Former Nevada CMO’s Reflection on the Mandalay Bay Mass Shooting, the Cost of Public Service and How to Fix Our Failing Healthcare System

On the night of October 1, 2017, Dr. John DiMuro woke to the news that would alter not only the trajectory of his career but his life. The Chief Medical Officer (CMO) of Nevada at the time, DiMuro was alerted at 1 a.m. to reports of a mass shooting at the Mandalay Bay Resort and Casino.

As details trickled in, the magnitude of the tragedy became apparent: a lone gunman had fired into a crowd of concertgoers at the Route 91 Harvest music festival, killing 60 people and wounding at least 413 others. The ensuing panic brought the total number of injured to approximately 867.

By 7 a.m., DiMuro was meeting with his team, knowing that this crisis would mark the beginning of a long and painful reckoning—both for the state of Nevada and for himself.

During that meeting, a high-ranking co-worker interrupted to post the all-important factoid about disruptions to getting the Halloween decorations in the office up.

“I could not believe what I was hearing,” tells me.

DiMuro, already frustrated, had reached a tipping point, illuminating a microcosm of what is wrong with much of the healthcare system in Nevada and across much of the United States.

A Career Defined by Service and Sacrifice

DiMuro grew up in a lower to middle-class family in New Jersey and initially studied economics at Rutgers University with a desire to go into physical therapy.

“While working with a friend who was a physical therapist, he told me, ‘If there’s one thing I regret, it’s not becoming a doctor.’ That planted a seed, but I never thought I was smart enough,” DiMuro recounted. “Then my grandfather was diagnosed with terminal cancer, and I watched how doctors treated him—with no empathy. That was the defining moment. I decided I wanted to make a difference, so I pivoted to medicine.”

Dr. John DiMuro was no stranger to high-pressure situations. As an anesthesiologist with extensive experience in pain management, he had spent years ensuring the safety and well-being of his patients in operating rooms. But his role as Nevada’s CMO was different—it was a position driven by policy, oversight, and an often thankless commitment to public health. Appointed in 2016, he had one clear goal: to combat Nevada’s opioid crisis and instill reforms in a healthcare system riddled with inefficiencies and, in some cases, outright fraud.

DiMuro played a pivotal role in shaping Assembly Bill 474, the controversial “Opioid Law” designed to limit prescription abuse and curb addiction. While the legislation was a critical step in addressing Nevada’s drug epidemic, it also brought its share of backlash from medical professionals, pharmaceutical interests, and even some members of the public. Despite the opposition, DiMuro remained steadfast, believing that he was making a difference. The bill ultimately passed unanimously in the 2017 state legislature.

However, as he later reflected, his unwavering dedication to the job came at a cost. The long hours, the stress, and the weight of his responsibilities consumed him, leaving little room for personal fulfillment. A baseball injury during his tenure became more than just a physical setback—it was a metaphor for how deeply he had thrown himself into his work, neglecting his well-being in the process.

Personal Fallout: Strained Relationships and Financial Hardship

Before becoming CMO, DiMuro faced personal challenges. He had gone through a divorce, but the demands of his new role widened the rift between him and his family, particularly his son. The job came with a significant pay cut, straining his finances and making it difficult to maintain stability. Despite the hardships, he believed in the importance of public service, stating, “You can’t criticize government and then not do anything to make it better.”

But the reality of his position was stark: bureaucratic inefficiencies, political infighting, and personal sacrifices mounted.

“I would go to meetings where the real discussions didn’t start until after everyone left. The meetings I attended would be mostly show; decisions were already made by the time the meeting ended,” he recalled. “And the primary concern of everyone in these meetings seemed to be when they could retire and start collecting their pensions. It was unbelievable.”

From his purview, everyone was focused on pensions rather than real action.

“No one wanted to go out on a limb. If you do something controversial, you risk being fired, which means losing your pension,” DiMuro claimed. “So, nobody does anything. When I became the Chief Medical Officer for the state, I saw firsthand how entrenched people were in their positions.”

The Aftermath of a Tragedy and a Career in Public Health

The Mandalay Bay shooting was a test of Nevada’s emergency response infrastructure, and as CMO, DiMuro was at the center of the health response efforts. Yet, even amid this massive tragedy, the cracks in the system became evident. The healthcare challenges exposed by the shooting—from trauma care access to mental health resources for survivors—reflected a broader crisis within the American medical system.

Realizing he could have more impact outside the system than in it, DiMuro resigned on Monday, October 30, 2017.

As DiMuro moved on from his role, he began to see his experiences as a microcosm of the larger healthcare struggles in the U.S. His time in government had opened his eyes to systemic issues: from unaddressed fraud—like the $2 million case of a mother allegedly fabricating a diagnosis for her child—to the red tape that stifled meaningful change. In one instance, he was even sued by a prison inmate over the quality of meals, only to later uncover that the inmate was exploiting the system. These experiences underscored the deep-seated inefficiencies plaguing public health administration.

Starting Over and Seeking Reform

Reflecting on his journey, DiMuro remains adamant that healthcare in the U.S. needs reform. His experiences serve as a cautionary tale of the sacrifices demanded of those who step into public service roles and the often-overlooked consequences they endure.

The Unanswered Questions and the Path Forward

Despite extensive investigations, the exact motive behind the Mandalay Bay shooting remains elusive. Much like many aspects of the American healthcare system, there are questions left unanswered, gaps unaddressed, and solutions that feel just out of reach. For DiMuro, the tragedy was both a literal and figurative moment of reckoning that illuminated the urgent need for systemic change.

Today, he continues advocating for healthcare improvements while rebuilding his life. His story is one of dedication, sacrifice, and the heavy personal price that sometimes accompanies public service. Whether through policy, practice, or advocacy, DiMuro remains committed to believing that real change is possible—but only if people are willing to pay the cost.

“The biggest problem in healthcare is labor—getting skilled doctors to underserved areas. Doctors have to complete continuing medical education (CME) each year, and I thought, what if doctors could fulfill part of that requirement by providing volunteer services in underprivileged areas? They’d volunteer their time, but the state would cover their malpractice insurance,” DiMuro surmised. “And what if we donated excess medical supplies—things close to expiring—to these underserved areas instead of throwing them away? It’s a way to get doctors to places like rural Nevada, where they’re needed, and address some of the healthcare disparities.”

That’s far from the only area requiring much-needed reform.

Dr. DiMuro sees two major issues plaguing the healthcare system: fraud and medical malpractice. Fraud, he explains, occurs in many forms, including when doctors refer patients for unnecessary tests at facilities owned by their associates. “For example, let’s say a Family Practice physician sends all of their patients for X-rays or MRIs to a facility owned by someone they know, even if it’s unnecessary. That’s one form of fraud.” This kind of financial exploitation drives up healthcare costs and erodes trust in the system.

On the other hand, medical malpractice is fueled by the constant threat of lawsuits. Because doctors can be sued for nearly anything, they often feel compelled to order excessive tests—many of which are medically unnecessary—to shield themselves from legal repercussions. Dr. DiMuro describes a scenario where a woman with a negative mammogram insists something is wrong. If a doctor decides not to investigate further and the patient is later diagnosed with cancer, that doctor could face a lawsuit. “So, doctors often order tests just to protect themselves legally,” he says.

Beyond fraud and malpractice, Dr. DiMuro points to the widespread abuse of Medicare and Medicaid. A significant number of patients with taxpayer funded health plans such as Medicaid, Medicare and “Obama-care plans” rely heavily on emergency rooms and urgent care facilities for their primary care needs, further straining resources. Even those with insurance aren’t spared from financial hardship—extreme out-of-pocket costs such as excessive deductibles and co-pays deter many from seeking medical attention unless absolutely necessary.

Meanwhile, fraudulent billing practices contribute to the financial instability of these programs. According to the National Health Care Anti-Fraud Association (NHCAA), Medicare and Medicaid fraud cost taxpayers an estimated $100 billion annually, with fraudulent claims ranging from phantom billing to kickback schemes that incentivize unnecessary procedures. Such waste drains resources and compromises the integrity of the system meant to serve the most vulnerable.

Another growing concern is the declining quality of medical training. Dr. DiMuro recalls hearing a retired surgeon discuss a young general surgeon who, after two years in practice, had never performed a lymph node dissection, a routine procedure for even a surgical resident. “This kind of training gap is concerning,” he says. Compounding this issue is the influence of Diversity, Equity, and Inclusion (DEI) initiatives, which, he argues, sometimes prioritize quotas over merit. He believes this approach places underqualified individuals in critical positions, potentially compromising patient care.

A shift in the medical workforce is also taking place. More women than ever are graduating from medical school, but many choose to go part-time after a few years to focus on family. “It’s a major problem when doctors are leaving the field or working fewer hours just as they’re gaining experience,” Dr. DiMuro says.

But this is not just a challenge for the industry—it’s a disservice to female doctors themselves. Unlike their male counterparts, many women face the societal expectation of stepping back from their careers to raise children while men continue progressing, often reaching higher-paying leadership roles.

Studies have shown that male physicians, on average, earn significantly more than female doctors—roughly 25% more for doing the same work, according to a report from the Journal of the American Medical Association (JAMA). This wage gap is typically tied to the number of hours worked. Female surgeons will therefore treat less patients, take less on-call time than their male counterparts and ultimately, spend less time in the operating room generating billable procedures.

From DiMuro’s purview, the system in and of itself does not penalize women as billables in the medical field are by CPT code, not the gender of the providing physician. But women by nature, given their societal role as primary caregivers, are the ones who often pay with career advancement.

For Dr. DiMuro, these issues are deeply intertwined—financial strain, legal risks, inadequate training, and workforce shortages all contribute to the growing dysfunction of the healthcare system. Addressing them will require a fundamental shift in policy and practice, ensuring that doctors can provide the best possible care without being hamstrung by bureaucracy, fear of litigation, or misplaced priorities.

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