Clark, Washoe health authorities complain about Sisolak’s directives

Carson City — The health districts overseeing the state’s two largest counties complained in a letter to Gov. Steve Sisolak that they’ve been shut out of his decision-making process about coronavirus restrictions.

In a scathing joint letter from the Southern Nevada Health District and Washoe County Health District sent to Sisolak’s office Friday, health officials said that not including them in the state’s policy discussions or development of COVID-19 directives has complicated the local response to the virus by forcing them to shift their plans and resources in order to respond to the governor’s changes with little to no notice.

“Since we are not consulted and engaged, we receive little or no advance notice of what these policy changes may be, and we are forced to react after decisions have been made and announcements are occurring,” the letter said.

The letter was signed by SNHD Chief Health Officer Fermin Leguen, Washoe County Health Officer Kevin Dick, Southern Nevada District Board of Health Chairman Scott Black and Washoe County District Board of Health Chairman John Novak.

In a response letter sent Monday night to the local health officials, Sisolak’s Chief of Staff Michelle White pushed back on the claims of exclusion, writing that the governor’s office has “regularly been in touch with and held robust conversation with elected officials in both Clark County and Washoe County — who purport to represent their communities as a whole.”

White’s response said that none of the complaints levied by the health districts in the letter had been brought up in prior phone calls with the state’s COVID-19 response team or any various state agencies, but said that they are “grateful for the chance to address these concerns and map out a solutions-oriented path forward.”

Locals not consulted

In the letter, health officials pointed to Sisolak’s Sept. 29 announcement that he was increasing the state’s gathering limit from 50 to 250 for most indoor and outdoor events, while also allowing significantly larger gatherings for bigger venues if they receive local and state approval first.

Sisolak had signaled his intent to change the state’s gathering limit days before the announcement. But health officials said they weren’t aware of the details of the announcement until they were told by Sisolak’s senior adviser, Scott Gilles, at 6 p.m. the day before the announcement came down.

But even getting that briefing from Gilles, they said, was “more consideration than local health officials have received from you in the past.”

The health officials also questioned whom Sisolak and his office are discussing the changes made in his directives with ahead of time if not with local health districts, saying that it appears that other groups “who do not have any elected governance or statutory public health responsibilities seem to be in regular consultation with your office and are engaged in the development of the directives and guidance.”

Before Sisolak finished making his announcement last Tuesday about the changes to the gathering limit, the letter said, Washoe County had already received a plan for a group to hold a large event.

“It is inappropriate that the local health authorities are not engaged and consulted in these discussions and when decisions are made. These decisions have significant impact on the health of our communities and impose additional mandates on our staff that are already overwhelmed with COVID-19 responsibilities,” the officials said in the letter.

Likewise, the letter said that local health officials were also not engaged in the development of Senate Bill 4, which was approved in a special session this summer and provides liability protections for most businesses and mandatory safety measures for hotel workers that gaming companies must follow.

That bill, the letter said, requires the local health districts to adopt a new regulatory program for resorts.

In the response letter, White said the governor’s office was “taken aback” by the claim that the locals were surprised by the gathering changes. She noted that the governor announced publicly on Sept. 3 that he was asking state health and regulatory officials to review the gathering limits.

“At no point during the review period that took place over the course of weeks up to the announcement last week did we receive any input, concerns, or suggestions from Local Health Authorities on the many phone calls you had with the State, all of which would have been welcomed,” White wrote, adding that no concerns were raised in the call with Gilles the evening before the changes were announced.

Governor’s health advisers

Epidemiologist Brian Labus, a member of the governor’s COVID-19 medical advisory team, said the governor wasn’t making decisions without input from public health authorities.

The governor has “plenty of public health people who he talks to all the time, and these are the people who report to him” in the state health department, said Labus, an assistant professor in UNLV’s Department of Public Health.

“I can understand why the local health departments would be upset. And I can understand why you don’t have every single health person in Nevada involved in every single health decision. I don’t know that there’s one side that’s right or wrong,” he said, chalking up the dispute to the challenges of communication.

Labus said the governor’s medical advisory team was not involved in discussions surrounding raising the limit on many gatherings from 50 to 250, but that the team had provided guidance earlier in the pandemic related to opening up safely that the governor could have factored into his decision-making.

Resources strained

SB 4 combined with the requirements for the local health districts to approve large gathering and convention plans have forced the districts to divert resources away from the normal public health duties in order to support the resort industry, they said.

“We are simply beyond the limits of what we can be expected to accomplish,” the letter added. “It is unreasonable and unfair to continue to demand more and more of public health agencies and staff that are already giving their all without allocating additional resources.”

Black, the chairman of the Southern Nevada Health District’s governing board and a North Las Vegas city councilman, characterized the letter to the governor as a “plea for help.”

The pandemic has strained local health authorities, he said, adding: “We’ve risen to the occasion, we’ve expanded our capacity. But in order to expand our capacity further, we need help. We need resources, we need communication, we need partnerships.”

“In regards to public health, I don’t know who the go-to people are for the governor’s team, but it’s definitely not the Southern Nevada Health District, as you can see in the letter.”

Black said he did not view the letter as a condemnation of the governor’s policies but instead a call for inclusion in the discussions that shape them.

The letter comes after Dick, the Washoe County health officer, and the director of the state’s COVID-19 response team had a public back-and-forth over the gathering changes.

After the gathering limit changes were announced last week, Dick said during a weekly media call that he had concerns with increasing those gathering limits as the northern county was experiencing a significant spike in cases.

But Caleb Cage, Nevada’s COVID-19 response director, questioned Dick taking issue with the rolling back of restrictions and pointed to Washoe County’s push to reopen bars and taverns. The state task force eventually approved Washoe County’s plan to reopen bars starting Sept. 16.

Cage also noted that governor’s directives are a minimum and that local governments could pass stricter standards as they see fit.

Contact Capital Bureau Chief Colton Lochhead at clochhead@reviewjournal.com. Follow @ColtonLochhead on Twitter. Review-Journal staff writer Mary Hynes contributed to this report.

Letter to Governor Sisolak by SteveSebelius on Scribd