Las Vegas Sun

March 28, 2024

UMC pick: What kind of success?

University Medical Center is on pace to lose more than $50 million this fiscal year, a grand jury is considering whether to indict its former Chief executive and two of its facilities managers face theft charges.

To perhaps understate the obvious, that suggests that Clark County commissioners face a big decision as they consider three finalists to replace the hospital’s disgraced former chief executive, Lacy Thomas, who was fired a year ago.

The central question: Who can best stem the hospital’s massive financial losses and restore public trust?

Commissioners have to choose from among three vastly different candidates.

There’s the homegrown insider, interim Chief executive Kathy Silver. She knows the hospital and its challenges well. Most commissioners give her the inside track, saying she’s done well in a tough situation. But she also worked under Thomas, and some say that’s a problem.

There’s the career military man, Brian Brannman. He retired from the Navy last year after 33 years of service, most recently as a rear admiral and commander of the Naval Medical Center in San Diego. A self-described “battering ram” for Washington, he talks about “servant leadership” and says he knows how to get things done.

And then there’s the hospital turnaround specialist, William Foley. He took a chain of hospitals in Illinois and turned an operating loss of $28.4 million into a $24.5 million profit — nearly a $53 million improvement — in two years. Now a high-priced consultant doing the same at a public hospital in California, he wants a shot at UMC.

Whoever gets the job will have a tall order to fill. UMC has a long history of bleeding money and, more recently, of suspected corruption. Commissioners want a leader who can bring integrity, transparency, stability and fiscal responsibility.

“They have to come out with some tangible objectives for how we continue to run this hospital without overrunning costs constantly,” Commissioner Chip Maxfield said.

KATHY SILVER, INTERIM Chief executive OF UMC

Silver has worked at UMC off and on for 10 years as an associate administrator and most recently as interim chief executive.

She took the reins in January last year, when Thomas was fired for racking up a $34 million annual loss and misleading commissioners about it.

She saw the hospital through several minor reforms in her first six months. The district attorney’s office now signs off on contracts, and those contracts are awarded through a competitive process. Commissioners also dropped several contractors hired by Thomas and made the county’s chief financial officer an administrator at the hospital to ensure financial transparency.

Despite the changes, losses mounted to $56 million by the end of the past fiscal year.

In the first half of this fiscal year, the financial condition has improved slightly. The hospital is on pace to lose $51.6 million, less than last year but still more than budgeted.

Most commissioners say they’ve been impressed by Silver’s work.

“I think she’s done pretty well under difficult circumstances,” Commissioner Bruce Woodbury said.

Commission Chairman Rory Reid said: “I know Kathy and I have a high opinion of her ... I have a lot of respect for what she’s done.”

But not everyone thinks it’s a good idea to go with an insider.

“I believe we should be getting someone from the outside,” said Commissioner Chris Giunchigliani, who has said Silver was part of the problem under Thomas.

Silver served a boss who misinformed commissioners about the hospital’s financial condition and who, according to Metro Police, may have awarded contracts to friends in exchange for kickbacks.

Silver said she saw problems with Thomas’ management, specifically skyrocketing costs, late payment of bills and the contrasting picture he painted for commissioners. But she never spoke out about the problems.

Silver realizes she could be criticized for keeping quiet, but said “people got fired” for speaking out.

“I wasn’t of a mind that I wanted to get fired,” she said.

Plus, others had complained to county overseers, she said.

Silver said the most important thing to do now is ensure UMC is totally transparent.

“If people realize that our life is an open book they’re less likely to try and pull some of these shenanigans or to be able to get away with it,” she said. “The message has to come from the top that this type of behavior is not going to be tolerated.”

Silver said she has several ideas to bring more paying patients to the hospital, but she declined to state them for this story to maintain her advantage over competitors.

“We’ve started the hospital on a good track here and I’d like to see us finish,” Silver said. “I know the hospital, the community and I know the job and the challenges that exist.”

BRIAN BRANNMAN, FORMER REAR ADMIRAL AND COMMANDER OF THE NAVAL MEDICAL CENTER IN SAN DIEGO

Brannman, 51, has overseen Navy hospitals from Japan to Haiti during his 33-year career.

Although he’s never managed a county hospital in crisis, he has dealt with crises of a different kind at the Pentagon, where he did a stint as a director of medical plans and programs at Navy headquarters. He helped coordinate health care response after the bombing of the USS Cole in Yemen in 2000 and after the 9/11 terrorist attack on the Pentagon in 2001.

Most recently, he commanded the Naval Medical Center in San Diego, the nation’s largest military hospital. During his time there, he founded Navy Medicine West, integrating oversight of 10 hospitals from the West Coast to Asia. Having retired in June as a rear admiral, he would begin his post-military career at UMC.

In an interview last week, Brannman said he is an advocate of servant leadership, the philosophy that leaders are stewards of their organization’s resources. He sees UMC and its mission to treat all residents, regardless of ability to pay, as a good fit.

“It’s all about service,” he said.

He knows how to navigate bureaucracy and has a record of getting things done, he said. He even referred to himself as “a battering ram for people back in Washington.”

In San Diego, for example, he helped get unanticipated congressional funding to replace the hospital’s ventilation ducts after mold was found, said Capt. Tom Chohany, who was Brannman’s director for administration.

“He also worked in D.C. himself and was very familiar with the political arena there,” Chohany said.

Brannman said his approach to most problems is the same: Set a goal and empower people to reach it. He did that in spearheading the construction of hospitals in Guam and Okinawa, Japan. He also established a comprehensive combat casualty care center in San Diego, streamlining what had been a disjointed approach to treating and rehabilitating wounded soldiers.

Chohany said Brannman’s style earned him respect among his staff.

“I found it very refreshing that he gave clear expectations to work with and trusted me with those issues,” Chohany said.

WILLIAM FOLEY, Chief executive OF NATIVIDAD MEDICAL CENTER IN SALINAS, CALIF.

In addition to his success in Illinois, William Foley has been part of a consulting team that’s turned around Natividad Medical Center in Salinas, Calif. Foley is serving as the public hospital’s interim Chief executive.

The company, Huron Consulting Services, contracted with the hospital in 2006 and realized a $20 million financial improvement from fiscal 2006 to fiscal 2007. Operating losses were reduced from $24 million to $4 million, according to Foley’s resume.

He did not return calls for comment.

Lew Bauman, county administrative officer for Monterey County, served alongside Foley under the board of supervisors. He said county policy prohibits him from speaking directly about Foley when he is seeking a new job, but spoke of Huron’s contribution to the hospital.

Like UMC, Natividad is a public hospital beset with financial challenges. It doesn’t have the same flexibility as a private hospital and is saddled with the burden of providing care to the indigent and the uninsured.

Huron dramatically improved business operations, and Foley was an important part of the team, Bauman said.

The hospital got aggressive with collections and took a hard look at business contracts and operations to bring in more revenue and become more efficient, Bauman said. Now it’s revamping the purchasing, information technology and medical side of the business, he said.

Foley is soft-spoken and leads with a style that’s collaborative and affirming to employees, said Lena Valdez, director of the San Benito and Monterey County branch of the Service Employees International Union Local 521.

“Everyone seems to like him,” Valdez said. “He has a good way of dealing with the employees and keeping them informed of things going on in the hospital.”

Foley took over from a fellow consultant who had alienated the staff with his abrasive style, Valdez said.

“He had a lot of challenges,” she said. “Not just in the things in the hospital, but trying to build that relationship and trust with the union and the members.”

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