She was named permanent chief executive Monday.

"I told Kathy this is a promotion that could end her career," Clark County Manager Virginia Valentine told the Review-Journal's editorial board Wednesday.

But Silver was not fazed by the risks, Valentine added.

Meanwhile, a former rear admiral in the U.S. Navy will be second at the helm. Brian Brannman, who has 28 years experience in hospital administration and finance, was chosen as UMC's chief operating officer.

Brannman was one of three finalists for the top job. He ran the Naval Medical Center in San Diego for two years and was once the director of the Navy Medical Services Corp.

County officials were impressed enough with his resume to hire him for another high-ranking position.

County commissioners must sign off on the hires and could vote as early as next week.

Brannman said he sees his role as handling the daily operations and Silver's as forming strategies to improve the hospital's efficiency and care.

To make room on the budget for the two high-paying posts, county officials slashed a couple of hospital jobs, including chief financial officer and chief information officer. Also, Silver's former job as associate administrator was downgraded.

Valentine said that Silver was not part of the inner circle of former chief executive Lacy Thomas. Valentine fired Thomas in January 2007 amid the hospital's swelling debt and allegations that he awarded hefty contracts to Chicago friends who did no work in return.

Silver said she observed Thomas act poorly as a manager, coming to work late most mornings and shutting out everyone but a few. But she said she saw nothing criminal.

"I didn't see him cutting any backroom deals or taking any money under the table," Silver said. If she had, she would've reported it to her superiors or the police, she added.

While Thomas was in charge, the hospital's operating deficit ballooned to $56 million in 2007. The debt is expected to drop to about $51 million by the end of this year.

Uninsured patients who cannot pay for care will always be a financial drain on a hospital that must treat them, Commissioner Rory Reid said. Given that burden, Silver has done as well as anyone possibly could, he said.

Dale Carrison, the hospital's vice chief of staff, said the hospital will be more efficient and transparent under Silver than in recent memory, he said. "She's been doing this job for 15 months and started with a horrible mess."

Contact reporter Scott Wyland at swyland@reviewjournal.com or 702-455-4519.