Subtext: Listen, Sands, we’re the big dogs here!

LAS VEGAS — Pecking order.

That’s what Clark County commissioners wanted to impress upon Dr. Lawrence Sands — the now-resigned chief health officer of the Southern Nevada Health District — back on May 15.

Perhaps even more than a raging money issue, pecking order questions — who should defer to whom — appear to have deeply roiled relations between county commissioners and the health district.

The words of two Clark County commissioners, Susan Brager and Stephen Sisolak, on the 15th, constitute strong evidence.

As the county commission opened the agenda item — number 84 on the agenda (and video log) — a county staffer confirmed for Commissioner Chris Giunchigliani that SNHD’s proposed 2012 budget included under the heading of revenues some $14.7 million in disputed funds.

Those were dollars that the county had chosen not to provide the health district, but for which the district, citing state law, had sued and won in Clark County District Court.

Commissioners then had appealed that ruling to the Nevada Supreme Court, which has not yet ruled.

But because the issue remains unsettled and the money is not assured, Board of Health members voted on April 23 to split out the disputed funds in the budgeted revenue for each of the 2012 and 2013 fiscal years. Each year’s disputed funds, they decided, would be segregated into separate lines above or below the undisputed-funds lines. Then, asterisks on the disputed-funds lines would reference explanations that those moneys are currently the subject of litigation.

County Commissioner Chris Giunchigliani, who sits on the Board of Health as one of the county’s two members, had participated actively in the board’s discussion, an audio recording of the board meeting reveals. That audio also records that the motion to split the revenue into disputed and undisputed line items was passed unanimously, with no member dissenting.

At the commission, however, Giunchigliani told fellow commissioners repeatedly that the Board of Health had instructed management — i.e., Sands — to not include those disputed funds under the heading of revenue.

She then told Sands, “I don’t think you were intentionally trying to misrepresent. I just think it still is not reflective of what the board’s action was.”

The remark appeared to jar Sands, who suddenly had a pronounced stutter.

“First of all, it w-w-w-w-would have been very helpful to have known in advance that you had questions about the budget,” he told commissioners. “I could have come prepared to answer those questions, and, and, and what I can tell you is that, as far as the budget, and for the policy about this 16.6 percent —”

At which point, commission Chair Susan Brager broke in with a warning, suggesting to Sands, essentially, that he did not know his place in the scheme of things:

Brager: Actually, it would be better for you to take — and I can just hear the buzzing on the floor [among commissioners] here — that you take the lead, it’s your budget, it would be important to you, sir, to come to us, and see if we had any questions.

Sands then started to speak, but Brager overrode him:

Brager: I think you’d better leave it at that or you’ll get a lot of… — she made a push-off gesture — …comments, and I think you need to take …

Sands: I just wanted to say that this was a budget that was approved by the full board…

Brager: I know. Do you have questions or comments you’d like to make on the budget, because you’re going to open up not a dialog you want to have, I don’t think.   

Sands then nevertheless sought to explain how the ending-fund policy established by the Board of Health differed from what county staffers had implied to commissioners — and upon which basis commissioners were preparing to reduce the county allocation of funds to the health district.

“The presentation that was shared by county management was the first I’ve seen [of] it — today,” said Sands. “So I certainly want to have some time to take a look at that and be able to respond to that, in more detail.”

Commissioners, however, paid no attention. Commissioner Mary Beth Scow immediately offered a motion to limit the county contribution to the health district to the sum that county staff had recommended, based on the percentages Sands had characterized as mistaken.

After Giunchigliani suggested an amendment to Scow’s motion, Brager called on Sisolak:

Sisolak: Dr. Sands.

Sands: Commissioner.

Sisolak: I won’t go into detail, but I think one of the problems, the biggest problem we’re facing here with the health district, is communication. The fact that you think we should call you —

Sands: (something)

Sisolak: Let me finish. Is it my turn now? The fact that you think the county didn’t present you with this [interpretation] beforehand, the fact that you closed down a building without getting anything from the city building inspector, the fact that you don’t keep us in the loop in terms of what’s going on — I think just goes to a certain amount of — I’m just feeling a sense of arrogance, that you just don’t want to cooperate.

So I will take a deep breath and step back, but before this comes back, you and I’d better talk, or this is nothing compared to what you’re going to hear the next time that you come forward with this, OK? And — I’ll leave it go at that, because…. Communication is important.

Sands: I agree.

Brager: And I think that’s been well [put]. And so, we have a motion on the floor, with an amendment. Please cast our votes. And let’s … move on. Motion carries. We look forward to hearing from you, Dr. Sands.

Remarkably, the situation that Clark County commissioners so dislike today — that they are required by law to give money to a legally independent health district that they do not control — is one that Clark County itself willed into existence.

In the 2005 Nevada Legislature, then-assemblyman David Parks had introduced legislation, AB 380, that would have set up citizen advisory boards for the health district and changed the membership make-up of the Board of Health.

Neither of those proposals made it through the Legislature. But the bill, with a Clark County amendment, nevertheless passed.

The county’s amendment was to, first, give the district a dedicated funding stream of $3.25 per $100 of property tax (raised to $3.50 by the time the bill was signed by the governor), and to, second, create a general-manager position within the health-district management structure.

Regarding the proposal for a statutorily stated funding stream for the health district, the county’s lobbyist, Dan Musgrove, said at the time that “… a designated funding stream [would] allow [the district] some long-term planning, because the only thing they can really do at this point is come to the Clark County Commission and ask them for additional funding.”

Later he made a similar point: “In years past … they’ve always just come to Clark County for a fixed amount and then, at the whim of the Clark County Commission, would receive that or not.”

Regarding the second issue, the general-manager position, the county lobbyist said, “With all due respect to [then-chief health officer] Dr. [Donald] Kwalick, who I count as a personal friend and someone I respect, we simply believe that the organization has gotten to the point such that it needs a chief administrative officer who has control over that agency, handles the administrative function, so that the chief health officer can function on what is in the best interests of the health of the citizens of Clark County.”

A subsequent amendment, by then-state senator Joe Heck, required that the district’s chief health officer have at least 10 years’ administrative experience. That compromise became part of the law.

Nevada Journal asked Clark County for County Manager Don Burdette’s recollections on the county’s thinking in 2005 when it suggested that state law be changed to give the health district a dedicated stream of property-tax revenue.

However, the county, on the advice of legal counsel, declined to comment, noting that “This specific legislation is the subject of litigation.”

Steven Miller is the managing editor of Nevada Journal, a publication of the Nevada Policy Research Institute. For more in-depth reporting, visit and

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