As much as Clark County leaders might want to punish clinics in their territory for shoddy medical practices, they are handcuffed by a century-old law designed to curb local authority.
Dillon's Rule, enacted at the turn of the 20th century, gave state lawmakers overriding power over local governments as a way to suppress corrupt political machines.
The law prevents the county from meting out penalties that are not outlined in the state statutes. That would include imposing fines on the four clinics in its jurisdiction the way the city of Las Vegas slapped a $500,000 fine on the Endoscopy Center of Nevada after it was found to be reusing syringes and single-dose vials of medication.
Eight cases of hepatitis C have been linked to the center and an affiliated clinic. Officials are wrestling with how to better respond to similar situations should they arise, and lawmakers have criticized state medical regulatory officials for not acting more forcefully against the clinics.
The city, unlike the county, has a charter that gives it more autonomy within its borders, including the power to devise punishments without the state's say-so.
"It's less confusing for a city because they do have a charter," said Sabra Smith-Newby, the county's director of administrative services and its head lobbyist.
By contrast, counties are subdivisions of the state, putting them directly under the state's authority, Smith-Newby said.
So strict is Dillon's Rule that lawmakers had to grant the county permission to change a code so that it could tow abandoned vehicles from public property, she said. The code specified that the county could tow vehicles from private property.
If the county wants to fine the clinics, it would have to submit a bill to the state Legislature in September and wait until next year's session before it's considered, Smith-Newby said.
County commissioners must decide how much of a priority it is to punish clinics, given that each county can introduce only four bills to the Legislature, she said. Each county once could sponsor 15 bills per session.
Last session, the county floated a bill that would have created a code for penalizing companies that violated the terms of their business licenses, Smith-Newby said, but lawmakers rejected it. Had it passed, the county could have fined the clinics, she said.
The county has restricted the four clinics in its jurisdiction to offering consultations to patients. No invasive procedures are allowed. Three of the clinics have voluntarily shut down.
Allowing the city, but not the county, to fine an errant clinic is a double standard that underlines the need to loosen the state's leash, said Jeff Fontaine, executive director of the Nevada Association of Counties.
"It's a consistency issue," Fontaine said. "What difference does it make if it (a clinic) is in the city or the county?"
A problem in Nevada is that lawmakers meet every two years, forcing counties to put important proposals on hold for 18-plus months, he said.
A law that hinders the county in the face of a public health threat might draw attention to the need for greater home rule, Fontaine said. "This is a salient example of where home rule would have made a difference," he said.
However, even a health crisis of this magnitude isn't likely to budge such an entrenched set of limits, especially on Clark County, said David Damore, political science professor at the University of Nevada, Las Vegas.
Lawmakers from the rural areas would resist giving any more power to Clark County, for fear that the state's largest county could break loose and run roughshod over the smaller ones, Damore said.
"This is the county that has the most to gain by having more autonomy," he said.
However, Commissioner Rory Reid said lawmakers are usually open to requests for tougher codes and penalties if the county can show a pressing need. Conversely, they are more likely to deny a request from the county to broaden its authority if there's no specific problem to fix, he said.
Reid said he's fairly certain that the Legislature would be receptive to a bill that punishes an entity for imperiling the public. He said he will push for the county to sponsor such a bill.
As for Dillon's Rule?
"I don't think it's been that much of a problem," Reid said. "It's the classic tension between state and local governments."
Contact reporter Scott Wyland at firstname.lastname@example.org or 702-455-4519.