Those who live in Las Vegas rarely think of their town as a hub of populist activity. It seems more an entrepreneurial oasis where the intrepid can dilate a modest grubstake into a restaurant, car wash, or string of check-cashing stores without fear of taxation or over-regulation. Indeed, the city takes great pride in its pro-business stance. Nevada is a “right-to-work” state. It has no franchise, inventory, or unitary taxes. No state, individual, or corporate income taxes. Its employers regularly classify their employees as independent contractors to thwart such passé notions as OSHA requirements and workman’s comp, and the business community holds an uncanny sway over the electoral process. Fully 89.5% of the candidates supported by the Las Vegas Chamber of Commerce get elected each year on average. That figure was 92% this year, an admirable record for any business lobbying group.
Yet despite this devotion to laissez faire economics―Nevada remained solidly red in the last election―deference to business interests has proved a mixed blessing for the community and a catalyst for bitter labor disputes throughout the years. For an example, one look no farther than the showdown this week between nurses and management at two Las Vegas-area hospitals.
Valley Health and Desert Springs are both "for-profit" hospitals run by Universal Health Services (UHS), one of the largest for-profit hospital chains in the United States [1]. The company controls more than a third of all hospital beds in Southern Nevada, [2] including Spring Valley and Summerlin hospitals. No southern Nevada hospital system has earned more profits in the last three years than UHS. [3] In fact, UHS hospitals have earned more profits in the last five years than all the other Southern Nevada hospitals combined [4], a whopping $71.1 million.
So, what’s wrong with making a profit? Why shouldn’t municipalities turn to corporate hospitals to ameliorate budget crises endemic at public facilities?
No reason at all, if the quality of care and cost of services remain constant. But the quality of care and cost of services at Valley Health and Desert Springs hospitals―and, indeed, at for-profits across the country―have been far from constant since their inception and have come under increased scrutiny in the last few years. For example, statistics show that Desert Springs Hospital jacks up their prices an incredible 361% above their own costs [5]. Prices at Valley Health are even more unconscionable― marked up an astounding 365%. [5] Much of those profits are sent back to UHS headquarters in King of Prussia, Pennsylvania, creating a situation where profits are squeezed from the sick in Las Vegas but do little to help their economy.
But what about patient care? Surely that extra cash translates into the best and most technologically advanced care for their patients, right?
Wrong again. 9.8% of the heart attack victims at Desert Springs Hospital die right there in the facility. [6] That’s a disgrace in a town as small as Las Vegas. Yet, the reasons seem even more disgraceful. Treatments known to improve the outcome for heart attack victims at Desert Springs Hospital are provided only 88% of the time.[7] Likewise, treatments known to improve the outcomes for heart failure victims are provided only 69% of the time. [7] While treatments known to improve the outcome for those suffering with pneumonia are provided only 71% of the time. [7] A full 83% of the hospitals across the country rank better in delivering quality patient care than Desert Springs Hospital. Little wonder nurses give the facility a “D” rating.
Statistics for Valley Health Hospital are even more appalling. 87% of the hospitals in the country rank better than Valley Health, [5] the third worst in Las Vegas. [8] 14.3% of heart attack victims at Valley die while there [9] and only 84% receive treatments known to improve their outcome. [8] Pneumonia victims and those suffering heart failure are especially vulnerable with only 67% of pneumonia victims receiving treatments known to improve their outcomes [9] and 66% of heart failure victims. [9] I recently visited a friend with a heart condition in Valley Hospital and the facility, with the exception of the nurses who tried their best under the circumstances, was a zoo. At ten o’clock one evening, an elderly woman was wheeled into my friend’s semi-private room screaming at the top of her lungs, “Jesus! Jesus! Jesus! Jesus!” After being strapped to the bed, she amended her invocation to include a strident request: “Jesus, help me! Jesus, help me! Jesus, help me! Jesus, help me!” I expected Olivia deHavilland to appear in the corner, clutching a doll with a glazed expression on her face. [10] The following afternoon my friend did what most Las Vegans do when confronted with illness―she fled to California. Not surprisingly, nurses give Valley Hospital an “F.”
Even so, the nurses at SEIU Local 1107 weren’t locked out today for their stand on the company’s profiteering or hesitation to provide treatment to their patients. They were locked out because they refused to accept a contract offered by UHS in November, a contract that ignored the company’s cost-cutting procedures (measures that have nurse-patient ratios at dangerously high levels) and refused to allow their union full access to the hospital.
I spoke with the lead organizer for the striking nurses at Valley Hospital, Jane McCauley, a fiery, bright-eyed blonde with a fierce determination. “If you’ve heard David Basoni, you understand why we’re here,” she smiled, referring to the Valley Hospital official who just moments before had been making his case on National Public Radio. “They set up fences around the hospital last month, turning it into a prison complex. They brought in scabs from U.S. Nurse Corp at five this morning. And they locked us out of our jobs when we arrived for work. They refuse to agree to what other hospitals in the valley have already agreed to.”
As might be imagined, David Basoni had a different take. “They want us to fire any nurse who won’t join the union and that’s unacceptable. This is a right-to-work state. We have a responsibility to the community!” But that sense of responsibility didn’t compel him to accept a thirty day “cooling off” period brokered by Mayor Oscar Goodman, Commissioner Rory Reid (the Majority Leader’s son) and others to prevent an interruption of services to the community. “Thirty days is an insignificant period of time,” Basoni said. He went on to excuse the hospitals’ union-busting activities by parroting company doctrine. “[UHS] works best when there isn’t a third party involved.”
But according to Jane McCauley: “There is no third party involved. The nurses are their union.”
Another nurse I spoke with on the picket line, Shelly Manzello―a neo-natal nurse with 28 years at the hospital―put the issues in more human terms. “The hospital wants the right to ‘float’ us wherever they want, but their cost-cutting measures aren’t safe. I’ve cared for babies in I.C.U. for years. I don’t know anything else. Yet, the company says they have the ‘right’ to put me wherever they want.”
Of course, cost-cutting issues, issues of quality care, and cries of union-busting aren’t unique to for-profit hospitals in Las Vegas. In San Diego last January, unfair labor practices were leveled against Southwest Healthcare System, a subsidiary of UHS, after a “nine month, intensive, union-busting campaign by management" that allegedly included withholding pay increases to foment distrust between nurses and their union. Californians are so concerned about quality care, they instituted a public process, including review by the Attorney General of all hospitals sold to for-profit corporations.
Nor are the calls for an eradication of for-profit hospitals unique. In a 2003 article in the prestigious Journal of the American Medical Association, 8,000 physicians―including two Surgeons General―endorsed a proposal for a “single payer” national health plan to eliminate for-profit hospitals and the insurance corporations who together drive costs through the roof to maximize profits. The proposal, penned by members of Physicians for a National Health Program, suggested that the $1.6 trillion spent each year by Americans would be more than enough to offset the cost of their proposal. Yet, despite their suggestion, and the fact that more than half the bankruptcies filed in the U.S. every year are directly tied to medical costs, national health care―or at least the eradication of for-profit hospitals―remains political suicide. The reason, in part, comes from the fact that for-profit hospitals donate heavily to political campaigns. The Center for Responsive Politics reports that federal campaign contributions from health insurance corporations and HMO’s to Democrats increased by 164% between 1992 and 2002. Those donations increased by a staggering 642% for Republicans. Over the same period, contributions from pharmaceutical manufacturers increased by 79% for Democrats and 594% for Republicans. Indeed, more than half of the fundraisers for George Bush’s campaign who raised between $100,000-$200,000 were, or continue to be, employed by the health care industry. And in the years since, it's been business as usual.
No one today can possibly dispute the fact that our health care system is out of control. And no one knows better than the nurses out there on the picket lines just how far our physical and financial health has been jeopardized by the privatization of these hospitals. But until we're ready to set aside our political ideals, admit that our health care crisis has become a robbery-in-progress, and stop prolonging the hackneyed argument that privatization holds the key to some consumer-driven Utopia, we may never get control of the issue. If not, it may be left to our harried nurses to carry the flag into battle.
Andrea Hackett is an freelance journalist, founder of the Las Vegas Dancers Alliance in Nevada, and editor of the Populist Review. She may be contacted at andreahackett@cox.net
- “Largest For-Profit Healthcare Systems,” Modern Healthcare, June 12, 2006
Nevada Hospital Quarterly Reports, Fiscal Year 2005 Summary Utilization Report, Table 1 “All Beds,” State of Nevada Department of Health and Human Services Division of Healthcare Financing and Policy, June 27, 2006
Profit figures drawn from the “Net Operating Revenue” column in the Nevada Hospital Quarterly Reports.. From June 30, 2003 – June 30, 2005
Nevada Hospital Quarterly Reports, Fiscal Years 2001-2005 Summary Financial Reports, "Statement of Revenues and Expenses - Clark County Hospitals Financial Summary” June 27, 2006
- The formula for calculating price markup is (total gross billed charges–total operating expenses) / total operating expenses x 100. Data can be found in the Nevada Hospital Quarterly Reports, Fiscal Year 2005 Summary Financial Report 1, Table 1 “Statement of Revenues and Expenses” and Table 3 “Statement of Revenues and Expenses,” State of Nevada Department of Health and Human Services Division of Healthcare Financing and Policy, http://www.unlv.edu/Research_Centers/chia/NHQR/Blue Book/Financial1 - Done/Financial1 - F05.xls, retrieved June 27, 2006.
- Joint Commission on Accreditation of Health Organizations (JCAHO) Quality Reports for all Southern Nevada Hospitals, issued June 23, 2006for all hospitals except UMC and North Vistawhich were issued July 8, 2006 and July 19, 2006 respectively
- SEIU Nevada[Failing to Make the Grade” September 12, 2006]
- National Rankings for Hospitals Per State: Nevada,” Health Insight, www.healthinsight.org/hospitals/rankings/rankings.html, retrieved June 27, 2006. Health Insight is a private, non-profit Medicare Quality Improvement Organization committed to improving the health care in Nevada and Utah. It utilized data reported to the Centers for Medicare and Medicaid Services (CMS) for hospitals with 15+ observations in 8 or more measures during 4th quarter 2004 through 3rd quarter 2005
- Joint Commission on Accreditation of Health Organizations (JCAHO) Quality Reports for all Southern Nevada Hospitals, issued June 23, 2006for all hospitals except UMC and North Vistawhich were issued July 8, 2006 and July 19, 2006 respectively
- For those too young to remember, Olivia deHavilland starred in the movie, “The Snake Pit” about the atrocious conditions in an insane asylum
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