District Board of
Health
Meeting Minutes
|
Members |
Thursday, June 26,
2025 |
|
Devon Reese, Chair |
1:00 p.m. |
|
Clara Andriola, Vice Chair |
|
|
Paul
Anderson |
|
|
Michael Brown |
Washoe County
Administration Complex |
|
Dr. Eloy Ituarte |
Commission
Chambers, Building A |
|
Steve Driscoll |
1001 East Ninth
Street |
|
Dr. Reka Danko |
Reno, NV |
1.
Roll
Call and Determination of Quorum
Chair
Reese, called the meeting to order at 1:00 p.m.
Members
present:� Devon Reese, Chair
����������������������������������� Dr. Eloy Ituarte
����������������������������������� Steve Driscoll
����������������������������������� Paul
Anderson
�����������������������������������
Ms. Lawson verified a quorum was present.
2.
Pledge
of Allegiance.
Paul Anderson led the pledge to the
flag.
3.
Public
Comment.
Molly Rose Lewis from Senator Jacky
Rosen�s office reminded everyone their office is available to help with
anything Federal related and to keep them posted regarding any specific funding
issues or assistance in terms of letters of support for grants or anything else
they can do to help individuals needing assistance with issues like Medicare or
other DHHS related items.
Darcy Phillips, Executive Director
of KTMB, wished to thank their partners GearHut and
NNPH for being so supportive of the work of KTMB, including the cleanups,
illegal dumping, etc. They are happy to announce that Sophia Morton, presenting
on e-cigarettes later in this meeting, will be heading to Washington to pursue
her graduate degree in public health.
With no further public comment, the
item was closed.
4.
Approval
of Agenda.
Steve Driscoll motioned to approve
the agenda with a second by Mr. Anderson, and it was approved unanimously.
5.
Recognitions.
New
Hire
i.
Kasimu
Muhetaer � Statistics & Informatics Supervisor � EPHP
Dr.
Nancy Diao introduced the new hire and welcomed him to NNPH.
Years of
Service
i.��������� Lisa
Lottritz � Division Director - CCHS - 30 years 6/26/1995 (Retiring 7/8/25)
ii.�������� Maria
Guadalupe Mendoza � WIC Office Specialist - CCHS - 20 years 6/30/2005
Erin Dixon thanked these staff members
for their commitment and years of service.
Health
Heroes
i.��������� Gia
Bethea - Environmental Health Services - Collaboration
ii.�������� Kaleigh Behrendt (CCHS), Kellisa
Shirane (CCHS), Tyler Henderson (EHS), Luke Franklin (EHS), Josh Foster (EHS) -
Collaboration, Compassion
iii.������� Megan Rennie (AQM), Candace Brown (AQM),
Dawn Edwards (CCHS), Lauren Huntsman (CCHS) - Collaboration, Compassion
Frenchie Rubio shared
congratulations on their work and the receipt of the Health Heroes awards.
6. Consent Items.
A.
Possible
approval of May 22, 2025, Draft Minutes.
B.
Recommendation
to approve FY26 purchases in the approximate amount not to exceed $150,000 from
Merck & Company Inc. for vaccines in support of clinic operations on behalf
of the Community and Clinical Health Services Division in Washoe County.
C.
Acknowledge
the 5-year renewal for the Fiscal Years 2026-2030 (July 2025 - June 2030) of
Accela, in the amount of $644,566.80, for the regional
permitting software maintenance and support, with Washoe County.����
D.
Approve
a Grant Award and Agreement from Nevada Clinical Services, Inc. for the period
of July 1, 2025 through June 30, 2027
in the amount of $162,692.00 each fiscal year (no match required) in support of
the Community and Clinical Health Services Division (CCHS) Tobacco Prevention
& Control Program and authorize the District Health Officer to execute the
Grant Award and any future amendments.
E.
Review the State
Public Health Funds
Priorities for the period of upon execution by the Nevada Board of Examiners through June 30, 2027, in the
total amount of 2,364,160 ($1,182,080 per fiscal year),
in support of core functions of public health, and authorize the Chair of the
Board of Health to execute the Interlocal Agreement upon receipt,
with staff to present the signed ILA to DBOH at the July
DBOH meeting.
E.�������� Acknowledge receipt of the Health Fund Financial Review for
April, Fiscal Year 2025.
Mr. Anderson moved to accept the
consent items, with Mr. Driscoll providing a second, and the item was approved
unanimously.
7.
Presentation
and Recognition of Gear Hut for their GreenBiz Award
in May 2023.
David Kelly noted that, while the
GreenBiz program recognizes businesses for their
practices at three levels, Gear Hut is receiving recognition for the highest
level, Innovator. In addition to innovative business practices, they go above
and beyond with community involvement, showing dedication to this commitment.
Leah Wzientek
from Gear Hut noted that KTMB was invaluable in helping them receive this
award.
Mr. Anderson thanked them for
the work they are doing. It is amazing to see how you can make a difference in
a community with the business you are doing.
Sophia
Morton, Service Learning Coordinator at KTMB as an
AmeriCorps Service Member, works to educate community members about
environmental issues in northern Nevada. She shared a presentation on her
research regarding the environmental impacts of e-cigarettes and the barriers
to their disposal.
Mr.
Driscoll asked about programs to provide an alternative disposal receptacle for
disposing of the units.
Ms.
Morton noted that there are currently no hazardous waste disposal resources for
households. Even with current limitations, great progress is being made.
Chair
Reese noted that the local cleanups are a great opportunity, where the amount
of material diverted from landfills has been incredible. He feels there should
be a discussion with the Board and the body about the importance of this type
of collection and disposal opportunities that may be able to be done as a
District. He also noted that the disposal of these making their way into the
waterways and other systems, is concerning. He also asked if a sharps container
was a proper method of disposal.
Ms.
Morton noted that the survey performed showed that many young adults will
collect them, so this would be a good option for containing the items. The
issue is that they must make it to one of the
hazardous waste facilities. Residents of Washoe County have one free disposal
per year of hazardous waste materials, so that would be beneficial for
disposing of these items.
9.
Recommendation
to accept the REMSA Health Monthly Franchise Report for May 2025 which includes
REMSA Health Accounts Receivables Summary, Compliance by Zones, Average
Response Times, Incident Details Reporting, Summary Penalty Fund
Reconciliation, Ground Ambulance Operations Report, Patient Experience Report
and Comments, Education Report, and Public Relations Report, and provide
possible Board direction.
Barry Duplantis shared that for
May and the fiscal year to date, REMSA Health has exceeded franchise response
compliance for priority 1 calls in all franchise zones. In May, REMSA responded
to 8,505 priority 1 calls, with 5,471 transports to area hospitals. The average
response time was 5 minutes, 47 seconds. For the customer survey report, they
received a score of 94.34. The highest score area of all responses was the
extent to which medics cared for each person. He is proud that their
organization exhibits genuine and sincere care for all responses. He also
stated that their EMS services are solid, ready to serve, without respect to
one�s ability to pay. Their care is always focused on the caller.
Chair Reese shared his sincere
gratitude for the commitment to public health.
Mr. Driscoll echoed the great quality
of service provided by REMSA, as well as the first responders who work with
them as a team. He noted that, over time, great service is provided to those who
need it, but when they do not arrive on time, the situation is reviewed to
determine what occurred, to provide better service in the future. In reviewing
the data, this appears consistent month to month. He would like to see a
presentation that explains to the Board what is seen in the reviews, what is
being done, and why it is not reflected in the response times.
Mr. Duplantis noted that they
are working on a franchise agreement negotiated many years ago, where the
requirement shows 90%, so they are managing to exceed that number. He will be
happy to provide an answer with data.
Mr. Driscoll also noted that he
would like a private meeting with the District Health Officer to explain the
decision-making process for penalty fund use. Without knowing the background of
the purchases, he is looking for education as to what the money is being spent
on, as he does not see this as meeting the current language in the franchise
agreement.
Chair Reese mentioned that this
discussion highlights the diversity of the body concerning local government. He
noted that Mr. Driscoll presented two important ideas, and work will be done
with the Health Officer to find the time for a presentation and to provide
detailed information to understand the questions asked.
Dr. Kingsley noted that, after a
year in the position, this is a great opportunity to review and look at it
historically.
Mr. Driscoll motioned to accept
the REMSA report as presented, and Dr. Ituarte seconded the motion, which was
approved unanimously.
10.
Recommendation
for the Board to uphold the decisions of the Air Pollution Control Hearing
Board to uphold the appeal of Notice of Violation No. AQMV25-0003, and deny the
appeal of Notice of Violation No.�s AQMV25- 0004, 0005, 0006, and 0007,
associated with Case No. 1511, issued to Saronic Investments, LLC and levy a
reduced total Administrative Penalty in the amount of $95,000.00 for multiple
violations of 40 CFR 61, Subpart M - National Emissions Standards for Asbestos.
Francisco Vega summarized the
violations of Federal Standards of the management of asbestos. The APCHB heard
the appeal, and based on their expertise, it was recommended to uphold the
appeal of -0003 and deny the appeals of -0004, -0005, -0006, and -0007 and levy
a penalty of $95,000. �
Chair Reese noted concern about
the amount of this fine and with the anticipation of such an amount, there appears
to be no one here to challenge this. He asked about their participation in this
process.
Mr. Vega mentioned that AQM has
a very inclusive process in investigating violations, with constant
communication with the violator, collecting information, and meeting with the
company to present evidence for an opportunity for rebuttal. After that, there a
violation is issued, then an appeal to the decision can be made to the APCHB.
Upon the appeal, work was done to hold the hearing on a date and time
acceptable to the violator. In this case, the hearing was once rescheduled, to
make sure the company was available to attend. After the decision of the Board,
communication was provided as to the determination, along with next steps, including the Board needing to approve the
decision.
Chair Reese noted this would
provide due process for the company to present their case.
Mr. Anderson thanked Mr. Vega
for the great explanation in the report and the steps taken to educate on the
issues, since this is a significant amount of money.
Mr. Driscoll asked about the inappropriate
work being done, where controls and protections were not in place. Did this
cause any material to make it into the mainstream of the waste system? If so, is
there any way this could be caught and mitigated?
Mr. Vega noted that once the
materials are disposed of with the garbage and make it to the landfill, there is
no going back. A concerted effort is made to do outreach and education as to
the proper disposal mechanisms.
Dr. Chad Kingsley asked for clarification
to the Board on the composition of the APCHB and where the fees go.
Mr. Vega shared that the APCHB
is made up of 3 subject matter experts, 1 attorney, 1 licensed contractor, 1
licensed engineer, as well as four at-large members. The penalties are provided
to the Washoe County School District. NNPH gains no value from penalties. The priority is always compliance, outreach, and education,
rather than enforcement.
Chair Reese motioned to uphold
the decisions of the Air Pollution Control Hearing Board, with Mr. Anderson
providing a second. The item was approved unanimously.
11.
Presentation
and recommendation to accept the "Washoe County, Nevada Air Quality Trends
Report (2015-2024)".
Ben McMullen shared that NNPH
currently monitors 5 of the 6 criteria air pollutants as established by the
National Ambient Air Quality Standards (NAAQS). This report details the ambient
air quality data and information for the criteria air pollutants over the last
year, along with data trends for the last 10 years, which shows a continued
improvement in the wintertime, but outweighed by summertime wildfire impacts.
Mr. Anderson asked if data has
been reviewed locally for the possible financial impact if we were found to be
out of compliance.
Mr. McMullen noted that we have
not looked into this, but a policy for supplemental
environmental projects using violation funds for interested parties is
currently being reviewed. It is possible that this could be done in the future.
Mr. Anderson noted it could make a bigger impact to the
community if these numbers were provided. He would like to see this done, if
possible.
Mr. Anderson motioned to accept
the �Washoe County, Nevada Air Quality Trends Report (2015-2024) and Mr.
Driscoll seconded the motion. The item was approved unanimously.
12. Presentation and Discussion of the NNPH Extensively
Drug-Resistant Organisms Database.
Christabell
Sotelo-Zecena shared information regarding the XDRO database, which tracks two
high-priority pathogens, Carbapenemase-Producing
Organism (CPO) and Candida auris, and serves as a surveillance tool to help
hospitals determine whether a patient has ever had a drug-resistant infection
before, to enable infection control practices. This has been integrated at one
hospital, with two others ready to onboard, and active communications are being
held with another. The hope is that this will be expanded to other health
jurisdictions and additional entities.
Dr.
Ituarte asked if there were specialized disinfectants being used in the
hospitals for C. auris. This could help inform the
importance of the database, as stronger disinfectants, PPE, and contact
isolation are necessary.
Ms.
Sotelo-Zecena noted that bleach is typically recommended, but the CDC has specific
recommendations. She indicated that, when using wipes, etc., the labels should
state the effectiveness against organisms.
Mr.
Driscoll asked if the XDRO information is noted in the single databases (i.e. MyChart) as a red flag to anyone accessing
the record.
Ms.
Sotelo-Zecena shared that the XDRO will have the information present for life,
but it is not something that patients will be able to access, and participating
hospitals will only have access to their own records. The database would help
with sharing information from one hospital to the next, as
long as they are both participants.
Dr.
Kingsley noted that public health is prevention, and this database helps build
an informed decision on care.
13. Presentation and Discussion of
the NNPH Strategic Reorganization for Alignment.
Dr.
Kingsley shared the reorganization information to be effective July 1, 2025, with
the goal of building a sustainable, resilient, and data-driven public health
system. The reorganization is expected to align the teams with the Foundational
Public Health Service domains, positioning the organization to operate more
cohesively, protect critical functions, and build a more stable future through
intentional alignment with our core responsibilities. Chronic Disease and
Injury Prevention and Sexual Health will merge with the Epidemiology and Public
Health Preparedness Division, which will be renamed Population Health. In
addition, enhanced integration between strategic planning and budget functions
within the Office of the District Health Officer will occur. This
reorganization will allow us to reshape the organization thoughtfully,
protecting core services and avoiding rushed or damaging cuts in the future.
Dr.
Ituarte asked about how the siloing will be broken down within the
reorganization.
Dr.
Kingsley shared that a component of sexual health that focuses on epidemiology,
sexually transmitted diseases, and the chronic disease injury prevention
program will be moving from CCHS to Population Health. The synergy among epidemiologists,
informatics, and statisticians will help provide clearer training and increase
decision-making abilities.
Mr.
Driscoll asked, with the work that has been done in data analysis and project
controls, are there metrics being used as a dashboard to determine if the team
is moving in the right direction?
Dr.
Kingsley noted that sexual health has an amazing throughput program on the
clinical side for individuals presenting with an infection. The new informatics
and statisticians would help to demonstrate the impact of this.
Chair
Reese mentioned he has been present through many steps of this process, though
the organizational structural changes being made are decisions that the
organization handles, rather than the Board, with Dr. Kingsley having the task
of leading the organization. The purpose of these changes is to decrease the siloing that has happened in the
past, allowing better integration.
Dr.
Kingsley shared that these changes are part of transparency and have been
discussed with leadership to determine how to continue to move this forward as
part of the strategic plan.
14. Review, discussion, and
direction to staff regarding the provisions of the Interlocal Agreement (ILA) entered into by the Cities of Reno and Sparks and Washoe
County for the creation of the Health District. Take action to accept the ILA
in its current form or direct staff to forward any additional recommendations
for possible amendments to Reno, Sparks and Washoe County.
Dania
Reid shared that the Board has the opportunity once per year to discuss the
interlocal agreement, recommend changes as a body, and determine if any
revisions or amendments might be desired, then direct staff to work on those
recommendations with the specific jurisdictions that formed the ILA. The last
amendment occurred in 2022 for the name change to NNPH. The time
period by which any revision amendment must be accomplished is before
October 1 each year, 90 days before the agreement renews at the first of each
year. As an alternative, if the Board is content with the ILA as it currently
stands, it can approve the agreement and move forward for another year.
Mr.
Driscoll asked if the Health Officer feels there are any updates to the ILA
necessary based on the reorganization spoken of previously, that may require
the assistance of the attorney.
Chair
Reese noted that these are two separate concepts, where the ILA governs the
desire of the multi-jurisdictional approach to public health and where the
reorganization falls under the purview of the DHO.
Dr.
Kingsley noted there is nothing from his position that would need to be
addressed in ILA revisions.
����� Chair Reese also noted that, in recent
years, work has been done with the County partners in the process of navigating
the challenges of financing and how the funding is handled. The ILA speaks to
this, and it may become a part of this body�s undertaking in a way that meets
the goals of the ILA.
Mr. Anderson shared that there were no concerns from the
City of Sparks, and Chair Reese also noted no concerns on the part of City of Reno. However, there was concern that with the Washoe
County representative not being present at this meeting, that opinion is needed
to move forward. This item was tabled for review at the July meeting.
15. Staff Reports and Program Updates
A. Air Quality Management - Congress
Disapproves California Waivers for Vehicle Standards, March 2025 EPA Small
Business Newsletter, Divisional Update, Program Reports, Monitoring and
Planning, Permitting and Compliance.
Francisco Vega shared that within his report, there is
information provided on actions taken by Congress to disapprove some waivers to
California and information on how that may impact us locally. He reported there
were no exceedances in May, and building plan review was at 93%.
B. Community and Clinical Health Services
- Chronic Disease and Injury Prevention Overview; Data & Metrics; Sexual
Health (Outreach and Disease Investigation), Immunizations, Tuberculosis
Prevention and Control Program, Reproductive and Sexual Health Services,
Chronic Disease Injury Prevention Program, Maternal Child and Adolescent
Health, Women Infants and Children, and Community Health Workers.
Christina Sheppard noted that the Chronic Disease and
Injury Prevention Program provided a nice report on the efforts around suicide
prevention.
Chair Reese asked about the effect of the reorganization on
CCHS.
Ms. Sheppard shared that the goal on the sexual health side
was to maintain the cohesion between clinic services and the sexual health
team, leaving no disruption to patient services. She is very confident that any
challenges can be overcome. There have been transition discussions, and the
referral process has been worked out, to ensure that clients needing to be seen
are coming in. There will be one member remaining with CCHS to make sure that
she feels well-integrated into the team. She is working closely with Dr. Diao
to make sure the transition is as easy as possible for the staff and the
community.
Chair Reese also noted that grants expected to be cut,
delayed, or reduced, have not yet been, and asked about how they are navigating
the uncertainty with this.
Ms. Sheppard noted that, with off-site testing and the CCHS
services remaining, if they don�t get as much funding or it is reduced or
delayed, they are looking for ways to pivot to provide these services, since
many in the community have come to rely on this testing.
Dr. Ituarte asked how the management of syphilis and
congenital syphilis is trending.
Ms. Sheppard replied that an uptick was noted, but over the
past month, there has been a slight decline. The Program Supervisor, Jennifer
Howell, worked hard to pass legislation that requires ERs to do rapid syphilis
testing on pregnant women coming through the ER, so they can receive treatment
as soon as the result is received. CCHS has also implemented rapid syphilis
testing in the clinic, so it can be treated right away.
C. Environmental Health Services Program
- Consumer Protection (Food Safety Plan Review & Operations, Commercial
Plan Review, Foodborne Illness, Special Events, Permitted Facilities);
Environmental Protection (Land Development, Safe Drinking Water, Vector-borne
Disease Surveillance, Waste Management / Underground Storage Tanks).
David Kelly highlighted that many EHS activities ramped up
in May due to the warm weather. A large number of
seasonal pools were opened, and a new online seasonal scheduling system was
opened for the pool operators, which seems to be working well. Waste complaints
have increased, and the special events season has gotten underway, with a
reported 36% increase in special events in the City of Reno. The food team is
planning a special processes fair, to assist customers as they work their way
through the permitting process.�
D. Epidemiology and Public Health
Preparedness - Epidemiology, Public Health Preparedness, Emergency Medical
Services, Vital Statistics.
Dr. Nancy Diao noted that outbreak numbers have remained
stable for the past three months, with a majority of
outbreaks being gastrointestinal and hand-foot-mouth diseases in daycares. This
month, in conjunction with National Mosquito Control Awareness Week, the
Program collaborated with the communications team on releasing a reel on
personal mosquito protection and awareness, which is posted on Facebook,
Instagram, YouTube, in addition to an Epi-News article being released covering
mosquito borne diseases that outlined evidence based strategies to mitigate
disease transmission and provide and overview of key mosquito vectors and the
pathogens they transmit.
Chair Reese asked about changes to immunization policy,
etc., and if we as a community will be prepared for the upcoming seasons.
Dr. Diao shared that COVID, is
experiencing a low uptick in new cases, even with the new variant. The Advisory
Committee on Immunization Practices (ACIP) could affect vaccine requirements,
but nothing is known yet, and the upcoming flu vaccine has not been determined.
Chair Reese also asked about how the changes in the
reorganization are impacting the team and how analytics fits
into it.
Dr. Diao noted that the team is always trying to work in
synergy with all teams. The name change to Population Health goes along with
the strategic goal of population-level surveillance and comparing data locally
to national and state levels. The focus of informatics is important to funding
sources, affecting staffing, caseloads, and diseases, and will help minimize
human manual work as much as possible while leveraging technology for
automation.
E. Office of the District Health Officer
Report - Northern Nevada Public Health Communications Update, Accreditation,
Quality Improvement, Workforce Development, Community Health Improvement
Program, Equity Projects/Collaborations, Community Events, and Public
Communications and Outreach.
Dr. Kingsley recognized the great work being done by the
communications team in managing many aspects of the community. He recognized
the ODHO division, where the PHAB recertification is being completed. The
Community Health Assessment process, in conjunction with Renown, has begun.
Chair Reese reiterated the requests
from Mr. Driscoll, that they be agendized
in a future meeting.
16. Public Comment.
With no public comment, the item was
closed.
Adjournment.
The meeting was adjourned at 3:01 p.m.