Okay, thank you, and good afternoon.

I'll call this meeting of the Northern Nevada Public Health District Board of Health order.

It's now Thursday, April 23rd, just uh one o'clock.

And we'll start, Madam Clerk, with a roll call and determination of quorum.

Uh Chair Reese.

Here.

Um, Vice Chair Andreola, present.

Board Member Driscoll?

Here.

Board Member Anderson.

Here.

Board Member Brown.

Here.

Dr.

Itorte.

Here.

Dr.

Rika Denko is not present at this time, and she's not online either.

We do have a quorum.

Thank you so much.

We'll move now to our Pledge of Allegiance.

Mark, and I'm hoping I'm not pronouncing it right.

Is it FIRE with our Turkey Meadows Fire Protection District President?

Would you lead us in the Pledge of Allegiance, please?

Congratulations.

And to the Republic for which it advanced under the justice rural.

Mark, thank you so much.

Madam Clerk, public comment.

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

Unused time may not be allocated to other speakers.

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

A speaker's viewpoint will not be restricted.

However, reasonable restrictions may be imposed upon the time, place, and manner of speech.

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

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

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

Warnings about disruptive or 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.

Thank you.

Item three out and uh just remind the audience that we also allow public comment on the individual items, and I think we do have some of those.

Thank you so much.

Uh I'll go now to item four and ask Dr.

Kingsley are there any changes to the agenda.

None noted at this time.

Okay, thank you.

I'll look for a motion.

Move to approve.

Okay, I have a motion by Mr.

Anderson, a second by Miss Andreola.

Any other 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 five is recognition.

No, sir.

Can we just note that Dr.

Denko is present at this time?

Thank you so much.

And also, please I'll remind everyone to vote on their tablets if you're able.

Ms.

Dixon, hello.

Good afternoon.

For the record, Aaron Dixon, Deputy District Health Officer.

It is my honor today to recognize one employee for 10 years of service, Miss Kelly Weerling.

She is a CCHS public health supervisor, who's been with us for 10 years.

She supports our maternal and child health program, and she ensures that our extensive Title 10 grant requirements are met, which is not an easy task.

So we are very grateful that she is on our team.

Thank you so much.

Fantastic.

Thank you so much.

Okay, we'll close out item five.

Item six, we have several proclamations this month.

Looks like we'll start with uh drinking water week.

And don't make me say that a bunch of times fast.

Ms.

Lord, thank you so much for being here.

Thank you for having me.

For the record, Latricia Lord, Senior Environmental Health Specialist with EHS.

And it is my pleasure to read this proclamation.

Um, whereas water is our most valuable natural resource, and whereas drinking water serves as a vital role in daily life, serving an essential purpose to health, hydration, and hygiene needs for the quality of life our citizens enjoy.

And whereas tap water delivers public health protection, fire protection, support for our economy, and the quality of life we enjoy.

And whereas the hard work performed by the entire water sector designing capital projects, operators ensuring the safety and quality of drinking water, or a member of a pipe crew maintaining the infrastructure communities rely on to transport high-quality drinking water from its source to consumers' taps.

And whereas we are all stewards of the water infrastructure upon which current and future generations depend, and whereas the citizens of our county are called upon to help protect our source waters from pollution, practice water conservation, and get involved with their water by familiarizing themselves with it.

Now, therefore, be it resolved that the Northern Nevada Public Health District Board of Health does hereby recognize May 3rd through the 9th, 2026 as drinking water week.

I think I'm supposed to say that last part, right?

Great.

Congratulations.

Thank you so much.

Thank you.

We'll move on to item six B, which is Washoe County Air Quality Awareness Week, Mr.

McMullen.

Good afternoon, Chair, Vice Chair, members of the board, here readoff uh proclamation for air quality awareness week 2026, whereas poor air quality can threaten the health of our citizens and visitors, and whereas the increasing intensity, duration, and scale of wildfires has negatively impacted air quality in the western United States.

And whereas children, older adults, and people with harder lung disease tend to be more vulnerable to air pollution.

And whereas the Northern Nevada Public Health Air Quality Management Division is responsible for managing sources of air pollution and ensuring compliance with federal, state, and locals laws governing air quality, and whereas the Washoe County Air Quality Trends Report, which contains information such as national ambient air quality standards, local ambient air monitoring network, and current air quality design values and state attainment status is available at our cleanair.com.

And whereas AQMD is dedicated to the protection and air quality of air quality and the safeguard of public health for all of Washoe County through the development and implementation of effective programs and regulations while supporting economic growth, community partnerships, and environmental justice, and whereas clean air will require a collaborative effort by all stakeholders in the region.

Now, therefore, be it resolved that the District Board of Health does hereby recognize the week of May 4th to May 8th, 2026 to be Washoe County Air Quality Awareness Week in Washoe County, Nevada, and encourages community action to reduce air pollution levels during this week and throughout the year.

I have a little bit to add on to that as well.

So to celebrate air quality awareness week, um, the air quality management division is working with Northern Nevada Public Health Communications team to provide information on social media each day to empower the citizens of Washoe County on the topic of air quality.

Daily topics will showcase uh air quality's five keep it clean programs, which are know the code, rack them up, no zone, be smoke smart, and be idle-free.

Um, also we have a media event to celebrate the grand opening of our new ambient air monitoring station at Verde Elementary School, uh planned for Thursday, May 7th at 11 a.m.

Um, we'd love to have you guys there if you're available, um, as we showcase the uh this important addition to our monitoring network.

So um thank you all again.

Thank you so much, Ben.

Appreciate it.

Yeah.

Okay, item six C is a recognition of emergency medical services week, Miss S.

All of you all, everybody can come on down.

We love that.

That one's yours.

Yep.

They were voluntary.

Don't be shy.

It's your emergency medical services week.

Improving outcomes together.

You told me you come up.

So we gotta laugh.

I told her she'd be behind me, so she's on camera.

Right there.

Okay.

Uh good morning, board Andrea asks for the record.

Um, I have a proclamation for you.

So um, whereas emergency medical service personnel are called upon to help others through one of the most frightening times of their lives, whereas medical emergency medical services is a vital public service with personnel ready to provide life-saving care to the community 24 hours a day, seven days a week, and whereas emergency medical service system consists of men and women in both the public and private sector, including emergency physicians, emergency nurses, emergency dispatchers, emergency medical technicians, paramedics, firefighters, educators, administrators, volunteers, and others throughout our healthcare system who work together to ensure those in need receive the highest level of emergency service.

And whereas the EMS commitment to patient care throughout Northern Nevada has been an integral factor in our safety and security.

And whereas Washoe County is proud to have organized such organizations such as the Reno Fire Department, Sparks Fire Department, Trucky Meadows Fire Protection District, North Lake Tahoe Fire Protection District, Pyramid Lake Fire Rescue EMS, Remsa Health, Trucky Meadows Community College, and Technical Medical operating throughout the region to ensure the highest quality of patient care and community support.

And whereas the members of emergency medical services teams, whether career volunteer engage in thousands of hours of specialized training and continuing education to enhance our life-saving skills, and whereas it is appropriate to recognize the value and the accomplishments of emergency medical service providers by designating emergency medical services week.

Now, therefore, it'd be resolved that Nornevada Public Health District Board of Health does recognize the week of May 17th to the 23rd, 2026 as a MERNC Medical Services Week with the theme of improving outcomes together.

And I would like just to acknowledge everyone that is standing behind me that although we have our differences, we do come together to improve the outcomes of our patients.

Well, I think we can all stand and cheer for that.

Okay, that concludes our items under the six proclamations item.

We'll move now to consent items, and I'll ask my colleagues if anyone has anything on the consent item to pull.

Doesn't look like it, so I'll seek a motion.

Any additional questions or comments?

Hearing none, I'll call for the question.

All those in favor, please signify by saying aye.

Aye.

Any opposed?

Motion carries unanimously.

Okay.

Item eight.

This is our monthly update from REMSA.

Mr.

Duplanus, I see you're here and coming down.

Welcome.

Thank you.

Good afternoon, Chairman Reese, members of the board.

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

First off, I'd like to publicly thank each and every one of you for serving on this board and for working to serve public health.

You have a tough job because there's so much noise and distraction in our world and community today.

Trust, ethics, and integrity are critical in public health matters.

RemSA is a committed partner in our regional health system, and our mission is to provide 911 callers with high quality emergency and non-emergency patient care and clinical transportation in a manner that is fiscally responsible and sustainable.

Today, I'd like to provide you with an update of REMSA's ground franchise component of the operation.

Ground services for REMSA represents about 45% of the organization's activity.

And it employs actually the greatest number of people.

It takes a lot of people to do emergency medical.

RIMSA utilizes a dynamic deployment model, which is designed to be responsive to the movement of people throughout our system.

So in further comment, um, in March, we saw a spike in demand for EMS services.

We responded to 8,647 EMS calls, and we transported 5,737 patients to area hospitals.

Our average response times for priority one calls were in the case of City of Reno, five minutes and 30 seconds.

Case of Sparks, six minutes and nine seconds, and Washoe County, uh eight minutes and thirty-seven seconds.

With reference to responses based on our compliance zone map, REMSA continues to meet or beat franchise compliance for all priority one calls in zone A, which includes the most populous parts of our region, and REMSA continues to meet its obligation for year-to-day year-to-date compliance uh in zones B, C, and D.

So what does that mean when we talk about uh uh compliance metrics?

It means that RIMSA is expected to be on scene in zones marked A, for example, 90% of the time in less than eight minutes and 59 seconds.

Mr.

Driscoll asked me in one of our previous meetings about the impact of the 10%.

I mean, because if there's a 90% criteria, what about the 10%?

And I prepared a response and provided it to him for review.

I'll review some of the points from that response now because it's kind of important to really explain the EMS protocol that we use in our community as it relates to the response metric.

The eight minutes and 59 second metric was popularized many years ago for high priority EMS calls based on cardiac survival science promoted by the American Heart Association.

This mess metric has been used for decades, quite candidly, and it's used because it's easy.

Uh it's easy to measure.

Specific to P1 calls, RIMSA is on scene first and only to the tune of 59% of the time.

In those instances where fire is first, and I'll speak to that in just a second, um, RIMSA is there within three minutes, 71% of the time, and under five minutes, 95% of the time.

Core response, which is very important to the way our system works, core response by our fire agencies is used on all high priority calls, things that we refer to as echo determinants, things such as choking, drowning, electrocution, um, cardiac arrest, major trauma.

Um, in these particular types of calls, everyone goes.

I mean, it's it's all wheels are rolling uh immediately.

Aside from that, um, each local fire agency responds a little differently based on the EMD of the call.

In the case of the city of Reno, um, they tend to roll and then cancel in route.

In the case of Trucky Meadows Fire Protection District, uh, because we coordinate uh their their EMD in conjunction with fire dispatch on our platform at REMSA, um, we are able to provide them with information as to the acuity of the call and the need to roll or not.

And in the case of Sparks, we use what we refer to in our industry or at least in our business as uh Code 76, which means that the personnel go down to the vehicle and they wait for the EMD determinant to determine should they go, should they not go.

But notwithstanding that, if it's an echo determinant, all wheels are rolling right away.

There's no delay.

Uh so I just wanted to make sure that we understand how the system works in terms of uh responding to calls.

So all calls receive a response.

Now, given that I showed you about that eight minute and 59 seconds, clinical quality of clinical care is important.

Studies and current professional research show that the quality of care actually matters more than speed.

In Northern Nevada, our system of patient care begins with the call triage process, which is handled by clinically trained technicians who begin life-saving care, such as CPR, tourniquet guidance, child birthing, coaching, clinical decision making, assignment of appropriate resources, including uh integrated health solutions.

In all cases, in all cases, this is an important point.

In all cases, patients receive care before ambulances or fire resources arrive on scene.

Clinically trained EMS triage and call dispatching is the secret reason why RIMSA has been one of the most successful EMS operations in the nation.

A few years ago, Trucky Meadows asked REMSA to provide fire dispatch services to the agency.

REMSA currently provides effective, efficient, and informative dispatch of fire apparatus for Trucky Meadows.

And today we're actually actively working with our fire partners to expand this practice of consolidating fire and EMS dispatch to improve the utilization of fire resources and essentially save resources for high higher acuity calls and in particular for fires.

Dispatching the closest appropriate ambulance is absolutely important.

But the thing to keep in mind is that keyword appropriate.

And the reason why is because what we find is that EMS is used as the safety net for health care in our region and in many, many other regions.

And for that reason, we have ALS resources and we have BLS resources.

We've seen a surge in the demand for BLS calls in recent months, and I really think that's going to continue to rise.

And it's important that we repres essentially reserve or preserve our fire resources for those highest acuity calls, and that we don't consume their skills on a stub toe, for example.

RIMSA is a not-for-profit 501c3 organization and only charges for ambulance services when patients are taken to area hospitals.

Now you probably recall that you're you actually determine what our average bill rate is.

Our average invoice that we're allowed at this point is $2,261 and 13 cents.

Now I point that out to you because Medicare represents 44% of the patients that we care for.

And although you give us an average bill rate of $2,000, et cetera, our average collection on a Medicare is $440.

In the case of Medicaid, which represents 31% of the patients we care for, our average reimbursement is 245.

In the case of private insurance, and keep in mind, you know, we talk about an average bill rate that you know is governed, controlled, if you will.

Private insurance, which represents 20% of our patient mix, only pay $1,700 on average.

We have to really claw payments.

And then we can have a fair amount of uninsured.

5% of our patient mix is uninsured, and our average collection on the insured uninsured group is 48 dollars.

48 dollars.

So I really want to kind of give you that context so that it all kind of fits together because the one thing that I think that we've come to realize, as we've had many conversations over recent months, is how complex the EMS world is and what it takes to make it work and how the public is consuming EMS.

With regard to REMSA's community partnership, RIMSA believes strongly in being able being a collaborative and cooperative partner in regional health care.

I want to give you just a couple of examples of that.

And this is one I that just kind of harkens because I I saw it in the news, which made me think there's confusion.

Um RIMSA replaces medical supplies used by fire agencies or reimburses fire agencies for the cost of such supplies used in the case of co-responses.

Absolute fact.

That's also part and it is stated in our franchise agreement that we will do that.

Not many people are aware that REMSA picks up that cost.

The other point that I want to just draw attention to, because it is significant, is last year, uh, as I think I mentioned, uh, we transported 61,290 patients in 2025.

And of that, um, we incurred it because not everybody needs a ride to the hospital.

A third of the time a ride to the hospital is unwarranted, but we provide care on scene.

The value of that care on scene, 7.7 million dollars.

That's a cost of doing business for REMSA.

The other component of uncompensated care is when we actually transport.

That's when we do provide the care and transport, and that's 1.9 million collectively or additively.

You know, if you put those two together, it's 9.6 million dollars of care that the organization provides to the community as a cost of doing business.

Speaking about our survey results uh for the month of March, uh, we had a score of 92.95, which was consistent with the same period uh in the prior year.

Our highest scores were the degree to which the medics took the problem seriously, and the skill of the driver uh driving the ambulance.

These uh ratings were higher than the national average.

Our goals to provide our community with timely, compassionate, and high quality emergency-free hospital care.

I want to speak just a moment for fire regionalization.

We are wholeheartedly supportive of the fire regionalization study that is being done.

We were asked to provide um and assist uh with with uh data that was needed for the study, uh, because as I think you've come to know, REMSA has an enormous amount of data.

Uh, we provided the data that we were asked for, and we uh we we look forward to the the results of the study later later this year.

I'm hearing September time frame with presentation to the governments in the um October-November timeframe for adoption, kind of like in the December time frame.

So that's the latest I've heard on that.

And then lastly, um I'm happy to report to you that uh our our meet and confer meeting that was referred to in the franchise discussion we had previously is scheduled for May the 4th, 2 p.m., I believe is the time.

And we're looking forward to those meetings, which I know we're going to discuss a little further in item number 10 for which Dr.

Kingsley is going to uh present.

All that being said, you know, I wanted to provide you with a bit of a detail and context to some of the parts of the operation that sometimes you know just kind of happens behind stage and uh and we we don't recognize uh what it really involves.

Um I'm happy to address any questions that you might have for me with regard to what I presented to you today.

Mr.

DePlanus, thank you for the excellent presentation.

Let me see what my colleagues have questions about today.

Mr.

Anderson's up first.

Thank you for the presentation, Mr.

DePlanis.

Um did have a couple questions, uh concern.

Um one of them in regard to the response times, and you were talking about the dynamic, I believe it's dynamic dispatch, um, how you move them around depending on um the algorithms that show where the need is.

My concern is that if you're using a system like that, you have light to medium duty vehicles with two people that are typically sitting in the vehicle.

And yet for the city of Sparks, a recent study that I showed or was shown was 44% of the time our heavy-duty fire apparatus with three firefighters, comes from uh fire station that they could be cleaning, working on equipment, cooking dinner, and they're able to respond more quickly than your ambulance 44% of the time.

I just want to make that comment and ask the question how can that be if you're more nimble and your equipment is operating in that that dynamic status.

How is it that we can respond 44% of the time on a heavy fire apparatus, which happens to cost 1.5 million in comparison to an ambulance.

How does that happen?

Well, first off, I'd have to say I'd have to know what your data is.

I mean, because without knowing your data, it'd be hard to compare.

I mean, like there's one example, in fact, that I had a conversation on uh just uh this morning.

Uh it came up in a matter of uh of well it it was part of uh a discussion that we had.

You had an incident, for example, at one of your fitness centers where there was a shooting um, or at least it was threatened to be a shooting.

Uh the person called, he was mentally um you know upset, and he was going to go in the sports center and shoot people.

Well, fortunately that did not happen.

Um, but we happen to be in that very parking lot.

That's why I mentioned that.

Um we have ambulances placed.

Sometimes we're going to be the closest, sometimes we're not.

Uh it just depends on where the incident is.

So I bring it up because that was just a matter of chance.

We posted in that parking lot of that particular health center when that particular incident happened, and your police responded very quickly, and you know, and it was gunfire and that kind of stuff that took place.

So I'd have to know your database to really um reconcile, if you will.

Okay, I'll I'll make sure I work with our team to be able to get that for you to make sure that we're comparing apples to apples.

But again, it's just I can't wrap my head around how that could happen, that this you know, big lumbering fire apparatus is is able to get there almost half as um often before before your units show up.

Um, the second question I had, or again, whether you want to put it as a question or concern, is you were talking about um how cost effective the services are that are being provided by um RemSA.

It just came up with us at the City of Sparks.

Our employees were submitting complaints to our insurance company because they were receiving bills from RemSA that were over and above with the insurance covered.

Once we looked into it, our human resources department found out that RemSA was overcharging the norm, and that's why our insurance company wouldn't pay the full amount for our employees.

So these are our very own employees at the City of Sparks, which we happen to have what I would call a Cadillac program, can't even cover the cost of your service because the services are so highly priced.

Once again, I have to, I mean, is it that your statement is a complex one because when it comes to ambulance coverage in insurance policies, they vary very significantly.

Uh so you can have, in fact, a Cadillac or Rolls-Royce policy, if you want to call it even more elevated than that.

And ambulance coverage in all of these policies varies significantly because it's kind of how the insurance companies manage the premium costs.

the the cost of your service because the services are so highly priced once again I have to I mean this it that your statement is a complex one because when it comes to ambulance coverage in insurance policies they vary very significantly uh so you can have in fact a Cadillac or Rolls-Royce policy if you want to call it even more elevated than that and ambulance coverage in all of these policies very significantly because it's kind of how the insurance companies manage the premium costs um so I'd have to look at that particular situation um because I really would want to understand the details um because with without the details and and the facts it it's hard for me to reconcile that but I do know from our billing office that ambulance coverage is all over the map when it comes to who covers what and and it just depends on the policy within the company because it's not like you could simply say well Signa's the best well because there are many, many, many versions of Cygna's insurance policy and the ambulance coverage will vary um you know from policy to policy and I understand that.

And yes just like any other services they they can vary a great deal in what insurance companies want to cover.

Again my my concern is that they're talking about the average cost of an ambulance ride if you will um that that RemSA was significantly higher than that average.

So I'll I'll work with my team to to contact you and and uh let them explain what what we're seeing.

Thank you.

Please direct it directly to me though because I want to make sure that we get get you a timely response.

Thank you.

Mr.

Anderson thank you so much for your comments I'll also offer that I'm happy because we are the district board of health we do oversee the franchise that if you have some data sets that provide the answers or the the issue that you're looking at we'd like to know them here too right it's not just enough for you to work with RemSA directly but if if your equipment is arriving first more often I think you said 40% I'd like to know that right and then if there's cost issues I'd like to know that because that's not consistent with what I understand we have evaluated and therefore I would like to be able to look at the data set.

I I agree um with Mr.

Duplanus that we've got to compare apples to apples um and I'm not sure that in this particular form we can easily do that.

So Dr.

Kingsley if you'll coordinate some effort in that regard and make sure that we are keeping track of the uh the issues as they arise we'll get to the bottom of it.

Any other questions from the body?

Mr Deplanus I have a couple um so the first thing I want to talk about was um and and I'm focusing on the report there may be other questions that I have in our other agenda items but I wanted to um you know we had this proclamation about this being um emergency medical service week and I wanted to uh acknowledge a couple of things I saw in the comments some of the comments roll from month to month and then they end up being there again but I a couple of them I noticed that I really wanted to point out uh this one really got me which it says you kept me from dying and I was very happy about that right that was a very nice comment that someone wrote in there was another comment that um someone says um the care I receive was empathetic and professional they eased my concerns making relieved that I was getting top notch services and ultimately the reason why I'm grateful for you to provide these in this comment format is because I cannot be there.

I certainly don't know what your folks are experiencing.

Occasionally there's a bad comment and that happens I didn't see any in here this time but what I will say is I'm grateful to see these comments because that is what our expectation is and certainly Mr.

Anderson's expectation or any of us on this board is that those are the kind of comments that provide an insight into what happens um with the delivery service that you've talked about.

The second thing I wanted to ask about was dispatch.

So I've had the opportunity to meet with a number of our different firefighting um uh groups individually individual members and there was a conversation which I I I'm not as well aware of or well versed in I wonder if you might shed some light on and it has to do with the way in which the calls are received by dispatch and then characterized as different levels of service as I understand it there's everything from one through five what what are the service levels I I don't I I can't comment about the the specific levels but what what you do say is correct I mean because I don't know that level detail what you do say is correct um in that the the calls come in to primary um answering points and then at that point they're saying police fire medical and what's important to remember is that when it comes to the call handling at that point when the person says fire or medical they tend to be intertwined uh and for that reason I and the and the fire chiefs talk periodically because I mean we have a common goal and as I indicated about the echo determinants those are calls that we pick up very quickly if it's a choking we know that you know wheels are rolling before we finish the EMD and that's gets triaged as for example like you just said that would be an absolute priority one all wheels are rolling right away get first hands on on patient.

All wheels are rolling right away, get first hands on on patient.

And then yes, as we go down the EMD process, it then trickles down into lower levels, um, all the way down to, you know, is it's a behavioral issue where somebody, and this actually is a person that does this in the community.

You we finally got them to stop calling 911 because he got anxious.

You every time he would get anxious, he would call 911, needed help, and we was respond.

So with integrated health, we were able to essentially work him out of the system.

And so that instead of calling 911, call us in our office.

You know, we'll walk you through, you know, this anxiety issue.

So yes, the calls do get triaged to where, as I said, it's from all wheels rolling immediately, all the way down, let's say next level would be like ALS, advanced life saving uh support.

And then but beneath that would be like BLS, where the patients essentially stable, not likely to die, but need help, all the way down to sometimes we send an Uber.

Um that is one of the things we do do.

If someone needs to go to urgent care, they don't have a ride, we'll send them an Uber, pick them up and take them where they need to go.

Well, and I think you've shed some light on it.

I I want to still ask the question though, and and it has to do with sort of an anecdotal experience where um there is some concern raised by firefighters in my jurisdiction that sometimes they arrive at the call and they have been dispatched and it's been mischaracterized in terms of what level it really should have been a one, a two, or three uh and so I I I'm not saying that I have a data point to share with you, but I'm trying to understand how frequently is that happening where um our firefighters and anything arrive at a call because they've been called to do so, but they arrive there and you find that they have been summoned unnecessarily, right?

And and the concern is that because of the control of the dispatch system, that you were able to dispatch them, but maybe you didn't need to, but you characterize it in a certain way so that the dispatch caused the fire folks to respond.

Does that happen, or is that something we're trying to work through?

I know it has to do also with the different kinds of communication equipment that are being used.

But what I'm trying to say to you is if a frustration comes from my firefighters that they believe they're being dispatched unnecessarily to a call, I don't want that to happen.

And similarly, I don't want them to not be dispatched, and then we find out it's a uh a life-saving issue, right?

So, how how do we work through that from the dispatch side?

Because that's what I didn't hear in the answer.

It can happen.

It can.

Um what I would ask is that when those incidents do happen, we need to know about them so that we can learn from them.

And you do like after action, yes.

Yes.

And in fact, we actually meet um nine o'clock every morning to do, we do an after-action review every single morning on campus where we look at calls of the previous day and what can we do better?

I mean, so an after-action review is a normal part of our process.

So if there are instances, I absolutely need to know about them.

Um, because yes, it can happen.

And and in part, the reason why it can happen is that if you take, for example, in your case with the city of Reno, City of Reno is operating on a different platform than what Remsa is.

I mean, so there's there are some differences there.

And obviously, we think that the hexagon or octave, whatever it's called these days, we think that it would offer a solution, but we we do have a plan B.

I know Commissioner Andriola has asked in the past, you know, what's the plan B if we are not able to go live with with the hexagon so that we can master this.

Chief Edwards and I have had plenty of discussion, JW Hodge at City of Reno and I have had discussion as well as uh uh Chief Cochran.

We want to solve this problem of getting everybody one way or another, we need to be on the same platform to minimize these types of uh of issues.

Well, I certainly think that that communication system and our hope is that it's coming soon.

We've been saying that for a while now, is part of the solution.

Let me ask as to the act after action calls that you do each morning, who are part of those?

It's it's you, your medical director, your chief of some.

I mean, tell me who's in there.

It's our dispatch leaders, is our ground operators, the managers and and supervisors that that physically work in the field throughout the day, overseeing the crews.

Um, and uh that's largely the people, and then of course, you know, you know, folks like myself, I pop into those meetings periodically.

Um, our chief operating officer Adam Hines is is is is frequently, in fact, typically all he's the one that chairs the meeting.

Um, but I also have a couple of my data analysts in that meeting as well, uh, because we're always looking at how are we doing with regard to or we put in ambulances in the right parts of town to get effective coverage in the in the community because we do have to make adjustments.

And then we also look at scheduling.

So, you know, the folks that we have that are responsible for scheduling are in those meetings as well, uh, because we're looking at if someone is sick, called out an issue, then we have to find another partner for that person in order to fill the shift.

So every morning, nine o'clock.

Um it's essentially my you know, the different the different disciplines of the operations team that it takes to get the job done.

And if one of our engine companies or crews at the city of Reno has had a bad experience the day prior, let's just say, how can they transmit or communicate that information to this uh clutch of people who are gathering?

First off, get it to myself or to Adam Hines, um, and we will make sure that it becomes an item that is resolved in the uh after action review meeting.

Okay, thank you so much.

I appreciate that.

I might also ask on that very topic.

Um, I'm guessing about six months ago, um, there was a question that um you know had a similar question came up uh with the um the leader of the 731 uh labor union group.

And you know, because he had raised this a similar kind of concern.

And you know, and I asked just as I'm asking now, you know, get me the data, get me the data so that I can work it.

You know, so it's not this is not the first time this question has been on our minds, um, of one for which we'd like to solve because the last thing any of us want to do is uh misassign and misallocate resources to our community because we've got to really be very judicious about what we use, and as you mentioned, you know, uh uh uh one to one and a half million dollar fire apparatus responding on a stub toe is just not what we want to do.

Yeah, I think we all agree on that.

I'm gonna um sort of put a note in my uh tickler to make sure that we circle back with you.

I know the folks at 731 pay very close attention to these meetings and are here today.

And so uh it sounds like an ongoing issue for which we'll need some additional conversation, but thank you for that.

You've given me a lot to chew on.

The last question I had, and then I'll see if anyone has any, is I noticed this EMS Explorer program.

Well, what is that?

But you've launched that just recently.

Yes, and actually I am not the right person to comment on that.

I mean, uh, someone circle back with me because it looks interesting.

I sort of fundamentally understand explorer programs and other agencies, and I'd like to know a little bit more, but in the presentation materials, it was a little blurry for my end, and I couldn't get into the QR code.

And so I would like to know about it because it sounds like an interesting program.

Well, thank you so much.

Let me see if there are any other questions from the board.

Okay, we don't have any.

Oh, Dr.

Kingsley, you've got some comments.

Thank you.

Just wanted to make a comment that with uh subtle change in the presentation and the monthly report that is presented.

So uh under federal obligations, we required to be accessible to our public in our community, and so uh we're in order to do that to meet that compliance.

We are providing a link to that report currently right now, so that's where it changed.

I just wanted you to be aware of that.

So when you click on that link, it does open it up there at Rems' page.

And so this is to meeting our uh actually this month's we are meeting compliance with our accessibility.

So I just wanted to acknowledge that uh the change in that report of how you receive it.

No problem.

Thank you.

That must be why I can't read it quite as well as I have in the past, but thank you so much.

Uh I'll look for a motion for acceptance.

Mr.

Driscoll on the first, Mr.

Brown on the second.

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, um that brings us to item nine.

Uh item nine is a hearing, unless there are any questions from the board.

I'll look for a motion.

Okay, I have a motion by Mr.

Brown, 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.

Any opposed?

Motion carries unanimously.

Nine B is a uh similar matter, but with air pollution quality control hearing board.

Any questions from this body?

Hearing none, I'll seek a motion.

Ms.

Andrew L in the first, Mr.

Driscoll on the second.

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.

Item 10 is uh presentation and identity or identified items with the Northern Africa Public Health to discuss the REMSA Health EMS franchise agreement.

Uh I believe if I'm not mistaken, Madam Clerk, we have public comment on this item.

Yes.

We have Mark Tyer, followed by Patrick Walsh.

Mark, welcome and good afternoon.

Thanks for being here.

Uh Mark is the president of the Trucking Meadows Fire Protection District.

Union.

And it's good to see you.

Absolutely.

President 2487 IFF uh trucking meadows firefighters.

Um I'm here today mostly to speak about the REMSA uh contract and the upcoming meet and confer meeting that you have with Remsa.

Uh before I do that, I'd like to start by recognizing and congratulating the flight nurses and paramedics of REMSA Care Flight Division who just recently voted to unionize under the Transport Workers Union.

Um this is a big bold step, uh giving them a voice in their own organization, specifically on their own safety, among other topics.

And I'm certain safety will be a primary topic when they come to collective bargaining under that new union.

The members of IFF Local 2047 stand with you.

Uh the new members of the uh the care flight divisions union.

Uh as mentioned, I'm also here to address the Northern Nevada Public Health Workshop's list of concerns regarding the extended REMSA contract.

Uh first of these is the REMSA board does not adequately adequately include public fire agencies that act as primary co-responders.

As was mentioned previously in the Trucking Meadows Fire Protection District, we are on scene uh predominantly more frequently and earlier than than uh RemSA, as our neighboring agencies are.

In these cases, um, we are providing that initial care to that patient to stabilize them, prepare them for transport.

Um we share that a large portion of that workload in the field, yet we lack any meaningful input in the system governance.

That disconnect impacts accountability and system design.

Representation should reflect the reality of how EMS is delivered in this region.

Secondly, priority two calls for service make up a significant portion of demand and should carry performance accountability.

While on the surface, they seem immediately life non-life threatening, delays can still affect patient care and system efficiency.

There should be defined response standards for priority ones, priority twos, uh, in addition to the ones that are defined as critical life hazards.

As an anecdotal piece of information, I went on a call a couple months ago that was not prioritized at all.

It was a ground level fall with a headlock, turned out to be um cardiac arrest.

So that's once again, this is anecdotal, one little bit of information.

But the system isn't perfect.

We do need to have accountability for our priority twos as well as our priority ones.

Um, and just as a point of clarification, any subcontractor for REMSA would fall underneath those same um requirements.

So this is not something that I'm suggesting that we're not willing to fulfill ourselves.

Uh finally, if REMs and the Board of Health are concerned with community safety and positive patient outcomes, they need to reconsider the closest unit response.

Fire and ambulance personnel can do a lot to stabilize a patient, but in most critical priority one cases, a positive patient outcome requires hospital-based interventions, such as surgery, labs, and imaging.

In other words, faster arrival to that patient is faster delivery to definitive care.

That's really all I have for you today, and I kept it under three minutes.

So you got 20 seconds for questions.

Well, we don't generally ask questions, but I'll uh ask um Certainly tell me the name of the care flight union.

I tried to write it down, but did you oh it's the uh sh it's the transport workers union.

It was announced on their website yesterday.

TWU or uh Transport Workers Union, yes.

Okay, thank you so much.

You're very welcome.

Thank you.

Madam Clerk Patrick Walsh.

Patrick, hello.

Sorry about that.

Good afternoon.

For the record, Patrick Walsh.

Uh at the center of everything being discussed, being franchise agreements, response metrics, compliance standards.

There's one principle that must guide every decision.

Getting the right help to the patient as fast as possible.

Right now, our system does not consistently achieve that.

We continue to operate within a structure where jurisdictional boundaries and franchise models take priority over what should be the standard of care.

Sending the closest, most appropriate available unit, regardless of whether that unit is fire-based EMS or private ambulance provider.

That gap has real consequences.

When the closest resource isn't dispatched, patient contact is delayed, and emergency and in emergency medicine minutes matter.

The materials listed in the Northern Nevada Public Health Workshop highlight important concerns.

A lack of clear compliance incentives and meaningful penalties, gaps in response time definitions and interfacility transfer standards, missing transparency and data access, and unclear or inconsistent expectations around system performance.

These are all symptoms of a larger issue.

We have not firmly established closest unit response as a non-negotiable system standard.

If we are serious about improving outcomes and accountability, then the franchise agreement must do more than outline participation.

It must enforce performance.

That means clearly defining closest unit response requirements across all providers, establishing measurable benchmarks tied to real-world deployment, creating transparent reporting so all stakeholders can evaluate performance.

And implementing enforceable consequences when the system fails to meet those standards.

Additionally, we should ensure that reimbursement structures and co-response expectations support cooperation, not competition between agencies.

The system should reward doing what's best for the patient, not what's best for a boundary line.

Thank you.

Patrick, and I didn't catch the agency you were with.

I'm so sorry.

I am a member of local 2047 and a 19-year paramedic 13 of which has been in Washer County.

Fabulous.

Thank you so much.

Thank you.

Appreciate you.

Madam Clerk, is that all we have for public comment on this item?

There is no additional comment.

Okay, thank you.

Dr.

Kingsley, welcome and come forward.

I'll just share for the board.

I asked Dr.

Kingsley to provide us with this update today.

And I'll just say a couple things to set the table as we're preparing the presentation item.

So the board directed Northern Nevada Public Health in January to meet and confer with REMSA Health within six months, and that work is underway, certainly as directed.

Part of that direction was to include feedback from stakeholders.

And so the district health officer through his staff requested feedback from all jurisdictions by May, or I'm sorry, by March 17th.

I believe uh you'll identify this hopefully in your presentation, but I'll say the workshops that were scheduled for skilled nursing facilities and one-on-one had no attendance from those facilities, unfortunately.

Uh, two jurisdictions did respond to provide written feedback, which was taken to consideration and is attached in today's packet.

Uh, the result is the 19 identified items, which in uh I have separated out as spanning governments, operational performance and contract language.

Uh, and today's presentation is designed to be informational.

The confer process does not require board action today, but is structured as a good faith dialogue process between Northern Nevada Public Health REMSA with board oversight.

So, with that, Dr.

Kingsley, the floor is yours.

Thank you.

Dr.

Chad Kingsley for the record.

Today, just bringing forward just the information that was summarized over us since uh the January District Board of Health meetings.

So, just an update to you today for the directive to meet and confer with REMSA.

So we synthesized our inputs from the both the uh district board of health concerns raised during uh the January 20 uh 26 review, as well as our system partner concerns on March 18th and April 1st in our workshops, as well as uh other contributions between 2024 to uh 2025, the dates of those which were provided in the in the attachments.

So, overall timelines and dates, sustained engagement for franchise discussion.

So, post-July to uh July 24 franchise renewal uh contractual dates, uh multiple forums from 2024 through 2025, uh which include JEC meetings, regular cadence and update up to the 2026 MSAB uh incorporation and the coordination with the District Board of Health, County City uh City Manage County and City Managers and Attorneys and Northern Nevada Public Health and REMSA coordination meetings.

Then post-January 2026 approval and amended franchise forums.

Those forums included the skilled nursing on February 8th, 2026, and February 12th, 2026, as mentioned, uh did not have attendance from those, but was widely broadcasted to them.

Uh workshop, the first workshop for our uh stakeholders uh was held on March 1st, April 18th, uh March 18th, 2026, and the second on April 1st, 2020 2026.

Those items discussed in there as well as the video um uh but it is available, but those items discussed were documented and uh provided here with any attachments.

So here, Northern Nevada Public Health and REMSA now on um It was noted on May 4th.

It was May 3rd here, just confirming May 4th, correct?

So the time is wrong there.

So May 4th.

May the 4th be with you.

Yes, may the fourth be with you at 2026, and we will meet confer.

So be the first of those meetings and then follow up to any of those, but items summarized and provided to the district board of health will be taken to REMSA to confer over.

And the intent that we see uh from that six month is identify immediate changes to incorporate into the amended and restated franchise agreement on July 1st.

Uh contractual performance and governance.

Um so we collect a clear year of data on those new performance metrics there.

And then identify and plan for future possible franchise amendment using annual or in the fourth year process to defined in the contract.

So we will return to the district board of health in May or June with 2026 from the results of those meet and confer.

Okay, Dr.

Kingsley, thank you for the brief report.

Um I'll bring it back now to the board.

I do have some questions, and so I'll reserve those till after, but I'll look and see who would like to start us off.

No one on this side.

Let me say a couple things.

Um, first of all, I I did hear a concern today raised by um seven or 2487 about the inclusion of firefighters in these processes.

And so this is sort of both a apology from me uh to those folks who find themselves in that position, which is to say that when um I got the green light as I understood it from our fire chiefs.

I of course believed that they were representing the interests of their members.

And so I think that's sort of some level of naivety on my part in part because I do not know uh, especially the emergency medical dispatch side of the house or the ambulance franchise uh fire fighting model that we've created in this region, as well as any of these people do.

So I want to know what we can do.

Is that something that's uh and maybe Ms.

Esp would say it's through the CIC or the MSAB?

There are all these organizations and the alphabet soup of it can be um confusing for those of us sit on this dias.

But how do we make sure that the people who are responding to the calls are have a role in the system that we are creating?

Because I, you know, if you're a firefighter and you're responding to 15 calls a day for medical services, but you're finding yourself frustrated by the service system that we've created, but no outlet to voice those frustrations.

How have we built a better mouse trap if that's the case?

Thank you.

In response to that, so it's it's complex, but simple it down is that the regional governance of the REMSA board that uh continues today is is one point of area that has been addressed and look towards that fire representation on the REMSA board.

Uh other areas that it gets into representation of uh is established in 2014 MSAB um, which is uh a model moving towards where representation can be uh increased there, but yes, also the joint advisory committee is where we meet with EMS chiefs and we review specific cases as well as performance and a lot of our performance metrics and our current amendment was was brought forward in those meetings.

Um there's always possi uh the opportunity to improve that inclusion.

I also say that we are also somewhat divided um in the sense that there are components that um require us to that they have to report to the state where we do not have authority and local authority that we've created through the ILA.

So some, if it is an individual, I say a case or a sentinel event that occurred and needs to be follow-up debriefed.

How can we improve that lies with the state many times?

We do not have the authority there, but we do try to incorporate that in.

But then how does that information from the state then come in and be integrated into our overall system?

So we do have various challenges as our point there, but yes, the recognition and is part of that to bring forward how do we better include fire within the participation of the city.

Well, and you can see I have a consistent theme today.

I I asked Mr.

DuPlanus sort of a similar and related question about how they get the information because what I don't want to have happen is someone like Mr.

Walsh, who's come here today and taken the time out of his day to air a concern, and then just have us go back to our lives and say, okay, we heard it here in this body in this room, but then we haven't done anything with it.

So I will be asking about that as we move forward in this process.

You and I have talked about the fact that this is an iterative process.

Today was not the opportunity to do every single thing that we wanted to talk about.

A lot of the material in the presentation was very good and very comprehensive, and I encourage everyone to read it.

We will have several months here still as we move forward to make changes, adjustments.

Maybe we're gonna add something back in that was removed, maybe we're gonna fix something that could be made better, and those are the areas where communication has to be improved for my perspective.

Um, that's both to Mr.

DuPlanus's concerns, which he gave me some good feedback today.

Um, but what we want to make sure happens is that the people who are the most affected by it, and you said chiefs, right?

They get to do the chief thing.

Chiefs start to get into that higher level of reaction.

And I'm looking for what happens to the people in the rigs.

Then you're transferring all these liabilities around.

I I don't like to hear those things, but I don't always know how to fix them.

And so from my perspective, I have you, and certainly um be you're like the tip of the spear to go to the parties, but there has to be a way for those people to plug into the system to build the better mousetrap.

And I think Miss Esp is someone who has been very consistent with me to be able to have let me voice my frustrations, but those have to be then translated into action.

So and and what we can measure and quantify, we can change, right?

It's not the anecdotal stuff is helpful because it makes some more sense to me, a non-person in this area.

But the important part is that you and Miss Esp and Mr.

Duplantis and each of the fire agencies are working to make these changes and adjustments.

Makes sense.

Yeah, you ready?

I am jumping.

I I am done, man.

I talk a lot.

Um I wanted to follow up on a couple things.

Thanks for putting this together, and more importantly, thanks for doing the workshops.

And thanks for actually dedicating the time to collect all this information, and it took a lot of time.

But I'm not clear.

What I'm not clear on is where the priority is.

It's it's there's a lot of information both in capturing and summarizing various members and and their um items that were shared at the January meeting, and then through the March 18th and April 1st, the 19 items that were captured, and again, thanks to uh everyone on the staff who put in the time and and capturing all of that data, but it's not clear on where these priorities lie.

Number one, number two, it was just echoed by the chair, and it was echoed throughout a lot of different comments by a lot of different folks about the JAC, and even though the MSAP is moving, the fact is it was removed, and that is not clear, and we keep on talking about it, but I'm not clear on how that gets integrated, and then how more importantly there is not only the voice the chair spoke about and some of the public commenters as well, but how they're actually at the table, and so I just appreciate the May 4th is around the corner, and um I will be saying may the force be with you as well, but it's not clear.

There's not a plan.

There's a plan to talk.

Is there and so I'm gonna make sure I'm understanding the entire packet of information that summarizes everything that came from both workshops and the January.

Will that then be discussed with RemSA on the changes?

So everything that's in here will be discussed.

That's what we're taking to REMSA, yes.

Okay, and so um will the JAC also be discussed in terms of how that works in turn in terms of what we just spoke about, not to re-regurgitate all that again.

It's on there to be discussed with REMSA, yes.

Okay, and what is the responsibility of RemSA to accept this information?

In other words, what I'm really getting at is a little bit rhetorical, because the contract is only as both parties and meet and cafe.

So there isn't really a responsibility for REMSA to agree to it, although we uh value the fact that it's in good faith, but there isn't anything that actually holds anyone responsible at this point in terms of the two parties to that.

And so May 4th, then we'll have the meeting, and then you're gonna be bringing back then the items that were agreed upon, and then the items that weren't agreed upon.

Because none of that plan, I'm I'm just making a little leap that that's what is that the plan then?

Yes, yeah.

And take those items to REMSA and discuss those items and bring back to the board those items that uh were either integrated and those ones that were not integrated and the the why.

And when will that come back?

Either in May or depending if it takes longer for those contract negotiations, uh not negotiations, sorry, just that discussion, the meet and confer.

Uh oh, not negotiations, sorry, just that discussion, the meet and confer.

Uh Herb will be there.

So as soon as would be uh May next district board health meeting or June.

When's when is the six months?

Uh August would be the August meeting, um, district board of health August meeting.

August or September?

I believe.

Yes.

I can't remember if it was September or August.

So in other words, if it's August.

It's August.

Okay, great.

So if you are meeting on May, and then it comes back in June.

And then if there is a high propensity of some items that seem to have a higher weight of um consideration, then what happens?

Do you go back and meet and confer again?

Or how how does that process fold out?

I would believe that that time it would be board's discretion.

And so any direction from the board on those items if they needed to be prioritized or um I can whatever it is not incorporated.

It doesn't mean it's no longer it's off the table.

It would be incorporated and prioritize that beginning uh July 1st.

What uh what is prioritized and what is discussed to uh for a possible amendment during that first year process as defined in the in the agreement.

So I think at one of the meetings, um I watched the um hour and 58 minutes or four hours, I can't remember.

It might have been four hours.

I don't know, I lose track of time.

It's a long meeting.

I watched, and then I went to the April 1st meeting, and I thought that there was going to be at least in this particular meeting before the meet and confer in these um tables that were presented as you guys were doing it live, that there was going to be additional columns of how you, meaning Northern Nevada public health felt were priorities, and I don't see any indication of what that is.

So that's where I'm a little bit confused on the plan.

Okay.

Is there I I know that was discussed.

It was uh forward on those points, and it was uh we would need to do further prioritization with our stakeholders stakeholders on prior prioritizing these items.

But we uh wanted to do to the expediency of the six months to be able to provide and move and be able to meet with REMSA in time so that we could come back and provide that information.

Well, I think it would be helpful to understand even if I were REMSA, I'd certainly want to understand.

I know all I had was you know shared, but in both the uh viewing of the uh workshop and then attending the second workshop, it was clear that there seemed to be some areas that seemed to have a higher priority.

I mean, all of it was important, and I'm not suggesting one isn't more, but if you if you're going into meet and confer, I would think a plan that would be helpful would be able to say this is really important for whatever the reason.

And so I was looking for that and just didn't see it.

So it's the plan seems to be lacking, at least from my perspective, a clear direction.

Okay, but um, and I thought that was clear in both of those.

So I just wanted to bring that up because I think we're trying to be fair to everyone, and REMSA certainly has been uh a good partner, and um very hopeful that their commitment to the community, which is longstanding, that the meet and confer is more than just this is what we'd like to consider, but the priorities, especially with the JC going back, and I'm not gonna pick the ones that I'd like to actually prioritize.

It's not fair for me to do that.

Well, Miss Andrew, that's ultimately why I made the decision not to change the structure of the report to you because every entity had priorities that were different.

So rather than say here are our priorities, which we wouldn't have had the ability to opine on, we just said all of these are priorities, go forth and in good conscience take them up.

I think people understand that some things are bigger things than others, right?

Okay, um, and but you and I could disagree about what those are.

So rather than like rank them or say these two are really important, we wanted all of them to come.

No, I appreciate it.

I think all of them should come for the record.

I wasn't suggesting they all shouldn't, but it was discussed.

So I was just following up what was discussed in the workshop that both I watched and attended.

So I was just following up from that perspective.

But thank you, sir.

Thank you.

Yeah.

I I wanted to go over something too um in some part to have a conversation with you, Dr.

Kingsley, um, about the board's authority over the agreement as we move forward.

So I I want to make sure that my colleagues understand and and uh Mr.

Kaplan might uh jump in here if needs to, but the board of course remains meaningfully uh engaged and has oversight at every stage of this agreement.

There's annual compliance reviews, a mandatory comprehensive review before March of 2030, and the ability to terminate for cause on all remaining uh remain fully available.

Is that correct?

Excuse me, Herb Kaplan for the record, yes, that is correct.

Thank you so much.

And then over the five-year term of the agreement, the board will have structured review touch points every single year.

So in years two and three and four, an annual compliance review is contemplated by September 30th of each year.

And in year three, there's a market study that is due by December 2028, which benchmarks REMSA's performance and cost against other EMS systems, which was the design check-in period.

And so I want to make sure that the board understands that there are comprehensive reviews built into the agreement.

On top of that, um, after the comprehensive review, not later than March 31st of 2030, the district can give REMSA health notice of non-remenewal at that time, and the parties continue under the term to the agreement or until 2031.

And so there are opportunities for us to have meaningful oversight.

We aren't locking ourselves into something that we can't get out of.

I want to share also for those who were not on the board at the time that this decision to structure this contract in this way was after a period of time in which we really had historically had much longer contract periods.

And I think what we learned uh through this process is longer contract periods do not endure to the benefit of transformative change.

And so we wanted to make sure that I think Dr.

Kingsley, thankfully, due to your leadership, there was a lot of um sort of pushback against the old model.

And so I think that you brought that experience from Southern Nevada, and and it was gratefully received here because I think and I think Ms.

Esp too is added to this conversation.

Those review periods are designed for us to continue to have control over it so that when we do see things that are not working, they can be reasonably uh brought into the conversation.

I don't think that RemSA has ever been the kind of partner who says it's our way or the highway.

I know some people have felt about that historically, maybe that was the case, but not under this current administration.

And certainly given their um participation in this process, they have shown me the confidence that they are participants willingly in the process.

So I'm very grateful for it.

I think I'll continue to stand by what I've said earlier, which is this contract maybe is not perfect, and there are still things to work out, but I have never believed that in contracting that uh perfect should be the enemy of good.

We all want the same thing, which is good patient health care outcomes.

We want people to save uh lives to be saved when it's necessary.

Um, and so that is I think what we're working on.

The fact that the REMSA agreement was amended in the 40 years of the agreement suggests that when there are issues that arise, they will be reasonably and timely dealt with, regardless of what any of the things that lawyers try to design to protect uh our consumers, right?

And so um I I can't remember what the number was, but and maybe Mr.

Kaplan would tell me, but it was something like um 65 amendments over the course of a 40-year period.

Now, some of those became side agreement and memorandas of understanding, but in some way it was an evolving document.

This document is not intended to be inflexible.

And I again I want to call out uh Dr.

Kingsley your role in that because um I'm good at contracts, right?

I'm a lawyer in my professional life, but you are very good in having the larger vision for what we're trying to accomplish, which is good patient outcomes.

And so for my part, I'll thank you for that uh and then see if there are any other questions at this time.

Okay, thank you so much.

Um and I'm not sure, Madam Clerk.

Was this for oh no, this was presentation only.

Thank you so much.

Okay, Dr.

Kingsley, don't go anywhere because you're on the hot seat.

Welcome to Nevada, where we get to review you annually in a public meeting.

Uh I will say as we tee this up, um, first of all, um, this is a unique thing that happens in Nevada.

Uh, it is something that uh we have on as elected officials certainly, and and and Mr.

Driscoll, you've experienced in a unique way, and Mr.

Brown, you've experienced in a unique way, um, that we do this the Nevada way.

And sometimes that becomes um very uh challenging.

Oftentimes it can be frustrating for everybody involved.

What I will say about this process is our great folks, um Lori, who's here with us today, have really made it so that we could be successful as a board.

And so I am grateful for it.

Uh this will be the opportunity for us to have uh a discussion then about Dr.

Kingsley's uh last year of work with us, the evaluation results, and so we'll open item 11 and welcome Miss Griffey.

Uh and again, you have my great thanks for your work in this because it has been iterative.

You've been very gracious and kind, uh, especially as to me, who is uh an old dog, and you've had to teach some new tricks, and also Miss Andrea, who has been really gracious to me in leaning in in this process.

So, Ms.

Griffey, you have a presentation, I think, which is brief, but I also asked Dr.

Kingsley if he would like to make a presentation.

So I'll let you start out, and then we might go the other direction with him.

Sounds good.

Thank you so much.

Uh good afternoon for the record, Lori Griffey, the HR rep for Northern Nevada Public Health.

Dr.

Kingsley's annual feedback survey process, questions and list of participants were approved by the board at the March meeting.

The survey was distributed to the list of 88 approved participants on March 27th.

Email reminders were sent to encourage participation on both March 31st and April 2nd.

The district board of health or the district health officers' feedback survey results are in your packet.

The 360 feedback survey process utilized as a weighted component format, and your packet includes two separate score ratings.

The first score is compatible with the 2025 360 survey as it includes the same three groups of participants.

The 2026 and 2025 comparable data can be found on page six of your packet.

The second rating score includes the original three groups and a fourth group of participants, uh staff who supervise that were added this year.

We are providing the two separate ratings as the first score provides the board with comparable data to last year's survey, and the second score provides the additional input from staff who supervise.

The results have been compiled, and you are in your board packet for your review.

The second page of the packet has Dr.

Kingsley's overall comparable rating for 2026.

Further information in the further into the packet, you will find the survey results, how each question was scored, and the overall rating.

The scores were averaged by section and then multiplied by the weight of the category.

The overall score was assigned based on a rubric three-point scale.

The 2026 comparable feedback results received a 2.08 overall rating based on a weighted average of all the components.

This score does fall within the effective rating.

The second feedback rating, which includes the new group, staff who supervise, received an overall rating of 2.07 based on the weighted average, and this rate also falls within the effective rating.

There are there was good participation this year.

We had 100% of the board members who participated, 100% of the internal leadership and direct reports.

We had 66.67% of the stakeholders who participated, and 70.27% of the new group staff who supervise participated with an overall participation rate of 84.24%.

This percentage, this participation rate is the highest we've had in many years.

If Dr.

Kingsley receives a satisfactory evaluation from the board, his contract will automatically renew for another year, and he would be eligible for a 5% merit increase, which is standard for county employees.

Staff recommends the board accept the 360 feedback survey results as presented, and if possible, approve Dr.

Kingsley's merit increase for this year.

Before we turn this item over to Chair Reese, so the board can conduct Dr.

Kingsley's evaluation, set goals, objectives, and expectations for the coming year.

I do believe Dr.

Kingsley has some information he would like to share.

And we also have Patricia Hurley, Chief Human Resource Officer, and Dr.

I'm sorry, Dave Solero, Assistant County Manager here to help answer questions.

Thank you so much, uh, Ms.

Griffey.

As I said, it's been a pleasure working with you.

Um, each of us work with different HR components in the various boards and we sit on, and you are one of the finest.

So congratulations to you for your hard work.

Um, Patricia, also a very gracious, and Dave Solero for their help in this process because it does take a lot of folks to do the HR work that you do, but thank you for that.

I'm gonna turn now, and you said that we we said it uh scheduled it as having Dr.

Kingsley go first.

Yeah, perfect.

Thank you so much.

Dr.

Kingsley, welcome.

Thank you.

Welcome.

Dr.

Kingsley for the record.

District Health Officer, and I'd like to mirror those comments.

Lori, thank you so much for your time and participation and patience throughout this process.

So just wanted to review over my last year on some of the points and uh successes of my second year.

So points to point out strategic leadership and governance.

We advanced the REMs of franchise revision for EMS accountability and adaptability.

Um we've had three since my during my two years here.

We've had three third-party reviews, both in CCHS, AQM, and EHS.

Uh CCHS and uh uh population health, uh, who had a realignment and support based on the first uh third party review.

And then during this year, the EHS announced uh visits pilot is continuing forward, and we are working towards performance metrics and workplace culture as identified with in that party review.

But uh those have been very valuable to us to be able to enact change and transformation and help guide us on those points.

And so, as always, change is always slow, but we have seen progress among our staff, and as well as points to being able to address for our community and the services that we provide.

We've had successful interventions in tuberculosis, measles, and pertussis.

Uh very unique case in tuberculosis, the first time ever in our history, we were able to actually use our authority to ensure that an individual was not contagious to our community and received the correct care within a hospital, uh, both legally and and and correctly, and uh and staff went above and beyond and what that individual experienced and what we were able to coordinate with that individual with another state.

We did have our first measles case, and again, staff and their time and uh that was put into that and the care and the focus on that.

And then, as over the last four months, our Protestant ongoing outbreak that we've been doing and responding and working with our community uh very much making sure that staff feels supported, enabled and being able to respond to that kind of uh successfully.

Uh, we had the completion of our district board of health strategic plan with transition to the next three year plan.

So when I began, we were midpoint in the previous strategic plan.

And uh, as direction from the board was to continue continue forward with that plan with no changes.

And so we have begun that next process of our next three-year plan and beginning our workshops with our staff to be able to identify from the direction that the board has provided for a strategic plan so that I can help enable and direct with the board's directive on that for strategy.

Uh we had a realignment over the last year of leadership meetings to focus on increased transparency and shared governance, uh, focusing on informational versus transformational.

Now we have a monthly series of agendized points of meeting both with directors as well as ODHO and AHS staff, then core leadership and recently started in January.

All staff that supervise, we have a monthly meeting with them at the end of the month.

That in transformational, there is beginning to do case studies as well as uh as trainings for them so they can feel enabled and strengthened three months into that and very productive and positive, and also including all those that supervise in those meetings.

We also had two surveys during this last year to help identify where we can uh in improve our workplace performance and our culture, both a PH wins survey and Washoe County HR surveys and a WCA survey that also came out uh post these ones.

From that, I began an all-staff one-on-one for both for transparency and shared governance, about three months of that.

So, based on their birthday months meeting with each staff members to get feedback from them and their input.

Um, those have been wonderful meetings and wonderful points that uh staff has brought forward focusing on what is transparent communication as well as what do they need to feel supported and valued in their position and any one point they can see to help improve.

And so we received valuable feedback on that and very positive meeting with the staff, and so that will occur during the rest of this year.

And then uh increased operational communication, the whys, and we are focusing to help provide our staff with the whys of decisions as well as incorporating to them.

What I'll say from the one-on-one staff meetings I've had with them and staff is is transparency but also boots on the ground.

Similarly, what we just spoke about with fire agencies is that those staff that are boots on the ground, that shared governance, what inputs are they providing?

And they they want their input and as well as valued.

So it's been some key points that they've brought forward and some uh great ideas that we'll be moving forward with that and being able to uh ensure that their voices are heard as well as uh and part of that shared governance.

And they understand very much that shared governance is not shared decision making, but having their voices there and heard and representative is important.

Uh performance metrics, just overall, but with our our partners increased uh biannual communications accountability with our interlocal agreement partner boards providing those um uh biannual updates to to the boards and accountability for those questions.

Uh started that during this last year and uh have enjoyed going to each of your boards to be able to be there, be accountable to you, but as well as provide the information of the of the health district of increased availability and accessibility to community partners uh you in the UNR School of Public Health.

We've had amazing programs.

We began shadowing programs for their students as well as a community advisory board and participating with them as well as upcoming uh research uh as part of the process too, being involved into it over the next year.

The the Nevada State Public Health Laboratory will be moving from the uh School of Medicine to the School of Public Health, and as we're looking to improve processes there on both uh early detection as well as testing.

And as we're looking to improve processes there on both uh early detection as well as testing, it's uh a project there working with Dean Mugay and been wonderful partners there with us.

Numerous community associations on meeting with them and their public where they are at, uh Chamber of Commerce and presenting there and being a participant of that, neighborhood advisory boards, making myself available and accessible to any of those community members out there.

And it's been wonderful to be out there and communicate and be part of uh those processes.

Um we have seen a decrease in environmental health services related complaints from stakeholders and community, uh, while an increase in uh in EHS deliverables.

This is really uh a point during my first year, but that has continued forward, and so it's been good to hear that uh those complaints.

Now there's always uh various ones that come in, but uh the larger complaints that we saw so many years ago.

Uh the community, we felt that we have worked with them and been able to address and meet those needs, which they expressed to myself as well as my staff, and uh and and meeting with you and asking has those numbers gone down.

I've confirmation on those points uh any large of what previously we saw, and then continue to provide a prompt response and partner uh to community to to our partners, both the county, um the any county sparks and reno to be able to provide and those community inquiries that come in and to be sure they get a prompt and prior response.

If not noted, so previously there is a scorecard that uh uh is for uh public records request as well, and uh we did very, very well in that.

And so we were uh uh happy to see that both staff that it is important for us to be interactive with our community.

Budgetary achievements.

We know that we are in difficult times across the board, both state and federal.

Uh, during my first year, we put the goal of a 10% reduction as well as using that through our vacancies and our fiscal year 25.

Our salary savings were able to save 1.5 million.

We are in the same uh projected increase for the for that for our fiscal year 26.

We'll have those numbers to you following the close of the budget.

Um, increased efficient through modernization.

So it was though a challenge.

We had been previously above the base for an informatics bringing, and uh, it was a challenge.

Do we bring this person on during this time?

But bringing that informatics component on has saved us the equivalent of three FTEs.

And so it's been a wonderful point that um we've uh that enabled the yes, direction-wise, please hire this individual and been able to follow for that, and it has brought that doing more with less, and it's been a wonderful process.

And what has brought in many of our dashboards because of that informatic specialist that was brought in and hired.

Continued representation to secure two million from the state.

So we were put into the governor's budget.

We have reported and we're spending every dime and ensuring that we're spending every dime penny of that to the state, and uh have been reporting to that.

But we're receiving that so a million a year.

So fiscal year 27-28, we do receive one million dollars from the state now in uncategorial funds, and that has been beneficial, essential for us, especially in our epidemiological services due to the loss of uh federal grants.

Uh establishment and ongoing partnership with the county.

So during my first year, we met uh uh various times, but I saw the importance that this year moving forward, we needed uh further alignment, and so we met monthly starting last September, uh, sometimes more than monthly, but meeting with them uh on a monthly basis to ensure that uh our the processing and preparation of our budget was in line with those uh budgeting principles as well as receiving direction from them on the management of it.

In April 2026, seeing that where we uh are currently adding our budget process, I initiated a budget Congress that will begin has begun.

We are exploring uh priority and performance-based budget and doing that with staff as well as analyzing each one of our programs.

Um, thankfully, uh Mr.

Zenteno, uh, the director of AHS had worked previously at the state and managed with those budgets.

So he's been a value process in that.

So, with our core leadership, we are going through that.

I think the biggest thing from that, what I've seen over the last year is how we tell you the story of that, and how do we prioritize and how do we uh with our performance?

And so where we are already set up many ways in that with our objectives that we set up.

It's uh been a priority.

So I started the budget congress, and we'll be getting debriefs as throughout this Congress with you to make sure that we are correctly aligned on that.

But we hope to have that budget and result of the budget congress beginning in September 2026.

Then our state and federal partnerships for advocacy and representation, just want to say how important these have been both in our state and representing and getting the uncategorial funding, but also at the federal level has been many challenges through this year, and both were grants that we have lost and was some that we have almost lost and got back.

Uh, on one in particular, it started at seven, uh started at eight o'clock in the morning on a Saturday, and that was for our public health infrastructure grant.

And I was one of the five states that responded and work with our federal partners through that.

And we got up to about 15 other states that we like, hey, I need this information.

How much do you spend?

We have to be able to go speak with our representatives.

And we I provided Nevada's information on that, and within four hours, they were able to turn around FIG previous, similar to the SAMHSA grant that was reversed.

It took about two to three days.

This one, thankfully, and took us one day.

So it was uh it was great to be able to have those partnerships at our federal level to be able to respond and and advocate for public health.

Uh communications, expanded visibility.

We're prompt informative and press releases.

We are bilingual accessible.

Um, I've done numerous uh interviews on that when staff bilingual staff is not accessible, making sure that that uh equitable trans information is provided and happy to do that.

Transparent accessible media with staff matters uh with staff matter experts.

And I say that that it's I always try to put them forward first.

They're the matter experts, and when they're unable to, I fill in.

But they are doing wonderful jobs and making sure us seeing and telling our story on the community, and we have a strong social media presence and just the wonderful points that are that is our very active in social media presence and continuing to help to enable that and make sure that they have the resources that they need.

I like also report that working with uh uh Mr.

Oxarat and digital accessibilities that we do meet the qualifications that put forward for our government.

We are in compliance as of this month for our PD PDS being optimized, and so we're compliant beginning forward this 2026, and so happy to say that we are and looking out there in many other communities who are not ready.

The efforts that were put into that, I'm glad we're able to focus on that over these especially these last two years.

Creditation and quality improvement.

So we did uh go through a degree accreditation.

I was part of that site process, as well as ensuring that reaccreasion we did achieve and met those standards, uh, enabling staff to be able to be able to move the needle where needed to, that they had this the resources and support they needed to achieve that.

Our 2027-2029 community health assessment currently continues in progress, but that was uh again ensuring that that continued forward, and then we are wrapping up our 2024-2026 community health improvement plan highlights, but uh wonderful interventions that the board has made in these economic investments and up to within our community where we're impacting systems necessarily where we can't be, but impacting those systems, and we hope to continue with that moving forward.

Quality initiatives we did over the last two years begin a QI team and process.

It does need some more improvement, but we're continuing for that with our team that our internal team that is working towards uh QI.

It has been formed, but it definitely is always a process to improve as well as address those items that brought forward to them.

Integration of staff performance metrics to add performance measures to strategic plan.

That's something that I've focused on a lot over the last year to be able to provide you with the correct information, our performance as well as where we are with our staff.

This is integrated a lot into our budget.

We begin our internal workshops for uh not only for this year's strategic plan, but also move towards and directed to have staff also include a workplace cultural strategic plan.

So we should be delivering to that of you as well.

I believe that is important and seeing that across the thing, and not only with the interactions had with staff that we are setting the correct culture and meeting that.

And that also helps us to be able to set that standard for our staff to be able to say, hey, we are not meeting our cultural plan and be able to better be uh incorporated into that.

Overall, as indicated, I increased employee value and recognition.

That was uh important for me that they filled value and recognized that they can be supported and gone out of my way for that to be able to make sure through their engagement and support of that they feel that they have a pathway to myself as well as to their directors as well as to their supervisors.

So identify trans information transformation and looking over my surveys, so where improved uh where I can lean into this year, and I feel it's important, it's clear direction on strategic initiatives.

I believe not only from you as participation to me, how do I take your strategic initiatives and make sure that they are enabled within our within the organization and operationally?

So that's my my number one that I am prioritizing on that, that there's clear strategic initiatives and that we are meeting those.

We have a lot of great infrastructure there, but uh something that perhaps is missed over the year uh over the last year, but how do we integrate that?

My second is managing organ organizational change.

Change is difficult.

We do have some change and continue change, both with our budget, but a clear defined process for that to be found out, and then third, trust and collaboration and communication clarity.

Um these are the three priorities that uh I'm setting for myself for this next year, but happy to hear from the board on other priorities on that.

It's basically the what to the how.

And so working with my directors already began to address of in the next 90 days, what would you like to see me accomplish and how, as well as through the next year?

What I found challenging from the last year was that I I set my smart goals and set my goals, the what to how based on comment on the comments as well as direction from last year.

Um, but it's not as transparent and easy during that evaluation process because of the anonymity of it to be able to do it.

So sometimes I want a better process to say, okay, this was expressed in here.

I see these points.

How do I what do I need to stop doing or what do I need to start to do?

But also where is the leadership change through that?

And so I need to provide that clear direction through that, but also have their input that has clear objectives and and purposes as any of our staff that has a transparent process to their evaluation.

But uh overall, that's my my what is to convert evaluation feedback into concrete leadership, practices to improve clarity, change execution, and trust.

Immediate changes.

Thank you for meeting with me.

Um what I inherited uh two years ago, and both in communication is sometimes from a fair weather board or or points, but there was improvement.

Uh member Anderson provided wonderful feedback on a two by two in process they do in Sparks, and I met with manager uh uh Dion, and to be able to discuss how that occurs.

And so beginning so expect invites, uh annual invites from uh Jackie setting up those processes.

So we'll begin two by two processes the week before our board meeting.

Well, you will have the agenda and provide that, and I will be as flexible as I can, both phone calls in person or teams, whatever works for you, but providing those two by two meetings uh from that wonderful uh example and moving forward, and also seeing if that's uh sufficient for once a month or twice a month in where at, or perhaps second uh portion of the month is something just uh an electronic update of currently what's going on.

But the it has been subjective, and I wanted more of a process portion of it to be able to provide the information interaction with you.

A second two is moving to have a district board health agenda item for district behold updates and information, just what I am working on and feel informed and what I can be bringing to you to the next month so you feel informed or be able to provide any interaction on those points.

I feel those were two important immediate district board health changes for our communication.

And then overall, today too.

I would like to request an evaluation process request that within the next 90 days.

I'm requesting that staff bring back for board consideration and updated valuation process that is more transparent, inclusive, directive, and trans more transformative while uh remaining compliant with open meeting law, performative, uh performing qualitative and qualitative data analysis and ensuring the organization has the right readiness and support structures.

Part of that would be not only my staff, but it would be also the county interacting with county HR in the processes.

I believe that even the county manager and other processes are exploring uh the next iteration of these annual processes.

And so I would like to sooner than later, so I have the whole year for the evaluation to bring back in that it's in alignment with your and your directives for for the next year.

So that was one of my requests ultimately from it.

So thank you.

That was a little bit longer, but just wanted to be able to, it's a lot to summarize up into uh one year into that process.

But thank you very much.

Dr.

Kingsley, thank you so much for the presentation.

I I'll maybe start us off in part because I have to spend the most time with you, I think.

And so I've had a unique perspective the last two years to be able to work with you.

Um, and so please take my comments both in the spirit of grace uh and also in the spirit of helping us to situate ourselves for our conversation today, because I think um there are some real strengths to highlight, and there are some areas for continued growth, which we all have.

And I think human nature suggests that every time we hear a negative, we think that that's like an attack on our personhood or anything like that.

And I don't believe that.

I think that I'll have some positive things to say, and I want some uh positive uh understanding of where we're headed.

Uh, the first thing I want to say is really a comment from my colleagues because as I reviewed this packet, it's very comprehensive.

There's a lot going on there and the charts and the numbers that starts to boggle the mind.

But I wanted to think about it in this perspective.

The 2025 scores were really first year results, which are often buoyed by I think goodwill and a fresh start, right?

But for me, what I took away from it at a high level was sustaining an effective rating through a more scrutinized second year with a different and expanded evaluation process and a more complex organizational environment is a meaningful result in and of itself.

So kudos to you, uh, Dr.

Kingsley.

The honeymoon period, you kind of get through that, and you there's some things that happen in that that are helpful, uh, but maybe are not indicative of the long-term growth model that is presented.

I I was looking at the year over year context, and I I note and will highlight that you've improved in your internal leadership, a section which most directly reflects the relationship with your own team.

And for me, that was very meaningful.

Uh, the community stakeholder engagement is also the highest scoring section at 2.24, with stakeholders consistently describing you as accessible, their word diplomatic and collaborative across the region and state.

That was very important to me.

Direct reports also gave you your highest single score, so 2.44 for evaluating and recognizing staff contributions.

I think that is also a leadership quality worth noting.

You delivered results on the strategic plan, which you highlighted here and was valued at 2.5, health equity integration at 2.5, emergency preparedness at 2.40, and the fiscal year 2027 budget approval 2.43, all very high scores.

Multiple community partners specifically praise your handling of real public health events this year, including the measles case, which you highlighted, a mass casualty event, which was very challenging.

And for me, that shows executive leadership under pressure.

And so I'm grateful for those things.

Areas where I wanted to see and think about growth, and then we're gonna have some conversation here at the diet because I have some questions for my colleagues that may help us move this forward too, is about strategic direct communication uh with your team.

I think this is an area where you've acknowledged and have been actively working on strengthening the clear board guidance going forward into year three, I think could support that progress, and you've noted it interestingly enough, as one of the things that you're looking for.

It was also something that I think is important.

I didn't I might not have heard it, but I I know that you have gone through this with Margaret Crowley.

You've been doing some different kinds of training, but I didn't see how that was highlighted in the report.

Um, so is that a different process than what you were highlighting in the report?

Because that's really about like mediation and mediating conflict.

Um, but I I would have thought that that would have been included because I thought it was an excellent uh part of your year.

Um, is it was that in the report?

And I missed it.

It was a lot to try to summarize how it's not.

No, I understand.

But it yes, wonderful process, both in communication with Margaret with my team as well as recent training we did towards mediation for our organization.

Well, and and for the benefit of the body who might not know that the teams have gone through that.

I think it is a very important part of advanced leadership because it's a skill that comes later, I think, in life.

And Margaret Crowley is a local mediator who takes organizations through different programming.

I actually would have liked to have participated to some extent, and maybe I'll have a chance at other time.

Um, I want to finish with the continued growth things um to make sure that I've made the points that I want to make, and then I'll turn it over to my colleagues.

One is that employee satisfaction and workforce development are long cycle challenges that reflect organization-wide dynamics.

I think this warrants continued focus for you in year three and and also board support, but it's not for me immediately alarming.

Uh board relations scores also reflect an effective working relationship, which means you've got a little disconnect between those two things.

So the board will support, I think, by continuing to engage directly with you, and your communication path board says that that's what you do.

Um, so for my part, um I ultimately concluded, and I know you can't see how each one of us maybe uh rated you, um, but I rated you um as an effective district health officer, completing your second year, leading a large and complex public health organization, which would be reflected in my comments.

Um, your stakeholder relationships are a genuine organizational asset, and your direct reports recognize your investment in them.

You have delivered on accreditation, budget, community health assessment, regional partnerships, the rent franchise, and uh the measles and TB uh related issues.

Um executive performance in a complex public agency develops over multiple years, and so I'm grateful for the opportunity to work with you uh the last two years, and I think that we're primed and well poised with your acknowledgments of some of these growth areas to continue that into the future.

So those will be my comments for this time.

I do have some questions that I have for the board, but I will leave those till after the comments, and then I have uh some concluding thoughts.

So I'm gonna start with my right uh on this end, and Dr.

Duarte, that means I'm coming to you first.

If you have no questions at this time or comments, um just uh it's um I just commend Dr.

Kingsley.

I mean, uh running a large complex organization and and doing all the things he's done is very tasking and very challenging, and I appreciate his uh expertise and his leadership.

So that's it.

Well, I'm very grateful for your insight because I do value the work that you're doing, is of a similar nature, I think, and so it has some very similar overlap.

So I'm grateful for your acknowledgement of that.

I also heard a statistic, and maybe you can confirm this for me.

I don't know if this is true, but the average shelf life of a person at this level, which would include your level, is about 18 months right now.

It's a very challenging time to be in public health.

So your kind words were very gracious.

Thank you for that.

Okay, Mr.

Driscoll, did you have any comments?

Yes, please.

Looking at the numbers, as you know that I'm kind of a numbers guy and something that kind of popped out to me that I thought would be curious, and I don't know how we would determine this.

But in the evaluation from the staff who supervise, there were quite a few lower numbers in those levels.

Yes.

And then looking at the questions and the um ratings.

The first thing that popped to me was not that you weren't doing a good job when that you weren't coordinating with them, but the people that were being affected by change were not happy about the change.

And in my mind, we're taking it out on the ratings.

That's just personal feeling and personal observation.

Because I believe that there were other scores that were scored much higher that are directly related.

So you had opposing views on what is theoretically the same discussion.

So large organizations that have a lot of expertise differences between them.

Change can be um very detrimental to that.

And if we're used to being in kind of control and now someone's asking us to do something different, it goes from there.

And so I believe with the conversations that you and I have had um on some one-on-ones and broaching a few of those topics that stay in the course of where you are, pushing for the success of the organization and letting the little bumps kind of work themselves through.

Um, I think is a prudent way to do it, and I compliment you for your strength.

Thank you, Mr.

Chair.

That was very interesting perspective.

I wonder, Miss Griffey, if you might come back up for a moment and just answer that question, in part because I I don't think it's necessarily a question that Dr.

Kingsley maybe could answer, but I think Member Driscoll is making a very good point.

There seemed to be, and I agree with the point being made, there seemed to be two questions in the same sections that pitted themselves against each other.

And again, I I don't know much about this last part that Dr.

Kingsley put at the end of the presentation about changing the way that we do evaluations.

It's just something I'm not as familiar with, but Mr.

Driscoll, I remember Driskel was making a point.

What is there anything there?

We the questions for the new group were the exact same questions that were asked of our internal leadership and direct reports.

And I don't think that's the questions that came over from 2025.

No, I don't think that was Mr.

Driscoll's question, though.

It seemed that there was like this an opposite thing where one was about what Dr.

Well, maybe you can explain it.

One was about what Dr.

Kingsley does and pushing out, and one was about what people do having reaction coming up.

Thank you, Mr.

Chair.

And I think it's it's not the questions themselves, it's understanding the personality and culture of the organization and knowing that there's stress there because of change.

And so looking at questions that, in theory, in my mind, and I could be way out in the left field, in my mind they were somewhat related.

Yet we had ratings that were opposed.

And to me, that just my evaluation of the numbers.

I'm not scientific, and I don't have any detail any more than anybody else does, but just my casual observation said this is the result of change.

And my perception of people through a survey that they know is anonymous, kind of poking a little, hoping that maybe the change will back off.

Yet you'll have another question that's for all intents and purposes the same thing, and everybody's happy about it, which means maybe the communication related to that was better received.

And so again, it's I don't think it's an HR issue that can be solved.

I think it's my perception, having played this game for a long time.

Thank you, Mr.

Chair.

The only recommendation I got is that maybe next time we can reword the questions to where maybe when they looked at them, they read them different than what we intended them to be.

So that maybe next time we can just adjust the wording to where the questions aren't quite quite so related to each other.

Thank you so much, Ms.

I'm gonna turn now to my colleagues on the left.

Miss Andreola, you're up.

Thanks.

So I think we could all probably have a workshop about how to make the best performance evaluating evaluation instrument.

I don't know.

I certainly have I think that um there is need, and I just won't keep on going on that, but I do think that there is need to look at the performance questions, because um I think one of the things that was missing, and I think um Dr.

Kinsley, thank you for pointing out Washoe County's leadership in looking at having the budget Congress and you adopting that.

And thank you for looking at priorities-based budgeting, which is an initiative I've been trying to champion for several years.

So not mentioning Washa was a little surprising.

And I think one of the great things about the relationship is the resources that come to an organization like Northern Nevada Public Health are the best of the best.

Truly the best of the best.

Lacking that was a bit of surprise.

That's why I do agree there's room for improvement.

The county, just for everybody's information, is looking at the county manager and a revamp of performance.

And I think you were referring to that leadership that Washoe County has and the expertise they're looking at and adopting that without uh a huge cost to Northern Nevada Public Health was missing.

So I'm going to take the time to thank Washoe County for helping Northern Nevada Public Health, which you do pay for shared services.

So I'm not suggesting it wasn't free.

But what you get for that really couldn't be paid for if you were an independent organization.

Having said that, there's always flaws in every performance evaluation.

You could spend your whole, you probably get a PhD and evaluating performance evaluation.

But just in looking at the comparisons, the fact that in 2025 was a 2.40, and you had a 13.33 degree decrease in from comparing 2.40 to 2.08.

Out of the five categories, which were the exact same categories of 2025, were the exact same court because the chair wanted to make sure those comparisons were exact.

So thank you for that.

But out of those five categories, four went down.

And what was significant, even in adding the um the fourth group, the Northern Nevada public staff who's supervised was your lowest score.

So to Mr.

Driscoll's point, we can only speculate.

We can't we can't define without digging deeper, but we can only speculate.

And if people are using this instrument as an instrument to not share their true feelings, feelings are real, perception is reality, and the reality is that it's lower.

Um the fact that Washoe County, not City of Sparks, not um the City Areno, invested in leadership training to the tune of 13,250, certainly was a wonderful opportunity to be gifted out of Washoe County's budget to see that improvement, and we didn't see it.

And that's just my interpretation, and I'm just one person.

And so I think that there's a lot of room for improvement.

Um, I think that um the fact that the WCEA had also put out their information from December of 2025, which was surprising.

I don't know why they did that, but they did, and there was a commonality between 2025 and in that in that uh picture to what the results are of 2026, at least what we're seeing in those.

And so if it was just an anomaly to Mr.

Driscoll's point of just an opportunity of using an instrument to maybe um not accept some change and not being acceptable in that direction, they had a whole year, so evidently that direction wasn't calibrated.

And so, from my perspective, I've not seen any improvement in terms of anything of any um meaningful way from a leadership standpoint, and I think that that um the struggle of some of the things and navigating some of the things uh fall directly on leading an organization.

The board sets policy, the board does not run the organization.

We're real clear on our role, and I do think our role can only be um gathering the information that was provided, but then looking at your position as a position to actually help us help you navigate that.

And it seems that there's been nothing but struggle.

And I also just in looking at some of the comments about not necessarily using some of the expertise that you have, the ability within your own organization seems to be something that's highlighted both in the WCEA and also in the results of this and just some of the comments.

And it's not all the comments, so I don't know.

You know, you can't, it's not like we're going around asking every single person.

But I do see some comparisons that really don't have the confidence to be blunt and being very respectful.

And this is a hard thing.

It's a hard thing to be in public.

The chair said that it's a hard thing, but I can only share what I am going to be respectfully sharing.

And that's that I believe that in working with many other organizations who are both larger and smaller than Northern Nevada Public Health, and spending years in executive leadership as well, and recognizing that there hasn't been an improvement really again gives me pause and actually has a very minimal lack of confidence.

I just have a huge lack of confidence of change, given the ability for the investment, given the ability that you had the feedback essentially, I don't want to say it's exactly a year ago, but you had feedback, and that it still seems to be you know carrying forward.

And so from my perspective, um I believe that you have tried your best, but that the position you're in requires the leadership that is expected, not the leadership that we hope.

And so from that perspective, it's been a big struggle, I'm sure, for you too, to be honest with you, and navigating recognizing that there are challenges, but those same challenges also are in the same others, whether it's budget and some of the other navigating challenges, every organization has challenges.

And I just think that given the fact that Washer County has invested in trying to help through that.

And I know that there's probably even board members who have helped as well.

Um, I just haven't seen the executive leadership needed to actually run this organization that has really huge, huge consequences in some cases life and death.

And so I hope that you understand I say this with real respect, and it's not something easy to do in public, but um I feel that not as an example, listening to some things with those experts, whether it be legal or whether be your staff, and you are the ultimately uh the person that makes the decision.

So I'm not suggesting every time somebody says something, you have to actually go in that direction.

But some of it has been very clear, and it seems to not necessarily be a trust but verify it's a kind of your way or the highway kind of interpretation, just an observation.

And so I think there's um I'll end it by just saying I I do appreciate your um understanding how difficult it is for me to say all of this as I empathize on how difficult it must be for you to hear.

And I really appreciate you giving me at least that consideration that I'm not saying this lightly, but I am saying it with not just emotion, but with actual quantitative data and plenty of time to see some improvement.

So with that, Mr.

Chair, I appreciate you giving me that opportunity.

Thank you.

Thank you, Ms.

Andrea.

I appreciate that.

Mr.

Anderson, you're next up.

Thank you.

I want to say that I appreciate the work that you're doing as a couple of my um members up here have mentioned that you're running a very complex um organization, a lot of moving parts, a lot of individuals working on complex issues.

You've also experienced um an unusually um difficult year as far as your funding and trying to figure out whether it's federal, state, or local, um, how you're gonna keep that organization solvent financially.

Um, not to mention, as we talked about the RemSA, you know, agreement and that franchise agreement was very complex as well, very time consuming.

Um and I I thank you for the work that's being done on the strategic planning.

I think in the past, historically, a lot of organizations have kind of let that slip by the wayside, focusing just on the fires, whether it's financial or whatever, um, and not looking at that long-range plan of of how we're gonna get to a better place.

So I I appreciate that, as well as like you mentioned uh the discussion that we had and you were able to have with Dion kind of talking through.

And I'm never expect that you're gonna do exactly like what we do in Sparks, but it's something that works for us on the communication side with the staff leadership and us at the council member level.

Likewise, I thought maybe it could be something you'd look at.

And I appreciate you um discussing it with Dion and kind of understanding how it works, because it really does improve that communication side.

For me personally, that was actually one of my biggest concerns um over this last year was um what I believe was poor communication um between us.

And and I'm taking some of the blame myself on that because I should have reached out to you um more often to have discussions.

Um but I really believe it's gonna help us and likewise your staff internally to be able to have a clear understanding of where things are, expectations, and and giving us all an opportunity to ask those those hard questions.

Um the other thing that I would ask you to consider is along those same lines, um, we in Sparks have started doing something recently over the past few years of um in this case, it's the city manager with his leadership team getting together once a month and allowing them to have a discussion to where you may have folks from from another portion of your organization that don't even realize this is a struggle, or likewise someone succeeding here and someone else may be able to utilize some of that information to to succeed um or have a greater success in theirs.

So it's uh just in that side of it, because looking at this, that was one of my concerns was a communication side, both internally and and then likewise with with us as uh board members.

I I am I am concerned about the scores um because it it was a market drop from the 2.4 to a point 2.08.

Um and then especially even from the supervisory level, um, having you know the 1.9, you know, which is is minimally effective.

Um I just I'm concerned about that.

It's it's not the trend that you or we want to see.

Um the good news is that uh you're not at the top and there's only one way to go.

Uh so you definitely have room that you can you can see some improvements on the communication side.

I believe you're already starting to look into avenues to to help you out with that.

Um on the leadership side, that that's that's also a concern of mine um to see some of the the comments um from some of the folks and whether we look at the look at the scores and say, well, maybe this is because of internal strife or whatever it is, in my opinion, uh does that really matter?

I mean, will we ever know that what those things are?

All I can look at is the numbers.

And you know, when you see numbers like a 1.79 um from your supervisors, and then it just you you have some work to do.

Um so with that being said, I as far as the um the leadership side of it, I'd say you there's a gap.

And and I really want to see improvement in that category that um clear, concise direction.

You know, your team knows their expectations that you have of them and and how to move forward as well as um the the leadership is as a whole on on the organization.

And with that, like I said, the good news is you're you've have room to grow.

So thank you.

Thank you.

Mr.

Henderson, thank you so much.

Mr.

Brown.

A lotman's head.

And uh as our chairman said, uh sat in a soft seat before in public and uh watch these things take place, both myself and uh I sympathize, but I also think this is a great avenue to hear truly how people feel about you, how things are you know, how things are working, what's not working.

And we've talked um, you know, for the last two years you've been here.

And you know, we have our strengths or weaknesses, and we see these weaknesses potentially.

Um I don't view them as a weakness, but it's somewhere where we need to start improving.

And as far this gives us a perfect avenue to start.

Um you've been doing it, doing it.

Um, but again, after an example like this, I think it's something that we just need to continue with.

Um, as Mr.

Anderson said, you know, there's always room for improvement.

You know, I can remember my vows were one through five, you know, you're not gonna get buys because that's you know, there's always a ways to make yourself better.

And so with everything said, you know, I think the point's been made across.

Um I appreciate the conversations we've had, you know, a lot of information uh on our last one-on-one.

And I appreciate the you know, information you have coming from the employees, you know, the same way.

I think that's that's great.

Communication on what's taking place in our community, very effective.

Um I haven't seen that in you know, prior health officers and the extent we're getting it from you.

I think it's coming from you, but I also think it's your staff.

You know, you've got good people, and those people are doing exactly what they need to to ensure the safety of this community through you.

Um appreciate all that.

And uh, you know, um we got a lot a lot to do here and a lot to keep going on.

So thank you.

Thank you.

Thank you, Mr.

Brown.

Any other questions or comments at this time?

I'm gonna come back to you now, Dr.

Kingsley, because uh I wanna make sure that you have the opportunity to say any words that you might like to say.

Oh, Dr.

Edward, you you were back in.

Sorry, I didn't see that.

I I don't know if it's appropriate.

I was gonna ask all of them.

Dr.

Kingsley, if he would be um I'm gonna set an invitation that if there are things that I can do that would be helpful, uh please let me know because uh we also need to be part of helping him uh do his job effectively and better.

And I I wanna be the first to extend that invitation.

Well, that was very gracious to you.

I I was going to pose some questions to the board, which naturally come from your inquiry, because as I saw it, there you have um some uh some good things and some things to work on, right?

You have one colleague who has really wants to see some serious and market improvement.

Um I wanted to ask, and these were board questions really, and I had three of them after I thought about this for some time.

And Dr.

Edward, I think it comes from sort of the same place you are.

And the first is what specific goals would this board like to set for Dr.

Kingsley in year three, and how would we measure progress together?

And these are rhetorical questions, not necessarily I'm demanding your answer here on the spot.

Second was how can the board better support Dr.

Kingsley's work on internal communication and strategic direction across the organization, which I think is what you're highlighting.

And then the other thing is what resources or partnerships would help Northern Nevada Public Health address employee satisfaction and workforce development in the coming year.

And that sort of I think is at a board level.

And in that regard, Dr.

Kingsley, I'm gonna come back to you because we've all had the opportunity to say a few things and and say to you what I have often told people who are in the position you're in, which is uh it's hard sometimes to hear, but it's also the opportunity for you to um grow through it, right?

We we we certainly grow where we are planted, as the saying goes, and uh there are high expectations for the job that you hold, in part because it is a life and death situation.

And fortunately, I've been with you this year where we've had to deal with a couple of those things.

You know, a call at you know, on Christmas Eve about a person who's got an infectious disease and we're trying to go to court on them, right?

I mean, these are things they're very serious.

Um, but for my part, it's um it's sometimes people in leadership, they take the information and they process it in a way that turns out to be a bad thing for them.

Other times they take it in a way that is a good thing for them.

And my experience with you tells me that you'll be one of the latter and not the former, right?

That you'll have the opportunity to take the information and react to it, not out of anger or malice or sadness or anger or frustration, but out of the nature of uh of leadership, right?

Because what we want is a health officer who will stay for 25 years, right?

And so, and and those are not always gonna be easy years, and sometimes you have different things going on.

So, those are sort of my thoughts as we close this item out.

And I didn't know if you wanted to be able to say anything um in response to what you've heard.

I do think there are opportunities and there will be opportunities for me and um our HR staff to really lean in and work with you in the coming year, and we'll um sort of address some of these things.

Just want to say thank you for the input and for the time and opportunity and and trust and those things that you're exhibiting, and very much so, yes.

I um I appreciate very much the the very first what specific goals does the board want me to see, and how do you want to see me achieve them or what they what is it, what is achievement on that and um that direction alone I would appreciate from the board um for that for those uh direct things and what does achievement look like and so um very much so on that interaction with the board and then next few meetings or whatever as we can specify those so I know what to achieve and how to achieve that through this year.

And just want to say thank you and exactly you know it is that we all have opportunities to grow we all have challenges but we also have wonderful strengths on both sides and I appreciate each one of your strengths and they've been valuable as I've spoken with you and the insights and the opportunities that you provide me and I'm grateful for that and for growth I think growth is if we're not growing we're not doing something correct.

So I look at that and I'm appreciative of that opportunity and I'm appreciative working with my uh staff and the time I've put into them and and the opportunity that they've given me and the same thing doing the same process with them and I went to them and I very much the same point I there's you know I'm not asking you to be nice I'm asking to be kind and it's not about being nice I need the feedback and I need the direct thing so I can take actionable items to make those changes.

I just don't need information I need transformation and so I need those actionable things that can transform me.

And so from this I've got the information but I need those transformational action items both from the board and from my direct reports on what is transformation and what is achievable and and and setting those standards just from my staff that I advocate for them is how do I make you successful how do I not how do I set you up for success I believe I'm also warranted that as well and so that's why I'm also seeking that how what is success look for you look like for you and how's it completely defined I think that's important so I can achieve that and uh and so setting up I think not only for my staff but for myself as all as an organization and that's a culture that we have to have that we advocate and that we support and that we sustain you know each of our each of our members and I strive that for my staff that they they have that excellence and they feel supported and they feel valued on those points and so seeking the same opportunity for myself and those growth and I appreciate that and I appreciate the comments and uh Commissioner Anderola thank you so much for your honesty and uh and that opportunity and what you've expressed and I if I have a goal one goal is to prove you wrong and be able this next year to show you.

So thank you very much and and same thing uh Anderson I I highly appreciate that impact and looking for more of that interaction there and on those points and and happy to address that and to work with you through on those points.

So thank you very much and for this opportunity and thank you for this community too because it's been wonderful to serve them what they've done for my family and being here and the support I received so from so many others too as well it's been wonderful and this is it is an amazing community and home does mean Nevada and it's uh it's wonderful to see where our communities and what we've been providing and for my staff they have been wonderful staff and it's been wonderful to get to know them and their lives and what the impact it has meaning working here as well as from the community and the challenges that we face but also to be able to go home and say I made a difference in someone's life today.

So very appreciative of that and this community and what it is and and the cohesiven how we can improve it and and that and what those decisions we make today and what it's gonna look like in 20 years.

So thank you very much.

Dr Kingsway thank you so much I didn't know if you were raising oh okay thank you so much.

I'm gonna uh Dr.

Duarte I I just uh wanted to make a a comment uh from one of something I learned in one of my classes and that's an organizational structuring and there's forming storming norming and performing that's right and uh we're we've we've you've you've been through the honeymoon we're in the storming um I'm hoping we get to the the uh norming and the performing so and I think we need to give Dr.

Kingsley an opportunity to show us so yeah no that's a great way to look at it I I think I said that it was the honeymoon period and now you put a few more legs on the analogy which I appreciate very much.

Thank you so much for that.

Chair I'd like to note for the record that Dr Danko did leave at three o'clock.

Yes I saw that I I had the opportunity to speak with her uh briefly and so I know her thoughts were uh positive and so I'll just leave it at that but um I appreciate you recognizing that and for the record okay um I'm going to hazard a motion then at this time and I'm gonna move to accept the district health officer's annual 360 feedback survey results renew the district health officer contract for a period of one year and approve a five percent annual merit increase that would be my motion as in the staff report second I have a motion and second any discussion hearing none Mr.

Chair yes please um just for a point of discussion on a couple of things that were just discussed when it comes to the next step with this being approved being goals and objectives something that Dr.

Kingsley asked for Dr.

And if we have a goal that doesn't have that, I personally would not accept it as something to hold the director accountable to if we can't share with him what it means to be successful.

So thank you for the conversation.

Well, I think you've made a very good point.

And what I guess I would say is we're going to get through the motion.

And my comment would be that Miss Griffey is here with us today.

I think has heard a lot of the feedback.

I think it will be incumbent upon maybe one or two of us, and it might be the two of you gentlemen, just because I can look at you and put you in the hot seat who have got to come with us into that conversation.

Uh and you have some experience to lend to it.

And so I'll invite you to that point in a different way, and Miss Griffin will help us to get there with those kind of measurables and some of those kind of things.

And I think we can do that in the coming weeks.

Dr.

Duarte did I think uh I want to make sure we've had a motion, which I've made.

It's been seconded by member Driscoll.

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?

No.

Motion carries.

Okay.

Thank you so much.

We'll close item 11 and move on now to some of our staff reports and program updates.

Uh and you know, we haven't had these in a couple of meetings because we've run into staff uh or just timing issues.

So I'm gonna see what we have today.

We'll start with item 12A.

12A is a report from Mr.

Vega Quality Management side of the house.

Hello.

Hello.

Good to see you.

We don't always get to get here.

So I'm happy to have you in front of us.

I did read the report.

Excellent.

Fantastic.

Thank you so much for that.

Anything you'd like to add?

Just a couple of things really quickly.

Um I always like to highlight um where we at with plan review, because I know it's been an important topic.

So in March, we were at 90% of plan reviews completed in a timely manner.

Again, just want to commend the team and their efforts because that's that does take time and it does take effort, and they've made it a priority, and they are being successful.

So again, want to recognize the team for that.

Um really quickly also, I didn't get to mention it last month, but uh this burn code season, um, we also had no red burn codes, so that continues that streak of positive winter time air pollution.

Um, also wanted to mention that we accomplished this uh burn code season.

Um, and one of my challenges to the team was um historically we've done this with like overtime or calm time.

And I I challenge them to come up with a way to do it and accomplish it through either technology or other improvements on how we can accomplish that without the calm time and overtime.

And we were successful.

So again, I really want to uh recognize the team for taking on that challenge and then being successful, and then also having a very successful uh burn co season from an air pollution perspective.

So again, a lot of kudos to my team.

With that, I'd uh be happy to answer any questions.

Mr.

Vega, and I'll just ask what do you mean by no burn code uh happenings?

There were no issued warnings or no.

So all of our uh so from um November through February is what we call our burn code season.

And so every day we put out a you know, red, yellow or uh um green burn code every single day was green, which meant we had like perfect uh air quality.

Okay, perfect.

Because I thought I I was just making sure it wasn't the related to the air quality, because there was one day a couple maybe a month ago where I was you know, my eyes were burdened because we had some uh uh controlled burns going on near us in Dog Valley.

So now I understand what you're talking about, and so thank you for that.

Yeah, of course.

Any questions for Mr.

Bake?

Okay, thank you so much.

Thank you.

Item 12B is our community clinical health services.

Uh Christina Shepard.

Good afternoon, members of the board.

Christina Shepard, division director for community and clinical health services.

I just have a couple of brief updates.

I didn't get a chance last um month to celebrate World TB Day.

Um, and so since we did cut the ribbon on our new TB clinic, um, I just wanted to really commend that team um for all of their work.

Um, these team members support the clients um that are being treated for active TB through nine to twelve months of treatment.

They help them maintain complex medication regimens, manage their co-occurring health issues, and oftentimes um navigate challenges such as unstable housing or food insecurity.

So their commitment, patience, and compassion really enables the clients to successfully complete treatment, move toward better health, and protect our community from further spread of TB.

So didn't get to say it last month, so I wanted to make sure I shouted out that team this month.

I just one thing from our report, our family planning special health program.

We are navigating a shortage of the primary medication that's used to treat syphilis.

So right now we are in a medication conservation um plan where we're um reserving our doses for pregnant people since that is the only treatment for them.

And um and any patient that has a contraindication to the alternative treatment, which is doxycycline.

But on a positive note, our clinic staff has successfully initiated a client on injectable prep for HIV prevention.

Um overcoming the very lengthy and complex approval process.

So want to congratulate them on that, because that was a huge accomplishment for the clinic.

So happy to take any questions.

And I got the opportunity to tour the facility.

Um that uh clinic and that building is under your uh division.

Um I I apologize.

I I would have liked to have recognized you over there.

I saw you, we talked, I got to wave, um, but I it I would be remiss not to say thank you for that.

I have you are your is your office over there?

Are you still here in the mothership or we're wish I was up?

It is a beautiful building.

Yeah, it is a beautiful building, and so you know.

I just didn't know.

I mean, it it is it was a beautiful building.

It's um a very light-filled place, but well, thank you for that update.

I appreciate it.

So he's moving now, I think.

She's ready, she's in.

No, I definitely don't have that power or authority.

Um, but thank you.

Any questions for Ms.

Shepherd?

Okay, thank you so much.

Item 12B is closed and 12C.

Next will be Mr.

Fida.

Welcome, Environmental Health Services.

Good afternoon, board.

Uh Robert Fida for the record, environmental health services director.

So I wanted to highlight some of the continued good work that we keep doing.

Uh, one of our staff members, uh they've started hosting a Spanish version of the uh AMC program, and that was actually done at the end of March.

Uh it was uh well attended and a lot of good engagement.

Uh, this is to help some of our uh folks with uh maybe not uh English as a second language, provide them the opportunity for education and for better uh knowledge base when uh kind of uh assessing food risk.

I know it is a challenge for uh our folks and for those folks to get that intervention sometimes in the field, so it helps that they have some dedicated resources.

Uh our team is also uh in the process of doing lots of improvements.

Our food plan review team is working with City of uh Reno business license team to kind of uh work out, I guess an amendment process and make some changes in our internal processes to kind of help streamline some things.

So they're looking at that.

And our uh mobile team is also working on they finalized a new Acello record to help streamline some of that application process.

And this is kind of in preparation for some other steps.

Uh we have another uh project that's in the development phase.

Uh it's an app for food trucks.

Uh so we're hoping that with this record creation, we can kind of uh start moving on that.

And then another thing of interest potentially is that uh our staff also did uh some follow-up with a food establishment.

Uh there was a report of eight ill employees uh with similar symptoms.

So our staff went out, collected samples.

We're still awaiting results on those.

Uh and then pool season is upon us.

Uh our permitted facilities team, they actually opened up their uh online booking site.

Uh that's in full swing now.

So uh that provides the opportunity for those folks who want to open their pool, they go online, schedule it, and online management of their uh appointments and whatnot.

Uh, this is the second year we're rolling it out.

We've had success last year with this program, so we're hoping that uh we'll see similar results.

And then the other thing is our safe drinking water program is doing their essentially their auditing for uh 2025.

Uh any missing samples are now being trying uh essentially tracked down as a best way of putting it.

Some of them may be with labs uh still pending, others may be uh weren't received.

So our staff is working to make sure that uh the 2025 water quality data is accurate and that any violations that are incurred are appropriate.

So they're in the middle of that process.

That's probably expected to be completed soon.

Uh and that's pretty much uh what I had to uh highlight.

Uh I am open to any questions if you have any.

Mr.

Fida, remind the board how many pool uh inspections will have to be done between now and I think Memorial Day was kind of the marker that I always thought about.

Uh I was gonna say normally we open the window a little earlier, so we try to get April.

There is a very memorial day, seems to be the very popular date, and uh there are uh I think about 600 pools that would want to be opened around that date.

So we try to uh I guess uh put it as a study trickle instead of a deluge.

Uh we've had issues in the past where people wanted to open it and we didn't have the capability to serve them on Memorial Day weekend.

Uh so we've uh uh kind of invented the system to help kind of uh space out and have people plan appropriately.

So, and this gives them the opportunity to book, uh, be prepared.

It even gives them reminder emails and all that stuff.

So it's a fairly uh, I think a great system that's in place now.

So it sounds great.

May the fourth be with all of you in that endeavor.

Any questions for Mr.

FIDA?

Mr.

Fida, thank you so much.

We'll close item 12C and move to item 12D population health with Dr.

Dow.

Good afternoon, Mr.

Chairman, members of the board.

This is Nancy Dow, division director over population health.

Um, you have my report.

I have nothing to change or add, but I do want to give a little bit of an update on our disease front.

Um, you heard our presentation from our Epi team in the last board meeting on the increase in protests, and this continues as we reach uh 25 total cases now and three school-wide notifications so far in 2026.

So the increase is still happening.

Uh, we're at over 80% of 2025 totals as we reach just a third of this year.

Um, so our Epi team is continuously to work closely with our school district, uh, which is uh mostly school age children that is affected, and our partners for an infection control and prevention.

Also, quick updates on our respiratory diseases front.

We're now into late respiratory season.

Um, this season we did experience the highest peak in influenza-like illness we have ever seen compared to the past five years in late December, which coincided with huge peaks in flu hospitalization, emergency department, and urgent care visits during that time.

Washoe County's influenza-like illness activities have gone below our regional baseline by the end of February and has remained low uh currently, uh which is good news.

And we did start to see flu B instead of flu A only since February, but that has not induced a second peak in the season.

Our RSV peak this season came out late as well, uh, usually increasing around December and peak around early January, but this season we didn't see RSV peak until late February.

Our cases have started decreasing uh in the month of March and currently is also remaining low.

And our outbreak numbers have also gone down in the month of March and also so far in the month of April.

Um, since July 2025, we parsed out in the population health division the statistics and informatics program.

Uh while we only had one staff brought in and has a uh working supervisory role for that staff to support our needs informatics per request.

I would like to give an update on what we have produced in the past 10 months so far.

Outside of our statistics, regular numerous data extractions, data management, and support to programs that remain in place.

Um, the program has published in collaboration with various programs in the population health division, three external dashboards for regular data and information dissemination, four internal dashboards for work performance assessments, internal data tracking for our volume-based disease programs and epidemiology and sexual health.

Um, there has also been various data extraction pipelines set up now to run in a completely automated daily schedule for data population.

All these are not only saving hours in our staff's time, reducing manual human error in data transformation, extraction and population, but also producing and providing better access to real-time data for our public.

Um, you have also heard in last month about our chronic disease and injury uh data dashboard, which replaces the need to create written reports and saves our funds that we used to put into hiring external vendor every year.

We produce the written report.

Another dashboard I would like to bring attention to that we haven't talked about is our CRO and CPO surveillance dashboard as our team monitors antibiotic resistance for healthcare associate infections.

Um, this is an interactive and completely automated dashboard now, created in collaboration between statistics, informatics, and the epidemiology program.

Uh and with the launch of this dashboard earlier on this year, we no longer produce written CPO topics uh for uh the public, and um, they can get real-time updates through just going to our website.

And on the topic of antimicrobial resistance, we did publish also our 2024 community anti biogram, which provides information on clinically important bacteria and their susceptibility trends.

And also happening just last uh just this month, we also published our quarterly communicable disease reporting and statistics for the first quarter of 2026.

This series that we produce covers tables and figures to compare reported morbidity and selected communical disease during the most recent quarter in comparison to the historical trends in the past five years.

And we are currently seeing increases in this quarter in animal bias reporting.

Animal bias reporting has been increasing continuously for us in the past three quarters.

Um to standardize and modernize our system and data tracking on April 3rd.

Um the EPI program did launch a new electronic portal for reports of persons exposed to rabies susceptible animals.

Uh the advantage of this modernized system is um not only to just empower our partners and residents to actively submit incidents for timely uh reporting, but also generates automated workflows and alerts to prompt public health follow-up as we benefit the communication and workflow between our partners and EHS and Washoe County Regional Animal Services.

So the digitized information does reduce manual work as well and feeds standardized data into a live portal for tracking program indicators and other outputs as benefiting the health and wellness of our communities.

And that's all my updates.

I'm happy to answer any questions.

Dr.

Dow, that was a very comprehensive report.

Thank you so much.

Let's see if we have any questions from the board.

Okay, nothing today.

Thank you so much.

We'll close out item 12D and move on to ODHO.

Item 12E.

Dr.

Kingsley, do you have any updates for us today?

Nope.

Just as the report is presented to you in just recognition that uh the answer from the sorry, for from Remsa to Member Drisco was provided as just an attachment in there, just documented and acknowledging that that response was put there in my staff report.

But other than that, open to any questions, but uh no further information on my report.

Okay, any questions for Dr.

Kingsley?

I wanted to say thank you to you also, Dr.

Kingsley, today for um the ribbon cutting at uh the TB clinic.

Uh very well attended, uh, a lot of media there.

Uh, thanks to Scott Oxarart also for uh organizing all of that.

Um, very important and I think for our region, sort of one of those things that we'll all look back on and be very proud.

I'm grateful to um the organization and for the opportunity to do it.

I'm grateful for the county for the the land and the space where we are.

And it's great.

It was a building that was uh long overdue and sadly and sorely needed.

The last building we used was built in 1959, and no public health facilities had been built in this region for the county since 1970, I think.

So um, and so it's very impressive to be there.

So thank you for that and for your team.

I'll close out item 12e and go to public comment, Madam Clerk.

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

Unused time may not be allocated to other speakers.

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

A speaker's viewpoint will not be restricted.

However, reasonable screw 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.

And we do have one request for public comment.

It would be Aaron Abbott from Technical Medical.

Mr.

Abbott, welcome and good afternoon.

Thanks for being with us here today.

You get the award for longest being here in the audience.

And thank you also for uh public uh EMS week.

Thank you very much, Mr.

Chair.

Uh Mr.

Chair, members of the board for the record, Aaron Abbott.

I'm the CEO and founder of technical medical.

Um preface my comments with a I come from a place of uh respect and understanding um of the difficulty of your positions, and uh thank you again for um all of you who serve our community in the way that you do.

But I also come from a place in an effort to uh try to better understand and hold public policymakers uh accountable.

Um, I think it's my duty as a citizen um and my right as a citizen as well.

On January 2022, this board um approved uh the REMSA franchise extension um uh despite a laundry list of concerns from the vast majority of the board members.

Um the uh those concerns are reflected into the 19 items um that were discussed in agenda item 10.

Um, not only um were there serious concerns and um in fact the comments that words matter uh you know echo in my head uh from that meeting.

And I'm not quite sure um what words were actually approved.

Um the deck deck deputy district attorney um at the time also uh commented that the that agenda item was up for a vote for approval or not approval.

It was not agendized for direction or staff approval.

Um that item ultimately passed with direction to staff and um uh proposed uh uh changes to that item.

Last uh month, uh board member Driscoll um requested that item uh get put back on the agenda uh for today um for reconsideration, and that um request was not granted.

Given that February's meeting was not a regular meeting, um, I'd like to understand why, better understand why that item was not placed back on the agenda for today.

Um, I'd also like to point out um that item 16 on this uh list of items um regarding airport transfer language, um, which attempts to grant exclusivity to the franchise holder um violates federal law.

And um a letter from our attorney has been sent to this board explaining that law further.

So if you all have not read it or seen it, um that was sent on February 20th, and we've not received a reply from this board that it's been received or read.

So I just wanted to point that out.

And um that's it.

Again, thank you very much for letting me speak.

Appreciate you all.

Mr.

Abbott, thank you so much.

And so that you know I have read and received the letter that was sent.

Thank you very much.

Appreciate that.

Any other questions, madam clerk?

Or I'm sorry, any more comments from the public?

No other comments.

Okay, we'll close item 13 now and more to board comments.

Any comments from the board?

I'll look here.

Okay, we'll start with Mr.

Driscoll.

Mr.

Chair, I will not be in attendance for the meeting.

And unfortunately, I will not be in a position to either call or zoom in how long this gonna must be just be absent.

Thank you for letting me know that.

Uh, hopefully you'll be somewhere like Bora Bora or something exciting.

Any comments over on this side, Mr.

Anderson.

Yes, sir.

Thank you, Mr.

Chair.

Actually, uh, I didn't even think about it.

The moment we were having the presentation there at the beginning, recognition of drinking water week, May 3rd through the 9th.

It wasn't until after the fact that I realized that uh that also coincides with Trekker Meadows Water Authority, Smart About Water Day, which is May 9th.

Um, and I believe it's from what 10 o'clock until 2 o'clock at the California building at Idawall Park.

So if you want to learn more about safe and safe drinking water and water supply, that would be the event.

I love that.

And I love that you've chosen the California building.

Have you been there since we did the remodel of it yet?

I have not.

How did you do it?

It's we just did it.

We did a grant a ribbon cutting for it.

It's a beautiful and stunningly remodeled building, and it's historically been still any water on the oh, you'll be okay though, because there'll be lots of people spelling lots of stuff in there.

It is a beautiful building.

I can't wait for you to see it.

Good.

Thank you.

Anything on the end there, Chief?

Nope okay.

Um, I have nothing, and so this meeting is adjourned.

Hi, my name is Ryan Gustafson.

I'm the division director of the Washa County Human Services Agency.

In 2017, we decided to open up the Family Engagement Center, and we did so for a number of reasons.

Primarily, we wanted to have an increased space for families and children to be able to visit.

The Family Engagement Center has many rooms, many spaces for families to visit, to cook, to play games, just to enjoy time with one another.

We also wanted to create a home like setting that is colorful, that has toys, that has items that kids and families can interact and just enjoy each other's time.

And we also wanted to make sure that we had the engagement center in an area of town that was easily accessible.

It's not downtown, it's right in a primary location where buses come, there's a nice parking lot, there's many rooms that uh kids and families can go in, there's a yard to play in, and we just felt that a home like setting would be very important.

Our conversation room is primarily utilized for our first visits, therapy sessions, private conversations, and mini meetings as we need.

We have some plate therapy objects as well as decor with multiple referral pamphlets available.

The video game room at the FEC is the only room that has a video game system.

We purposefully chose a Nintendo Wii because that's a game system that encourages families to play games together and be interactive with one another.