Thank you.

Madam Clerk, are we ready to begin?

Yes.

Thank you so much.

Good morning, members of the public.

I'm going to call to order this Thursday, October 23rd meeting of the District Board of Health and ask Madam Clerk for a roll call and determination of a quorum.

Chair Reese.

Here.

Vice Chair Andreola.

Present.

Board Member Anderson.

Here.

Board Member Brown.

Here.

Dr.

Denko.

She's not here yet.

Board Member Driscoll.

Here.

And Dr.

Eduarte.

Here.

Okay.

We have a quorum, Chair.

Thank you so much.

And Madam Clerk, when Miss or when Dr.

Danko arrives, just note that for the record.

My understanding is she will be with us in person, but was running a little late from an earlier meeting.

Yes.

Can we now uh move to the Pledge of Allegiance?

And uh Mr.

Driscoll, would you be kind enough to lead us in that please join me?

My pledge of allegiance is to fly of the United States of America and republic for which it stands.

One nation under God, indivisible with liberty and justice for all Madam Clerk.

Item three is public comment.

I'll note for the um people who are here before you read the public comment statement that one of the items is coming off the agenda, and that's item 10.

If you were here to give comment on item 10, it's going to be removed from the agenda when we get to the approval of the agenda, and so you'll want to make sure you sign up with the clerk for public comment on that item.

Madam Clerk, the public comment statement, please.

Comments heard under this item will be limited to three minutes per person and may pertain to matters both on and off the board agenda.

Unused time may not be allocated to other speakers.

Comments are to be made to the board as a whole, and virtual public comment may be taken when facilities are available.

A speaker's viewpoint will not be restricted, however, reasonable restrictions may be imposed upon the time, place, and manner of speech.

Irrelevant statements, unduly repetitious statements, and personal attacks that would objectively antagonize or incite others are examples of speech that may be reasonably limited.

This board carries out the business of Northern Nevada public health and its citizens during its meetings.

The presiding officer may order a person removed.

If the person's conduct or statements disrupt the orderly order or safety of the meeting, warnings about disruptive conduct or comments may or may not be given prior to removal.

Furthermore, certain disruptions of public meeting are criminal access defined under NRS, which may result in prosecution inappropriate cases.

Okay, Madam Clerk, I have received Mr.

Brown's October 21st email, and we'll make sure you've lodged that for the record.

Is anyone in person for public comment?

Yes, we have Aaron Abbott.

Perfect and followed by Brad Kitts.

Okay, Mr.

Abbott, Mr.

Kitts, if you want to cue down here, it's an off a long way to walk.

Mr.

Abbott, hello, good afternoon.

Good afternoon.

Um for the record, Aaron Abbott, uh founder and CEO of technical medical EMS services here in Reno.

Um I appreciate that uh item number 10 has been pulled.

Um I did still want to, however, um provide some comments um about some concerns um as that uh agenda and the red line version of Rems' franchise agreement was still posted um publicly under the agenda item.

Uh the concern that we have uh greatly is that uh that item um again I'm glad it was pulled.

Um it was posted seven days ago and would add an additional new regulation under Rems' franchise agreement with seven days uh for the community to react to that had it been heard and approved.

I understand it's been pulled, and and again, thank you very much.

Um currently um we see uh that multiple providers are necessary providing that service regarding specifically 2.1a of the proposed language of the franchise agreement, which would have granted exclusivity to RemSA uh over all airport transfers.

Um involve a coordination between medical teams and ground ambulance providers as those air medical teams come into the community.

Um they need reliable ground transportation to transport that patient uh to the hospital.

Those air providers stay with those patients the entirety of that transport.

Um they're responsible for that care.

We're essentially a set of wheels, a rolling oxygen tank, some supplies, and a couple of qualified people with hands in case there's a patient care issue.

We uh believe strongly that previous to having multiple providers in Washoe County for that service.

Um the the franchise holder had to compete with emergency 911 calls and their franchise compliance with providing that service on the ground, which is not measured.

It's not a uh a part of the franchise performance criteria for those particular calls.

Um furthermore, I do think as a business owner it's an unnecessary uh government regulation.

Um so that piece of that language in that franchise that was proposed draws us great concern.

We are providing a lot of those transports to our customers, um, and we try very hard to meet the customers' needs.

We're on time, we're courteous, and we do everything that we can to meet their needs, we take them back to the airport on the dead leg, um, whereas I'm told other service providers uh typically will not do that.

Um so again, thank you for polling that.

Um I also uh have concern um regarding some language in the franchise agreement that um you know compels Ramza as the franchise holder um to contract and subcontract for services.

Um right now their subcontractor, the primary subcontractor is Razi.

RASI is a whole owned subsidiary of REMSA.

It's very hard to be uh a correct oversight um when it's a company that you own.

And for that, I appreciate your time.

Thank you.

Mr.

Abbott, thank you so much.

Next up is Brad Kitts, followed by William Baker, hello board, good afternoon.

I was originally going to comment on item number 10, but at your request, I'll retract my comment.

No problem.

Thank you so much.

Okay, William Baker.

Good afternoon, board.

On behalf of Intermountain Health, uh regional health care providers serving Nevada and the West.

I'm express our strong opposition to Section 2.1 of the proposed franchise agreement with REMSA Health.

This section would grant Ramsa exclusive rights to provide ground ambulance transport for patients arriving via air ambulance from outside the franchise area.

We believe this provision is not in the best interest of patients or the health care system in the in our region.

It also appears to conflict with federal law, specifically Airline Deregulation Act, which preempts local regulations that affect air ambulance services over the past year.

Intermountain health has transported more than 250 patients into Washoe County, and REMSA has consistently proven to be a strong and reliable partner, assisting with the vast majority of these transports.

Our concern centers on the preserving the integrity of our ability to choose the best ground transport option for each patient we bring into Washoe County, ensuring that patients' needs remain the top priority.

Our concerns grounded in both legal precedent and free market principles are as follows, and I summarize one Section 2 likely violates federal law, the airline deregulation act of 1978, which contains an express preemption clause that says no state or local entity may enforce any law related to price, route, or service of an air carrier.

Two, the proposed exclusivity is unprecedented and unnecessary.

Courts and regulators consistently favor open competition in EMS.

Three, Section 2.1 undermines free market principles and patient choice to the detriment of the community.

In summary, while we value REMSA's role in our communities, Section 2.1's grant of an exclusive market is but is both a legally problematic and bad public policy.

It would reduce competition, possibly increase cost, and likely violate federal law.

We respectfully ask that the board remove or amend Section 2.1 to eliminate the exclusive ground transport language.

By doing so, you will help safeguard patient choice and competition in our emergency transport system and avoid entangling the county in a potentially legal conflict with federal aviation law.

Thank you for the opportunity to provide input on this important issue.

Intermountain Health is committed to working with you, REMSA, and all stakeholders to ensure the highest quality emergency medical services for our community without sacrificing the principles of legality, competition, and patient-centric care.

Thank you.

Mr.

Baker, thank you for being here today.

Appreciate it.

We have no additional public comment.

Okay, Madam Clerk, we'll close out item three, then and move on to number four, which is the approval of our agenda.

I'll first turn to turn to you, Dr.

Kingsley, other than the item which I've already removed, which is item 10.

Do you have any other changes to the agenda?

None of the none at this time.

Thank you.

Okay, I'm looking for a motion to approve.

I'll move to approve.

I have a motion by Miss Andreola.

Second, second by Mr.

Driscoll.

Any additional comments or questions at this time?

Hearing none, I'll call for the question.

All those in favor, please signify by saying aye.

And on your iPad.

Any opposed?

Motion carries unanimously.

Item five is our recognition section.

Dr.

Kingsley, I'll turn this portion over to you.

It looks like we've got uh a couple of special recognitions, years of service, health heroes, and one particularly special recognition.

So the floor is yours.

Yes, uh starting out before I turn time over to uh deputy district health officer, uh Ms.

Dixon.

I just want to go ahead and recognize uh the receipt of our public health um accreditation board.

So this is a reaccreditation for Northern Nevada Public Health.

It states that we meet the rigorous standards for quality, performance, and accountability.

It affirms that a public health agency is effectively delivering essential services, engaging with its community, and uh and is engaged in continuous improvements.

So I just want to recognize that we've received our reaccreditation and the staff has put in uh many times and uh uh many hours for this to ensure that we continue with this accreditation.

So thank you.

And turn the time over to uh Miss Dixon at this time.

Congratulations, Dr.

Kingsley and all of your team.

I know how very hard it was uh and how many hours went into it.

Thank you so much, Ms.

Dixon.

Thank you very much for the record, Aaron Dixon.

Um I too must give kudos to the entire team for the accreditation.

Um if you've never been involved with that, that 18 months of heavy lift of finding all that documentation, and even though we know we aren't all of our teams do great work, it's really nice to have that recognition.

Um so I am here just for the uh special recognition and then years of service.

So it is my honor to recognize Ms.

Andrea Esp with a Nevada Emergency Management Certification.

Ms.

S.

received her emergency manager certification from the Nevada Emergency Preparedness Association, and it's a recognition of her knowledge skills and management in emergency management.

We're very proud of her for those efforts.

For our years of service recognition, both of them happen to work in environmental health services, and actually they both work in the permanent facilities program.

Uh, this and this program is responsible for public health inspections in schools, child care, pools, hotels, tattoo parlors.

I'm sure I've missed a few of those examples.

Um Scott Strickler is an environmental health specialist, and he has reached his 20-year milestone.

In addition to working in permanent facilities, he is also in our vector program.

And then Jesse Celine has been with uh Northern Nevada Public Health for 10 years, and she helps ensure operators have all the information and resources that they need for all their permit needs with that program.

So we thank both of them for their years of service.

Thank you.

And now we have uh Miss uh Rubio to present our health heroes.

Hi, um, for the record, I'm Franchi Rubio, an office specialist with environmental health services.

Um the Health Heroes Committee recognizes three employees that were nominated for the month of um September 2025 Health Heroes.

Um we have uh Mike Escobad from ODHO.

Um he was noted for the values of adaptability, collaboration, and trustworthiness.

Mike and his team were assigned to conduct 15 focus groups which fall outside of Mike's usual duties and responsibilities for the community health assessment CHA, which will inform the community health improvement plan, also known as CHIP for the next three to five years.

He truly stepped up to assist and ensure and ensured hot spots for transcripts and recordings at locations outside of NNPH and kept track of the inventory for participants incentives, as well as managing logistics.

So thank you, Mike, for all your help.

Definitely couldn't have achieved this without your support.

Um next up we have Gloriana Alvarez from AHS, noted for the values of adaptability, collaboration, and compassion.

So just recently she immediately acted on a supervisor's emergency where the supervisor was unable to cover main communicable diseases, uh disease reports due to a system issue, which caused a potential delay.

Um public health responses.

And as always, Gloriana responded with uh compassion and reassurance, and within five minutes, she restored the supervisors access, which prevented a critical gap in the public health surveillance.

So, yeah, she's definitely a health hero whose work enables all of us to better serve our community.

And at last but certainly not least, uh, we have um Elizabeth Munoz.

Um she was noted for compassion.

Um Liz handled a confused client with a history of a mental health disorder very gracefully and professionally.

Um being that the client was very loud and persistent, um, Liz remained professional and calm and was able to calm the client down.

Now, although we were not able to provide the client with services mainly because we couldn't offer them, she still remained professional and calm and guided him to seek primary care for services that you know we were unable to offer.

So great job, Liz.

So, yeah, thank you.

Well, congratulations for all those recognitions.

I am especially uh excited for the reaccreditation and for Mr.

Strickler's 20 years of service.

That's incredible.

Thank you so much for that.

Okay, I'll close out item five now and move to item six.

Item six is our consent agenda items.

Is any of the board wish to have any item from the consent agenda pulled from that agenda.

Seeing none, can I get a motion for the consent agenda as approved and okay?

I have a motion by Mr.

Brown.

Second, a second by Mr.

Anderson.

Any additional questions or comments at this time?

Seeing none, I'll call for the question.

All those in favor, please signify by saying aye and vote on your iPad.

I opposed motion carries unanimously.

Item seven.

This is a recognition.

I think Ms.

Esp, you're gonna come down and chat with us about that.

Sounds like we've got crash responder safety week.

Congratulations again for um your recognition as well.

Uh the Nevada Emergency Mandament certification, I know is quite challenging and comprehensive, so thank you for that.

You're welcome.

Andrea S.

for the record, um, EMS Preparedness Program Manager for North Nevada Public Health.

Um, before I read this proclamation, I do want to recognize that we have several providers in this room who are directly impacted by this, and we want to thank them for all the work that they do.

Um, so I'll start.

So, whereas law enforcement officers, firefighters, emergency medical personnel, road maintenance crews, public service utility workers, tow operators place themselves in danger every time they work within inches of vehicles traveling at highway speeds to conduct valuable life-saving operations in adverse weather conditions.

And whereas it is imperative that we promote safer incident scenes through public education and awareness to protect all responders as they courageously work to clear incidents.

And whereas Cross Crash Responder Safety Week serves as an opportunity for the Department of Public Safety, Nevada Highway Patrol Division, the Nevada Department of Transportation, and other first responder agencies to participate in a coordinated efforts to educate the public and bring awareness to first responder safety and to promote effective traffic incident management strategies and training for first responders.

And whereas the North Nevada Public Health reminds drivers of the move over law NRS 484B.607, which states, if possible, the driver in a lane that is not adjacent to the lane where the traffic incident is located, unless roadworthy traffic, weather, or other conditions make doing so unsafe or impossible.

Whereas, according to the National Highway Traffic Safety Administration, less than 30% of Americans are aware of the move over laws and fail to abide by them.

Whereas NNPH is committed to effective traffic incident management response and management through collaboration and training, which reduces the duration and impact of safety or of traffic incidents and improves the safety of motorists, crash victims, and emergency responders.

And whereas over 1,500 first responders have participated in Nevada traffic incident management coalition efforts throughout the state since 2014.

And 79% of all responders in Nevada have received traffic incident management training.

Whereas during Crash Responder Safety Week, Norton NNPH remembers and honors those national first responders who have lost their lives in 2024.

Twenty-six law enforcement, three fire EMS, 12 tow operators, and one service technician, and four uh Department of Transportation for a total of 45 first responders.

Now, therefore, it be resolved that North Nevada Public Health Board of Health does here recognize the week of November 17th through the 21st of 2025 as Crash Responder Safety Week, recognized today, the 23rd day of October 2005.

Thank you so much.

2025.

I would like to recognize everyone in uniform sitting behind us.

They do participate in the coalition here in Northern Nevada.

We they do meet and talk about even with talk about for traffic safety, but that also includes our private sector who are building our roads.

So those vendors are also there talking about how do we improve the safety of the roads, how do we improve it for you on the road?

Um it also shows up in the regional EMS strategic plan that we work on safety for our first responders.

So I think we often over forget that they do put their lives not only online to save those individuals, but they're risking at the risk of others not paying attention, and that's not just distracted driving, they're just purely not moving over.

So I'd like to express our gratitude to all first responders, those who are present in the room, and throughout our community.

Thank you.

Thank you so much.

Okay, Madam Clerk, before we move on to item eight, I forgot to mention that uh Miss Molly Rose Lewis in Senator Rosen's office is with us online, so she's here virtually and um is not making public comment but wants to make sure that uh we know that they are available during the shutdown for any needs that the constituents or the health district might have.

Okay, we'll now move on to item eight, which is a recognition uh an important one.

So uh come on down.

One of my favorite restaurants glorified ham and eggs.

I know.

Let's go.

Okay.

I love it.

Um, well, great.

Good afternoon, Mr.

Chair and members of the board.

My name's Olivia Alexander Leader, and I am a senior environmental health specialist here in the food safety program with Environmental Health Services Division.

And I'm here today with the wonderful honor to um recognize Fred Lee and his team at the PEGS Glorified Ham and Eggs on Lemon Drive for the Excellence in Food Safety Award.

It's a wonderful accomplishment.

Um, the Excellence in Food Safety Award is a program offered by the EHS division to recognize Washoe County food establishments that go the extra mile with food safety practices to protect consumer health and well-being.

Winners of this award demonstrate excellent food safety practices and exhibit active managerial control over foodborne illness and food safety risk factors in their establishments.

To qualify for this award, the facility must have three consecutive passing scores, um, no more than 10 total observations of non-critical violations in a three-year time period.

And they also have to have documentation of food safety training and record keeping that they maintain on site at their establishment.

And not only has Peggs met these requirements, uh they have also raised the bar in terms of building a culture of food safety, and they are a true example of maintaining a clean and safe working and dining environment for their staff and for all of our community members here in Washoe County.

Um, when you walk into the Peg's kitchen, you can see that the facility is cleaned, that it's organized, and that all of their equipment is maintained in a good condition uh good condition, even though they have a very large menu, which it sounds like we all enjoy, and a very bustling dining room.

Um, so as a risk category three establishment, they also are um performing complex food handling procedures, which include things like cooking and cooling down the food, they're using time as a public health control, um, things that we don't see all the time, but they're executing it perfectly.

They maintain these processes in a good condition, and they're almost always accompanied by detailed logs that are diligently maintained by their staff.

And the staff is who really cares about food safety at the Pegs on Lemon Drive.

The team has regular meetings where they talk about the importance of food safety, and they even take quizzes and tests that relate to food safety to kind of gamify and make it fun.

They utilize a group chat where the managers from multiple locations can submit pictures of logs and discuss any issues that arise, and that could facilitate the constant and consistent verification of procedures and monitoring of critical food safety controls at their establishment.

Every employee at Peg's Lemon Drives takes pride in and ownership of proper food handling practices.

And so, even though our regulations require that only one certified food protection manager is required to be on site during operational hours, the PEGs at Lemon Drive has gone above and beyond by certifying 70% of their staff, including both full and part-time workers.

So they are always covered in terms of having food safety knowledge and having that wonderful support system in their establishment.

So when we asked Fred why food safety was important to him and his team, he shared at our company, we have created a culture surrounding food safety through continuous training, communication, and accountability.

And he also shared the funny anecdote that he personally observed a busser chase an experienced cook to tell them they were not doing things properly in terms of food safety.

So at the Pegs on Lemon Drive, educing and empowering every single staff member on their team has been their major kit key to success for food safety, and it is observed at every inspection and every time we have the opportunity to interface with Fred.

So it's for all of these reasons that I am so happy and um proud to be able to present them with the Excellence in Food Safety Award.

Um congratulations, Fred, and to your team at Pegs on Lemon Drive.

Um keep up the good work.

Thank you so much.

Thank you so much.

Thank you.

Thank you.

Fred, we'd love to have you tell us a little bit about the history of PEG.

Well, I think we most of us know the history of Pegs, but come on up to the microphone, Mr.

Lee.

Well, um, true story.

Mom and mom and pop were retired, and they traveled from Oregon to live here in Reno, one of their favorite places to visit.

And one day, and this is not a very well-known fact.

One day, Dad was sitting there with a big piece on his belly watching TV, and he polished off the entire pie.

And mom says, you know what, we're done retiring.

We're gonna go back to work and open a restaurant.

And then so Peggs was born.

It was just meant to be a fun little thing.

Mom and dad did just to pass the time and and keep things going.

And at one location has now become nine operations throughout Nevada.

So it's still family-owned and operated, and we're very very, very proud to be serving the community.

So thank you, everyone here, and thank you so much for supporting our business.

And thank you to the team that that does help us so much do with all our inspections, and it's been sincerely very uh uh very great partnership and very collaborative.

So thank you so much for all your help.

Well, Fred, uh, my location is in Northwest Reno, and we're there with some frequency.

Uh the Monte Cristo is my favorite thing.

But thank you so much for being here.

It's very important to us that we uh recognize folks who are doing it right.

Uh, we hear a lot of things in the news sometimes about those who maybe are having some difficulties.

Um, probably the majority of people are trying to do it right, but don't always hit the mark.

So it's nice to see people who are consistently uh doing that active managerial control program and really working hard to keep our community safe.

So thank you to you and the entire PEGs team.

Uh every location I've been to has always been exceptional.

And so thank you so much for that.

Um can I offer the chair to try the Moco Loco?

Yeah, so it's excellent.

Yeah, um that dish actually was voted by uh you uh food networks, one of the best local MOCOs, um, one of the 13 best local mocos outside of Hawaii where it originated.

So we were very proud of that today.

And here's a whole story on that.

I'll tell the chair later.

Thank you so much.

Okay.

Thank you all very much.

Thank you, so thank you, Mr.

Lee.

Me too.

Okay, we'll close out item eight and move now to item nine.

Item nine, uh, Mr.

DuPlanus, welcome and good afternoon.

This is our uh monthly uh report on the franchise at REMSA.

Good afternoon, Chairman Reese, members of the board.

I'm Barry Duplanta, CEO and president of Remsa Health for the record.

I understand you've been provided with a copy of Remsa Health's September 2025 report for September and for the fiscal year to date.

Remsa Health has met and exceeded uh franchise response compliance with all priority one calls in all franchise zones.

In zone A for September, we've reported 91 uh percent compliance, and in BCD, um 96 percent um uh compliance.

During September of 2025, Remsa responded to 8,471 priority one calls and transported of 5,000 539 uh patients to area hospitals.

That volume actually, the the transport rate I might comment is just a little bit higher in the month of September than it was in the month of uh of August, but no particular reason uh seems to stand out.

Our customer survey report for September resulted in a score of 93.71, which was which was consistent with the prior month.

Our highest score was in the cleanliness of the ambulance and the degree to which the medics took the patients serious problem seriously.

These ratings were higher than the national average for the national database that we are part of.

Our goal is to provide our community with timely, compassionate, and high-quality emergency pre-hospital care.

I also would like to comment with regard to penalty funds in the month of September.

We provided almost $5,000 in signal kits for Lake Tahoe Fire Protection District at Incline, and we provided 127.

Actually, the number in total is 527, but we provided 127 of those as flu immunizations in partnership with Nevada, Northern Nevada Public Health using penalty funds at the CARES campus, our place, and many of those people had not received a flu shot uh vaccine in the last year.

Additionally, on top of that 127, renowned health donated money to supply an additional 400 uh immunizations.

So we uh definitely had a strong campaign of providing flu immunizations in the in the month of September.

Next, as part of my uh report to you today, um, I'd like to recognize Caitlin Roberts, who was nominated and selected to represent RemSA and our region at the emergency medical services Stars of Life event, which will be held in Washington, D.C.

March 3rd, uh I'm sorry, November 3rd through November 6th.

I'd like to um welcome Caitlin up as I read a few things about her and we uh celebrate a little bit with her.

Every year, the American Ambulance Association hosts the Stars of Life event in Washington, D.C.

It's an opportunity for triple A member organizations of which Remsa Health is one of to sponsor an employee to attend the event and be recognized as a star of life, which is a provider or a staff member who demonstrates exemplary service, compassion, and dedication for their EMS work.

This year, Remsa Health is honoring Caitlin Roberts, who is an EMS manager, and she is being recognized for exceptional leadership and compassionate support for her colleagues and community.

In early November, as I mentioned, from the 3rd of November through the 6th, Caitlin will be in Washington, D.C., where she is going to join with about 145 other stars that are being recognized throughout the nation for the for the outstanding and important health care contributions.

This group will also have an opportunity to meet with members of Congress to share their frontline experiences and advocate for the future of emergency medical services.

And I will tell you from my experience, the senators and representatives are very engaged with the folks that come to represent EMS on a national level, wanting to understand what brings them there.

So it's a very exciting uh opportunity, both for us as community to be present as well as for us to recognize amazing people in our community, such as Caitlin.

In addition to being an exceptional clinical provider, Caitlin is known for her collaborative leadership style, listening to employees, and committing to finding solutions that benefit everyone.

Caitlin's contributions actively enhance the culture of our organization every day.

She is responsible, responsive, caring, accountable, and proactive.

Characteristics that help paramedics and EMTs feel supported and patients feel cared for.

Since Caitlin joined the ground operations team, she has made several positive contributions.

Her focus on employee wellness and recognition is remarkable.

She is a proactive communicator and helps her team understand the reasons behind decisions.

Working as a woman in EMS leadership, Caitlin values representation, and she demonstrates that leaders who lead with empathy, strength, independence, and collaboration earn trust and respect of their colleagues every day, just as she has.

She is a member of the organization's peer support team and works to improve the day-to-day lives of our EMS professionals by serving on the Fit for Life, Fit for Duty, and EMS planning committees.

Caitlin, you're an incredible and deserving and deserving of this recognition, and it is my honor to present you to today as part of the District Board of Health meeting.

I've got here which what I would like to also provide you with is your medal of recommendation.

And I would also like to invite Miss Shirley Folkins Roberts to also join me up as I present this medal.

Ms.

Shirley Folkins Roberts is the chair of our board, and she's joining us here today.

And I'd like Shirley to join me in presenting this award to Caitlin.

Thank you.

Thank you, Grant.

Thank you for the one picture.

Yes.

Thank you.

So that concludes my presentation to you today.

I'm happy to take any and all questions that you might have.

Well, let me start with this.

Caitlin, welcome.

It's a privilege to get to hear a little bit about your story.

I really enjoy that part of the presentation.

We don't always get to spend as much time talking about the people that are the organization.

So thank you for that.

Glad to have you here.

Let me see if any of my colleagues have any questions for Mr.

Duplanis this month.

Any questions?

Okay, no questions, but Barry, I did note two things from the report.

One is the customer survey report was very high.

I mean, you're consistently high, but it was up several percentage points.

So congratulations on that.

And then I noticed that you have a new executive director for CareFlight, Joe Drago.

So that would be someone we'd love to meet at some point in time in the future, too.

And of course, welcome him to the REMSA family.

We'd be delighted to introduce him to you.

We're so proud that he uh joined the organization.

He came from another um air ambulance organization.

Um he's just an impressive individual.

So yes, I'd be delighted and honored to introduce him to you.

That'd be awesome.

So thanks a lot for the report.

Appreciate you this month.

Thank you.

Can I get a motion to accept the report?

So moved.

Okay, I have a motion.

Second.

Second by um Dr.

Danko.

Any additional questions or comments at this time?

Hearing none, I'll call for the question.

All those in favor, please signify by saying aye.

Aye.

Aye.

Any opposed?

Motion carries unanimously.

That brings us to item 11.

Item 11 is uh Dr.

Kingsley.

That's an item for you.

Presenting to the board our 2026 schedule, as well as where we will post it for our community and awareness of when we will be holding our district board of health meetings during the uh next coming year.

I don't know that I had any questions, but I just want to make sure we had had this conversation offline.

So I'll just say um occasionally throughout the year, you know, our board meeting uh is interrupted or impacted by uh holidays.

So we made the adjustments this year as we always do.

Correct.

Okay, thank you so much.

Any questions uh from the body?

Okay, I don't see oh, I do see this out for possible action.

Can I get a motion to accept the um calendar?

Okay, Mr.

Anderson.

Second by Mr.

Driscoll.

Any additional questions?

Hearing none, I'll call for the question.

All those in favor, please signify by saying aye.

Aye.

Aye.

Any opposed?

Motion carries unanimously.

Okay.

Staff report updates in item 12.

We'll start with air quality management.

Mr.

Vega.

Thank you, Chair, members of the board for the record, Francisco Vega, Director of the Air Quality Management Division.

Um, just a quick uh highlights of my report.

I did provide some information on the wildfire emissions prevent uh prevention act.

Um we are pretty excited about the possibility of you know something like that moving forward.

Um we work really closely with our partners to the West on fuels management, forest management, obviously prescribed fires being part of that.

Um so again, uh like I said, we work really closely with those.

One thing we would like to see though is if our monitors are impacted by uh these prescribed fires.

Historically, uh, there has been a potential for a lot of staff work time in order to remove some of that data from any kind of regulatory significance with this proposed legislation that would be done a lot easier.

So saving staff time so we could focus on more, you know, important issues that really impact air quality.

So again, we're really excited about this potential.

Um let's see.

I'm also excited to report that we had no exceedances of the air quality standards for September, so that's always a good thing.

Um always like to provide an update on how we're doing on plan review.

Um I'm excited again to report that we were back to 100 percent.

We were 98 percent in August, and again, like I said, I'm I'm had to report that we were back to 100 percent.

Um lastly, I did want to kind of bring to the board's attention some um challenges we're having with uh um our stationary source program.

Um if you recall our stationary source um permitting program went under uh went under a lot of change in the last year.

Uh and the first uh of this year our regulations kind of went into effect that uh was approved by the board, I think on last September or October.

Um one of the major changes that's um required as part of the regulations is that um permits and sources are renewed once every five years.

So again, this is something new, and it's important for uh not just air quality, but also for the businesses to make sure that their uh permits are reflective of their current operating status and kind of risk all from an air quality basis.

So historic historically, that is not taken place.

So if you got issued a air quality permit in 2001, we've never probably reviewed it ever.

And so the the permit probably does not reflect who you are as a business and really does not set you out for success uh from an air quality perspective.

Um so again, getting to the new regulations.

Um the businesses have to apply um in order to update their permit.

Um we're not seeing these applications being submitted.

And you know, just some of the work that we've done to try to help the businesses be uh successful.

Since the regulation was passed, and like I said, in September, we've done multiple workshops from November 2024 through March of 2025.

Just again providing some information on kind of what you need to do to be successful and also offering up uh, you know, our staff if you need assistance as well.

In addition, um, there's a window that at the applications must be submitted.

And these businesses are being notified um that uh so this the application must be submitted between 270 and 180 days from expiration.

We are sending out notifications at day 300, 270, 210, and another one at 180.

So you get four notifications from us saying that hey, you know, this needs to be done, and if you need help, you know, please reach out and we'd be more than helping to uh more than happy to help you.

Um as of today, I think for applications that were expected to be submitted um, I think through June, July, and August, we've seen seven of the 12 applications be submitted.

So just a little, you know, over you know, 50 percent, which is which is concerning.

So more recently, what we have done just to take the next step from a customer service perspective is we've actually driven to the business and dropped off a letter and an application saying, hey, you know, here's kind of what you need to do.

And again, if you need help, please reach out.

It's got a QR code on you can schedule an appointment with our staff at a time that's convenient for you to get again some assistance to help you know navigate the process.

So I just want to kind of communicate that you know this is a challenge that we're experiencing.

And again, if you have any ideas on how we can improve, you know, you know, please reach out to me.

Um that's it for my update.

Happy to answer any questions.

Okay, any questions for Mr.

Vega.

Mr.

Chair, I do have a comment if I may.

You always may.

Thank you.

I really want to uh recognize Mr.

Vega.

I had the pleasure of attending uh uh symposium, a conference, right?

Uh by DRI, and he was on a panel and you did a great job.

And and you really were among some um great folks on that panel representing various topics throughout the state of Nevada and wildfire and heat mitigation, and I just really want to recognize you for really representing the Northern Nevada public health in an exemplary way.

Thank you.

Thank you so much.

Thank you, Vice Chair.

That was very kind.

Any other questions, Mr.

Vega?

I just have one ask, which is you mentioned the WEPA language, the the bill working its way through the Senate, it sounds like I'd like to just make sure that we're checking in with our congressional representatives.

Um you know Miss Molly Rose Lewis is listening in and certainly can provide uh you can provide her office with any background information she might need.

Absolutely.

Actually, at the same uh DRI uh event I was able to speak to uh Senator Cortez Mastos staff about this exact legislation.

So absolutely.

Okay, thank you so much for that, Mr.

Vega.

Appreciate you.

Okay, we'll close out item up 12A and move now to 12 B.

Uh Ms.

Shepherd, this is your update on community and clinical health services.

Good afternoon, members of the board.

Christina Shepard, Division Director of Community and Clinical Health Services.

You have my report for September.

I would like to apologize for a typo in that report on page four.

We referred to um assemblymember Heather Golding as health golding.

So I apologize for that typo.

That should say Heather Golding at the top of page four.

Just a couple of updates in addition to that report.

We have received COVID vaccine in all funding sources.

And we began offering COVID vaccine to the community on Monday.

So we were really excited to receive that.

We are prioritizing children and uninsured adults for COVID vaccine because there is an access issue there.

And encouraging those with insurance to obtain their COVID vaccine from a pharmacy.

Currently, the state is funding WIC on a week to week basis contingent upon the receipt of federal funds.

Our latest communication from the state is that WIC services will remain operational through October 31st.

But again, we're we're getting word week by week, usually on like Thursday or Friday.

We happen to get it on Wednesday this week.

In preparation for any potential disruptions, our team is actively developing contingency plans in the event a stop work order is issued.

Should that occur, we intend to maintain a minimum sorry, we intend to maintain a minimal amount of staffing in the WIC clinics to ensure that we're still accessible to the community so that the community can continue to access their benefits and receive support for other essential resources.

Happy to take any questions.

Any questions from Ms.

Shepard.

I I wanted to just um say thank you, Ms.

Shepherd, for the update on the COVID vaccine.

And also I think you made an excellent point given the resource shortages in our region that if you have the ability to get it through your primary health care provider or through a clinic uh CVS or a pharmacy or whatever, that's a great idea.

Um I did get mine at CVS, and it was easy, you know, like three minutes in and out.

I we've made it very easy to gain access to some of these resources.

Uh so um, yeah, thanks a lot for the presentation.

Thank you.

Okay, we'll move on now to item C is in Charlie 12 C is a report by Mr.

FIDA uh for EHS.

Good afternoon, board members and Robert Fida for the record, environmental health division director.

Uh there's a couple of highlights I wanted to highlight from our report.

Uh one of the highlights is uh I don't know if many of you know, but uh NNPH, our food program serves as mentors for other food with programs across the nation.

And we've been hosting uh Watcombe County and actually we have Walla Walla County with us today, and they're learning from our practices, and we're exchanging information so that uh we can make sure that uh everyone is striving to kind of uh meet those retail food standards.

Uh and then also uh staff presented at uh UNR public health class, uh PBH 320, and this is a class that kind of informs students about career paths and public health.

And I believe it was Miss Uh Olivia Alexander Leader and Taylor Stokes that actually did the presentation, and it was called uh stories from the field, environmental health and practice.

And I know they got a lot of interest.

Uh and we're also partnering with that class for shadowing opportunities.

We're doing a pilot on that as well.

And I think we've had a few students actually come through this week, actually.

So and then our food plan review program has also seen uh very good engagement with their uh office hours essentially.

So it's a drop-in appointment where people can come in and discuss plans.

Uh our staff are looking at maybe restructuring that because of the demand is starting to get uh a little good, uh too good, I guess.

So uh and then some other highlights are uh we've wrapped up our vector season, so we will be probably bringing something to the board, a recap of that season so you guys are aware of what occurred and uh how the outlook looks.

Uh additionally, there have been some improvements on our septic record.

We actually went live on ACA with a new septic record type.

Uh so we're making improvements to make it easier for customers to submit applications for their septic systems or wells at this time.

And then speaking of septics, we actually are having our workshops this month uh regarding the septic regulations that we're updating.

And we had very good attendance.

I think over the two public workshops we held, we had about a hundred people attend.

So and we had comments uh everywhere.

So uh we'll be being bringing those forward for the board for review.

Um that's pretty much all the highlights I wanted to uh kind of highlight for you.

Uh uh, I'll open up to any questions for the board.

Questions from the board for Mr.

Fida.

Just briefly, Mr.

Fida, a couple of things.

One is uh so very proud of your division and especially for this Alexander leader being able to make the presentation this morning or just a little while ago about pegs.

Um those are really great opportunities, I think, to engage with our uh restaurant community.

So I really appreciate that.

Um my understanding, and I had the privilege of being interviewed, is that um we've had sort of a consultant who has also interviewed a number of your folks.

How has that been received?

And can you tell me what the status of that is in terms of when we expect a report back?

Uh yeah, so uh we engaged a consultant, uh Dr.

Wrangler, he was uh based out of Arizona, has done previous work for I believe Maricopa County out there uh in environmental health.

Uh he's very good at system evaluations.

Uh so he's been going through and kind of collecting data on our behalf, and he's kind of uh there was I think two focus questions that he had uh that we requested him to ask.

And uh I believe he's actually in the process of drafting that report.

So that we're past the data collection phase at this point, and I think he's synthesizing that data and drafting it a report.

I'm hoping by the end of the month he should have something.

Uh and or maybe early November, I think more along the lines, but yeah.

Well, Dr.

Wrangler was very impressive and and had the opportunity.

I think a number of us did have the opportunity to interview with him.

Um, and I was um, you know what he said to me that stood out was that um EHS was doing very well.

Basically said there's not we're not trying to fix a broken thing, we're trying to make something that's really good be better.

And so I really appreciated his thoughtful comments about your team because I think it's important to recognize when people are doing good things as equally as is when you're trying to offer instruction for change.

So he had a lot of very good things to say, not only about you and your department, but also about your team.

So thank you for that.

Of course, please.

I I too will echo the chair's comments.

Um Dr.

Wrangler is really impressive.

One of the things I wasn't clear, and I'm just gonna ask for clarification.

Um, when the report comes back, is he gonna be presenting those findings?

Because he wasn't clear and I wasn't sure either.

Uh initially, I don't know.

Uh I think we had him uh coming to present those findings uh maybe via uh Zoom line.

Yeah, but uh we can make arrangements for him to come and present as well.

I I'm not sure.

I'll leave that to the chair and others.

I just uh wasn't clear on when he compiled all the information, who was going to be sharing that.

So um I'll I'll leave that to the discussion by the chair and I think Dr.

Kingsley has an update for you.

Yeah, so we've um thank you for the recommendation and we took that to heart.

Uh we'll be bringing him in December, I believe, with the report presentation district board of health as the plan right now.

So thank you.

Okay, thank you so much.

Appreciate you.

Thank you.

Okay, we'll close out item 12C now and move on to 12D S in David or D is in Dow.

Dr.

Dow.

I wonder if they gave you D on purpose.

I don't know.

Good afternoon, Mr.

Chair, members of the board.

This is Nancy Dow, Division Director of Population Health.

Um, so you have my report, nothing to change or add.

Um I did want to give a quick update right now on our uh extensively drug-resistant organisms or XDRO for short of database.

So as a refresher, um, because I I know we had that presentation, so the epidemiology program in collaboration with tech services, uh, developed the uh XDRO database to store and track our cases of carpapendamus producing organisms and Candida Oris reports in Washoe County.

So these are two pathogens of extreme concern and healthcare associate infections.

Um the database is also designed to alert participating hospitals when a emitted patient has a history of CPO or C oris.

And to enable this, the epidemiology program and tech services have worked with hospital staff to securely connect emission data feeds into the XCRO system.

Um so currently, two area hospitals are already fully on boarded with receiving alerts.

Um another one is in the active testing phase already, and we have one last one pending testing at uh right now.

So this has a uh has already received great feedback on onboarded hospitals.

Um we also use the database to uh run data on our quarterly CPO surveillance reports, and starting January of 2026, uh, with the Help R Statistics and Formatics teams collaboration.

This report will also be moving to become a real-time dashboard for the public for easier access.

Um we're live in respiratory season as of week 40.

Um so currently uh COVID, RSV, and flu are circulating but at uh pretty low levels.

Uh we did see a bit of a COVID uptick in the late summer, but it's been decreasing now.

Um, the current most frequently identified influenza virus type reported in Washoe County is uh flu A, H3, and this is included in the season's flu vaccine.

Uh we do not at this time have regional and national data comparisons uh due to the federal government shutdown.

Um I also wanted to let the board know that our new interactive respiratory virus disease dashboard is live and on our website under the EP program, thanks to collaborative efforts with the Stats Informatics program and support from our communications team.

And then finally, we published in Epi News our quarterly communical disease reporting and statistics for the third quarter of 2025.

Uh this series covers tables and figures to compare reported morbidity uh for selected um communical diseases during the most current quarter in comparison to historical morbidities reported over the past five years.

So increases seen in this quarter of 2025 compared to previous years were most noticeable in animal bite reports, and uh we do tend to have increased animal bites over the summer month.

So that's all my update.

I'm happy to answer any questions.

Any questions from the board?

Dr.

K.

I have a comment, and I the dashboard is wonderful, and I I've used it, and I thank you very much for for having the data available to us.

This is uh really big fee that we struggled over summer to get it up from our EPI and uh with collaboration, like I said, with our comms team our and our informatics team.

So uh we're really happy that we have this for the public because not only do you see our current data, you can uh select drop downs to see historical data and comparisons.

And this is also um replacing our uh weekly report that we used to have, and this is uh this dashboard is updated on a weekly basis.

It's a powerful tool.

Thank you very much.

Yes, and we hope we will bring you more dashboards to come.

Awesome.

Thank you so much.

Thank you.

Okay, we'll close out item D and move on to uh Dr.

Kingsley, your report.

Thank you.

Uh just you have my report uh before you, just a few comments in there.

Just want to recognize that the community health assessment that we are in conjunction with Renown and those uh activities continue as we uh engage our community to have them uh let us know what's important to them for health and where we can improve and where we can leverage resources for them.

And those were continued again, hopefully with uh looking for a January to have a report before the board and part of it leading into our strategic uh planning uh in February.

But I want to thank staff for the time they put into that as well as our partner renowned for the wonderful help that they're helping us and participating with on this.

And then I'll just recognize also uh the deputy district health officer for her work uh with the state in coordinating uh the public health funds that were recently uh uh approved yesterday with uh the uh board of county commissioners just uh allowing us to be able to continue to develop our infrastructure as well as to support our community with this extra help from the state has been an extremely beneficial, and she's done amazing work on being able to ensure we receive those funds in a timely matter.

So other than that, if there's any questions, any questions for Dr.

Kingsley this month?

Dr.

Kingsley, I just had one.

I understand that we had a couple of uh department or district board of health-wide uh trainings or um some outside um uh facilitator came in and everyone went to those.

Could you just tell us about that a little bit?

It sounds like uh an important thing.

Yeah, we've had uh various we always engage our at least twice a year uh through grants to be able to provide training to all of our staff, and actually it will be a next month's report, but we had a uh training this month last week on to uh for all of our staff about three-hour training that we provided different days, and this time was on process uh on our system processes, how to analyze our systems that we use and how to uh correctly analyze them and apply new tools to them to see if we can do it more efficiently as well as be able to provide that uh expertise to all of our staff to understand uh where they add in the systems and that affect our communities.

Uh and so that was recently conducted this past week, and uh we can have further reports moving forward, but uh yeah, we're excited.

We're always excited for those trainings that we're able to offer our staff.

It sounds uh remarkable.

Let me ask.

Did you say there was a report that they do post the training that like the facilitator does something and tells you how it went?

Yes, so we collect both pre and post with our staff to see the impact of that training.

So we collect basically the qualitative quantitative information from that asking do you feel do you feel confident in doing this?

And then a follow-up, same thing.

Do you feel confident doing this?

We saw a general rise in uh each of those questions from our staff.

Awesome.

Thank you so much for that.

Anything else for Dr.

Kings with this month?

Okay, I'll close out those items.

Items 12 then are finished, and now move on to public comment.

Madam Clerk, do we have any closing public comment?

We do.

Ums heard under this item will be limited to three minutes per person and may pertain to matters both on and off the board agenda.

Unused time may not be allocated to other speakers.

Comments are to be made to the board as a whole, and virtual public comment may be taken when facilities are available.

A speaker's viewpoint will not be restricted, however, reasonable restrictions may be imposed upon the time, place, and manner of speech.

Irrelevant statements, unduly repetitious statements, and personal attacks that would objectively antagonize or incite others are examples of speech that may be reasonably limited.

This board carries out the business of Northern Nevada Public Health and its citizens during its meetings.

The presiding officer may order a person removed if the person's conduct or statements disrupt the orderly order or safety of the meeting.

Warnings about disruptive conduct or comments may or may not be given prior to removal.

Furthermore, certain disruption disruptions of a public meeting are criminal acts as defined under NRS, which may result in prosecution inappropriate cases.

And he doesn't appear to be present.

So we'll close that item out, and if they should reappear, you'll let me know and move on to item 14 board comments.

These are just opportunities for the board members to comment on announcements, reports, or updates, or requests for information for future agendas.

Any board comments this month?

Okay, seeing none, I'll close that out, and this meeting is adjourned.