I don't know, keeping this board in line as a challenge most days, but good afternoon, ladies and gentlemen, and welcome.

I'm going to call to order the December 18th, 2025 uh Northern Nevada Public Health Meeting for the District Board of Health.

Uh thank you all for being here and happy holidays.

Before we get started with the actual agenda and determine the roll call and quorum, I'm gonna just remark about uh a longtime friend of this board, Dr.

George Hess, who passed away uh just a couple weeks ago.

So we're gonna observe a moment of silence.

Dr.

Hess uh was a family practitioner, I believe, and worked primarily in his latter years at the University of Nevada Reno, uh, but was a tremendous advocate for this body and the work it did and continues to do here.

So we'll just observe a moment of silence for Dr.

Hess.

Okay, thank you.

And now, Madam Clerk, we'll move on to the agenda as posted and start with item number one, which is a roll call and determination quorum.

Chair Reese.

Here.

Uh Vice Chair Andreola present.

Board member Anderson.

Here.

Board Member Brown.

Here.

Dr.

Dinko is absent.

Board Member Driscoll.

Here.

And Dr.

Duarte.

Here.

We do have a quorum.

Thank you, Madam Clerk.

And we'll start now with the Pledge of Allegiance.

Um, Ms.

Faraza, you wouldn't mind leading us so much.

I would appreciate that.

Pledge of allegiance to the United States of America and to the Republic for which it stands one nation under liberty and justice for all.

Probably reminds you of your days as a council member.

So I knew it wouldn't be a foreign to you, Ms.

Ferraza.

Thank you for being here.

Madam Clerk, we'll move on to item three, which is public comment.

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 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 a public meeting or criminal acts as defined under NRS, which may result in prosecution inappropriate place cases.

If anyone in the public wishes to make public comment, please indicate at this time.

Seeing that, I'll call uh public comment to a close and move on to item four, which will be the approval of the agenda.

Dr.

Kingsley, do we have any changes to the agenda?

None noted at this time.

Okay, thank you so much.

Uh to my colleagues, I'll look for a motion.

Move to approve.

I have a motion and a second.

Any additional questions or comments at the 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.

We'll also vote on our tablets.

Okay, item five, one of my favorite parts of the meeting.

Dr.

Kingsley.

Thank you.

At this time, I believe we're turning it over to Dr.

Dow for new hires and years of service in Health Heroes, and then uh Ms.

Rubio for uh Health Heroes, correct?

Yeah.

Fantastic.

Dr.

Dow, welcome.

Good afternoon.

Uh Mr.

Chairman, members of the board for the record, Nancy Dow, Division Director of Population Health.

Um, I would like to introduce to you Miss Emily Nelson, who joined NMPH and is currently with the Population Health Division since December 2nd.

Uh, she is a fellow from the University of Nevada, Las Vegas Applied Epidemiology Fellowship Program.

So this is the second year we're continuing this partnership between NMPH and UNLV, which allows our department to host one applied epidemiology fellow each year to support real life work experience for a newly graduated MPH student around the U.S.

So Ms.

Nelson comes to us holding a bachelor of science in microbiology from the University of Minnesota, and she has a MPH in global epidemiology from Emory University.

And she has a MPH in global epidemiology from Emory University.

She recently served as an ORIS fellow with the CDC's Rapid Response Research and Surveillance Branch, where she analyzed wastewater surveillance data to support national pathogen monitoring efforts.

She also previously worked with the Georgia Emerging Infections Program on Healthcare Associate Infections and with the St.

Charles County, Missouri Department of Public Health, coordinating countywide drive-through testing and outbreak monitoring.

Ms.

Nelson also brings global field experience from working on large-scale tuberculosis screening events with uh correctional facilities in Mozambique.

And in her free time, she likes reading, knitting, film photography, and being outside with her dog Lucky.

So we're super excited to be hosting Ms.

Nelson this year.

And she has started out this month already working on various projects in our epidemiology program and in our chronic disease and injury prevention program.

Fantastic, Miss Nelson.

Welcome to Reno.

By my count, you're a gopher, an eagle, and a rebel.

And we won't hold that last one against you, go pack, but welcome.

We're very excited to have you, and you've got great leadership to learn from.

So thank you for being here.

Thank you.

All right, for years of service.

First, we have Miss Jackie Lawson, uh, currently administrative assistant one in ODHO and hitting her 15 years of service with NMPH.

Uh Ms.

Lawson provided what provides, continues to provide invaluable support in the office of the district health officer and this board.

Um and she previously held roles, including working with the population health division and was a key player in supporting our work in ICC and in preparedness.

And next, we want to recognize uh Miss Sonia Smith, a public health nurse supervisor with the CCHS division uh with her 10 years of service.

Ms.

Smith is responsible for the tuberculosis clinic as well as our community health workers team.

Uh, she plays a vital role in ensuring some of our most vulnerables do receive the service and support that they need.

So thank you both for your service to our organization and our community.

Congratulations to them both.

I know that I get the privilege to work with Miss Lawson almost every day and absolute joy, a ray of sunshine in my day, that's for sure.

And next, Miss Rubio for Health Heroes.

Good afternoon.

Um for the hold on one second.

Okay.

For the record, I'm Frentia Rubio, an office specialist from EHS.

Um for the month of November 2025, uh Health Hero recognitions.

Um agents were recognized from NNPH.

First one being uh Christalina Christensen, a community health worker from CCHS that was um noted for the values of compassion, collaboration, and trustworthiness.

She's a community health worker who consistently goes above and beyond in her role.

She not only completes all of her responsibilities with dedication and compassion, but she also continues her work outside of paid hours simply because she cares deeply about the people we serve.

Her positive spirit, kindness, and resilience create a welcoming atmosphere for both colleagues and clients.

She truly embodies what it means to serve with heart, purpose, and integrity.

Next up, we have both Steve Coots and Jan Hock, uh both RNs from CCHS, noted for the values of adaptability, compassion, and trustworthiness.

Jan and Steve worked together to vaccinate in employees a really scared child.

Um they were very kind and compassionate during the vaccine.

Um they were able, they adapted to the evolving needs of the appointment and the child by explaining the process and every detail so that the child knew what he could what to expect.

Um they really gained his trust, and these are their job duties, but in the mother's eyes, they definitely went above and beyond.

Um next up we have Diana Karlizek in a health inspector from EHS.

Uh, she was noted for the values of um compassion, collaboration, and trustworthiness.

Um, Diana's example and leadership in coordinate coordinating holiday donations for local boys and girls clubs are commendable and heartwarming.

Thank you for bringing the gift of giving to NNPH.

Thank you.

Thank you so much.

Okay, we'll close out item five and move on now to item six or consent items.

Do any of my colleagues desire to pull any of the agenda items identified in six as consent items?

Okay, and Madam Clerk, was there any public comment on any of these items?

Thank you so much.

I'll look for a motion to approve the consent items as posted.

The motion second second.

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.

Okay, item seven.

Mr.

Fida, I believe that's your item.

Welcome.

Good afternoon.

Good afternoon, members of the board.

So uh today will be a presentation, discussion, possible acceptance of the environmental health services evaluation report.

And giving the presentation will be uh Dr.

Ralph Ranger.

Uh he's here right now, so I will turn it over to him.

Good afternoon.

Thank you, Robert, for that kind invite.

Thank you, uh all board members and chair Reese for the invitation and the opportunity to present the evaluation findings.

And uh we'll just dive right into it here.

Um by the way, as I go through, if you have any questions, just stop me right away.

Uh probably better than just letting it uh sit till the end, and then we can just address the questions as we go.

Um so January will be 30 years that I have been evaluating public health programs, initiatives, uh interventions, and so forth.

And every evaluation always starts the same.

Um we try to meet with the client, understand what those uh needs are of the client, and then we try to align our evaluation approach uh to those needs.

And that's what we call in our in our world being fit for purpose.

And this evaluation began the same way.

Um we met, uh, we defined some key evaluation questions, and uh off we went.

Now, once in a while uh you get thrown a curveball.

And this particular evaluation was that curve ball.

And there were some unforeseen findings that required an adjustment in the evaluation strategy, and I think that's one of the really cool things about being an evaluator is that you are able to make those adjustments because our goal in evaluation as opposed to, for example, in research, is to make sure that we give the decision makers the best possible information upon which to make decisions.

So in this case, um we did have to reframe that uh evaluation approach.

Um while some may see that as a negative, I actually saw it as a positive because what it helped me understand was that some of the findings that we had, which may have been viewed as more as independent sort of freestanding findings, are actually related to each other, and there's a relationship between those findings.

And um when this unforeseen um series of events happened, it forced me to rethink that.

And I think the upside of all this, hopefully, what what we'll leave you today is it is it allows us to be able to prioritize the different recommendations.

So right now we have this massive report with a lot of recommendations, and the question is like, where the hell would we start?

Am I allowed to say that?

I'm sorry.

I I I didn't want to break those rules.

I saw the rules.

I'm sorry.

Um, but where do we start?

And so I think um in the end here, hopefully um you'll be able to follow my my reasoning and my logic, and um you know we'll see if you agree with it or not, but um, it will give you a better place, I think, to start in terms of understanding uh Chad, maybe and Rob, where you might want to start making some changes.

All right.

So we started with some key evaluation questions.

Uh the two questions were number one simply how does NNPH EHS compare to other similar organizations?

Relatively straightforward.

I would call that more of our secondary data analysis, looking for what other types of data are out there and doing those comparisons.

What's not mentioned up there is about a month spent of time working in through census track data only to find that that was a dead end.

But I'm only going to report on the things that had a fruitful end today.

The second evaluation question, very simply was how do permit holders perceive NNPH program specifically environmental health.

And there we were using primary data collection, surveys, and interviews.

All right.

So let's dive into some of the findings around key evaluation question one.

First thing we did is we compared.

And I have that study here if anybody wants to actually see it, but the studies here.

We compared how you were doing how EHS was doing to a study by the National Association of County and City Health officials, also known as NACHO.

And that study looked at 2,532 health departments, and we're looking at the kinds of services they provided.

They divided those services in what do they call common services and uncommon services, and that's simply differentiated by the percentage of agencies that provide those services.

So on average, um when we look at other health departments that are serving a similar similar size population, about half a million or so, they provide about 14 of the 34 core services.

And when we look at what is being provided here, we see that they're providing 23 of those 34 services.

16 of those are common, six are less common.

If you're wondering why that doesn't add up to the 23, that's because hazmat uh is something that's being dropped.

So that does not account.

So then the question is, okay, well, you're doing a lot.

Do you have the FTE support to be able to do that?

And here again, I relied on another study that had already been done, so uh relying on some other source documentation.

And this particular study, I'm not sure I'm pronouncing the author's name correctly, but it's Beach or Baiche.

I'm not sure how that's pronounced, so I apologize to the author for that.

Um but based on that work, um EHS has 32.61 FTEs, but they need about another five or so FTEs to be able to do the work.

So if we wanted to just summarize simply, based on this comparison, where I land is NNPHEHS is doing a lot more with less.

That's kind of where we land with that.

All right, let's go on to the next um, or I'll just stop there.

Any questions on that comparison?

Pretty straightforward.

Okay.

Second comparison was looking at the public health accreditation board and their standards.

And so I was using version 1.5.

That database has 484 accredited local health departments in it.

Um they have uh uh the public health accreditation board uses 12 domains and 32 standards and has a hundred measures.

That's sort of what they look at when they're doing accrediting.

But what was interesting when we looked at that is they actually have an EH environmental health subscale or theme.

And what they do is they pull out 25 of those measures and they say these measures would be indicative of environmental health.

And they come predominantly from domains two, which is investigate health problems, and in domain six enforced laws.

So it's heavily weighted toward those two things.

What's kind of neat about this database is it has multiple filters that allow us then to try and narrow down from that 484 to a smaller subset that more closely resemble what's going on here.

So this is a graph that also appears in the report, it's just summarizing where we stand, and I'll just run through one of the bars there on the left, and then I won't belabor the rest.

Um but you'll see that orange bar there represents what we were able to narrow down to that 484.

We were able to narrow it down to 22 local health departments that look very similar to what we have here.

Okay, and we were at have a similar governance, similar, similar population size that they're serving, and similar FTE support.

So we got it down to 22.

So I think that's pretty good in terms of you know, looking at something that's comparable in terms of other health departments.

And you'll see there on the left-hand side it says that those particular accredited institutions meet about 80 percent of or fully demonstrated about 80 percent of those 25 measures.

So 80 per so 16 or 17 or so of those measures are fully demonstrated.

And you'll see we are in green, and uh we have about half of those that are fully demonstrated.

Now keep in mind again, this is against accredited institutions.

So the standards obviously a lot higher.

Um, but nevertheless, it looks like there could be some room for improvement from moving maybe some of our largely demonstrated things to making them fully demonstrated.

Does that make sense?

We also have we were also able to look at the health and human service region, nine, and you can see the comparisons there as well, but it's a similar kind of pattern.

But it's a similar kind of pattern.

So if we were to summarize this, um I would say that it appears, and I'm going to say the word appears because that brings me to one of the problems with the accreditation scoring.

But it appears that you're doing quite well on those 25 EH standards and measures.

But when you look closely at how the accreditation actually scores these things, there's an important quote in there, which I then verified with someone that did an internship with them, that the confirmation of whether a standard is met relies on the documentation and use.

And what that means is when they're scoring a particular standard, they're looking for examples from the health department as to whether you've met that.

And so the health department will submit some examples to say, yeah, this is how we meet that particular standard.

However, those those examples can come from anywhere within the public health department.

They don't have to come from EH.

So you don't really know at the end of the day how well EH is doing based solely on that, because it's a little bit confounded there.

And I'm going to come back later as how we can actually turn this into an advantage in one of the recommendations.

Any questions on that comparison?

All right, let's move on to the primary data collection and the permit holder survey.

So we did um had two surveys, one for the one-time permit holders and one for the annual permit holders.

And the survey touched on those different areas you see there, uh experience with plan review, permit applications, clerative material, and so forth.

Um I was surprised actually, we had a pretty good uh response rate when Rob first suggested this.

I wasn't really a big fan of trying to use this approach.

Um I'm more of a meet the person in person and you know have that kind of more deeper discussion.

Uh, nevertheless, um I think it actually provided some very interesting results.

But before I go any further, um, one of the reasons I was a little reluctant is because when you kind of put out these customer satisfaction surveys, you're tending to invite the people to just want to complain.

And so you have a big complaint bias built in.

And I'm happy and was quite surprised to see that maybe well over half of those survey respondents that took the time were actually happy.

And um I think that's kind of unusual in this kind of a customer service certified um customer satisfaction survey to see that kind of level of of response in a positive direction.

And I think that's something that you should take away and feel good about that there are a lot of people out there that actually feel very good and are taking the time when they didn't need to to express their satisfaction with what's going on.

All right, so what did the survey uh findings reveal?

Well, they reveal that uh generally uh people see the um EH staff as highly professional, and I know we have some of them here with us today, and um they were often mentioned actually into the people here today were actually mentioned by name as those people that were very professional.

Uh they don't like the fees, no surprise there.

Uh the educational efforts they see mostly as ineffective, so they try there's a lot of outreach efforts to try to you know engage the public around uh what it is to permit and so forth and apply and these kinds of things, but the public generally or the permit holders generally perceive those as being ineffective.

And um the unannounced visits that are being conducted around the food program, they are creating an enormous amount of tension, and I'm gonna come back to that in a little bit.

It's also interesting that many of the permit holders don't understand the role of NNPH and EHS specifically.

Uh there were complaints about you know, you didn't do a good job, Chad, with the birth certificates.

Your passport processing was slow, et cetera.

So there were those kinds of complaints, which made me uh understand that I needed to focus more the evaluation on those things that are within the control of EHS to be able to change.

But the number one and recurring complaint, and the thing that I want to focus on with in terms of the findings and the recommendation, the number one complaint is inconsistency.

That comes up over and over and over again, always in consistency.

All right, so that's the survey findings.

Now, the interview, and I think this is where um some things may have been a little misunderstood internally.

To prepare to do the interviews.

But I don't know anything about underground storage tanks.

I don't know anything about, as you can probably tell, IBD, you know, I don't know about tattooing and piercing.

I know nothing of that.

So I thought it would be important for me to have a better understanding of the acronyms, the jargon, those things that go along with that before I conducted the interviews.

So I spent a lot of time shadowing different staff.

I met with the division rec director, I met obviously I met with the supervisors, not all of them, to be clear, many of the seniors and many of the staff.

But the purpose was not, the only purpose was, I'll say it in a positive way, was to help me prepare for the interviews.

So that gives you a summary of the interviews.

In the end, we did 26.

Um we reached out to obviously a lot more than that, but there was really nobody in some of those areas that people, if they didn't want to participate, they didn't want to participate.

So you know, you can't make them do that.

So do we have fairly good representation?

Yeah, but not all the areas are represented.

All right.

Interview findings.

Uh they validated a lot of the survey findings.

I won't repeat all of those there.

But um, so that was good that we had some validation from the one-on-one that we saw in the surveys, so that gives me more confidence in the findings.

And here's the part that I think gets missed a little bit and is an opportunity for improvement.

The permit holders really value the relationships they have with the staff.

And as I mentioned, three to four of the staff unsolicited are repeatedly mentioned every single interview as people that they just love working with, uh, want to continue to work with.

Um, one of them is here, and I'd recognize her today as Latricia.

I have never met her before today.

Happy to meet her.

Her name comes up all the time.

David Kelly's name comes up all the time.

And again, I'm not looking for this information.

This is just unsolicited coming forward, and people just happy with that.

And obviously, the trust and respect uh is there uh in those situations.

But the permit holders are willing partners, and every single permit holder I asked, would you be willing to take time and use your facility and use your expertise to help with the training of staff?

Would you be willing to do that?

And every single one said yes.

And I don't think that that resource is being tapped enough, and we'll come back into that a little bit.

All right.

So, what happened that threw everything off track a little bit here?

The unforeseen revelations.

As I said, the purpose of me meeting with the different uh staff and so forth was to prepare me to be able to do a better job with the interviews.

And without asking, the floodgates just started to open, and there's like there's concerns about leadership.

And then there's their we're operating in silos, and there's interprogram resentment.

We hate the food department, and we think they get too many resources and blah blah blah.

And what I was troubled by was that some supervisors are very quick to blame, but I never once heard anybody take personal responsibility to say this is my role, this is what I can do, this is how I can make it better.

And I'm not much one personally for just listening to the complainers.

I put out a lot of stuff in my field.

People are free to criticize, but one of the things I always ask is tell me a better way.

And if we have a better way, that's good.

But I'm not just listening to someone that just wants to complain.

And so I was kind of disappointed that there was not that people stepping up taking that personal responsibility.

And then in shared spaces, and I'm not and we've already had this discussion between Rob and myself, the language and tone didn't really reflect a professional environment.

I was quite taken back by some of the places that I was sitting, the kinds of things that were on the wall and so forth, but that has been since corrected.

I just think you ought to have an environment that you're not ashamed that anybody could walk in at any time and feel comfortable in that environment.

And that to me wasn't the case.

All right.

So, how do we take that experience and reframe the findings in a way that makes sense?

I'm sorry, Devin, are you okay?

Yeah.

Oh, okay.

Okay.

Um questions yet up to this point.

All right.

So I had to reconceptualize how we were looking at those findings, and I got to thinking, all right, what are we seeing?

What are we seeing and what could that possibly, what are the reasons for for that?

And I think I'll just dive into this and explain this as I go in the interest of time.

So at the top of this pyramid is really the content.

So this is really what the permit holders are perceiving or what they shared with us.

And there's the list of the findings that we've already covered.

I want to focus in on the inconsistencies, as I mentioned before.

And the inconsistencies, one of the reasons for in inconsistencies could be due to what's just beneath the surface there are the processes, right?

So for example, if we're talking about an inspection process, if we have the same inspector going in multiple times and doing it differently, that's going to be perceived.

That's a process, a workflow that's not being followed consistently, and that will lead to perceptions of inconsistency.

So obviously then a recommendation if it were at that level would be just continue to reinforce that consistency and staff training.

They need to be following those written stands.

We ask a lot of our um of our permit holders to have standard operating procedures.

We ought to be doing the same thing.

Right?

Practice what you preach.

Um and I do think, um, having shadowed that different inspectors have their own little techniques that would really benefit other inspectors.

But I don't think they have the time or maybe it's not deliberate, where they're able to shadow each other.

I know we have the shadowing is when somebody knew is coming in, but shadowing of experienced people.

Um we even had in Arizona a situation where they came from one county and shadowed in another county to be able to see and learn how that's done.

And I think, you know, standard operating procedures are still fluid, and I think we can make them even better if we have these uh the shared, if we share our best practices, so to speak, um, and then keep evolving our SOPs, and I think then they also become a little bit more efficient.

So that would be one of the recommendations at that level.

And wouldn't it be great if all our inconsistencies were only due to that level?

That would be an easy thing then to fix, right?

It was just a lot of training.

But if we dig a little deeper, um, there's other reasons for inconsistencies that surfaced in this particular evaluation.

And um of that relates to uh the structures of NMPH itself, or EHS itself.

I don't want to say keep saying the whole thing, but I just mean EHS.

Um it wasn't unusual to hear we just do our own thing.

That's a direct quote.

We each just do our own.

It reinforces this idea that the programs are operating in a siloed way.

And so if they're operating in a siloed way, you're gonna get this variability between those programs.

And what's really interesting about working in this particular community is it's probably of all the communities I worked in, one of the ones that has the most permit hold or most permit holders that hold multiple permits.

And if they're holding multiple permits and you're getting different folks coming from different programs coming across, they're more apt to perceive an inconsistency across those programs.

And then we have just multiple staff doing multiple job jobs, they're stretched very thin as we noted earlier with the FTE support and so forth.

And ultimately you stretch someone that thin, you're gonna get some inconsistencies that are gonna surface.

So some ideas on reducing uh the program variability.

I kind of alluded to it earlier.

Um but this is again sharing and adopting the best practices across the EHS programs, EH programs.

So I know there's a little bit of pushback on this one, but I do feel that um when you see underground storage tanks, um, some situations even where the um invasive body decoration folks were uh were aware that we were coming.

Um the inspection goes much smoother.

People are prepared, they have the documentation ready, um, they maybe have people that they need to do corrective actions on site.

So I think that's a practice that would be good to from food that would be good to adopt or from other areas that would be good to adopt in the food area.

On the other side of it, one thing that food does very well is they will always review the inspection report with whoever's there, the person in charge, after they finish the inspection, right there, while it's fresh in their minds, and they'll go over that.

That doesn't happen in the other areas.

So some of that pushback is well, you know, the person that is running the gas station really doesn't really understand about you know underground storage tanks.

And I'm like, yeah, you know, though, but the person I talked to in Texas who actually does quality control for all of those, guess how they started?

They started like that service station attendant.

So I just feel like it's worth taking the time to educate folks, whoever's there, if you have a chance to educate them and go over that report, regardless of whether you feel they are, you know, um, the permit holder themselves, for example.

Other changes to improve consistency.

Um, you could either, I'm just trying to figure out how you get this in line.

So there's a couple options.

Obviously, try to staff up, that could be challenging.

Um, you might be able to think about what programs you could offload.

Um how we came to this one was I've got hazmat highlighted there.

In that first article that we did the comparisons with on the NATO article.

One of the less common services is Hazmat.

And it just so happened that Hazmat, when I came and started to do the evaluation, was also something that you were considering dropping.

So I thought, well, maybe a good place to start would be to look at those less common programs, see what other less common programs you have, and is there a chance to offload some of those programs?

And you got to get on top of this website.

Okay, this website website is a mess.

Um there's way too many people involved in doing website changes.

Um, and I they have varying levels of expertise in so doing.

Um I think you need to have some kind of dedicated webmaster or uh however you're going to get on top of that.

But uh one of the things that feature it should have, uh, which comes up over and over again from our permit holders, is some kind of tracking portal.

And I know from talking to the different supervisors, they spend a lot of time going, somebody gets a call, well, where are we with this?

What's going on with this?

And I think you could end up saving a lot of time if you actually could in your next gener or next iteration of the website, build in some kind of tracking portal so people don't have to bother you, they can see exactly where they are in the process, uh, application plan review, whatever it is.

All right, and then we have finally drilling down here to the culture kind of related.

There's just a lack of team cohesion, there's lots of communication problems.

As I mentioned, there's this diffusion of responsibility that's going on.

And when I asked for what are some of the cross-cutting priorities, I didn't really get any.

And I think even though you run different programs, you can find some things in common of those programs that guide your whole initiative.

I happen to be fortunate enough to study under Albert Kairn.

He was the person that um founded the whole idea of team cohesion and task cohesion.

I studied with him in uh back in Canada in 88, dating myself, but the goal is to build team cohesion.

Um, but let's not confuse team cohesion.

There's two aspects to that, and I think you really want to focus on task cohesion.

Okay.

There's task and social cohesion.

And so and there's a great example of rowers uh that were studied who actually won many gold medals but hated each other.

Because they were able to put aside their differences for the purpose of um for the purposes of success and pulling in the city, literally pulling in the same direction.

And I I think you have different folks here right now.

You have some folks that maybe aren't on board with the direction, but they're not getting in the way.

I can live with those folks.

I can't live with the folks that are pulling in the opposite direction.

And as an old coach used to say to me, you're either in or you're in the way.

And I think you have some of that here.

I think at some point you have to make a decision around some folks.

If they don't want to pull in that direction, what are you going to do with them?

And I understand in bureaucracies it can be a little challenging sometimes to make those changes, but they are clearly an impediment.

Um, some typical kinds of things, I think you need more frequent and regular division meetings.

They don't meet, and I mean, right across, everybody needs to meet together.

That's not happening as often as it should.

And this was an idea that came from the staff.

They would like to be involved in maybe some problem solving.

Like, what's a case study that just happened?

And it doesn't matter what program it came from, you get everybody together and you put your minds together.

And I think that can build a lot of team cohesion.

And I do think you need to have some cross-cutting priorities.

Like, is it are you about performance measurement?

Are you about quality improvement?

Are you about community engagement?

Like, what are you about that binds you together?

And you need to be have that clearly stated.

And one come back to that public health accreditation board, the standards and the scoring.

Um, I think that's an opportunity to do some of that team building is you have to, you know, go through that exercise again because we're not clear um how much EH is actually contributing to that score, and I think that would be an opportunity to do that.

Is you have to, you know, go through that exercise again because we're not clear how much EH is actually contributing to that score, and I think that would be an opportunity to do that.

With respect to just looking at competencies, competency sort of transcend all those things I talked about.

Do we have the people that are, you know, with the necessary skills to do what we need to do?

And I do think pretty good with most of the stuff, but one area that you might want to explore is systems thinking.

Is are our people, and this is a quote from John Powers.

You know, they are dealing with multiple complex, it's like it's a complex operation.

It's got a lot of moving parts.

And it would be beneficial if inspectors had an understanding of maybe how those parts go together when they're doing their specific piece of that inspection.

Um as I mentioned before, many operators are willing to work with you all in your training efforts.

So actively engage them.

Now I know I'm gonna hear, because I heard well, we do use some, we work with some of the operators.

Yeah, you use their venue, but you don't actually co-design anything with them.

And it would be nice to actually engage them, not just hey, can we use your facility, but hey, can you work with us to design how we're gonna do this training?

And then on the resource side, so we're wrapping up here.

I know it's been long and I apologize, but I appreciate your patience.

Um the resource side, these are resources that are being provided to permit holders to the public.

And they basically are saying, you know, the materials are difficult to understand and follow.

And interestingly, if they see different inspectors over time, they see that as an inconsistency.

Well, so-and-so was here one time, now so and so comes, you know, like, ah, this is just inconsistent.

That's how they see the world.

Or if uh they get a different result from the same person over time, they see that as an inconsistency as well.

And I think we have opportunity here to reshape this.

Um, first of all, you got to rewrite those resource materials.

We got to be writing them at a grade six level.

They have to be something that folks can understand.

And there are many of them mentioned that they were having trouble understanding those materials.

And I think you can take the opportunity in that rewrite to shift that perspective.

I happen to think that if I had different eyes on a particular problem over time, that that's a good thing.

The more things that we can catch, the safer we are.

And I think if it was written from that perspective, it would help.

And sometimes what you're seeing over time is a natural progression, right?

Especially in food.

If there's a as one of the folks said, um, an establishment that's a hot mess, right?

Then you start with the most critical things first and you try to get those under control.

And then when you come back, you're focused on the next level of critical things.

Well, those are different things.

They're perceived as an inconsistency, but it's not an inconsistency.

It's just a natural part of the process.

It would help um permit holders to understand that.

Um it would also help to design a lot of these educational efforts with some intention.

Um it just seems kind of random now.

Like the boot camps are good.

Well, why are they good?

What makes them good?

What is the underlying thing you're trying to change?

We call that the program theory.

Um, there's some examples of realtor training that I thought was a great example of like we're gonna train the realtors because they're gonna be dealing with new homeowners who then can they can share with them what they can expect from the standpoint of permits and things that they may need to be dealing with before they purchase a home.

That's a great example of upstream thinking.

That needs to be shared with everybody.

And is there opportunities to do that across the other programs?

And then, Clara, just this is more along what you and I were talking about with the implementation theory.

Um, they have a horror house, that's another one of their activities where they're using for training.

What makes that successful is that it's based on adult learning principles of engagement, right?

And reflection, but it's fun.

It's just fun.

And we have to be thinking not only about what we're trying to change, but how are we trying to change it?

And we have to be deliberate about that.

And if we're not, we never make that explicit, then we'll just keep making the same mistakes.

Or if we have something good, we won't know how to replicate it because we're not sure what it is that's be what it is that makes it successful.

All right, last star last slide.

Where to start?

So we have all those recommendations and all those different levels.

And uh given that it goes all the way down to culture, I think you really need to start with culture.

That's where we need to start.

If I had to highlight where we wanted to, of all those different recommendations, I would be starting with the recommendation related culture or the recommendations related to culture.

And then I think you need to stabilize what I would call, I don't know how else to word it, first points of contact.

Our first impression is really important.

You don't get a second chance at that as we know.

And so where does the public first come in touch with EHS?

It comes in touch at plan reviews.

It comes in touch at permit applications, the website, and any kind of resource materials that you are providing.

I really think like that's where your effort needs to be in terms of cleaning things up.

So if I had to look at all those recommendations, that would be my suggestion as to where you start.

That's it.

Sorry it went on so long.

I know Devin, you just said 15 minutes, but on Santa's naughty list, but it's that time of year where we give lots of grace.

Thank you.

So thank you for the very thorough presentation.

And I'm actually going to kick us off here.

I have a couple of comments, and I want to start at the beginning as I often do.

The first is I want to commend uh Mr.

Fida for the staff report.

I I know it's a short one, but understand that the staff report is the opportunity for the board to first understand in a bite-sized and meaningful way the thing that's being teed up for us.

So I I I think the staff report was excellent, and it helped me to frame the analysis because I will be honest with you, and I think I told you this, Doctor, that it's a comprehensive report.

It includes an incredible amount of work product, and we'll talk about in a minute uh the how grateful I am for you for the report.

Uh but without the framing narrative, it's hard for us to understand as board members how to engage with it.

And so I thought the staff report did an excellent job of helping me to understand what my role was.

Uh Dr.

Ringer, first of all, thank you for the tremendous work product that you put into the report.

I know that it it took a tremendous amount of work.

Uh certainly you were here uh in Reno with us.

I had the privilege, I think several of my colleagues did as well, of interviewing with you, and you um really I think there's a lot here.

Um so I want to commend you for the effort, the work product.

Um what I did when I looked at the report is I tried to place it into three different categories.

You may have had different categories and your report broke it into different ways, but I will tell you for me, I had to think about it in these ways.

And my notes tell me first it's a bucket for EHS folks.

The truth is is I do not work in EHS.

I do not understand all the component parts of what EHS does.

It is a complicated job, and and they are doing just a tremendous amount of work.

The volume is incredible, the intellectual capacity to do the work is very high.

Our EHS department is really punching above weight class in so many ways, as your report acknowledges.

The second was what I'll call a bucket for Dr.

Kingsley, and this is really where leadership has to meet the moment of the report.

And I think that there are parts of this report that speak to that bucket and are very specific and directed at a person in Dr.

Kingsley or or Mr.

Fida's position, right?

I'm talking about leadership.

And then the last one, which is what I want to focus my energy on, is a bucket for the board.

Right.

Um I will say that my colleagues on this board are some of the most professional colleagues I have the privilege of serving with.

We all come to it with different backgrounds.

Some of us are elected, others are appointed, some has background in medicine, which gives them a tremendous leg up on a poor slub who's just a lawyer like myself.

And so I had to think about it from those perspectives because the reason why is otherwise it was pretty overwhelming to look at the report and say, well, what do I do with this thing which we have now gone out and paid to have done?

And certainly um it provides a roadmap for a lot of things.

And so then um for my part, I wanted to just point out a couple of things, and then I'll open up to my colleagues.

And I'm going in order of the report, although because I was up here trying to scribble notes furiously, I have moved some things around.

So bear with me as I try to talk about in a way that will drive with your report.

Uh the first one is on page three of the report, and the recommendation simply notes something that I think is important for this board to understand, which is that our folks are overworked and we don't have enough of them.

So you've made recommendations here, which will be relevant to our board when we meet in, I suppose it's January and February as we start working through next year's budget process and our own uh efforts to um look at strategic planning.

Those are already underway.

I had the privilege of meeting with our staff to talk about that.

Uh but this recommendation, very important to me as a board member.

Okay.

Um next is we jump ahead a little bit and on page six.

Um I want to point out the one of the findings you make is that um that permit holders perceive our staff as professional.

I will tell you this is what I hear every day in the community, and our EHS team is fantastic.

When I go out into the community, and because I do have the privilege of being elected and also the curse of being elected, um, you hear a lot of bad stuff, because they think that it's their time to tell you what they find redressable by government.

But I often hear people say how professional EHS and their inspectors and staff are.

And so I think that this was a key takeaway from me for your findings.

The second page or the second recommendation there is more important, and this is I would put in the bucket that relates to our chair.

I mean, I'm sorry, sorry, our Dr.

Kingsley and Mr.

Fido, and that says that EHS should be deliberate and intentional in developing a mentoring program using exemplary staff or stars.

This seems like the way, right?

I think that acknowledgment is very important to me and certainly suggests that uh our leadership team will rely on folks uh in their capacity and the learning that they have already undertaken.

Um then my favorite recommendation, and we might have to spend just a few minutes talking about this.

On page eight, you come to a recommendation, and and I will call this somewhat burying the lead.

And the reason why I say that is because there is a transformational uh comment and best practice being recommended here, which is something that I have and and Mr.

Brown has been uh critically thinking about uh at least for four or five years, uh, and something that has become very important to me.

And I will tell you that when we first met, I did not want to reveal any bias, and I did not want to reveal any interest that I might have in this topic.

So while I understood what the meeting was going to be about, I withheld from you my interest in this topic.

And that has to do with announced inspections.

Um I am someone who has come to believe, although this is a change in my view from when I originally joined this body, and based on my experience here and in the community, I believe that this board will have policy decisions to make and hopefully a robust discussion today about all plan review inspections being scheduled, not done by surprise.

There are so many reasons for it, and and of course I read some of the abstracts and white papers that you provided me.

Um I think we are in a position to, in the new year, roll out a pilot program if given the staff availability to work on such a pilot program that would allow our inspection programs to be scheduled.

It has a number of beneficial impacts, I think, on our community, but it is also continuing uh just a programmatic theme of this entity, our N NPH, about education versus uh gotcha moments.

It's about training for the lifetime of a permit holder's permit rather than punishing them.

Um the last thing I want to do is put people out of business who are really working hard to provide services and goods and restaurants and bars and pools for our community.

Uh and this particular section, uh, you have outlined the reasons and rationale for it, and I could not agree more with it.

And so I want to make sure that I have spent some time here on this page.

And then um the last thing I'll do is remark on an uh an item under nine, which also is somewhat buried, but you addressed it at the end, and that is this question about whether EHS has a lack of team culture.

And and again, this is something for not me.

I I I am uh sort of the the chair because I sit up here and I get to do that once a month, but it's really reliant and heavily depends on our uh Dr.

Kingsley and his teams to make that happen.

And so uh thank you again.

I apologize for to my colleagues for being a little bit uh monopoly monopolizing of the time, uh, but I just thought it was a good way to frame how I viewed the report, and then I'll be excited to hear my colleagues' comments and concerns.

I appreciate that.

Can I add one comment to the board bucket?

So I I've always seen a board as a as you mentioned and outlined as a resource.

And I don't think um that it's being used enough as a resource.

Um you have tremendous experience sitting up there.

When I had boards, if I had a problem, I would be coming to the board and saying, here's my problem, like do you guys have any solutions for this?

And seeing you in that capacity, and I would encourage that that happens a little bit more.

Well, I appreciate that.

What I will say is what I said at the top.

These are some of the most professional people that I have the privilege of serving with, and their experience is invaluable and can't be duplicated, right?

I I cannot replicate the 40 plus years of service that Mr.

Brown has in um emergency medicine in transporting patients and fire service.

I cannot replicate some of the work that our good doctor does.

Uh Dr.

Danko's not here, but also Dr.

Duarte.

So it is very important to me that we all come to it from a different perspective, um, and I'm grateful for it.

Let's now turn it to the board and hear from more important folks than me, our vice chair and my dear friend, Miss Andreola.

I feel I may not be taken as seriously, especially if I do this.

So I'm going to take it off.

Okay, well.

Because it really is my lane.

And I can't thank you enough for the time I got to spend with you and the discussion, and I know others did too.

Um I I'll leave it to uh other conversations if those want to ask some of the conversations we had when you were asking me if I held credentials that I don't hold.

I say that because this topic is something that I spent years studying, and I try every day to live.

And here's what I'm getting at.

Number one, thank you.

And I don't know who and how this all happened, but thank you, Dr.

Kinsley, and thank you, Mr.

Feda.

Am I pronouncing your last name?

FIDA.

One mark of mistake.

But this is the most important subject of any organization is culture.

And one of the things that I have been blessed to see at Washoe County is having a third-party entity come in.

And one of the things that they had done that I've never seen done, and I shared that with you, and I'm going to share it with my colleagues here.

Is the fact that a lot of times a professional like yourself with lots of experience will come in, provide this analysis, look at the findings, you know, meet with everyone, do the hard work, give the report, and leave.

What the experience that Washoe County got to enjoy with the leadership that resulted in a very similar, not this topic, but not this detail, but the topic of a very similar analysis was they actually worked with a leadership team at Washa County and came up with an implementation plan.

And you know what?

I have never seen that done.

And I'm going to recommend to my colleagues that we as a board, in terms of looking at being a resource, because I agree with you, a board is a resource.

Our job is to look at providing the resources so that those can do the job.

Because if we deplete those resources and they're not able to carry it out, I mean, that that really is a function of a board.

And the reality is is that I also want to thank Dr.

Kinsley and Mr.

FIDA for allowing you to come do this presentation because I asked if that was something that was included and it wasn't, and now it is, and I appreciate it.

So everyone can hear.

But what I'm going to ask my colleagues to consider from a board perspective in the lane that we are in, is that we look at what that implementation plan is with the team.

Because most of us have probably have all kinds of different experiences and professional ways, but I'm going to use the example that I've experienced.

When I was asked to be an adjunct professor on many of the topics that you're covering here.

Now I was very comfortable in the topic that I was going to teach.

But I had lots of questions, you know, like what are the grading policies and attendance and all of these things.

They were like, oh, you know, it's a very, it was a very um very difficult thing to try and maneuver when I was trying to follow the policy.

So I found myself spending a lot of time.

My analogy to this is that it's the same thing as this report.

There's great information in here.

There's guidelines of findings.

There's some things that you may be recommending that, quite frankly, maybe as folks dive deeper, aren't realistic for whatever reason, or may take a different uh flavor or turn, just because these are the folks that are their professionals are doing a great job and they're really trying to do their best.

And so I think this board has an obligation to invest in further with you coming back, meeting with a team, coming up with an implementation plan, and more importantly, what that timeline is, and a gant chart for that, and letting Dr.

Kinsley do his job in terms of leadership and looking at continuing to give us updates and seeing how it changes.

This is just one part of the organization.

Culture permeates from the very top.

And it and it spins down.

And I'm gonna read a quote because I love good to great.

If you haven't read good to great, read good to great.

A culture of discipline is not a principle of a business, it's a principle of greatness.

We want to be a great organization, and we have the people to do that.

We have the leadership and the infrastructure to do it.

But the train is moving constantly.

They have a responsibility to go out and do all of these things.

And so creating a carve out time to create this implementation.

In my opinion, if we don't professionally give that uh opportunity to go to that next level, I think that we are actually putting a lot of mispectations that may not it might get there, but it may not get there as effectively and efficiently as it should.

So I feel now I can put this back on.

Because it is Christmas.

And say that I appreciate the chair.

Because we have to have this.

Yeah, that's fabulous.

Yeah, and I really appreciate all of the detail, and I appreciate your analysis.

I've spent a lot of time reading all of this.

I again want to thank you for you really saying the way it is, doing the job that you're doing, and really showing and proving your credentials as a doctor and uh discipline and what you're doing here, along with your background.

When I asked you your background, it was really this is the right person.

So, Dr.

Kinsley, thank you for bringing Dr.

Renger.

Is I might pronouncing that lesson?

I got one out of two.

So I really really appreciate it.

Thank you, Mr.

Chair, for giving me the time, but I am going to make that recommendation strongly.

And I can take this off if you need me to make it again.

Nope, I think we got you loud and clear, and thank you for your engagement in this iterative process.

Let me continue now with Mr.

Add.

Just one comment to you.

Thank you.

Uh on the recommendation, that's a really important uh point that you made.

Look, it's just a recommendation.

I don't have all the background information.

I don't know everything that's going on behind the scenes, right?

So and I think that's a really good point.

It's like that's my best guess as to what one should do, absent all the information.

And um, but I do ask, if possible.

I like to track the utility of my work.

And so it would be good to know whether you've considered those recommendations and whether you've adopted them.

That would be helpful for me.

So thank you.

Thank you so much for that.

Let's continue, Mr.

Anderson.

Yeah, starting off, I just want to uh think I'm on so uh just want to say thank you for the report you did.

Um fantastic uh as far as the material um all kinds of notes that I took before the meeting and and during it here.

But uh just a few things I want to echo um what you've said as far as and and likewise uh member Andreola, um the culture, and and I same thing I believe wholeheartedly that uh an organization, whether it's a business, a family, or something like an NPH, it can rise and fall based on the culture, and and I appreciate you pointing that out.

And uh, I mean, really, it's it comes to us as a board and and Dr.

Kingsley to implement that with everyone.

Um so I I appreciate that.

Um and the first points of contact.

I I love that focus because again, it's something that I looked past and I never even thought about until you you mentioned it, but a lot of times that's where it's at, and that communication and and confidence that the folks are having, engaging on that point of contact.

And it also goes to the consistency.

If that point of contact is not accurately or are communicating well, it could be seen as an inconsistency and and a concern.

I mean, I've heard great things about some of our employees, true story.

And and I just want to say I I believe we've got others that are great, but sometimes the frustration is well, my inspector was different and they said different things and wanted to go a different direction.

And and what how you pointed out was perfect, and that that can also be a good thing.

It can be good for us as as an organization to look at different things, but it can also be that educational process.

And folks that I've talked to in our community that engage NMPH, they talk about the educational side of it and the value that they gain from that.

So I think those points of contact um, if if we're training them up well, that we can we can engage on that level, uh, which then takes me to the training up well.

I I love the point about the the intentional mentoring.

Um again, that's something that I personally have implemented in and everything I've tried to do in life, and I believe if if we're focusing on that well here, we see waves of of retirements and people moving on to other opportunities.

And there's in my opinion, no better way than using those superstars to to help bring that next level up.

Um so yeah, well done.

I guess a lot of what I had overall though is I guess looking at us as a board and and Dr.

Kingsley.

Um, how can we implement these items?

Um starting with the low-hanging fruit and moving from there.

I mean, it's so easy for us to get caught up in the financial side of it.

Oh, we don't have the money to bring on more FTs.

We don't have the money to do this or that.

But some of these things I believe we can be doing with without that and not being so focused on the financial side of it.

Um so that's actually, I guess, the task that we have at hand.

How do we implement this?

Which then brings me to the last point I wanted to discuss is the proactive engagement with the board.

Um that's one that I really think and I want to say thank you to Mr.

Vega.

I think he does a good job of of doing that.

We work well together, and um he'll give me a call or uh text if if there's something he wants to talk about.

But I would say let's let's do more of that type of stuff to make sure that if if we can somehow bring value to the the group, utilize us.

So with that being said, thank you very much.

Well done.

And I appreciate it.

And just great one follow-up comment to that is it is a difficult thing to have to talk about the culture.

As an evaluator, you're looking you want everything to go well.

You want a nice positive thing, and and and maybe it wouldn't be just limited to you know a process related issue.

And it is difficult um when you get down and you go like, okay, this is the issue to have to talk about that and bring it up.

And I I do appreciate the professionalism with which that was handled by Rob and Chad and everything else, because it's not a comfortable topic uh to have to bring up.

So thank you.

Well, and thank you uh to you both for the iterative conversation.

I will say, uh, Mr.

Anderson, uh, you have raised an important point, and and I'll sort of remark that remember this is one division of the work that we do here, um, and they've really had the opportunity to do a very deep dive.

We, of course, in our strategic planning efforts after the first of the year, we'll be looking at a broader uh question for all of our divisions, all of the work that we do here, and so I think you'll have the opportunity to make some of those same important points in that process.

And I know that Dr.

Kingsley um is committed and perhaps might want to comment on on what does one do with such a report now, having received it, right?

Um so Dr.

Kingsley, I'm gonna turn the chair over to you for a moment and have you answer Mr.

Anderson's question.

Thank you.

So many of these points already having received this uh report.

You know, I see it as an opportunity, and these are great opportunities.

Um, don't see it as opposition, but the opportunity to grow.

And so I'm excited for that.

I think many of this team members are excited for that.

We've recently had some um ongoing honest discussions with our EH team, but also very excited for an implementation plan.

And I think we have the tools in place, right?

We have our uh clear point objectives that we set.

And so on the same thing, we will be coming back to you with an input implementation plan with those clear objectives and all these points that you have all uh all identified, how when we're gonna meet those and how we're gonna work towards that, and also uh culture across, and that's an important thing across the the district that we've been addressing and working towards uh with the directors and our core leadership on addressing those things, addressing those with that.

So very excited for these points, and so saying that we will be coming back to you with an implement implementation plan, and I believe we will carve out part of our strategic planning in February directly for this, um, if not sooner.

Um we already have dates set on many like the website as well as the pilot program for announced, but they're there, but I want to give a clear point on all these points for the board so that we can utilize you on those points.

So just comment on those things, and I'm just eating this up right now, so I appreciate so much from the board and what they're providing here in this direction and looking forward to where we're gonna take this and how we're gonna grow.

And I think the EHS team feels the same way.

They they appreciate this and we're looking forward to this growth and ultimately for serving our community.

So thank you.

Mr.

Brown.

Great report.

And thank you.

Your presentation was perfect, as far as dumbing it down for a lot of us to all the lingo and everything in there.

Um, you know, I got to see our staff, you know, I see them sitting out there, we see them working all the time, and they did a phenomenal job, you know, helping you to get this presentation together, and also come up with your findings and recommendations.

I had several notes written down, and our chair stole everything.

But uh that's okay.

But one thing it did step out was you know, your uh um suggestion about the SOG standard, the guidelines.

Um, I can't agree more.

You know, um, I came from fire background where SOGs were something that we visited daily, and when SOGs do get put into place, it's something that's actually going to be visited yearly to ensure we're up with the latest and greatest.

Uh I see a lot of organizations that will implement SOGs and you know, whatever they call them policies, procedures, they put them on a shelf.

Somebody comes up for a promotional evaluation or anything else, they tell them to study them.

Got new people coming in, learn them.

But it's something that we got to revisit on a regular basis because um things are always changing.

So I think it'd be a great opportunity to make those changes once we get them in place and get help you know implemented.

And you know, it always starts with the top, you know, as the songs come in, they don't come to us for approval, they're gonna come to the leadership of the organization.

So our district health officer.

So I think it's something that's uh well needed, and uh, I was glad to see that put together.

Great report, and thank you for all the participation from our staff.

Yeah, yeah, those standard operating procedures or SOGs, they're as you mentioned, they're super important for new trainees to have those in place, right?

But uh they are a living document.

Yeah, and as they if they were to share their best practices with each other, they'd be modifying those workflows to become more efficient and uh and more consistent.

So yeah, I appreciate those comments.

Thank you.

Well, I I wanted to um invite you, Mr.

Brown, to maybe comment on this question about inspections, because I know this is something that you and I had worked on independent of this report, and so uh I was hoping you might speak to that.

Well, I don't want to steal all the thunder on that, but I'm so happy to hear about that taking place, you know.

Um, surprises, you know, they're great for birthdays, everything else, but those surprises that come forward.

And our our chairman, he's um we had a lot of input from the community on that.

Uh, a lot of meetings with a lot of our stakeholders, and that was one thing that came up time and time again.

Now it wasn't that they were worried about missing something being missed.

Um a lot of the worry was is that at those times and they show up, it's usually the busiest period of the day, and you take one of the lead folks from the organization out of the out of the the mix, you know, for the success of the organization for that day, things start to fall behind.

They get very concerned, they appear nervous.

Everything else that's involved with that.

And so it was something that was hit time and time again.

And again, you know, with a previous my career, you know, um, having to do inspections, I always found it very beneficial to get an outline to uh to allow them the time and the courtesy that hey, we're coming, here's what we're gonna be taking a look at, um, so they could be prepared.

And it uh uh it worked really well and it continues to work in a lot of the areas.

So uh really glad to see that taking place and one of your findings as well as your recommendations.

So thank you.

Yeah, no, you're welcome.

I you know, I know it can be hard scheduling, but I think you know, man, my heating guy tells me I'm gonna show up sometime Tuesday, and I gotta be there all day.

So, like, I mean, if we give folks uh, you know, some reasonable time to allow flexibility because staff will get uh sick or so forth, and why can't we just say like within this week we're coming?

And that would probably be um you know enough to handle the the scheduling related issues, logistics.

Thank you so much.

Let's go here to the Mr.

Driscoll.

Thank you so much for your patience.

I was just sort of intuitively I reached to the left, but I didn't mean to say Mr.

Chair.

Um just the opportunity for all of us to share, I think is their first thing on the report.

Um spent a lot of compliments on it.

And while I definitely appreciate the report, I much more appreciate the process getting to the report.

And the different directions you find yourself going in our in the interview we talked about it and having to pivot a couple of times because of direction being dictated by something not contemplated.

Correct.

And so at the end of the day, one of the biggest recommendations is about a culture.

And while we're talking about EHS in general, it's really about culture of the entire organization.

And culture is very difficult because you have so many different personalities and directions and responsibilities and professional requirements.

But where it comes together is when there's a consensus at every level of the organization that's responsible for decision making and outcomes.

So it starts with the board.

It starts with having a consensus on what is the mission at whatever level, and then management having a buy-in to that and people coming to it and working in the true word of the consensus in business to where we look at all the issues, we boil them down to the key points, and then we walk away from the table.

And then management having a buy-in to that and people coming to it and working in the true word of the consensus in business to where we look at all the issues, we boil them down to the key points, and then we walk away from the table.

Not everybody's happy.

Not everybody likes it, but they've agreed to do it and to follow certain directions.

That then, when we get into inconsistencies today, start to go away because the consensus is that an inspection is for the purpose of doing this, which is the education piece, it's the safety piece, it's working with it.

And I'll digress a little bit.

One of the complaints that I've heard over years in my previous life is that well, if you tell them you're coming, they can clean it all up and be ready for you.

Okay.

I don't see that as a negative.

They've got their documentation correct and caught up.

They've taken the things that they know they should have been doing, and it's there, and it gets going.

An inspector can still see in the food industry that there's buildups in the corner that you didn't get because you knew they were coming, and they can work with it.

So I don't see that as a negative.

I see it as a positive on both sides.

The other thing with that level as we're working through, we have the ability to have similar answers to questions.

And it doesn't matter who the inspector is.

Someone challenges you on a fee, we have a consistent answer as to why the fee exists and what are we doing with it.

It's not out there to make the county and the district health board money.

It's offsetting cut.

We know that.

So with that level of single understanding, that's how you get to culture.

So thank you.

Yeah, and just to you know follow up on that point that you're making there.

When they if somebody knows that you're coming, yes, they prepare, but that's a good thing.

They are engaged in an educational process.

We are preaching active managerial control.

Well, what's active managerial control?

It's thinking about these things beforehand.

And to your point, they don't know what they don't know.

And they're still going to miss those big things anyway.

So why not remove that animosity?

Why not let them know you're coming?

Um, you know, my site visit was a great example.

They knew I was coming and they didn't get all the ducks in a row anyway.

They did a great job, but there's still things that no matter how hard you try, you just don't know, right?

So I couldn't agree with you anymore.

I think Mr.

Driscoll, too, at least the white papers that um I read on this topic, and and Dr.

Ranger can uh confirm this, there are no measurable health outcomes that improve.

And and of course, we're mostly talking about food inspections, but there's also other inspections for pools and the like, uh, different kinds of permitting process.

But the of course we all are wanting to make sure people are healthy.

We we don't want to have food-borne illnesses or different kinds of outbreaks happen.

But the evidence-based practice suggests that in the scheduling of them, you really are encouraging people to adopt those best practices more routinely, and then you're digging deeper into the things that may be more significant issues because you have the time on site to spend with them when you're there, and they don't feel so adversarial, so maybe they're more likely to come to our trainings and do the kind of active managerial control that we ask them now to do, but only generally when they're being uh forced to do it as a fine or punishment.

And so there are definitely measurable outcomes that I believe will improve, and there's no evidence that suggests contrary.

So that's why I have advocated for the pilot program in that regard, and think it's a very important part of this.

And Mr.

Sherry, I totally agree with that.

And when we start talking about culture, and start talking about yes, we're have done a deep dive into one particular level over time as you have the suspended thought about how are we doing things.

It affects the entire organization at every single level.

How we address a customer, how we solve a problem, how we um do education, every single component benefits from a more similar way.

And that's I think what we're talking about, and we have the opportunity to dig deep in a particular area, and that gives us the foundation for going across the board over time.

I couldn't agree more.

Thank you so very much.

Keen insight.

Dr.

Duarte, the floor is yours.

Uh thank you, uh, Mr.

Chair.

I don't I don't have a lot of thoughts because most of them have already been covered, and that's and that's a good thing.

Um, I think from a population health perspective, uh, what uh what I'm looking at, I agree the process is very important.

Um I I would I would I'm looking to see what outcomes do we want to define and what does success look like.

And uh I think that's a conversation we all need to have uh and uh in the upcoming board retreat, and um it's gonna take me some time to process through your very uh thorough report to kind of define what I what I would consider those endpoints, but those that's what I'm going to be looking at.

Understood.

Yes, Ms.

Andrew Hill.

I I would just like to add, um I really cannot feel any stronger word of thank you for having you come.

And I know I've already said uh extended uh deep appreciation for Dr.

Kinsley um having you come and do this presentation.

Because as I had earlier mentioned, this is just one area, right?

But the information that can actually come from this report from a cultural standpoint can permeate throughout and then create that good to great.

And I think the fact that you were willing to be flexible in what you had called adjusted to the curveballs, um, also is an indication of why I'm I'm at least looking at the board considering having you work with the implementation, not to do the implementation, but to work with the leadership to create the plan because when you're too close to something, even though you realize and recognize, oh, he mentioned this or this finding, sometimes you are so close to it that you necessarily don't necessarily have the ability to maybe step up higher and and look at it from a higher level.

I think the um the assessment of where this um started to where it's at now and where it to can go is far beyond this department, far beyond, and can and can really have that good to great um in in every and every um discussion and every uh peer to peer, whether it's outside, external, internal, it doesn't matter whether the board is being advocates, how we see that.

I I really feel that um 2025 in ending this and looking at what 2026 can be is pretty powerful, but I am just going to bring it back to at least a recommendation um again of looking at just creating and being a part of that implementation with the leadership and what I saw the benefit of that that I've not ever seen happen before is just something I'm asking the board for consideration because again, when you're too close to something, um, and I'm not talking about doing a big report, I'm just talking about literally working through these are the findings.

How do we get there?

What do we do?

Not um having Dr.

Ranger be the person to do it, but have the team do it with the leadership by Dr.

Kinsley.

That model and that exercise can then be implemented throughout other departments and other opportunities to get N MPH at the level that we all know Dr.

Kinsley wants, and all of the employees are there to to rise to it.

So I just wanted to clarify my recommendation and what I was really trying to get at a little deeper.

So thank you again, Mr.

Chair, for the opportunity.

Ms.

Andreola, I think um the uh Dr.

Kingsley hears you loud and clear, and it it certainly will be within the purview of uh the possible motion that's identified here that would include that.

I want to go um to Mr.

Fida for a moment.

So, Mr.

Fida.

Thank you, everybody.

Merry Christmas.

You're not out of here yet.

Um Mr.

Fida, thank you so much.

And um look, I I want to make sure that you hear from me very specifically, but also hope that you hear from the board.

Um this report was not in any way designed to um speak ill of um you know your department, the work that you're doing there.

Um I want you to understand I value your leadership tremendously, and this report is really the opportunity for us to get better as an organization.

And I I take it, given our interactions that you've seen it that way and view it as a positive.

Um of course, we're all trying to get better in our own personalized, professionalized everything we do is an effort.

I think it's sort of human nature.

One of the things I would ask is if you can tell us maybe um, you know, you've read the report, probably some of your team or all of your team, or maybe every person in the department has read the report.

I don't know.

What what is the sense or mood about some of these things?

And of course, in particular, I'm interested to know maybe initial reactions to um this question about uh scheduled inspections.

How is that being received?

Uh I was gonna say uh it's uh I think uh the in scheduled and uninscheduled inspection, it's like uh almost like a coffee and tea debate, right?

There is everyone has their own preference.

Uh there is a lot of uh arguments that people throw for pro and for con.

Uh one of the arguments I hear for unannounced inspections is you get to catch them act operating as they normally do.

You get to see the normal behaviors and stuff like that.

Uh and then I think as Dr.

Ranger uh mentioned, right?

The there is an element on the other side where you can prepare all you want, uh, but ultimately what you don't know you don't know.

And ultimately those behaviors still creep up.

You can't change who you are and how you practice things overnight.

Uh uh so uh I think it's generated some discussion uh amongst the staff regarding it.

Uh I know there was some concerns regarding uh I guess kind of the uh scheduling asked component of it, uh kind of committing and what happens if something runs along or anything like that.

I know they're logistical concerns, I think is the best way of uh describing it.

So yeah, it seems like things that your team will work out in the new year as we explore this opportunity.

I suppose I'm looking maybe for um you to confirm what I think I understand, because uh uh quite frankly, folks do reach out to us as board members.

But I I hope that um even in the debate about coffee or tea or you know, mint chip versus Vidella.

We all know mint chip is better.

Um, that the conversations are um academic and that they're polite and respectful.

I mean, I make an assumption that the folks on your team are highly educated, and so they have opinions, and we would expect them to have opinions, and so my hope is that they would engage in this process in a way that is respectful of perhaps change.

Uh oftentimes change is a difficult concept, and people are reluctant to it.

But maybe on the other side, we are made better by the you know robust uh debate about which one of those is things.

I'm uh a coffee person in the morning and a tea person in the afternoon.

So I I like it both.

Um so um that that's really my thought process.

And again, I appreciate your leadership and your willingness to engage in the iterative process that this report generates.

I know uh I've had discussion with some staff members, and I think I think well as Mr.

Dr.

Ranger put it, it's uh being intentional about it, right?

So ideally, I think staff are opening to piloting this and seeing and then measuring some of those outcomes.

And I think uh from a public health perspective, uh the question is gonna be what are we looking at, right?

Are we looking at violations?

Are we looking at cases of foodborne disease?

Are we looking at outbreaks?

What are these measures that we are looking for?

And is there a measurable impact?

So and I think Mr.

Anderson commented very specifically on that about those measurables and those kind of things.

We we all in our personal lives and public life are trying to measure outcomes and make sure we have data to support the decisions we make.

So I appreciate that.

Thanks so much.

Let me see if any of my colleagues have any other questions.

And then Dr.

Kingsley, I don't know if you have anything to say before we close out this rather lengthy item.

You want to look at colleagues first, or any other comments?

I didn't see any, but I I wanted to make sure that uh you had the last word.

You're the boss.

Yeah.

This was uh a wonderful guide and a north star for us to achieve and work towards, and I highly appreciate this.

When I first began here, um this had started with uh uh CCHS, and we had a report on that, and we pulled uh you know, some made a few changes from there and been able to adapt, and then we went to air quality and now environmental health, and we're gonna continue that process dedicated to where we can go through and identify those points.

And so we have uh uh Dr.

Dows and as well as ODHO and AHS next uh as as as we're going through uh this process to identify how do we dig up the roots and renourish them and strengthen us for a future.

So I I thank you for the direction of the board that has guided us through this and brought us here.

You know, and so looking forward to this, and especially for the next portion of it of implant the implementation plan as well as what we're gonna do for the community and and really connecting with them.

So thank you guys for this involvement and this direction that we've heard loudly and we'll be moving towards.

And uh, Mr.

Dr.

Ranger, looking forward to working through our implementation plan and have you as a consultant with that.

We'll be able to make that happen.

So um thank you for the direction today, and uh excited to continue to work to the board and the staff and the and the team on this.

So thank you.

Thank you.

If there are no other questions from my colleagues, I'm gonna make a motion and I'll move to accept the Northern Nevada Public Health Environmental Health Services evaluation report and direct Dr.

Kingsley to implement it as directed by the colleagues on the dais today.

A second, Mr.

Chair.

Thank you so much.

Any other questions or comments?

Hearing none, I'll call for the question.

All those in favor, please signify by saying aye.

Aye.

Any opposed?

Motion carries unanimously.

Dr.

Ranger, thank you so much.

Happy holidays to you, safe travels.

Thank you so much.

Appreciate you.

Okay.

Madam Clerk.

Lots of presentations today.

Let's move on to item eight.

Item eight is a presentation by Ms.

Lord on PFAS health and regulatory impact.

Thank you for your patience.

It was uh I know something a lengthy presentation before, and so hopefully not a problem.

I work in EHS, so it's all very interesting to me.

And that I'd love to hear.

That's who this is mostly for, anyways, right?

So thank you so much for being here.

Thank you.

Uh so members of the board, my name is Latricia Lorde.

I'm a senior environmental health specialist.

I lead the septic and well construction team as well as the safe drinking water team under Dave Kelly.

So I'm the senior, and then he's the supervisor.

And I'm here today to give a brief presentation on the health and regulatory impacts of PFAS in drinking water in Washoe County.

Sorry, wasn't ready.

Um I tried to keep this in the interest of time, tried to keep it really high level.

A lot of acronyms for that, I apologize, but it's part of the vernacular.

So I plan to cover what are PFAS chemicals, what are some of the pathways for PCAS PFAS chemicals to enter drinking water, the health concerns of these chemicals, the regulatory requirements for public water systems in Washoe County, as well as a private well sampling grant that has been received by NNPH from the Nevada Division of Environmental Protection.

So PFAS chemicals are PER and polyfloral alkyl substances, and it's a category of human-made chemicals since uh used since the 1930s, 1940s that were made to resist water, grease, stain, heat.

And uh, as many of you may already know this by now, but they can cause here serious health problems when exposed to over long periods of time, as well as during certain lifestyle life stages, pregnancy, childhood, early childhood.

Many of them have been largely phased out, but since there are so many, uh they are still prevalent in everyday environment.

Because they were made to be so durable, they have been nicknamed forever chemicals, and they are very hard to break down, and therefore we have very widespread exposure found in soil, water, air, and various consumer products that we all probably use every day to keep our food from sticking to our pans as we're cooking, things like that.

So here in EHS we have a safe drinking water team, and so that is gonna be our primary role when it comes to PFAS.

Uh the pathways are quite extensive.

Um I don't want to read through all of them, but obviously we're gonna have industrial releases that could lead to wastewater that are going, potential wastewater going into our lakes and rivers, at McSphere's transport coming back back down through rain and snow through the hydrologic hydrologic cycle.

Um, and then any accidental spills that we might encounter that obviously want to control, but we can't.

So some of the documented health effects are listed here.

Um, cholesterol.

I wasn't quite sure about this one at first, and then as I looked into it more, it um primarily has to do with how the PFAS chemicals can interfere with how the body processes fats.

Um, as well as we're gonna have possible immune system suppressions, thyroid disruptions, potential kidney or testicular cancers, and then other pregnancy related risks.

Those are all been documented, and then there's quite a few other emergence emerging concerns and tests being done when it comes to immune development, fertility, and increased risk of cardiovascular diseases.

The biggest concern and the hardest to quantify is going to be the fact that many studies have shown that multiple different compounds, even at low individual concentrations when added to or when present together create an additive effect that can be hard to quantify.

So this is the this slide and the next slide will kind of be relative uh regulatory background and then a look forward as far as where EHS is going to be involved.

So NNPH currently regulates 69 public water systems in Washoe County.

These are small water systems that serve groundwater, or they are a consecutive connection to Truckee Meadows Water Authority's surface water system.

So in Washoe County, we have the main Trucky Meadows Water Authority surface water system and then the Incline Village GID surface water systems that pulls from either the Truckee or Lake Tahoe.

And those two systems, water systems are regulated directly by NDEP in environmental protection.

Here in NAP NNPH and EHS, we regulate 69 other water systems.

Every five years, EPA then requires monitoring for contaminants that may be present in drinking water but have not yet been regulated.

And this is known as the unregulated contaminant monitoring rule.

And it was for community and non-transient non-community water systems, and I'll explain that second term here in a minute, serving greater than 10,000 people for 30 different contaminants, five of which were PFAS compounds.

All of the results from that sampling event from water systems in Nevada across all of Nevada were below the minimum reporting limits of 70 parts per trillion at that time.

UCMR three or five, excuse me, is currently ongoing, happening happening between 2023 and 2025 for numerous public water systems, all of which that serve greater than 3,300 people, and then another nationally representative sample set for 29 additional PFAS compounds and lithium.

Obviously, since it's still ongoing, data is still being collected and compiled, and to date, one Washoe County water system has had PFAS data reported to EPA.

But they still have till the end of 2025, obviously, to even sample as well as compile the data.

With initial monitoring required by 2027 and then compliance with the maximum contaminant levels that are established in the rule by 2029.

And for that rule that was established in April, there were six PFAS compounds, five of which were from that UCMR3 monitoring, and one additional that EPA had enough information on.

So this just kind of gives you the background of how regulations in the EPA world are developed.

Of those six, two now have an MCL of four parts per trillion.

So in 2013, 2015, we were in the 70 range.

Now we're down to four for two of them, and a 10 parts per trillion for four others of the six.

So it's kind of in flux.

They have told me they plan to request a two-year extension to the time frames that are required or that are set forth by the EPA to obtain that primacy.

It will not extend those 2027 or 2029 deadlines, but it would then give primary authority over the regular enforcement authority over any items associated with PFAS in Nevada directly to the EPA.

They do also plan as part of their primacy request to allow any data for PFAS samples collected since 2019 to be used towards any of that initial monitoring.

So anything that was collected during that current this current UCMR5 that I was referring to should apply.

So that initial monitoring and how it's going to affect our Washoe County water systems is listed there.

Public water systems serving greater than 10,000 people will be required to collect four quarters of samples and then serving 10,000 people or less or in e or equal to will be required two samples within 12 months for initial monitoring.

And so what this means is there's 34 water systems in of that 69 in Washoe County that will that we regulate here at NNPH that will be affected by this rule.

Once NDEP achieves primacy from the EPA or is granted primacy, excuse me.

NNPH staff will assume regulatory oversight for the PFAS rule associated with these public water systems.

And to explain the community water systems, there's quite a few small little mobile home parks in our community in the Truckee Meadows area.

There's the town of Gurlach, Sutcliffe, Empire, those are all small communities.

As well as non-transient non-community water systems are industrial complexes.

We have two schools through Washa County School District that are public water systems, Pleasant Valley Elementary, and the Natchez School.

And then we have other large industrial complexes that have enough employees that come to work every day, but they don't live there.

So those are water systems.

They have enough employees on a regular basis that they are they qualify under this rule.

So just give you an idea of who's affected.

There are quite a few treatment and funding options already available for PFAS.

Granular activated carbon and ion exchange medias are both considered best available technologies already on the market.

Reverse osmosis also works well, but it's going to be more effective in smaller quantities and volumes than what a public water system might be utilizing.

There's also numerous funding opportunities available through NDEP to these Washoe County water systems through the State Revolving Loan Fund, the bipartisan infrastructure law, and then there's an emerging contaminants and small or disadvantaged communities grant that NDEP processes and implements these grants, but we work very closely with the staff at NDEP to try and get our water systems connected to possible funding sources.

And if you recall from last month's meeting where you accepted a grant from NDEP to NNPH for private well sampling of PFAS, we have been granted approximately 228,000 that will provide for private well sampling.

We're estimating approximately 300 residents of private individual wells that are not part of a public water system to sample their well to give them idea of what they're drinking and to also get an idea of what kind of levels might be in the local aquifers.

The grant deliverers were listed there.

I won't belabor by reading them all, but I just wanted to include our planned completion dates for each step.

We do have until 2029 to spend out the grant, but obviously we want to try and get it out there and take advantage of it and get some sampling and take care of it in the in the first of the year.

That is all I have.

If you have any questions, I'm happy to answer them.

Okay, Ms.

Lord, thank you so much.

Fascinating topic and something that I know very little about and I'm interested to know more about.

So thank you for that.

I'm gonna turn this over to Dr.

Idahuarte, who had requested this item uh be agendized at a previous council or a meeting.

So I just want to make sure that the floor was yours.

Thank you, uh Mr.

Chairman.

I was uh very pleased to to learn that you've got the study going, and I look forward to seeing what the data tells us and how it informs us about uh our drinking water.

So thank you very much for your work.

Thank you.

You're welcome.

Let me see if my colleagues have go ahead, Mr.

Driscoll.

I'm not very familiar with what how what starts at EPA and ends up with us.

So educate me just a little bit.

When EPA sets a standard, do they also then set what compliance look like and what the repercussions of noncompliance is?

Yes, yeah.

They will they will institute monitoring requirements, and usually for something like this, even if it was a brand new water system that needed to comply with existing standards, it's usually gonna be four consecutive quarters of some sort of sampling.

So you get an idea if there's any seasonal fluctuations, and then they will they will establish what levels need to be uh achieved, and you need to be below in order to be in compliance.

So when that works down through the primacy of the state and comes to us as the people that are responsible for ultimate compliance, how does that work?

We are literally reading the code of federal regulations and how they've written it out and interpreting it and utilizing our partners at NDEP who are working directly through EPA to gain that primacy, and we're asking for guidance and assistance and consistency so that we are just like an EHS, uh, all things EHS, we're asking for them to help us implement these rules consistently across Washoe County as they are throughout the rest of the state.

Thank you.

Yeah.

Moving to the left.

I would just say thank you so much.

It's um definitely an awareness that we um all are uh hearing about in various ways at various levels, and sometimes that spurts up depending on what has been discovered.

And I'm just wondering are there what I would call areas in the community that are being monitored?

I I know you outlined obviously the various um guidelines of timing and that kind of thing, but are there are there areas because there's other organizations and entities and agencies like Tumwa, for instance, and I'm sure everybody's working together in some crossway, but I'm just curious what they are.

Yeah, so to offer explanation of uh when it comes to Truckee Meadows Water Authority, they actually have six different water systems that they operate.

They have their main water system that um the primary sampling point is at the Chalk Bluff treatment plant off West Forth, and then maybe their Glendale surface water treatment plant that serves the majority of the valley.

And it is considered a surface water treatment plant because the majority of their water is coming directly off the truckie.

They have five of their water systems in Washoe County that they operate that are all on wells only.

So we at NENPH actually regulate those five.

Okay.

One of which is out in Wadsworth.

And they've already tested, and they are at or above the limits that are established in the current rule as it reads, and they are already in the process of submitting to NDEP for a water project and for treatment and one of these uh available technologies.

And they have a timeline that in order to do so, they may barely meet that initial 2029 timeline, and they've already started versus some of these other systems haven't even maybe sampled yet, for example.

Thanks.

Yep.

Okay, any concerns, Mr.

Anderson.

Thank you for the report.

Yeah.

What a wonderful topic to get to cover, huh?

Yes.

So I was actually wondering if we've thought far enough out once we become responsible for the compliance oversight.

Um, what do we foresee as far as staffing, training, um operationally, how how we're gonna make this work within an NPH?

And and that was kind of my question that I had um I would usually confer with my supervisor.

Uh it will depend greatly on what kind of results we see uh coming in.

We receive a monthly report from NDEP of all water quality data that is entered that meets any sort of trigger.

Uh if it's half of an MCL, depending on what the item is, nitrate, for example, can cause immediate acute health effects.

The MCL for that is 10.

Well, if anything's above five, we are alerted to it, just so that we know.

And then there's other items that are maybe more aesthetic concerns and not necessarily health concern that we will be alert that we are alerted to if it's just over the limit.

So until the broadband sampling is maybe wrapped up or the UCMR5 is all compiled, uh it'll be hard to tell how many systems are maybe above the limit.

And I would also refer back to the the one out in Wadsworth that is already treating, there is another water system in between us and them that is in Storey County that is also treating and going through the process because they are downstream of our wastewater effluent from our community.

So if anywhere, I would see it on the eastern side of the county.

Okay.

And just one more question, if I may.

Absolutely.

I'm just curious because some of us here are either actively involved on the Tumwa board or have been.

And I know one of the things that they've been struggling with is the balance of making sure the public is educated but not causing hysteria.

Are we kind of planning through a communication process, especially now as it's moving closer?

And I think it's going to be more publicly acknowledged.

Um what's happening?

So I'm just curious how how we're looking at that.

So one of our grant deliverables for this grant is setting up a website that includes educational materials, at least to the private well owners, but it will also be utilized and available and helpful when it comes to regular public water systems.

There's always more grants.

So this is great, especially with some of the current or recent federal grant uncertainties.

But there is another one that if a water system is known to be above the limit, that water uh customers of that water system can apply for a small countertop um treatment unit just for their drinking water.

So it won't be huge volumes that they could utilize or run through it, but it is coming kind of down the pipe.

So once we get more data, we would be able to know who to send them to.

Okay.

Thank you.

You're welcome.

Thank you so much, Mr.

Brown.

Anything?

Um I I suppose I would say a couple of things in um response to my colleagues' good inquiries first.

Um such an important topic that we just do not have a lot of information about.

I I was proud to serve on Tumwa for six years and and um we're just starting to understand the conversations around PFAS.

And I think Mr.

Anderson's right that a lot of it is just trying to make sure that that's good information going out and not disinformation.

I suppose from my perspective, what I want to avoid is uh sort of embroiling public health into a new area for which we don't receive funding.

Um and so a lot of this starts to bleed into that, like and another example would be related lead to say this is the kind of presentation that I would like to see made at Tumwa, potentially made at regional planning governing board where this question has come up, because sometimes what happens is well-meaning folks in the community see a development and they um they react by pushing whatever lever they think is appropriate in their objection to that uh development, oftentimes, and they might say, well, this warehouse or this um home or this residential development is going to be next to a place where we heard one day there were PFAS things there, and therefore we're not going to do a thing there for all time immemorial until the experts figure out PFAS.

And I I don't it's very hard place to be put in because of course none of us want to expose people to some dangerous thing that might harm them and their children, and you you have a lot of information here about some of those very real and serious harms, but it's like reacting out of sort of chat GPT-driven conspiracy theories versus reacting to science, those are sometimes the disconnect.

And so I wonder if the takeaway from me from the presentation is a awesome job, B, um take the show on the road, um, which might be something that we can talk about offline and C just sort of a cautionary warning about um the role of NNPH in this space, and and maybe that's the one thing that I might ask you to address, just if you know or if if Dr.

Kingsley or your team would want to say, like what is the role that we might envision for ourselves in this space outside of this, the grant that you've already identified.

Well, when it comes to the regular everyday compliance for the public water systems, that is we do that work underneath a grant that is provided on a regular basis.

I don't know how much that is on a regular, it's a fine, it's it covers staff time across the board and has for for quite a few years.

Um we used to regulate the main Truckie Meadows Water Authority surface water system and the Incline Village GID water system just for an example and for reference, and that was then requested to be turned back over to NDEP because they um regulate numerous other public uh water systems with that serve surface water, primarily all of Clark County, excuse me, Clark County, and in turn we began doing the chemical compliance portion.

So just for a history of what our role has been and where it would work into the workload.

And I don't know if Dave has any other comments when it comes to the workload, and he would be the one determining that.

For uh first Letra, wonderful presentation.

Thank you for coming and bringing this forward.

Historically, I think the last time that the public really where we saw education was with uh the flooding of Swan Lake, and we needed to be able to address that and then begin and then it kind of died out, correct?

And so we are continuing forward with this, and anything that we permit, so this is where when unfunded or we get mandates or those things, you know, when we permit, then we're able to recoup costs.

So that is the one thing here.

It's the educational pieces or private wells that we have to seek those loans out.

So I would say bonus point on that that this is something that you know, within we're able to regulate because we permit, so then we get a feedback.

So this is something we can is sustainable for us to do on those points, and so it's always evaluating that.

So anytime we receive more, then it's just that's when we have to reevaluate our fees on those points.

So it's always that process.

So we do have a way to make it sustainable.

Uh concerns where we're at currently is that we've seen progress in this, but as mentioned in May 2025 was the first talk of rescinding all of these.

So there is talk at the federal government of rescinding many of these points that we would no longer have to regulate, which is a challenge because on one point we hear we want healthier food, we want the healthier water, yet we're gonna pull back the regulations from our corporations that enable that.

So working with our federal partners to monitor that and hope that we can continue those.

There was up to six, and then they went up to eight PFAS that were acknowledged to cause uh were carcinogenic, and I believe they did pull those back.

Unfortunately, uh they had started down that road, and then it was pulled back.

So we see a lot of ups and downs here.

But I see in our community this desire to move forward where in Nevada we are very well specific, you know, and we have trucky meadows.

I think it's uh this is just where we will work with our board, Turkey Meadow uh Tumwa, and making sure that you know what's important is our water and um our the our health of our community.

So while we may see fluctuation in the federal government, I think it's something here that we will always monitor and listen to our to our public where we can and where we can deliver.

So thank you.

Such a time to be alive.

And certainly we're all reacting in real time to things outside of our control at the federal government level, so no problem there.

I just want to make sure that I emphasize that I hope we were not engaged in some kind of mission creep with a new thing, and it's a fancy thing.

You explained it beautifully to me, and so now I understand.

And again, I'll sort of emphasize the point I did make, which is take the show on the road.

I think you've got something here that the public would like to know about.

Um, and maybe they're not always paying attention to NNPH, but maybe they would be more receptive at somewhere else, uh, like Tumwa.

And I know Miss Andreola uh serves there and is the chair.

So you got the right people.

So thank you so much.

Yeah.

Fantastic, really informative, and I'm very grateful for Dr.

Awarte for raising the issue and for your presentation today.

You're welcome.

Okay, thank you so much.

I think um, and I'm not sure.

Was this item for action, or is it just no, it was not.

Okay, thank you so very much.

Uh, we'll close this item out now and move on to our next presentation.

Uh Ms.

Shepard, been incredibly patient waiting for us to get our show on the road, and a topic that I was very interested in, and I think asked for.

So thank you so much.

Appreciate you.

You're welcome.

Good afternoon, um, members of the board.

Christina Shepherd, Division Director for Community and Clinical Health Services.

Today I'm just gonna give you what I hope is a brief overview over of um sexual health services offered through our family planning sexual health clinic.

Um, so this is just some STI numbers at a quick glance for Washoe County.

Um, I think the key takeaways here are that over the past three years our STI rates have remained fairly steady.

Um we are still finalizing our 2025 data.

Um I will point out that please don't get too excited about the congenital syphilis number in a recent update from my colleagues in population health.

We actually are now up to 15 congenital syphilis cases for the year.

So I think that trend is gonna remain steady.

Um when we look at Nevada's uh STI rates nationally, the latest year we have data is 2023 and Nevada ranked um in the top 20 nationally across all reportable STIs in 2023.

Most of that was driven by rates in Clark County, but I would say what is particularly concerning for Washoe County is that we do have high rates of congenital syphilis and primary and secondary syphilis.

Um so the family planning sexual health clinic provides accessible client-centered focus care focused on reproductive and sexual health.

Our clinic's mission is to reduce barriers to care, support informed decision making, and promote overall health and well-being through education, prevention, and high quality clinical services.

We don't turn anybody away due to inability to pay.

Our fees are based on income and family size with special provisions for teens seeking confidential care.

So who are our patients?

Well, most of our patients are between the ages of 15 and 44, which is considered the reproductive age range.

About 60% are assigned female at birth, so we see about 40% that were assigned male at birth.

A couple of things to point out here is that nearly half of our clients are uninsured, which makes access to care a real challenge because they're having to pay cash pay at other places that most likely don't have a sliding scale fee for services.

And then even those, even among those with insurance, many face barriers like not having a primary care provider or having really long wait times for appointments.

And then around 70% of our patients report incomes below 250% of the federal poverty level.

So just a little bit of context there for a family of four that is at 150% of the federal poverty level, they earn about 48, 48,000 annually.

And then we do see have a significant portion of our clients that identify as Hispanic or Latino, about 50%.

So I'm not going to talk too much about our reproductive health services.

We have been providing reproductive health services since Title 10 began in 1970.

But I do want to highlight a couple of crossover services.

So every patient that comes in does receive a comprehensive sexual health history, as it is a key part of understanding overall health and identifying appropriate testing or screenings that need to be offered.

Per CDC guidelines, we do offer chlamydia and gonorrhea screening to all females, 24 and under who come in for reproductive health services.

And then anyone with a positive pregnancy test is screened for STIs that day.

And that includes an in-house syphilis test if they are eligible for it.

After their positive pregnancy test and testing, they are then referred to a community health worker for a warm handoff to prenatal care so that we can get them hooked in with prenatal care as early as possible.

So our clinic does offer comprehensive STI testing with same-day results for chlamydia, gonorrhea, syphilis, and HIV.

We have treatment available for most STIs, both the recommended and alternative regimens are available on site, so it eliminates the barrier of people having to go to a pharmacy to pick up medication.

They can get their medication just from us.

And then all services are delivered with client-centered counseling.

We engage clients in practical, respectful conversations about their sexual health and how to reduce their chance of acquiring a sexually transmitted infection.

So over the past few years, we've really expanded our prevention services, especially around HIV, and this was in direct response to patient feedback and changes in community provider availability.

We had a lot of patients that were coming in for testing who were very interested in PrEP for HIV prevention but weren't able to get it through their primary care provider or at any other community provider location.

And so we implemented oral daily PrEP about two years ago.

And we are currently in the process of implementing injectable PrEP, which is a brand new intervention as well, which is super exciting.

Our community health workers have been instrumental in our PrEP efforts because they because they serve as our PrEP navigators, so they help patients access medication, manage prior authorizations, and stay on track with their refills.

We also offer post-exposure prophylaxis for HIV treatment.

So this is treatment that needs to be started within 72 hours of a potential exposure to HIV.

So we do try to prioritize these patients due to the critical time frame that they need these medications.

And then we, I apologize for my typo, but we've been trying to transition them from PEP to PrEP.

So if they needed a PEP regimen, then they likely are a good candidate to transition to PrEP.

This has shown to be very effective in reducing that person's ability to then transmit the virus to somebody else, and also shows really good health outcomes.

So the sooner you can get somebody started on anti-retroviral therapy, the better that their outcome is.

We also do doxype, so antibiotics that are taken within a certain time frame to reduce the chance of requiring certain STIs.

So in studies, this has shown really, really good prevention or post-exposure prophylaxis for syphilis and chlamydia, not so much for gonorrhea, but is another exciting um intervention that we've implemented in the past year.

And then we do vaccinations and partner services.

Partner services also involves partner delivered therapy for some sexually transmitted infections, and then testing and treatment for partners that may have been exposed.

These sites allow us to reach vulnerable vulnerable populations and provide education and resources in addition to testing.

And then we've also worked really hard to raise awareness about our services through partnerships with NNPH's communications team, IC Media, and Commando.

We've been able to launch a couple of different public service campaigns across dating apps, social media, billboards, and radio.

So the one on the right was a one that ran on the dating apps, and then the kind of two on the left were our billboard social media radio ad push.

The instability at the federal level has made it really difficult to plan for long term for the long term.

So because of this, we've had to delay filling vacant positions.

So the clinic currently has six vacant positions.

And this has led to a longer wait time for appointments.

So people are waiting on average two to three weeks for a scheduled appointment, and our walk-in appointments fill up very quickly during the day.

And then access in the community is still very limited.

We are the only clinic that offers walk-in appointments for sexual and reproductive health services.

So it's very hard for somebody that has multiple competing priorities to find a place to go to get services when they need them.

And then I would say changes to Medicaid and Affordable Care Act incentives are going to likely increase the number of uninsured clients that are relying on our sliding scale fee for services.

So not extending the tax credits for those affordable care act plans starting January 1st.

I think we may see an increase in the number of uninsured people versus the number of people that are on private pay.

But I'm here and happy to answer any questions, and I have my phone of friend colleague here if you have questions about specific STI rates.

But I do want to take a moment to recognize the incredible staff in the family planning sexual health clinic.

Despite limited resources, they show up every day and provide exceptional, comp exceptional and compassionate care to our patients.

So I'm very proud to work alongside them.

Thank you.

Okay, thank you, Ms.

Shepherd.

Outstanding presentation.

Let me turn to my left first and see if anyone has questions on this side.

On this side.

I just wanted to sometimes in storytelling it uh it receives an impact.

And so just uh Chris uh Christina's team.

So there was an individual within our community that had spent over two, three years, I believe, trying to resolve a medical issue that she had and with various treatments.

And by coming into our clinic by chance, she came in with a simple wet mount that able to diagnate diagnose and cure her.

And so sometimes the expertise that we have out in our community, we have wonderful doctors, but they just don't see it as frequently we as we do.

And the fact that we were able to, Christina's team was able to meet that and cure her and change her life after two years of struggling with the diagnosis of what is going on, that they we simply were able to do it here.

So we do provide very specific, and again, being the only walk-in clinic in Washoe County is is a difference that we do that we meet that community, that's where we are with that stop gap that individuals that if um where we help in the community.

So I just want to recognize on that story and the impact that we do have with individuals in our community.

Thank you.

Yeah, I will never forget my first patient that I started on prep, um, an older gentleman that had been trying for years um to get on prep.

He had resources, had insurance, had a primary care provider, and was never successful.

And so it was just such a it felt like such a big win to be able to get him on to prep.

Yeah, well, thank you for uh that comment.

Um, a couple of things.

First, as a sort of an apology.

Um we put you on a very busy agenda uh six days before Christmas.

And I I want you to understand that if I could go back in my time machine, I would not do that because I do think that this is a topic which we could spend enormous amount of time.

So my my thought is perhaps we will find time during our strategic planning workshop to revisit this topic.

Very important uh to me and our community personally.

I wanted to ask one question that was not covered in the report uh or in the presentation, and maybe see um it's a sort of a gap in my knowledge.

And this is about rapid HIV testing and whether that is available in this community in any way.

I have been in other larger communities and I have seen it.

Um I've not had the chance to participate.

I would like to, um, but I wonder is that something that exists in northern Nevada?

And if so, who is doing it?

Is it what what can you tell me about that?

So we do rapid HIV testing in the clinic.

Um that's what pretty much exclusively what we do is rapid HIV testing.

We rarely draw a lab-based so that people have their results that day.

Rapid HIV testing is also done at our community um testing sites, so at our center um at the jail, and then um at Eddy House, we're doing um rapid HIV testing.

There are some other providers that are doing like Planned Parenthood.

I think Hope's Clinic does rapid HIV testing, I think Shaw does rapid HIV testing.

I would say like your run-of-the-mill primary care provider is likely not providing rapid HIV testing.

And I don't believe they're doing rapid HIV testing in the ERs.

Okay.

So clearly you can see the gap in my knowledge base in this area.

And and I suppose my interest is because I had a constituent come to me and say, hey, I am doing this uh event, and um his name is Ray Lutzky.

Yes.

And he is doing an event with uh NNPH, and I saw the advertisement for it.

So I was very excited about it.

I'm out of town when the event is happening, but I was very encouraged that the fact the event was occurring.

And I think he had asked me, he wanted to have rapid HIV testing on site, but maybe he didn't understand that we didn't do it in that way, or there was some reason why he wasn't able to couple that with the event that he was hosting.

Um and again, why I asked is because his constituent raised the question with me.

Um yes, I'm Jennifer Hell for the record.

Thank you, sir.

Um sexual health program coordinate our supervisor now.

Congratulations.

For like two years, and I forgot that.

Um so yes, we do know about that event.

Um we do have limited funds for the community-based testing that is paid for out of the staffing and the tests for the HIV tests are paid for out of the CDC HIV prevention grant, which we don't know what that's going to land with, like funding-wise, it in May 31st.

Um my plan was to have um our community health workers direct people to our center and to an MPH for testing.

Awesome.

Great.

Thank you so much.

That it gives me the opportunity to respond in real time to the inquiry.

Um again, my apologies to both of you for the length of our meeting today because I do think there are probably more questions that might be asked under different circumstances.

So I'm gonna hold on to the report.

I'm gonna look to my colleagues left and right to see if anyone has any additional questions.

It doesn't look like they do, but please know that this is a topic that I will be interested in following up with you about.

Just so you know, April is uh has S T D awareness week in it, so maybe that's a good time as well.

I would love that.

Dr.

Kingsley, make that happen for us.

Thank you so much for the presentation.

I appreciate it.

Thank you.

Okay.

Uh now we're gonna close out item nine and move to item 10.

And let me also just for a roadmap for folks and for those watching at home and in the audience, um, by just the chair's prerogative.

A couple of these items are gonna come off the calendar today in the sake of preserving our quorum and uh getting everyone back uh to their uh regularly scheduled assignments.

Items 13A, 13B, 13C, 13 D will not be heard today.

Uh, we'll accept them as uh written presentations only, and if any of the board members have questions on those items, um we will take them up um uh individually and offline.

Um and then I think that is all the items that I am going to remove at this time um and we'll see what we can get to in the next couple of items.

So I'll close out that item, move now to item 10, item 10 as a presentation uh by you, Dr.

Kingsley, and you've come off the dais to make it.

Uh thank you so much.

Yeah.

Thank you.

So Dr.

Chad Kingsley, district health officer for the record.

Uh just gonna go quickly review over previous to last month we received our uh data from 2025 mosquito season.

So I just wanted to get direction from the board to as well as our essentially our three jurisdictions, as it may impact our budget this year on presenting and going moving forward and looking at that.

So this was previously presented.

Again, we're looking at that three years data.

When you look at that graph real quick, that uh green one in the back is when we didn't start, and so we saw mosquitoes rise, and then right when we started the aerial larva site, we see it go down.

We see the purple one where we delivered correctly across the system that we kept mosquitoes down, and then that the kind of the orange one is this past year, 2025.

We had a favorable season right up to August, and then we saw the mosquitoes go up.

So we see the impact that doing our our aerial larva side does and uh what it is for our community.

Um the mosquito abatement, you privilege saw this and the work that we did.

So I'd be presenting this to the county commissioners on these points, and just showing this is kind of what an average year looks like us when we were doing mosquito abatement.

Um so updated our numbers from 2025.

We saw numbers of dengue fever, and again, those yellow ones that are there are though we do not have the mosquitoes that transmit or carry these diseases, so individuals that had been traveling came back to our community had this, so it wasn't acquired here within our community.

But as uh looking at it, a lot of our mosquito abatement came from the early 2000s with West Nile, the increase of it.

Um over the last year, we've had one over the last five years, we had one case.

So looking at that.

Um then so just looking at NRS really.

So there's NRS 439 and 318 and 439 again.

That's just allows us the authority for the extermination or abatement of mosquitoes and other vectors at health deterreat, really.

The DHO allows me to designate uh to be able to do that, it gives us certain property rights and to go on to property for abatement.

Um NRS 318 is a creation of special districts for mosquito abatement, any special uh uh uh districts.

So a commission, the commissioners are allowed to create these districts, they would have to find funding for it uh is an option, and just uh comment on that.

So recently Clark County commissioners did discuss creation of special district in Clark County for mosquito treatment.

Tentatively looking at it though, it is very cost prohibitive.

It cost prohibitive.

Um but anyway, essentially, so these statutes empower us as the myself as well as the district board of health.

Um, the only recovery costs that are actually in RS is to put a lien on a property.

And so that is very lengthy, it can go on for years, and it's not very popular, so that's why it's not used.

But that's the actual actually only really recovery costs that we have the option of.

And mosquitoes is really not gonna be that, that would be more rats or other vector things on there that somebody perhaps is not cleaning up, then we can put a lien on their property, but that could take years or up to the sell of that property.

So currently, right now, we do not have a dedicated funding source uh from in the in our statutes for abatement, just the authority to do that.

So previously funding, so 2005 to 2010 during an optional flood and public safety sales tax, so one eighth of a sense of tax was imposed by the county commissioners.

So five years, this is the uh 2005, six, seven, eight, and nine, and ten, those are the amounts that we received in Northern Nevada public health at the time for abatement on mosquitoes.

It was relatively new, you know, as Mooner, that's when really Zika came out, and they were doing that.

So that's previously there.

Then in 2017 and 2018 post-flooding, uh, the general fund contingency transfer was approved.

And in 17, 205,000, and then 534 in 2018 was provided in Northern Public Health.

Um any of those gap years and up to present, um, the rest of the abatement has been absorbed through Northern Nevada Public Health EHS.

So last year, as we brought to the board with our budget struggles, we did suspend the large area treatment for fiscal year 26.

So this uh uh this past season.

Though it was one of our largest uh expenditures that doesn't impact our staffing, is why we moved towards that, and it was in our consideration the lowest risk that we had with only one Zika case in here.

So that saved us uh thread uh just about 300,000 dollars yesterday on our on our uh fiscal year budget.

So looking forward as we move forward.

Um currently, this is what it costs for us to run a season.

Um and this is as efficient as we can.

We have about uh environmental health services.

So we do when they're not doing a mosquito abatement, we have them doing plan review, pools, uh tattoos, schools, and those inspections.

So looking at that, so an supervisor over them, a senior, and one EHS.

So these are all REHSs that go down to the field.

To supplement that, we use interns at $15 an hour.

So on average, we get about 3.3 of them, three to four to three and a half that we use from May to September, and they go out and do our trapping.

They uh help us, so it's a way for us to do it as economically as we can.

Uh mosquito abatement in the helicopters where we cut back last year, but we have our overhead charges.

We also have a warehouse, that's about 51,000 where we rent and do utilities.

That's also where we do uh grow our fish at and keep those supplies there, then a vehicle cost and uh operating cost was like that.

So about $830,000 for us to run this abatement uh uh costs.

So public health has a number of unfunded mandates that are a must that we must do, and authorities that are a May.

Mosquito abatement is an unfunded author authoritative may.

So we do not have a must on it uh on that, but it is one that is more in the public's eye.

And so we have uh as a nuisance that we have uh moved out to towards to always address since 2005.

Um federal, state, and local public health funding lessons that require to so prioritize risk and impact for delivery of services on all health programs and explore alternative funding sources for low to no risk authoritative May activities.

So that's kind of where we're at with our budgets.

I'm just trying to help us be able to provide a clearer path forward.

And this is necessarily just going to the commission, but representing the three jurisdictions to say this is this an interest to us that we would like to ask the commissioners, and they can say no.

We're all in budget constraints, but it just allows us to better understand our budget moving forward.

So this is what I put forward to you what I would go and present to the commissioners for their consideration.

Okay.

Any questions from the board?

Ms.

Andreola, I'm particularly interested to know for your perspective because I think when we had the discussion uh this summer, you were the one who probably got the most um feedback from the community.

It it wasn't uh I I did not hear about it, uh, but I think maybe your uh area where you represent may have more possibilities for this to occur.

Well, I'm not I'm not sure exactly what to add other than um I think to a certain extent we all were receiving um some feedback based on the um decision by this board to uh and the upon the recommendation of Dr.

Kinsley to at least I'll use the term pause.

Uh the um mosquito abatement with the helicopter.

Yeah, which as you listed as 281,000.

And I want to actually use this opportunity to thank you because and the staff, because there was a lot of confusion, as if the program was entirely going away, uh, which is a little bit of a segue of what you're sharing.

So we went from maybe just pausing the helicopter to how do we even sustain this?

Yeah.

Um so I I really don't really have much to add other than to say that I think the fact that the helicopter crosses all jurisdictions.

Yeah.

The helicopter doesn't stop on the line of unincorporated Washer County.

Yeah.

Or the city of Reno or the City of Sparks.

Mosquitoes, I don't think can be bred to actually identify jurisdictional boundaries.

So uh all I'll say is I don't know enough about this.

I actually noted the fact that there was the eighth cent tax imposed by the Board of County Commissioners that you noted in your slide.

I'll reserve the opportunity to continue to research this and look at maybe um having discussions possibly with um with that impact.

I I do think it is always into interesting to put on any body no matter who it is, an unfunded mandate.

Um that in this case has the language of May versus Shell, which is you you have no choice as a as an entity.

So I think it gives room for further discussion and exploration, and I'm gonna use that opportunity, Mr.

Chair, to do that.

Thank you.

Thank you so much.

Um, Ms.

Andrea.

Any other questions from the board?

Okay.

Uh I'll move to approve the presentation on mosquito abatement funding and approve the present data and future funding options to the Board of County Commissioners.

I'll second it.

Okay, 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.

Any opposed?

Motion carries unanimously.

Okay.

Uh well, that'll close out item 10, and we'll now move to item 11.

Item 11.

Uh that's you, Mr.

Kelly.

Maybe we need trans mosquitoes together.

Good afternoon.

For the record, my name is David Kelly.

I'm a supervisor with environmental health services.

The item you have before you is business impact statement for some proposed changes to the regulations governing sewage wastewater and sanitation.

Uh, more specifically, the sections that we are addressing uh pertain to residential septic systems, as you know.

Anytime are being updated, we present a business impact statement to the board pursuant to NRS.

Um I'm just gonna highlight a couple things.

I gave you guys a lot of information in your packet in the staff report.

I mentioned that our team started receiving feedback about 10 years on our regulations, about two and a half years we actually started engaging with drafting them and uh engaging that process in earnest, and then approximately five months ago with the shutdown of the Donovan Pitt, we lost our only source for engineered and advanced treatment septic systems, and that um created a little sense of urgency as part of these regulations will help address that issue.

Um the reality is is all almost I'm gonna say all of these regulations are based on the needs of industry, and um uh there is in no way more restrictive or costly to end industry.

Um that's our final conclusion on the business impact statement.

Um, Mr.

Kelly, that is the key finding and recommendation.

That is the key finding, yes.

And I and I believe that sincerely.

Uh, just a couple of examples right now.

If you cross a water course or drainage, uh uh you would have to go through a variance board and process that's about three thousand dollars in a one to two month timeline.

Um, as I mentioned, the sand filters, this opens up alternative technologies, which the industry has available, but our regulations just have always been a little bit behind the times, and this opens that door.

Uh and in addition, it opens up uh for contractors and homeowners to use uh additional licensed professionals other than engineers for percolation tests.

We felt there are other qualified professionals out there, so that will increase access to uh for those types of services and hopefully reduce costs on them as well.

So, again, as I said, the final finding is that uh there's no negative impact.

There are also no fee increases associated with these proposals.

Uh, I mentioned in there that we made a few changes, I think eight based on public feedback, um, the both from industry and the state board of health.

We or not the board, but state health, we talked to them.

Um I've received word from legal, so the draft that's posed is the final draft.

There will be no additional changes.

Legal's okay with it, uh, state health is okay with it, and they were posted on the uh 8th of December.

Just those additional seven changes.

If uh if you do approve the business impact statement, I'll be back before you next month, and we can have more in-depth conversations if you want to, but I'm also happy to answer any questions about the business impact statement, about our outreach, or any of the regulations that you might have.

Mr.

Kelly, thank you so much.

Um, first of all, a couple of things.

One is thank you for the great care that you took with me to help educate me about the topic.

Um, it was not something I was particularly aware of.

Um it's a strange thing when you get into office, you have to know a little bit about a lot of things.

And the uh concern that often can be raised is that we don't desire to see unintended consequences of the actions we take based on our lack of knowledge, but you may be feel very comfortable with the action we are taking.

I appreciate the care and thoroughness that you undertook in terms of the timing of the review, the multi-year process.

I understand that uh you know we haven't changed our process since 2013, and so that seems uh a fair uh cry from where we are today in twenty almost 2026.

Uh, thank you for the public workshops that were held and for the thoroughness of the engagement process.

I I note uh for the record and so that the record is clear that there were uh a lot of people who engaged in those.

I think attended by 65 and 35 property engine uh owners, uh engineers, installers, realtors, people who have a real stake in the outcome of these kind of regulations, and it's on that basis that I am able to make all the findings necessary to um move forward with the motion that's uh uh identified in the staff report.

So I want to make sure that for legal compliance needs that we have done that.

Um any questions for my colleagues on the board?

Mr.

Chair.

Yes, Mr.

Driscoll, thank you so much.

Um in reviewing all the documents were there, there's the the one that's the final regs, if you will.

Um, in that there are numerous um figures that the title tells us that they're to be updated.

So I reached out to staff and received an answer that we're dealing with the um business impact statement and the type of very fine changes to some of those figures, do not change any of the language and do not change any of the regulations.

There's simply will be the become the best schematics that we can do at the end, and they may or may not change, which is why they're left that way.

So we're not approving that.

We're only approving the business impact statement.

And so while the document says final, I'm comfortable voting that while it's an ancillary document that it is in flux.

Thank you.

And just to clarify, I I probably could should have called out.

I think the the draft that I posted, if you look, it'll show a figure that says to be updated.

But right before I posted it, I got my digital things.

So if you look underneath it, there's a cleaner picture, and that is the intended uh picture.

So and you'll have a final copy in all the red lines next next.

Yeah, thank you for that.

Any other comments or concerns from the board?

Okay, I'm gonna close this item and I'm gonna make a motion to approve and adopt the business impact statement for the proposed revisions of the district board of health regulations governing sewage wastewater and sanitation with finding that the rise regulations do not impose a direct and significant economic burden or on business or citizens in order.

The revised regulations directly restrict the formation operation expansion of the business and set a public hearing for the possible adoption of proposed revisions to regulations for January 22nd, 2026 at 1 p.m.

Any additional questions or comments from my colleagues?

Hearing not on call for the question.

All those in favor, please signify by saying aye.

Aye, aye.

Any opposed?

Motion carries unanimously.

Thank you.

Little did you know that my high school debate career would pay off in being able to read fast.

Okay.

Item 11 is now closed.

Item 12 um is I'm I'm not sure how much discussion will need, but I'll bring Miss S.

forward as she's already here.

Look at that.

Um it sounds like this is a reappointment of Miss Dean.

Is that correct?

No, it is the appointment of so um chair, members of the board, Andrea S.

Preparedness EMS program manager for the record.

Um today I'm here asking for the appointment of Cassandra Dean to the MSAB Hospital Continuous Quality Improvement Representative.

Um Miss Dean is uh currently works as the director of clinical excellence for renown.

Um she becomes she comes highly recommended um from the her predecessor, Mr.

Joe Macaluso, who recently gave his resignation and wanted to pass the torch.

Um Miss Dean was also the only applicant we got for this position, but we do find her uh well qualified and look forward forward to her expertise and to help move the board along.

Um this position is uh holds a term of three years and then eligibility for two additional two years terms.

Thank you so much, Miss Essa.

And I apologize I had indicated a reappointment, but it was the appointment of Miss Dean.

If my colleagues don't have any questions, I'll entertain a motion.

Okay, I have a motion from Mr.

Brown.

I'll second second for Miss Andreola.

Any other additional questions or comments?

Hearing none, I'll call for the question.

All those in favor, please signify by saying aye.

Aye, any opposed.

Motion carries unanimously.

Item 13, uh A, B, C and D I've removed, but I have left item 13E on the agenda.

And that is for you, uh, Dr.

Kingsley, for any time that you might need with us before we break for the new year.

None at this time.

Thank you.

Okay, I should have removed you as well, but I didn't close that item out.

Item 14, Madam Clerk.

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 order or safety of the meeting.

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

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

I do not have any requests for public comments.

Thank you so much, Madam Clerk.

We'll close out item 14 and now move to item 15.

Item 15 is reserved for board member comments.

Uh if anyone has any, now is your time.

Dr.

DeWarte.

Um yes, I just wanted to uh mention that that the PFAS chemicals are uh present in multiple sites, not just water.

Uh people can get them from food and clothing and uh and and other household items.

So this is not just a drinking water problem, and the health effects are still being defined, but it's looking like there may be some significant health effects related to ingestion and chronic exposure to these chemicals.

So that's why I think it's important that we look at this.

Thank you so much, Dr.

Duarte.

Any other questions are coming in?

Ms.

Andreola.

And I have created a motto for December of a no scale zone in my home for the whole month of December.

It may change in December in January, but it's it's not going well.

I cheated today and on the scale, and it is not going well.

So on a very serious note, um, I really appreciate uh the opportunity to serve on this board, and I certainly appreciate the opportunity to get to know everyone, and everyone brings so much complimentary experience and professionalism to the board.

I'm gonna celebrate that and taking that away from 2025 and looking forward to 2026.

And I hope everyone has a blessed holiday.

Thank you.

Thank you so much.

Any other comments or concerns?

Okay.

Um I'll just take the opportunity to say um, of course, Merry Christmas, happy Hanukkah, whatever holiday you're celebrating, happy new year to everyone.

Thank you to all the staff for uh sticking with us today.

It was a longer meeting than I had anticipated, and that was because great presentations and lots of important topics.

So with that, we'll move and we'll make I'll be adjourning.

Merry Christmas.

Happy holidays.