Until a few years ago, it seemed nothing could be done to stop the bleeding from University Medical Center's balance sheets. The valley's only public hospital, propped up by Clark County taxpayers, lost more than $42 million in 2001 and 2002 alone.

Slowly but surely, the hospital took steps to stem the losses, and by 2004, UMC was only $6.2 million in the red. Determined to improve the hospital's cash flow further, UMC Chief Executive Officer Lacy Thomas in 2005 persuaded the Clark County Commission to authorize contracting out operations such as patient admitting, billing and debt collection.

This was a good idea. The execution, however, was lacking.

Since ACS Consulting took over key financial duties at UMC, a Clark County audit found the firm, in its first 12 months on the job, fell $6 million short of what the hospital had collected the year before. Among other findings:

-- UMC officials didn't properly assess the costs and benefits of the contract before lobbying for its approval.

-- UMC did not build a termination clause into its initial contract with ACS.

-- In authorizing the sale of supposedly delinquent accounts to a third-party collection agency, UMC in fact sold 3,900 accounts that were being paid by patients. The deal netted a $1.2 million commission for ACS, some $800,000 for the third-party collector -- and only $10,000 for UMC.

-- Although ACS was supposedly working on a pay-for-performance contract, the firm collected about $1.3 million in fees as overall hospital revenues fell through the floor.

"It's a bad contract," Clark County Manager Virginia Valentine said. "The concept was good. ... The devil was in the details."

Mr. Thomas and Ms. Valentine promise that they'll try to make sure taxpayers aren't looted again. Good.

But local residents can be excused for their skepticism in the face of so many recent local government boondoggles, such as the delay-plagued Regional Justice Center, McCarran International Airport's land giveaways, and the city of Las Vegas' attempts to lift a deed restriction and accept a fraction of its value in return.

Of course taxpayers don't want this to happen again. What they really want, however, is to finally see the parties responsible for a multimillion-dollar mess held accountable.