Children’s care to be jeopardized by Sunrise contract standoff

By Marshall Allen (contact)

Thursday, Dec. 28, 2006 | 7:02 a.m.

Starting Monday, some of the sickest children covered by Sierra Health Services, the state's largest health care provider, may be forced to leave Nevada for treatment.

The reason: A 17-year contract between Sierra and the national hospital giant HCA Inc. expires at the end of the year, after which Sierra's 600,000 customers will no longer be reimbursed for nonemergency visits to HCA's four local hospitals. HCA is known locally as Sunrise Health, and operates MountainView Hospital, Southern Hills Hospital and Medical Center, Sunrise Children's Hospital and Sunrise Hospital and Medical Center.

Sierra and Sunrise officials blame each other for failing to resolve their contract standoff after months of public posturing. While most patients can turn to other hospitals that have contracts with Sierra, some specialized pediatric services provided by Sunrise are not duplicated in the region.

Thus, the patients most likely to be affected by the conflict will be children.

Sunrise officials said Wednesday that they were negotiating with Sierra to at least handle the special needs of its pediatric heart patients.

Barring that resolution, Peter O'Neill, Sierra's vice president for public and investor relations, says pediatric heart patients will now be sent for treatment to UCLA, UC San Francisco or the Mayo Clinic in Phoenix. He said that if given the choice, the parents of these sick children would likely choose to go to such places instead of staying at Sunrise Children's Hospital.

Not true, according to Sierra clients MiaJoy and Ryan Wilson, whose 20-month-old daughter faces multiple health problems and already has been hospitalized 14 times.

The child, Lily, is missing part of a chromosome. She is fed from a tube, is developmentally delayed and was born without a pulmonary artery, which carries blood between the heart and the lungs.

The suggestion that Lily receive treatment outside the state annoys her parents.

"I don't think it's a solution, I think it's a cop-out," MiaJoy Wilson said. "Send people out of state? Are they going to pay for our airfare, for our place to stay if we don't get into the Ronald McDonald House?"

Sierra did not reimburse all the family's expenses when they took Lily to Stanford, Calif., for surgery, Wilson said.

"It just stinks" that the two profitable companies would make families suffer because they can't come to an agreement, Wilson said.

"Big business runs my daughter's care," she said.

Wilson is critical, but her feelings are mixed because she's also thankful for the care both companies have provided Lily. She said Sierra's PPO plan has been "wonderful," but now she doesn't know what she'll do with her two other children - ages 4 and 6 - if she needs to take Lily out of state for treatment.

Last week she visited Sunrise and noticed new flowers were being planted outside. Sunrise is quibbling with Sierra about money, she said, when it's spending to beautify the campus.

"Who cares about flowers?" Wilson said incredulously. "It's the middle of winter. I was just annoyed by it."

The most recent effort to renew the contract was initiated by Sierra in early December, said O'Neill, when Sierra Chief Executive Anthony Marlon traveled to HCA headquarters in Tennessee for a meeting that ended within 45 minutes.

O'Neill said Sierra is offering HCA a higher reimbursement rate than it pays any other hospital chain in Las Vegas, guaranteed for three years.

There were initial efforts to make an agreement so children could be covered at Sunrise Children's, but those also failed.

HCA officials said the contract with Sierra needs to be radically restructured, which the insurer is unwilling to do, and that while the hospital company is profitable overall, it has been losing money in Las Vegas because of the Sierra contract.

Las Vegas insurance broker John Grady said it's too early to tell the effects of the contract termination. Grady works with about 100 companies who contract with Sierra for health insurance on behalf of their employees, and after he informed them of the looming change in the Sunrise contract, none wanted to change insurance providers. That could change once employers see how the contract's expiration affects their employees, he said. Grady speculated that the companies would eventually resolve their disagreements and renew their contract.