A plan to give oversight of University Medical Center to a separate board could come with a significant cost: a dramatic restriction of public information.
Under a proposal that county commissioners could vote on Wednesday, previously available hospital records could become exempt from the state’s public records law. Contracts with doctors and companies, the names of hospital employees – nearly everything outside the hospital’s annual financial report – could be private.
The same goes for hospital board meetings. Only one meeting a year, “to report on the affairs of the corporation,” could be public. But if any part of that meeting delves into competitive data or a subject that could cause a competitive disadvantage to the hospital, then it could be closed off to the public.
That would be a dramatic shift for the taxpayer-subsidized hospital, and it has some people nervous.
“I don’t like it,” said Commissioner Lawrence Weekly, who is chairman of the hospital’s Board of Trustees. “You’re headed down a slippery slope when you do that.”
Commissioner Steve Sisolak said, “How do you not let the public know how you’re spending their money?”
But advocates say the move will make the hospital more competitive.
UMC provides roughly $250 million in uncompensated care every year and makes enough money to cover all but $60 million to $70 million. The county has been footing the bill for that amount, but most people agree the model isn’t sustainable.
So county commissioners, who are the hospital’s board, are entertaining several options to keep UMC viable, including handing over their responsibilities to a full-time hospital board, like private and public counterparts across the country.
They need permission from the Legislature before making a change. They could make that decision as early as Wednesday’s meeting. The Legislature meets in February.
Advocates for the change include the hospital’s CEO, Brian Brannman, who contends he needs to make important decisions in private so competitors can’t undercut him.
Most of the big hospital decisions today come before commissioners, in public meetings, and contracts are considered public record.
Brannman expects that making the hospital’s actions private will garner intense debate, but he said that many other public hospitals in other cities have made similar moves, and it will help the hospital in the long run.
He said he has seen officials from private hospitals attend meetings. Las Vegas has a higher concentration of for-profit hospitals than any other urban area in the country.
“The goal is, can we make UMC more agile and more competitive in a very challenging environment?” he said last week.
Commissioners would still be in charge of naming people to the board and would have final say over issues relating to incurring debt through the county or changing the hospital’s mission.
Brannman added that even if commissioners ask the Legislature for permission to make hospital functions private, they can still choose not to take that course.
But at least three commissioners feel that the change would be drastic and possibly unnecessary.
“I understand what Brian is saying,” Sisolak said. “I get that. At the same time, these contracts have got to be public.”
He said the situation could create an environment ripe for nepotism and favorable deals.
Weekly said that as long as UMC takes taxpayer money, it should be transparent and open to the public.
Brannman’s arguments don’t support the change, according to Dr. Nick Spirtos, medical director of the Women’s Cancer Center of Nevada and a member of UMC’s Hospital Advisory Board, an oversight group that recently voted against the governance change.
Spirtos said that nobody shows up to their meetings anyway and that he fails to see the benefit of moving meetings behind closed doors.
“Changing the governance doesn’t do anything functional that would be different except taking us away from the open meetings law,” he said.
He also believes the situation is more fundamental.
“We’re spending taxpayer money. We’re accountable. End of discussion.”
Commissioner Chris Giunchigliani, who is against efforts toward secrecy, thinks the argument over UMC’s governance has taken attention away from the real issue: how to fund the hospital in the future.
UMC is a public hospital that provides services that others don’t, such as its level 1 trauma center and burn center. Giunchigliani said it shouldn’t be expected to make a profit.
“That always means we’re going to be losing some dollars, and we have to find ways to raise funds in other ways,” she said.
That is also what Spirtos believes.
“We need a regular funding source that can be counted on to improve the physical plant … so that every year it’s not a scramble to pay bills,” Spirtos said.
Some commissioners want to consider a tax district to pay for the hospital, or try billing the other municipalities. Even though UMC is available to everyone, the county pays the bills.
But that won’t be the subject of discussion on Wednesday. Giunchigliani said she doesn’t support a hospital board meeting behind closed doors.
“I just don’t see the benefit for the public,” Giunchigliani said.
Brannman said the hospital will adapt to any decision the commission makes in the next few weeks.
“We’re going to be the best hospital we can be regardless of how we’re governed,” he said.
Contact reporter Lawrence Mower at email@example.com or 702-383-0440.