Madam Clerk, when you're ready, we'll get started.

Recording in progress.

Okay, we'll call this meeting of the Northern Nevada Public Health District Board of Health to order.

Thursday, July 23rd, 2026.

It's now 1 p.m.

Madam Clerk.

Can I get a roll call and determination quorum, please?

Chair Reese.

I'm here.

Vice Chair Andreola.

Present.

Board Member Anderson.

Here.

Board Member Brown.

Board Member Driscoll.

Here.

Dr.

Itwarte.

Present.

Dr.

Denko is currently not present.

Um, but we do have a quorum.

Thank you so much.

And now for the Pledge of Allegiance.

Um, Dr.

Kingsley, I'd like you to lead us today.

We need the pledge allegiance.

Pledge allegiance to the flag of the United States of America.

And to the Republic for which it stands.

Madam Clerk, public comment, please comments heard under this item will be limited to three minutes per person and may pertain to matters both on and off the board agenda.

Unused time may not be allocated to other speakers.

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

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

We did receive one emailed public comment and one e-comment, and they have been forwarded to the board members and entered into the record, but will not be read.

We have no requests for public comment under this item.

We do have requests under other items.

Under a specific item.

Okay, so I'll just look out to the public.

This is the time for general public comment.

If anybody wishes to make public comment during this general public comment period, please let me know.

Looks like no, so we'll close that one out.

And Madam Clerk, you'll keep me on task and let me know where those fall.

Thank you so much.

We'll now move on to item four.

Uh Dr.

Kingsley, are there any changes to the agenda?

No, no to at this time.

Okay, I'll look for a motion.

Second.

I have a motion by Miss Andreola, a second by Mr.

Driscoll.

Any additional comments or questions at this time?

Hearing none, I'll call for the question.

All those in favor, please signify by saying aye.

Aye.

Any opposed?

Motion carries unanimously.

Make sure to vote on our tablet too, please.

Okay, item five is uh the most fun we have during these meetings, and I'll turn that over to you, Dr.

Kingsley and your team.

Great.

Thank you.

Turn over the time to uh deputy district health officer Aaron Dixon for uh years of service.

Uh we just have one five year views of service today.

Uh Tamara fromitially joined the immunitation program and then cross-crained to support the family planning federal health program.

So even out there is an option special for both programs, demonstrating the extensive knowledge required to meet each program to meet requirements.

Fantastic.

Thank you so much.

And at this time, we recognize uh Frenchie uh Rubio for Health Heroes.

Um be on the agenda TA and contact.

So for the month of June 2021 before the missions, um we um have recognized 10 health heroes.

Um they're recognized for going above and beyond their normal job duties, um, demonstrating teamwork and commitment to serving our community.

We have Jordan Marchie, uh Raquel Grafton, Steve Shipman, and Melissa Schaefer, all from PhD, and then we have Lauren Huntsman, Steve Coots, Bianca Trujillo, Charmaine Roque, Beth Reeve, and Khalisa Suarez, all from CHCCHS.

Thank you to all our June Health Heroes for the positive impact you make every day.

Thank you.

That is it for the for recognitions.

Thank you.

Okay, great.

Thanks.

We'll close out item five and move to the consent item.

Do any of my colleagues have any items that they wish removed from the consent agenda?

I don't see anything.

I'll look for a motion.

Move to approve.

Okay.

Thank you so much, Mr.

Anderson, and a second by Miss Andreola.

Any additional questions or comments at this time?

Hearing none, I'll call for the question.

All those in favor, please signify by saying aye.

Aye.

And opposed motion carried unanimously.

Yeah, Dr.

Danko, welcome.

Madam Clerk, you'll note for the record, Ms.

Danker is present.

Thank you so much.

Okay, we'll move on now then to item seven, uh, which is our monthly report.

Uh, Mr.

Duplantis, welcome and good afternoon.

Good afternoon, Chair Reese, members of the board.

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

I'd like to provide you with an update of REMSA's ground franchise performance.

I understand you've been provided with a copy of the REMSA's uh REMSA Health's June 2026 report.

In June, we responded to 8,000 682 EMS calls, and we transported 5,619 patients to area hospitals.

Um, one thing I'd like to point out, which is kind of unique for our community.

For the first time in REMSA's history, and I suspect ever for this community, uh we responded to uh over 100,000 calls of service in fiscal 2026.

So I'm excited that we were able to cover that for for the community, and I anticipate that that will continue to uh to increase over time.

Our average response times for priority one calls were five minutes 31 seconds in the Reno area, six minutes 13 seconds in the Sparks area, and eight minutes and 46 seconds in the Washoe County area.

The variances between those performances of response times have to do with density of population.

Priority two calls, our average response times were in Reno, seven minutes six seconds, Sparks, seven minutes fifty-one seconds, and Washoe County, nine minutes and thirty-six seconds.

With response to, with reference to responses based on our compliance zone map, REMSA continues to meet and RB franchise compliance for all priority one calls in zone zones A, as well as uh meeting uh compli uh or beating, I should say, um, response requirements in uh B C and D.

Our year-to-date average uh in zone A is 90 percent, and our year-to-date average in uh BCD is 93 percent.

We give significant attention to the quickness of response, which is important.

Last month I mentioned that we worked with the District Board of Health to change the company that does our customer surveys.

Why to change?

The current the new new system allows our EMS oversight manager to have unrestricted real-time access to the survey results uh on the platform to review data as it's taking place, and our patients are contacted within 10 days of our service and asked about their experience and the quality of care they've received, communication with our team, and their overall satisfaction with the encounter.

Now, what we're learning is actually really interesting.

In the months of of May and June, for example, patients are asked, as they will be it month after month going forward, open an open-ended question about what matters most to you.

And survey results for the months of May and June indicate that callers state that professionalism, care provided, and caring matters most.

It's interesting that response times, which is a historical measurement for our industry, came in ranked as third in the month of May and fifth in importance in the month of June.

As I reflect on the on that data, uh a couple of things I I think I'd like to really highlight, um, and is that our performance score in the month of June was 97.

I'm sorry, month of May was 97.54, and then increased uh to 98.63 uh in patient satisfaction uh in the month of June.

The specific questions that are focused on in the survey have to do with dispatch instructions, prop arrival, professionalism, compassion, explaining procedures, and treating of a condition.

I think what we're starting to see, uh and I actually had a conversation with Chief Cochran earlier this week uh about this, because it's it's it's a little different than candidly than what I expected.

And I think it's reflecting the fact that 911 is truly become the safety net and the access to health care in this community.

And people are more focused on the outcomes, the care that they're receiving, and less important less focus on how fast did you get here.

And so we are finding that we are getting more calls, lesser acuity, and so that's my theory as to why the explanations of the kinds of things that matter to people are what they are.

With regard to fiscal responsibility, RemSA is a 501c3 not-for-profit.

Our fiscal year in was uh June 30th, like many of the governments.

And uh uh we're we're very satisfied with the way our our year ended.

We look forward to our fiscal 2027, and we're in the process of closing our books so that our auditors uh can do the third third party audit that we provide to you each year.

Today at RemSA, we were joined by District Board of Health member Mike Brown, as well as members of the District Board of Health, as we uh had the honor of presenting leaders from the North Northern Nevada Peer Support and Trauma Intervention Program with contributions from the uh community investment fund, previously known as the penalty fund.

Just to say a little bit about those two programs, uh I'd like to personally thank Gabrielle Titan uh from the trauma intervention program and Charlie Tabano from the Northern Nevada Peer Support for their leadership and everything they've done for our team and patients this past year.

Northern Nevada Peer Support and Trauma Intervention Program are two vital organizations that serve all of our first responders, not just Remsa Health.

They support the firefighters uh of all of the jurisdictions in our area, as well as all of our police uh uh members.

With regard to the fire regionalization study, I've updated you in the past uh on some of the activity there.

Uh at this point, uh, the update that I'd like to share with you is that we had a meeting earlier this week, which was called the uh a workshop.

Um it was well attended.

Um the consultants stated where they thought they were and asked for collective feedback from the group in attendance, and they're taking the the feedback that we gave them, adjusting their plan, and they will come back with something um most likely in the next couple of months because their report is actually due before the end of 2026.

With regard to the uh compute common computer aided dispatch system, the common CAD, our teams continue to work on the project, which is significantly behind as a result of the vendor uh that was selected not being able to perform as we had anticipated.

Currently, I understand the Go Live is expected around April 2027, irrespective, and very important to this group, I want to reassure the community that RIMSA's current software platform, which supports EMS and Truckee Meadows fire protection services, is fully supported by the vendor and is 100% up to date to meet the needs of our community for as long as we need.

With regard to meet and confer, the other item that's been on our agenda for a while, we've completed our meet and confer meetings under the franchise approval condition, and I believe this update, uh an update on this topic will be provided further in the agenda by the district health officer.

Those things being said, I'm happy to address any questions that any of you might have with regard to my presentation today.

Mr.

DePlanus, thank you so much.

Let me see if my colleagues have any questions today.

Looks like Mr.

Driscoll will start with you.

Thank you, Mr.

DePlanis.

Um I continue to kind of focus on the response time and what happens to the system.

And consistently over time, system overload is the main exemption that you um petition the health department on.

So in this case in this month, there were 52 exemptions total.

All of them were for system overload.

So in the analysis that your team does, do you look at those 52 individually and determine if there's some commonalities?

And if you find commonalities, does your management team work to try to fix those commonalities so they don't happen in the future?

I I think uh we can address that.

In fact, uh, I would like to ask one of my team members, um, Adam Hines, could you help me uh address that question?

Adam participates in looking at the after action review, which is all of our previous days' activities.

So I think it might be helpful if he could opine on that question.

Thank you.

Good afternoon, Adam Hines is Chief Operating Officer for Rens Health.

The answer to that is yes.

So there obviously are some things that are going to be outside of our control.

So many of the times, uh, and there's a specific definition that is approved by the district health officer as far as what meets system overload.

Uh and so it has to do with historical call volume and fluctuations, increased fluctuations, um, specifically two times the standard deviation of what we normally would respond to.

So when the system surges like that, uh, and there are calls that uh do not meet the response time requirement, uh, those would qualify for an exemption.

Uh we are going to begin to represent those a little bit different as far as a percentage so that we can look and track and trend and see if those are different.

I think it's also important, at least from a confidence perspective, that if in those particular times, uh ambulances are being consumed responding on calls, we have mutual aid agreements with our fire service partners that are then being called to respond to those medical emergencies in the appropriate jurisdictions.

Um but every morning our team meets, and in fact, I think maybe as a result of a comment that was made, it may have been by you, Member Driscoll or somebody else.

Uh uh, Ms.

S.

manager ESP, uh participates in our after action review group, which occurs at nine o'clock every morning, um, so that we not only look at uh some of these system anomalies, but also um look at areas of opportunity and different deployment strategies.

Thank you very much.

Thank you, Mr.

Chair.

Mr.

Driscoll, thank you so much.

Dr.

Duarte.

Uh thank you very much, uh Mr.

Duplanus.

My question for you um are are you looking at um whether or not extreme temperatures uh or snow events impact your response times or your your call volumes?

And then my second question, I'll put them both out.

Um, is there any data that informs us about priority two events that then become priority one?

So that they're originally thought to be a lesser acuity and then found to be more emergent or exigent.

And I wondered if you could comment on either of those things.

Certainly.

Um Adam, I might ask you uh since uh you're in the in the operational sphere and experience it and live it every day.

Yes, thank you, Adam Hines, again for the record.

Uh so yes, we do.

So during actually the after action review group, one of the things, in fact, it's I think it's the last slide, we look at is what is the projected temperature, what is the inclement weather that we may be experiencing, and how does that change our deployment?

So, for instance, if we're uh forecasting snow, which we do not foresee this particular week, um, we will add additional resources into the system, have conversations to ensure that we are prepared for those things.

We know that we're going to be responding to more traffic accidents, or it's gonna take us longer to get into those jurisdictions.

Similarly with summer, and particularly that is one of the strategies uh when there are special events in the community.

So, for instance, Hot August nights, there will be additional not only ambulances in the system, but there will also be uh resources deployed at the various venues.

So we are deploying our command center uh so that we can be down in the downtown corridor, and then we will adjust our posting plan as Virginia's closed.

We're not gonna be able to cross.

So we will have resources both on the west and east side.

Uh we don't necessarily track uh priority two calls that go to priority one, although uh if it does occur, but I think um you know, when somebody calls 911, they're not medically trained.

Uh, they do go through a uh very strict algorithmic protocol-driven question set that provides us with a uh a determinant code that the medical directors associate with a response priority, and that tells us should we go lights and sirens?

Uh, what is the time requirement?

Should the fire service respond with us?

Uh inevitably it over-triages patients for safety reasons.

So there are many times in which we will respond to calls for service where it is coded as an emergency and we find that it is not.

Similarly, that can happen as well if somebody contacts us and says, you know, my my mother's not feeling well, but they don't articulate, and obviously they don't get into the comorbidities that could potentially go along with that, and then we find the patient may be sicker than what was relayed.

And then we find the patient may be sicker than what was relayed.

And I think that that's just something that happens.

Now I will tell you that any time there is a concern, whether that be driven, and I think this board has asked.

And one of the things that Barry had mentioned when he was um sharing the new uh customer feedback, the patient experience perspective, there is now a portal, a phone number, a survey that calls you.

Um there's EMS oversight.

So if they didn't come directly to us, they can go through direct EMS oversight.

In any of those complaints, if they are uh uh relevant to a patient care or clinical care, are not only reviewed by our clinical standards practice, but also our medical director, Dr.

Jenny Wilson.

So if there's a priority two that goes to priority one, will that be reviewed by your chief medical officer?

So if it is something in which there is a problem at will, I will tell you that it changes the response time.

So if we are responding, uh for instance, if somebody's telling us on the phone um you my mother is not feeling well, and that is prioritized as a sub-acute complaint and the dispatcher in general, our dispatchers spend about five and a half minutes on the line, typically until either the fire service arrives or REMSA.

If during the uh that call the complaint changes and they say, My mother's now experiencing chest pain or she's not she stopped breathing or whatever, that will change the call priority and it will upgrade and we will upgrade that response.

Okay.

So it kind of happens uh just as part of the part of the course.

If we are or if fire services on scene.

So another way in which that could happen is if the fire service gets on scene and the call is triaged as a lower acuity complaint, and they say no, we're on scene and this person's experiencing shortness of breath, then that call gets upgraded just like an alarm, and then we respond uh commensurate with that.

And there is a response time that is commensurate with that as well.

Do you keep numbers on that?

Do you have data on that?

We definitely could, yeah, absolutely.

We definitely could report those changes in our I would find that helpful.

I'd be happy to bring it.

Thank you very much.

Thank you, Mr.

Duplantis.

Um, I have questions that are not um germane to the report, but are germane to a presentation that we received at the city council yesterday from Jane Fox, who's at the Nevada Orbis School of Nursing.

And so she brought to our attention a program that I had learned about last December, which is a street health program, basically the teaching of um both social work and medical professionals to be out in the community working with our unsheltered population.

Largely it involves wound care.

Um I think there's some needle exchange programs going on through it.

And it seems to me that one of the stakeholders that we ought to be including in some of the discussions we're having is this group and they with you, right?

So reciprocally.

So can do you do you know the group already?

Am I telling you something you haven't already heard?

Or we we know the group.

And in fact, uh we've met with the dean of the nursing school, and we are engaged.

Fabulous.

That makes me very happy to hear.

I'm gonna make the same request of Dr.

Kingsley here that we have that presentation made here at our board.

Uh, and I think that you're an important part of that puzzle.

That's why I ask it of you.

Um, I also learned a little bit more about the Northern Nevada Harm Reduction Alliance, which I imagine you also must have encountered because these are groups who are focused on both the clean needle exchange programs and the Nalox and uh programs here in the community.

Um and then the third one is the building communities of support.

It's a subgrouping of RISE, and they are working on training community health workers.

And I suppose ultimately what I'm looking for, and why I ask it of you is that um, and and Ms.

S.

may also get some of this from me today, um, is that I think that there's something special going on within these communities, and it's largely being driven by um sort of not top-down, but it's bottom-up, right?

There are community members who are concerned about other community members and they're working in this space, um, but I'm not sure they entirely um have the same structures to navigate the structures above them, right?

And so um what I'm hoping for is that uh Northern Valley Public Health has a role.

Um, certainly our um uh I think you have a role.

I I'm certain that our police and fire apparatus have a role.

There's a role that all of these are playing, and I want to make sure that no one is siloed.

And so I'll invite you to participate any way that you are.

I'm so excited that you're already familiar with the groups, and when um they come and make presentations here, it'll give us a broader awareness of the work that they're doing.

Um, because I do think that some of what you have encountered, and and maybe even some of what we were talking about earlier um with Mr.

Driscoll has to do with working in those more difficult population groups.

And so I don't think um, although I I acknowledge that REMSA provides a tremendous value to this community because there's a lot of unreimbursed care going on.

Uh as a whole.

Does that make sense?

Makes complete sense.

And if I might add about a year, maybe a year and a half ago, um during the COVID period, we had to reorganize the way we did things.

So we had integrated.

Didn't we all?

So during the COVID period, we redeployed, we essentially suspended our integrated health and deployed everybody in response to 911 calls.

About a year and a half ago, uh maybe close to two years ago, we re-implemented our our uh integrated health program.

Uh and the our manager of integrated health has enormous passion um for the community and and and for folks that have really have maybe kind of have drifted uh off the beaten path, if you will.

And uh one of the things that we are focused on in particular because we have a good line of sight of the folks that uh uh you know uh rely repetitively on our services, and we've been doing outreach to try to provide them with the right levels of care because in most cases um these are folks that taking them to the ED would be probably more traumatic than anything, uh, because they may be struggling with anxiety um and uh or and maybe need a meal um and lights and sirens to the hospital just would not be the appropriate answer.

So to your point, it is an area that we absolutely do need to grow, uh, which is really uh that you know that um you know that left and right uh reach into the community as opposed to caller to ED.

Um because we've got to put people in the right paths of care.

And as I indicated, my theory is that more people calling 911 to access services.

Um, and they're looking for a solution, and an ambulance is just one of those things that we can provide.

Um we really need to provide the right solution to uh to the patient.

Um and the I I from my vantage point, I I'm happy to share with you that there's a lot of effort in this community that's taken place amongst many of us, from the hospitals to the county with the services that the county is able to offer because candidly, I I don't as you would I think appreciate we don't want to replicate, we don't want to recreate and make silos of things.

I think it's important that we engage the services that are already available, um, like uh shall we say um you know community care.

You know, uh you know, I don't have uh social workers uh on my staff.

Um and oftentimes uh within integrated health, we find that what's really needed is not someone with medical training, but it's someone with social work training.

And and forgive me, Mr.

Duplana's just for my own lack of knowledge.

You're referring to integrated health as the operational program that serves that population.

Yes.

Okay.

Um thank you so much for that.

You really have answered my question.

I I think a lot about, and maybe Miss Andreola would want to jump in here about calls for service that go to the CARES campus, for example, which are uh a lot of them are ambulance related.

At one point in time, they were uh a lot of our fire apparatus is rolling there, and now I think the sheriff's department is largely making um inroads there.

And so there's just a lot here that I think is worth our uh making sure that we are integrated on.

I also think that um what happens in my experience is that some people start in REMSA in one role and then they use that as a springboard either to um the fire service, they use it as a means to go to college and obtain other degrees, many, many high degrees, I'm sure.

And so the fact that they might enter through REMSA as an employee there, but find themselves more drawn to these other type of programs is a benefit to our region writ large, I think.

So that's why I thought about it.

Thank you.

And I might add, it does happen.

I think at the present time, uh we have five, I believe, uh folks currently in medical school who previously worked for REMSA in recent years.

Um so it's not unusual uh for people to come into REMSA and discover that um they'd like to do something else within the area of health care.

Um, quite candidly, you know.

I mean, we have people that I know in a community that are currently optatricius and uh uh optometrists um and um and dentists who once worked for REMSA.

So it's just very interesting that you get exposed to so many things, and that's the nature of you know our industry.

You know, we know we have turnover, and it's to be expected because it's a high intense, uh high demanding industry, and um it's one that takes wear and tear on the body.

So it's not typical that you see someone going into EMS and working until a retirement age of say 65 years old.

I mean, that would be kind of unheard of because it's a very difficult job.

Well, I know one uh honri uh former fire chief who wrote an ambulance for many years.

So um thank you for that.

Any other questions or comments from the board at this time?

We do have one public comment.

On uh item seven.

Yes.

Great, thank you so much.

We'll hear it now.

It's Aaron Abbott with technical medical.

Mr.

Abbott, welcome.

Good afternoon.

And the board did uh receive Mr.

Abbott.

I think your letter and um I wasn't entirely sure what it was.

Is like a diagram that identified, and maybe the clerk will have to tell us what that was.

Uh no, it wasn't a diagram, but there was a uh letter that I submitted for item 10 and then a comment, e-comment for item 10.

So I think it's in the e-comment, it ends up identifying the number of comments in a pie chart.

And I didn't know if that was our system or yours.

Yeah, okay.

Perfect.

Thank you so much.

That is why I was confused.

It's okay.

Good afternoon, members of the board.

For the record, my name is Aaron Abbott, founder and CEO of technical medical EMS.

Rems' monthly franchise report for June 2026 uh reports 90% compliance for both zones A and B, C indeed compliant combined.

They're also reporting 57 system overload exemptions to reach the minimum number of 90 percent.

There have been a total of 195 system overload exemptions and 63 weather related exemptions since July of 2025.

At the same time, REMS reports an extremely low utilization mutual aid requests from other ambulance services in the region.

In fact, they boasted on social media two weeks ago less than 0.18% utilization of mutual aid.

At the same time, the EMS strategic plan calls for dispatching the closest DMS responder, which is not reflected in the franchise agreement.

This issue was discussed at the franchise confirm meetings.

There's a list of reasons noted in that meeting notes uh as to why REMS is unable or unwilling to fulfill this requirement of the EMS strategic plan.

One being technological differences between CAD systems.

Tuesday this week, a passerby who happens to be our executive assistant and a retired law enforcement officer and veteran saw Reno Police on scene of a motorcycle accident on Double R Boulevard without an ambulance on scene, right next to our ambulance station.

Our paramedics responded to the scene to assist.

I personally alerted REMSA dispatch over their air over their radio to ensure they receive the call, provided the scene size up and updated condition on the patient.

EMTs and paramedics from technical medical REMSA and RFD work professionally seamlessly and without ego or conflict in the best interest of this unfortunate citizen.

This incident not only highlights cooperation is possible among multiple agencies when they work together, it also exposes very serious problems when the closest resources aren't sent or communicated with.

Unfortunately, the patient was pronounced dead on scene as after resuscitative efforts.

On this occasion and four other occasions, a motor vehicle accident has occurred near our ambulance station in the past six months, in which we responded and checked with REMSA dispatch to confirm they received the call, in which they confirmed every time that they'd had.

On all occasions, they did not contact technical medical to see if we were at our station and available to assist and did not downgrade or cancel their resources, even when qualified EMS personnel on scene reported the incidents were non-injury.

I know for a fact that technical medical's ambulance station has been built into REMSA's CAT as a known resource.

Why, in the case of a deadly motor guy, uh motor vehicle accident or any other medical emergency would REMSA not contact the closest advanced life support providers.

Thank you.

Thank you so much.

Madam Clerk, any additional public comment at this time?

No.

Okay, I'll come back to the board and ask if there are any final questions or thoughts on this item.

Mr.

Chair, I don't have any questions.

I just want to clarify that the preliminary mid-study report has been um made available to the public for the regional fire services study board.

And Mr.

Deplantis reference to the meeting on July 21st, he already shared, but I do want to let everyone know that EMS is throughout that study as well, in terms of the um at least the mid-study report that they're calling it.

And so um the fire board will be meeting um later, but the final uh report is not complete, but the mid-study is, and I think it's worth everyone at least knowing that that's available.

Fantastic.

And Vice Chair Andrew, can you um remind me?

Because I'm not sure I'm not on that technical review.

Are you one of the county?

No, it's it doesn't.

None of the fire board um members are on that.

It's more of a technical board, if you will.

I'll just sum it that way.

Thank you so much.

Any other comments?

And for um you, Dr.

Kingsley, I would like um to have a um briefing and understanding of some of the items that were identified by the public speaker, uh, Mr.

Abbott referenced some uh incidents that are concerning because I I never want to hear that a community member did not receive the care they so uh needed.

And so I'd like to have that be something that you and I take up at a future time.

Okay, we'll close out item seven now and move on to item eight, item eight, Mr.

Chair.

Oh, I would move to approve to accept the report as present.

So much, Mr.

Criscal for catching me asleep in here.

Uh I have a first by Mr.

Driscoll, second by Vice Chair Andreola.

Any other questions or comments at this time?

Hearing none, I'll call for the question.

All those in favor, please signify by saying I.

Aye, any opposed motion carries unanimously.

Daniel, thank you for keeping me on track.

We'll close out item seven and move on to item eight, item eight as a presentation, which requires no action.

Uh, by Miss ESP.

Welcome and good afternoon.

This is a presentation of the inter hospital coordinating council for fiscal year 26 and accomplishments.

All smiles.

Welcome and good afternoon.

Okay.

Um, Andrea asked for the record preparedness EMS program manager from about public health.

Um, uh, do you have a presentation for you?

We have a short video, and then we have a handful of comments to be made.

Um, before we present this video, they're getting up and going.

Um, it really highlights our inner hospital coordinating council.

This is a preparedness coalition that has been in existence for about 30 years in this community.

Um, they do work on a variety of things, and they're going to give you different examples of what we work on and respond to together.

Um, but it really heights the collaborative um effort that has made this community more resilient in times of disaster, but it also looks at how they leverage each other um when different issues arise.

So I'm going to talk about some of those things that have happened most recently, and so will my colleagues.

We'll go ahead and get this video going.

Ms.

S.

Will you do me a favor when you do speak right into it?

Sorry, I think our folks who are listening online are having a little harder time hearing.

Thank you so much.

It's always fun to get a presentation to play.

The IHCC continues its mission to bring partners together to mitigate creative work and respond to patterns of ending Washington County Celtic established in 1994 to be connected to more than 122 partners, including EMS fire, public health, long-term care facilities, emergency management, schools, and others.

The coalition remains a trusted of original coordination and comparison.

FY26 will take your measurable progress.

IHCC delivered major exercises, expanding training opportunities, exceeded assessment responsibles, launched practical special projects, and invested more than 128,000 dollars in coalition reviews.

Exercise and incident coordination remained a defining strengths from data for radiation, better comment breakdown in operation distance size HCC help partners and test compliance, strengthened multi-agency coordination, data group readiness for complex emergencies.

The coalition also supported the North Fire Protection District's multi-capitality isn't real to reinforce the Walter County SC IHC take off of this we are in July 2025.

In April 2026, the very one breakdown exercise highlighted the coalition's ability to convene the right order complex has material scenario.

In April, IHCC also supported Morton Tallow Fire Connection District's NCI Drill as an evaluator to help ensure adherence to the Washington County S.

In May 2026, agencies joined forces to support Airport authorities driven exercise.

Operation Western Skys.

IHCC tested health care facility roles within the Washington County multiple instant plan during a stipended aircraft crash.

The exercise involved more than 40 partner agencies and over 80 volunteers.

The IHCC coordinator in Washington County emergency manager shared lessons learned from the data's fire response.

The coalition also sponsors training weapons of mass destruction, radiation, burn care, decontamination, cybersecurity, and health care facility evacuation.

The hospital preparedness program capability assessments provided a clear review of strengths and opportunities across providers.

Response rates increased from 35% to 46%, exceeding the 38% goal.

This year's assessments have expanded to include cybersecurity, extended downtime, supply chain integrity, and workforce facilities.

IHCC completed a regional hazard vulnerability analysis using a new provider weighted methodology.

The results identified earthquake, external fire, and unplanned power outage as the highest range of risks.

While reinforcing concerns related to workers, active sales incidents, extreme wind, cybersecurity, and other operational threats.

Do special projects deliver practical value for healthcare parks.

A new data sharing agreement with home health hospitals and ILC agencies for secure information collection and CMS requirements.

While a GIS mapping tool improves visibility to provider locations and evacuation and password lessons learned from the SIR.

IHCC backed planning with tangible investment and FY26.

The coalition spent more than 128,000 on supplies, equipment, and travel to strengthen response capability.

Purchases included Lucas devices, radios, pediatric sensory kits, shelter supplies, blood pressure units, and hospital has not equipment.

Travel funding supported 22 coalition partners attending six trainings and conferences.

Taken together, these accomplishments strengthen coordination, improved planning, and expanded operational capability across the region.

IHCC enters the next fiscal year better position to support healthcare partners before, during, and after emergencies.

Looking ahead to FY27, IHCC will focus on enhancing collaboration and preparedness through ELC training updates and training for the multi-casting incident plan and additional interagency training opportunities.

Thank you to our coalition members, healthcare partners, and community stakeholders for making this progress possible.

Together, we are able to more prepared, connected, and resilient healthcare system for Washington County.

And I have a uh two statements I want to read, and I have some comments from our partners.

Um, so the first statement I would like to read is from our federal project officer, Captain Kevin Sheehan.

He writes North Nevada Public Health Interhospital Corneon Council stands as a shiny example of what a unified committed forward-thinking health care coalition can achieve.

Um, guided by the dedication leadership of Andrea Esp and Jordan Markey, the IHCC has become a catalyst of resilience, bringing together hospitals, partners, communities with a shared purpose to safeguard North Nevada against any disaster or emergency that may arise.

IHC IHCC doesn't simply meet expectation, it surpasses them with vision and heart from pioneering regional plans like the mutual aid evacuation agreement plan to design advanced community strengthening exercises such as Project Lifeline and the coalition consistently demonstrates what readiness looks like when fueled by passion collaboration and commitment to excellence.

As a federal product officer supporting coalitions across both region and the nation, I first hand I see firsthand what distinguishes good coalitions from truly exceptional ones.

IHCC is among the very best, not just for its preparedness, but its willingness to uplift others.

The most impactful coalition coalitions share their knowledge generously, support partners beyond their own borders, and lead through example.

The IHC embodies this spirit inspiring coalitions nationwide through its mentorship, shared planning, national preparedness, presentations that strengthen our collective preparedness.

Of another statement I will give uh to Jackie instead of reading it, but I want to highlight that he said sharing past our borders.

This statement I have is from Carson Um Tahoe Health, their emergency manager Jim Freed, who was unable to make it today, and he really highlights the ability that he participates fully in our coalition, and he would have the opportunity to go to uh burn training at Schreiner's hospital at the same as others standing behind me and in the audience.

And he really highlights the ability that he participates fully in our coalition, and he would have the opportunity to go to uh burn training at Schreiner's hospital, same as others standing behind me and in the audience, I believe.

Um, and how he recognizes that he would not be able to build relationships without being part of this coalition.

Um, Dr.

or Captain Shan also talks about uh helping other partners nationally.

We serve as a model and mentorship for coalitions in California in Idaho as well, um, helping them guide and build their coalitions and as well as we have stood as the model for doing assessments, which the feds are trying to use nationwide as best practice and implementing as how they evaluate how coalitions should operate.

I'm gonna let one of my lovely colleagues go first.

Let's start in a line.

Who wants to go?

I some of you have Leslie Alfrey.

I work at student health services for the Washoe County School District, and I'm honored to be the current chair of the Interhospital Coordinating Council.

The partnerships that are built through IHCC are essential to keep in our community prepared and resilient.

Beyond just planning and preparedness, the coalition provides a critical uh resource function through the medical services unit called the MSU, which supports health care partners by provide monitoring health system impacts, coordinating information sharing, identifying resource needs, and even after hours, because we all know that emergencies don't just happen nine to five.

I've seen this in action during the Davis fire when the MSU worked tirelessly tirelessly to ensure that those who needed to be evacuated needed help evacuating, got the care that they needed.

And during the Protussis outbreaks and exposures this spring, they worked through their unique role to help us coordinate not only patient care, but meet health care provider needs and communicate with surrounding communities and the state so that we were prepared should this situation become have more profound effects.

This around the clock coordination strengthens our entire health care system and ensures our community is better prepared to respond and to recover after emergencies.

The work of the IHCC is invaluable.

And the MSU, because their work is done so well, it's largely invisible.

We only know when things go wrong.

So often we don't know when they've mitigated further damage.

This continued collaboration through IHCC and the MSU makes our region more resilient.

It keeps us safer.

And as Andrea mentioned, we serve as an example throughout the country, which is quite an honor.

So thank you for your time.

Thank you so much.

For the record, Aaron Abbott, um, I didn't prepare a statement, but I've worked in emergency services and emergency management in several different communities throughout my career.

Um I will say in my observation, and I'm probably I'm I'm a voting member, but I'm probably one of the least involved voting members.

Um, all the people behind me are um extremely active in this group, and it is one of the shining examples in this community of cooperation.

Um, you know, community involvement, sharing of resources, knowledge, information, um, and I've seen other communities throughout uh my career who are much, much less prepared because they don't have something like the IHCC has here in Washoe County.

So you should be proud of all these people behind me.

Thank you.

Good afternoon, Sean Slam and Rimsa Health.

Um you look at any type of an organization, the success of any organization is built on relationships and trust.

And proof is in the pudding, and when we look at an operational impacts, just a few months ago, we saw a very major fire in Tracy, the Medline Fire, which was a major supplier of medical supplies to our region.

IHCC through public health had weekly meetings with all of our partners where we were able to share who was struggling with supplies, what supplies were needed, and through those relationships, we were able to supply each other of all of our health care facilities so that we had the necessary equipment to continue to work through until um uh additional supply chains were identified and came through.

That is a critical, critical thing for our community, and it would not have been possible without the IHCC.

So that is just one of those operational behind the scenes that we don't hear or see about, but it happens because of this group.

Thank you.

Good afternoon.

I'm Division Chief Scott, me as a Sparks Fire Department.

I'm the City of Sparks Emergency Manager.

Um a lot of those drills that have been put up there.

Uh, when you look at them are a gross understatement of all the work and design and hours that go into designing those.

I've had the opportunity to participate in the majority of them.

And this group really prepares us for what is not only possible in this area, but is very practical in this area, and it really stretches our boundaries and opened up our open up our mind to what we have to step up and start coordinating every time.

And this group has really done that.

They're kind of the glue that sticks a lot of us together.

With that, I was a part of the incident command structure in the Davis Fire.

I was a liaison between the IC and the EOC.

When we all got the doomsday report, I think you guys remember the fire is gonna run six miles.

This place is gonna be scorched earth.

Um, I immediately picked up the phone and called uh Jordan Markey and Andrea and asked them how many private health care homes are in the path of this fire, because those are the people we're gonna have to get to first.

The answer I got is I don't know, I'll call you back.

And within a couple hours, they identified that problem that thankfully were not in the path of the fire, but that led us to a progressive path to where they worked on a an application that that they overlaid that they showed in the presentation that identifies them quickly and easily, so we know what people we should probably think about getting out before we have to fast forward.

We had the D'Andrea fire not too long ago.

Um, as you guys were probably a part of, there was a huge power outage.

Um, I was coordinating the evacuations and evacuation center through Washer County Emergency Management myself, and I get a phone call from Andrea, and she says, We have a problem.

And I said, please let me know because I have so few.

And she said, the power is out in your medical facilities, they're at 78 degrees, and your medical facilities have to be evacuated at 82 degrees.

And it was my turn to say, I'll call you right back.

So I was able to get on phone with ND Energy, advise him of the problem, and with that kind of communication, we did not have to activate.

Well, you activated the MAEA, which is the evacuation plan for medical facilities, and we didn't have to use it, but I also knew it was off my plate because of the coordination that these people provide for me.

So, with that, thank you for your time.

New friends joined us.

Hard to follow that, but I'll do my best.

Hi, Calieta Varia.

Uh, for the record, I'm the Washoe County emergency manager.

Um, I would like to um brag on IHCC for a little bit, if I may.

I have been a part of it in this role, uh, but also in a previous role with the Red Cross.

And so I've worked with IHCC for going on 13 years now in different capacities.

And I've had uh myself and members of my team have had the privilege of being able to attend national conferences with members of IHCC and see how our program stands up against other programs from around the country.

And I feel incredibly lucky to be surrounded by such professionals who are passionate and incredibly intelligent.

Uh, we like to joke that IHCC is only if you're type A.

Um, but but that is such a wonderful thing uh for this group of people.

Um, you know, disasters and emergencies so very rarely happen between the hours of eight and five, and this team is planning and training during the hours of eight and five and sometimes afterwards, uh begrudgingly.

Uh but but always ready to respond.

Um, you know, during floods, fires, earthquake, uh, pandemic, you name it, any one of our 13 hazards, they're always there, always there at any time of day.

And I think that our community is more resilient and better for it.

And so, as someone who plans and trains and responds with all community partners, um, to have these community partners as a part of that, just you know, is is incredibly special to us because we know that our community is better for them being a part of it.

So uh thank you so much for your time.

Hello there, I'm Angel Panel with Neural Restorative.

I can sincerely tell you firsthand because we were one of the facilities that evacuated with Davis Fire.

Um without the group behind me, none of that would have been possible.

The reaction times, emergencies happening anytime.

Um, the reaction time that it took me to Gima get to the facility, they're already there on the phones, communicating, working together, um, and then leading me on the right path to what to do with our patients and all that until it shows um how I can I was able to show off last year in Orlando and talk about now on national level with Joe Joint Commission and really show off on what this group does entirely as a whole.

Thank you.

Tell me what facility you're with again.

Neural restorative neural restorative facility.

Yeah.

Um today is just a few people who are part of our coalition.

Um, if you've attended any one of our meetings, we usually have an average attendance about 50 to 60.

It's kind of been bumping over that in-person attendance every month.

Um, we work actively with over 137 healthcare organizations within this community and extending beyond our borders.

I mentioned earlier beyond our borders.

As I was up here, I'm getting messages that are coming across my watch from our partners in the south asking for some help on an incident that has just occurred.

And so they're we are always helping each other.

We also know that emergencies don't stop at jurisdictional lines.

And so we are very proud of that and the work that we have done.

Um my closest friends and family at time.

Um, but with that, I would like to entertain any questions you may have.

And thank you for your support.

Thank you so much.

Let's look to the board members to see if there are questions on this particular presentation.

I'll just say thank you so much.

Uh, certainly you have my gratitude sincerely.

I know that these interagency coordinating campaigns are just Herculean task.

I quite frankly don't know what that all that goes into it, which is a good thing, right?

As I think what you said was we don't see it, so it's not really there to us.

But I do know that when we had some of those very real fire dangers last year, and we were thinking we were the next Lahaina or Southern California.

Um, those were some very um difficult moments in my life as an elected official.

And so I know that our region uh was able to get through that unharmed in that way.

Um, but I know it's thanks to the preparation that goes into these kind of regional efforts.

So thank you so much uh for the work that you do.

Appreciate it.

Okay, we'll close out this item then.

Thank you so much for the presentation.

Madam Clerk, we're now on to item nine.

And I think that's Miss Navoy, our presentation and possible acceptance of the fiscal year 27 through 30 and NP strategic plan.

Yeah, thank you for having me.

Good afternoon, Chair and members of the board, Rihanna Lavoy, Director of Programs and Projects with the Office of the District Health Officer's Office.

Today I'm pleased to present our updated strategic plan for fiscal year 27 through fiscal year 30 and share how it builds on the direction you provided during our strategic planning retreat in February.

For today's presentation, I'll focus more on the strategic plan itself.

Um, together, we've already had a very thoughtful discussion about the data and the stakeholder input that informed our strategic direction.

So, really, uh, I'm gonna concentrate on how those insights have been translated into the plan that you have in your packet.

Uh, before I get started, I just want to take a moment to thank the board for their engagement throughout this process.

You know, it started with um board meetings and just discussing with you what you believe is important for this organization over the next three years, um, but you really help guide and help shape not only the priorities that are reflected in the plan, but also how we intend to measure our success over the next three years.

So, as we reviewed in the retreat, the strategic plan is grounded in three key sources of data and evidence.

The first being our Washoe County community health assessment, and that really serves as the primary foundation for identifying the significant and most pressing needs here in our region.

The second is our public health workforce and needs survey, and that assessment and that data was helping us to understand that uh what we need to do to invest in our staff and their capabilities that are necessary to meet the needs that we've identified in our community health assessment.

And then finally, we also have the Bay Area Regional Health and Inequities Initiative assessment, and that helps us better understand factors that are likely to influence uh the health outcomes that our clients are facing and that we get to see every day.

So together, these assessments provide a comprehensive picture of the community's needs as well as our organization's capacity to respond to those needs.

And as an organization, we remain committed to conducting these assessments every three years.

We're on a three year cycle because public health is evolving, as you know, public health challenges are always emerging, and just you know, quite frankly, our community is evolving.

So we just want to make sure that we are absolutely being a data forward and thinking organization and that we are serving our community based on data rather than the assumptions that we are making.

So at the retreat, this group reaffirms a three or four uh key priorities.

The first being this group directed us to continue to focus on reducing health disparities as a standalone organizational commitment.

So reducing health disparities is embedded throughout a lot of our programs' initiatives, but there's also a standalone commitment that we have been committed to to continue to build capacity around this area.

As Northern Nevada's public health authority, we recognize that our responsibility extends beyond just delivering services, but really ensures that we are serving everyone, and it's really our vulnerable communities that we want to make sure have the opportunity to achieve their highest level of health.

We also identified the importance of adding an additional operational excellence goal as a new district health goal.

And so this will focus on organizational efficiency and effectiveness.

So the performance indicators that are in the strategic plan that fall under this section, you'll notice that this is really focused around our commitment to being good stewards of public resources while continuously improving how we deliver our services.

The third is this group emphasized the importance of expanding the use of our community health assessment data and by sharing it more broadly with our community partners and as well as using it as a foundation for decision making across the organization.

And then finally, this group asked us to explore additional opportunities legislatively to see what we could do to advance public health priorities.

And so we're gonna remain committed to that.

So following the retreat, we translated that direction into action.

Over the last several months, I facilitated a series of strategic planning workshops with every program, and those workshops serve several priorities.

The first, they ensure that every program considered what the board has asked them to do, as well as those considerations that I just mentioned.

The second, they created an opportunity for staff to discuss emerging trends andor vulnerabilities that are out in the community, those things that they're seeing through their work every day.

And third, they helped identify where we should focus our collective efforts over the next three years based on community data as well as that frontline experience.

So one of the greatest strengths that I believe that you're going to find in this strategic plan is that it builds upon the foundation established during our previous iterations of our strategic plans.

Over the last several years, I think that all of you know that our organization has become increasingly disciplined in measuring our work.

We've done an excellent job tracking process measures.

So those are things like how many people did we serve, how many inspections did we do, how many educational events did we conduct.

Those measures are still very important because they demonstrate accountability and operational importance, our performance.

But you know, however, over the last three and in many cases, I'd say five years of consistent data collection, we're now in a position to ask a more meaningful question.

And that question is what is the difference in our community because of the work that we do?

That represents an important evolution in how we evaluate our success as an organization.

So for example, rather than measuring only the number of food establishments that are inspected, we're now looking at examining whether compliance rates are improving over time, whether repeat violations are decreasing, or perhaps you know, our foodborne illness trends going downward.

Those are examples of impact measures that's telling us whether our work is making a measurable difference here in our community versus process measures just telling us what we did.

So this shift, I just want to highlight again, I think that's very important for an organization of our size because it strengthens our organizations by connecting our daily work to those long-term community outcomes that we are actually hoping to improve.

It allows us to better understand where we're investing our resources and also gives us the opportunity to take a pause if we need to to redirect those resources if we can see that we have greater impact in other and other areas.

So let's talk about next steps.

Um our strategic plan will continue to serve as a roadmap because it aligns our organization around shared priorities as well as uh helps us um you know stay accountable to those that we serve.

More importantly, the strategic plan is a tool that we're using to support decision making.

All of these things are going to help us continue focusing our attention on achieving measurable outcomes every quarter.

I'm committed to um presenting and consolidating the the narratives and the progress that we've made over every quarter.

I will present those results to you, so you'll continue to see that.

Um, but then you that gives you all an opportunity to hear how uh and and provide input about how the organization is uplifting this work beyond the strategic plan just being a document that sits on a shelf.

So again, I just want to thank the board uh for your continued leadership, your partnership, um, as well as your commitment to helping us advance public health in northern Nevada.

And with that, I'll take any questions that you might have.

Thank you, Ms.

Lavoy.

Very excellent work that you're doing.

Let me look to my colleagues and see if they have questions.

Ms.

Andrea.

Uh thank you.

Uh, Charese, I am really grateful to your hard work along with staff.

And I think we have to also include on strategy.

I think it would be remiss for us not to mention their involvement and their expertise that they bring.

I think the fact that we move the needle from process to impact or measurable outcomes and how that ties in.

And thank you for confirming that you're going to come on a quarterly basis.

I I can't, I think you said every four months uh to give uh uh uh a temperature read on how things are going.

I would I would also um throw out that it might be helpful as we see whatever the trend may be, because we don't know, right?

What that looks like, what policy as a board to challenge us to think about what we can do from a policy standpoint.

Not that you want to always be moving the needle in such a quick way that you're not being able to gather that data and analyze it accordingly, but it is really important to be able to measure um not just the numbers of serving that you use as an example, but also what that outcome is and how that impact is sometimes it's hard to measure, as you know better than anyone.

Um things that can't be necessarily qualified by data.

And so that's always a challenge how to capture that.

But I think on strategy and you and um the team are really doing a great job in and really making Northern Nevada public health an example of how to use you know, SMART goals and and really be able to um stretch even what you're currently doing and identify what needs to be changed, even or you know, evolve as we grow and as things come up that we may not even realize.

So I just really want to make sure that you're acknowledged for taking all of that information during the strategic planning meeting, along with continuing that process that you used and diving even deeper with coming up with these several pages of of um goals.

So thank you.

Um I I just have a question.

I just want to clarify that, and it may be to the chair um that these performance um measurements for these strategic goals are not necessarily correlated to the performance evaluation of the health officer.

I just want to make sure because when you're looking at um evaluating anyone, not anybody in particular, but anyone, you have to look at additional information, not just the strategic goals.

So this is an organizational function, not a performance evaluation.

Um it's a factor, but looking forward to when we're able to have that information that includes fairness and inclusivity, and looking at the health of the orders organization, looking at leadership, looking at building trust, looking at behavior and organizational effectiveness, although you touched upon that a little bit and the goal, which is really important and what those stakeholder relationships are.

That isn't necessarily captured quite as succinctly in this.

So it's a factor, but I just feel it's important to bring that up.

Fantastic.

Thank you so much for your excellent comments, Madam Vice Chair.

Any other questions or comments from the board?

Oh, Mr.

Driscoll.

Thank you, Mr.

Chair.

Um in the past, I've talked about how monumental this task has been to get to this point.

And the fact that we now have a good reporting mechanism that tells our story.

Doing the measurements and doing the work that this report represents is the easiest thing to put to the side if anything else is going on.

And so the fact that we as an organization from top to bottom have been committed and remain committed to the reporting mechanism is critical because if we don't measure it, we can't manage it.

And the management part is the benefit of the entire organization all over all the goals.

And then it is a piece.

As the vice chair talked about, there's lots of things involved in analyzing how we're doing.

This is a piece.

And so I just thank you for the work you do, and I compliment the health officer and his organization for doing the hard work and to continue to do that.

Thank you, Mr.

Chair.

Thank you so much, Mr.

Driscoll.

Dr.

Duarte.

Yes.

Thank you, uh Chairman.

Um I um I was looking through the the um uh the document, and it's very impressive.

And thank you very much.

Um under health risk early detection, you mentioned melanoma, mammograms, prostate cancer um uh incidence rate, and the syphilis incidence rate and adult taking BP meds, which are all excellent.

I didn't notice anything about lung cancer.

And with smoking and radon being uh risk factors and um lung cancer having significant uh mortality here in Nevada, 138.6 deaths per 100,000 people with a 19.8 uh percent five-year survival reported by CDC.

I I'm wondering if that's something that might be considered or if you've already considered it and excluded it as something to follow.

Yeah, thank you, Dr.

Ituarte, for the question.

So our strategic plan and the community indicators that you're looking at, those are primarily focused on the Washoe County Community Health Assessment.

We know that many things are important in this community, but for this organization to remain successful, we have to stay focused on the most uh pressing needs of our community, and so we really try and make sure that we narrow our focus into what that actually looks like for our community.

And so it does evolve, and that's why we are committed to looking at those community indicators every three years to see what is the most pressing needs of the community.

And so those indicators that you're looking at are those things that bubbled up to the top.

Again, recognizing that there are so many things that are very important to this community.

Um, and so these are some of the things that we're going to remain committed to over the next three years.

Thank you for the question.

Okay, any other questions?

Ms.

LeVoy, I wanted to ask about the staff report, and I just want to make sure I understood something.

Is it that the fiscal year 26 Q1 results will be presented in November?

Is that what you anticipate?

So our sorry, let me, I'm like getting my fiscal years.

I know, it's that's why I'm confused because I read in the staff report it looks past previous action, but this suggests to me that the future action will be the acceptance of those so our annual, our annual results for fiscal year 26 will be presented to this board here coming up.

Perfect.

I'm really interested in that because in the abstract, and I know this is where Miss Andreola and I sometimes uh find ourselves in interesting corners because um I am not as familiar with the process work that you are doing, and so it's been a great learning experience for me.

Uh, Miss Andreola has come alongside and helped to prop up some of my weaknesses in that regard.

Um, I do think that this is the type of document that is iterative and allows us to have a forward-looking thoughtfulness to it.

And so uh certainly I'm excited to uh very nearly soon be not the chair and having someone who has more of that background experience in this role because I think it will be helpful as we move into the next three-year period, or I suppose it's yeah, three-year period.

Um, I'm excited for that.

So thank you for the work that you're doing on it.

It's great.

Thank you.

Any other questions or comments at this time?

Okay.

Um, let's see here.

There is a motion that's sought, and so I'll ask that there be so moved.

Thank you so much.

I have a motion to accept the strategic plan and a second by Mr.

Brown.

Any other questions or comments at this time?

Hearing none, I'll call over the question.

All those in favor, please signify by saying aye.

Aye.

Any opposed motion carries unanimously.

Great work.

Okay.

And that'll close out item nine.

And we'll move now to item 10.

This is a presentation discussion, possible approval of revisions to the amended and restorative franchise agreement.

Preampulance services following the confirmed meetings with REMSA Health.

This is stylized for possible action and staff will be uh presented by AndreaSp.

Looks like Dr.

Kingsley is going to join you.

As he's moving down there, let me also say um Ms.

Aspen just lay a little bit of the table.

Um it's been uh a really iterative and robust process.

And I've used that word twice today, and I've not used it in many years.

But uh, what I will say is that I'm grateful for the work that's gone into getting us to this point because in my time on this board, this is the thing that has for me crossed multiple fiscal years and has been something we've been working for on for a long time at the board level, which means I know you've been working on it for much longer than I have.

And so um, by way of background, I did read the staff report, and I just note that we brought this and had a uh vote in January for the agreement, which now has sprung forth as of July 1st.

Um, what was always contemplated post that was this series of meet and conferrers that allowed us and other stakeholders, including REMSA and our fire agencies to figure out if there were parts of the franchise that could still be improved, uh, meaning there was some sense that maybe as we got towards the finish line, there were still seem things that could be worked on, and it sounds like many of those things have, and so I don't want to um you know delay your presentation, uh, but I give you that by way of my understanding of why you're here today.

Uh Andrea asked for the record preparedness EMS program manager.

Um I do have a short presentation for you today, um, as up on the screen, and then we can talk about any questions that you may have.

Anyway, the next where's the clicker?

Sorry.

All right.

Um, so after the January meeting, the board directed us to go how to have some meet and confer meetings addressing um items um discuss within that particular board of health meeting, stakeholder meetings, which included workshops with our fire other fire EMS partners.

Um we also held or gave the opportunity for our skilled nursing facilities and hospitals to participate in other workshops as well.

And then there was feed uh feedback from NMPH and changes we also were interested in seeing done.

So we did have a meeting, a confirmed meeting or confer meetings with Remsa Health on May 4th, May 14th, and June 16th.

Those meetings took place after our workshop meetings and other concurrent meetings with healthcare partners, so we could come with a cohesive list that then went back to Remsa Health to have discussions on in your packet.

You do have a red line version of suggested changes or the proposed changes to the franchise.

We believe that these changes um, although not every item was um revised in its entirety, and there are multiple reasons for that.

Um but we do believe that we made changes that take the current version that went effect July 1 and better enhanced that agreement.

Um no agreement is perfect, is what you guys have told me in the past, and I don't want to say no agreement is a perfect, but we are working towards a better agreement.

Um, and there are a lot of exciting things happening within the program to do additional measurements.

So changes that we may do believe uh help improve um the review process and a QA QI process.

Um we have now franchise agreement review guidelines.

So this is a new attachment to the back of the franchise that outlines how this franchise will be reviewed in the in the future, providing guidance to everyone.

Um not only those parties of the agreement, but our um also informing our community how this process will take place in a more transformed transparent mechanism.

Um uh we address penalties and performance metrics, exemptions and corrections, um complaint reporting and complaint reporting and increased transparency.

Um it does address the community investment fund.

This is probably one of the a larger change.

This changes from uh Remsa Health holding the physical funds that are collected or accrued through penalties, and then those funds will now would, if passed today, would be held by the North Nevada Public Health and then to be distributed um from us right now.

Those funds are held by RemSA.

There is collective decision making on how those funds are spent, but no, those funds would be held with the Northern Battle Health and then spent accordingly to meet the intent of the franchise.

And then we try to clean up some more language on the enforcement clarity, specifically addressing how does the board and how does RemSA address when there's not compliance of the of this or triggers for how we going to change this?

Um, because you have always asked what is how do you terminate the agreement?

And we think we clarified a little bit of language in that as well.

Um that is all I have for you today.

Um I will hand it back over to the chair and yeah, thank you so much, Ms.

S.

I want to um also go to Madam Clerk.

Do we have public comment on this item?

I think that could be helpful before board comments.

Say that one more time.

Two requests for public comment.

Great.

Let's hear them.

Aaron Abbott from Technical Medical, followed by Joey Lochner.

Good afternoon, board.

Uh for the record, my name is Aaron Abbott, founder and CEO of Technical Medical EMS.

Sorry to continue to be the squeaky wheel today.

I'm here to once again urge you to remove proposed language in the draft restated ambulance franchise agreement under Article 2.1, which aims to grant exclusivity to RemSA for ground ambulance transports that originate outside the franchise area for air medical transports.

I, along with air medical industry representatives, have previously addressed this board in regard to this proposed language.

I've also submitted a letter to public comment regarding this matter that includes a letter from our legal counsel addressing this board sent February 20th of this year.

If you've not read that letter, an attached letter from our legal counsel, please do so before voting on this item.

The letter describes the airline deregulation act, which pre which preempts local and state regulations from interfering with service price and route of air carriers.

As such, this board simply does not have the authority to regulate who air medical providers choose to partner with for these medical transports.

Federal supremacy laws supersede this board's authority on that matter.

The proposed language is outside the legal authority of this board and therefore unenforceable.

More concerning is the way in which this language was crafted and slid into the restated franchise agreement.

January 21st of this year I was granted a meeting with district health officer to discuss the proposed language.

At that time, I contended the new language was disparaging and appeared intentionally to disrupt my business specifically.

At that time, the district health officer stated to me and my director that the language was quoted left in the agreement to stick it to technical medical.

So how am I supposed to interpret that?

I and the rest of the public supposed to believe the new franchise language was developed in the best interest of the public, or the best interest of patient care, or in the air medical crews or their patients at times critical, awaiting an ambulance on the tarmac of the airport.

Or was this agreement crafted to further REMSA's financial interests?

Additionally, despite the removal of the word perpetual, this agreement still is without a defined term.

The franchise, which grants exclusivity without a bid and contains language in this, uh in which this board has no authority to regulate, has no defined term.

Remsa provides a valuable service to this community, and I don't oppose an extension of their agreement.

I don't.

But the development of this new franchise language has been devoid of any third-party expertise, any studies aimed at ensuring the safety of the public and the patients in which it's affected.

Once again, I urge you to please remove the language in Article 2.1 that is preempted by federal law and unenforceable.

Thank you.

Next up is Joey Lochner.

Uh Joey Lerner, for the record, my handwriting is terrible.

I apologize.

Um my name is Joey Lerner.

I'm a resident of Washoe County.

I'm also the CEO of Battleborn Medabac.

Um I come here as both today.

Uh as Mr.

Abbott said, I echo his sentiments that Remsa provides a valuable and quality service to Washoe County.

I have no financial interest in Washoe County or the ground ambulance service they provide.

Uh I have no concerns about extending their franchise agreement whatsoever.

I believe they meet the expectations of the service.

As Mr.

Abbott said, however, I have a serious serious issue with 2.1A and regulating air ambulance providers' ability to contact whoever they believe is the best resource available.

Uh, when we fly into the airport, we have to call for a ground ambulance.

Sometimes it's technical medical, sometimes it's REMSA.

Since the implementation of technical medical in Washoe County, the service provided by REMSA has also improved significantly.

The response times the airport have improved, and I believe this is a direct result of compet competitive pressure.

Um I believe that removing this clause from the agreement is critical to keeping this competitive pressure on the organization so they continue to improve.

Again, they provide a good service, but it can always be better.

Competition breeds improvement, and I think that removing this incentive from the area is gonna negatively impact future future uh airport transfers.

So that's all I have to say.

Thank you so much.

Tell us again uh the organization worth we couldn't hear that part.

Oh, no worries, battle-born medevac.

Battle-born medevac.

Yep.

Thank you so much.

Okay.

Madam Clerk, any other additional public comment at this time?

No, no other public comment.

Okay, we'll close public comment and bring this item back to the board.

Any questions, comments, or inquiries from my colleagues.

Mr.

Chair, if I may.

Mr.

Abbott, welcome.

So I this franchise agreement is one of the most important decisions this board is going to be making because it's impacting our community for years and years down the road.

And I really believe that that framework that we're working from, we need to get it right.

Um, and so with that, I I just want to read a statement here.

Our responsibility as a board is not to simply approve a contract, it's to ensure the agreement protects patients, preserves accountability, and gives future boards the tools they need to respond when the system is not meeting the community's expectations.

After reviewing the agreement, the materials from the workshop, the meet and greet conferred process.

I remain concerned that several significant issues raised by the member agencies have not been resolved through clear contract language.

Three of those are one in Article 13, failure to comply of the proposed agreement, REMSA refused to change language that defines failing to comply as material and repeated.

Noncompliance with the agreement's metrics, meaning REMSA can always claim its failures to comply with response times are not material or repeated, making enforcement more difficult when the public expects accountability.

Second, in Article 5, under communications and Article 17, termination of for cause, RemSA refused to change language that attempts to illegally bind nonparties, meaning REMSA is trying to claim that this agreement governs both the Hexagon Governance Board and any future contractor for ambulance services chosen by the district, which is illegally and uh it which it does not legally have the ability to do.

Third, Article 17, termination for cause.

RemSA refused to change the language that only allows a district to terminate if REMSA commits an undefined repeated and material noncompliance or commits material noncompliance with federal laws that impedes the ability to provide patient care.

Meaning, even if REMSA is convicted of federal crimes, there's no way to terminate this agreement without fighting with REMSA about whether the violation of federal law was material enough.

My concern is not whether REMSA is providing good service today.

My concern is this agreement provides future boards with sufficient authority, flexibility, and accountability to protect the public, regardless of the provider that who it may be.

I also do not believe this board has received a comprehensive presentation of every significant concern raised by the member agencies, how REMSA responded to each concern, what language was accepted or rejected, what legal and operational consequences of those decisions may be before entering into a long-term agreement.

I believe this board should have that information in a transparent and organized manner.

For those reasons, I believe we are in no position to make a fully informed decision for the residents of Washoe County.

And therefore, I move to delay the currently drafted effective date for this franchise from July 23rd, 2026 to March 1st, 2027, and to continue considering proposed changes to the franchise agreement until at least the regularly scheduled meeting of February 2027.

Direct NNPH staff in the interim to work with and include staff and legal counsel from Washoe County, City of Reno, City of Sparks, and REMSA to extend necessary to address and summarize for the board all members' member agencies' concerns, Remsa's responses regarding the franchise agreement draft presented today.

Four, bring this item back to the board in February of 2027 with a full explanation of each member's agency's positions, REMSA's responses so that the board can make an informed decision.

One final comment.

Taking a few additional months to produce a clearer, more accountable agreement is far less costly than spending years interpreting or litigating language that could have been clarified before approval.

The public expects us to get it right, not just get it done.

Thank you.

Mr.

Anderson, thank you so much.

I'm not recognizing your motion at this time because it's premature.

The other members have not had the opportunity to speak to it, but we'll come back to you.

Any other questions?

Okay, I'll say a couple of things.

Um first, I want to make sure that I'm clear, and Miss Reed, you might have to help us here.

Um this is in response to Mr.

Anderson's concerns.

Um, but we have an agreement in place today.

We have a franchise agreement that was voted on in January over the objections of Mr.

Anderson.

I'll note for the record, but that agreement then had a period of time before it became executory before it sprang into existence, which was on um June 1 or was it uh July July 1?

I'm so sorry, June 30.

So July 1.

So the question is not whether or not we have a contract today.

We do have a contract.

That contract is valid, enforceable and binding.

The question that's being presented today is whether or not that contract should have revisions made to it.

The revisions are identified in the report, and then we're identified in Ms.

S presentation.

Is that correct?

Okay.

So is there today, given what you've noticed and what is here in front of us?

It's not a question of whether we're voting up or down on that contract.

That contract already exists.

It's a question of whether or not there should be these specific defined changes made.

Correct.

This board voted to approve the original revisions in January of 2026 to take effect July 1st, 2023.

Okay, thank you.

Thank you so much.

Uh, for my part, I continue to believe that the contract represents the sort of culmination of several years' worth of work.

It was the right thing to enter into when we entered into it in January.

I continue to believe that today, and believe that what we have in front of us is small revisions that were supported both by our stakeholders, member agencies, and also um REMSA.

Now, whether or not there were other items that were not agreed to is really not in the purview today because those are not in front of us for a review or a vote.

It's really just an up or down vote on whether or not the changes that have been presented are ones that would improve the existing contract.

So that'll be my comments for now, and I'll come back to the board and see if there are any other comments.

Mr.

Chairman.

Yes.

Thank you, Mr.

I have a question for legal.

So you know, Mr.

Abbott's presentation, he alleged some legal issues.

What is the opinion of the district attorney's office on the agreement that's in place with the language that was questioned by Mr.

The District Office are reasoning Mr.

Abbott that airline regulation act prevents the grant of exclusive ground transport authority.

So what does that mean to the executed agreement that started on July 1 related to that exclusive ground transportation?

The language is in the agreement.

Whether or not I would be speculating as to any outcome of potential legal action.

However, I can represent that the district attorney's office agrees that the airline deregulation act does preempt the grant of authority.

Um whether or not that is ultimately challenged and what my office how my office would respond or by this advisors board would be speculative for me right now, other than to put on the record that we we do agree with that.

And that has been explained to the board previously.

Follow-up, please.

Well, I I just caution that our attorney client privilege does not extend to the meetings that we have in public.

So much of what you've now discussed and which Ms.

Reed has revealed represents a disclosure of that attorney client privilege.

I would be very careful about concerning the items which you've already asked about and going further.

With that in mind, I'm moving on.

Thank you.

Thank you so much.

Any other questions or comments at this time?

Uh, Mr.

Chair, I I would just say that I think there's been a lot that's been learned by this.

We all understand to your point that the contract is in place and it became effective on July 1st of 2026.

But I would ask that we look at um maybe even agendizing would be a proper place, I think, to put a request so that we have full transparency.

Full disclosure.

And I'm not suggesting to your point that there's been work.

There has been work.

We know there's been work.

But I can only speak for what other boards I serve on almost 15, I think, I think it's now 15 boards, and have seen various contractual processes be presented to the board with clear timelines, clear plans, clear um transparency, not only to the board itself, but to the public, and also to those parties that would be involved in either renegotiating a new contract and or uh an RFP type of process.

So I'm just saying that I really feel that there was a lack.

I think that there's room for improvement.

I'll do it that way.

I think there's major room for improvement on looking at how we can have a very clear uh plan on, especially to um member Anderson's point.

This is probably the most um one of the most, not the only, but one of the most instrumental contracts that impacts our community.

And RemSA is to be commended for the 40 years they've been here.

But I think that there's a lot of things that um haven't necessarily been as clear to the board that lacked a real process.

And you know, just to kind of talk about the many of the conversations you and I've had where everyone has different strengths.

Everyone on this board has different strengths and brings worldview of um experience and a wealth of knowledge.

But the fact is is that I believe the process has major, major room for improvement.

And I am going to ask that we look at that for the future and that we look at um asking um uh Dr.

Kinsley to come back with a clear plan that the board would approve in terms of at least understanding how this moves forward.

I also think that there's an opportunity for um very clear information when legal is sharing.

I'm gonna be careful.

So you you stop me if I need to, but if there's legal information that's being shared by legal counsel that represents and supports the board of health, that that information, you know, be um disclosed as best as it can be.

And I feel that um we haven't necessarily had that full transparency.

Um this clearly to me is an evergreen contract.

Um, and I think that is um also going to be interesting to see as it moves forward what that looks like.

So again, this isn't against anyone, this isn't against REMSA, this isn't against any particular person.

I just think that um lessons are always learned when you're going through something like this.

And um I also would say that having the expertise within the board of health is one of the reasons I believe in 2014, I could have that date wrong, that the previous board actually looked at hiring the expertise in the negotiation of this because and I'm not trying to be disparaging to you, Ms.

Esp or anyone, but I am saying that having the expertise um is really critical when you have such a technical piece of a contract, and we did not afford that study, which was done in 2014 when the contract actually looked at moving into things that we currently had in the contract, and then it moved and changed.

So I think there's just some things and lessons learned that we can look at to prevent um any misunderstanding, out of alignment expectations, the uh health officer giving clear um uh transparency to our community, to the board on how things are going to be executed.

This has been uh quite a process that uh or a lack thereof, and it's been more uh more reactive than I would say proactive, and I'm looking for proactive and planning and organizational leadership.

So thank you.

Thank you, Vice Chair, Mr.

Brown.

Did you have comments?

Yeah, you know, um amendments.

This franchise has been amended how many times since it started up.

Um there's a lot of discussion about what's taking place here.

Are we gonna turnaround and amend it again here, you know, and and again and again and again to try to get the improvements that we want out of this.

Um I I agree, you know, with uh my partner here for the City of Sparks.

I think timelines we we got a contract in place, but to approve this today with all the questions, all the concerns, everything that's taken place.

You know, staff has done a phenomenal job.

I know that, but I'm gonna go back to again.

We never had any public meetings concerning this, you know, bringing the stakeholders together to allow them any time we make changes here at the district board of health, whether it be with increases in fees or anything else, we have to hold X amount of public meetings before we can make that happen.

We didn't do that, we didn't follow those rules, but franchise is different, I understand it.

But going down that route again, there's a lot of concern out there, and we're hearing this concern.

Um I'm gonna stand again on patient care.

You know, if you stand on patient care, you're always gonna do the right thing.

And I'm not saying there's any patient care negativities that we're stating here, but for the good of the patient care side of things, I think we need to take a good look at what's been brought up to make sure that we're doing everything we can to ensure that our community members are getting what they need in the time frames that they need as well.

So uh my comments on it right there.

Thank you so much.

Yes, vice chair.

Can I ask legal question, please?

Of course.

Um would if in fact the um vote doesn't take into consideration the vote fails for these recommended changes.

Is it true then that the contract that's in effect is technically in effect?

Yes.

So Mr.

Mr.

Chair, I know that you said that, but I'm just bringing it up again because I think it's really important as of July 1st of 2026, that contract's in effect.

And so if we did not accept these changes as presented, the contract that's currently in place right at this moment, as of July 1st of 2026, is in fact intact.

Yes.

So um I just I feel that that clarity is needed again, just for clarification, because I do have a lot of concerns to be honest, but the contracts in effect, and I don't and learning more about this.

I don't even know how we'll ever really be able to change it, to be honest, because um both parties would have to agree to the changes, and as um member Anderson pointed out, um, with the um whether it's Article 13, 5, 17.

I have concerns about um, and and many of the other things that were said has to be as written, it has to be agreed upon by both parties in order for it to take effect.

So if both parties would never agree, then I'm not sure how anything would ever change.

Well, how about we ask our lawyer, right?

That sounds good.

I am a lawyer, but I'm not your lawyer.

So uh, Ms.

Reed, maybe you can answer a question for Miss Andreola.

This contract has a number of different provisions for how we exit it at any given time, how it's reviewed annually, what changes can be made to it and when how would one make a change if both parties are not in agreement?

Is it a termination clause?

What would happen?

Correct.

So the contract discusses um another essentially meet and confer process at the end of five years, which I believe would be about this time 2031.

Um based on my reading, it is very similar to the meet and confer to discuss whether proposed changes are desired, and then that requires a meeting of the minds and an agreement by both parties.

The options in lieu of that would be either to have Remsa and the health district agree to additional changes based on additional meet and confer as requested by this board, or the board would have to terminate contract, which the termination for cause provisions have a high bar.

Okay, does that answer your question, Miss Andrew?

The high bar ending answered everything.

Because the high bar is so high, it may never be changed.

But we'll we'll can I'll I will cease to um keep on going on that.

Um, but I do I would like to know though, I think that we need to have a clear process.

We need to have transparency.

We did not have that.

Yes, we had things that were reactive.

I was the one who called for the workshops.

The workshops then came into play.

I think that we could continue down this discussion, which I'm not going to on various things that happened or various triggers or lack of information, lack of real understanding as legal provides information as the example that was already um share that the district attorney's office and looking at the item in terms of it being unenforceable.

Um I don't think was clearly disclosed.

Before we voted in January, I think there's a lot of provisions that had um legal sharing with Dr.

Kinsley that lacked that information then coming to the board.

And I think that's been a real learning experience.

So I'm just trying to avoid that from happening again and asking that we have a very clear process.

Ask when legal is sharing information that we at least get that legal um information in order for full transparency.

So that's what I'm asking for in the future.

And I know it's not necessarily directed exactly to this because the contract is in place, and even if we all if if it if the if the motion carried, um, member Anderson has a motion on the table.

If that motion ended up carrying, it would um really not have any um effect because the contract's already in place.

So I think there's plenty of room for improvement.

And we as a board have a huge responsibility and weight on our shoulders, especially now knowing that um some things maybe could have been shared with this board that that weren't.

So I think that we have um a CEO has a responsibility to share that information.

And so we become more informed, is what I'm getting at.

So process is what I'm asking, and full transparency with legal analysis.

Thank you.

You're always so positive looking for the future ways to improve.

Uh, for my part, I'll just respond um just briefly and then we'll see where we can get to with the motion.

You've used the words, and I tried to write them down as you use them clear, transparent, reactive, and lack of information.

Those words don't mean a whole lot to me, right?

Um, we use those are buzzwords that are speaking to something which I'm not sure what it is.

So when you say it's not been transparent, um I dispute that.

I I believe that we've held hundreds of meetings, public facing meetings, meetings with every stakeholder, meetings with the board, meeting with lawyers.

Um, this question about whether or not there should be more public workshops.

In government, we we like to talk about transparency without really defining what that term is.

I I believe that this contract has been the most thoroughly vetted, the most transparent.

And what happens with contracts is you can have two lawyers, as Ms.

Reed and I are, who see the same terms and view them differently.

I I'm not going to opine today about, for example, whether I believe the airline deregulation act is implicated by this contract, because Ms.

Reed is our lawyer, and she has given an opinion, and maybe that opinion does not jive with mine.

But to say that it was not provided, I think is not true.

Um lots of information provided, Ms.

Esp and Dr.

Kingsley have worked, I I think more on this contract than any other contract in the history of contracts, uh, to my knowledge uh at this organization.

And so I I have continued to believe that uh we should not make the perfect be the enemy of the good.

Um, but what we should do is what we have done at this board, and each of one of us took a vote other than Mr.

Anderson to move this contract forward in January with the understanding that it would be revised as they have been historically over the years, as Mr.

Brown notes.

Each contract is revised as changes and methodologies occur, better health information is known, more data is collected.

I am grateful to REMSA for the work that they have done in this community.

Um, and I I know some others have said that, but I'm not sure saying it and believing it as the same thing.

Um we have a unique situation where we're dealing with a lot of variables today, which this contract allows us to work through, whether that's fire regionalization and consolidation, whether that's changes to how emergency medical services are delivered.

And what I have found in the last two years and certainly in the last six months is that REMSA has been at the table and been a very gracious partner in that endeavor.

Um, and so that one member agency does not like it or its impact on their fire service is something that we're trying to correct, right?

And in fact, currently today, uh, the city of Reno and the City of Sparks are looking at a joint um sort of operational agreement which will allow us to open up some of the stations that have been for other reasons uh browned out or closed.

So there's a lot that will change, I think, in the coming years.

This contract represents absolutely um the best contract that it could be today, and with the changes that are proposed to be made today would be made better.

Uh a vote for something other than, and I'm not even sure we'll have to get to that, but a vote for anything other than an up or down vote on this particular contract and the revision suggested um just leaves us with the current contract in place.

And so I think that that would be a mistake because they spent the last six months working on how to improve it.

Uh each of the member entities and the fire agencies and stakeholders said, How can we improve what's in front of us?

And they did that.

And so for my part, I uh I will not hide behind words like clear or transparent, reactive or lack of information.

What I will say is I have read the documents, I understand legally what they mean, and I also understand the party's intentions, which is to provide the best quality care and service that this region can have and does deserve.

And so that will be where I had uh at some point in time as we move through the next uh discussion points.

Well, I feel compelled to just respond.

The reason I'm using those terms is not just to be um throwing out a term and not substantiated.

I'm just in the in light of not being able to go through every single one of the concerns that um I had tagged for the this document is it was the brevity of me trying to move this meeting instead of going through, I would have been happy to bring all of the tagged items that I had um highlighted, um, but was shared that there really wasn't any room for that discussion.

So I'm sorry that I'm using terms that I'll use are generic, but they can be substantiated and certainly would welcome any opportunity in terms of being here quite some time.

If you'd like me to run up and get every single time.

Well, I think we had a meet and confer process that allowed for you to bring those conclusions.

When we did, but and those can and Miss Andreola, if you don't want to speak over me, I want to speak over you.

I hear you.

Umly one of us can speak at a time.

But I guess my point is is Washoe County, your fire chief, uh the various uh EMS coordinating committees have all had a time to chew on all of these things.

They did not do so in this room because it's not a practical thing to be done, uh, but it doesn't make it less transparent that it wasn't done here.

Those are just the way in which contracts are worked through and the negotiating over those contracts.

When we vote on it here in this room, that is an acknowledgement that those things we may not have agreed on them.

I think there were some things that certainly could not have been agreed to or were not, but many of the things were agreed on, and many of the things that were needed to be fixed from January, which were asked to be fixed, have been fixed by this new thing.

So I think that is uh where I look at the contract and the strength of the process we put in place, which was intended to, as was the concerns that you raised in January, which I think were the basis for your uh yes vote on the contract.

Okay.

Thanks.

Mr.

Chair.

Yes, Mr.

Anderson.

Um I would just like to add, if my members up here uh do not feel comfortable with where I'm standing on this, I would strongly encourage you to vote against this because if we approve this today, um, we're actually giving REMSA more control and this board less um based on the wording that's in in this new agreement.

And this just isn't my opinion.

I am not an attorney, but this is um our legal team from the City of Sparks have made that.

And if you'd like, I've got three pages of uh statements that I could continue to go on to go point by point if that's what I don't know how you expect the members to vote on your claim that your city attorney has analyzed it differently than the county, unless you put in the record.

So you either have to submit it in writing or you can read into the record.

I we can be here till 10 o'clock tonight.

It's no skin off my back.

Well, I'll leave it up to the board if they want to hear it.

I can go down through some of those.

But it I'm just encouraging you.

Um the way that things played out.

We we heard that um these the meet and confer went well.

We heard that um all the items were addressed.

That was not the case.

That was not the case.

And in fact, like I said, some of these um things that are in this agreement now are even uh giving us less control.

So can you give an example?

Okay, how about this?

Um the definition of response time changed.

Uh Spark provided evidence of one year's worth of hold time data from the PSAP and its proposed definition that would make REMSA accountable for hold.

That was disregarded.

Exact excessive hold times can result in dire consequences of our resonance.

Remsa is responsible for patients for their entire wait time, not just the time REMSA chooses to track um based on when it believes it's all of the information.

Um July version gave us less control over that.

I am not understanding the point.

And maybe Mr.

Um King or Dr.

Kingsley or Miss Esp need to respond to your concern.

Is that a question you have for our staff?

I can't answer the question you're asking, right?

And nor do I think your lawyer at the City of Sparks is qualified to answer it either.

But these are experts in emergency medical services.

If you have a question for them, they're here.

Okay.

So then let's just talk about one that we heard in the presentation.

One of the biggest changes was in the fund, the penalty fund.

So the changes that were made, um, there were really none that affected REMSA.

While RIMSA agreed to let the district administer the penalty funds, REMSA is still the only contemplated user of those funds and jointly administers the funds.

Penalties for vendor noncompliance should not be available to be used by the vendor who used to build public trust when they're the ones that were non-compliant.

Um things like do you have a response to Mr.

Anderson's concern or Ms.

S.

Thank you.

To answer their question directly, I believe it existed as as previously just moving over into the funds to us, but uh all funds are approved by the district health officer.

And so moving forward, I I did ask for clarity on those points just to move forward.

Um intention wise, it's always been approved by the district health officer.

My intention is to bring it to the board moving forward.

Historically, the past 40 years, that's where it's been.

It still exists in the contract that any of the activities that REMSA request for that money to be spent on is is authorized on an annual basis through the district health officer.

Which means we have more control over it than previously.

Okay, so if I may then um some of the changes like Article 17, uh RemSA deleted the word repeated, the new language RemSA added requires any violation of law to be both material and impede the ability to provide patient care before the district can terminate the agreement, making the provision more vague and more difficult to apply if RemSA violated federal, state, or local law.

Ms.

S.

or Miss Reed, why was the language changed?

Yes, uh Andrea asked for the record.

Uh that word repeated was discussed multiple times.

Um, and the word repeated it was unable to be defined.

It was advised by Isle that it could not be defined and would not.

So we needed to remove the word repeated.

Um we removed the word repeated.

Um because it is not defined and how it would be defined, we were told.

Sort of like several, several could mean one, two, three, or I suppose it couldn't mean one, but it could mean two, three.

Uh I mean, contracts and words have meaning, right?

So putting words in contracts that are susceptible to being interpreted differently creates the conditions under which that contract cannot be enforced.

So I assume Ms.

Reed said that those words were surplusage, it was a legal nullity, it should be removed.

You would like my response I would love it.

What I recall the thinking was is that if there is a material breach, why would we wait for a material breach to be repeated multiple times?

So the thinking was a material breach is material, not even if it only happened one time.

So you believe that removing it allowed us greater strength in our ability to terminate the contract for cause.

Correct, rather than then waiting for that material breach to be repeated multiple times at potentially the detriment of the public meeting services.

So that was the agreement we reached.

I I suppose Mr.

Anderson, this is why springing forth your laundry list of things in a public meeting doesn't really help us to improve the contract, right?

Right?

You and your team had multiple times to make these arguments in these kind of meet and confer, and Miss Reed would then have been able to advise about why the changes are made rather than having a conspiracy theory about why they were made, right?

In your mind, it was to help REMSA.

I assure you that was not certainly, I think in our legal team's mind, they represent us.

But I don't know if you have more that you'd like to go through.

If you'd like, sure, we can talk about uh the agreement in recent history, have included five-year terms.

The agreement here has no defined term and cannot be terminated simply for reaching the end of the five-year term.

As the chair erroneously stated last meeting.

Furthermore, the review cycle idea is demonstratively not working as none of the serious substantive concerns raised by Sparks were addressed in this round, and the board does not know why those changes were rejected by REMSA, nor why the board cannot simply dictate certain terms to its vendors, like each member agency does in normal government contracting every day.

This flips the normal balance and gives REMSA unchecked power while binding all future public health boards with a franchise agreement that's impossible to cancel or terminate.

Okay, we just I mean I disagree with the statement you've made.

Right?

The contract has lots of provisions for outs, and again, I get it.

The City of Sparks does not want a franchise ambulance service.

You keep referring to them as a vendor.

That really diminishes and really cheapens what they are.

They are a franchise E.

They're not selling widgets.

And so you and I will have to disagree about that.

Um, but certainly this board is free to take any other opinion it wants of that language.

Anything additional, Mr.

Anderson?

I'll leave it at that.

Thank you.

We'd love to have your comments submitted as part of the record.

Any other questions or comments from the board?

Mr.

Dirskel.

Mr.

Chair.

This meeting confer process was directed by this board in order to clarify or um enhance the operations of the agreement.

I'm going to support it because staff did what we asked them to do.

Just because they asked the question doesn't mean the other party had to acquiesce to it.

So the negotiation process gave this board the most opportunity for what was on the matrix of the questions that we asked.

There are a lot of things that need further clarification and further discussion.

And I believe the agreement, as it currently stands, as it will be if it's amended, gives us processes that can be immediate if we think something is uh emergent and needs to be done immediately.

We have a chance to review things in a 12-month cycle and chance to review things in a four-year cycle.

So if we were to do as the vice chair was suggesting, that we have a very defined plan about issues within that and over time how we're going to solve them and come to conclusions.

I believe that what the staff has done does give us the ability to do that, so I'll support them.

Mr.

Driscoll, I agree with your comments entirely.

Thank you so much.

Any other questions or comments?

Dr.

Danko, are you um having I don't see if your hands raised?

No, okay, thank you so much.

Okay, we'll come back to the body.

Thank you.

Thank you so much, Dr.

Danko.

Um, I'm looking first for a motion, and I'll go to you first, Mr.

Anderson, because you've already raised one, but you'd have to restate it for the betterment of the group.

Um is it recorded or do you want me to read restate the whole the whole uh motion?

We can pull it from the recording into proof this slide.

Well, I'm not sure that colleagues will know what they're voting on if they wanted to support it.

I think for a clear record, if you can reread your motion, that would be appreciated.

Okay, thank you.

All right, I move to delay the currently drafted effective date of this franchise agreement from July 23rd, 2026 to March 1st, 2027.

Continued considering proposed changes to the franchise agreement until at least a regularly scheduled meeting of February 2027.

Direct uh public health staff in the interim to work with and include staff and legal counsel from Washoe County, City Areno, City of Sparks, and Remsa to the extent necessary to address and summarize the board, all member agencies concerns and REMSA's responses regarding the franchise agreement draft presented today.

Yes.

Okay.

Okay.

So there's a motion to continue with direction.

I I'm looking first for a second.

I'll set it then.

There's a move to continue.

There's been a second by Mr.

Brown.

All those in favor, please signify by saying aye.

All those opposed, no.

Nay.

Board Member Drescell.

No.

Chair Reese.

No.

Board Member Anderson.

I would member Brown.

Dr.

Danko.

No.

Dr.

Duarte.

I'm going to abstain.

Dr.

I don't think you can abstain on public bodies on items of action.

So you must register a yay or a na on the motion.

Is that right, Miss?

I just want to make sure.

As your chair, I'm telling you, you don't understand.

Thank you.

I need a moment.

Okay.

Um Do you need to converse with your legal counsel?

Or do you just need a moment?

Yes, may I do that?

Yeah, we're going to take a break and we'll be in recess until we'll say ten minutes enough.

I'm confused.

Madam Clerk, I'll call this meeting back to order.

We've just been on break for a few minutes.

And then I'll come back to you, Madam Clerk.

I think we are sort of mid-motion and voting.

And so as I understand it, we need to come back to Dr.

Duarte on the main motion.

And so Dr.

Duarte, I need your vote.

I'll vote no.

Okay.

So that means the motion to continue fails for three.

A second by Mr.

Driscoll.

Any questions or comments at this time?

Is that what you want, Madam Clerk?

Well, let's do a roll call vote.

Okay, Vice Chair Andreola.

No.

Board Member Driscoll.

Yes.

Chair Reese.

Yes.

Board Member Anderson.

May Board Member Brown.

No.

Dr.

Denko.

Yes.

Dr.

It Warte.

Yes.

Okay, the motion carries four three.

Thank you so much to agenda item.

This will now close agenda item 10, and we'll move on to staff reports and updates and programming.

While we get our folks back to where they're coming, uh, Mr.

Vega, you're up first with 11A to AQM.

Thank you so much for the written staff for presentation and report.

I appreciate that.

Um, anything further?

Yeah, just really quickly.

Um, I provided some information and updates on I always forget to introduce myself.

Francisco Vega, director of the air quality management division for the record.

Uh I did provide an update on some uh standards, air ambient air quality standards that happened.

Um the Court of Appeals did affirm that the nine micrograms per meter cube for PM 2.5 was in fact um adequate and correct.

So uh we are going to be continuing to move forward in um utilizing that standard uh for all of our operations.

Uh let's see.

We did have one exceedance in the month of June for ozone.

Um let's see, on plan review, we processed 54 plan reviews.

It took us an average of 3.7 days, so we did meet 100% uh of our timelines.

Um and that's really all I have to update the board on.

Any questions?

I'm happy to answer.

Uh thank you, Sir Vega.

I actually did have a question.

I wanted to ask.

So I guess one night ago or two nights ago, I can't remember now.

Uh, I was driving on the freeway and happened to see a fire that happened at a local box or cardboard company.

And so here was this fire, it's quite visible because I guess the way that cardboard burns, it's rather um ashy.

I don't know, but then was out near there, and the ash was raining down, right?

So is this something that air quality management has any um measuring of?

I mean, how is this part of what you're doing in air quality management?

In the orders I asked, someone asked me, right?

They said, Devin, how come the health district is not telling us that it's not safe to go outside?

I could not answer the question because of course I'm not you and don't have that skill set.

So, what am I to say to that constituent?

Yeah, it's it's an excellent question.

Um, I think I've previously mentioned to this board that we do have seven monitoring stations within the county.

Uh we're happy to report, and I think the board knows that we have one now in Verde.

Um, those regulatory regulatory required uh modernizations are very expensive.

So we can't put one in every single neighborhood.

Um, but we do monitor the data very closely.

Uh we also utilize low-cost sensors, which you can see the information on the EPA's fire and smoke map, and that's available on airnow.gov, and they have an app as well.

So you can monitor that stuff pretty closely, and it's especially for fires.

Uh it's gonna tell you a pretty good indication of uh what the quality of the air is.

Uh for example, I think it was a week ago.

Um, I live in Sparks.

Uh this the smell, you know, we were being impacted by smoke.

I checked the air now app because I have it on my phone, and I was like, oh, this is kind of delayed because I'm definitely smelling this, but it's not showing up on the app.

So there is a delay, and we get that question a lot.

Is he I'm I'm seeing bad bad air quality, but I'm not seeing it on the app.

There is a slight delay uh that you know folks should be aware of between kind of what you're seeing and observing and what's going on in the app.

But uh to answer your question, um, we try to capture the the you know uh wide area that is our region with as much data and information as possible.

We definitely track it continuously, and if we ever do see uh concerns, uh we report that out to the public as soon as possible.

And and then is it our um judgment call about you know uh school children shouldn't play outside or sporting events should not go forward.

Do we make that judgment call or the individual, you know, the school district making that judgment call?

Yeah, well, specific to the the school district.

Uh we work with them very closely, and what we do is we provide information and suggestions from there is up to the individual organization to make the decision.

Great.

Thank you so much.

And I apologize for having such a random question, but that was the question that was posed to me.

Thank you.

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

Vega.

No, thank you so much.

Appreciate the presentation.

Thank you so much.

So I'll close item 11A.

We'll move on to 11B, Community and Clinical Health Services, Ms.

Shepard.

Thank you, and good afternoon.

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

Um, you have my June staff report.

Just a couple of things I'd like to highlight.

Our report this month featured the results of our customer service survey that we conducted in February.

I'd like to commend our staff for their continued dedication to providing client-centered care.

One notable insight from the survey was who referred clients for services at NNPH.

Um, word of mouth was very significant, you know, family and friends referring.

Um, but many clients reported being referred to NNPH by hospitals and health care partners and then social services agencies such as Medicaid and SNAP.

So I think these referral trends kind of underscore how essential our clinic services are within the safety net system for our community.

A couple other things I want to touch on our family planning, sexual health, and IZ programs are collaborating to begin offering HPV vaccine at no cost to our uninsured individuals that are receiving care in our family planning sexual health clinic.

Um this effort expands access to an important preventative vaccine and sets the stage for potentially offering additional no-cost vaccines to uninsured clients in the future in that clinic.

And then lastly, our WIC staff have officially transitioned out of the Moana location, and they are now fully operating from our ninth street clinic.

Um our participation rates remain strong though, with a 5% increase compared to June of 2025.

That's all I have, and I'm happy to take questions.

Thank you much, Ms.

Shepherd.

Any questions?

Mr.

Chair, I don't have any questions, but thank you so much for providing just the responses and the breakdown.

It's really helpful, and I just wanted to thank you for that.

Thank you.

Thank you.

Ms.

Shepard, I wanted to ask.

I had raised earlier with REMSA and also Dr.

Kingsley, a number of organizations that I know you're familiar with.

I think you and I attended the Street Summit together in December.

Correct.

Um is this an area where you think there's an opportunity for us to don't know if it's like I'm not, I don't want you to do any more work, I promise.

You are already doing so very much, um, and we are doing so very much with so very little, but is there an opportunity here for us to sort of expand opportunity either regionally or in collaboration?

It seems like you would be like someone who really knows this area well.

Um, and so I want to make sure that we're um highlighting your skill set and experience and your divisions and department um in that regard.

Does my question make sense?

Um so I have actually had the opportunity to attend some of those street reach collaborative meetings.

Unfortunately, they fall at the same time as this meeting.

Um so I have not been able to attend them for several months now.

So I have had one of our community health workers kind of going in my place.

Um I have had conversations with Jane Larson, or sorry, Jane Fox at the Larson Institute about you know potential ways that we could help with um the street reach efforts.

Um then um, and then like I said, my community health worker has established a relationship with um the Northern Nevada Um Harm Reduction Alliance.

Well, and and I suppose in my uh small view of it, uh, perhaps there are internship opportunities where those nursing and uh uh Larson Institute students are coming alongside and supporting your efforts in some way, because I have a feeling that uh they need to see it from your perspective too.

It's not enough to see it from the perspective they're coming from, but as a broader public health issue in in the way that only you can provide.

So I don't know if that's part of it.

You know, the University of Nevada Reno has some different programs that are um where they like they pay a portion of an internship, and then maybe the entity pays a portion of the internship, and again, I don't know enough about it.

Sure.

And it would seem like that's a way for us to create future members of your staff.

So we have actually two collaborations right now.

One we have with Orvis School of Nursing.

So we do have um all levels of their nursing programs rotating through our clinic.

So we have their bachelor's prepared nurses, we have um their nurse practitioner students, and then we also have their um students that are participating in doctorate and nursing practice are all um taking advantage of rotations that come through.

Um, in addition, we also have a partnership with um Dr.

West and her community medicine residents at the School of Medicine.

Um, so last year they did two weeks with us where they rotated through all of our clinics, learned about all of the things that public health does.

Um, this year, what they're doing is they are gonna do a week in the street medicine um rotation, and then they're gonna do a week with us.

Um, so the week that they're here, we just try to make sure we give them kind of as much experience as possible, um, going to our off-site testing opportunities, um, sitting with some of our sexual health staff and talking about um disease investigation.

They rotate through all of our clinics, our WIT Clinic, our family planning sexual health clinic, they sit with our community health workers for a little bit, learn about um the services that they provide, they sit with our chronic disease and injury prevention team and also learn about a lot of the health education activities that they're doing.

So we have, I think, a lot of those partnerships and collaborations in place.

Certainly always open to more opportunities for that, though.

Well, it sounds fantastic, and it sounds like you really already are doing all that I could ask and more quite frankly.

Um, would you just work with um Dr.

Kingsley and Ms.

Fox and your team to make sure that we can get um them in here for presentations and and anywhere you can find opportunities for us to support your activities, please let us know at the board level.

Thank you so much.

If there are no other questions, I'll close item 11B, and Miss Shepard's time with us will end and we'll move on to 11 C.

Mr.

Fida, come on down, EHS.

Probably a very timely topic as we start hearing more about foodborne illnesses and uh I can't cyclops.

I don't remember.

Uh cyclothora, I believe is the one you're uh thinking of.

Yes.

Yes, I don't think we've had a case so far.

Uh Dr.

Dow could probably confirm that or not, but I know on our end, uh we've had, I think, one environmental assessment related to foodborne illness, but that came back negative.

Uh that was a nice that was in my staff report.

So uh thank you so much.

Uh the other thing, uh, but uh I think one of the things I did want to highlight was our food inspection boot camp.

I think that is uh taking off really well.

I think we had 33 establishments last time around, and that was uh end of June.

And then some of the other things is I know our temp events uh staff are in full swing.

I think we have about five reoccurring food truck events throughout the season right now, and that's on top of any special events.

Uh like uh I think uh one of the ones mentioned was barbecues and blues and brews.

Uh and I know I think dancing in the streets was also so uh I temp event season is in full swing, so hopefully you are all partaking as uh out there.

And I think one of the other things I did want to highlight is our PFAS grant, which is progressing pretty well.

Uh so this is uh residential well sampling for PFAS.

Uh we had about 40 samples, about a third of them came back with a hit for PFAS, and about five of those were actually above the uh drinking water standard.

So uh the grant has been working on trying to uh help homeowners interpret some of those results and help them try and potentially find some treatment options that might work for them.

So we're working on getting that educational material out to those whole well owners.

So that's kind of the big stuff I wanted to highlight.

I'll open it up for any other questions.

Okay, any questions for Mr.

Fida.

Not a question.

Not a question.

I just want to give a shout out to your inspectors.

Um I heard that uh they're doing a good job of of uh actually working with the folks and helping to educate them instead of just writing them up.

So I want to say thank you for working with the the ref uh the various restaurants and you know the owners that they interact with.

And so please pass along my thanks for for their effort.

We'll do.

Yeah, that's super great feedback.

I'll I'll build on that and just ask, and perhaps it's because we need an update on it in uh the main agenda item.

But we had launched the uh scheduled inspection program rather than the surprise inspection program.

Is that been uh launched?

Is it out there happening?

Is it part in, part out?

Tell me how to explain it.

Uh it is out there, and so a lot of it is tied to the uh Acela account.

We were able to stand it up pretty quickly with email notifications.

We explored a couple other uh communication options.

However, I think we hit a couple barriers with in terms of costs and uh infrastructure pieces.

I think specifically we'll looked at texting, but I believe there's some F in uh I may have to go back and talk to our tech services folks, but I believe there was some FCC rule where you had to consent to texting before you could notify folks.

So uh we opted to continue with the email route, potentially explore uh texting later on down the line.

But uh right now, uh we are doing the announced inspections.

Uh I'm working with the uh supervisor of the program to maybe do some better so increase our data collection so that way we can uh have an idea of how effective I guess the communication is as well as what the results look like uh compared to unannounced inspections.

So let me see if I understood what you said there um and just confirm for me.

You send out an email saying, Dear Devon's donut shop, we want to come inspect you.

Here's some days or opportunities.

And it's the question is whether or not Devon's donut shop responds because maybe the old email or it's not an email or they didn't give you an email.

Is that what you're saying?

That is uh kind of the crux of the issue, right?

So there are people who are responsible.

So there's the business owner, there's someone who potentially handles the payment of it, uh, the bill, and then there's other contacts, right?

So we've picked one contact.

Question is is that the appropriate contact?

And sometimes when we do send out the message, does it make it down to line staff at the restaurant?

Uh that's the kind of the struggle we've been reaching with.

Do they are they required each year when they renew their business license or whatever there is some renewal to make sure their information is up to date, or how can we make sure that we've got the right person on the other end uh for each of these businesses?

Uh usually uh it's self-reporting.

We assume the information is over.

Uh so uh they get their annual renewal, so they get a notice and stuff like that.

And so typically, if they get that, uh they'll go in, they can confirm the information, update it there.

Our staff will also do it over the phone if there's any issues, like if they want to correct something, business address or contact info.

And what about just education campaigns around it?

Like what if I'm a business owner and I get your email and it says we're coming to do inspections.

Maybe I don't even know that you've changed from surprise inspections to scheduled ones, or I think, or I didn't get it, or I paid attention, I deleted it before I did that.

What kind of educational outreach are we doing to share the good news of the program?

So we did a couple different avenues of outreach.

Uh we did a press release, I believe, as well as we have our food listserv that uh is some of our active participants in the community.

And so we reached out to them.

We kind of did a press release, and then we kind of did an email blast with all our existing emails to kind of give them a heads up as well to know what to expect.

Well, it sounds like between Mr.

Anderson's comment, which is about the graciousness of the approach and this new inspection, you may have some time to get through the newness of it, and maybe next year it'll be more robust or it'll be more understood.

You know, that's my point.

Yeah.

Uh I think as uh it keeps going, I think people start picking it up on it.

So very cool.

Thank you so much.

Mr.

Chair, yes, Ms.

Andrew.

Thank you.

Um I wanted to echo, I didn't want to take any more time, but um it just made me think of something.

So at the boot camps, I wonder if there's not an opportunity for people to actually sign up at that time and provide an email, and then that way they then will have the most current email that if there are changes, because there, unless there's a cost impact, um, you know, if you have one email or you have two emails, you have 10 emails, at least there's a higher propensity that's going to get to the right person.

So I'm just throwing out an idea.

If you have them there, maybe there's an opportunity for you to get their email.

I I know our staff are always looking for active partners in the community.

So I know the senior running their program is always looking for people to join her listserv and make sure that they are aware of the most recent trends.

So yeah, and then I'm sure Washoe County, the comms team would also help to kind of keep on pushing that information out in terms of sharing if you feel it's appropriate.

Oh, perfect.

Thank you for that.

Great comments.

Dr.

Edward.

Um I um thank you, uh Chairman.

Uh Mr.

Fida, I had the opportunity to attend the boot camp there at the at the end of June.

Your staff were really excellent.

They gave an excellent presentation, and I thought it was really extremely well done.

And so I want to compliment you and your staff for a job well done.

And then uh second part of the second question is is there a clustering of the PFAS positivity in a geographical area, or is that something uh you don't want to share at this time?

So uh we this is the first round of results.

So I'm working with uh Dr.

Dow's team to see if we can potentially map those results.

So thank you very much.

Okay, any other questions for Mr.

Fida.

Okay, we'll close item 11 C.

Thank you, Mr.

Fida, for your work.

Thank you.

And move on to 11D, population health and Dr.

Dow.

Dr.

Dow, while you're coming down, please forgive me for not always understanding the technical way in which you and Ms.

Shepard have related overlapping things going on and also with uh Mr.

Fida, I apologize for that.

I mean I mean no disrespect by it.

Thank you.

Um and good afternoon, uh, Mr.

Chair, members of the board.

Um I'll get to cycloscleriasis in a bit.

Um, but we have uh just a few highlights.

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

Just a few highlights of what's happening more recently.

So a quick update on our chronic disease and injury prevention program on our recent effort uh in healthy food access in some valley.

Um, because with the closure of uh the scolarity uh food uh grocery store in Sun Valley, there has been a significant gap now in access to healthy affordable food in Sun Valley residents and recognizing both this immediate need and the opportunity to address food access challenges.

NMPH identified that Grab Healthy program, or also known as our Healthy Corner Store Initiative, is a practical and evidence-based strategy to increase the availability of healthier food options through existing neighborhood retailers.

So to better understand a community needs and to inform future implementation, we conducted a Grab Healthy Food Access Survey in April of this year.

Uh community outreach included survey distribution at two Sun Valley mobile harvest events and promotional flyers across local businesses and social media outreach as well as uh public engagement through our Sun Valley CAB meeting.

And the survey findings did reinforce concerns previously identified through community assessments and CAP discussions, and these included concerns with uh residents frequently having to travel outside of the Sun Valley region to purchase groceries due to limited local options, and then neighborhood convenience stores do serve an important food access point for quick and frequent purchases, but the availability and consistency of healthy food options did vary considerably.

So survey findings and recommendations were discussed at the uh May Sun Valley CAB meeting, and then moving forward in our efforts, the chronic disease program will continue working with community partners and local retailers to introduce the Grab Healthy program uh in Sun Valley and plan activities that we're doing going into uh fall of this year will include retailer engagements, partnership with food um suppliers, uh healthy food promotion, nutritional education, community outreach, and um ongoing evaluation to ensure any implementation efforts we put forward will reflect uh community priorities.

And then another quick um item to highlight is our epidemiology program has published our second quarter of disease statistics results in the form of our epinews distribution.

This statistic report compares disease morbidity trends in the present quarter uh to averages in the five past years.

And animal bites reporting is still one that is going up in the second quarter, and this has been high for quite some time.

And as we approach our late summer and early fall, we do anticipate continued increase in that uh in that area.

And then just an update on cyclosporiasis.

Um, we do still have just one case that um reported to us this month, and that is the travel-based um uh contingent that happened while this person was traveling to the Midwest, and um, there has been um other members who also went to similar establishment that were also ill, but that is also happening um in and out of state establishment.

It has not been any cases or exposure that has happened in Nevada.

I'm happy to answer any questions.

Okay, let's come back to the board.

Any questions?

Dr.

Dow, I had one question.

It's about the Grab Healthy program.

Yes.

Um first of all, it was new to me.

I wasn't familiar with it and I understood it launched in June of this year.

Um there is an interesting overlap with something that we're dealing with at the city of Reno and I would seek, then maybe your input or some help or assistance.

So in the city of Reno, we have some requirement that when um liquor stores in the downtown corridor operate, they have to have a certain amount of floor space dedicated to food so that there would be healthy options.

And I think we probably don't know enough to know what we're talking about when we make those things.

So I'm wondering if this might be an area where we might get some expertise about how to ensure that uh various stores in the downtown area do have some access to this kind of food resources because I I know um Commissioner Garcia and Commissioner Andreola over at the county commission are dealing with this issue in Sun Valley very specifically, but this has been an ongoing and active issue in the city of Reno, but for which I only having read your report could connect the dots to something that I could understand.

We would love to partnership some more and have a further discussions offline when we have the chance.

And the Grab Healthy program or our healthy corner store initiative is not new to us.

It's just something we're trying to introduce right now to Sun Valley.

We already have six um stores that's currently partnering with us already.

Fantastic.

I'll look to learn more about it when we are offline.

Thank you.

Okay, I'll close out Dr.

Dow's report as 11D and come now to uh Dr.

Kingsley on 11E, the report of the Office of the District Health Officer.

Thank you.

At this time, no changes or edits and open to questions.

Thank you.

Any questions for Dr.

Kingsley?

I did Dr.

Kingsley want you to speak very briefly on your most recent uh conference that you had attended and some of the uh good work that we're doing and learning about out nationally.

If you just share a little bit with us.

Yeah, we had the opportunity as a wonderful experience, both meeting with uh up to sometimes 47 other states and their state association of city and county health officials and just where focuses.

We have uh large federal focus right now on the OMB and upcome changes to those uh policies and procedures that they have that could affect our federal grants.

We continue to monitor that and provide input and support uh over on the uh on that process.

So a lot of discussion was on the rural transformation grants that came through that um not so much really affected public health here in Nevada, but many other states had access to those funds for public health and and where they were championing and putting those funds towards.

Uh, we had the opportunity to hear from the CDC uh deputy director that was recently instated.

She had about three weeks.

So there was a lot of questions for her, but not a lot of answers, but optimistic of uh where she is and uh seeking to address uh state and as well local health departments' needs as we move forward.

Uh there was a large emphasis on AI and maybe the improvement of uh uh the efficiencies that can be provided there, and uh many points had the opportunity also to present myself there uh for that for other uh new emerging district health officers and had uh what very well attended in uh a great discussion there and sharing some points there for seeking for success and thriving.

And then overall also uh one of our staff members, Ava Sandoval, attended, and she bring back many pages of notes that we are going to introduce to the core leadership and see what we can introduce to for improvements here.

So thank you.

Well, thank you for that update.

I I do think a lot of that really pays dividends.

You don't always see it in the moment, uh, but I know that your commitment to that uh ongoing work is very important.

I also wanted to highlight in your report some of the communications and public information.

It was a very busy month, right?

I think in part because there's been a fair amount of Cytosporinium stuff happening, um, but also um I've seen restaurant inspections, TB, um, you know, a lot going on.

And so I want to thank your team, a lot of earned media that was present this month, uh, and I really am grateful for all of it.

Um that's all I had.

I have a quick question.

Um Dr.

Kinsley, are you referring to is that the conference that NACO's involved in?

Is that what you're talking about?

Or no?

No, this is conferences.

We actually they almost overlap.

I believe they did kind of overlap.

So this is National Association of City and County Health officials in HO.

Great.

Yeah.

The reason I'm asking is because um the recent OMB changes at a federal level are going to be are probably the most unusual or unique than has ever been seen.

And uh NACO is going to be holding a um essentially a briefing, and so I'm happy to give you that information so that you can get on.

Um I just got back from a national conference for the um National Association of Counties.

And so anyway, I just thought I'd share that to make sure that you're aware of what's going on.

Um, and it is at lightning speed.

You know, government has a tendency to be glacial.

This particular one is absolutely the opposite.

So uh I mean, I don't even know the term, lightning speed versus glacial.

So with uh with some real um uncertainty.

So um I'm happy to send you that uh email because um as part of Washoe County, you know, you can you can join that.

So I'll send that to you.

Okay, that'll close out item and that are all of the 11 items, and we'll close those out and move now to our last public comment period.

Uh, Madam Clerk, do we have 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 action items with comment limited to three minutes per person.

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

We do have one request for public comment.

In January, the REMSA franchise agreement was agendized for possible approval, not for changes and not for staff direction.

The motion that was made and carried and approved was for staff changes and direction.

Despite the comments made from Deputy DA Dania Reid right before the motion was made.

Very next meeting, board member Driscoll requested the item be heard, reheard and revoted on in accordance with the bylaws of this board.

That was denied in the past.

I requested an explanation as to why that request was denied, and we've not heard one.

That's all I have to say.

Thank you.

Okay, no other additional public comment at this time.

No additional public comment.

Thank you so much.

We'll close item 12 and move now to item 13, which is board comments, board member announcements, reports or updates, or requests for information topics for future agendas.

Any on this side over here?

I I take it uh Mr.

Anderson, though you had an item for future agenda that you'd like additional discussion points.

Is that something you can take up with me offline or or tell me what you're looking for?

Perfect.

Thank you so much.

I just want to make sure that I don't miss something that you intend to have as a future agenda item.

Okay, any and no member announcements on this side.

Okay.

Uh hearing nothing, I'll close out item uh 13 and we are adjourned.