County Pauses CNHD Admin-Physician $380K Salary Increase

During their regular meeting on Nov. 19, the Churchill County Board of County Commissioners decided to delay a decision to potentially increase the Central Nevada Health District Administrator/Physician Health Officer's maximum salary to $380,000. The pay package would cap at $592,800, including a benefit plan valued at $212,800. The county's cost would be 68%, with CNHD budgeted to cover the remaining 32%. 

On Nov. 13, the CNHD board approved increasing the salary to the proposed amount, acknowledging that the County Commission would have to approve the measure for the increase to take effect. Chief Civil District Attorney, Joe Sanford, explained that the county has been recruiting for this position for some time. The most pressing challenge has been finding an administrator who is also a licensed physician, ideally with experience in public health. According to CNHD Interim Administrator Shannon Ernst, very few apply, and even fewer are qualified. Two who were qualified would not accept the position at the current salary of $179,441.60 to $241,342.40.

"When this was proposed, CNHD was really looking to make sure to get a health officer, which is expensive," Ernst said. Churchill County Manager Chris Spross added that the need for a physician aligns with the medical requirements for the jail and the Juvenile Justice Center, which operates under Churchill County's Juvenile Probation Office (JPO). 

"It was agreed that Churchill County or any other [CNHD] entity that wants to engage and have those services would pay a portion," said Ernst. Churchill is bearing the bulk of the initial cost because it is the first county for which this is being developed; however, two other counties are considering participating, which could later reduce the cost.

One way to help cover the position's costs may lie in whether Churchill County becomes a Medicaid-billable entity. Ernst said that many individuals within the jail system are either eligible for or currently on Medicaid, and the county could see reimbursements. In her other role as Churchill County Social Services Director, Ernst said that she recently received an update on opioid settlement funds, which would also help.

Commissioner Matt Hyde expressed concern about the fiscal sustainability of such costs, saying, "My concern is we hire one doctor and then others [counties] join in and then we're going to have to continue to keep supporting and hiring."

Ernst noted that Churchill has expressed the most need right now. "Churchill County is the only one that we are working to try to provide this for. And this has been a request for years." The cost of the increase in salary is in addition to what the county currently pays for their annual CNHD assessment. "This is not part of a public health structure," Ernst stated, explaining this is an add-on, similar to family planning services, for which the county receives grant funds.

Commissioner Eric Blakey remarked on how this might affect the sheriff’s office and JPO. "No discussions have been had with medical at juvenile detention, the jail, or the sheriff to see if this model is going to work or can work or how it's going to work.” 

Ernst explained it was Churchill County that brought this up during the CNHD workshop. "I will go on record saying, these conversations have been happening with the Sheriff's Department since the pandemic. I was involved in those.” She said she mapped both the jail and the Juvenile Justice Center during the pandemic, and they continue to reach out to her.

Commissioners questioned whether a person could realistically manage jail medical across multiple facilities and counties. Ernst said that the doctor will oversee the program, review things, and meet with patients on a certain basis. "The goal was to utilize the staff that's there because, truly, they're being underutilized in our communities."

"They [the jail and JPO] have a laundry list of things they would like. They would like us to provide mental health services. That is not public health either," Ernst said. "But it can be an option if the county is willing to pay for it." 

Spross told commissioners, "If we revert away from this and go back to an administrator for CNHD, the county still has a responsibility to fulfill the obligation to the jail and to JPO." 

Sanford added that proposals for jail clinical services received were upward of $1 million. He said that a medical doctor would serve as the licensing authority and oversee nursing and other staff. "We understand that's an additional cost, but that may be cheaper than what was already being proposed," he said. "It would give us significantly more oversight over that group than we would have with an independent contract." 

Chairman Myles Getto recalled that costly proposals for jail medical services came in at $707,000 and $1.1 million and stated that he did not think that was the best way forward. "And if we can roll this position and utilize CNHD staff to take care of that medical aspect, then I think that's more … but I want actual confirmation that covers our liability and covers the MD for the jail and for JPO."

Ernst urged commissioners to move quickly, reminding them that she was intended only to serve as an interim administrator at CNHD for three months and has been in the position since March. "Truly, the structure, how it is with me being their administrator and running social services and the Life Center, doesn't work. I don't think we can wait three, four months to start recruiting."

Commissioners tabled the item, agreeing that other stakeholders, including the sheriff's office and JPO, should be brought into the conversation. No public comment was offered, and the matter will be placed on the Dec. 4 board agenda for further consideration.