News

The new St. Mary’s owner

When Dignity Health announced in March that it was selling Reno’s St. Mary’s Regional Medical Center to Prime Healthcare of Ontario, Calif., the news release announcing the sale read in part, “Since 2008, Dignity Health has invested $67 million in Saint Mary’s, which has significantly strengthened the facility’s ability to sustain its mission. However, the hospital continues to experience significant challenges brought on by an ailing local economy and insufficient reimbursements. In 2011, the hospital posted a net loss of $43.5 million.”

It was not surprising that Prime, which has 14 California hospitals, would want to take over a hospital that was faltering. The corporation was founded by cardiologist Prem Reddy, who has been quoted saying, “Every hospital I acquire, I acquire in bankruptcy.” It has regularly picked up financially troubled properties, often assuring that local opposition or regulation will be less rigorous.

But that has not kept the corporation free from bad publicity or strong regulation outside those areas. In September last year, California Attorney General Kamala Harris refused to allow Prime to take over a hospital in Victor Valley: “We have concluded that this proposed sale is not in the public interest and will likely create a significant effect on the availability or accessibility of health care services to the affected community.” Although there were other buyers available, the hospital continued negotiating with Prime and won a court ruling that allowed the sale to go forward.

In recent years at least three different U.S. House members have called for Medicare investigations of Prime billing practices. In February, at a time when former Prime employees were being questioned by the FBI, Prime president and chief executive officer Lex Reddy—brother of the founder—resigned.

What prompted the calls for Medicare probes was principally charges that Prime was using Medicare number codes for maladies to upgrade to more expensive treatments. Specifically, malnutrition was designated as kwashiorkor, a rare form of malnutrition found mainly in Africa. The investigative organization California Watch reported, “Reports of kwashiorkor at Shasta Regional Medical Center exploded after Prime acquired the hospital in November 2008. That year, the hospital reported only eight cases of kwashiorkor. But in the two years that followed, 1,030 cases were billed to Medicare, more than 70 times the statewide rate for general hospitals. In [patient Darlene] Courtois’ case, the hospital’s reimbursement from Medicare increased by more than $6,700— from $4,708 to $11,463 – by noting kwashiorkor on the bill, according to a California Watch analysis of billing information obtained under the federal Freedom of Information Act.”

In a letter, Prime responded, “California Watch is once again trying to misinterpret a patient’s medical records to suit its malnutrition story angle. Prime Healthcare has sent California Watch hundreds of pages of literature documenting the issues, but still it persists in promoting a misleading and unfair narrative. In the latest query, the patient, who has chronic problems, was referred by her primary care physician from his clinic to Shasta Regional Medical Center emergency department. Essentially, the attending physician documented protein malnutrition based on very low blood albumin levels and sub-optimal nutritional status. … The physicians did an excellent and comprehensive job of identifying, addressing and documenting her significant health issues including her malnutrition.” The entire Prime response can be read at http://tinyurl.com/bvr7jvg .

Prime has also been accused of violating patient confidentiality. Los Angeles Times writer Michael Hiltzik wrote a piece titled “Her case shows why healthcare privacy laws exist” after Prime showed the medical records of Darlene Courtois to her hometown newspaper. Prime argued that it was no longer bound by confidentiality after she showed some of her records to California Watch.

In 2009, Prime was the only for-profit company to be listed on Thomson Reuters list of the 10 best health care systems in the United States. Prime has said that many of its problems are caused by a labor union, the Service Employees International Union/United Healthcare Workers West, and that it would look outside the union’s territory for new hospitals. Besides St. Mary’s, it has also taken over two hospitals in Texas.

PHOTO/DENNIS MYERS

‘Their’ votes

Romney and Heller campaigns seek victory by limiting voter choices

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Mitt Romney and Dean Heller backers are trying to reduce ballot options in order to force all voters seeking Dennis Myers alternatives into major party choices. In Nevada, they are suing jointly to overturn the state’s “None of these candidates” (NOTC) ballot line to keep it from draining away votes from them. And in Michigan, Romney is suing to keep Libertarian Party presidential nominee Gary Johnson off the ballot to keep him from drawing votes that might otherwise go Republican. The NOTC option in Nevada has been in place since 1976, but only in statewide races. State legislators in the 1975 Nevada Legislature did not want it applied to themselves. And they made it non-functional. Although voters would get to express their unhappiness, it could not prevail in an election. The election results would be certified as though NOTC were not on the ballot—the human who came in first still won. Romney and Heller are arguing that by creating the NOTC ballot option and inviting voters to use it while making it ineffective, Nevada is invalidating their votes without due process. Their complaint says state officials “ignore it [NOTC] in determining and certifying the winners of elections”—which is what the law requires election officials to do. Among the plaintiffs are two state Republican leaders, including one of Romney’s presidential elector candidates, plus several unknown voters.

NOTC is generally regarded as draining votes away from challengers, so incumbent Heller could be adversely affected by the lawsuit.

In the past, NOTC victories— which came in pluralities, not majorities—have occurred mainly in non-competitive races where one party or the other fails to field a serious candidate. And so far they have always come in primary elections, which political analysts believe are regarded by voters as “free” votes whose effect can always be remedied in the subsequent general election.

In 1976 NOTC won its first victory in the GOPprimary election for what then was the state’s only U.S. House seat. Nevada Republicans were unable to get a strong candidate against incumbent Democrat James Santini, with the result that unknowns Walden Earhart and Dart Anthony both trailed NOTC. But because “None of these candidates” is non-binding, Earhart won the nomination anyway. NOTC did have one effect, though—whatever small chance Earhart had was snuffed by the indignity of losing to “None of these candidates.”

Earhart went on to achieve the uncertain distinction of being a double-NOTC victim, when he came in second in the GOPprimary for secretary of state in 1978.

In their complaint, the Romney/Heller group said there were at least two ways the Nevada Legislature in 1975 could—and should—have made NOTC effective.

It could, they said, have required that when NOTC won an election, “the office at issue must be deemed vacant at the commencement of its term,” upon which the normal procedure for filling vacancies would kick in. That’s the way Nevada law works when a person who has died after getting on the ballot is elected.

Or the legislators could have required that if NOTC won, a runoff would be held for that office. “States that require candidates to win elections by a majority (rather than plurality) of votes often hold run-off elections after Election Day for races in which none of the candidates received more than 50 percent of the vote,” the complaint reads. It fails to note that runoffs are held mostly in Southern states and were devised as a way to keep black candidates from winning the plurality elections that prevail in most other states. It is also used in what the Atlanta Journal-Constitution calls “some politically charged cities north of the Mason-Dixon line.”

Runoffs have been the target of attacks under the U.S. Voting Rights Act. Moreover, in Nevada they could require an additional statewide election, which brings an expense factor into play.

Obama and Romney have been in near-ties in several surveys since Romney emerged as the clear frontrunner for the Republican nomination, and those same surveys have shown unusually small segments of undecided voters for so early in the campaign year. That makes the few votes that might be drawn by other ballot options precious.

Both major parties have a history in tight races of attacking independent or third party candidates for taking “their” votes and being “spoilers,” as when such charges were thrown at Ralph Nader on Al Gore’s behalf in 2000. In a 2010 New York Times story about the impact of NOTC on that year’s U.S. Senate race, a Republican manager said, “Any vote not for Sharron Angle is a vote for Harry

‘None’ has actually won in some primary elections.

A Reno resident voted at the University of Nevada, Reno student union during early voting this month.

Reid.” In that race, it turned out not to be true—if Republican Angle had received every vote cast for NOTC, she still would have lost heavily to Democrat Reid. But in 1998, NOTC saved Reid—he defeated John Ensign by just 428 votes as NOTC took nearly 8,000 votes.

NOTC rarely breaks the 5 percent mark, but even a smaller number comes dearly in a close election.

Although the Romney/Heller complaint says NOTC nullifies votes, it also says that the option does have some impact—the Legislature, the complaint says, gave the public “a way of expressing ‘nonconfidence’in their candidates for elected office and telling the prevailing candidate to ‘clean up your act.’”

Though Nevada’s unusual ballot option has become known outside the state, there is little indication that other states are anxious to imitate it. In California, voters rejected, by a 2 to 1 margin, a 2000 ballot measure that would have created a “none” option in that state.

The Romney effort to keep Libertarian Gary Johnson, a former New Mexico governor, off the ballot is more complicated. Johnson began the year running for the Republican presidential nomination and appeared on the Michigan GOPprimary ballot. He later dropped out of that race and won the Libertarian Party nod at its national convention in Las Vegas. Michigan Secretary of State Ruth Johnson, a Republican, says state law puts a time limit on when candidates can switch parties and then run for office. The Johnson campaign was informed of the decision in a letter written by state Attorney General William Schuette, Romney’s state campaign chair. The secretary of state also said candidate Johnson’s ballot application arrived in her office three minutes past the deadline.

However, in 1980 when Republican presidential candidate John Anderson ran in the general election as an independent using a newly created Michigan party— the Anderson Coalition Party—as a vehicle, that state’s officials did not interfere with his ballot listing. In addition, it is uncertain whether states can impose additional qualifications on candidates for the presidency that do not appear in the U.S. Constitution.

Elections deputy Scott Gillis in the Nevada secretary of state’s office said the Libertarian Party already has ballot status in the state and all it has to do to list Gary Johnson as its presidential nominee is file the paperwork.

Nevada Secretary of State Ross Miller is a Democrat. He does not have a position, honorary or otherwise, with the Obama campaign. He said he would decline such an invitation: “I am very cautious about political activity because I count the votes.”

He’s speaking figuratively— county officials do the actual counting—but he writes the election rules the counties must follow. Ω

Bucket list

Passers-by read some of the entries written in chalk on the “Before I Die” blackboard on East Fourth Street, one of two in the downtown Reno area on which people can write their “Before I die I want to ...” wishes. A nearby sign put up by the Black Rock Art Foundation describes the blackboards as “a snapshot of the values our neighbors hold dear.”

Turnover

In 19 weeks, Reno voters will have a duty that does not often present itself. In a single election, they will elect a new majority of the Reno City Council. As a result of term limits taking hold, four of the seven seats on the Council will turn over. The importance of this election is certainly apparent to power players in the valley. Developers in particular are believed to be pushing hard for a Council they find congenial. Some activists who were appalled by the sprawl allowed by the current council—particularly approval of a housing development 30 miles north that is detached from the city proper—are also hoping for a better deal from the next Council. Growth and environmental degradation have been issues before the Council since 1978, when six casinos opened in the valley. People poured in looking for jobs, which were very available, but there was no place to live, and the sewer plant ran out of capacity about when available housing nearly vanished. People lived in cars or in tents at a highway rest stop. Traffic problems increased. Overnight a controlled growth movement was legitimized in a city that had always given developers a long leash. Controlled growth advocates Barbara Bennett and Peter Sferrazza were elected mayors into the mid1990s but control of the Council was a more expensive proposition and the controlled growth faction never quite managed a majority of the Council. Reno attorney Bill Bilyeu has some experience with the dynamics involved in a sudden sweeping change in membership of a public body. In 1984, a Republican surge gave the GOPthe only majority in the Nevada Assembly it had in 40 years. Bilyeu said the result of the sudden new majority tended to show itself more in procedures than in

policy. For instance, it had been, and still is, the practice to shut the public by out of the legislative process by “susDennis Myers pending the rules” in the closing days of the legislative session. Bilyeu did it, too, but he waited longer than usual. “I didn’t suspend my rules over on the Assembly side until—what?— it was at least two weeks after the Senate has suspended theirs.” He said turnovers also costs the public something, and pulls in people who aren’t necessarily suited to the job: “If you get a sudden influx of new people, anyway, because of term limits, there is not institutional memory and you really don’t know what kind of wild cards you’re drawing these days.” Truckee Meadows College political scientist Fred Lokken agreed the changeover will cost the voters. He said the current council has not been appreciated for its ability to govern. “The consequences can be very dramatic,” he said. “Frankly, it puts at risk what has been a very productive working culture, largely because of Mayor Cashell, but it has taken time.” Cashell will likely continue as mayor for two years after November. His first years were very difficult because of infighting on the Council. “The city is coming through this period of remarkable accomplishment, and of holding it together during hard times,” Lokken said. “It takes time to train new faces and unless they’ve served on a neighborhood board, it can take a year or more to get them familiar with the budget process and working routines.” He said that “some candidates who are seen as more insider than others” would likely adapt more quickly, but that doesn’t necessarily help them win. Moreover, some newly elected officials have been known to arrive in office with fire in their eyes, determined to follow their own priorities. “Often when someone does come on board with their own agenda, that can be even more destabilizing than the other factors,” Lokken said. “Getting something done isn’t always the first thing they think about. In Reno particularly we have dealt with very difficult elected officials, who forget that they were elected to be part of a team and pursue their own agenda.” He said getting things together fast is especially important, because in two years the rest of the Council will also be term limited out. Ω

PHO TO /DENNIS MYERS

This year, 27 Renoites—some of them shown here at a public forum—ran for Reno City Council. In the primary election this week, they were winnowed down to eight.