Sunday, April 11, 2004
Copyright © Las Vegas Review-Journal

PAHRUMP PROBLEM: Medical services lacking

Proposals to build hospitals have failed as population has grown

Roy Mankins stands at the site of a proposed hospital in Pahrump, which will not open this year, as the sign indicates. Nye County's largest community is home to 30,000 people, but the nearest hospital is in Las Vegas, 60 miles away. Mankins' father, Bill, died because the community has no hospital and no emergency room. Photo by Clint Karlsen. After two years, tape continues to hold a sign on the door of Pahrump Medical Center. The sign was placed on the glass door when the facility closed in April 2002. Even then, the medical center had long ceased operating as a 24-hour urgent care facility. Photo by Clint Karlsen. Mercy Air has stopped using this helicopter pad in front of Pahrump Medical Center, the one-time urgent care facility that closed in April 2002. Mercy Air, which built a new pad nearby, provides the fastest access to emergency care for Pahrump's 30,000 residents. Photo by Clint Karlsen. Click image for enlargement. Illustration by Mike Johnson.

Roy Mankins still gets tears in his eyes when he talks about the night three years ago that his father's life slipped away because of Pahrump's lack of emergency medical care.

It was Feb. 10, 2001. Bill Mankins, 74, and several hundred other people gathered in the showroom of a Pahrump casino to hear a Milwaukee-based company pitch its plan to build the community's first hospital.

As the meeting broke up, Bill Mankins' face went gray and slack, and he collapsed into a chair. His wife, Pat, a longtime member of the Pahrump Hospital District board, rushed to his side.

It took close to two hours to get him to Summerlin Hospital Medical Center in Las Vegas. By then, his aorta had suffered permanent damage.

"If we had been able to stabilize him right away, he probably would have made it," Roy Mankins said. "The symptoms he had were so well-recognized when he got to the hospital in Las Vegas, there wasn't any doubt. But the damage was so extensive when he got there they didn't expect him to make it through the night."

The 47-year resident of Pahrump hung on for almost a month at the Las Vegas hospital. He died there March 1, 2001.

Within a year, the hospital plans he heard about were abandoned. So was a competing project, bringing the grand total of failed hospital proposals to five in the previous six years.

Since Bill Mankins' death, little has changed in Pahrump except its population. The valley is now home to about 30,000 people, and no hospital or emergency room.

If a resident needs either one in a hurry, they can expect to take a ride in an ambulance or in the belly of a helicopter.

Mercy Air averages at least one flight per day from its base next to Pahrump's shuttered urgent care center. The base is consistently Mercy Air's busiest in Southern Nevada.

But if it isn't the helicopter, it's the highway.

Four of the town's six ambulances are used exclusively to transport patients to hospitals in Las Vegas. On Wednesday morning, three of the four were in Las Vegas at the same time, each of them loaded with two patients.

"There's no readily available mutual aid," said Scott Lewis, chief of the Pahrump Valley Fire-Rescue Service. "We're truly an island."

Doctors at Pahrump's handful of private practices will treat emergency cases on a walk-in basis, but from about 7 p.m. to 8 a.m. on weekdays, patients are pretty much out of luck. Coverage is even worse on weekends.

The last time Pahrump residents had access to 24-hour urgent care services was 1996, when St. Rose Dominican operated Pahrump Medical Center.

Three failed operators later, the medical center closed for good in April 2002.

As a result, the Pahrump Valley Fire-Rescue Service now averages six to 10 trips to Las Vegas each day. The oldest of its transport ambulances was built in 1999 and already has more than 400,000 miles on it, Lewis said.

Last year, the service responded to 3,663 911 calls and hauled 2,070 patients to Las Vegas. Each round trip covers at least 120 miles and ties up the ambulance's two-person crew for anywhere from three to seven hours.

A large percentage of the calls involve patients in cardiac or respiratory distress, patients like Bill Mankins, who could be stabilized if not fully treated at even a basic rural hospital.

It's no wonder. According to the 2000 census, 21 percent of Pahrump residents are older than 65. Statewide, the same group makes up 11 percent of the population.

What happened to Bill Mankins is not unusual, said Dr. Michael Reiner of Pahrump.

"There are at least a couple people a month, if not one a week, who could have been saved if there was an ER around where they could do something," Reiner said.

Reiner said the risks go beyond a simple lack of emergency care. "A lot of the time, patients won't have screening tests done because they can't or won't make the trip to Las Vegas," he said.

So why do people, especially those with serious health problems, keep moving to Pahrump?

"It's a gambling mentality," Reiner said. "The people who move here are gambling every day and every night that they won't need the services of a hospital."

Pahrump's best hope for a hospital rests with Utah-based Rural Health Management Corp., which has until next week to move ahead or surrender its right to build the project to another developer that may or may not be waiting in the wings.

"There is no question in my mind that the deadline will not be missed," said Roy Barraclough, vice president of project development for the Utah-based nonprofit. "We're ready to move forward."

Rural Health expects to close next week on a $13.5 million loan to build Desert View Regional Medical Center, a 25-bed hospital with a 24-hour emergency room, full ancillary services and a surgery center.

If Rural Health cannot secure the construction money by April 20, it will forfeit the certificate of need it received from the Nevada Department of Health and Human Services in July 2002.

To date, the company has missed at least three key deadlines and received two extensions from the state, all of them stemming from financing problems.

"This is like their final, final deadline," said Mary Griffith, a health resource analyst who helps administer the state's certificate of need process.

A confident Barraclough said the company expects to break ground in May at the 25-acre site donated by longtime Pahrump resident Hollis Harris. Construction is expected to take 14 months, Barraclough said.

After that, the biggest challenge could be recruitment. The hospital is expected to employ a staff of about 120 people, and Barraclough said the toughest people to find will be nurses, lab technicians and physical therapists, all of whom are in short supply nationwide.

"I suspect we will know how we stand in about six months. We'll start to receive applications as soon as we break ground."

Reiner, who came to Pahrump in 1999 when Barraclough hired him to work at Pahrump Medical Center, has his doubts about Rural Health.

"Why have they had so much trouble borrowing money for this project? The answer is simple: People loan you money against your ability to pay it back," he said.

"Don't get me wrong. They run a great hospital in Nephi (Utah). But Nephi is like Pleasantville, and Pahrump is like Amityville," Reiner said. "This is a town where you really need to be sharp because you have so many indigent (patients) and so many people who don't want to pay their bills."

Whether Rural Health succeeds in building a hospital is "totally irrelevant" as far as Roy Mankins is concerned.

By the time the facility opens, Pahrump won't need 25 beds anymore; it will need 100, Mankins said.

But Barraclough defended the size of the proposed hospital, which is necessary for the facility to be designated as a critical care hospital and earn a higher reimbursement rate from Medicare.

He added that Rural Health's development plan calls for a full review of the operation at the end of the second year. If there is ample evidence to support expansion before that, the facility has been designed to allow more beds to be added with relative ease, Barraclough said.

Pahrump residents have many theories about why it has taken so long to get even this close to a viable hospital project.

Some say the valley's infrastructure is inadequate. Some say it lacks a sufficient tax base. Some blame Pahrump's status as an unincorporated town or its proximity to Las Vegas, where hospital projects seem both easier to develop and more likely to succeed.

Others cite what they see as a combination of meddling and inaction by local officials from the Nye County Commission on down to the now-defunct hospital district board, which oversaw the construction of the more-than-a-doctor's-office, not-quite-a-hospital that was Pahrump Medical Center.

"Everybody in the valley thought the hospital board was going to build a freaking hospital," former board member Ed Sharp said.

He thought the same thing when he became one of the first people elected to the board in the mid-1990s.

After millions of dollars in losses at Pahrump Medical Center and two failed attempts to get voters to increase tax revenue for the hospital district, the board on which Sharp and Pat Mankins once served was disbanded by the Nye County Commission at the public's request.

"I'm very hurt and disappointed that they didn't believe in us. I've never felt so worthless, and I had so much to give," Sharp said.

Then there are those who blame the certificate of need process itself, which is designed to protect health care projects in communities deemed too small to withstand competition.

So hated is the certificate of need in Nye County's largest community that Assemblyman Rod Sherer, R-Pahrump, pushed through a bill last year that exempts Pahrump from needing such state approval for its next hospital project, should the present one fall through.

But unlike her predecessor with the State Health Division's Bureau of Health Planning and Statistics, Griffith stopped short of saying the certificate of need has outlived its usefulness.

"We're just following state statutes," Griffith said. "But I guess when you look at Pahrump, it didn't help the situation of getting a hospital built out there quickly."

There's one thing people do seem to agree on: Until a hospital finally opens in Pahrump, elderly retirees will continue to sell their houses and move out of town in search of a higher level of medical care.

One day, Roy Mankins said even his mother might have to join the exodus.

"My mom has been trying to get a hospital out here since 1969," he said. "She fought so long she finally just decided somebody else could do it.

"The problem is nobody did. Nobody goddamned did."