AGENDA ITEM NO.   

7A 



District Board of Health Meeting Minutes


Members

Thursday, August 22, 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


  1. Roll Call and Determination of Quorum.

    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. John Klacking (via Zoom)

    Ms. Jackie Lawson verified a quorum was present.

    Staff present: Dr. Chad Kingsley Erin Dixon Francisco Vega Lisa Lottritz Robert Fyda

    Dr. Nancy Diao

  2. Pledge of Allegiance.

    Mariluz Garcia led the pledge of allegiance.

  3. Approval of Agenda.

    August 22, 2024

    Michael Brown moved to approve the agenda for the August 22, 2024, District Board of Health regular meeting. Mariluz Garcia seconded the motion, which was approved unanimously.

  4. Recognitions.

    Years of Service

    1. Raquel Depuy Grafton, Public Health Emergency Response Coordinator, EPHP – 5 years, hired August 5, 2019

      1001 E. Ninth Street, Building B, Reno, NV 89512

      Telephone: 775.328.2415 – Fax: 775.328.3752

      www.nnph.org

    2. Elizabet Munoz, Clinic Assistant, CCHS – 10 years, hired August 4, 2014

      Dr. Kingsley shared the years of service for Raquel Depuy Grafton and Elizabet Munoz.

      Resignations

      1. Heather Kerwin, Epidemiology Program Manager, EPHP – effective 8/9/24

      Dr. Kingsley wished Heather well and thanked her for her efforts in carrying us through COVID.

      Washoe County Health Heroes


      1. Kristen deBraga - EHS

      2. Lauren Huntsman - CCHS

      3. Dianna Karlicek - EHS

      1. Brittany Lucier - EHS

      2. Noah Glick - ODHO

      Dr. Kingsley thanked the above individuals for their Health Hero recognition.

  5. Proclamations.

    A. International Overdose Awareness Day Proclamation Staff Representative: Joe Dibble

    Accepted by: Anne-Elizabeth Northan, JTNN Executive Director Chair Dahir read the proclamation into the record.

    Joe Dibble introduced Anne-Elizabeth Northan as the Executive Director for Join Together Northern Nevada. She thanked the Board for this proclamation, which is an important part of raising awareness and collaborating to make better futures for our community. This provides an opportunity to consider the lives lost, the strength of the community and the movement toward collective solutions. Prevention is one of the most powerful tools we have, not only to fight overdose, but to impact a wide variety of chronic diseases.

    Chair Dahir mentioned that he is on this Board and appreciates what Ms. Northan and the whole team do at JTNN.

    Commissioner Garcia moved to accept the International Overdose Awareness Day Proclamation. Michael Brown seconded the motion, which was approved unanimously.

  6. Public Comment.

    Chair Dahir opened the public comment period.

    With no Public Comment requests, Chair Dahir closed the Public Comment period.

  7. Consent Items.

    Matters which the District Board of Health may consider in one motion. Any exceptions to the Consent Agenda must be stated prior to approval.

    1. Approval of Draft Minutes.

      1. July 25, 2024.

    2. Budget Amendments/Interlocal Agreements.

      1. Approve a Notice of Subaward from the State of Nevada Department of Health and Human Services, Division of Public & Behavioral Health for the period October 1, 2024 through September 30, 2025 in the total amount of $103,099.00 (no required match) in support of the Community and Clinical Health Services Division (CCHS) Fetal Infant Mortality Review (FIMR) Program and authorize the District Health Officer to execute the Subaward and any future amendments.

      2. Approve the Notice of Subaward from the State of Nevada Department of Health and Human Services, Division of Public & Behavioral Health in the total amount of

        $1,216,230.00 (no cash match) retroactive to January 1, 2024 through July 31, 2026, in support of the Centers for Disease Control and Prevention (CDC) Epidemiology and Laboratory Capacity Program; the funds will be used to complete epidemiological surveillance and investigation activities in Washoe County and authorize the District Health Officer to execute the Notice of Subaward and any future amendments.

      3. Approve the Notice of Subaward from the State of Nevada Department of Health and Human Services, Division of Public & Behavioral Health for the period retroactive to July 1, 2024 through June 30, 2025 in the total amount of $333,333 (no match required), in support of the Northern Nevada Public Health Sexually Transmitted Disease Prevention and Control Program and authorize the District Health Officer to execute the Subaward and any future amendments.

    3. Recommendation to uphold the decision of the Sewage, Wastewater & Sanitation (SWS) Hearing Board to approve Variance Case #H24-0002VARI of the Northern Nevada Public Health Regulations Governing Sewage, Wastewater, and Sanitation, allowing a crossing of a drainage ditch by a septic transmission line with protective mitigation measures, for Page and Olivia Bailey, owners of 14075 Bihler, Rd, Washoe County, Nevada, Assessor’s Parcel Number 142-241-14.

    4. Acknowledge receipt of the Health Fund Financial Review for July, Fiscal Year 2025.

    Michael Brown made a motion to approve the consent agenda. Commissioner Garcia seconded the motion which was approved unanimously.

  8. Regional Emergency Medical Services Authority.

    A. Recommendation to accept the REMSA Health Monthly Franchise Report for July 2024 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.

    Presented by: Barry Duplantis

    Barry Duplantis shared that the Franchise requirements were met or exceeded in the month of July. REMSA responded to 8,772 calls, with 5,436 patients transported. The Customer Survey report produced a score of 92.17, consistent with prior months. All public comments are taken seriously, with a goal of taking care of the community.

    Effective July 1, 2024, REMSA contracted with the City of Sparks to enable REMSA to utilize the city’s ambulance resources within designated service areas of Sparks to enhance service to citizens. He is exceptionally pleased to announce this is going very well, perhaps exceeding the expectation.

    Mr. Duplantis opened the item up to Board questions.

    Chair Dahir commented that this is a lot of patients. He thanked REMSA for the care brought to the city and county.

    Mariluz Garcia moved to accept the REMSA Health Monthly Franchise Report for July 2024. Dr. John Klacking seconded the motion which was approved unanimously.

  9. Business Impact Statement – CHAPTER 030 – SOURCE PERMITTING Regulation development Review, discussion and possible adoption of the Business Impact Statement regarding proposed revisions to the District Board of Health Regulations Governing Air Quality Management, CHAPTER 030 – SOURCE PERMITTING, with associated changes to the Air Quality Management Fee Table which would provide an estimated revenue of approximately $200,000 based on FY22-23 service volume, with a finding that the revised regulations do not impose a direct and significant economic burden on a business; nor do the revised regulations directly restrict the formation, operation, or expansion of a business; and set a public hearing for possible adoption of the proposed revisions to the Regulations for September 26, 2024, at 1 PM.

    Staff Representative: Francisco Vega

    Mr. Vega shared the mission for AQM and the background for Chapter 030 and provided some of the reasons for the adjustment. Some of the major changes proposed are raising the minimum permitting threshold, the permitting renewal timeframe, expanding and clarifying the list of exemptions, and raising the Best System of Control. Also included is a general permitting program for well-defined sources along with changes to the fee structure to better align services with the air quality impact.

    An extensive stakeholder process has been completed with several organizations reached out to and concerns were addressed.

    Assuming this is approved today, a Public Hearing for adoption will occur next month, for a proposed implementation date of January 1, 2025.

    Mr. Vega opened the item to questions.

    Dr. Kingsley shared a letter of support from Nancy McCormick, Economic Development Authority of Western Nevada (EDAWN).

    Chair Dahir shared that he and Commissioner Garcia sit on the EDAWN Board, and he loves that there was a letter from them, to show that collaboration is taking place.

    Taking the time to communicate and explain and getting support while regulating.

    Sarah Collins with the Nevada Petroleum Marketers and Convenience Store Association shared that they are in support of the revisions. Mr. Vega has done a great job of reaching out to the community. He has reached out for every revision of the AQMD Code and has met with the community to answer numerous questions.

    Chair Dahir thanked Sarah for her comments.

    Michael Brown moved to approve and adopt the Business Impact Statement for the proposed revisions to the District Board of Health Regulations Governing Air Quality Management, CHAPTER 030 – SOURCE PERMITTING, with associated changes to the Air Quality Management Fee Table and set a hearing for the possible adoption of said revisions for September 26, 2024, at 1 PM. Commissioner Garcia seconded the motion which was approved unanimously.

  10. Presentation and possible acceptance of the Annual FY24 Strategic Plan Results

    Staff Representative: Rayona LaVoie

    Counsel Dania Reid noted that this item was determined to be designated as an action item, but was not recognized as such in the agenda, so the item will be pulled for next month.

  11. Northern Nevada Public Health Quality Improvement Program Staff Representative: Rayona LaVoie

    This item also was also to be an action item and not recognized as such in the agenda, so will be pulled for next month.

  12. Staff Report and Program Updates.

    1. Air Quality Management – Air Quality Management – Research Shows Wildfire Smoke “Greatly Raises” Risks of Dementia, EPA Finds That Agencies Did Not Regulate Synthetic Minor Sources Appropriately, Calls for FEMA to make Smoke Events Eligible for Disaster Relief Funds, June 2024 EPA Small Business Newsletter, Divisional Update, Program Reports, Monitoring and Planning, Permitting and Compliance

      Staff Representative: Francisco Vega

      Mr. Vega opened his update with highlights on new research regarding wildfire and the impact on dementia.

      Chair Dahir asked about the article regarding FEMA and funding for wildfires. Mr. Vega shared that he was asked a question about how businesses can get reimbursed for impacts associated with wildfire and feels that this may be an opportunity for business impacted by wildfires to be reimbursed.

      Chair Dahir would like to understand more about this, especially when notices are sent out about restricting being outdoors.

      Mr. Vega will put more effort into educating himself on exactly what this looks like.

      Mr. Vega shared one additional item from a report from the Office of the Inspector General, where they conducted an audit of air quality agencies in southern California and Texas and found minor sources were not being permitted correctly, with actions being taken against them. He has also seen similar things happen in Colorado. He is seeing the EPA turning its eye closer and closer to smaller sources.

    2. Community and Clinical Health Services – Divisional Update – National Immunization Awareness Month; 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

      Staff Representative: Lisa Lottritz

      Ms. Lottritz provided an update about the successful back to school season. She is very pleased with the hard work of staff for the clinics provided. Up next is COVID and flu. The FDA recently approved the 2024/25 COVID vaccine and the team looks forward to receiving the COVID and flu vaccines in September.

      Chair Dahir mentioned that the number of vaccines provided were top in the county and across the state and shared kudos for this.

    3. Environmental Health Services (EHS) - Program Activities for: 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)

      Staff Representative: Robert Fyda

      Mr. Fyda opened the item by highlighting some things from the report. Over 200 people attended The Food Business Fair which provided inspection services and staff to work with the community to submit applications. He gave a shout out to staff for coordinating and organizing the event. There was a lot of participation from partners at the Small Business Administration, the City of Reno and City of Sparks.

      Mr. Fyda also shared that another helicopter larvicide treatment of about 300 acres was recently completed and went well.

      Commissioner Garcia mentioned that she attended the Food Business Fair and was very pleased with how easy and comfortable it was for the constituents to be able to move through, getting lots of questions answered. She expressed kudos for the collaboration in bringing everyone together.

      Chair Dahir also said congratulations to the team for supporting businesses the best we can.

    4. Epidemiology and Public Health Preparedness - Epidemiology, Public Health Preparedness, Emergency Medical Services, Vital Statistics.

      Staff Representative: Dr. Nancy Diao

      Dr. Diao shared there was a noticeable increase in outbreaks reported in the month of July compared to June. The big contributors were the summer surge of COVID outbreaks and rash outbreaks from childcare facilities. The final COVID monthly report was published in July, and going forward, select COVID statistics will be merged into the influenza surveillance report, produced weekly during the respiratory virus season. The Epi News distribution published one issue, the dissemination of the Health Alert Network article from the CDC, bringing awareness to the mpox transmission in the DRC, with a spread to neighboring countries. The mpox risk in this country remains very low at this time.

      Dr. Diao also mentioned that the Epidemiology Program Manager, Heather Kerwin left to move on to other opportunities. She would like to voice her deep appreciation for all the work she has done for the community and teams during the immense difficulties of the COVID pandemic and her contributions to various projects and initiatives for the Division and the Health District.

      Commissioner Garcia asked about home COVID tests. She wondered if there are still opportunities for people to sign up for the free kits to be sent to their homes.

      Dr. Diao responded that this has subsided, with no current offering.

      Chair Dahir asked about exercises for contaminated water and wondered if any had been done.

      Dr. Diao responded that this is something that can be looked into and she would bring back to the Board.

      Dr. Kingsley noted that water contamination is part of the emergency plan, like a mass casualty incident. This is written into the plans and hasn’t been practiced for a while.

      Chair Dahir indicated that this was brought up in a meeting and thought maybe it should be addressed.

    5. District Health Officer Report - Northern Nevada Public Health Communications Update, Accreditation, Workforce Development, Community Health Improvement Program, Diversity, Equity and Inclusion, Community Events, and Public Communications and Outreach

    Staff Representative: Chad Kingsley

    Dr. Kingsley thanked Michael Brown for the visit to Incline Village while he makes his way through the County meeting with individuals and associations in the community.

    Staff was able to attend the NACCHO conference, also attended by the CDC. He noted more awareness is being taken of those with accreditation, providing future grant prospects. Reaccreditation is going well, to be submitted by the end of September.

    Chair Dahir shared that he is happy that Dr. Kingsley is getting around and doing what needs to be done for NNPH and noted that the Board is there when needed.

  13. Board Comment.

John Klacking pointed out how serious the wildfire impact on dementia is with new diagnoses increasing 21% for every mcg increase in the concentration of wildfire particles, comparing to 3% increases for every 3mcg jump in non-wildfire particles. This is a huge difference for other contaminants being breathed in.

With no other Board comment, Chair Dahir closed this item.

Adjournment.

Chair Dahir adjourned the meeting at 1:53 p.m.



Possible Changes to Agenda Order and Timing: Items on the agenda may be taken out of order, combined with other items, withdrawn from the agenda, moved to the agenda of another later meeting; moved to or from the Consent section, or they may be voted on in a block. Items with a specific time designation will not be heard prior to the stated time but may be heard later. Items listed in the Consent section of the agenda are voted on as a block and will not be read or considered separately unless withdrawn from the Consent agenda.

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)”


Posting of Agenda; Location of Website:

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 the Northern Nevada Public Health Website https://www.nnph.org pursuant to the requirements of NRS 241.020.