for the record. If any member of the Board wishes to extend the length of a presentation, this may be done by the Chairman or the Board by majority vote. Acting Chair Tarkanian asked if anyone wished to address the Board and noted that speakers are limited to five minutes. Ann Markle, Southern Nevada Health District retiree, stated that today has been refreshing from the board and district staff and she is extremely proud of the district at this meeting and the leadership. The Chair asked if anyone had further comments and seeing no one the Public Comment portion of the meeting was closed. XI. ADJOURNMENT There being no further business to come before the Board the meeting was adjourned at 11:06 a.m. SUBMITTED FOR BOARD APPROVAL John Middaugh, M.D., Interim Chief Health Officer Executive Secretary /vk