Physician calls Health District ‘greatest
source of competition and derision’

SNHD uses government-based price advantages to monopolize immunization business

Health districts always face financial constraints, but usually seek to deal with that challenge quite differently from how the Southern Nevada Health District does, says Dr. Michael Silvers.

A member of the Center for Disease Control's international health program office and chief medical adviser to the Peace Corps during the Clinton administration, Silvers worked in Africa, South America, the Pacific and Eastern Europe. He speaks Spanish, Portuguese, Fijian and some African languages and currently is working in New Zealand.

In his far-reaching career, he also served as chief health officer at two different U.S. community health districts — Corpus Christie, Texas, and Louisville, Ky.

“I’m a public-health proponent,” he explains. “That’s my specialty.”

To Silvers’s way of thinking, public-health programs succeed, not by seeking to monopolize local health services, but by working to develop additional resources, out within the broader community. If that is achieved, some of the load on the local public health agency is removed and it can address other, more serious, higher public-health priorities.

“In fact,” he said, when serving as chief health officer in Corpus Christie, “I was trying to train a local person … to take over travel medicine from us — because it’s that inconvenient, when your resources are stretched.”

Silvers was of the same frame of mind when he moved to Las Vegas in 2003, he says. He thought that the local health district would naturally welcome a highly qualified local clinic specializing in travel-medicine immunizations, because it would lighten the district’s load.

But first he checked — sitting down with the district’s chief health officer at the time, Dr. Donald Kwalick, and his two lieutenants: then-director of administration Karl Munninger and Director of Clinic and Nursing Services Bonnie Sorenson.

“At that time” — Silvers subsequently wrote to a friend — “they were all too happy to have a local travel expert and a place to send their travelers, since Bonnie even admitted that they are not doing travel properly and that, like most health departments, they really cannot afford to take away nurses from pediatrics and, further, keep someone around who is truly skilled in travel.

“The only issue was that they thought no one could make a living just doing vaccines,” but still, “they would do all they could to help.

“So I told them I would open in the LV area and they agreed that they would let callers know that there was a full-service travel clinic in town.

“In exchange they asked me to help chair one of the positions in the new SNIC (Southern Nevada Immunization Coalition), and also to attend and participate in other functions; especially flu vaccines and back to school events. I also signed on as a vaccine-for-children provider, [which] badly needed local support.”

Silvers then opened his travel-medicine clinic — named Immuvax — and “let the SNHD know that we would see travel at the Henderson Office and we were available basically Mon -Fri.”

However, he says, “I never got a single referral.” Nevertheless, he continued going to their meetings — “participating whenever they needed the ‘token’ local doctor involvement.

“This was an issue between SNHD and the State Health Department, because SNHD operates so independently, and [is] often criticized for not having a greater presence with local health providers.

“Really, very few local Drs or nurses will work with them, and I didn't know why at that time ... of course, now I do.”

“They kept asking me,” Silvers told Nevada Journal, “How are things going in Henderson?”

And, he says, “I kept them apprized.

“I said, ‘Hey, actually, we’re doing good. Actually, my clinic is growing. We’re doing all right.’”

Then, about a year or so later, he received a shock: The Southern Nevada Health District — which he says had told him it would be opening no offices south of the airport — opened a Henderson office not far from his and “started telling people that they’re doing travel medicine down in Henderson at an office they had there that had been there for years.”

Appalled that SNHD, after all the discussions, would conduct “a blatant attack” on his business by going into competition just down the street, says Silvers, he then began looking at the district in a different way.

This particular health district, he began to conclude, was “not interested in having people in the community get involved with things that are generally considered preventive medicine and public health.”

It had taken him a long time to realize it, he told Nevada Journal, but “in truth what I found was that they are highly ‘territorial,’ if that’s a fair way to put it.

“They do not welcome people getting involved in public health and healthcare initiatives in any shape or form as far as I can see — unless they are basically controlling it, unless they ‘own’ it.”

“Over the years,” said Silvers in his letter to his friend, “I labored under the belief that SNHD could care-less about my tiny operation, but in the end I found them to be my greatest source of competition and derision.

“At one point I was able to lower my typhoid costs to below their costs. Shortly after, they lowered their price to coincide with mine when they learned of my pricing.

“In fact, it was years before I learned that they had been monitoring my pricing and fixing their prices to compete with me basically ever since I opened (just look at their fluctuating TB testing prices and the fact they still perform the test erroneously to save money).”

Silvers chose to sell his immunization business and leave Las Vegas.

One of the biggest reasons for doing so, he wrote his friend, “is because of the horrible and misleading relationship I've encountered with the SNHD.”

Near the end of a long-distance telephone interview with Nevada Journal, Silvers concluded by saying, “Let me give you this parting shot.

“You know the statistics and you know the Southern Nevada Health Districts has one of the worst rates of immunization. And it’s not just immunization. We have bad rates of TB, we have bad rates of sexually transmitted diseases.

“And they blame it all on ‘being Las Vegas’ and what Las Vegas is. But how do you have a $25 million surplus if you’re doing your job?

“It’s an outrage.”

Asked for comment, the district responded:

Our staff was always very cooperative with Dr. Silvers and we did refer many clients to his clinic. We have had a longstanding presence in Henderson and several years ago opened a new clinic located near the original location. We always considered Dr. Silvers a colleague and worked cooperatively with him. It is discouraging to know he is making these false allegations against the health district.

SNHD representatives also included comment from district nurse Cheryl Dolesh, who said:

For the record, I use [sic] to work at McCarran Airport in the First Aid Clinic. Part of my job was to provide routine vaccines to kids and adults as well as travel vaccines. When Dr. Silvers started his affiliation with CCHD and opened his Travel Vaccination Clinic, he came to the airport on various occasions and spoke with me personally. He was one of the most congenial and genuinely helpful physicians that I have ever encountered.

He left brochures and cards with us and even offered his services if we had any questions pertaining to travel. I gave out his information often. People would call and even stop in to the clinic prior to travel. I would advise them as to vaccines that would be available for consideration but always informed that we were not capable of writing prescriptions. So I would refer them to their own doctor as well as offer information regarding Dr. Silvers locations and phone number. In all cases, if the traveler had significant underlying health issues, I would advise them that Dr. Michael Silvers was highly knowledgeable in the field of travel medicine and would suggest that they get a consultation with him.

I have no way of knowing how many took my advise [sic] but I know many did because the client would inform me, or Dr. Silvers would mention it if he popped in to the clinic before or after travel. I was glad that he had a presence in Las Vegas and was working with the Health District in a cooperative partnership. I do not know the person that is depicted in this article.

Steven Miller is the managing editor of Nevada Journal, a publication of the Nevada Policy Research Institute. For more in-depth reporting, visit http://nevadajournal.com/ and http://npri.org/.

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