M I N U T E S. Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada Clemens Room

Transcription

1 M I N U T E S Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada Clemens Room Thursday, - 8:30 A.M. Chair Strickland called the meeting of the Southern Nevada District Board of Health to order at 8:30 a.m. and led the Pledge of Allegiance. Stephen Minagil, Esq., Legal Counsel confirmed the meeting had been noticed in accordance with Nevada s Open Meeting Law. Chair Strickland noted a quorum of was present at the start of the meeting with Members Anthony, Christensen, Eliason, Fairchild, Giunchigliani, Jones, Menzel, Onyema, Tarkanian and Vigilante seated. Chair Strickland mentioned that the meeting is being webcast to staff and asked both Board members and attendees to turn off all cell phones and electronic devices as they interfere with the sound system, which in turn affects Mrs. Clark s ability to transcribe the meeting, and can interfere with webcasting. Board Members Present: Linda Strickland Tim Jones Donna Fairchild Stavros Anthony Kathleen Boutin Jim Christensen, MD Robert Eliason Chris Giunchigliani Nancy Menzel, RN John Onyema, MD Lois Tarkanian Jimmy Vigilante Lawrence Weekly Chair, Councilmember, Boulder City Vice Chair, At-Large Member, Regulated Business/Industry Secretary, Councilmember, Mesquite Councilman, Las Vegas Councilwoman, Henderson At-Large Member, Physician Councilman, North Las Vegas Chair, Commissioner, Clark County At-Large Member, Registered Nurse At-Large Member, Physician Councilwoman, Las Vegas At-Large Member, Environmental Specialist Commissioner, Clark County Executive Secretary: Lawrence Sands, DO, MPH Legal Counsel: Stephen R. Minagil, Esq. Other SNHD Board of Health Members/Alternates Present: Michael Collins, RN Alternate At-Large Member, Registered Nurse

2 Board of Health Minutes Page 2 of 43 Other SNHD Board of Health Members/Alternates Not Present: Travis Chandler Councilmember, Boulder City Alternate Tom Collins Commissioner, Clark County Alternate Susan Crowley Alternate At-Large Member, Environmental Specialist Karl Gustaveson Councilman, Mesquite Alternate Joseph Hardy, MD Alternate At-Large Member, Physician Debra March Councilwoman, Henderson Alternate Frank Nemec, MD Alternate At-Large Member, Physician Steven Ross Councilman, Las Vegas Alternate Anita Wood Councilwoman, North Las Vegas Alternate Staff: Scott Weiss; Angus MacEachern; John Middaugh; Glenn Savage; Jennifer Sizemore; Bonnie Sorenson; Karen Atkins; Mark Bergtholdt; Stephanie Bethel; Jerry Boyd; Mary Ellen Britt; Dennis Campbell; Rory Chetelat; Noreen Clark; Alice Costello; Cara Evangelista; Steve Goode; Forrest Hasselbauer; Paul Klouse; Eric Lahr; Christina Madison; Ann Markle; Veronica Morata-Nichols; Robert Newton; Lorraine Oliver; Patricia O Rourke-Langston; Gwen Osburn; Michael Palmer; Mars Patricio; Eddie Ridenour; Walter Ross; Marlo Tonge; Kent Wirtz; Leo Vega; Valery Klaric and Shelli Clark, recording secretary ATTENDANCE: NAME REPRESENTING Elisa Acevedo Self Petya Balova LEA Engineering Tony Garcia NV Energy Jeff Gerber PGAL Meg Kawan AAP Section on Breastfeeding Milen Mintchev i Planet Recycling Dave Peter SEIU Local 1107 Kathleen Peterson Self David Rigdon Nevada Energy Government Affairs Madeline Sigman-Grant UNCE Breastfeeding Task Force of Nevada Krystal Tran USN Pharmacy Student Corrine Travons USN Pharmacy Student OATH OF OFFICE: Southern Nevada District Board of Health Members, Alternates and Officers Chair Strickland asked Shelli Clark to administer the Oath of Office to those newly appointed elected and at-large members, as well as newly elected officers present at the meeting. Shelli Clark, recording secretary and Notary Public, administered the Oath of Office to the following Board members and officers: Linda Strickland, Chair; Jim Christensen, MD Physician; John Onyema, MD Physician; Lois Tarkanian, Member City of Las Vegas; and Jimmy Vigilante, Environmental Specialist. Chair Strickland expressed her appreciation to the Board for the honor of serving as the Chair of the Board of Health. She said will put forth her best effort to attend all meetings and be a part of all Board committees, as she feels it is important to do so. She stated her expectations of the Board, which are that she expects each Board member to make his or her best effort to attend each meeting. If a Board

3 Board of Health Minutes Page 3 of 43 member is unable to attend a meeting, she asked that the respective alternate be contacted so that business can continue to move forward so alleviate the need to revisit issues occurring in the past. BOARD OF HEALTH SERVICE RECOGNITION: Lonnie Empey, Alternate At-Large Member Environmental Specialist Dr. Sands said that Mr. Empey was unable to attend the meeting today due to some last minute issues and we will recognize him and his service at a future meeting. GOVERNOR S PROCLAMATION: Breastfeeding Awareness Month Dr. Sands thanked Commissioner Giunchigliani for bringing this item forward and working with staff on this important issue. Governor Gibbons declared August 1-8 as Nevada Breastfeeding Awareness Week. Unfortunately Nevada was among the lowest ranking in terms of breastfeeding as indicated by the 2009 National Breastfeeding report card produced by the Centers for Disease Control and Prevention (CDC). The percentage of infants receiving formula or being bottle fed prior to two days of age was 32%; the percentage of babies being exclusively breastfed was 31.8%; and the percentage of baby friendly hospitals was 0%. In recognition of breastfeeding awareness month, the district presented copies of the Governor s Proclamation to Dr. Meg Kawan and Dr. Madeline Sigman-Grant for their ongoing efforts to promote breastfeeding in our community and to improve Nevada s breastfeeding report card. Dr. Kawan is a local pediatrician and a member of the Nevada Chapter of the American Academy of Pediatrics (AAP) and serves as the Chapter s breastfeeding coordinator. She is currently seeking her master of public health and her thesis was entitled Promoting Breastfeeding in the Hospital Setting. Dr. Sigman-Grant is a registered dietician and professor at the University Cooperative Extension, and is also a certified lactation coordinator and member of the Southern Nevada Breastfeeding Coalition. Gwen Osburn, community health nurse manager presented the proclamations to Drs. Kawam and Sigman-Grant and recognized their efforts in promoting breastfeeding in the community, both with professionals, the hospitals and the community. Nursing mothers have been asked to leave public facilities (such as libraries) because they were breastfeeding their children, which is in violation of the law. There is much work to be done for the public to accept breastfeeding. Dr. Sigman-Grant thanked the Board for this recognition and noted that supporting and promoting breastfeeding will reduce healthcare expenses as well as improve the health of Nevadans as these young children grow. We need to continue to promote and support breastfeeding throughout the community, as well as the rights of nursing mothers. Dr. Kawan said the American Academy of Pediatrics in collaboration with the Academy of Family Physicians is hosting an event on Wednesday, September 1 st for healthcare providers on infant feeding and reducing the risk of childhood obesity. She shared the event information with the Board (attachment #1). (Member Boutin arrived and was seated at 8:39am) Member Giunchigliani noted one of her former students had contacted her because she was asked to leave a library because she was nursing her child. She asked if a resolution could be issued to promote breastfeeding in the community. Member Giunchigliani thanked staff for obtaining the proclamation and recognizing the importance of breastfeeding. Nursing mothers are able to nurse their infants in public in Nevada and we need to promote acceptance and support. She asked if we could provide a program on

4 Board of Health Minutes Page 4 of 43 channels 2 and 4 to promote breastfeeding awareness and education. She said education is key and many in the public do not fully realize the benefits of breastfeeding, nor do they accept nursing in public. Chair Strickland said many are still uncomfortable with mothers nursing their children in public, though it is very natural. She agreed that providing educational information on the government channels is a worthwhile endeavor. Dr. Sands shared a brochure (attachment #2) with Board members about Nevada law and breastfeeding rights. He noted that part of the Health Reform Act requires businesses with more than fifty employees to provide a quiet, clean space, which is not a bathroom, to enable mothers to express breast milk during work hours. The district was successful in obtaining a small grant which allowed us to designate a small private room with a small refrigerator and rocking chair for this purpose, which is located at the end of Wing #8. This enables the district not only to be proactive, but also a best practice model in supporting and promoting breastfeeding. Ms. Osburn said the grant came from the United States Breastfeeding Coalition and allowed the district to dedicate a room to nursing mothers. This allows SNHD to be a leader in the community. The provisions in the Health Reform Act requires businesses with over fifty employees to provide space for nursing mothers to express milk, as well as time to do so this does not have to be paid time, the time is agreed upon between the mother and the employer. (Member Weekly arrived and was seated at 8:44am) Member Christensen asked to provide the criteria for baby friendly hospitals so he can begin working on this item. This information will be provided to Member Christensen. I. CONSENT AGENDA These are matters considered to be routine by the Southern Nevada District Board of Health and may be enacted by one motion. Any item, however, may be discussed separately per Board Member request before action. Any exceptions to the Consent Agenda must be stated prior to approval. 1. Approve Minutes / Board of Health Meeting: 7/22/ Approve Payroll / Overtime for Periods: 6/26/10 7/09/10, 7/10/10 7/23/10 & 7/24/10 8/06/10 3. Approve Voluntary Furlough Program Reports for Periods: 6/26/10 7/09/10, 7/10/10 7/23/10 & 7/24/10 8/06/10 4. Approve Accounts Payable Registers: #1238: 7/02/10 7/08/10; #1239: 7/09/10 7/15/10; #1240: 7/16/10 7/22/10; #1241: 7/23/10 7/28/10; #1242: 7/31/10 8/05/10 5. Petition #21-10: Approval of Amendment #1 to Interlocal Contract with Nevada Division of Environmental Protection for Administration of Federal Safe Drinking Water Act in Southern Nevada Chair Strickland asked if there were any discussion on the items brought forward on the Consent Agenda. Seeing no further discussion, she called for a motion to approve the Consent Agenda as presented. A motion was made by Member Eliason to approve the Consent Agenda as presented; seconded by Member Fairchild and was unanimously approved.

5 Board of Health Minutes Page 5 of 43 II. PUBLIC HEARING / ACTION 1. Memorandum #23-10: Consider/Adopt Amendments to District Emergency Medical Services Regulations Chair Strickland declared the public hearing open. Rory Chetelat, emergency medical services & trauma system manager spoke relative to this matter. The basic changes to the regulations occur with normal growth to any system and are mainly housekeeping items, including name and acronym changes. Section 200 includes the addition of training centers. The system has increased from two to five training centers. The language allows staff to regulate training centers the same as a permitted agency such as a fire department or ambulance service. Sections 300, 400, 700 and 900 address the addition of critical care paramedics. An endorsement was added for EMT-Paramedics as critical care paramedics, as this type of service has been recognized for several years. Section 850 outlines the increased training requirements for medical directors, as a result of new requirements for entry as a medical director. Section 1000 includes new subsections to differentiate between fixed wing and helicopter air ambulance services. Previously these two items were handled similarly, though they are completely different including their missions. Fixed wing aircraft do not operate in the 911 system, while helicopters do. These changes were addressed to separate these two types of aircraft into different sections. Section 1600 addresses requests of Medical Advisory Board members, including term limits serving as chair and providing the opportunity to serve in a leadership role. Section 1800 incorporates new language to address the training centers being subject to the disciplinary process. Mr. Chetelat said other changes include acronym changes, language changes and small shifts that have occurred over time. Member Giunchigliani said the FAA took control of where helicopters are handled for trauma purposes and the trauma board no longer has jurisdiction over this. Mr. Chetelat said more than ten years ago there were case rulings that determined SNHD has no authority over the aircraft, solely the safety and patient care within the aircraft. The FAA controls where the aircraft is based and where it can fly from; SNHD controls patient safety, patient equipment on board and the training of those caring for the patient. The health district has no authority over the type of aircraft used nor regulating the regions where the aircraft may fly. When we added new helicopter service locally, there was a certificate of need at the state level. Mr. Chetelat said a fixed wing aircraft operates in a more stable environment, where the patient is stabilized and the hospital authorizes transfer from one doctor/facility to another by order. Training requirements have been updated for nursing staff as well as equipment necessary for patient care. Most of the changes in this section refer directly to the training of the nurses and paramedics on the aircraft.

6 Board of Health Minutes Page 6 of 43 Member Jones asked if there is any regulation on the hours a pilot can work versus rest time, or if this is related to the FAA. Mr. Chetelat confirmed this is restricted to the FAA and is not under the authority of SNHD. The health district is only involved with patient care. Chair Strickland said FAA controls airspace and the aircraft, which the Board needs to keep in mind. In our area this is Class B airspace, which is entirely controlled by the FAA. In areas such as Boulder City, there is more uncontrolled airspace. FAA trumps everything when the aircraft is in the air the health district is solely concerned with the health and safety of the patient aboard the aircraft. Mr. Chetelat said our authority also includes the destination of the patient, including whether a patient should go to a Level I trauma center versus acute care. This is about patient care, not the air issues. Member Giunchigliani said there is an attempt to add an additional pad in her district and she denied the land use because of inter-facility transfers not related to emergency purposes. She said that is not a good justification to add something to the airspace. She said she was unsure as to the jurisdiction of SNHD and patient care. She said her concern is that the transfer of patient could be business-related. Mr. Chetelat said inter-facility transports are based on doctor-to-doctor agreements and the health district is not involved in this arrangement as it falls outside the 911 system. SNHD only has purview over the health and safety of patient transport in the 911 system as it pertains to the RTAB, MAB and the Board of Health. Chari Strickland asked where fixed wing aircraft are based. Mr. Chetelat said they fly from the Henderson Executive Airport. Member Giunchigliani asked what constitutes a special purpose agency. Mr. Chetelat said these agencies provide event coverage at the speedway, off-road events or rodeos and the like. These are special purpose ambulances, equipped and staffed as other ambulances to cover special events but are not part of the 911 system. These agencies are hired by event coordinators who can contract with AMR, MedicWest or a special purpose agency. In regard to do not resuscitate (DNR) orders, Member Giunchigliani asked for clarification on valid identification. Mr. Chetelat said a DNR is issued for someone who is terminally ill as determined by a Nevada physician. The DNR should be kept by a family member or loved one. The DNR is different from a living will, as the person must be determined as terminally ill by a Nevada physician. Member Boutin asked the role of the Medical Advisory Board and the make-up of this Board. Mr. Chetelat said the members are the medical directors for each permitted facility in the 911 system as well as the operational director, which is two persons per agency (fire departments and franchised ambulance services). The members are assigned by the agency itself. Member Boutin asked if there will be a fee increase for the certification application. Mr. Chetelat said there are fee opportunities built into the regulations and there are fees currently assessed for both certification and licensure; however there are no fee increases proposed at this time. Fee language and structure was added for training centers, but no fee has been assigned. Once the economy is better language is in place to implement a fee, which must be approved by the Board prior to implementation. Chair Strickland asked if anyone else wished to testify on this item. Seeing none, she closed the public hearing.

7 Board of Health Minutes Page 7 of 43 A motion was made by Member Giunchigliani to approve the amendments to the District Emergency Medical Services Regulations as presented; seconded by Member Fairchild and carried unanimously. 2. Memorandum #24-10: Consider/Approve Application for Mintchevi, Incorporated dba Planet Recycling to Operate a Solid Waste Management Facility Recycling Center, Located at 1816 Industrial Road, Ste. 4, Las Vegas, NV (APN: ) Chair Strickland declared the public hearing open. Walter Ross, environmental health supervisor/engineer, and Kent Wirtz, environmental health specialist II, spoke relative to this matter. Mr. Ross said that Planet Recycling has met all requirements to operate a recycling center as specified in Section 4 of the Regulations Governing Recycling Centers. Staff recommends approval based on the conditions as outlined in the memorandum and a final inspection. Milen Mintchevi and Petya Balova, representing Planet Recycling were present to answer questions of the Board. The facility plans to accept most types of paper, metals and plastics. conditionally approved by city and county. The facility has been Chair Strickland asked the parties understood and were in agreement with the conditions as specified; the parties responded affirmatively. Member Weekly noted the facility leases 2,000 square feet of a 35,000 square foot warehouse. He asked if the facility looks to expand their operations in the future and what the procedure would be to occupy additional space. Mr. Ross said any modification or expansion of area or amount materials accepted requires issuance of a new permit. Whatever changes or modifications made must be submitted to plan review with proper form and fees for consideration and then submitted for permit modification, which lists the original issue date and the modification date. This is approved internally at present. Member Weekly asked to include in a motion to approve that any permit modification due to area expansion come back to the Board for approval. Member Weekly asked for an explanation on how the facility will limit the amount of odor, dust or litter emitting from the facility. This is an internal operation the trucks will unload materials at the loading dock and all materials are taken inside the facility for separation and processing. Member Weekly asked that all identification must be verified to ensure that no contraband materials are accepted at the facility. Ms. Balova said the owner is aware of the various items subject to theft and will follow all procedures to ensure no questionable materials are accepted. Mr. Mintchevi said he is working closely with law enforcement, who will conduct site visits on a weekly basis. Ms. Balova said the operational plan includes provisions from AB23 and reporting requirements for recyclable solid waste, including taking a thumbprint and photos and entering information in a log. Chair Strickland asked if anyone else wished to testify on this item. Seeing none, she closed the public hearing.

8 Board of Health Minutes Page 8 of 43 A motion was made by Member Weekly to approve the application with the conditions as outlined and inclusion of a requirement for permit modification due to area expansion to come back to the BOH; seconded by Member Giunchigliani and carried unanimously. 3. Memorandum #15-10: Consider/Approve Application for Nevada Energy to Modify a Class III Landfill for Reid Gardner Station, Located at 501 Wally Kay Way, Moapa, NV (APNs , , and ) Staff requests that this Item be heard at the September 23, 2010 Board of Health meeting, or at another time as determined by the Board of Health Chair Strickland declared the public hearing open. She noted that the Board must approve the continuance of this particular item. Member Giunchigliani suggested to defer action on this item to a date determined by the Board of Health. Mr. Minagil reminded Chair Strickland that the public must be given an opportunity to be heard on this item. Chair Strickland asked if anyone else wished to testify on this item. Tony Garcia, environmental manager for NV Energy, addressed the Board. He reported NV Energy has followed the application process in accordance with the established regulations. He said the application was submitted December 22, 2009 and received notification on March 16, 2010 that the application was complete. Two public workshops have been held concerning the application. At a public workshop in May 2010 one member of the Sierra Club attended the meeting; at the June 2010 public workshop in attendance were three members of the general public, one representative from the Sierra Club and one person from the Paiute tribe, and this person did not submit comment. The item was to have been heard at the June Board of Health meeting, and the item was withdrawn. He said NV Energy continues to work with staff on the application and expressed his concern that the item has not been heard by the Board due to continued public comment. He said staff continues to accept comment though the comment period has passed, and the approval process is being delayed. On behalf of NV Energy, Mr. Garcia asked that the public hearing be held on September 23 rd in Las Vegas as originally planned. Member Boutin asked what caused the delay in hearing the item. Dr. Sands said a request from the Sierra Club on behalf of the Paiute tribe was received to hold the public hearing on or near the reservation to allow tribal members participate in the proceedings because many members may not have the means to travel to Las Vegas. A later agenda item will consider the possibility of hearing this item separately in the Moapa area. Chair Strickland asked if anyone else wished to address the Board. Seeing none, she closed the public hearing. Member Giunchigliani noted she had asked for the item to be continued previously due to calls she received from interested parties. She said there is nothing wrong with receiving additional public comment and ensuring due diligence in the process. She cautioned underestimating enthusiasm on a certain issue due to lack of attendance at a public meeting. She said the Board must err on the side of caution and ensure all interested parties have the opportunity to be heard. Member Weekly noted his respect for NV Energy s due diligence in the application process; however he did express concern that no effort had been made to provide transportation

9 Board of Health Minutes Page 9 of 43 assistance to the tribe when workshops were held. He asked that this be done in conjunction with a pending motion. Chair Strickland said it is important to discuss this matter. The Board must fully discuss and explore the issue at hand. She said it is important to remember the district s mission to protect and promote the health, the environment and the well-being of southern Nevada residents and visitors. As such it is important to allow everyone to speak on this matter and ensure all interested parties have the opportunity to do so. If there are any health issues involved, the Board would not be fulfilling its mission by not allowing everyone the chance to speak and be heard. Member Boutin noted NV Energy worked well with an issue in Henderson, including communication with residents and elected officials. She said this is a very different approach concerning this matter. She recommended NV Energy take every step necessary to inform the elected officials, as well as residents, as to how the changes will affect the community at large and any long-term impacts. A motion was made by Member Giunchigliani to 1) consider the application for Nevada Energy to Modify a Class III Landfill for Reid Gardner Station at the September 23, 2010 Board of Health meeting; 2) ask NV Energy to assist with transportation as needed for a public hearing; and 3) require the interested parties to provide more outreach and contact with elected officials and residents concerning the changes and impact of this item; seconded by Member Menzel and carried unanimously. 4. Memorandum #11-10: Consider/Approve Proposed Amendment to SNHD Regulations Governing the Sanitation and Safety of Used Mattresses, Bedding and Upholstered Furniture to include a Section for Chemical Sanitization and Bed Bug Control Measures; Consideration of Business Impact Statement Staff requests that this item be withdrawn to be re-noticed for hearing at a later date III. REPORT / DISCUSSION / ACTION 1. Receive Report from the At-Large Member Selection Committee; Selection of Regulated Business/Industry At-Large Member Alternate by the Elected Board Members for Two- Year Term Beginning July 2010 (Committee: Chair Strickland and Member Giunchigliani, Weekly and Wood) Chair Strickland noted the committee met again on August 9 and referenced the minutes and supporting documentation in the Board materials. The committee discussed the applicants and tried to determine an area or industry that is not fully represented on the Board at this time. The committee recommends the appointment of Kam Brian as the alternate for the regulated business/industry at-large member. Member Giunchigliani said there were many good applicants, though most represented the same industry as Mr. Jones. The committee felt having a representative from a different industry could help the Board better understand issues as well as provide guidance. Chair Strickland said Mr. Brian is an attorney working in the recycling industry and the committee felt that there could be intricacies in this industry of which the Board is not aware. They felt Mr. Brian could share information and provide input to the Board to assist them in making informed decisions, including if regulations are needed for a specific area in the recycling arena.

10 Board of Health Minutes Page 10 of 43 Mr. Minagil stated that only the elected members of the Board are eligible to vote on this item pursuant to NRS (2)(b). The following elected members of the Board voted on this item: Chair Strickland and Members Anthony, Boutin, Eliason, Fairchild, Giunchigliani, Tarkanian and Weekly. A motion was made by Member Giunchigliani to accept the recommendation of Kam Brian to serve as the alternate regulated business/industry at-large member for the balance of the two-year term beginning July 1, 2010; seconded by Member Eliason and carried unanimously. 2. Petition #23-10: Consideration of a Request by the Sierra Club to Hold a Public Hearing in a Facility near the Reid Gardner Power Plant, Moapa, Nevada on the Consideration of a Landfill Permit for Modification and Expansion of the Coal Ash Landfill at the Reid Gardner Power Plant, Moapa, Nevada Chair Strickland opened the item for discussion by the Board she referenced the backup materials provided and asked the members to consider the pros and cons of both sides of the issue. Member Giunchigliani referenced a letter received on behalf of the local band of Paiutes which requests the public hearing to be held on the reservation. She suggested having a subcommittee of the Board convene to hold the public hearing to obtain testimony and subsequently report back to the full Board in order to the Board to receive additional testimony and make a decision on the item. She said for the formal public hearing on September 23 rd NV Energy could provide transportation options for those unable to attend the meeting. Member Jones said with all the items coming before the Board at any meeting it could be problematic to relocate the Board of Health meeting and other items could be precluded and impact any business decisions. He expressed support for a separate public hearing on the item prior to the full Board meeting in September. Chair Strickland said her intent was not to take the entire Board meeting to Moapa, just the one public hearing item. She expressed concern about setting precedent for future items where financial hardships are cited resulting in requests to relocate the meeting. She said we need to provide opportunities for individuals to be heard when there are financial restraints involved in attending the set meeting. She would like to take the opportunity to look at the facility in question to better understand what the Board is being asked to consider for approval. Member Anthony confirmed the intent is to vote on the application at the September 23, 2010 Board of Health meeting. Prior to that time, the Board is being asked to hold a separate public hearing in the Moapa area to allow all interested parties to testify on the matter. He agreed that touring the facility is a worthwhile option. Chair Strickland asked about facility rental costs for a public hearing in Moapa. Dr. Sands said when the petition was prepared staff planned for any contingencies. Since that time, the tribe has identified four locations that require no rental fees; any expenses incurred will be minimal to hold a public hearing in Moapa. Staff would need to provide the necessary equipment to conduct the meeting, including recording the proceedings, and projection of any presentations. Member Boutin asked if Mesquite council chambers have the ability for remote communication. Member Fairchild said there is no video feed, solely audio. Member Boutin said a special notice should be issued to the residents concerning the September 23 vote and allow them to testify

11 Board of Health Minutes Page 11 of 43 via audio at Mesquite council chambers. Member Fairchild said if someone has a laptop they could join the meeting via skype on the reservation itself. Member Boutin noted this area is in Commissioner Collins district and he should reach out to his constituents and provide community notification, in collaboration with Member Fairchild. She recommended that NV Energy work in concert with both Commissioner Collins and Member Fairchild to communicate with the residents in Moapa regarding this process. A member of the audience asked for an opportunity to respond to the petition being discussed. Chair Strickland noted this item was not open for public comment and invited him to speak during the public comment portion of the agenda. Mr. Minagil, board legal counsel, advised members of the public may present materials to the Board it is the call of the chair if she wishes to take public comment on any item. Chair Strickland noted she did not wish to violate Open Meeting Law and allowed the gentleman to speak with the advisement that his discussion is limited solely to this particular agenda item, which pertains to the issue of whether or not the Board will hold a special meeting in the Moapa area. Dave Rigdon, NV Energy, Government Affairs Department addressed the Board. He said NV Energy has serious concerns with the process being discussed. He said as an applicant, NV Energy has certain due process rights which he feels are being violated by the creation of a new process. Holding the meeting in Moapa would be done in a hostile location, as the tribe has historically adamantly opposed all NV Energy projects. He suggested that a meeting be held in a more neutral location where everyone feels welcome. He said this is not a legislative item affording the Board broad discretion it is solely an administrative item for a review of the technical administrative proposal with no discretion of zoning or master plan type of application. He said the Board is only acting in an administrative capacity to determine whether the technical merits are met. He wants to ensure NV Energy s objections are on the record. He said there have been adequate meetings held in the Moapa area concerning this particular item and much input has been received. NV Energy objects to a separate process for this item and will challenge the process in the future. He asked again that any special meeting be held in a neutral location other than in a place where someone opposing the application is in control of the location. Chair Strickland said the Board needs to discuss holding a meeting and that the Board s opinion and vote would not be affected by holding a meeting to obtain testimony in what Mr. Rigdon described as a hostile location. She said all Board members sit in meetings where people are adamant in their opinions and Board members continue to exercise their best judgment in voting on particular items. She said by having a subcommittee obtain testimony at an additional public hearing is not creating new rules this is a way to fulfill the district s mission and exercising due diligence in obtaining information from those with financial inability to travel to Las Vegas and testify. The Board is accommodating the public s needs and allowing all opportunities to obtain testimony from interested parties. Lastly, she said the technical merits of the application stand regardless of any testimony received on the item. She understands Mr. Ringdon s concerns and respects his right to object and asked to hear further from the Board, particularly if the Board desires to hold a meeting at a more neutral location. Member Boutin said she feels it is appropriate to expect NV Energy to provide transportation to the public hearing and not provide equal input as to where the public hearing should occur. She said the meeting should be held at a public facility, such as a school or library. Member Fairchild said there is no need to appoint a subcommittee to conduct the public hearing, as staff regularly conducts public workshops throughout Southern Nevada. She

12 Board of Health Minutes Page 12 of 43 suggested staff conduct a public hearing and bring all information back to the full Board for consideration and vote. Member Anthony echoed support for this suggestion. He said to hold the hearing as close to the reservation as possible with the health district hosting the hearing. Board members could attend and hear testimony. The item will then be considered at the September 23 rd meeting. Glenn Savage, director of the environment health division, addressed the Board. Staff has been in discussion with both the Sierra Club and Western Environmental Law Firm concerning this item. Staff is of the opinion there is no facility large enough on the reservation itself to accommodate a public hearing. Staff recommends holding the hearing at either the Moapa Justice Court or the Moapa Recreational Center, both of which are 5.5 miles from the reservation staff has used these facilities in the past for public meetings. Mr. Savage asked for clarification on whether this meeting would be an additional workshop or a public hearing itself. There are different meeting notices involved for each type of public meeting and staff needs direction. He would also like direction from the Board as to the presentation for this particular item at the public meeting. Staff conducted two public workshops for this item one in Moapa, which was at the Moapa Justice Center, and one in Las Vegas. In the technical review of the application, both the tribe and the Sierra Club asked the district to review every aspect of the application. Community Health Division staff has been involved due to various concerns with health effects studies. Staff has been in contact with the Sierra Club and Western Environmental Law about other federal agencies which may be able to assist the tribe in trying to evaluate the health effects, including CDC, EPA, ATSDR and Indian Affairs. Staff understands the applicant s concerns; however the final packet coming to the Board for consideration must be complete and obtain all information needed to make an informed, educated decision. Staff is currently preparing maps, compilations of environmental studies from BLM, information from water quality and air quality, as well as information from our own staff regarding health effects for the Board s review. Most of this information has been shared with attendees at the public workshops. NDEP has also shared information with the tribe during their permitting process with NV Energy. Member Christensen asked if staff has looked at similar facilities around the country, which Mr. Savage confirmed. Member Christensen said when faced with the unknown we must look for previous examples to determine which health effects, if any, could be possible we must go forward on past experience. Mr. Savage said staff was asked about radioactivity in coal fly-ash waste, and staff is working with DOE to research this concern as well. Staff continues to address each concern as they come forward. Member Giunchigliani agreed with Chair Strickland that no new rules are being imposed on this process. She agreed that the meeting location should not influence the Board s decision one way or another. She suggested the following: 1) hold a public hearing rather than a workshop; 2) a list of questions must be submitted by a time certain and after that date no additional questions will be entertained; 3) compile a complete package of information, including responses to the questions submitted for the Board s review; 4) allow Board members to attend the public hearing if they desire; and 5) allow Board members the opportunity to tour the NV Energy site to better understand the what the applicant is seeking. She noted that though the issue may become contentious, the Board s responsibility is to make this a public process and to honor and consider any reasonable requests. The Board has a long history of making decisions based on factual information and will oft times collect information on their own in order to make that decision. She asked for clarification on what constitutes a class III landfill.

13 Board of Health Minutes Page 13 of 43 Mr. Savage reported a class I landfill accepts industrial and municipal solid waste, such as the Apex landfill, which is the second largest landfill in the United States. Class III landfills accept waste normally generated at the point of generation. In this particular situation, there is a power plant and the waste stream is fly-ash and bottom-ash. Waste materials are representative of the business or facility that co-locates the land. The application in question is seeking to expand the existing landfill by an additional 45 acres. The boundaries of the landfill will be shifted to include the additional 45 acres. The complete package coming to the Board for consideration will include aerial photos and maps. Chair Strickland summarized Member Giunchigliani s recommendation: 1) hold a public hearing with the option for Board members to attend if they so desire; and 2) interested parties may submit questions with a time specific deadline. She asked for confirmation on where the public hearing would be held, either on the reservation itself or in a public facility. Member Giunchigliani asked Dr. Sands with whom he had been in contact concerning this item. Dr. Sands said staff had been in contact with individuals in Moapa to discuss potential meeting locations. Mr. Savage said staff is working with Ian Zabarte, an environmental representative from the tribe and Daniel Galpern, an attorney from Western Environmental Law Firm. The request was to hold the public hearing on the reservation; staff asked about the feasibility of holding a public meeting on site due to the various technological needs. Staff s recommendation is to hold the hearing at either the Moapa Justice Center or the Moapa Recreational Center. Member Giunchigliani suggested to direct staff to continue researching for a suitable location to accommodate the request. The motion before the Board is to: 1) hold a public hearing conducted by district staff; 2) staff will work with the tribe to accommodate the request to hold the meeting at or near the reservation; 3) Board members may attend the public hearing if they so choose, including making carpool arrangements to view the landfill facility; and 4) interested parties may submit questions with a time specific deadline. These actions must be completed prior to the September 23 rd Board meeting, at which time the Board will consider the application submitted by NV Energy. Member Jones asked regarding the timelines for the necessary public notices. Member Giunchigliani said the questions are not subject to a posted timeframe, other than the deadline to submit to staff. In reference to the public hearing, she said we must provide a three-day notice. A motion was made by Member Giunchigliani to 1) hold a public hearing conducted by district staff; 2) staff will work with the tribe to accommodate the request to hold the meeting at or near the reservation; 3) Board members may attend the public hearing if they so choose, including making carpool arrangements to view the landfill facility; and 4) interested parties may submit questions with a time specific deadline; seconded by Member Fairchild and carried unanimously. 3. Petition #22-10: Receive Report from the Replacement Facility Committee and Take Possible Action Regarding the Need and Financial Feasibility of the Replacement of the Ravenholt Public Health Center Scott Weiss, director of administration and Tim Jones, committee chair presented on this item. Member Jones said the committee met to discuss the project, including current financial scenarios. The committee has been discussing the feasibility of moving to a new building or expending funds to maintain the existing facility. PGAL LLC is the contracted architect and is

14 Board of Health Minutes Page 14 of 43 providing assistance with space planning needs. The committee wants to ensure that the main facility is in a location that best serves the public. (Member Onyema left the meeting at 9:58am) Mr. Weiss shared a PowerPoint presentation with the Board (attachment #3). Due to space limitations the district is required to lease additional space to accommodate programs and staff. Further, the main facility is challenged with structural, plumbing and mechanical issues due to the age of the building. The current facility encompasses 75,518 square feet; an additional 25,317 square feet of space is leased at 400 Shadow Lane and 6330 W. Spring Mountain Road, resulting in $638,186 annually in lease expenses neither location provides clinical services. The current lease for the 400 Shadow Lane facility expires January 2011 and the landlord is requiring at least a one year extension on the lease. The lease for the Spring Mountain Road facility expires January 2012 and we will be obligated to pay the terms of the lease ($9, monthly) if the premises are vacated prior to lease expiration. The district is currently in the annual auditing process and it is anticipated at the end of the audit there will be an undesignated balance of approximately $34 million. Of this amount $6.1 million will be transferred to the lab proprietary fund, capital reserve, the building fund and the liability fund, leaving an anticipated undesignated balance of approximately $27.9 million. These are soft numbers as final numbers are not available until the conclusion of the annual audit. Current options for a main health district facility include: Build a new facility Purchase an existing building (CenturyLink building on Valley View) Remain at existing facility and continue to lease space on Shadow Lane and Spring Mountain Road Option #1: Construction of a New Building Initially the plan was to construct a new building on the existing property; however the City of Las Vegas offered property at Lake Mead and Martin Luther King Boulevards, which significantly reduced the construction expenses. Construction of a new main facility would allow for consolidation of existing leased facilities and programs, while keeping clinical services in outlying areas (Henderson, East Las Vegas and Mesquite). Construction costs are anticipated at approximately $60 million, which is a reduction from $87 million as originally estimated in Challenges with new building construction include higher financing needs, a longer time frame for occupancy and height restrictions which then increase the building s footprint and ultimately a smaller parking area, which could result in the need for a parking garage. The district currently has $10,447,474 in the building fund. With anticipated construction costs of $60 million, there would be a balance of $49,552,526 requiring financing, either from general fund transfers, financing from Clark County or a combination of both. There is also possible assistance from the RDA. Option #2: Acquisition of an Existing Building The committee asked our broker to research available properties in a given parameter (Buffalo Drive to the west; Cheyenne Avenue to the north; Paradise Road to the east; and Tropicana Avenue to the south). The district is considering purchase of the CenturyLink building, which is 166,000 square feet and has 932 parking spaces. This building is in close proximity to I-95 and falls within three bus routes, which makes it very accessible for the community. As approximately 56% of all nursing and clinical services are provided at the current main facility location, it is prudent to keep the main facility in this area.

15 Board of Health Minutes Page 15 of 43 (Member Giunchigliani left the meeting at 10:00am) The architects have modified the original space plans for a new building to meet the footprint of the CenturyLink building. There are numerous advantages in relocating to this facility, including: o o o o o o o o o o o o o o Adequate square footage with an open layout Prime location Time frame significantly reduced versus new construction Modular furniture included with purchase Well-maintained back-up generator New A/C units and roof (within last three years) all infrastructure in place State of the art IT infrastructure Existing building access control system, energy management system and video surveillance Decreased utility costs Reduced operational expenses due to reduction of leased facilities Increased efficiency by consolidating programs and staff in one location (except where direct services are provided) Multiple bus lines Well-maintained building Benefit to Clark County as the existing property will be vacated, which is in the academic medical center thereby providing economic opportunity The building is twenty-seven years old. Staff would complete due diligence to ensure the building is structurally sound, as well as verifying the life capacity of the building meets our needs. The asking price for the building is $19.5 million. PGAL has completed spacing planning needs and the necessary tenant improvements are approximately $17,836,719 the Southern Nevada Public Health Laboratory would remain at the Desert Lane location. The estimated build-out costs include: o Construction $12, o Moving Costs $ 150, o Soft Costs $ 1,275, o Construction Contingency (4%) $ 496, o Furniture fixtures & equipment (FFE) $ 3,250, o Project Contingency (2%) $ 349, Total 2010 Project Budget: $17,836, Project costs are projections but may be reduced due to current space needs, savings of contingencies and reduced FFE needs. In order to return the current main facility property to the county, we will need to demolish all existing buildings, which is an added expense of $475,000. We are anticipating $150,000 in moving expenses, bringing the total projected cost of this option to $37,336,719. (Member Giunchigliani returned to the meeting and was seated at 10:06am) Total cost for this option is estimated at $37,336,719. With the fund transfer from the building fund ($10,447,474) leaves a balance of $26,889,245. We could help offset this balance with the transfer from the undesignated ending fund balance and/or short-term financing. Current

16 Board of Health Minutes Page 16 of 43 balance is estimated at $26,889,249 there is an option to transfer $14,747,530 to the building fund, which would keep us within the minimum levels in the reserve as established by the Board, leaving a balance of $12,141,719. With this option we also realize $638,186 in lease savings annually. There is also the possibility of RDA assistance from the City of Las Vegas. The district receives 3.5 cents per $100 of assessed property value annually in property taxes to the general fund, of which.25 cents is dedicated to the building fund. For FY12-16, $1,463,615 will be allocated to the building fund. For FY17-21, approximately $1,836,220 would be allocated to the building fund. Currently we are anticipating a 10% decrease in property tax allocation for FY12, and then fluctuating between 2 and 4% over the next four years. If the district were to finance a loan of $12,141,179 for ten years at a 6% APR, loan payments would be approximately $1,617,756. A loan in the same amount of a fifteen year period would lower the payments to $1,229,508. Again, we realize $638,186 in lease expense savings annually. County management and financial services staff have met with district staff to discuss these funding projections and are in agreement that the district can support the debt obligation. Option #3: Remain at Existing Main Facility and Leased Buildings The third option is to remain at all current locations, including those which are leased. The existing main facility is 45 years old. There is continual deterioration of the infrastructure, as well as limited space for existing staff. We are unable to seek certain grants as we have no space for additional staff that would need to be hired in support of grant deliverables; however leasing additional space is an option. There is also inadequate storage space at the current facility and we incur $36,000 annually in rental fees for storage containers. In order to make necessary repairs as well as maintain the existing main facility, the following projected costs were offered: o Fire suppression system: $1,100, o Parking lot renovation: $1,383, o Additional structural repairs: $ 675, ** o Roofing repairs: $ 250, o Water lines and replacement flooring repairs: $ 200, o Waste line replacement: $ 183, o Energy management system: $ 150, o HVAC (Hot/chill water lines): $ 100, o Lead abatement in x-ray room: $ 15, Total projected cost for repairs/maintenance: $4, (** 2008 cost estimate doesn t include abatement fees and potential floor replacement costs or disruption of services) The HR Annex was built in the 1950s and also is in need of repairs and maintenance, of which the estimated expenses are: o Fire suppressions system: $ 500, o Electrical upgrade: $ 200, o Roofing repairs: $ 45, o Water line replacement: $ 40, o Under slab waste line replacement: $ 20, Total HR Annex cost of repairs and maintenance: $ 805,000.00