Hale to the chief at UMC

Art Nadler

Saturday, Feb. 21, 1998 | 3:39 a.m.

It was 1931 when a 20-bed hospital opened on West Charleston Boulevard. Staffed by one doctor and a nurse, Clark County Indigent Hospital soon became a lifeline for Southern Nevada's rapidly growing population.

Traditionally recognized as a non-paying entity, Clark County was -- and still is -- subsidizing the hospital's financial losses.

The little hospital has since grown to encompass two blocks between Tonopah Street and Shadow Lane. Its name changed to Clark County General Hospital in 1940 and then Southern Nevada Memorial Hospital in the 1950s. When it became associated with the University of Nevada School of Medicine in 1986, it henceforth became known as University Medical Center.

Until recently, even with 544 beds, more than 900 physicians, and hundreds of nurses and other medical personnel on staff, the hospital operated at a loss.

Throughout the 1980s, the county contributed yearly subsidies of up to $5 million.

Frustrated, the board fired its management company, Hospital Corporation of America, in 1988 and hired former Sunrise Hospital and Medical Center administrator David Brandsness to try to make the hospital profitable.

Brandsness revamped the hospital's billing office, and in February 1988 collected more than $14,000. In March 1988 it was $15,000. That same year, the hospital submitted an application to the state Health Division to open a Level II Trauma Center.

In 1993, Clark County commissioners -- who double as the Board of Hospital Trustees -- allocated $12 million in emergency funding to meet payroll and attempt to retire $5 million in credit owed. The hospital's accounts receivable hovered around $24 million.

The hospital, in an effort to compete with for-profit hospitals, opened its Quick Care Centers in the late '80s to make primary care more convenient and faster.

However, while still operating in the red, Brandsness left UMC in July 1993 following terse disagreements with some commissioners.

The board hired two hospital administrators on a temporary basis to try to turn UMC around. They brought in Charles Jervis, chief executive officer at the San Bernardino County Medical Cener, and Bill Hale, his chief operating officer, in 1993.

When Jervis was offered a more lucrative career opportunity elsewhere, Hale expressed his desire to become CEO. The County Commission, in a 6-1 vote, approved him for a five-year contract in February 1994.

When Hale ascended to the helm at UMC, the hospital was taking 180 days to pay its bills. Commissioners immediately pumped in $12 million, trying to keep the hospital afloat.

"I felt we had to market a service superior to all the other hospitals," Hale, 47, remembers of his early strategy. "We were a public hospital, but we also had the ability and resources that, given the right direction, could market ourselves like the for-profit hospitals in town."

To achieve this objective, Hale thought he first must make UMC more appealing to the public. Most people saw the hospital as dark, dingy, dirty and pandering only to indigents.

Hale proposed a five-year facility plan that included renovating all the floors in the hospital, creating some private rooms and changing the furniture. He pitched the commissioners on the $20 million project and it was immediately approved.

"You can't say your facility is top notch, when you don't have the physical environment that people expect and deserve to be in," he told the commission.

Hale soon thereafter noticed that only specialists were using UMC and that primary care physicians were shying away. He talked with them about their concerns and discovered that they didn't like the image of as many as 50 hospital personnel daily standing outside smoking cigarettes. They also didn't like the way the telephone system worked, and they complained the rooms weren't very clean.

"I talked to the physicians and made it clear to them to talk to me if they had a problem," Hale said of his hands-on style.

He also began meeting with physicians and housekeeping personnel on a regular basis.

"I feel I have better communication now with the hospital administration than before," said Dr. Dale Carrison, medical director of the Medical Department. "Bill Hale is the kind of guy who listens."

Carrison said he had problems with physician consultants refusing to treat patients if they couldn't pay. He felt that because the doctors were being paid by the hospital to consult, they shouldn't be refusing to see anyone. Hale agreed and got the consultants to change their subjective policies.

Also, Carrison said he constantly had arguments with the prior administration when he wanted to go on hospital alert. This occurs with all hospitals at busy times of the year when no beds are available. Ambulance services are advised to transport en route patients to other hospitals.

A hospital loses money when it diverts patients, Carrison said.

Another problem had been with the hospital's trauma unit, which was in a freestanding building, a good distance from the emergency room. Carrison said he told Hale about the dilemma, and that Hale immediately initiated plans to build a connecting hallway.

"I know as a department head, I can go to Bill Hale and get some answers," Carrison said. "The hospital is cleaner and more attractive. What I think he has done is turn the image around. We are not just a county hospital; we are a university medical center."

Former Commissioner Don Schlesinger said he liked the way Hale kept the board informed of conditions at UMC. He said the previous administration "did a lot of wheeling and dealing."

"The trauma unit was built away from the hospital," Schlesinger said. "It was a deal that was not favorable. There was some questions about the lease. We wanted to bring an administration in to deal straight with the board."

Schlesinger said those who went to UMC got quality care, but the image and guidance from the top was stymieing the hospital's financial success. Hale, he felt, began turning these problems around as soon as he came on board.

Former Clark County Commission Chairman Paul Christensen said he had no problem with the Brandsness administration and praised the former CEO with starting Quick Cares. But he also finds Hale to be an admirable administrator.

Christensen said negotiating a contract with the Service Employees International Union, increasing the number of Quick Cares, opening a pediatric emergency room -- the only one in Las Vegas, renovating floors and making attempts to solve physicians problems proved to be a winning formula.

"Other hospitals that handle just indigent patients are second rate," Christensen said. "We gained a lot of patients because we had a first-class pediatrics unit. We wanted a single level of care -- not just for indigents, but for everyone."

Christensen said he was extremely pleased when last month University Medical Center was chosen as one of the top 100 hospitals in the nation by HCIA Inc. The hospital competed against 300 in its category of teaching facilities with 250 beds or more.

Hospitals were judged in nine areas of clinical quality practices, operations and financial management.

"I looked at that, and my chest swelled up a little bit because I was part of it," Christensen said. "We always knew we had a good hospital."

Michael Levine, director of account services at the advertising firm Dunn Reber Glenn Marz, said he and Hale worked on television commercials depicting a cleaner hospital inside and staffed by friendly doctors and nurses.

"All the dialogue was designed to show that UMC was not a dark and dingy place but had a professional atmosphere," Levine said. "Then we ran 10- and 15-second spots just showing Quick Care, to drive home name awareness."

Adair Dammann, a representative of the SEIU, thinks UMC is one of the best public hospitals in the nation. She said the staffing ratios to patients are strong, which has worked to improve the hospital's image.

"Bill Hale is viewed by employees as being interested in their views," diagnostic radiologist Dr. Carl Recine said. "He keeps a low profile but allows easy access to himself. We talk to him about problems, how to make things better, and he's open to suggestions."

Cancer specialist Dr. John Ellerton, who's been in Las Vegas since 1979 and is vice chief of staff at UMC, said practicing medicine has always been first rate at the hospital, but dealing with management had been a problem before Hale.

"He has a great deal of knowledge of how a hospital should operate," Ellerton said. "He's been able to maximize the paying side. I think the taxpayers should appreciate that he tries to minimize the county subsidy."

Currently, Hale said, the county financial support of UMC has fallen to $7 million per year. When he became CEO, it was $12 million and rose to $17 million his second year as administrator.

Accounts payable have since dropped from 180 days to in the 70s, according to Hale. And for the first time in fiscal year 1995-96, UMC made a profit of $500,000. In fiscal year 1996-97, it made $2 million.

"It's been a joint effort between strong leadership, Mr. Hale, the doctors and nurses," said Commissioner Erin Kenny, chairwoman of the UMC Board of Hospital Trustees. "Under all the circumstances of a growing community and competition from for-profit hospitals, UMC is doing very well."

Kenny said Clark County will always have to subsidize the hospital, but she pointed out that taxpayers can expect funding to go down as more Quick Cares are built and some bonding is offered.

"We always realized in this environment in Las Vegas that we had to be competitive in order to exist," Hale said of his decision to serve more than indigents. "You have these major corporations with corporate resources. We are like an island here. The only thing that for-profit hospitals have that we don't are corporate resources."

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