UMC debate shaped by tenure

Tony Cook and Marshall Allen

Wednesday, Feb. 7, 2007 | 7:21 a.m.

The Clark County Commission, in a governmental version of a do-over Tuesday, reaffirmed a controversial University Medical Center contract that it had botched the first time.

Tuesday's meeting saw the commissioners reconsider a cardiology contract awarded Dec. 20 when Commissioner Yvonne Atkinson Gates cast a deciding vote when she should have abstained.

The touchy meeting was characterized as much by the subjects avoided as those addressed, with the commissioners' tenure appearing to shape how they handled the sensitive issue.

The two newest members, Chris Giunchigliani and Susan Brager, who were not involved with the initial contract, spoke boldly about the flaws in the agreement, how it was awarded and the commission's culpability.

Giunchigliani grilled Kathy Silver, UMC's acting chief executive, and sharply criticized past practices, while Brager bluntly suggested that part of the problem was the commission itself.

The veteran commissioners, in contrast, primarily offered platitudes. Commissioners Bruce Woodbury and Chip Maxfield sounded the message that everyone acted in good faith, that the current contractor is doing its job and that "this is totally separate" from a criminal probe of the hospital's former boss. Former Chief Executive Lacy Thomas is under investigation for allegedly giving contracts illegally to his Chicago associates.

Silver, meanwhile, promised reforms to the slapdash process of awarding contracts at the public hospital. Every contract will now require a signature from the district attorney's office and a list of each person providing services. Additionally, hospital administrators will craft tighter contract language and clear performance standards to prevent the kind of problems that led to Tuesday's hearing.

The $5 million-a-year deal with Nevada Heart and Vascular Center stirred controversy because Thomas had passed up another group's proposal to do the job for a million dollars less. Thomas argued that Nevada Heart and Vascular had a better business model and a reputation that could draw more patients to the financially struggling hospital.

The controversy was heightened last week when the Sun revealed that Atkinson Gates cast a deciding vote on the deal despite having a conflict of interest because of her pending bid to build a home for one of Nevada Heart and Vascular's partners, Dr. Raj Chanderraj.

Atkinson Gates says she did not know that Chanderraj was with the physician group, even though he visited her personally to lobby for the contract - a meeting she says she forgot.

After the Sun's stories about her lack of disclosure, Atkinson Gates asked that the contract be reconsidered at Tuesday's commission meeting. This time, she abstained.

Giunchigliani, who suggested that the previous commission had rushed the Nevada Heart and Vascular contract, spent at least 20 minutes Tuesday interrogating Silver, who recommended the commission keep the agreement. Every time she pressed Silver, the acting chief executive admitted weaknesses in the process or promised changes.

For example, after Silver reiterated that Nevada Heart and Vascular's business model was superior, Giunchigliani asked for specifics.

"I don't believe there was a similar model with Heart Center, but I am not sure," Silver conceded.

Silver also said Heart Center, which had held the contract since 2002, was not fulfilling its obligations under the contract.

Giunchigliani shot back that she didn't see much in the contract about obligations, prompting Silver to admit that the performance standards were vague.

"Your point is well taken," Silver said. "I think that is problematic."

Giunchigliani also pointed out that the contract lacked a list of doctors who would be performing the services.

Asked why, Silver said: "I think that's a good question. We haven't always included a list of doctors. We will do that."

The new commissioner also pressed Silver about why the contract prevented the hospital from canceling without cause for four years.

Silver acknowledged that the arrangement was "pretty unusual," but added it was fair because Nevada Heart and Vascular had to recruit doctors to long-term commitments in Nevada.

Still, Silver said after the meeting that when negotiating future contracts, the hospital would push for shorter noncancellation terms.

Brager, the commission's other new member, also raised concerns, arguing that the cardiology contract represented only a small part of UMC's problems. She noted that for at least six months, UMC did not provide monthly financial updates to commissioners.

"It is just not acceptable this board didn't know what was happening," she said. "There is a whole lot more that we need to make sure is working properly."