Nevada’s public health sector faces significant funding challenges. That’s according to new District Health Officer Dr. Chad Kingsley, who recently shared his experience as a Mexican doctor transitioning to public health in the U.S. Kingsley said the state’s low ranking in public health funding highlights the need for more resources. In the meantime, he said collaborating with other local government leaders is critical to working with limited resources. We sat with Dr. Kingsley to discuss his vision for Northern Nevada Public Health, previously the Washoe County Health District.
This interview has been edited for length, clarity and readability.
BC: Welcome to Washoe County. I’m Bob Conrad with This Is Reno. I’m sure you’ve been forewarned about me.
C.K.: [Laughs.] I wasn’t forewarned, but I know you used to work for the state as a public information officer for the state or something.
Yes. I was a communications director at the university for some time, became a PIO for the state for several years and went out on my own in 2015. I’m now a half-time instructor at the university and run the news website half-time.
Tell us about yourself and what brought you to Washoe County.
Most immediately, I’m coming from Mohave County, Arizona. I was there for the past two years as a public health director. Prior to that, I worked for 10 years with the Southern Nevada Health District. I was born and raised in Las Vegas, so Nevada is very familiar to me, career-wise. I wanted to really come back to Nevada. I have my medical degree from the Mexican university, Autonomous University of Guadalajara School of Medicine. I’m a Mexican doctor, but I transitioned to public health here in the United States.
Are you a licensed doctor in Nevada or the U.S.?
I’m not a licensed doctor in Nevada. I have my M.D., and I am certified by the United States. I don’t have a license to practice clinically.
What are the big issues you’ve seen here in Washoe County that are new and unique to you or that are consistent with southern Nevada or northern Arizona, where you came from most recently?
There are always issues that come and go. Congenital syphilis is up, and that’s also across the nation. We continue to monitor that as part of our responsibility. We have certain infections that we are mandated to report that we follow. It’s the day-to-day of public health. There’s air quality, environmental health, public health preparedness, and there are all the issues out there that are pretty routine – everything that I’ve seen in my career. Northern Nevada Public Health is doing an excellent job at all those points and moving forward.
The big issue that is coming up, especially for Nevada and other states, is sustainable funding. ARPA [American Rescue Plan Act] funds are finishing, and we’ve had such a shift in what budgets are, so we’re facing some of those challenges. Nevada is about 47th in public health funding, so we’re at the bottom, especially for the rural counties. They haven’t really had that type of funding that can support them. I see that as one emerging importance for Nevada – that we have sustainable public health funding. That’s what’s on my plate right now, especially with the upcoming legislative session.
Will there be any layoffs as Covid funding ends?
We did have temporary staff. Most public health departments did that as we hired temporary contact tracers, and those positions are naturally transitioning out. We’ve had a few of that staff who have shown interest, and they’ve had opportunities to apply for internal positions. Some have been moving on to the next stage of their careers.
You mentioned air quality. At a recent RTC Washoe board meeting, they mentioned that Northern Nevada Public Health had communicated regarding traffic. I believe it was related to Interstate 80 and some of the changes being proposed for that. What were the concerns related to air quality in terms of traffic in the county?
Anytime you increase traffic, you will have your particulate matter and ozone increase, so you will be affecting two different things. Sometimes, we want wider roads or the widening of 80, but there’s the challenge of the natural consequences.
We recently received a news release about the ozone incident. I was a little surprised to hear about it a week after the fact. I’m curious as to why it took so long to let people know that it had occurred.
Ozone is relatively newer for reporting on air quality, and some people are a little like, “What does ozone mean to me?” People understand particulate matter, fires and inversions, where you can see the cloud hovering in the valley. But you can’t see ozone. It’s detected differently, so we monitor and report on it. Nevada, as you know, is registered as one of the fastest warming areas; not the hottest, but the fastest warming. Anytime you have that heat, you have an increase in ozone. It is one of those atmospheric processes that can affect those who have respiratory complications.
My question was more about the timing of the incident versus when the public was notified.
I have to look into it. I see the alerts when they’re going out, so it’s definitely something I can look into.
One thing I’ve dealt with with the health district a lot over the years is that there’s been a lot of internal and external consternation. We have had a number of incidents with employees. I’m curious as to what you are going to do to ensure that employees feel like they’re heard so that they don’t feel like they have to go public, to the news media or engage in litigation to get their issues resolved.
Internal culture is made up of all small little parts of how you respond. Employees can give us anonymous comments or directly speak to us. We’re doing that across the board, and some of our directors are also doing it. I think a part of it is listening. Part of leadership is being available and being accessible. There are always concerns from employees. Moving forward, I will handle things in a way that is accessible, have anonymous feedback and be available for direct contact.
I’m also going out into the field with the inspectors. Sometimes, some people can’t thrive in certain spots, so it’s important to always identify issues, work with them, and do that in a very organic, healthy way. If we can address your concerns, let’s do it. I’m a relationship builder, so I believe it’s building those relationships, doing those small things, responding, and continuing with NNPH being a very positive place. Yes, we have individuals who don’t feel heard now and then, but we hear very positive things on our internal surveys and during those processes where we engage staff.
Speaking externally, there have been some concerns over the years, and even recently, among the people you serve or have to regulate. You had an issue with the Kava bar. They felt like the regulations being enforced in their case were not being enforced the same way down south. Another problem is that contractors felt like there had been a lot of hold-ups on construction projects. What will you do to ensure that policies are clearly conveyed to ensure that those folks are treated fairly?
Part of it is those changes that you’re addressing were from 2019. Changes were made to help address that. For the past two years, environmental health specialists would cover restaurants, pools and maybe they also did wells inspections. Over the last two years, there have been changes in environmental health, such as having more specialists to provide better consistency. When someone’s unfamiliar with what a restaurant needs, they may say, “Yeah, I need to do this, this and this.” Then somebody who is more oriented toward restaurants in six months would come back for inspections and say, “Well, why didn’t you do this and this?” Things were missed.
Specializing is important, but it is also important to be able to cover those services so they’re not delayed. Another is that it is the responsibility of those restaurants to understand requirements. Sometimes, they are behind.
You also have to go back to the data: How many complaints are we receiving? How many complaints have gone down? I believe the changes that were made to environmental health, to be more specialized, helped to address those issues on a lot of points. We have more consistency and learn from our quality improvement processes.
I started going out with inspectors. I did some restaurants, some wells, and we will be doing pools as well. It’s part of my process also to build the relationship with the environmental health inspectors, as well as air quality, to be out there in the field and to see what the concerns are and see if further improvements can be made.
I don’t know how much Northern Nevada Public Health is responsible for this — probably not very much — but we have a big problem, one I consider a public health problem. There is a need for adequate garbage receptacles and, frankly, places for people to use the restroom in public. I know they just installed that new Portland Loo downtown, which is great, but what role does NNPH play in that and can you twist arms to see better garbage disposal?
We inspect the number of porta potties and hand washing stations so they’re all adequately working. That is part of our purview, which would only be for mass events. We have a role in solid waste and disposal in environmental health to ensure solid waste is adequately and correctly disposed of. The services that go outside of our realm are up to elected officials. Our role is to ensure that things are disposed of correctly and sanitarily. Other issues would go to the city, the county or the elected officials.
How will the health district work with other jurisdictions on those issues? Let’s say you don’t have any teeth to enforce something that is, in my opinion, a very obvious public health issue or possible public health concern: How will you work with the local governments to help them be more proactive?
In many of these situations, public health has a seat at the table, and we sometimes have a small regulatory role. We don’t oversee all of that. A lot of times, we are invited to the table to discuss those things and make sure that they’re adequately not going to cause any type of disparities within our communities.
There was a lot of ire amongst the local jurisdictions aimed at what they perceived as the health district being a “fiefdom.” There was even a push to change it legislatively. How will you mitigate, perhaps, or repair some of those past perceptions and ensure that you are accountable to all community members, not just the health board members who approve your contract? There was a perception in the community that the health officer was accountable to his bosses, and maybe that’s about it.
Part of the board’s makeup, and the interlocal agreement, is that there’s a council member from Sparks, one from Reno, and one of the county commissioners also sits on the board. With any large decision, all three governmental bodies must come together. My approach as a leader is relationship building. I do feel that I am accountable to the point that I go to each of our local councils as well as to the commissioners and present to them. I have direct phone calls with them. I would love to see myself presenting at the city boards and getting the interaction that I think would help improve public health. That’ll be my approach moving forward – as much as they want me there, I can be there.
Now that Immunize Nevada has crashed and burned, what is NNPH doing to increase immunization efforts?
A good example is the Neil Road Community Center family festival. We had four of those this year. There was also just a recent meeting with most of the stakeholders. It was organized by Dignity Health, but they had a meeting about how they will move forward with immunizations. We also just received a mobile unit to use as a command post. So that’s one thing that NNPH’s community and clinical health services staff are very excited about. We can be better out in the community with that mobile unit to show up and have that as our immunization station.
Some people were very disappointed that another white male was appointed to your position and that the board itself is really lacking in diversity. Do you have any suggestions on how to ensure there’s better representation in the community?
The board chose me. I would have been happy with any of the other candidates, too. I thought they were amazingly qualified. Being bilingual was important for reaching out to the community. At this point, I’ve done a lot of interviews in Spanish.
One of the focuses that was started by former Health Officer Kevin Dick, but also continuing forward, is that we have an equity part of our workforce development. We have a lot of emphasis on what equity is and what equality is. We will continue that with our workforce development and help answer how we really reach out and how we resemble the community we serve. I can only go forward as myself, as a leader, and I hope to serve the community as best I can.
