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By Jesse Jones, The Paper. — For years, Bernalillo County has poured millions of dollars into fixing healthcare at the Metropolitan Detention Center, bringing in a new medical provider and overhauling its behavioral health system. Despite millions of dollars in new investments, turbulence continues at MDC. The facility has cycled through three wardens since 2022 and most recently faced a union-led vote of no confidence in warden Steven Kai Smith. So when the county recently hired its first chief medical officer, Dr. Rebecca Fastle, taxpayers might reasonably wonder whether the position is another attempt to tackle the jail’s long-running healthcare challenges.
According to the county, the answer is no. The role grew out of recommendations in the county’s 2024 Behavioral Health Ordinance and three-year strategic plan, which called for a behavioral health medical director. County Manager Cindy Chavez expanded that idea, creating the chief medical officer position to oversee health-related programs across county government, from public health and employee wellness to emergency preparedness and youth services.
Interim Communications Director Paul Evans told City Desk the chief medical officer position is “part of Bernalillo County’s long-term strategy” and “not a response to any single challenge or issue.” By bringing medical expertise in-house, Evans said the county views the new position as the next step to “better coordinate services, make more informed decisions, improve efficiency and ensure that health-related policies and programs are aligned with best practices.”
Dr. Fastle brings more than two decades of clinical and leadership experience to the role. A board-certified physician in pediatrics and pediatric emergency medicine, she later moved into hospital administration, helping manage the University of New Mexico Hospital’s response during the COVID-19 pandemic and serving as associate chief medical officer for special projects. When UNM Hospital took over healthcare operations at MDC in 2023, Fastle spent two and a half years helping build the jail’s new medical system as a physician leader within the MDC Health Authority. Fastle told City Desk that experience gave her a firsthand look at the challenges facing people in custody, many of whom struggle with mental illness, substance use disorders and a lack of stable housing and other support services. She said those factors make MDC a particularly complex environment.
Looking ahead, Fastle said success will depend on how well the county connects its various health programs under the new behavioral health authority division. As the county begins implementing its three-year strategic plan, she said she wants residents to see “the healthcare arm being integrated into those other services,” bringing greater coordination and accountability to county programs. She will earn $350,000 a year and be the county’s highest-paid employee, according to salary documents reviewed by City Desk.
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