Recording in progress Madam Clerk, are we ready to get started?

Yes, we are ready.

Thank you so much.

I'll call to order this uh May 28th, 2026, District Board of Health meeting for Northern Nevada Public Health and ask for a roll call for determination of quorum.

Chair Reese.

Here Vice Chair Andreola.

Present board member Anderson.

Here.

Board Member Brown.

Here.

Dr.

Tuarte.

Here.

Um Dr.

Denko is not present.

And board member Driscoll is absent today.

We do have a quorum.

Thank you so much.

And if uh I'm having a little bit of a hard time hearing today, so just make sure that the sound is on.

I will now move on to the Pledge of Allegiance.

Uh Mike Brown, would you lead us in the pledge?

And to the republic for which one individual we put in kind of exciting that we've got voting going on outside our doors in public meetings here and the Pledge of Allegiance kind of makes my civics heart just grow.

Um 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.

The board may also hear public comment under individual actual action items with comment limited to three minutes per person.

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

I do have one request for public comment.

It is Michael Day.

Okay, Mr.

Day, welcome.

Looks like we've got a great summer camp flyer up here.

Thank you.

Thank you for that.

I sure wish that I could go to summer camp and was the beneficiary of many summer camps as a child.

Did that cut into my three minutes?

No.

Okay.

So first off, let me introduce myself.

My name is Dr.

Michael Day, uh retired dentist.

I've been in the dentist in this area for 47 years.

Uh, and um third generation of Northern Nevada.

Um I'm here representing the it's called the Mason TRT's Youth Outdoor Skills Incorporated.

I am the president of that organization.

And uh we formed 16 years ago with the help of Nevada Bighorn's Unlimited, North Nevada Safari Club, and the Rory Club of Sparks.

And the idea was to develop a summer camp for youth in our area so that they can be exposed to outdoor activities.

Uh and that's what we were doing for 16 years.

Uh, we're a nonprofit organization.

All the money that we raise are through donations that are given to us, and uh we do the camp uh for the kids.

Uh and uh we do charge a minimum fee.

Uh I wish I could say that we do it pretty much uh for no cost to the kids, but we learned early on in our process that uh if we don't charge a fee for uh you know for skin in the game, the kid people and adults don't think that there's a value to it, excuse me.

So uh it's a minimum fee, but we also offer scholarships there's no kids who are not uh who cannot go or attend a camp in order to do that.

So we've been doing this camp, like I said, 16 years or planning on doing it for a long period of time.

Uh we always apply for a county permit, uh, which usually comes in April 15th.

It's about a 18, no, about an 80-page document that I submit at which point in time it's always approved, and then we have to apply for food permits because we provide food, lodging, I mean tents and sleeping bags, stuff like that for the kids out there.

Uh 32 boys, 32 girls, and again, I guess I forgot the ages are 11 to 14.

This year, um, we our food permit usually runs 180 dollars, and then not counting our county permit, which is over a thousand dollars, and also not counting whatever the fire department uh uh tricommunals fire protection district.

This year we've been asked to apply for a different and additional permit, and it's called it was explained to me it was called a food organizer permit, but the title is actually called a food promoter permit event, which at what point it charges $847.

So our permit fees have gone up for 189 to over a thousand dollars.

And uh we really we just put we just provide food for the kids, breakfast, lunch, dinner, and our volunteers, and uh we don't sell food, we don't raise money or anything.

I just don't see how uh that uh uh that permit is justifiable, nor does it really explain to me.

We're not the nugget putting on the uh rib fest.

Mr.

Day we need your help.

Yeah, no problem.

Thanks.

Is that the end of your comment?

Yeah, I don't want to take over three minutes.

I could go on for a long time.

Sorry.

Thank you so much, Mr.

Day.

We'll take a look at it.

Okay, thanks.

Yeah, um I'm available for any help.

I appreciate that.

Thank you.

Appreciate it.

Okay, Madam Clerk will close out public comment unless there's anyone else in the room and move on now to item four, which is the approval of our agenda.

There are no changes.

Does anyone have any changes?

Okay, I'll seek a motion.

I have a motion by Mr.

Brown, a second by Mr.

Anderson.

Any additional questions or comments at this time?

Hearing none, I'll call for the question.

All those in favor, please stand by by saying aye.

Aye.

Aye.

Any opposed.

Motion carries unanimously.

And our yeah, we'll vote on our tablets as well, please.

Okay, item five are recognitions, and it looks like we've got a few.

It looks great.

Dr.

Eginson.

We'll first begin with Ava's coming up, but it's not actually.

So uh we will begin first with a new hire.

Uh Dr.

Dell will be introducing our newest uh public health informatics specialist.

Dr.

Dow and Elijah, welcome.

Good afternoon.

Um, for the record, Nancy Dow, Division Director of Population Health.

I'm super pleased to introduce to you Mr.

Elijah Golish here with me.

He joined us in the population health division this month as a public health informatics specialist.

Mr.

Golish holds a master's in epidemiology from the University of Nevada Reno, and we have previously worked with him during a summer internship with the epidemiology team here at NMPH.

He uh most recently came to us from the Nevada Health Authority as a biostatic with a focus on adult mental health services.

Um, during his time with the state, he did provide data related to support for legislatures and programs, initiatives for informed decision making and improved access for community health.

So in his free time, Mr.

Golish really enjoys spending time outdoors in Donner or Tahoe.

And we have multiple quick moving initiatives that we're spearheading in our statistic informatics program.

Um, so we are really uh fortunate and really looking forward to working with Mr.

Golish here in a much needed time.

Great.

Well, welcome.

Thank you, Mr.

Golish, and go back.

Next, we have years of service present uh presented by Deputy District Health Officer Aaron Dixon.

Good afternoon for the record, Aaron Dixon.

Um today we have three uh years of service, all with five years, but representing three different divisions.

Uh so that's very nice.

Um, first we have Vicky.

She is in our administrative division, she's an account clerk too, and she is responsible for making sure all of our contracts are efficiently processed, our invoices are paid, and our facilities are addressed.

She is one of those uh behind the scenes staff that helps make everything happen.

Next up, we have Britney, who's in our environmental health uh services.

She has been with us for five years as well, and she represents our food program special events team.

So she makes sure that our community event vendors are set up for success and that public health concerns are mitigated for community safety, and so our events can go off successfully.

And then finally, we have Megan with her air quality uh division.

Um she works with our air quality compliance team, so she ensures that permit holders are in compliance with the requirements and works together with local businesses to ensure that air quality standards are being met, and that helps keep our air clean for all.

Thank you.

Thanks, Ms.

Dixon.

Appreciate it.

Congratulations to everyone for the five years.

Next, we have uh health heroes presented by uh a uh Miss Ava Sandoval.

Hello, good afternoon, Eva Sandoval for the record.

Today, the first three nominees are part of our population health division.

Ariana Tomasello was recognized for her rapid response and strong collaboration during the suspected foodborne illness outbreak.

Her abilities to identify trends early, coordinate with partners, and support evidence-based response.

Then we have Leah Legman, which was recognized for her compassion through working during a suspected outbreak investigation through her patient interviews, strong coordination, and dedicated follow-up, follow-up and follow-through.

And lastly, we have Nicole Alberti was recognized for going above and beyond in her role by organizing a clothe driving drive to support the Eddie House.

Her efforts reflect strong compassion and collaboration with partners, making an meaningful impact.

The next nominee works in our administrative health department, Virginia McDonald is recognized for her outstanding support and guidance related to travel policies and procedure.

Her patients adaptability and willingness to collaborate across departments help staff now navigate complex situations with confidence and clarity.

Next, we have our air quality management division with Josh Ristori was recognized for fostering positive team culture centered on collaboration, innovation, and adaptability.

He has strengthened his engagement with his team and connected within the division.

And then our last nominee in community clinical community and clinical health services division, Olivia Bustamante, was recognized for her persistence in professionalism and resolving a complex insurance reimbursement issue that resulted in significant organizational and provider impact.

Her dedication, expertise, and advocacy exemplifies collaboration and trustworthiness going above and beyond in her role.

Thank you.

Thank you, Ms.

Sandoval.

Okay, item six will be a proclamation, and we'll welcome uh Lisa Schurtz for recognition for June 2026 as Alzheimer and Brain Awareness Month.

Good afternoon.

My name is Lisa Sherratz.

I'm a health educator too in the chronic disease and injury prevention team and the population health division.

The proclamation is for Alzheimer's and Brain Awareness Month in June in Washoe County.

Whereas June is internationally recognized as Alzheimer's and Brain Awareness Month, a time to increase public knowledge about brain health and lifestyle behaviors that can help prevent dementia that affect millions worldwide.

Whereas Northern Nevada Public Health recently was accepted into the Alzheimer's Association Dementia Risk Reduction 2026 Learning Collaborative, a public health partnership to improve brain health and help prevent Alzheimer's disease here in Washoe County.

And whereas Nevada has seen a 363.1% increase in Alzheimer's deaths since 2000, one of the sharpest rises in the nation.

And whereas promoting brain health includes proactive habits such as regular social interaction, proper nutrition, and physical activity to maintain optimal cognitive function.

And whereas dementia is an umbrella term for a decline in mental ability and changes in the brain.

And it impacts not just the elderly, but also people in the prime of their lives.

Whereas roughly 87,000 family caregivers in Nevada provide an estimated 146 million hours of unpaid care annually, a service valued at over 3.1 billion.

And whereas the toll on family caregivers is significant, both emotionally and financially.

And our community is encouraged to support brain health in their everyday lives.

Now, therefore, be it resolved that the Northern Nevada Public Health District Board of Health does hereby recognize June 2026 as Alzheimer's and Brain Awareness Month in Washoe County, recognized this 28th day of May 2026.

And we have the pleasure of having Nikki Rubarth, who is the regional director of the Alzheimer's Association, here to make some brief remarks.

Thank you.

Welcome.

Thank you so much.

Good afternoon, and thank you so much to the Board of Health, to Northern Nevada Public Health, and to Lisa.

My name is Nikki Ruboth.

I'm from the Alzheimer's Association.

And I'm sure that many of you, like me, have had your lives touched by Alzheimer's or another form of dementia.

You know what a challenging disease it can be, not just for those who are diagnosed, but of course, as Lisa mentioned, for those who are caregivers, it can be overwhelming.

But what the research is telling us is that there are things that we can do.

There are habits that we can adopt.

There are healthy behaviors that we can modify to really reduce our risk of developing any form of cognitive decline or dementia.

So we are very, very excited to partner with Northern Nevada Public Health on this effort to bring brain health awareness to our community and to really move the needle because as you've heard, Nevada is especially badly affected by this disease.

So thank you for your support, for your help in raising awareness and removing the stigma.

We're really excited to work with you.

Thank you so much.

Ms.

Rubart, thank you so much for your comments.

Would you tell us a couple of those habits and behaviors?

Yes, I would be glad to.

There was a new study, the results of which were published last year, the U.S.

Pointer study.

And two of the behaviors that were identified in that study were common sense things that I think we all know and are not going to surprise anyone, nutrition, exercise, as well as health monitoring, knowing what your what your labs are, and making sure that you're cognitively engaged, learning new things, developing new pathways in your brain.

Those are just some of the things that you can do.

I have a whole list of them.

So drop by my office, and I'd be happy to give you more.

Thank you so much for being here.

Thank you.

Okay, we'll close item six and move on now to item.

It's not identified here for action, so we're okay today, but thank you.

We do certainly adopt it.

Um we'll move now to item seven.

If there are not consent items that anyone wishes polled, then I'm looking for a motion for the consent items as posted.

Okay, a motion by Mr.

Anderson, second by Mr.

Dr.

Duarte.

Any additional questions 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 eight, Mr.

Duplantis.

Welcome.

This is Remsa's monthly report update.

Chair, for the record, I just want to announce that Dr.

Denko did a 10 or did arrive at 115.

Fantastic.

Always happy to have her.

No worries.

Good afternoon, Chairman Reese, members of the board.

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

It is our expectation that more citizens will utilize 911 to access emergency and non-emergency health care in our community, both public and private, uh, will be required to do more with less.

You might have seen recently in the press, uh, there's been reports that about 147,000 Nevadans on Medicaid are likely to be affected by new work requirements for adults without children.

Limits on coverage, eligibility for lawful immigrants, and higher copies for adults without children beginning January 1, 2027.

That in addition to the fact that Nevada is the sixth highest uninsured rate as a highest uh sixth highest uninsured rate in the nation, according to the the the Kaiser Family Foundation.

That said, um, I do anticipate that health care needs through our 911 system for all of us uh will continue to rise.

And we're already seeing some evidence of that.

In addition to that, last week on May the 22nd, the Center for Medicare and Medicaid Services issued a proposed rule to limit GMET subsidies to EMS providers.

The proposed rule is in accordance with President Trump's June 20, June 6, 2025 memorandum on eliminating waste fraud and abuse in Medicaid.

This proposed ruling will not directly affect REMSA, but it may significantly reduce GMET funding to government agencies who REMSA subcontracts with on certain responses beginning in 2029.

For my report today, I'd like to provide you with an update on REMS's ground uh franchise operation, which represents about 45% of Rems' business, um, as we discussed before.

I understand that you've been provided with a copy of Remsa Health's 20 April 2026 report.

In April, we transported 8,006 EMS calls, uh, and we transported 5,297 patients to area hospitals.

Our area uh average response on priority one calls uh in the city of Reno, five minutes and 29 seconds, City of Sparks, six minutes and ten seconds, Washoe County, eight minutes and forty-seven seconds.

Why there are differences?

Um it's basically got to do with the density of population surrounding um our our area.

The city of Reno has a very, very high dense um population area uh where the calls stem from.

With regard to priority two calls, uh, which uh we uh report in our franchise report, and you have that with you as well.

Um, our average response times in the city of Reno, seven minutes, five seconds, Sparks, seven minutes forty-six seconds, Washoe County, nine minutes and thirty-five seconds.

Things that would constitute a priority two call would be unknown conditions, common falls where there are no other extenuating circumstances.

With respect to responses based on our franchise compliance map, uh REMSA continues to be fully compliant in all zones.

We're 90% in zone A and 93% in zones B C D.

Quality of clinical care is our absolute aim.

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

In Northern Nevada, our system of patient care begins with call triage handled by clinically trained technicians who begin life-saving care on the phone line.

In essence, all calls are being cared for while resources are rolling.

In our last meeting, Councilman Anderson asked me about the data in the instances where Sparks Fire arrives on scene first.

We met with um the Sparks Fire EMS chief, and we tried to reconcile that data.

Unfortunately, what we have is data that's hard to segregate by city jurisdiction.

Um I I can't say one way or the other, but one thing that we certainly have been working with uh the city manager of Sparks as well as the fire agency is really being more selective about when we do roll fire assets.

So I would expect that that number would be declining over time anyway.

Um so while I would really like to be able to say we looked at the data set, and you know this is the definitive answer.

Um we're not that, and because we're dealing in a kind of a static environment where we're constantly trying to improve how we respond and what we respond with, it's also a moving target.

So I appreciate the question.

We looked at it, and I wanted to give you something more than what I'm giving you today, but it's the best that I've got.

Um currently, RemSA is the region's only ACE accredited fire dispatch center, and we provide fire and dispatch services to Trucking Meadows Fire Protection District.

Our community continues to work on a common CAD system, but that implementation date has been delayed, unfortunately.

Now, that said, uh Chief Edwards and I with the Trucking Meadows Fire Protection District are working on extending our existing agreement where we provide EFD to the Trucky Meadows organization, and we will continue to support that service for as long as it takes.

Fortunately, I can stand here before you and tell you that the REMSACAD is not at risk of going into life.

Dispatching the closest appropriate ambulances always important, but the word important is one that I want to continue to bring attention to, because as I mentioned in my opening comments, folks are calling 911 to access health care.

We're finding a spike in the request for basic life support services rather than advanced life support services.

Now, also too, what I'd like to comment, and I because there's a lot of data here.

I've asked if I can show this uh to you on on the chart as I speak about it.

Can you a little small, but I think it it'll serve the purpose.

Um REMSA is a 501c3 not-for-profit organization that charges for ambulance services when patients are taken to area hospitals.

And our average ground transport collection, and I say this because as I point to this number here, 2,2613.

That is the number that this board has issued to REMSA as an average bill rate.

Of that 2,261 that you allow, the average collection that we actually get is $639.

The cost to provide the service is $701.

Now you might ask the obvious question, well, how do you stay in business?

Is because REMSA provides things other than the 45% that I'm talking to you about today.

So as a whole, um, the organization works, and it's like, for example, if you were to take a hospital and you look at the services a hospital performs, well, maybe surgery makes a little bit more than um then the than the than the ER department.

It's very much that situation.

With respect to Medicare and Medicaid, and actually, I think in one of the previous um uh Board of Commissioner meetings, Commissioner Hill actually made a comment of the fact that Nevada is widely known for under-reimbursing with Medicaid.

Medicare reverses reimburses us an average of 440 dollars for transport.

Medicaid, 245.

Now, in my comments about the GMT, which I included earlier in my talk today, the reason we have GMET is because it's widely known that the states underpay uh for the performance of services under Medicaid.

And so GMET exists in order to help equalize that picture.

But this also gives you a kind of a sense of what's going on at a national level, because more and more, and not just in the case of GMET, but in many federal programs, we're seeing the federal government try to trying to shift the burden of payment to the states.

And you can easily see why that is the case here.

So that proposed regulation that I mentioned to you with regard to GMET is suggesting CMS is suggesting that the maximum GMET allowed reimbursement would be the Medicare rate.

It would not be based on cost as we currently know it today in the GMET program.

So I I I pass these comments on to you, telling you that REMSA is not directly affected by that, but many of you are involved in other organizations where it's something that I think it's important for you to know.

Now it's not a simple thing because there are actually three forms of reimbursement on the GMET, and it just depends.

So that's why I say it may have an impact.

I think you know, more needs to be learned uh and understood uh as to what that downstream impact is going to be.

Private insurance, for example, as I'm pointing to right here, pays an average of $1,700.

So even though you've given us an average reimbursement rate, um even private insurance short pays.

I mean, that's just kind of the nature of the industry that we're in.

And of course, we have uninsured, which is for the most part is whatever we get.

Now, one thing uh uh Councilman Anderson asked me in the last meeting, too.

I think you asked me about average West Coast or average average uh transportation rates.

And what I found is average West Coast, and in this particular case, West Coast is defined as California and Nevada.

Um, the average bill rate is $2,594, which is not out of line with what you've allowed us here.

But what's different is the average West Coast collection is $1,173.

Now you might ask yourself, why is there such a gap between the $1,173 and the $639 that I just represented to you that we actually do collect here?

And it's because California has a very rich reimbursement rate on the Medicaid, uh, whereas you can see here uh of what I'm pointing to, Nevada lacks.

Um, and so that's why there's such a disparity there.

With regard to our partnership in the community, we believe strongly in being a collaborative and cooperative partner in regional health care.

It's critically important to patient care that we align patients with the right um uh path of care.

So my point here is that REMSA operates a tiered response system, and you might ask yourself, so what does that mean?

Um a tiered response system means that we look at the call, we tree Ash the call in EMD, and we discern between ALS, BLS, ILS, et cetera.

REMSA is very good at applying the right resource to the right call, and that's kind of how the we make the chemistry of REMSA work, quite candidly.

Our average wage amongst all paid paid groups, which would mean the paramedic E all the way down to EMT, um, the average wage is $80,000.

Um, on the other hand, when you look at some of the other wages, and I think it's been mentioned in a couple of other meetings, when you look at if an EMS fire wage to do the very same work, it's over 200,000.

Um so you can see where it's been very, very important for REMSA to be very astute at managing labor costs and applying the right skill to the right care that a patient needs.

The other thing I wanted to point out is that, and we we don't actually talk about this hardly at all.

Um, and is that REMSA operates at a managed integrated health program?

And what we do there is we're focused on high utilizers.

In one of the previous uh uh district uh uh um uh county commission meetings, um Judge uh Walker um talked about a sequential um intercept model and and did an awesome job.

I mean, if you've not seen that, I would really encourage you to go back and revisit that because when you look at his point um and the legal process for how we handle mental uh mental patients, it becomes clear that our jails, in essence, are quasi mental institutions because 80% of the people there have some kind of a mental issue, and it really becomes a hamster wheel.

And RIMSA is a part of kind of like that sphere of addressing some of those same folks in the population because we find with the homeless population for which we encounter day in and day out mental issues uh are very prevalent.

Um, and every once in a while we get a success where we look at the frequent utilizers and we're able to put them into a program.

Um, for example, um the head of our MIH group this morning when I chatted with her, she was all excited.

And I said, What are you so excited about?

She says, Well, this homeless person who's been sleeping out on the street, and I finally got him into the Keras campus.

So you look at these things and you and you recognize the success of that.

Continuing, um, with regard to our customer um survey report, our number for the month of April was 94.84, which is higher than the same period of last year.

Most prevalent comment that was made by folks was recognizing the care of the medics who provided the service to them.

I also want to comment just very briefly on the fire regionalization study.

Remsa is not one of the contracted participants in the study, but we have been at the table providing all information that's been asked of us uh to help facilitate um the project.

And the next two meetings that are scheduled are I think there's one for June the 18th, and then a workshop for July the 21st, because that group's got kind of a short timeline at this point in terms of providing a deliverable to the cities.

Lastly, I want to talk about the meet and confer.

Uh, we've concluded our meetings, uh, and I believe uh Dr.

Kingsley is going to make a couple of remarks on where we are uh with the meet and confer um in his comments later.

And then there's one more question that I'd like to address before I wrap up.

Um in the um previous meeting, Chair Reese asked about our EMS Explorer program.

And um to help give you an answer, I've invited uh Miss Jenny Walter, who's the head of our education department, to make a couple of comments to you today about what that program is and what it looks like.

Great.

Ms.

Walter, thank you.

Sorry, my name is Jennifer Walters for the record.

Um, our EMS Explorer program launched this March for youths ages 15 to 18, and it's essentially a career exploration program in partnership or as part of the Scouts of America Exploring Division, um, where students will learn about the various pathways that EMS can take them.

It's uh led by our experienced EMS instructors as well as guest appearances from specialty teams from our search and rescue division, our Thames medics, um Ski Patrol and so forth.

Uh they'll learn leadership techniques as well as leave there with certifications such as first isn't first on the scene and health care provider CPR, which is a prerequisite for the EMT basic um course if they choose to follow that path.

Um, and lastly, we're excited that it is completely free to the participants.

Think uh in part of the community investment fund uh in partnership with the Northern Nevada Public Health District.

Um do you have any questions?

No, I don't think so, but it's a great update.

Thank you for that.

Thank you.

Appreciate Mr.

DePlanus, you kind of circling back on things we asked so they don't just evaporate.

Thank you for that.

That said, I'm happy to answer any all questions you have.

I even brought some additional help uh today to make sure we don't leave anything uncovered.

Any questions?

Mr.

DePlanis, thank you for that.

Let me see if anyone has questions today, Mr.

Anderson.

Actually, uh, don't have a question, but uh Mr.

DePlantis just want to say thank you.

Um, our team reached out to you and and uh you guys did respond.

Yeah, we you know don't have hard numbers yet to figure out why the difference between you know your numbers and ours and what we're showing, but I truly appreciate you um working to help figure out why we're seeing a difference in those response time reportings.

Um, so that's one, and then secondly, yes.

Uh the the second concern I had was um insurance coverage and um insurance companies saying that they weren't covering it because it was above average uh charges and all that good stuff.

And likewise, I you personally, I believe got involved in that as well and helping us to understand that better.

Um, and then thank you for going in a little bit deeper and doing the comparison for us.

So I just want to say thank you for being responsive.

Well done.

Thank you.

Thank you.

Any other comments?

Okay, Mr.

Deplantis, thank you so much.

And I'll mention that commission of the oh no, Mr.

Duplantis.

Exactly.

But uh I've been promoting thank you, Miss Andreola for uh a motion for approval or acceptance of the uh report.

Yes, perfect.

Any other uh and a second okay, and a second uh by Mr.

Anderson.

Any other questions or comments?

Hearing none, no call for the question.

All those in favor, please do by by saying aye.

Aye, aye.

Any opposed?

Motion carries unanimously.

Okay, that ends our items under the eight items.

And now we'll move on to staff reports and programs updates.

Uh 9A is Mr.

Vega with air quality management.

Thank you, Chair Reese, members of the board for the record, Francisco Vega, director of the air quality management division.

Everybody should have my uh report in front of you.

Just wanna highlight a couple of things.

I did uh summarize in my report the American Lung Association's uh 2026 state of the air report.

Um as you can see in the in the uh report, we received a grade C for ozone F for short-term PM 2.5, and then we passed for annual PM 2.5.

Uh just wanted to clarify a little bit.

Uh the standards set by the American Lung Association are slightly different than you know what the EPA sets, so that's why you might see some of the differences.

So just kind of wanted to explain that a little bit.

But uh we appreciate the American Lung Association.

This is really tremendous information that they put out.

Um also wanted uh update on fuel waivers, because that's kind of been in the news on an air quality perspective.

So providing some information on how that might impact us here locally.

Uh again, these are typically more short-term waivers, and we understand the economic impacts of some of the things that we're experiencing in the federal government.

So we recognize the benefit, maybe some short-term kind of uh concerns on the air quality side, but uh for the most part um we're supportive of that as well.

So wanted to provide that.

Um in April, happy to report we experienced no exceedences, which is always something I'm happy to report on.

Um also wanted to mention that we did have a grand opening for our new Bird Eye Air Monitoring Station and wanted uh send appreciation out to Councilman Anderson for uh joining us with that and uh saying some kind words.

Um on the plan review side in April, we got back to 100% um of review times within uh jurisdictional time frame.

So again, happy on that.

And I think that's about it.

So quick update, happy to answer any questions.

Any questions for Mr.

Vega?

Dr.

Duart.

Mr.

Vega, I'm looking at the um graph on the uh Ohio zone days, and I noticed that we have very low on uh 2009 to 2011, and also 20 uh 22 to 2024 is very low, and then there's several peaks in there.

Can you help me understand a little more about what's going on there?

Excellent question.

I wish I had further insight for you, but uh we can certainly look into that.

One thing I uh I'd like to point out 29 uh 2009 to 2011.

Um we did experience somewhat of a downturn, obviously, in the economy.

Um I want to say that probably played a factor, but that is a guess.

So let me look into that further and I can get you a definitive answer.

Yeah.

Thank you so much.

Any other questions, Mr.

Anderson?

Thank you for the report.

And I do have a question in regard to the fuel waiver.

Are you notified by the state or anyone if we are actually bringing in the fuel that is falling under that waiver or ones that a fuel that is out of compliance normally in this region?

Is are you notified of that so that you can actually match air quality to to when that fuel starts arriving in our community?

Yeah, it's a good question.

Um we are we are not notified.

I'm trying to think so.

We do permit, for example, the um SFPP gasoline dispensing um.

Yeah, gosh, I get I'm missing the word here, but uh the fuel tanks in Sparks.

We do permit that facility.

Um, but to my knowledge, we are not notified of uh what fuel deliveries look like.

We permit the tanks um and we conduct testing on those tanks, but for the most part, I'm not aware of any uh notifications that we receive on the types of fuel that uh are delivered.

Okay, yeah, I I was just thinking it would be nice to see if all of a sudden you see air quality changing and then you can see corresponding.

Well, yeah, that's because we're bringing in fuel from out of this region that doesn't isn't normally meeting that that specification that we have here.

So I'm just curious.

I I think that would be a great idea if we could figure out how to how to do that.

The question is, yeah, it's not coming through the pipeline, so you wouldn't be able to pull it from Kinder Morgan.

So it would probably be all the common carriers that are hauling it, would be about the only way.

I I don't know.

But anyway, thank you.

Yeah, of course.

Yeah, the only other thing I'll add is it uh these waivers are fairly consistent.

They typically happen on an annual basis, one way or another.

Uh and so we track our monitoring sites obviously very closely and see if there's any impacts there.

So uh we typically will see the kind of the end result, and if we have concerns that we will definitely communicate that.

Yep.

Anything else?

Sir Vega, thank you so much.

We'll close this item out to move on to clin uh item nine B, Ms.

Shepard.

Good afternoon, Christina Shepard, division director of community and clinical health services.

Um a couple of highlights I wanted to share from the staff report.

Uh RSV season typically ends March 31st in our community, but following guidance from the Nevada State Office of Epidemiology, um RIZ team did extend RSV prevention efforts through April 30th.

Um, this ensures continued protection for eligible infants, young children, and pregnant individuals while the RSV virus was still circulating in our community.

Um our family planning sexual health clinic continues to navigate a shortage of bisillin, which is the medication that we use to treat syphilis, the primary medication.

Um the FDA has authorized the temporary um importation of a medication called lenticillin, which is considered clinically interchangeable with bisillin, and our clinic was able to secure 60 doses of that medication, which will be primarily used um to treat pregnant people with syphilis or individuals who are unable to be treated with the oral antibiotic regimen.

That's typically either a 14-day or 28-day course of oral antibiotics twice a day.

So a lot of people find they have um significant difficulty getting through that um treatment.

Um and then our WIC program partnered with our communications team to share WIC information with approximately 100 community organizations.

Um, this is supporting our efforts to maintain or increase participation at our um N NPH WIC clinic.

And then as we close out the month of May, I just wanted to recognize that May 6th through the 12th was National Nurses Week.

Um, so during this week, we honored the dedication, expertise, and compassion of our nursing workforce.

Our 16 full-time and 19 intermittent hourly public health nurses play a vital role in protecting and improving our community health through prevention, education, and outreach.

And I am incredibly grateful for their skill, dedication, and heart that they bring to work with them every single day.

And that's all I have, and happy to answer any questions.

Any questions for Ms.

Shepard.

Oh, thank you, Ms.

Shepard.

Appreciate you.

Close out item 9B and move to 9C.

Uh Mr.

Fida, welcome.

Good afternoon, board.

Robert Fida for the record, environmental health uh division director.

Uh, you have my remote in front of you, so I kind of wanted to highlight a few things that have been going on.

Uh some of our educational outreach efforts.

Uh staff hosted our first risk factor workshop on April 28th.

It was well attended.

We had nine different uh food establishments come through for that.

And additionally, our land development team did a real estate uh outreach uh program for their in April, and that was attended by 27 folks.

Uh another thing that our food folks have been doing, our food program is there was a confirmed outbreak.

So our staff went out and did an environmental assessment.

Uh so that included interviews with staff, uh environmental samples, food samples, uh, and that investigation is still going.

So another thing to highlight is uh vector season is upon us.

So we did uh get another additional intern.

So we're up to three interns now in the vector program.

And the surveillance is uh was set to begin, I think May 18th.

So uh we should be going in full swing there.

And lastly, uh we are looking at a pilot project with the county manager's office.

Uh this is an idea to work with KTMB for uh rapid response cleanup on some smaller sites.

So we're kind of exploring those options to see if uh that is something that we can uh potentially do.

So uh after that, I think uh I'll open up for questions from the board.

Questions?

Okay, Mr.

Biden, no questions this month.

Thank you so much.

Thank you.

We'll move on now to item 9D.

Dr.

Dow, welcome to the good afternoon.

Um record Nancy Dow, Division Director of Population Health.

Um, you have my report, which always provides update covering the previous months.

So I like to just give a few quick highlights on what's happening currently more this month.

Um so May is older American months.

Um with that, our CDIP chronic disease and injury prevention program has launched several initiatives focused on um our senior falls prevention.

Um a new multimedia campaign in English and Spanish is currently running on TV and social media through May, and it's been directing viewers to fall prevention resources.

Um staff also participated in the county's annual information fair on May 1st, which is um engaging directly with older adults and promoting the upcoming stepping on workshop that we'll be doing starting in June and going all the way into July.

Um so building on the success that we had in the fall, um, for the second time this is the first time we did it in the fall, so this is the second time this fiscal year.

We're in partnership with Renown offering um the stepping on workshop to our community.

Um it's an evidence-based fall prevention workshop that's seven week series, and it provides uh weekly two hour sessions for at-risk older adults and participants gain practical knowledge and skills to reduce their risk of falling and uh increase confidence in safely performing daily activities.

Um the National Council of Aging has noted that evidence-based programs like stepping on has shown effectiveness in reducing fall risk by up to 35%.

Uh additionally, we're also offering the Enhanced Fitness, which is a 16-week evidence-based group exercise and fall prevention program at the Sierra Crest Senior Living beginning in June as well.

So these combined efforts really do aim to address the growing need for fall prevention in our community, and uh we are well aware that unintentional falls remain the leading cause of injury-related emergency department visits and hospitalization among older adults in Washoe County.

Uh, in other highlights in epidemiology this month, we issued two new Han publications uh due to the Hontavirus outbreak involving the Andy strength and also one for learning physicians and the public on the Ebola uh Bundimbuccio virus outbreak at the DRC in Uganda.

There are no cases currently for either confirmed in the US.

Traveler monitoring is taking place right now with the epidemiology team.

Uh flu season has ended on May 23rd.

Our 2025 to 2026 flu season, um respiratory season, excuse me, uh, did reflect a continued return to pre-pandemic levels.

So influenza and RSV was driving the majority of activities, and COVID did remain quite low at its lowest level since the surveillance began.

The three viruses were circulating this season in staggered pattern, COVID in the early fall, influenza in mid-winter, and RSV in the spring.

And while this influenza season peaked its highest weekly hospitalization rate observed in five seasons, our overall trend did show less compared to that of the last season.

And in Pertusis, as of May, we totaled 30 cases.

We're only halfway through the year.

So in comparison last year for the entire year with our surge in cases, we landed at 31 total cases.

Um so we are quite high still in Perthuses.

We're seeing mostly between the age of 11 and 18 years old.

And um we are seeing more of unvaccinated cases now.

Uh, well, as in before it was more of a mix.

And finally, in outbreaks, we're seeing quite an increase in outbreaks declared in May compared to April.

Uh, as we hit the warmer months, we're seeing a little more of GIA-related outbreaks that we're monitoring.

And that's all my updates.

I'm happy to answer any questions.

Dr.

Dow, thank you so much.

We'll see if there are any questions or comments.

Ms.

Andrea.

Thank you.

Thanks for sharing about the fall prevention.

Um, I know capacity is always an issue.

There's always a need to have more people to do everything that needs to be done.

But is there any thought to actually visiting the senior centers and um you know throughout the community and providing that same opportunity that you just shared?

Was that and I'm sorry, I can't remember.

We we will try to, we do try to promote it through our social media, and then uh we are actually having epic news coming out, going to physicians so they can pass on to their patients and also to our community.

But uh, we're definitely trying to do a little more outreach so they're aware.

Uh may I just offer a suggestion?

Yes.

Um, the senior advisor advisory committee meets for Washoe County, and it might be a great opportunity to actually share that.

So that's my first suggestion.

The second suggestion is is there a possibility, even um not everyone uses social media.

I know that's a surprise, but maybe there's an opportunity to put flyers in the um all of the senior centers, and maybe the senior set of advisory group could help facilitate that.

So just offering a suggestion.

Thank you so much.

Any other questions?

Okay, Dr.

Dow, thank you so much.

We'll close out item 9D and now move to 9E, which is a report by the office of the district health officer, Dr.

Kingsley.

The floor is yours.

Thank you, Dr.

Chad Kingsley for the record.

Uh, just for current updates, want to provide just a quick commentary as it is in the the news, but is uh sometimes on a daily basis engaged with the CDC and our national partners about just reviewing the recent hantavirus as well as Ebola viruses.

Um, as per the HANTA virus, currently there are uh no cases or individuals under surveillance in Nevada, nor do we anticipate any of those individuals that have been under surveillance to be to come to Nevada.

And then as uh as additionally the same information for Ebola, uh Dr.

Dow and her team are in contact with CDC and have their updated guidelines guidelines and comments on all these points, but again, very low risk for Nevada.

Uh second, just want to uh comment on the meet and confer with RemSA.

So all items that were provided to the District Board of Health on record have been uh we have met and reviewed each item with RemSA.

Currently uh those that review and the outcomes of it are with our attorneys, and it is being reviewed and is projected to return to the district board of health in June.

And lastly, just to for current update, just to notify that I will be out during the week of June's district board of health, and the deputy district health officer Aaron Dixon will be here.

Um then just for want to verbally uh recognize an authorization per the authority given to the district board of health.

It was just to adjust a our uh current fees for a uh vaccination uh with uh Washoe County Northern Nova Public Health Fee Schedule.

It is to so that we're able to get the correct reimbursement, but it is a uh meningitis.

It's a five in one vaccine, so we're just able to meet the fee schedule so we can get appropriately reimbursed for that and just acknowledging that for the record.

Uh lastly, you have your report uh for me and those updates within it, and uh I'll entertain any questions at this time.

Dr.

Kingsley, thank you.

Let's see if there are any questions from the body.

Okay, none I'll close your item, Dr.

Kingsley, and now move to our final public comment period.

Madam Clerk.

We have no requests for public comment.

Okay, we'll close that out and come to board comments.

Any comments by the board?

Vice Chair.

Thank you.

Um, I just want to go for full transparency that um Dr.

Day actually reached out to me about the um the public commenter.

That's who I'm speaking about.

And so um he forwarded me an email uh that um was sent in term in terms of correspondence, and I'm just in learning a little bit about it.

I wonder if there's an opportunity to really rethink.

Um exemptions are always hard, and I'm not suggesting that um everything be an exemption, but um, and not just this entity, but I think those that are not promoting an event in a traditional way, um, those considerations could be looked at.

Um, and I think it may be a policy that could be reviewed and could be considered.

I asked if I could just have the status um here's a constituent, and not that it matters, it matters about what we do for the community as a whole, but I do think that that fee impact went um at an exponential level, right?

From 150 essentially to 840, if I'm got those numbers correct.

So I'm wondering if there might be an opportunity to explore what can be done, not just for his organization, but for those that are similar that are not necessarily event promo traditional event promotion.

Um he used the rib kickoff as an example, which is probably coming up in September.

Can't wait.

Um gotta love those ribs and sparks.

Open Mr.

Anderson will invite me this year.

I'm telling you, we're expecting an invitation.

I heard him say yes.

Yes.

I heard it.

Anyway, I do think that there is a difference and I think there's a significant opportunity to help the kids help the community and help those nonprofits that are giving back in exceptional ways and not to look at fees or fees.

But I do think that there's a level that we could look at a tiered approach.

So appreciate it.

And I'd like the feedback if I could please we're going to bring it back to that I've already talked to Dr.

Kingsley and we're going to take a look at it offline.

Nothing that we can do today but uh it's something that I think we'll have an ongoing discussion about any other questions at this time or comments?

Okay, we'll close the board comments and this meeting is adjourned