In his first meeting as chairman of the Nevada Gaming Commission, Tony Alamo Jr. turned the Sawyer Building conference room into a doctor's office.
Alamo, a specialist in internal medicine, is the first non-attorney to head the part-time regulatory panel.
Using a bedside manner similar to how he would address a patient, Alamo attempted to calm the jittery emotions of a restricted gaming license applicant seeking approval for five slot machines in his Las Vegas restaurant.
Two weeks earlier, the Gaming Control Board spent two hours in heated discussion on the application, grilling the 30-year-old applicant over a laundry list of legal matters that were later resolved.
Alamo watched the hearing from the audience. Later, he reviewed the transcripts.
At the commission meeting, the applicant acknowledged he suffers from attention deficit hyperactivity disorder.
"I diagnosed you at the board hearing," Alamo said, advising the applicant to "relax and take a breath" before answering questions.
The hearing wasn't intended to be adversarial, although Alamo noted that Gaming Commission hearings can present an "uncomfortable environment" for many individuals.
"I just want to get to the core of a gaming issue," said Alamo, 50. "As a doctor, I'm going to look at the human side. As a regulator, it will be under the laws, regulations and statutes that govern our industry."
But, Alamo added, "you can't take away the fact that I'm a doctor."
Alamo was first appointed to the Gaming Commission in 2008, by then-Gov. Jim Gibbons. He was elevated to chairman in July by Gov. Brian Sandoval when Las Vegas attorney Peter Bernhard, who was in his 13th year as chairman, decided to step aside.
Bernhard reportedly suggested to Sandoval that Alamo replace him in the $55,000-a-year job heading the five-person panel that meets monthly and makes the final determination on recommendations coming from the full-time Control Board.
Alamo was at one time the Gaming Commission's only non-lawyer. The current panel has Alamo, two attorneys, Joe Brown and John Moran Jr.; former state Sen. Randolph Townsend; and retired Southern Nevada Water Authority General Manager Pat Mulroy.
"I think the commission now reflects the true legislative intent," Alamo said. "We want a balanced commission. I'm glad we have different personalities and varied skills."
Before his appointment to the Gaming Commission, Alamo was an eight-year member of the Nevada Athletic Commission, the last two years a chairman.
In 2002, Alamo sided with the majority of the Athletic Commission to deny boxer Mike Tyson a license to fight Lennox Lewis for the heavyweight title. Commissioners were under heavy pressure from the casino industry to sanction the fight, which meant millions of dollars in economic benefits.
Alamo said the same principles he followed as a member of the Athletic Commission govern his actions on the Gaming Commission. His style as chairman will be similar.
"I'm not here to push an agenda," Alamo said. "I want to work with the industry but within a regulatory environment."
Alamo grew up in the casino industry, although he never aspired for a career in gaming.
His now-retired father is Tony Alamo Sr., who held executive positions with Circus Circus Enterprises and the Mandalay Resort Group. Alamo Jr. said his father "inspired and pushed him."
Alamo often mentions his father, a Cuban-born immigrant who worked more than 40 years in the industry, working his way up the ranks to oversee operations of several Strip resorts, including Mandalay Bay, Luxor and Monte Carlo.
"My dad worked swing shifts and holidays most of my life," the younger Alamo recalled. "Everything he achieved, he worked for."
A close family friend — an emergency room physician — inspired the son to go into medicine.
As a Bishop Gorman High School student, Alamo would travel with the doctor — who was also a private pilot — to hospitals in rural Nevada. By age 19, Alamo had his pilot's license.
He graduated from the University of Nevada, Las Vegas and then the Keck School of Medicine at the University of Southern California. Alamo has served as chief of staff at two hospitals — Sunrise Hospital and Children's Medical Center and St. Rose Dominican Hospital, St. Martin Campus, — and has operated aclinic in Henderson since 1994.
When the doctor was a teenager, gaming revenue drove the Strip. Today, more than 60 percent of Strip resort revenue comes from non-gaming activities, such as nightclubs, restaurants and retail sales.
Alamo points to changes in the gaming industry in just the six years he has been on the Gaming Commission. He said the approval of mobile wagering inside casinos and the launch of real-money online poker in Nevada show that regulators and the industry both must quickly evolve.
"As we forge ahead, we have to be flexible," Alamo said. "But we're not going to jeopardize the integrity of the industry."
Alamo's closest friends, Las Vegas attorney John Bailey and Kirk Hendrick, general counsel for Ultimate Fighting Championship, surprised him by attending his first Gaming Commission meeting as chairman. His wife, Karen, and his 16-year-old son, Tony Alamo III, also were there.
And quietly watching the proceedings from the back of the hearing room was his dad, looking proud.
"My father is part of everything I've ever done," the new commission chairman said. "He always pushed me to do more."