AGENDA PACKET NO. | A |
Members | Thursday, July 25, 2024 |
Kristopher Dahir, Chair | 1:00 p.m. |
Devon Reese, Vice Chair | |
Mariluz Garcia | |
Michael D. Brown | Washoe County Administration Complex |
Dr. Reka Danko | Commission Chambers, Building A |
John Novak, DMD | 1001 East Ninth Street |
John Klacking, PhD | Reno, NV |
Chair, Kristopher Dahir called the meeting to order at 1:00 p.m. The following members and staff were present:
Members present: Kristopher Dahir
Michael Brown Mariluz Garcia Dr. Reka Danko
John Novak, DMD Dr. John Klacking
Devon Reese (via Zoom)
Staff present: Erin Dixon, Deputy District Health Officer
Jack Zenteno Francisco Vega Lisa Lottritz Robert Fyda Dr. Nancy Diao
Dr. Chad Kingsley (via Zoom)
Dr. John Novak led the pledge to the flag.
July 25, 2024
1001 E. Ninth Street, Building B, Reno, NV 89512
Telephone: 775.328.2415 – Fax: 775.328.3752
Promotions
Charmaigne Roque, promoted from Juvenile Services RN to NNPH Public Health Nurse II, CCHS – effective 7/1/24
Ms. Lottritz introduced Charmaigne Rogue to the Board.
Susy Valdespin, from NNPH Administrative Assistant I to Legal Assistant Supervisor at the Public Defender’s Office – effective 7/8/24
Deputy Health Officer, Erin Dixon, acknowledged and congratulated Ms. Roque and Ms. Valdespin on their promotions and briefly shared their destinations and new positions.
Years of Service
Keyla Solorio, Community Health Worker, CCHS – 5 years, hired July 8, 2019
Dianna Karlicek, Environmental Health Specialist, EHS – 10 years, hired July 14, 2014
Virginia McDonald, Office Specialist, AHS – 5 years, hired July 8, 2019
Ms. Dixon acknowledged and congratulated Ms. Solorio, Ms. Karlicek and Ms. McDonald for their years of service.
Transfers
Jackie Lawson, from Animal Services Program Assistant to NNPH Administrative Assistant I, ODHO – effective 7/8/24
Retirements
Irene Ramos-Hernandez, WIC Human Services Support Specialist, CCHS – effective 6/26/24
Kevin Dick, Health Officer – effective 7/5/24 (13+ years)
Ms. Dixon shared the tremendous impact on the number of families reached by Ms. Ramos-Hernandez over her 29 years with the Program. She also congratulated Mr. Dick on his retirement.
Washoe County Health Heroes
Andrea Esp – EPHP
Danika Williams – EPHP
Heather Holmstadt – CCHS
Immunization Program – Clerical and Billing Staff - CCHS
Kelsey Zaski – EPHP
Jessica Connor - CCHS
Rachel Cord – AHS
Intermittent/Hourly Immunization RNs
Ms. Dixon acknowledged and thanked the awardees for being recognized as Health Heroes.
Molly Rose Lewis from Senator Jacky Rosen’s office shared her congratulations for awards and promotions. Ms. Lewis reminded the Board to reach out to their office for any assistance needed in terms of funding or other legislative requests. They are also available for Federal Agency assistance. Ms. Lewis is available any time for questions.
Matters which the District Board of Health may consider in one motion. Any exceptions to the Consent Agenda must be stated prior to approval.
Approval of Draft Minutes.
June 27, 2024.
Acknowledge receipt of the Health Fund Financial Review for June, Fiscal Year 2023.
Presented by: Barry Duplantis
Mr. Barry Duplantis shared that REMSA met compliance in all zones for the month of June and for the complete fiscal year, which ended June 30. For the month of June, REMSA responded to 8,286 priority 1 calls and transported 5,176 patients to area hospitals, with an average response time of 5 minutes, 53 seconds. The customer survey showed results of 93.23, up compared to May. Over the last year, the data showed the payments have been more commercial payors and less Medicaid, possibly showing a healthy barometer of employment in the community.
Mr. Duplantis opened his item for questions from the Board.
Chair Dahir thanked REMSA and their families for what they do to try to bring safety to those in need and make our region better and better.
Dr. Reka Danko asked if there has been a drop in the number of calls to the Cares Campus that did not require transport since the HOPES clinic opened for walk-in opportunities.
Mr. Duplantis noted that he does not have the data for this, but during the day, the people come and go from the Campus, which makes it difficult to maintain numbers.
Staff Representative: Jordyn Marchi
Jordyn Marchi introduced Zeb Nomura, IHCC Chair, who presented on the FY24 IHCC Accomplishments. Ms. Marchi shared that she will be presenting at the Healthcare
Coalition Preparedness Conference in December. Mr. Nomura shared that Andrea Esp and Jordyn Marchi provide excellent support for the coalition, navigating where the funding goes and how to support other facilities, broadening the scope of the coalition’s efforts.
John Novak, DMD shared that he has been attending these meetings for many years and IHCC is ahead of most other coalitions and helping assist others in their planning efforts. He is very proud of this organization.
Commissioner Garcia asked about 1) Where the $1.6M in funding came from and 2) Of the 122 IHCC participants, are there still others that aren’t involved and what is being done to draw them in?
Andrea Esp noted that the $1.6M in funds were unspent funds from the State of Nevada that were going to be sent back to the Federal Government. She petitioned the rest of the state to allow IHCC to use those funds locally. Regarding membership, staff has done a tremendous job over the years of getting partners involved. For most of the partners, this is just another hat they wear and getting them to the meetings can be difficult. The only agency not currently represented are group homes.
Commissioner Garcia thanked the group for their work in keeping the funds in the state.
Chair Dahir shared that collaboration is the key, which is not happening in many communities and shared kudos for these efforts.
Mr. Nomura indicated that they have already used some of the new equipment, which has proven to be a valuable resource in patient care.
Brian Taylor, REMSA Emergency Manager and past IHCC chair for two terms, mentioned that this coalition is envied by the rest of the nation because of the collaboration. The organization breaks down political lines to do what is right by the community. It has been his honor to serve this organization from the beginning.
Chair Dahir thanked the group for their work and presentation.
Staff Representative: David Kelly
David Kelly, EHS Supervisor, shared the applications and staff recommendations for the Sewage Wastewater and Sanitation Hearing Board. After having reached out to the industry for applications, the applications were reviewed for experience regarding regulations and the industry in which they would be working.
Staff Representative: Robert Fyda
Robert Fyda, EHS Director, shared the staff report, which states that in accordance with NRS, the NDEP requires a letter of support from the District Board of Health in order for OneWater Nevada Advanced Purified Water Facility at American Flats to obtain their permit. This project is for an A+ category effluent, which is a highly polished effluent designed for indirect potable reuse, which is where water is put through an environmental buffer (the aquifer), then drawn out for use such as drinking or irrigation. This is a joint project between the City of Reno and Truckee Meadows Water Authority to enhance the water resource portfolio, diverting some of the wastewater from traditional discharging points. The facility will be located at the Reno Stead Water Reclamation Facility and will be diverting discharge from Swan Lake. From a Public Health standpoint, there are health benefits, including clean and safe access to water.
This facility will be a step toward the goal of direct potable reuse. Initial testing shows that this meets or exceeds all Federal drinking water standards, which are more stringent than the sewage treatment plant discharge standards. Staff recommends this as a boon to the community. Mr. Fyda opened this item to questions from the Board.
Chair Dahir shared that many have seen this in action, and we must be diligent about looking to the future and leaving a legacy for our children of making sure that if our river ever didn’t do what our river has done, we have the potential of growing and learning more about the process. Mr. Dahir feels it is good to be looking at options and asked about the maintenance review.
Mr. Fyda shared that regulatory oversight for this facility will fall under NDEP with facility maintenance under TMWA.
Scott Finley, Washoe County resident, shared that he feels the NNPH Board must reject this letter of support. His opinion is none of the water produced at the plant should be injected into our local aquifer for storage, as it does not suffer from evaporation, thus creating an inherent vulnerability. In November 2023, he voiced concerns at a OneWater Nevada meeting.
Mr. Finley noted that when the information was reviewed a new polishing step had been added known as PFAS absorption, and affirmed there were concerns as unknown hazards cannot be monitored which can lead to a failed monitoring systems for those hazards.
Mr. Finley shared it can be assumed that monitors measuring the purity of the water will be connected to the internet for remote access and monitoring, which would mean a vulnerability to being hacked. A hacking could cause PFAS failure.
Mr. Finley mentioned that when, not if, a failure were to occur, contaminants hazardous to human health will be injected into our local aquifer. He feels the modifications in these diagrams suggest a mentality of making it up as you go, which is unacceptable.
Susan Vanness, Washoe County resident shared research documents from the Canada Military Family magazine, where they have shown water polishing is fallible. System failure and equipment malfunctions can reduce treatment effectiveness and inadequate maintenance can lead to reduced performance.
Ms. Vanness noted that no response was received when asked about 24-hour/7 day per week maintenance before release to the public. Incomplete removal of chemicals or incorrect dosing could leave harmful residues, and some pollutants may also not be addressed by conventional polishing methods. To ensure safety, she noted there has to
be regular monitoring before water is distributed into homes.
Devon Reese moved to approve a letter of support for the OneWater Nevada Advanced Purified Water Facility at American Flat. John Novak, DMD seconded the motion which was approved unanimously.
Staff Representative: Dania Reid, DDA
Dania Reid, DDA shared that this was brought forward from the last meeting. The DBOH is required once per year to review the ILA for desired changes. The task of the Board is to determine recommendations from the City of Reno, City of Sparks or Washoe County, then bring them together to discuss. Any changes need to be activated by October 1, 2024, 90 days before the renewal of the agreement, January 1, 2025.
Chair Dahir clarified that this agreement is strictly for the creation and activity of the Board.
Staff Representative: Erin Dixon
Erin Dixon shared that the Tuberculosis Clinic is on time and budget, will be a freestanding 7,000 square feet building, with state-of-the-art technology, serving TB clients and staff and have additional office space.
Ms. Dixon opened the item for comments or questions.
Dr. John Klacking asked how many patients are anticipated and the anticipated amount of time necessary for treatment.
Ms. Dixon shared that they expect to maintain the current client base, but there is potential for more clients every 23 minutes, utilizing additional areas as necessary.
Ms. Lottritz shared that the range for treatment is dependent upon the particular situation and can be up to 9 months.
Dr. Klacking asked if, with approximately three new cases per 100,000 population in the US, are we prepared for an additional 18 new cases per year.
Ms. Lottritz shared that, in many cases, we are able to go to the client, depending on their current situation, but this new building increases the overall capability.
Dr. Klacking asked if staff go to the prisons, where TB could be a potential hot spot.
Ms. Lottritz shared that they provide technical support to prison staff, but do not do treatments there.
Chair Dahir reminded us that the more prevention and education we can provide, the fewer cases in the community. He shared kudos for finding the funding for the new building.
Commissioner Garcia shared that she was unaware that providing this service was linked
to NRS. She wondered how many such clinics there currently are in Nevada, or if we are treating clients from outside Washoe County.
Ms. Lottritz is unable to speak to the number of these clinics in Nevada. She mentioned the hospitals have negative pressure rooms to also accommodate clients. Our clinic is designed to allow clients the freedom to remove their masks during their several hours of treatment.
Chair Dahir thanked Ms. Dixon for her update on the clinic plans.
Staff Representative: Francisco Vega
Mr. Vega opened his item by mentioning a recent Supreme Court case that may impact how the air quality and clean air act is implemented. He also highlighted that there were two exceedances of ozone, which occurred during overnight hours. The analysis determined the ozone was transported here, making them exceptional events.
Mr. Vega opened his item for questions from the Board.
Chair Dahir asked about the heat index and if it is affecting air quality at this time.
Mr. Vega responded that it would take some time to determine these effects, but so far, we have remained in the moderate zone.
Staff Representative: Lisa Lottritz
Ms. Lottritz began her report by sharing that customer satisfaction survey is featured in the report, with staff doing a very good job. For an update of the CCHS Assessment, the Intermittent/Hourly staff are now receiving regular check-ins with their supervisors. The electronic health record data is being used to inform staffing levels.
Ms. Lottritz noted that the Bridge program is coming to an end at the end of August, which is how individuals with no insurance were able to get the COVID vaccine. Work is being done with community partners to ensure we can continue to provide the vaccine. There are two back to school events coming up on August 10, in conjunction with Community Health Alliance. She gave a shout out to the Communications Team for their social media posts.
Ms. Lottritz opened her item for questions from the Board.
Chair Dahir shared that he realizes that we want to help people here, but it is very important to maintain the community partnerships.
Ms. Lottritz shared that they are working on the opportunities and will be sharing more as they come about.
Staff Representative: Robert Fyda
Mr. Fyda opened the item by highlighting some things from his report. They are holding a permitting fair on Monday, July 29, where there will be state, local and community partners available for mobile vendors talk with to provide them the assistance they need for permitting.
Mr. Fyda noted the annual itinerant permit has been rolled out, where with participation in 8 or more events, a permit can be obtained. This will be the trial run, which will be reevaluated next year.
He noted staff has run into challenges with temp events, where some mobiles have not had running water or temperatures out of range and issues with larger events submitting for permits late. Mr. Fyda asked the Board to help get information to event organizers about working with NNPH early, when they hear of upcoming events.
The June Food Safety Letter was released, with Raley’s Deli on Caughlin Pkwy and Peg’s Glorified Ham and Eggs on Lemmon Drive receiving the Excellence in Food Safety Awards.
Since the start of pool season, staff have inspected 87% of all seasonal pools and they are working toward locating and coordinating openings with the outstanding pools or confirming closure.
Mr. Fyda shared that the lead service line inventory rule will require some of the smaller water systems to submit which lines are lead and which are not. This is expected to be completed by the October deadline.
Mr. Fyda opened his item for questions from the Board.
John Novak, DMD asked if the number of violations for Friday Food Trucks were of a normal level.
Mr. Fyda replied that he isn’t sure if this is a trend or a spike.
Chair Dahir noted that there seems to be a lot more events recently. He appreciates the request for reinforcement from the Board for these events.
Staff Representative: Dr. Nancy Diao
Dr. Diao began her presentation by noting that multiple Epi News publications were distributed in July, with one being the quarterly Communicable Disease Reporting and Statistics. There has been a slight increase in COVID cases, more noticeably since July 4, with an average of about 30 cases per day. The Epidemiology COVID contract staff are transitioning off by July 31, with some permanent staff taking on additional tasks. She noted the temp staff has been a tremendous group of individuals, who helped during the difficult times. Due to demand and capacity, the final date for home testing was July 19.
Dr. Diao opened her item for questions from the Board.
Staff Representative: Erin Dixon
Deputy Health Officer, Erin Dixon, shared that staff is formatting documents for accreditation submission. The Quality Improvement Training was well done and will be helpful moving forward. Saturday, August 3, there is a Family Health Festival at Hug High School, 9-12. She gave a shout-out to the team invited to do a poster board presentation at the NACCHO 360 Annual Conference on efforts to advance our organization’s mission through partnerships. The Legislative Team has been quite busy strategizing with key partners for the upcoming 2025 Legislative Session, which begins in February. Work has been occurring with public health partners on a sustainable funding stream, so money can be allocated non-categorically. In addition, a base funding formula is being sought to provide funding for smaller counties, to include tribal areas.
Chair Dahir asked the Board for questions on this item.
Having no comments from the Board, Chair Dahir closed this item.
Special Accommodations: The District Board of Health Meetings are accessible to the disabled. Disabled members of the public who require special accommodations or assistance at the meeting are requested to notify Administrative Health Services in writing at Northern Nevada Public Health, 1001 E. 9th Street, Building B, Reno, NV 89512, or by calling 775.328.2416, 24 hours prior to the meeting.
Public Comment: Members of the public may make public comment by submitting an email comment to jlawson@nnph.org before the scheduled meeting, which includes the name of the commenter and the agenda item number for which the comment is submitted. Reasonable efforts will be made to hear all public comment during the meeting. During the “Public Comment” items, emails may be submitted pertaining to any matter either on or off the agenda, to include items to be heard on consent. For the remainder of the agenda, public comment emails will only be heard during items that are not marked FOR POSSIBLE ACTION. All public comment should be addressed to the Board of Health and not an individual member. The Board asks that your comments are expressed in a courteous manner. All public comment is limited to three minutes per person. Unused time may not be reserved by the speaker nor allocated to another speaker.
Response to Public Comment: The Board of Health can deliberate or take action only if a matter has been listed on an agenda properly posted prior to the meeting. During the public comment period, speakers may address matters listed or not listed on the published agenda. The Open Meeting Law does not expressly prohibit responses to public comments by the Board of Health. However, responses from the Board members to unlisted public comment topics could become deliberation on a matter without notice to the public. On the advice of legal counsel and to ensure the public has notice of all matters the Board of Health will consider, Board members may choose not to respond to public comments, except to correct factual inaccuracies, ask for Health District staff action or to ask that a matter be listed on a future agenda. The Board of Health may do this either during the public comment item or during the following item: “Board Comments – District Board of Health Member’s announcements, reports and updates, request for information or topics for future agendas. (No discussion among Board Members will take place on the item)”
Pursuant to NRS 241.020, Notice of this meeting was posted electronically at the following locations: Northern Nevada Public Health, 1001 E. 9th St., Reno, NV
Reno City Hall, 1 E. 1st St., Reno, NV
Sparks City Hall, 431 Prater Way, Sparks, NV
Washoe County Administration Building, 1001 E. 9th St, Reno, NV Downtown Reno Library, 301 S. Center St., Reno, NV
Northern Nevada Public Health Website https://www.NNPH.org State of Nevada Website: https://notice.nv.gov
How to Get Copies of Agenda and Support Materials: Supporting materials are available to the public at Northern Nevada Public Health located at 1001 E. 9th Street, in Reno, Nevada. Ms. Jackie Lawson, Recording Secretary to the District Board of Health is the person designated by the District Board of Health to respond to requests for supporting materials. Ms. Lawson is located at Northern Nevada Public Health and may be reached by telephone at (775) 328-2415 or by email at jlawson@nnph.org. Supporting materials are also available at Northern Nevada Public Health Website https://www.nnph.org pursuant to the requirements of NRS 241.020.