Health Care :

Aging Boulder City Hospital dares to dream of progress during downturn

Saturday, Oct. 11, 2008 | 2 a.m.

Tom Maher wanders around the 67-bed Boulder City Hospital, some of its tile floors unchanged since 1973.

Hallways are bumpy from rewiring to accommodate high-tech equipment. The five emergency room beds are separated only by thin blue curtains, providing little sense of privacy.

Patients sometimes struggle to navigate walkers in tiny rooms, some of which lack bathrooms.

“We have some great equipment,” says Maher, the hospital’s chief executive. “We just need the space.”

That will be up to the residents of Boulder City.

And, with the economy sinking faster than the water line at Lake Mead, this may be about the worst possible time to ask for help.

An advisory question on November’s ballot will ask Boulder City residents to pay additional property taxes to start refurbishing the 35-year-old hospital, the only one in town. The proposed tax of 15 cents per $100 of assessed property value would cost $105 a year for the owner of a home worth $200,000. (Property owners pay taxes on 35 percent of the assessed value.)

If voters approve the measure, the Legislature would then have to sign off on the deal.

The special tax district would raise $750,000 annually for the hospital, which Maher says needs as much as $10 million in improvements.

The money would be used to help improve the hospital’s bond rating, allowing it to finance improvements, while helping offset about $550,000 in annual loses.

This is a quaint hospital, a place that brings to mind the days of black-bag-toting doctors. Yet it’s facing modern challenges. About 10 percent of the patients who come to the emergency room are uninsured. Handicapped by its size, it struggles in reimbursement negotiations with huge insurance companies. And it is facing the rising costs of employee benefits and liability insurance.

The nonprofit hospital is overseen by a local board of directors. But it’s Maher, 47,a California native with a shaved head and soul patch, looking not unlike Howie Mandel, who has to face an increasingly tough audience.

For the past six months, Maher, who lives in Henderson, has been pitching the tax plan at city forums, library meetings and social clubs, trying to maintain his passion as the economy worsens and his audiences grow less sympathetic.

He’s getting some push-back from residents who claim the hospital doesn’t need the money. And then they attack him personally for not living in town.

Maher is more accustomed to boardroom civility than rough-and-tumble engagements with townspeople.

But this is a pocketbook issue in a town with a disproportionate number of residents on fixed incomes. More than one-third of the 15,000 people living in Boulder City are senior citizens, compared with 22 percent in Clark County.

Another 21 percent of Boulder City residents are ages 55 to 64, many living in homes that have been passed down through generations.

Joe Roche, a resident who runs a Las Vegas recycling company, has become the ring leader for the opposition.

“There’s no indication at all that people in the community are going to vote for a tax on themselves,” Roche says. “I think Tom Maher has a disconnect with the people who he talks to in these venues. There’s been a resounding no in all these meetings.”

Opponents — including some residents who are regular critics of city government — question the hospital’s financial records, saying they should be able to find ways to cut costs or increase revenue.

The increasingly vitriolic opposition is wearing Maher down.

He keeps trying to persuade the public that the hospital is part community service, more like the police department than the grocery store. Not everyone buys it.

Boulder City’s hospital tax district would be run by Clark County commissioners, although the hospital board would oversee day-to-day operations. It would be first hospital tax district in the county, although there are eight formerly private hospitals in the state, mostly in Northern Nevada, that are now partially publicly funded.

Even if residents agree to tax themselves, the hospital still may not see a nickel of it. The state Legislature would have to approve the tax — no sure thing since the T-word is reviled by politicians.

As a backup plan, the hospital wants to put the same question on the 2010 ballot.

If taxpayers don’t approve it then, the hospital will stop performing emergency surgeries and close the intensive care unit, Maher says.

That would be the beginning of the end.