Okay, thank you and welcome.

Today is Thursday, March 26th, 2026, and I'll call to order this uh district board of health meeting for this day.

Um, Madam Clerk, can we call the roll and determine quorum, please?

Chair Reese.

I'm here.

Uh Vice Chair Andreola present.

Board Member Driscoll.

Here.

Board Member Anderson.

Here.

Board Member Brown.

Here.

Dr.

Tuarte?

Here.

And Dr.

Dinko.

Here.

Okay.

Dr.

Denko is virtual today.

We do have quorum.

Dr.

Danko, thank you and welcome.

If you need to speak, just let me know.

Or the clerk.

Thank you so much.

Okay, we do have a quorum.

We'll move on now to the Pledge of Allegiance.

And I'd ask Mr.

Drskill to lead us today.

And to the Republic before we just stand one nation under God, indivisible with liberty and justice for all.

Madam Clerk, public comment, please.

Comments heard under this item will be limited to three minutes per person and may pertain to matters both off 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 are criminal acts as defined under NRS, which may result in prosecution inappropriate cases.

Mayor Lawson, welcome.

Thank you.

Is that on?

Yes.

If you will uh bring up for your next meeting reconsideration of the REMSA contract.

I want to uh make this abundantly clear.

The city of Sparks has asked through me to uh investigate ambulance services for ourselves and to uh put a request for proposal out to see if there is something better.

Um we don't know what's gonna happen, obviously, but we are investigating that possibility to uh provide better service to our our constituents at this time.

We have a fire station closed and be largely because of the REMSA contract.

We can't open that fire station.

So that's doing a disservice to my constituents.

So we're gonna investigate it.

I just want to be a hundred percent open and honest with you guys, and I would love for you to reconsider this thing and let's see if we can find something that works for all of us and not just a portion of us right now.

Sparks has been largely ignored in this contract process, and we would we want to be heard.

So thank you.

Mr.

Mayor, thank you so much for being here.

We have no further public comment.

Thank you.

We'll close item three and now move to item four.

Before I seek approval, please note that item 7B will be heard after 6A.

So 7B is being removed from the consent items and will be heard uh after uh 6A.

Any other changes?

Okay, I'll seek a motion.

Move to approve.

I have a I have a motion by uh Vice Chair Andreola and a second by Mr.

Brown.

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.

Any opposed?

Motion carries unanimously.

Madam Clerk, are we voting on our tablets today?

Give us just a chance and everybody vote as indicated.

We'll see if the system's working.

Looks like it might be.

We'll close out item four and move on to item five recognitions.

Thank you.

We're going to start with new hires and uh Christina Shepard will be presenting our first new hire.

Good afternoon, Christina Shepard, Division Director, Community and Clinical Health Services.

I'm very happy to introduce Kathleen, Kathy Patterson, our new APRN for the family planning sexual health clinic.

Kathy joined the team on February 23rd.

She grew up in Reno but spent 30 years in Washington before returning to Fallon about eight years ago.

She's been a family nurse practitioner for the past eight years with previous experience in family practice at Renown, as well as public health at Central Nevada Health District.

Outside of work, she enjoys day hiking, spending time with her family, playing cranium, attending the Broadway series at the Pioneer, and going to concerts.

Her arrival comes at a critical time as our family planning and sexual health clinic has very limited APRN coverage over the past year.

Kathy's addition expands access to essential sexual and reproductive health services and reduces barriers for those who need care most.

We are thrilled to welcome her to our team.

Kathy, welcome.

Thank you.

Next, we have a recognition of years of service and health heroes given to us by Deputy District Health Officer Aaron Dixon.

Good afternoon for the record, Erin Dixon.

I'm going to start with years of service.

And I actually have to start.

This is an impressive group.

So this is kind of exciting to be up here for this one.

We have two staff with an amazing 30 years of service.

We have Lorena Silar Silorio.

She's an office specialist.

And Lorraine has actually been here 32 years.

But the first two years were as a contract contractor providing translation services.

She's worked in almost every CCHS program and now provides excellent service and support at the TB Clinic to both clients and staff.

Then we have Sony Munga.

She's a registered dietitian, dietitian nutritionist, and she's with our WIC office.

Sony is a strong mentor to her team and a go-to expert, not only by our internal team, but our state and local WIC partners as well.

Her commitment to clients is unwavering, and our community is absolutely better off because Sony is on our team.

So then it dropped down to 20 years.

And that's Nick Flory, who's an environmental health.

He works in our permanent facilities program.

He has demonstrated across the years that he's extremely knowledgeable and resourceful team member that can succeed in any program.

10 years of service is Michael Crawford.

He's with Air, he's an air quality specialist, another wonderful employee.

He works with our monitoring team to help ensure that our community is aware of any changes in our air quality and making sure that they have the information to keep themselves safe.

And then finally, five years is um Dr.

Dow.

She's a division director for Population Health Division.

And what do I say about Dr.

Dow?

She demonstrates her excellence on a daily basis, and you'll be hearing from her later this afternoon.

And so finally, I'd like to thank these staff for the combined 95 years of service to the health district and our community.

Well, and if I did the math right, because I was thinking about the same way, 97 years if we add the two extra years with uh Miss Solario.

Yes.

We have to do this.

I mean with Service.

Hello.

I wasn't born in you know those years.

I'm a very young man myself, so I wouldn't know, but thank you so much.

Those are great milestones.

Thank you so much for recognizing them.

Absolutely.

It's an honor to do so.

So next we're going into our health heroes.

And we have um five health heroes.

We are combining um both the two months since we did not do this at our strategic retreat.

So first we have Ryan Rennie, and he's with environmental health services, and he's being he's recognized for adaptability.

And Ryan, as an inspector went in above and beyond to conduct analysis of the enforcement program, including doing advanced statistics.

It actually says what he ran here, but I can't pronounce it.

So I'm just gonna say advanced statistics test to prove the statistical significance of the uh enforcement program and the data that they run.

So very grateful to him for that.

Uh Victoria Nick Nicholson Hornblower.

Victoria was recognized for assisting someone who's lost in the building.

And she went above and beyond to ensure that the safety of that uh lost individual was um of number one priority.

Um, and that was greatly appreciated by that individual.

We also have Eva Sandoval with ODHO.

Oh, and I apologize, I wasn't saying what they are honored for.

She's on for compassion and inclusivity.

They did an outstanding job.

They organized and executed a friendship flower fundraiser where coworkers uh purchase flowers to be delivered to other um co-workers.

And it's helped bring colleagues together and raise funds for future employee events.

It was greatly greatly appreciated.

And then we have a combined recognition for Dawn Edwards and April Miller.

And they were recognized for adaptability, compassion, collaboration, inclusivity, and trustworthiness.

And April and Dawn, they uh assisted in running the not this past meeting, but the one before that, which is a little bit outside of what they normally do.

So we they are being honored for their excellent professionalism and commitment to the integrity of public process for filling in and supporting January's District Board of Health meeting.

So that's who I have.

Thank you very much.

Ms.

Dixon, thank you so much.

Always good to hear about our employees doing great things.

Okay, that closes out item five.

Item six is six A is a proclamation by Mr.

Oxarart recognizing National Public Health Week.

Thank you, Chair, members of the board.

Scott Oxavart, Communications Manager, Northern Nevada Public Health.

Magic, I have a proclamation here that I'm going to read and give a couple updates on what uh the organization is doing during public health week.

Yeah, so here we go.

And I'll try and read it as fast as they do at the legislature.

Umas this week, April 6th is National Public Health Week, and the theme is ready set action to recognize how public health has improved our daily lives, safeguarded our families, expanded our lifespans, and strengthen our communities.

And whereas Northern Nevada Public Health and NPH works every day to protect and improve the health of residents in Reno Sparks, Washoe County by preventing disease, promoting wellness, and preparing communities to respond to emerging health threats.

And whereas public health professionals and community partners help ensure residents are ready for health challenges through programs that monitor disease trends, promote vaccinations, support maternal and child health, prevent chronic disease, and ensure access to essential health services.

And whereas NMPH helps communities get uh set for healthier living through initiatives to improve uh environmental health, including restaurant and child care inspections, food safety education, and programs such as the Winter Burden Code, which helps reduce particular air pollution and improve regional air quality, and whereas NMPH is taking action to protect community health through efforts such as disease surveillance and outbreak investigations, emergency preparedness planning for disasters and public health emergencies, safe transportation initiatives for children, and expanding population health strategies to address the root causes of health disparities, and whereas National Public Health Week is an opportunity to recognize the essential contributions of public health professionals and partners whose work protects the community often behind the scenes by preventing illness, ensuring safe environments, and preparing for emergencies.

Now, therefore, be it resolved that the Northern Nevada Public Health District Board of Health hereby recognize the week of April 6th through the 12th, 2026 as National Public Health Week.

No need to applause.

So a couple things that we do during this week every every year is send out a press release, try and engage our media partners who can then help us educate the community about what we do in public health at the local level.

A couple other uh a really nice partnership we have with the University of Nevada Reno School of Public Health.

Uh, we have two different things.

Uh Dr.

Kingsley uh sat down for a podcast with the School of Public Health Dean to go over just kind of you know public health trends in in Washoe County, things we're doing, ways in which we're working together, and that podcast is actually going to be released on the week of the sixth, so we'll be helping promote that.

Um, also uh there is a um a coordination with the uh public health week and national giving day.

Uh so we are partnering with the School of Public Health on that uh to really just promote giving to that to that program at the university uh just to show our support and you know demonstrate the coordination and collaboration between the two entities.

Without uh unless there's any other questions, um that's all I got.

Great outstanding work.

Any questions?

Okay, thank you so much, Chris Roxburgh.

That'll close out our special proclamations, and now we're gonna move on to seven Charlie and welcome Miss Shepard forward.

And I think we have a representative from Swoon Bridal.

I asked that this be moved and did move it from the original consent agenda because I felt as though it was a really gracious thing that SWOON had done.

And so I just wanted to make sure that if you were here that we could honor you.

So I'll let you take the floor, uh, Ms.

Shepherd.

Thank you.

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

Today I'm pleased to recognize Savoon Bridal.

They are a local woman-owned bridal boutique, and thank them for their generosity through this year's Swoon Holiday Give initiative.

And this past holiday season, they chose CCHS to help expand access to menstrual health products for individuals in need.

Brides participating in the holiday give received a discount on their gown when they purchase supplies for menstrual product kits, creating a very meaningful partnership between Swoon, its customers, and our community.

So as part of this initiative, Swoon donated 160 tampon kits, one of them here.

65 pad kits, and then inside are some cleansing wipe supplies and some hand hygiene supplies.

So they have everything they need all in one place.

Period poverty affects individuals nationwide and here in Washoe County.

Those experiencing homelessness, living in low-income households, are facing financial instability, often struggle to access basic menstrual menstrual products.

Lack of access can lead to missed school, work, or community activities, unsafe alternatives that increase health risks and emotional distress that comes from not having essential hygiene supplies.

Access to menstrual health products is a public health priority.

These items support personal hygiene, reduce infection risks, and help ensure individuals can participate fully in life.

Donations like those from Swoon Bridal make a real difference for community members who already face significant barriers to health.

Providing these products removes removes one of those barriers and advances our broader efforts toward health equity.

So we extend our sincere appreciation to Swoon Bridal and to their manager, Alicia Twistle.

Ah, did I say it right?

You did great for their commitment to supporting the well-being and dignity of individuals throughout our community.

And so thank you for also pulling this agenda item out and recognizing Swon.

Thank you so much.

Ms.

Twitchell, um, tell me first, are you related to Barbara?

I sure am.

She's my mother-in-law.

Fabulous.

Just a great northern Nevada, and we all know and love her.

They extend our grace to her as well.

Tell us a little bit about Swoon Bridal, if you would.

So Swoon is a local business owned by Michelle DePole, and we have two uh businesses that operate within within our community providing gowns um to our local brides.

We um can't say enough good things about what it means to work for a local business, to be a local business, and not we also can't say enough good things about our clients who participated in this, and we're so giving and gracious, and we're we're really thankful to be a part of the community.

Well, it's just a great presentation.

Tell me where the kits are being distributed.

How do they get into the community?

Um so right now we have them just at all of our front counters.

Um so um if they just need supplies, they can just ask somebody at the front counter.

We have them in our exam rooms.

We've distributed them to all of the CCHS programs.

We also have some signs up in the bathroom around building B that says, you know, on your period need supplies, stop and ask at the front desk.

And then we're also putting some free supplies in um a couple of our bathrooms, because some of you may not have noticed, but if you go into the women's bathroom here at the county complex, there are no menstrual product supplies in the public restroom.

So just trying to put out some free supplies as well for somebody that may not um have the competence to ask at the front counter for those supplies.

No, that's great.

And maybe we'll have another opportunity to chat about that lack of resources just generally in the county complex another time.

But thank you so much for the gracious donation.

Any questions from the board or the thank you so much for being here today.

Very gracious.

Okay, that'll move us on to um the seven items, which are consent items.

Do any of my colleagues wish to pull any of the items from the consent agenda?

Okay, I'll seek a motion.

Move to approve.

I have a motion by uh Vice Chair Andreola, a second by Mr.

Anderson.

Any other 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 nan.

So please make sure to vote on your tablet.

Okay, that closes out the seven items, and we'll move on now to presentation.

I'm sorry, Mr.

Chair.

Oh, noticed that seven seemed actually accept consent donation.

Oh, we need uh a motion.

I'll move to approve.

Okay, I have a motion on item 7C.

A second by Mr.

Driscoll.

Any other questions or comments at this time?

Hearing none, I'll call for the question.

All those in favor, please signify by saying aye.

Aye.

Motion carries unanimously.

Miss Reed, thank you for keeping us on track.

Item eight.

Item eight A is a presentation by Ms.

Who was the motion and uh Miss Andreola was the motion maker on C and on seven uh C is in church.

And who is the second?

Um item eight A presentation by uh Joe Dibble.

And as Joe's making his way down, this is an item that had, I think previously come before us, but we uh just ran out of time, and I asked that it come back and had the privilege of meeting with Joe and his team to discuss it more in depth.

And I asked that it come back and had the privilege of meeting with Joe and his team to discuss it more in depth.

Uh very important topic uh that I know that we're all interested in, and I think this will be a great presentation.

Mr.

Dibble, thank you so much for being here.

Thank you for the record.

Um, Joe Dibble, Health Educator too with our chronic disease and injury prevention program, CDIP under Population Health Division.

And I'm here to talk to you about an uh important topic, which is our suicide prevention initiatives uh that I work on.

And I'm gonna start with just asking why this matters and why this work matters.

And oh, can you give me just a second?

I'm having a hard time hearing the presentation.

Can we make sure that the mic is on and also that it's recording and loud enough out here?

Okay, thank you so much.

I'm I acknowledge I'm pretty soft spoken.

No, it's been the whole time in Washoe County and across our nation, suicide is not just a mental health uh issue, it's a preventable uh public health crisis.

I rarely encounter uh someone who's not been directly impacted by suicide.

I wanted to touch very quickly on some of the data and some of the numbers uh that we look on at when uh monitoring suicide uh here in the community.

Nevada routinely ranks among the top 10 in the United States for suicide death rates.

So the rates of suicide deaths when adjusted for population.

Um so we have some of the highest suicide death rates, including here in Washoe County, and where where the death rate often exceeds our state rate.

Of these suicide deaths, most are attributed to firearms.

Um when we look at uh methods and means of suicide, um the lethality and the means really determines survival, and we have a very high uh suicide related uh death rate and um the number of those attributed to firearms are uh a couple uh attributed to most of those.

Then firearm deaths, both in the United States and here in Washoe County, um are two to one uh for suicide as it relates to homicide.

So by a ratio of two to one more suicide deaths than homicide deaths that are firearm related.

This statistic was pretty alarming to me when I looked at gun violence um here in our community and in the United States.

Firearm deaths when a firearm is involved with a suicide attempt is lethal nine out of ten times.

Um so when when there's a gun involved with suicide, there's not usually a second chance or the opportunity uh for emergency services or medical treatment.

It's usually a permanent solution uh to a temporary problem.

In fact, have just having a firearm in a home triples the odds of death by suicide, not because the gun prompts um thoughts of suicide or because people with guns are more likely to attempt suicide, but simple because of the lethality of a firearm.

As I mentioned, means matter.

So when it comes to suicide provide suicide survival, the means which is chosen for a suicide um determines the outcome.

So by putting time and space, the kidal component is time and space.

A suicide, a person may consider or have thoughts of suicide for a long period of time.

That long period of time can provide opportunities for intervention or even like risk uh reduction.

But the actual suicide crisis, the time between a thought and an attempt can be very intense, but often very quick, sometimes just minutes.

Most suicide attempts between the thought and the action are less than one hour.

So by creating time and distance between the both lethal uh means of a suicide um can mean living or dying.

So as shown in this model, uh it represents um how having less access to lethal means during these critical time frames can actually result in fewer suicide attempts and fewer suicide deaths and higher rates of survival.

Right.

So this is very important.

Our approach to public health in our CDIP uh team, it revolves around policy systems and environmental changes, and within this uh framework, we started the Washoe and co-founded the Washoe Suicide Prevention Alliance.

This is a multi-sector approach that includes health care.

That includes public health, that includes suicide prevention advocates, but also uncommonly includes firearm owners and even firearm retailers are involved in this approach.

This raises awareness.

This is this is not a top-down effort, but this is a community-driven prevention model where members of the community and often and also gun owners and retailers are helping share and drive the information and being a resource.

This raises awareness about how temporarily reducing access to lethal means like firearms during these critical periods can be life-saving.

We have a vision and we have a mission.

And we work to change our lived environment here in Washoe County by creating uh more knowledge, more training, and more access to secure and temporary secure storage and understanding of solutions for temporarily securely storing a firearm during a crisis and other means of of suicide uh here in the community.

So really, this is a great community.

This is the most collaborative effort that I work on, and we're all involved directly.

Uh one of our uh key components is our secure storage network, which involves firearm retailers that will voluntarily uh store uh someone's firearms during a crisis.

Oftentimes they do this for free or at a very nominal fee, and all follow both federal and state uh guidelines for that firearm transfer and the transfer of the firearm.

We are very active in outreach here in the community with multi uh media campaigns, awareness campaigns.

We uh present at trainings and provide trainings, and then have resources through firearm retailers and locations where uh firearm owners frequent, including gun shows and other uh locations and community outreach events.

We do a lot of outreach.

We're constantly out in the community uh leading this charge.

We also work on public policy.

So we shepherded the effort to pass a passage of the number one uh limiting factor, the key barrier for firearm retailers actually participating in this initiative, which is civil liability.

So we shepherded assembly bill 451, this last legislative session, and that was successfully passed, which provides that civil liability when they participate, when they follow the rules, when there's a contract in place regarding the exchange of that firearm if any uh harm occurs.

This position in Washoe County as a leader and also helps create a model for expansion by removing this barrier for the retailers and this fear of liability, firearm retailers.

We've been able to bring in an additional initiative, the Armory Project to help expand this effort that has even more dedicated funding or have more dedicated funding support and uh financial resources.

So we actually now have the first firearm retailer here in arena.

We're happy to say Reno Guns and Range, which is um coming on board with the Armory Project and just being a leader here in the community with the firearm retailers on secure storage and temporary uh storage for our community.

Lastly, we provide a lot of training.

So I've personally been involved with training uh over 200 uh community members and certifying over 200 community members on a two-day suicide intervention skills training course.

It's like first aid for suicide.

And here in Washoe County, I've helped facilitate and been involved with training over 500 people just between 2023 and 2025 again, certified in suicide prevention training on an on a uh very comprehensive two-day course.

We also provide the firearm retailers and their staff with suicide prevention training to help them identify someone who may be at risk of harm to themselves or others and what to do uh during a uh a transaction.

So strengthening our impact.

Um I always ask, and I ask you, you know, continue to help me invest in our community base uh efforts here.

Our suicide prevention training help champion this effort, help you know, to support expansion of additional partnerships here in the community, uh working hand in hand with firearm owners to pre and anyone at risk of suicide.

Help to support this growth and sustainability and alignment as far as our efforts and and messaging to to help prevent suicides.

So with leadership support, we can accomplish this.

Do any of you have any questions?

Mr.

Dibble, thank you so much for the presentation.

I wonder you had done um, I guess it would be maybe a couple of years ago, a whole um social media campaign, and there was a media campaign around the safe storage of guns.

And you were uh able to share with me a video, which I thought was very helpful and very impactful.

Is that something you might just circulate to each of the board members after the meeting so that they have a copy of it in the top of their inbox?

Um I just think it was very powerful.

And then also maybe perhaps you can tell me is that something we can put out again.

I I don't I don't know if we own the content.

I know that it was magnified by some of our media partners, um, but I felt very moved by the content, and so I didn't know if it was something we could recirculate.

It didn't seem like too time based, meaning it didn't look out of place today.

Um, is that something we could do?

We we're we're actively working with um doing more multimedia work, and we have some videos that we've developed uh in-house and with with work with uh local media production companies, and I'll share the videos uh with the board members here, and then we're we'll probably run we're working right now on the agreements to run those and do multimedia work uh this spring.

Awesome.

And I think Mr.

Oxarart, who is here still might be able to help us too with a kind of a campaign built around that.

I know we have a social media presence uh on a number of different platforms.

Just think it's a great message and and really timely.

And so thank you for that.

Let me see if my colleagues have any questions about the presentation.

Mr.

Anderson, thank you.

Nice haircut, by the way.

Yeah.

How come you're so clean shaven in that way?

Yeah, that was uh shave for the brave for children's cancer research.

So uh we missed you this year.

You did miss me this year.

I might have been setting you up, but uh you look great.

Thank you for doing that.

Thank you, Mr.

Brown.

What's your excuse?

Natural.

Oh Mr.

Anderson, the floor is yours.

Just as meaningful.

Mr.

Dibble, I want to say thank you so very much for all the work that you're doing on suicide prevention in in Washoe County here and the impact that you're making, especially through AB 451.

Um, back in 2019 when I was working with the mayor's challenge for the prevention of suicide of service members, veterans, and their families.

We were shooting towards the same goal of trying to get this.

And we have some wonderful um retailers that wanted to take part, but they were afraid um for for what this covers here.

It it takes that away.

And I just want to say thank you so very much.

So I did have a question as to the retailers that are involved in it, um, other than uh Reno Guns and Range, I think that's the name.

Are there any other retailers that are taking part in the program?

We have about 13 different retailers that are involved either in the secure storage network or that are involved in you know, distributing our marketing or you know, our suicide prevention resources uh in their retail facility, and then that's continuing to grow.

And then as we add um the TAP uh initiative here, now we're you know, we're we're in conversations.

We have active agreements there um to to start tap starting with Reno Guns and Range and others with high interest levels that are coming aboard.

The law just went into effect October 1st.

So we expect this year our goals are to add uh three or four more direct retailers for the secure storage network.

Wonderful.

And is there a guide that we can go to and find where where those locations are?

So if you if you sort of Google uh WASO suicide preventionalliance.org, uh, there's a secure storage network.

It's a Google-based map where you can click on it, and then when you click on each of the pins, it'll show what the terms are.

Maybe like some of them have limitations and on the types and number of firearms they can, or they charge a small fee or business hours, things like that, contact information, and it'll take you straight to you and literally from that map navigate, navigate directly to a facility.

Perfect.

Thank you very much.

I still have a question.

Thank you for these questions.

Some of the questions have already been asked, so I'm not gonna duplicate, but I do want to say thank you.

And um I I know I obviously saw the multimedia campaign and we heard more about that, but I wonder if there is um a flyer or something.

All of us have um, like for me, I have cabs, we all have different ways of sharing this information.

I mean, it's pretty alarming alarming to your point when you said the two to one.

And I think the more information that we can get out, and I'm just thinking maybe a little bit old school because having a QR code to where those locations are to point to it might be another effective way to continue to share um not only where those locations are, but also some of the data that you've event provided here and and where those resources are for someone or a loved one or a friend that that might be helpful that we could always have, for instance, at I'm just thinking selfishly of putting out the those materials at our cab meeting every month.

And where those resources are for someone or a loved one or a friend that might be helpful that we could always have, for instance, at I'm just thinking selfishly of putting out the those materials at our CAB meeting every month.

Two to one, maybe we can get that to be zero.

Like I'd love to bring more resources if you're able to distribute those.

I think you mentioned like you have a couple opportunities there, and I can share those.

We have formal like trifle brochures and a bunch of different types of information that sort of meets the needs of different individuals.

Um kind of both electronically and physically in physical form.

So I'd love to connect with you on that.

Thanks.

I appreciate it.

Thank you.

Okay, any additional questions or comments?

Okay, thank you so much for the presentation.

Close out item 8A and move on to 8B.

Who's here on 8B?

This is our discussion of the chronic disease and injury data dashboard.

Great.

Everyone's here.

Nicole, Stephanie, and Taylor.

Welcome.

This is tall.

It's like gumby, though.

It moves all around.

It can do anything you want it to do.

It doesn't have to be too close.

You yeah, it moves.

It's great.

Okay.

Good afternoon.

For the record, Nicole Alberti, Health Educator Coordinator, Crack Disease and Injury Prevention Program, Population Health Division.

And I'm here with my colleagues today to share with you the new chronic disease and injury data dashboard.

Our program began producing a chronic disease data report in 2009 after the Washoe County Chronic Disease Coalition identified a need for centralized data to inform the community and decision makers.

Early reports were developed as static documents, distributed as printed copies and shared as PDFs on our website.

Over time, the report expanded to include local injury data and incorporated external graphic design support to create a more polished product, adding to both timelines and costs.

Although the report was successfully published every three to four years, each cycle required substantial staff time and coordination with partners to request, clean, analyze, and present the data.

When the opportunity to transition to data dashboard became available, our team decided to move in that direction to support more frequent updates, improve accessibility, and reduce production time and costs.

Good afternoon.

For the record, Taylor Gerhard, uh graduate assistant population health division.

So information about chronic disease and injury prevention, also known as CDIP's uh programs and efforts, are centralized on Northern Nevada Public Health's Get Healthy Washo page.

The link to the chronic disease and injury data dashboard also exists here.

Um, this webpage is accessible by visiting get healthywashow.com.

Uh it has become an amazing resource hub for anyone looking to learn more about as well as access resources for a healthier living.

The dashboard is simply the most recent addition to CDIP's growing list of resources to help keep the Washoe County community informed and healthy.

I'm just going to take everyone through a quick preview of the dashboard.

Um we developed it with interactivity in mind.

The dashboard consists of six overarching sections, each with several subsections that culminate to provide users with an in-depth view into the topic that they're exploring within chronic disease and injury in Washoe County.

We open first by providing users uh with an informational introduction that conveys the importance of understanding, monitoring, and addressing chronic disease and injuries.

Our population health indicators section allows users to compare the overall health trends of Washoe County in comparison to statewide and sometimes national trends.

The chronic disease risk factor section is important because it utilizes some of our most prolific health surveillance data to show how trends in Washoe County, Nevada, and the US all compare across a variety of chronic disease risk factors, many of which are high priority among our current programs here at NNPH.

Our injury section takes data from a variety of sources to show trends over time for several different types of injury, again, several of which are currently high priority among our current programs here, including fall-induced trauma and suicide prevention, which we just heard about.

The fifth section focuses specifically on mortality trends from chronic diseases and health conditions and allows users to make comparisons between county, state, and national levels across different years.

And finally, our last and possibly our most significant section is prevention efforts in Washoe County.

This section has allowed the statistics and informatics team to work with CDIP to identify and showcase how their efforts have been and still are present in the community and how their impact can be identified.

We divided this section between our three major program areas, including healthy eating and active living, which showcases the progress we've been making with our healthy corner stores initiatives as well as our various school-based nutrition education programs.

Tobacco free and nicotine-free living, which displays a wide range of data corresponding to CDIP's progress in education as well as policy and environmental changes, all for the sake of prevention, cessation, and protection against second-hand smoke.

And injury prevention, which not only highlights our growing resource base for suicide prevention in Washoe County, but also CDIP's direct engagement with the public through important trainings and events aimed at preventing suicide, as well as unintentional slips and falls among seniors.

Thank you.

Good afternoon.

For the record, Stephanie Chen, Health Educator Coordinator, Population Health Division.

This new dashboard serves as an efficient, streamlined way to update and disseminate data, eliminating delays and ensuring everyone has access to the information.

By centralizing the data, we're enhancing transparency and strengthening communication with grantors, stakeholders, and partners.

When we can clearly show our progress and outcomes, it becomes much easier to demonstrate impacts and maintain strong relationships with our funders and community partners.

This tool also supports our internal work.

It strengthens our data sharing practices and improves our ability to pool accurate data instantly.

Another major benefit is how this promotes collaboration with our statistics and informatics teams.

With a shared consistent data platform, we're better able to ensure that what we collect, report, and share is accurate, usable, and aligned across teams.

And finally, the dashboard features some current programmatic activities in a way that's clear, accessible, and easy to share, helping us tell a fuller story about the work we do.

I'll now highlight a few of our current activities and show how data continues to drive and shape our work.

Starting with a healthy eating and active living section, the data shows an important trend.

Over the last 10 years, the percentage of adults in Washoe County who report eating at least one serving of fruits or vegetables per day has steadily declined.

This highlights a clear need for programs that increase access to healthy food.

One of the ways we're addressing this is through our Grab Healthy program, which partners with local corner stores and neighborhoods with limited food options.

The program supports store owners through education, partnership, and small in-store improvements that make healthy choices easier to find.

We also work closely with Reno Food Systems to bring fresh, locally grown produce directly into these stores.

This not only supports local farmers, but also helps residents access nutritious foods closer to home.

Next, looking at the injury prevention section, balls remain the leading cause of injury-related emergency department visits and hospitalizations among older adults in Washoe County and statewide.

We know from evidence that regular strength and balance training can significantly reduce fall risk.

CDIP has made this a priority and have expanded access to evidence-based programs like Enhanced Fitness and Stepping On, which are designed to improve strength, mobility, and balance.

These programs help reduce fall risk, increase physical activity, and support social connection.

I'll now hand it over to Nicole, who will highlight our tobacco-free and nicotine-free living efforts.

For the record, Nicole Alberti.

The percentage of middle and high school students in Washoe County who report purchasing their own electronic fate products directly from tobacco retailers has shown an overall decline in recent years.

Following the passage of the Tobacco 21 law in December 2019, which prohibits the sell of all tobacco nicotine products to individuals under age 21, our program's efforts have focused on increasing retailer awareness and compliance.

A key strategy has been promoting participation in Nevada's tobacco merchant training program to support responsible sales practices and reduce youth access.

Because storefront tobacco and nicotine advertising can make our make products more appealing and normalize use among youth.

Our program partners with retailers to improve displays and promote healthier messaging.

We have supported three storefront reorganizations in the past couple of years.

Together, these activities demonstrate how data guides our priorities, shapes our interventions, and helps us deliver programs that directly respond to community needs.

Before we wrap up, we would like to recognize the hard work of both the statistics and informatics team and the chronic disease and injury prevention team.

And thank you also for your time today.

We'd be happy to answer any questions you may have.

Okay, thank you.

Excellent presentation.

Let me see if there are any questions at this time.

Ms.

Andrea.

I noticed early on, and then you re-emphasized it.

Obviously, the percentage of adults that consume one serving of fruit vegetable per day.

Um you had it on earlier in the slide, and then at the end you um re-emphasized it.

And Washoe County compared to even Nevada over the displayed years from 14 through 20.

Well, there was one real spike between 2016 and 2018 in terms of an increase to the top of that scale, that XY axis of 70 percent, and then it drops down to um about looks like about 55%.

I'm just wondering what happened in that 2016-2018 year that it just maxed out in terms of people eating fruit and vegetables.

Yeah, Stephanie Chen, for the record, it could be various reasons that um the data where this comes from, it is BRFS data, so that's secondary data that is collected, but we know within the community factors such as access to convenience stores or even grocery stores if that's limited, um, transportation barriers, et cetera, those can all impact access to fruits and vegetables.

And so through our programs, that's where we really try to address what we see at a local level of what barriers they may be experiencing, how we could possibly address that.

Again, it's it's you know, we can't know for certain why those numbers increase or decrease over time, but we do see the trends, and that's what we try to really help mitigate is how we address that.

I was just wondering as an overlay of if of cost could be a particular factor.

You know, healthy choices um sometimes have a higher a higher cost point, right?

Absolutely.

So I was just curious, but thank you so much.

It's a great presentation.

Thank you.

Okay, Mr.

Driscoll.

Thank you.

Great presentation.

On the falls for elderly and then what are we doing as the health district to interact with those places where fall training and falls occur?

Yeah.

Currently, um, we are participating in various outreach opportunities.

So in May, there's going to be older Americans month, and we are absolutely present to table to share resources, share materials.

We also do reach out to independent senior living facilities, and we are offering workshops where we can talk about the importance of false prevention, also offer our programming if that's you know of interest to them, and then really just providing resources that they might find valuable.

So we do our best as a team within our capacity to get out there, inform the community, and also not just seniors at risk, but also family members who might be able to help a loved one.

Great, thank you.

Okay, uh, my question is uh, where do we get the data from?

I mean, there was a lot of data there.

I know your informatics team, you gave them a shout-out.

It's pretty incredible.

I'm just trying to understand like all this data seems useful used, but I just can't tell how we get it.

Um, yeah, so a lot of the data um we said uh it does just come to us through like BRSS or Wire BS, some of those surveillance systems that we have.

Um, we do also uh take a lot of the data um locally from other uh organizations or like even the state um that provides us with like trauma data.

Um let's see, some of some of it came from like Washoe County, uh, the medical examiner's office um for again some of that that injury data.

So, yeah, this project definitely was a large culmination of you know, combining multiple sources of data to create a coherent store uh story, but um we have all of it linked, you know, in each of the figures as well where where it's been pulled from.

So if people want to delve further, go into you know where the data comes from, they're able to.

Yeah, very impressive.

Um, a group like Truckee Meadows Tomorrow.

Uh, this is seems to be a good group too that collects data, puts data together in a certain way, and I know that Mr.

Vega serves on their board.

Um, is that a group that we can be working in collaboration with to share the data with and gather data that they are collecting?

Um, yeah, I definitely think so.

I actually am not sure if we I'm trying to think on specific figures that we had in there.

We might have taken some from Trucking Meadows tomorrow as well.

Um, but yeah, they definitely ones that we would be able to share and collaborate with.

Super cool.

It's just a group that I think um has been around a long time, I think like 75 years, but it's often overlooked when we think about who is gathering data and data together, um, all that sort of thing.

So thank you for that.

Okay.

Any other questions from the body?

No.

Okay, we'll close this presentation out and thank you so very much.

Thank you.

We'll move on now to item eight, CE Charlie presentation discussion of the 2025-2026 Pertussis overview.

Ms.

Wilburt.

Good afternoon.

For the record, Liliana Wilburnt, epidemiologist, population health division.

I'm here today to provide a brief overview of protussis and share with you the current state of protessis activity in our county.

So protessis or whooping cough is a highly contagious respiratory infection caused by the bacteria borderella protessis.

Risk factors for severe illness include age and underlying health conditions.

For example, infants who are too young to be vaccinated, and also people with certain health conditions.

The disease progresses in three stages.

The first stage, it starts out as a mild cold, which is when people are most contagious.

Stage two is marked by the start of intense coughing fits, and the third stage is when the cough gradually improves over a very long period of time and then could last several weeks, which is why this illness is commonly known as the 100-day cough.

So how contagious is protessis?

The basic reproduction number or are not is estimated at 12 to 17, meaning one infected person can spread it to as many as 12 to 17.

The level of contagiousness is especially concerning because people are most infectious when they uh realize before they realize they're sick.

When protessis circulates in the community, it quickly reaches those at highest risk, such as infants too young to be vaccinated and people with certain underlying health conditions.

For infants in particular, whooping cough can lead to severe complications, hospitalization, and even death.

That's why preventing transmission in the broader population is essential for protecting those who are most vulnerable.

Before protessis vaccines became available in the 1940s, approximately 200,000 people got sick with whooping cough annually in the United States, and about 9,000 died as a result of the infection.

Since vaccine implementation, the number of cases each year has decreased more than 90% compared to the pre-vaccine era.

The graph on the top left of the of your screen illustrates a decline in protessis cases after the vaccine implementation in the 1940s.

Now over to your right, the graph shows uh reported protessis incidents in the United States from 1990 to 2023, broken out by age group.

Across the entire period, under the infants under the age of one are consistently the ones who experience the highest burden of disease.

Across the entire period, also school-aged children and adolescents show a noticeable increase beginning in the mid-2000s, reflecting the well-documented waning immunity.

Following this incident's decline to drops uh sharply in 2020 and 2021, uh likely due to the COVID-19 19 uh pandemic mitigation strategies and health care, uh reduced health care interactions.

And by 2023, as you can see, we start seeing uh some rebound activity.

Locally, 2025 recorded the highest number of protesses cases in Washoe County in a decade.

And 2026 is off to a big start with 19 cases in just the opening months, which um additional cases are currently under investigation for confirmation.

In 2025, protessis cases in Washoe County saw a six-fold increase uh compared to 2023 and 2024.

A total of 31 cases were investigated with an average age of 22 and a median age of 14.

And these uh the cases ranged in age from zero to 78.

The monthly distribution of protessis cases shows the highest incidence observed in August, with followed by a secondary increase in November and December.

Case counts during the remaining months remained comparatively lower, indicating a mid-year and mid-year increase followed by transmission activity towards the end of the year.

I do have to mention that uh quickly that these data are preliminary and are subject to change.

The table over on the left compares reported protessis cases in 2024 and 2025.

Nationally, at the top of the table, cases decreased by 18.8%.

And while this is great to see, 2025 was still above pre-pandemic levels.

In contrast, Nevada saw a 92, 92.4% increase in Washoe County experience a 520% increase over that same period.

The figure over on the right shows that protessis activity in 2026 began earlier and with higher case counts.

In February, 13 cases were reported compared to four in 2025, with additional activity in January and early March.

With 19 cases already reported by early March, we are at 61% of last year's total, just in the first quarter, suggesting continued transmission in the community.

Given this early rise in cases, it is a good time to review vaccine recommendations and implement key prevention strategies.

Vaccines remain the most effective way to prevent severe illness and death for those old enough to receive them.

As protesses begins spreading earlier this year, staying up to date on vaccines becomes even more critical, not only because it protects infants and others at high risk, but because every surge comes with real costs to families, healthcare systems, workplaces, and increasing strain on the public health system.

The impact of protesses spans across multiple sectors.

The medical costs can include clinic visits, testing, medication, emergency care, and hospitalization.

Severe cases may require intensive care, which significantly increases costs for families and the healthcare system.

At the societal level, protessis cases can lead to work days lost for caregivers, school exclusions of up to 21 days, productivity loss from the prolonged illness, and outbreaks that can disrupt child care and create ripple effects across workplaces in schools.

Protessis also places a very heavy financial and staffing burden on local health departments.

A health department in Nebraska published a study reporting spending around 52,000 to manage an outbreak of 24 cases in a school, which was about $2,100 per case.

This translates to over 75,000 or about $3,000 per case in 2026 dollars.

The response pulled 12 staff from routine work and delayed multiple projects across departments for 83 days.

Overall, the outbreak consumed 25% of the department's labor budget for that time period, with investigations and document development driving most of the workload.

A social ecologic social ecological lens helps us helps clarify how these layers intersect to influence both transmission dynamics and response capacity.

At the individual level, Northern Nevada Public Health has investigated a total of 19 cases, each case requiring extensive time in pre- and post-investigation follow-up, with a few more cases currently under investigation.

At the interpersonal level, we have identified 64 known contacts, two workplaces, three schools, at least nine close contacts at a medical office, including patients and staff, and at least 70 at sporting events.

At the organizational level, we work with partner organizations like Northern Nevada Public Health State Lab, Washoe County School District, the Office of State Epidemiology, and Infection Prevention of all major health systems in the area through frequent communication with situational awareness and alerts.

We have also sent out an estimated 25 notification documents, most of them unique on exposure exclusions, as well as communication advisories.

At the community level, we also work with agencies I previously mentioned.

For example, Washoe County School District to notify the three schools, which included over 3,000 students, a workplace with approximately 20 employees, and we have worked with communication teams internally to promote communicating wide messaging and media awareness.

At the policy level, we work with federal and state entities that set surveillance standards and outbreak control procedures.

So the public health effort required for disease investigation and outbreak control is substantial, especially for highly transmissible diseases like protestus.

By interrupting transmission and applying proven prevention measures, we can prevent adverse outcomes.

Underscoring the necessity of strong public health measures to stop transmission before it reaches the most vulnerable.

Okay, can you go back to Bartonny?

I realized that was hard to watch.

And that is exactly why prevention is so important.

Public health efforts help protect those who face the greatest risk, our vulnerable populations, particularly infants.

Thank you.

Thank you so much.

Yes, incredibly hard to watch.

Any questions from my colleagues?

Dr.

Duarte.

Can you inform us uh about the ages of the index cases and what was the age distribution of your uh of your cases?

Currently, uh the nine the 19 cases.

I'm really sorry, I'm a little hard of hearing.

I keep No, the room is sort of odd today.

Our speakers aren't working that great.

Dr.

Eduarte asked about the age ranges for the 19 cases you've experienced this year.

Is there an age range?

And the index cases there is there so the age range right now stands um at zero to ninety-five.

Okay.

And the highest group of cases is the school-aged population.

Okay.

Um those are supposed to be immunized people.

Okay.

All right.

Yeah.

Good pointing that out.

Thank you so much for the presentation.

Um Dr.

Danko, are you looking to jump in on the conversation?

I see your name popped up, and I don't know if that meant you wanted to chat.

No, thank you.

Thank you for involving much.

Okay.

Thank you so much for the presentation.

I am I I sort of am at a loss to figure out uh my role in it at times, but I understand that you know our role in it, which makes me very happy that someone knows what we're doing in that area.

So thank you for that.

Okay, I'll close out this item and we'll now move on.

Um let's see, Madam Clerk, which item are we on?

Nine.

Mr.

DePlanus, that's you.

Good afternoon and welcome.

This is our monthly report for January and February.

Thank you.

Good afternoon, Chairman Reese, members of the board.

I'm Barry Duplantis, CEO and president of Rimsa Health for the record.

I understand that you've been provided with a copy of Rimsa Health's January and February 2026 franchise report for January and February 26th, and for the full fiscal year to date, REMSA Health has exceeded franchise response compliance with all priority ones in all franchise zones.

In the month of January, we transported or responded, we responded to 8,619 calls in the month of February, 8,048 calls.

Of those, we ended up transporting in the case of January, um, 5,000 852 patients.

And in the case of February, 5,379 patients.

It basically works out to be just under 70% of all of our responses resulted in patient transports to area hospitals.

Putting it that in simple terms, it works out to be about 190 patients per day on average in our region.

Also, in the uh one probably several of my previous uh presentations to you.

I mentioned that we anticipated uh as folks would fall off of government programs and become uninsured or underinsured that we was we we are expecting to see an increase in our call volume.

I can't say definitively if we're seeing that, but I certainly can say that in the month of February, uh we have seen a spike, particularly in BLS related calls for service, meaning the acuity of the call is not necessarily life-threatening.

Um so we're we are seeing a spike in that BLS range of calls for service and actually a bit of a reduction in the ALS calls for service.

ALS would be things like heart attacks, strokes, et cetera.

So I just wanted to point that out.

I don't know if that's a trend that we're going to continue seeing more of, but um we are seeing certainly some data that's in a sense corroborating um part of the message that I've delivered to you previously.

Our customer survey report for January and February resulted in scores of 93.85 and 94.93 respectively, which was consistent with the prior month.

Our highest scores were cleanliness of the ambulance, care provided by emergency medical transportation service care shown by the medics who arrived with the ambulance skill of the person driving the ambulance and the degree to which the medics took the patient's uh concern serious.

Our performance exceeds the the database of the national pool that we participate in.

So I'm proud to um to present that conclusion to you.

And at this point, I'm happy to address um any questions that you might have with regard to my presentation today.

Okay, Mr.

DePlanus, thank you so much.

Any questions from the body look like any today?

Thank you, Mr.

DePlanus.

Appreciate you.

Yeah, I think this is one of the items the board accepts.

Motion to approve, yes, we will.

Okay, we've got a motion by Mr.

Brown, a second by chair uh vice chair Andreola.

Any 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 tablets.

We'll give Dr.

Duarte uh opportunity to get to his tablet before we clear it.

Items 10 and 11 are next up, both are by Ms.

Esp.

They'll require separate action items, but are they a combined report or are they separate?

Okay, we'll start with item 10.

Okay.

So Andrea as for the record, uh, program manager for preparedness and EMS, Nora Nevada Public Health within the division of population health.

Today I'm presenting to you on the annual compliance report uh for Ramsa Health.

Uh, you do have the report in front of you, the the report in its entirety, and the staff report.

Um the report to do the franchise, the annual compliance, we look at a variety of different metrics.

Although the franchise itself only states compliance with time response, um, there are more than just that.

And so I bring that to your attention to let you know that we do analyze outside of just time response, and and that is important.

Um there were 52 metrics that met compliance, two of which parts partially met compliance.

Um, so we gave that a rating of a 96 percent um overall compliance and for the franchise.

Um there's 15 items that were not included in the metrics or the overall analysis, and that is because those metrics are only analyzed if there were out of compliance for something, such as uh they had uh exceeded the uh average max bill, and so there would be an audit that did not occur, and so that metric was not included in the analysis.

Um I bring that you also have the checklist in your packet for review, um really it outlines everything that is collected, and then one of the stipulations is that the data is reported to us um by the end of the calendar year.

And so I just note if it was submitted or not on time, and then um analyze that data.

The you're probably wondering what are the two partially met franchise compliance.

Um, and those two items fall under uh 2.4 and under 7.6.

I don't want or 7.2, I don't want to misspeak.

Um, those have to do with EMD, so emergency medical determinants and the review of those in the region.

And so why this was at a partially met is that we did not change any determinant codes this year or this the previous year.

Um, however, in the franchise, they are supposed to be reviewed and approved by our the medical directors of the fire agencies, and they were not reviewed and approved and document formally documented, although changes were not made to any of the determinant codes.

And so I do bring that to your attention.

Um, and it is noted in this report for your awareness.

Um, I would be happy to take any questions that you may have in general or specific to one item, one article item.

Thank you so much, Ms.

Slow first, my colleagues.

Mr.

Driscoll, we'll start with you.

I believe on page 10 and item 6.1 that that report is in error.

And the reason I state that is the final the final part of the paragraph says no requests for data or records were made by the health officer or the oversight program.

That's an incorrect statement because on January or July 26th, this body asked for a report related to 7.1 on response times and reasons for not being compliant.

That report has never been received by this board, and it has not specifically been um even discussed with me since August.

So I believe that 6.1 is not in compliance.

Um, so although you may have not received a response to your request in July, that July time period is not covered under this annual compliance review.

Um, the annual compliance review uh is from July 1 of 2024 through June 30th of 2025.

So that would then be reflected in the next annual compliance report.

Yeah, thank you for the information.

But to Mr.

Driscoll's point, he's asked for some information which he has not yet received.

Is that something that we can work on?

Uh yes, it is.

It's something that him and I have discussed.

Yeah, great.

And he he's uh master of understanding a lot, oftentimes minutia in these reporting requirements in a way that I will never master.

So I take my lead from him because he is so effective at it.

I just want to make sure that when a board member asks for a report that we're I suppose quick to get it to him, and so that he hasn't received it.

I'm sure there's a reason.

It's no, I'm not saying it's a fault-based issue, but I want to make sure that um if Mr.

Driscoll's asked for something, he receives it.

Yes, perfect.

And I have discussed this.

Yeah, thank you so much.

Appreciate that.

Mr.

Driscoll, anything further on this one?

No, thank you for following up for me.

We'll look over to this side.

Ms.

Espa, my uh question really is uh sort of a broad one.

Um the staff report was quite excellent.

It laid out um some of the history of the franchise.

Um, and of course, because of the timing, uh, your franchise history section in the previous action uh only went through February 27, 2025, right?

Um that was the last note in the staff report.

And I was just making sure that there was not something that should have otherwise been reflected by the fact that we in January of this year have amended and changed the franchise in a new way, entering into a new contract, but that would not have been uh included in this report.

Okay.

And then the second thing is is um 96% uh as a compliance rate seems quite high to me.

Is it the 4% is a reflection of the two partially met ones, and that's why it's sort of uh not a hundred percent compliance, and I think everyone strives for 100% compliance, 96% still an A plus, but I'm just trying to understand where the metric falls off.

Yes, we tried to do something a little bit different this year in previous years.

We've come to you with they have met compliance or they have not met compliance.

And I think there's been a few years where the words partially substantially have been used, and we wanted to quantify that.

Um we do have a checklist that we use, and so using that checklist, we wanted to identify a percentage of compliance to it.

Um moving forward with the uh franchise that goes into effect July 1.

Um, it outlines a better rubric with uh metrics to clearly identify what does it mean to have met compliance outside of just a time response, and uh we tried for that, it never was clear in the past.

I'm like, what is this?

What does this even mean?

You know, this is arbitrary information, and to me it never sat well, and so uh I went with something a little different to show you a better picture this year, and then hopefully moving forward that will become more clear and more transparent as we move forward.

Well, thank you for that.

I mean, I certainly think that that is the goal of this body is more clarity and more transparency.

Uh, we're very blessed to have such an incredible organization as REMSA in our region, and I think that's reflected in the long history that we have.

Um, this report suggests to me that through that process of evaluating those metrices, is if that were a word matrixes or metrices, um, that there is always room for improvement, not only in our reporting structure requirements and the transparency that is related to that, but also in how we receive information as a board, right?

Because I cannot replicate the knowledge you have.

Your knowledge in this area is very expansive and it covers a lot of things.

Um, Mr.

Brown is also someone whose knowledge in this area will far exceed mine because he spent a lifetime in this area.

And so, for my role on the board, when I see this kind of a presentation, I'm trying to figure out how do we use it to the betterment of our community.

And I think you've laid out that process by you know, refining those matrix, and of course, it's about holding accountable our franchise uh holder so that we make sure that our people are getting the best care delivered to them.

So thank you for that.

Any other questions at this time?

Okay, we'll close out this item.

I think that this is being required to be action.

Can I get a motion, please?

Motion.

Okay, we got a motion for approval from Mr.

Driscoll and a second from uh Vice Chair Andreola for the compliance report for the period of 7-1 2024 or through 2025.

Any additional questions or comments in 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.

Ms.

Esp, you're here again.

Didn't even have to go anywhere.

I didn't.

I didn't get it.

Okay, this is item 11 now that we'll move on to, and this is uh presentation discussion on possible approval of the proposed REMSA response zone map for ambulance franchise service area with a July 1, 2026 effective date.

All right, Andrea asked for the record.

So, first I want to start off with um we have not always brought this map forth to you.

So, again, increasing transparency, and then I'm gonna show you some new tools we have for the public and for yourself to increase their awareness of how um response zones and time metrics work in this region, and uh we've made them all accessible, which was very, very difficult.

Um, but I want to walk you through how the map um the history, of course, you know the history of the franchise um starting back in 1986, and then to most recently having an approved agreement uh back in January 2026, and I'm not gonna go through each key point.

You are fully aware.

So, why are we here today?

Um, I'm here to help educate everyone in this room and those watching, help engage in this process that does take place annually, and then we're looking for approval on the map.

And one thing I want to say is that this is not a requirement of the franchise.

Um, it is something that I also, as I've expressed in many areas, I was not really happy with about the program and transparency is that I felt it was important that every year we take the map forth, regardless of any changes or revisions that have occurred, present that to you and get your approval on it.

Um this is the original um map that was proposed back for FY24.

It is very hard and very it's I know it's small and you can't see it, and maybe you can see a little bit better in your packet.

Um why I show this to you is it is antiquated in how we looked at the map and how people our public could assess what their response area was and what kind of service they were going to be provided, at least on a time response.

And then I'm gonna the next slide.

Um, you can access this on our website.

This is an interactive map for the public, and so it um outlines the response time requirements by zone, and then you when you access this map, you can type in an address.

So I want to type in uh my home address, my work address, I can type it in and it will tell me what zone I'm in, and what um the calls for service in that area, number wise, how many we have, and the time at which someone should get to me.

So if I pulled up if I I don't know, this address falls in zone A, so it has a response time metric of eight minutes and 59 seconds, and I could see that.

And so this is allowed, especially when we've had public comment about areas like Washo Valley.

There is some kind sometimes misunderstanding of what zone they live in and how fast an ambulance should be able to get to them.

And so this allows the public the opportunity to look it up for themselves, but increase that transparency.

So understanding the franchise map.

So every year we go through an annual review.

We do have a methodology that we have adopted back in 2014, but we more formalized that.

It was kind of a this is what we should do.

Wasn't really formally written down.

When I came on board, I said, I want a step-by-step, I want to make sure we're consistent on how this process takes place.

And really stemming out of an issue we had that was discovered about two years late.

There was an issue with the map and adoption that had occurred, I think in 2018.

And the program failing to provide that data and our requirements of the change of the map to REMSA.

And there was an issue in the CAD system.

And then it did require us to go back and reanalyze a lot of those calls.

Of which REMSA compliance did not change because that was important to note because we did look at that to bring it back to the board.

So we did formalize this process.

We did put in SOPs, we did work with our GIS team to make sure that they also had a formal process.

So we were being consistent with the methodology.

But we did per the franchise, we are to work closely with Remsa Health.

When they brought on Trucky Meadows as a subcontractor, we worked closely with Trucky Meadows in that process as well as reviewing the map annually.

But again, that really wasn't transparent.

So I said we need to broaden that up.

And we started including feedback through our joint advisory committee known as JAC.

Well, I feel just called the Jack.

So we collect the data, we analyze the data from the previous fiscal year.

We have discussions with the franchisee and our fire agencies and look at areas of concern, areas that have had a population change, especially in our in the out the outlying areas of the county.

We see areas going from frontier to urban as we have housing development change.

So we look at census data change.

And then we also look at call volume change.

And so do we see a significant call volume change?

And then now we do take it annually to you guys, even though it is not required for us to do so.

Okay.

So this is since 2014, there has been a few revisions that have taken place.

And so there's and we work through some of those issues and keep an eye on what is happening in those locations.

So things we take into consideration, population growth, population density, geographic development.

So sometimes we have areas that are developing but have not been, they're not occupied yet.

For example, a community in South Reno, 55 and older.

Um we already had seen an increase in calls, although most of that development had not been built out, but we were seeing a spike in that area.

The as a region, we decided to change that a few years ago from a B to an A, because we anticipate to see even more calls happening with that population that was going to be occupying occupied occupying those houses.

We look at REMSA's performance data.

Um though we look at it, it really doesn't drive the map change.

Um obviously there's franchise agreement terms we have to do, and then if there's any direction from the board.

Um there have been areas that we have switched from an A to a B in the double diamond area specifically, there was one street that had the map issue several years ago.

We said it never made it from our GIS over to REMSA, and that was an error on our end.

And so, more importantly, why we have standardized procedures now.

And but we had to switch that from an A to a B, or I'm sorry, a B to an A, um, and because of rapid growth in that area.

Um it does, I want to note up there that it says zone upgrades must be matched by REMSA's health staffing and fleet capacity.

I bring this up only because someone mentioned it to me is what does that mean?

And that means that REMSA needs to meet the need.

Um it does not for us to meet the need of what REMSA's capability is, is that REMSA to meet the need of what we have identified, and it was increasing a response area or increasing a zone.

Um can you guys open up the link?

So annually we've done a map review.

This has just been printed out large maps that we've sat at a table and looked at.

Um, and we really discuss we can scroll because I can't scroll through this.

Um, you can access this also through our website.

So this is public now.

This is the first time we've ever published this.

Um, and it goes over what is our process doing the map review.

We look at we produce call volume density maps.

Um, and last year we re-assessed our baseline data.

We used to use fiscal year 24 or fiscal year 14 as the baseline data for comparison and looking at change.

Um, we now have reset that after a decade and use FY24.

Um, and this map, you can scroll.

If you um I'm not gonna ask Loriana, but you can see there's a little button in the middle with little two little arrows that can scroll back and forth, and you can look at change if change did occur.

And this happens on multiple different maps.

Um, this one is about call volume for service.

So, oh shit, hold on.

We'll just say on this, go down, we'll just stay on one for a second, and I'm gonna explain.

So, this one looks at daily service call volume.

So, we're looking at a change in daily calls.

Um, and so this is important um assessing what is really the impact.

We can look at year, and that's also important.

But when we get down to the granular level, how many calls in a singular day are we seeing this growth happen?

Um, one area that we've continued to look at year after year is the CARES campus.

High call volume, it continues to increase.

Um, and you can see that by uh the color coordination.

So the higher call volume increase is occurring in that darker red color where we see maybe just one call increase a day or every other day in that yellow color.

And so this is a really great visual for people to see and seeing how that change fiscal year to fiscal year.

And so next year, when we do this again, we will also compare back to year FY24, and then we'll do it.

Uh, we'll look over a period of time as well.

But we have baseline data being FY24.

Um, this just notes some areas that have had high call volume increase, but they are also already in a zone A.

So we're still watching it and talking about what is happening in these areas.

What is something we can do differently?

Um, but it doesn't necessarily mean that they are going to change a zone because they're already in zone A's.

Okay, scroll, you can scroll down.

Okay, hi.

So thing that we typically refer to as our high utilizers.

So we do annually look at not just where are our call volumes high just in geographical areas, but specific locations.

The website only highlights 10.

We do look at the top 30.

Um, this year in the top 30, we actually had an individual household that made the top 30.

Yeah, and that's a concern.

You're really vague, Commissioner Andreola.

And so there was work with REMSA.

Like, how do we what are those services?

What are the needs of this particular individual?

So we stopped.

So they stopped calling 911 when it's really not for a 911 call.

And so Remsa and their team did work with that individual.

They have now that call volume for that individual has dropped off.

They were calling multiple times a week.

Um, what is important to look at this is I already mentioned CARES campus being a high utilizer, and there's been a lot of work done on that area.

Um, but those other places we have our place, Washoe County Detention Center.

Go ahead and scroll down a little bit, Floriana.

Um, our casinos show up on there as well, and we have some skilled nursing facilities.

Now, this doesn't mean that they're doing anything wrong, it doesn't mean anything needs to change, but what it does mean is that what education can we there's a couple things with our skilled nursing.

We're sitting down with them and talking to them, what is happening, and specifically looking at the type of calls and why they're calling.

There's a lot of different reasons for why they call their patients versus staff and why that call happens.

So working with them individually, providing kind of a flow chart to help them understand when is the best time to call 911 versus when should they be calling for an interfacility transport?

And then is there a lack or a knowledge uh gap that we need to address or skill set with their staff per NRS that they should be able to do?

Um so we're not going.

So one example is lithosis.

We get a lot of calls for lists lift assists, and so uh, you know, what what needs to happen to help that facility be able to do that and not be taking our EMS services out of service.

Um looking at our casinos, this is a challenging issue, and I do want to bring it to your attention.

We get a lot of calls out of our casinos, and there's a lot of people there.

But what I want to mention is that we do have some casinos have the EMS providers practicing there, but they don't have a medical director and they don't have protocols, and so that makes it challenging for our first responders showing up because they're there's an interesting exchange with these other individuals.

Um, we're concerned about protocols not being followed and not having a medical director.

This is not fall under the purview though of the of Washoe County Health District.

It actually falls under the purview of the state.

Um, but it does we do have a real increase of calls, and so we're really looking at what can we do?

How do we get the appropriate EMS in those facilities so they can help triage calls, make it you know, make the assessment of when something needs to be called, but then they're also providing the appropriate level of service within their scope.

Um so it's not just a map review.

We look at overall utilization of the system, and then how do we best address that as a community?

Don't remember what's going on, you can scroll.

Oh, areas of interest.

Um, I talked about areas of interest.

Um, Spanish Springs has continued to be one as we watch it.

Um, and especially the growing the outlying area and growing development about when do we fly switch it over from an A from a B zone to an A zone on those perimeters?

Um Verdeye, especially specifically looking over at Boomtown area.

Um, you'll have a very you'll have the um that very light almost white color, and then we have like a deep red right in the middle.

One little one little hexagon sitting at boom town, and that just really aligns again with our casino industry and what we see with call volume happening in those areas.

Um and I think that's oh, it just shows it just um we just zoom in on those areas for you to see, and then of course, Cold Springs already talked about um as far as we are we have been watching those areas, we've had discussions um about how do we not only address the higher call volume that's happening, but we also have the issue of we have congestion and traffic and and how do you get an the apparatus up to that location?

What if the apparatus that are there have taken somebody or out on a call?

It is really hard to move those vehicles around, um, not just for REMs of a fire.

So it's a um when they do it the best they can.

Um, but we face those challenges and we talk about those challenges as a group.

So we're very excited about this.

This was brand new published within the last month and is now available to the public.

So increasing that transparency for the constituents, yourselves as well.

Um, and so with that, I would well one, I take any questions.

We are not proposing any changes to the map um this year, but I will happily take any questions that you have and then hope approve this map effective July 1.

Okay, let's start to my left.

We're gonna start with Mr.

Brown.

Thank you, Andrea, for the presentation.

Just a question.

Um, on the first map you show uh 2000 FY 2014 as the next map changed as far as boundaries go.

I'm not worried about response zones because that boundaries are wrong on the Mount Rose Highway there.

Yeah, it had changed.

So the map, yes, from 2014 to now, it is different.

Okay, but the Mount Rose Corridor, yes.

So it is so the 14 map, it would it's not reflect the map as it is today.

Okay, so it reflects uh the ELA exclusive operating area of the North Lake Call of Fire Protection District.

Yes, it does.

Because um it's and I can't see it in the next map, that bottom portion, uh, Washa Valley and everything's cut off.

Yeah, but it does reflect the changes that have been made in the reflects, yes.

Okay, because there's always uh, you know, when you start looking at CADs and cat systems from our different CAD providers, if you don't have the right geographical maps in there, um perfect example, NHB for any vehicle accident, they're still calling REMSA for the vehicle accidents within the EOA for the North Lake Tall Fire Protection District, and that's usually done off of maps, and so just want to make sure before we go approving, just because I can't see that lower one there.

So um, and then I'll also follow back up with maybe why that's happening.

Okay, sounds good.

Thank you.

Okay, any other questions from this?

Ms.

Andrea.

You know, Ms.

S.

You are a rock star.

You should know that because I know that you're working really, really hard, and I know you've got a lot of different moving parts and a lot of different um voices and various capacities with various volumes.

So I just really want to say thank you on a serious note because I participated in almost everything and listened to the recent workshop for an hour and 58 minutes.

Played it back a few times, and uh it's it's really uh to be commended for your dedication and your work and and how much you're doing everything that you can within your capabilities and your skill set and your resources that you have.

So I just wanted to say that, but I have a question.

Thank you.

Several times you've mentioned the word we so you said for instance, um we look to change the zones, or we even when you were talking about Spanish Springs, we look at at that.

Who who is we so I do nothing on my own?

Okay.

Um I have well, I have a statistician of which none of this work could be done without her.

She's brilliant.

Um, but we, in the sense that we may analyze the data initially, but then we present it to REMS.

Wait a second, though.

The statistician and you?

Yes.

Okay.

So we work together on that.

She present she we talk about it.

I flush out, I ask questions.

I'm trying to come from where are those fire agencies going to ask me the toughest questions and make sure we present it to them.

Um and then we take it to them during JEC.

So take it to them being them being the fire agencies in REMSA.

So is it to the Jack?

Mm-hmm.

Okay, so it's to the JAC.

So you do the analysis with the statistician statistician, you look at it and analyze it, you take that that um extrapolation of what you two came up with essentially to consider to the JAC?

Correct.

And then the JAC does what?

The JAC provides feedback.

So since the Jack is not a formal body and doesn't have like bylaws yet, or authority, or authority, right?

So then like voting can be complicated and people can disagree on how that works.

And so um, we look for feedback and general consensus from them, um, or do they have areas of concern or things that they would like us to further explore?

When we took this in um February, there was no areas of concern or areas of which we were asked to further explore or consider making a revision.

Um the what we only actually talked about was this top utilizers, and then how do we address them?

Are there standard benchmarks in terms of just that the process the process that you go through with your incredible statistician?

Yep when you're looking at these true benchmarks that that you're analyzing, so it's not I'm not suggesting I'm just asking so it's not uh no, we don't just look at it and say I think um you when we look at the map, if we were to pull back up, you'll see when we look at um, like I said, definition of population change.

So if we like the census change, if we went from a frontier rural, rural to urban, urban, and metro, we look at the frequency of what's changed during the day and then what changed during the year.

So um, for example, uh, we would consider minimal change in a year if we had about 25 calls, plus or minus, we consider it minimal change, it's not significant change, and that's within the little hexagon.

Like remember, we're looking at the little tiny boxes of change.

And then we so there's a day of benchmarks.

There are metrics, yes.

And so when we where is that come from, those metrics?

Those original metrics um were uh developed by the previous team of ours and statistician, and then it has maintained using those same benchmarks.

Okay, well, Mr.

Chair, I I could go on and on.

I'm a data junkie, and so I'm going to reserve an opportunity through Dr.

Kinsley, through the chair to Dr.

Kinsley, to Miss S to maybe have a deeper conversation if that's okay.

Oh, yeah in the background.

Yeah, she's name.

We should go.

My name is Anastasia.

Okay, well, okay, yes, and she is brilliant.

Thank you.

Thank you.

And thanks for everything, really.

Thanks.

Great comments.

Any questions over here, Mr.

Driscoll?

So I have three questions, and I want to just clarify again what you said that we are not modifying the previous map this time.

We are not requesting revisions to the map that would go effective July one.

Correct.

So with that understood, are our fire partners and Ramza are they good with the assumptions for not making modifications currently?

As discussed in JC, there was consensus that no changes should be made.

Okay.

Second question.

How does this not modifying it currently?

Does it change any of the current response areas for the fire agency ambulances that are um worked with the approval of Remse?

Let me make sure I understand your question correctly.

Does it change any of their response areas?

So we've got the response areas where the three agencies have ambulances assigned to certain areas to provide primary service REMS obligated them to do that.

Correct.

So the fact that we're not making any changes and there's different things going on in those areas.

Is that changing any of the responsibilities for those ambulances that's increasing because the volume not enough to change the map, but volume enough to change their calls?

Um so you may see no, there would it results in no map changes.

Um if we're thinking specifically out in Sparks, there um and we're watching there has been volume increases in certain areas, but they're already in zone A's, so we're not increasing the time response or increasing as of right now, it's eight minutes and fifty-nine seconds.

That time response will not be reduced to like seven minutes or something that nature.

Um it does not impact them from this fiscal year to next to next fiscal year as far as their responsibilities.

Um if you look at Sparks ambulance, and if Medic 51 has been out at a call and another call comes in for that area of which they have been quote unquote assigned or responsible for, and they are unable to get there on time because they're at another call, they are actually not charged for that call.

Um that is that falls back on Remsa's responsibility, and they are charged for that late fee.

That was an alternate, okay.

Because that it is ultimately, yeah, it comes back.

It's a system approach.

So that is an agreement.

Um that is how that current agreement works.

Good.

Good job.

Last question.

Yes.

So again, because in theory, the JACs accepted the assumptions, we're not making any modifications.

Does that lack of change on the map cause any concerns with the MOUs or MAA's of the three agencies?

Um, I can't speak on behalf of those agencies, and if they have concerns that they have not expressed with their agreements that they have.

Um that's that's that's a good answer.

Thank you very much.

Thank you, Mr.

Chair.

Okay, Ms.

Aspen.

I don't have any questions, but thank you so much for the presentation.

Uh if there are no other questions, I'll seek a motion for the acceptance.

Okay, have a motion by Mr.

Brown.

Second, second by Mr.

Driscoll.

Any other questions or comments at this time?

Hearing none, I'll call for the question.

All those please signify by saying aye.

Aye.

Aye, aye, opposed.

Motion carries unanimously.

I'll just note my my screen has uh frozen, so I'm not able to accommodate the question.

Well, so let me um take a moment here, because what we're gonna do is I'm gonna um get IT to fix that for you.

We're gonna take a bio break of about 10 minutes, and then I'm gonna let presenters know on items 12, 13, 14, and 15.

Um, the staff reports are sufficient for my needs.

I do not require presentation.

I'll let my colleagues on the dias decide if they wish a different or alternate route as to items 12, 13, 14, and 15.

Uh and then what we'll do is when we come back from the break.

Um, if anyone has any questions or concerns for me about uh no presentation action on those ones, we'll do that.

But we'll be in recess for the next um 10 minutes.

Uh until three o'clock.

Thank you so much.

Well, I'll call this meeting back to order, and I want to start a little out of order and uh exercise a little chair prerogative.

But Dr.

Rhea, who is a local hero, and we have a story to tell.

Would you come on down?

You're the next contestant on the price is District Board of Health.

Come on down.

Dr.

Dow is gonna come down with you.

Dr.

Rhea, first of all, thank you for joining us for our meeting today.

Um, I know that you're a doctor here, and you'll tell us a little bit about your practice.

Uh you and Dr.

Dow are gonna share a little bit about uh what dragged you in here today because it's a good thing.

So thank you for being here.

Dr.

Dow.

For the record, Nancy Dow Division Director of Population Health.

I do have the absolute pressure of uh introducing to you guys Dr.

Randall Rhea, who has tremendously supported us in our uh well, our first case of measles that was reported to us on Christmas Day, um, and uh with Northern Nevada Medical Center's free CED and having to deal with this uh with such rapid identification to prevent additional uh cases.

Um, I like to also uh thank the collaboration we always had with our health care partners and as well as with our own internal epidemiology and CCHS team who acted quickly to also help with our contacts uh who received either PEP or vaccination.

Wow, what what an incredible thing, and something I didn't anticipate we'd be chatting out in my lifetime.

But uh Dr.

Rio, welcome.

And and could you just tell us a little bit about yourself and your practice and and what happened here in December?

Okay, yes.

Um, yeah, Randall Rhea.

Um, I'm local emergency physician, been here for just over a year, uh transplanted from Tulsa, Oklahoma.

Um, here for everything that Northern Nevada has to offer.

Um so yeah, I work with the Northern Nevada Health System out of the two main hospitals as well as our uh freestanding emergency departments, and on uh on Christmas Day, um I was covering the McCarran emergency department, and I had a very uh typical presentation of measles in a non-vaccinated um uh middle-aged person.

Um we uh as was stated, we uh identified it very rapidly.

It and it was a very typical presentation, so we it uh it it wasn't hard to recognize that it was measles at that time, but we took the appropriate action, put the patient in uh airborne precautions, um, brought them on board um our infectious disease colleagues as well as infection control, and um it got handled appropriately.

Well, thank you so much for that.

And and since we have you here, can you just remind us and the public um I was vaccinated for measles, so does that mean I can't get measles?

Um no, it does not.

It does mean that you are at a lower probability of catching measles, but um the measles is highly contagious, and um, somebody such as this patient who had not been vaccinated, um, could easily have uh acquired it.

Real and a real serious health problem.

Thank you so much for that.

And and again, I think the reason why we asked you to be here is um number one to honor your commitment to this public service.

It is public service when you're in public health, and and uh that clinic happens to be in my neck of the woods, and so um I really was appreciative of their uh inquiry to have you here.

Dr.

Dow uh also keeps us apprised when things like this might happen, and we're monitoring national trends.

Sometimes I ask her, hey, what's going on over here in Houston?

And she already has the lowdown, she already knows what's going on because we're such an area where people are coming in and out of it from other places that we need to know what's going on from a public health perspective.

So you've helped us to do that.

So we just want to say thank you for being here.

You have our sincere gratitude and thanks for working with our team and Dr.

Dow and her team to make sure our region is safe.

Okay, I appreciate the recognition.

Yeah, thank you so much.

I did just want to add, as you guys have seen on the protests, um, you know, that video of how a disease could affect um our vulnerable populations.

Early detection is so key, and having such great partners as Dr.

Rhea, who is able to identify with this expertise early, that really helps our job as epidemiologists as well.

And your tracing team, which they have to figure out how who they've come into contact with.

Yes, we well, we do have to do the contact tracing to make sure we're keeping our community safe.

Yeah, great.

Thank you so much.

Thank you for being here.

Appreciate you.

Thank you very much.

Yes.

Okay, we're gonna move on now to uh resume our regularly scheduled programming here with item 12.

Item 12, uh, the staff report is comprehensive, and Mr.

Kelly, thank you for that.

I don't require presentation unless anyone on the body requires a presentation.

Uh, I will make a motion to accept staff recommendation, which is uphold uh the SWS hearing board's uh variants.

I'll second.

Okay.

I have a motion and a 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.

Any opposed?

Motion carries unanimously.

Item 13 is uh the review and discussion for the BIS statement regarding the proposed revisions of the District Board of Health Regulation governing air quality uh in food establishments under 40.033.

Again, Mr.

Peterson, um, thank you so much for being here.

I have no questions.

The staff report was absolutely comprehensive and complete.

And unless any of my colleagues require presentation, I will also seek a motion.

Okay, but motion by Miss Andreola and a second by uh Mr.

Driscoll.

Any other questions or comments at this time?

Hearing on our call for the question, all those in favor, please signify by saying aye.

Aye.

Opposed.

Motion carries unanimously.

Items 14 and 15, actually, we will hear.

Um, and I think, especially in both of them, there are some very specific action items, and perhaps uh Ms.

Sandoval and uh Miss Lavoie, you'll be able to focus on those areas.

These were originally, I think, intended for our board retreat, but our board retreat ended up uh going as long as it did, which is always a good thing, but that's why they're here.

I will say on both of them, Miss Senable and Miss Voy, both staff reports and presentation materials are outstanding and comprehensive.

I don't necessarily have a lot of questions based on them because you've answered all of them in it.

But the floor is yours, Ms.

Hannibal on item 14 first.

Good afternoon, Chair, members of the board.

My name is Eva Sandoval, and I'm a community health educator within the office of the district health officer.

Today I will be presenting the Bay Area Regional Inequities Initiative Framework and highlight key assessment findings that will help guide NNPH efforts to improve health outcomes.

Throughout the presentation, I will refer to it as the BARHE.

I'll close by outlining the action plan that will guide strategic priorities and the next steps.

So strengthening public health systems to improve health outcomes.

Public health is a system of interconnected parts that influence health outcomes.

Health equity health outcomes are shaped by a variety of factors.

For example, people without reliable transportation, a community member may miss a routine visit, leading to gaps in preventative care, and a greater reliance on the emergency room for services.

To improve health outcomes, we need a consistent way of how well the system is working and where gaps and opportunities exist.

The Barhe assessment is a nationally recognized tool that helps local health departments assess how well their services are improving health outcomes.

The BARHE assessment was first implemented in 2022 and then conducted again in 2025.

This assessment helps us compare baseline data to our current state and three-year goals.

This approach is a continuous improvement by guiding decisions, aligning resources, and strengthening community health outcomes.

Next, we'll move into assessments and inputs and results.

The assessment gathered from inputs from multiple surface sources with a well-rounded view and identified common themes across the organization.

We collected feedback through staff assessments, partner surveys, staff focused groups, and leadership interviews.

When the input was synthesized, four themes emerged.

Four themes emerged.

Theme number one is to strengthen data informed decision makings to guide priorities and measure impact.

Theme two, to address broader factors influenced community health beyond direct services.

And theme three, modernizing hiring practices to support workforce aligned with community needs.

Lastly, theme four is build workforce capacity so staff are equipped to meet evolving community needs.

These themes were consistent across staff and leadership, reinforcing their importance and forming our foundation for our recommendations.

Next, I'll provide a deeper analysis of each theme, highlighting progress and areas of opportunity.

So in theme one, data-driven decision makings from 2022 to 2025.

Insights from this service will from the survey will guide future delivery informed planning and help standard aise metrics to props to see progress over time.

There's an opportunity to strengthen our data infrastructure to consistently drive measurable community impact and enhance organizational accountability.

One way of doing this is by developing accessible dashboards that improve information sharing across the organization and with partners to strengthen coordination and reduce duplication.

Together, these efforts support data-informed decision making across NNPH and our partners, strengthening our ability to demonstrate impact.

In theme two, when we address factors that influence health, from 2022 to 2025, NNPH has improved on how it's engaged with this community to support healthier environments.

Some of those examples include hosting town halls and food vendor resource fairs to improve food safety.

These food safety resource fairs bring together a hub of permitting services and partners, allowing new business owners to access multiple services at once and materials available in other languages.

This helps reduce transportation and language barriers.

The organization has an opportunity to further strengthen its efforts by considering factors such as language and transportation.

These examples highlight ways staff can continue to approach problems holistically to improve community health.

In theme three, we focus on modernizing hiring practices.

Effective public health requires not just the technical expertise, but also strong interpersonal skills.

From 2022 to 2025, an NPH piloted a hiring project in collaboration with Washoe County Human Resources, the Office of the District Health Officer, and Environmental Health Services.

For an open position in environmental health services, the project team kept technical assistance requirements the same, but required a performance-based screening to assess interpersonal skills.

This allowed the hiring team to see how the candidates handled real world situations and ensure that they can both perform technically and connect with the community.

There are opportunities to further strengthen hiring practices by integrating interpersonal screenings across all positions and expanding recruitment to reach a broader talent pool with the skills our work requires.

Lastly, and theme four building workforce capacity to meet the needs of the community.

At NMPH, we prioritize training and professional development to ensure staff continue to expand their skills and stay at the forefront of public health practices.

From 2022 until now, the Office of the District Health Officer has supported divisions by providing technical assistance for workforce development needs.

As an academic health department, NNPH has supported the next generation of public health professionals through student programs and partnerships.

Strengthen the regional public health workforce.

Building on that momentum, there are opportunities to provide tailored training that equips staff with targeted skills needed to address the emergency emergency emerging community needs.

And then lastly, I'll move into the action plan.

The assessment informed a three-year action plan developed by an internal committee to ensure organizational priorities align with the community needs.

In your packet, you have a copy of the action plan and you can review it in more detail as needed.

The plan focuses on four priority areas that reflect the key assessment themes, outlining clear strategies, timelines, and deliverables to ensure accountability.

Progress will be monitored, monitored regularly, allowing NNPH to measure impact and adjust as needed.

Key strategies over the next three years include leveraging performance management data to guide decisions and program improvements and strengthen our partnership with the county to modernize hiring practices.

Thank you for your time.

I'm happy to answer any questions.

Ms.

Sandoval, thank you so much.

Like I said earlier, this particular presentation was very uh informative to me and your staff report and work up for it was very um well done.

I wanted to ask about theme three.

Um, and I just thought I would maybe start here only because there were some in my mind hiring-related overlap between this and Miss Lavoise Wind survey.

So I just didn't know how these interact.

That was sort of my overarching framework issue with both of the presentations.

Right.

It sounds like you must have a similar thought about it, or or you thought this could be a thing.

Yes.

Okay.

Well, so I'm glad it wasn't just me.

Thank you, Chair, for your question.

So we're really trying hard with all of our plans throughout the organization to make sure that they are interwoven together so that we are uplifting our strategic plan.

So our uh Barhe assessment is one of those assessments that are integrated into the strategic plan.

And so we do uh realize that there's an opportunity to strengthen uh training within how we view reducing health disparities, and so that training component is going to make its way into the workforce development plan.

My presentation is slightly different, um, but there's definitely a thread between many of the presentations that are.

Well, it just makes sense to me because on this slide that's modern modernizing hiring practices that talks a lot about expanded recruitment efforts.

And I think the idea is that as public health changes and evolves and that the communities were serving change and evolve, we have to have hiring practices that are reflective of that community.

And so I think we've been doing a good uh job at that, but probably need to just refocus our efforts, um, especially because our community is also often evolving, and we have people moving here from other places.

There seems to be a consistent like 25% of the people here are new.

And so as we continue to expand population health in areas where it's like Spanish speaking, some of our different Chinese dialects, Tagala, other different kinds of languages, that also is reflective in the hiring practices process.

So it just seems important, and I wanted to make sure that you understood I was observing it in the slide deck.

Absolutely.

Thank you for that.

Any other questions from the colleagues on this particular one?

Again, excellent presentation, Ms.

Annal.

Thank you so much for it.

I think for our purposes, I would encourage my colleagues to look at the action deck that's in there as well, because they're real specific call-outs for things that we can and should be doing, and which I think you're going to be focusing on in the coming year.

So thank you for that.

Okay.

Let me just make sure this is identified as for possible action.

And so this is an acceptance of that report.

Okay, and I'll look for a motion from Mr.

Brown.

A second from Mr.

Anderson.

Any additional questions or comments at this time?

Hearing none, I'll call for the question.

All those in favor, please signify by saying I.

Any opposed?

Motion carries unanimously.

Ms.

Lavoy, you're already here.

You knew where we were going.

This is item 15, which is also for possible action today, which is a presentation discussion and possible acceptance of the 2025 PH win survey results in workforce insights.

Thank you so much, Ms.

LeVoy.

Appreciate your keen insights in this area.

Thank you.

Well, good afternoon again.

Ray Anna Lavoy, Director of Programs and Projects with the Office of the District Health Officer.

Today I'm going to be presenting the findings from the public health workforce insights and needs survey.

I'm going to refer to that as either PH wins or quite frankly, just the survey.

Because this was slated for our discuss a discussion for the retreat because the survey informs our strategic priorities because workforce is such a key component of organizational health.

And so I'm bringing it forward again to just ensure that our planning remains grounded in data.

This presentation is specifically going to focus on the findings from the survey, and it's going to give us a better understanding of the workforce, our strengths, some of those challenges, as well as some training priorities.

Before we get into the data, I want to take a moment to talk about PH wins and explain why we use this tool.

The PH WIN survey is used to inform our workforce development strategy because this tool was designed by national public health experts, and it's also a recognized tool among our accreditating bodies, and they view this tool as a valid and a comprehensive assessment tool.

To build on that, we had to have at least a 70% response rate to be able to get our data analyzed as well as returned back to us.

This survey is a national survey, so we're we are also able to look at other local health departments who are similar in size and also in scope.

So all of this matters because it means that we're looking at credible data.

We understand that the sample is representative, and when we're looking at that data, it also tells us, or when we're looking at those findings, we're also able to see is this workforce pattern something that's happening nationally, or is this an isolated event that's only occurring here with our workforce.

Because our workforce is a core part of our infrastructure.

More than 90% of staff are full-time employees, and really that's important because it's telling us that our we're structurally stable.

And that is important because uh for various reasons, but um it supports continuity of services and it helps uh know that we're preserving that institutional knowledge.

We don't have a lot of temporary staff or contracted staff, which is also uh something to highlight because uh that allows for greater consistency when we're delivering those services.

Majority of uh staff are working directly in public health programs like surveillance, assessment, um, environmental health, our clinical division, um, and these are all essential to maintaining a forward-looking health department.

One piece that I do want to note um here is that 78% of our staff have been in their current role for less than five years, so very early in tenure, and with many staff um early in their role, um, this is important to shed a light on because uh transferring knowledge becomes very critical, and we really want to ensure as an organization that we're building that leadership depth or that capacity when roles start to transfer over.

So, while many uh frontline staff are early in their careers, our supervisors have significantly uh deeper public health experience, and so we're talking about 10 plus years uh of public health practice, and that's a real strength, right?

And that's a real strength, right?

So when you're thinking about institutional knowledge or regulatory experience, grant management experience, all of that knowledge is being kept up at that leadership level.

But then that also it also poses the organization at risk because then we're structurally dependent on this smaller group of staff who are in leadership positions that are likely closer to perhaps retirement or in other positions that may leave the organization.

So just like I said in my previous slide, there's certainly an opportunity, and the encouraging part is that we have a strong pipeline of early career staff that we can develop that talent internally to make sure that we're ready when those transitions occur.

Another component of the survey is organizational health, which includes measures related to employee engagement, overall work experience.

PH Ones does a really good job of looking at other factors, not only employee engagement, which is usually something that you typically see.

They really want to see the employees' work experience holistically so that we can look at the drivers influencing retention or even reasons why staff stay.

But when we compare our local health district to other local health departments across the nation, we're seeing that our engagement and our and our anticipated turnover are comparable across the nation.

Overall, our employees are reporting a strong satisfaction across key areas of the organization, and so I'll take you through that now.

So the findings do highlight that every division has their own culture, and I'm sure that that's no surprise to you.

This does contribute to variations in employee experience across divisions.

But overall, employees are reporting that they have high levels of satisfaction with their direct supervisors.

Another key component that I want to highlight that's not included in the bar graph that you're looking at is work-life balance.

But I want to share feedback from staff that is very positive about this area.

They're very happy about their work life balance.

And coaching, mentoring, and work-life balance are three key areas that we focused on in our last workforce development, as well as our board increase our workforce training line item in our budget to put some resources behind workforce development trainings and such.

So this is really a response to that investment that we've done over the last three years.

So I just want to highlight that because that's pretty significant.

While overall job satisfaction across the organization remains relatively high, the most notable findings in the survey are the variation between supervisors and staff regarding workload pressures.

And so supervisors are reporting higher levels of fatigue compared to our frontline staff.

For example, some of that strain when we start to drill down in that data point, is they are their perception of organizational climate is less positive than our staff.

And so there are several key factors that we receive feedback around, but this could be contributing to currently, you know, obviously we are dealing with budget reductions as well as there's been less public health resources, and so our supervisors are often those that group that is between trying to make sure that they're delivering services but also feeling constrained by the resources that they're provided.

So the data doesn't necessarily say that this is a crisis, but we absolutely want to make sure that we're getting ahead of this because when those pressures are extended over a longer period of time, that can gradually influence morale and culture.

And so again, while you know work-life balance and that relationship coaching and mentoring are happening, those are all positive attributes of the organization.

We just want to be mindful that burnout is one of the strong strongest predictors of voluntary turnover or uh yeah, turnover.

And as I mentioned in the last couple of slides, um, because burnout is happening amongst our supervisory staff, you know, we risk losing that institutional knowledge, and and we don't want to create a cycle where those who are left at the organization are having to pick up that workload.

So we just want to make sure that we're getting in front of that, and so that's something that's more going to be mindful of as we're building our workforce development plan.

So this might be the most forward-looking part of the data is our training priorities.

Um, this is another component that of the survey that assesses perception of competencies among our public health professionals.

The training needs identified by PH WINs are not necessarily technical gaps.

They're really skills and financial management, wanting to better understand policy engagement, how systems thinking works, cross-sector collaboration, those are all areas that were identified as areas for further growth.

And so as we're building our next workforce development plan, training priorities is absolutely going to be critical during this time because it's essential that we have trainings so that staff can execute their responsibilities effectively, especially in a constrained fiscal environment where we don't necessarily have the resources to increase head count.

We really need to invest in our staff skills so that we are productively and efficiently doing the work that we need to do to meet the community's needs.

So what's next?

I spent a lot of time today talking about employee experience, but all of this data is going to inform our workforce development plan.

We really want to make sure that we have high engagement and that our turnover is at a is at a um it's bearable because we just want to make sure that you know our performance and our continuity of services will follow that.

And so we just want to be mindful of that burnout and those key components that I mentioned earlier in the presentation.

Um but with that, I will take any questions that you might have.

Mr.

Way, thank you so much.

It's been sort of a privilege to learn more about this area, and you have been helping me to understand a lot of the things going on and uh call it broadly like uh workforce and HR related stuff.

So thank you for that.

Let me see if my colleagues have questions about this particular presentation.

I I just sort of had one, and that was you know, some uh months ago now we had um uh hired an outside consultant to help us evaluate the EHS folks and and certain aspects of it seemed very much in line with your recommendations here, meaning there were lots of things talking about how do we build culture and uh cross competency.

I don't know if that's the exact word across divisions and uh within different sets of leadership.

And so I just wonder how maybe some of these things are gonna then get applied using that kind of a outside consultancy and then just merging them together.

So maybe your thoughts on that.

Yeah, I'm glad that you asked about that.

So uh Rob, the EHS director and I have been working together to take a look at the public health accreditation board um competencies, and so I've given that to him.

So we are working together to make sure that he has performance metrics that are tied to that.

Now, to speak to the culture piece, we are actually going to start our program workshops where we're gonna be talking about program metrics along with building out culture action plans.

So you'll see all of that, all of the assessment findings, um, you'll see that come to life through our culture action plans.

And is the uh working group that you're talking about, can that be specific to include the employees?

Like I don't want to have um sort of uh us micromanaging how you do uh what you do on your side of it.

That's not really our role as a board.

We're sort of at that 30,000 put foot policy view, but I I want to understand and appreciate that our employees, their opinion of what happens in their department is very important to each of us, and so um I would hate for us to sort of top down cram it down as opposed to it being collaboratively done.

Is that what you're identifying here as the working group?

Yeah, so we have several ideas for a working group.

The working groups that I'm um speaking of is I'm going to be meeting with every program and their supervisory and division director to be able to build out their strategic plan as well as their culture action plan.

So they'll be driving that work and their performance metrics.

All of that work is going to uh roll up into the strategic priorities that this board has set uh when we when we met for our strategic plan retreat.

Uh, there is also conversations about um about forming a another team.

I'm not sure, Chair, if you are familiar with um CSD's Spit team, um, but they have a fantastic team that they are that they've rolled out where um it is a group of individuals, they're individuals from the organization or the department who go out and they just talk to their fellow colleagues about the culture of the department.

Um so we're kind of thinking about that idea.

And that's in Clark County as well.

You were saying that is at our very own Washoe County CSD community services department.

Yeah, so um, I just met with them, and so we're kind of thinking about that idea.

Um, but there are several ideas that Chad and I have talked about to make sure that culture is absolutely a part of our strategic plan and a focus.

Well, and that's very exciting to hear.

Um, for my part, um, I don't know as much about each of the divisions as I would like to.

Sometimes the divisions are um like foreign to me in topic.

Sometimes the divisions are um like foreign to me in topic, uh, and so it sounds like I'm sort of picking on certain divisions about them when I reference, you know, EHS or EPI or one of the other divisions.

It's never in that vein, it's just that those are the ones that I have more experience in.

And it seems to me that, and you said a part of this in your presentation, which I took notes about was that um, you know, when you are in a budget constrained environment and financial constraints are one of the primary issues we're facing as an organization, that sometimes it's harder to implement the changes you want to see, and also that there aren't spaces to hire for bodies.

For example, um, I know that our um food safety inspectors feel very stretched thin, and the work that they do is very important, but they're not meeting the metrics of different national organizations.

And so when you are doing this, and as you work through those things, please make sure that we're addressing those concerns too, um especially where we are in a constrained environment where it's not easy to hire more people, and we're basically trying to stretch our people further and further.

And I think at some point in time as like a rubber band, it just snaps.

So I just want to make sure that that's part of the consideration.

Any other questions or comments from the board?

Okay, yeah, we'll close this item then and bring it back to the board for present uh an approval.

I'll move to approve.

Okay, I have a motion by Vice Chair Andreola, a second by Mr.

Anderson.

Any other 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, as uh Miss Griffey is coming down.

Um, this is item 16, which is a review and approval of the annual 360 feedback survey questions and process.

And um, I am uh identified here as part of this process, but I'm gonna not steal uh Miss Griffey's thunder and just say that of course every year we annually will evaluate uh the district health officer.

And so we have spent a fair amount of time over the last several weeks, months uh working with uh Miss Griffey and also internally um and the vice chair has been very helpful in this regard too.

And so the conversation today is really um being directed by Miss Griffey, but I want to just let my colleagues know uh very iterative process.

So any input that you have today is greatly appreciated.

Ms.

Griffey.

Hi, for the record, Lori Griffey, HR rep for the Northern Nevada Public Health.

Uh today we're seeking the board's approval to start the district health officers 360 feedback survey.

This information will be used next month once it's provided, so that you as a board can do his evaluation.

Uh the staff report in your packet shows the process, the district health district board of health used in 2025 for the 360 feedback survey.

We would like to utilize the same process for 2026 so that we can keep can provide comparable data for his first two years on the job.

Uh Vice Chair Andreola was great, and she gave us some wonderful recommendations.

Uh, she would like to include a fourth group the people that actually complete the survey, and to be able to provide a comparable data.

We've come up with a way to provide two different score ratings.

The first one will have the three groups that provided input last year.

The second score rating will have the four groups, the three that were last year, and the fourth group that would be the Northern Nevada Public Health staff and supervise.

Excuse me.

Um, what we can do, what we're gonna do is once you approve, look at the information in your packet and review both the participants, the questions, and approve the process that we would like to use, which is Microsoft Forms, which provides an anonymous way for people to complete the survey, and then we can put all that together and bring that information back to you in April so that you can provide the health officer with his evaluation.

Um we only thing we've had the change in the questions was one question on the strategic planning initiatives.

That was question number 11.

That related to the uh groundbreaking and the opening of the new TB clinic.

Since that has been accomplished, we have now set up a new question that relates to community health assessment.

Uh using the online Microsoft Forum survey tool, specific surveys will be sent out to each group with questions that are related that pertain to their actual interaction with the health officer.

Uh, we're seeking the board's approval for the 360 feedback survey process, the list of participants, and the evaluation questions.

Uh the board can make adjustments to this.

You can provide me with more names that you want included.

You can make recommendations on adjusted questions.

As long as it's just minor adjustments, we can move forward.

If it's major adjustments, we will have to redo it and come back next month.

The survey will be distributed hopefully tomorrow.

And it will they'll be open for 10 days to give people plenty of time.

And I'd like to send out reminders every couple days saying, hey, if you haven't had a chance, please please participate.

Once the survey closes, we'll be able to provide the results and the consolidation to the chair, vice chair, and the health officer.

And we usually do that probably about a week before it actually hits the packets.

That way they have there is no surprises for anybody.

If the boys chooses to make any major adjustments, we will have to come back next month.

What I was um wanted to also let you know is since we've included a not applicable or a participant has no basis for judgment this year.

The Microsoft Forms program doesn't allow for a zero rating.

So on the rating, it's going to have one, two, three, and four.

But at in both in the email that they're you're going to get and at the top of the where the instructions are, it will indicate that uh one will equal zero points, a two uh two will equal one point, a three will equal two points, and a four will equal four points.

And what we can do is the one point uh one that says that it is um minimal effective.

Um I can actually include in that somebody had made a uh comment that uh that might be like a needs improvement rather than changing the wording from last year.

I can add in parentheses needs improvement in that in the directions.

So people when they're rating, they can know okay.

If I mark a one mark that one, that actually means that person needs a little improvement in that area, that they haven't quite they very minimally met that objective.

Uh all the information will come back to the board in April, and I'm looking for an approval if possible.

Well, again, thank you so much for the work that's gone into it to date.

I know it is a very comprehensive thing, and for my part and for my colleagues' benefit, I'll just say that again we uh only get to make the decision at one level, right?

We we have this fair gentleman to my right um who is our health officer and our sole employee, so to speak, and then the rest of the things that happen below that, we don't get a lot of say in.

So this is our one chance to really think about uh the direction of our health officer and his performance over the prior year.

So I'm very much appreciate the process and thank you for your wisdom in it because you have been very helpful, uh, as has Vice Chair Andreola, who has a considerable more experience in this area than I do.

So it's been good to learn from the both of you.

Let me open it up to the body and see if there are questions from anybody.

Mr.

Driscoll, we'll start with you.

You're you're someone who is familiar with this uh intimately, my friend.

Could you please remind us?

Since this is an analytical survey that deals with data points, there's also areas for comments.

Yes, there is.

How do the comments make their way to the board?

Is it just the comments from our section or do we see the comments from the entire survey?

Each of the surveys have an opportunity, the groups have an opportunity to provide comments.

So when they come in, when I put it all together so that nobody knows which ones came from the board, which ones came from which group, I throw them all together and then I put them in random order.

That way it's all mixed up, nobody knows who made what comments, but you do it.

The board will receive all comments that are made.

Thank you.

Um, I just really want to thank you, Miss Griffey for your um patience and um the opportunity for all the board members to look at even the list that they may think about later that instead of right now that they have that opportunity if they have names, stakeholders and other folks that they think might be helpful.

Um I just wanted to kind of reiterate that that point.

Yeah, there's a lot of people in the community, and we all touch the community in various different ways.

So there might be something that somebody might see, but on a very serious note, I just want to thank you.

Any other comments or questions?

Uh, for my part, as we close this item out, I'll just say too that um all sections of this survey are important.

That's why it's a 360.

I think there have been boards or even in this board's history, as I've sat on it now for many years, where we haven't always valued each of the parts, and sometimes we're adding to it, right?

Ms.

Andreola has helped us to do some of that too.

I want to encourage all of our colleagues on the dias to really take the opportunity to review it thoroughly, provide yourself enough time to evaluate uh Dr.

Kingsley, because that'll be an important component of the overall evaluation.

Um and sometimes as our harried lives get and doctors and uh electeds, uh we can get pretty bogged down too.

So just make sure you give yourself enough time.

Uh when will they come back?

Uh when will we be providing our actual evaluations?

Um you'll be doing the evaluation next month at the board meeting.

Perfect.

And when I put send this out, hopefully it's tomorrow morning, and we'll be open for 10 days.

Yeah, so you'll have to do that.

On at the 6th or 7th, I should be able to provide you, the chair and the health officer and the vice chair with the results.

Well, and and you'll be letting uh any of us know if we haven't quite gotten back to you yet.

Yeah, I'm pretty good at nagging, so thank you for that.

Sometimes we need it.

Okay, I'll look for uh an approval uh on this Mr.

Chair.

I move to approve.

Okay.

I have uh first and a second, but first by Ms.

Andreola, second by Mr.

Driscoll.

Any other questions or comments?

Hearing none of call for the question.

All those in favor, please signify by saying aye.

Aye.

Any opposed?

Motion carries unanimously.

Thank you.

Item 17A through 17 D are accepted as written.

Thank you to all the staff members for the excellent presentation reports.

You all have those in your board packets, and so um we'll move on now just to 17E, uh, which is a report by the district health officer.

At this time, nothing to report that is outside of the staff report.

Okay, great.

Thank you so much for that.

Okay, madam clerk will now move to item 18, 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 object 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 cases.

And we do not have any further requests for public comment.

Thank you so much, Madam Clerk.

And is there any public comment for item 18?

No public comment.

Thank you so much.

I'll close item 18 and now move to item 19.

19 is reserved for board comments, board members' announcements, reports and updates, requests for information on topics for future agendas, and I'll remind all that no discussion among board members will take place on the items.

So I'll start with my right and start with Dr.

Duarte if you have any items.

Okay.

Mr.

Driscoll.

Thank you, Mr.

Chair.

Um I would like to on the next agenda do whatever's the appropriate um process to begin the reconsideration process for the REMSA agreement that we approved in January.

Okay, thank you, Mr.

Driscoll.

I'll take that under advisement.

I will tell you that I'm not certain that such a request is timely, but that's something that I'll have to address with uh our legal counsel, Miss Reed.

And so I've taken a note that you've identified that as an item for consideration at a future agenda, and I'll go now to my I have no items, but I'll go now to my left.

Okay, miss anything further?

Okay.

Uh hearing no other items, I'll close item 19 and we are adjourned.