03/31/2026
The election for the hospital district is drawing blessedly near. Election Day is April 7 and early voting has been available for several weeks. Almost everyone is sick to death of the topic, me included, and this message is not for those who have firmly decided how they will vote or have already voted. But for those who have not decided if they will vote or how they will choose, I offer up some observations about the arguments and positions I have seen over the past few months.
One of the most frustrating aspects of this question is the uncertainty associated with it. Will the hospital fail if the measure doesn’t pass? Would the city be willing to part with the hospital property? What kind of arrangement would be negotiated between the city council, the new hospital board and the old hospital board? How would the ownership structure look? Whose advice would be taken? When would the sales tax end and the property tax be collected? How much of the allowed $1.00 per hundred dollar assessment would be levied? What will happen to the current building in all its various stages of aging? It’s hard to know what to support and how to decide with this much that is unknown. Welcome to my world and how I have to think all the time. It’s kind of like making recommendations for testing and treatment for medical conditions. What’s the list of likely versus rare but possible reasons for the symptoms, how best to order tests to find the problem and not spend unnecessary money, what treatment will be best effective, tolerated and affordable as well as completed by the patient and how much should they worry about it if they don’t? I suppose the reason why the ballot uncertainties don’t get to me is because this is a normal amount of unknown for me. However, I understand that this feels entirely wrong for people who experience more certainty in their lives and work. There are some known and very likely to be true statements that can be made and they might help someone make a decision in this uncertain situation.
The city of Nevada, specifically the city council, has made a number of past statements suggesting they desire nothing more than to be out of the hospital business. Nevada Regional Medical Center is a burden that affects the city’s ability to borrow money and operate. They worry about the liability if the hospital should fail. The city council is an elected body and three of its seats are on the same ballot as the Vernon County Hospital District measure. That means the majority of the future voting members of that body have not been elected. The current hospital board members have determined that separation from the city is the best choice for NRMC and are in complete support of this measure. The new hospital board members have not been elected and I doubt very many people have even indicated a willingness to run for the seats yet. I will be quite surprised if any current NRMC board members run for the hospital district board. This election has been a long and difficult process and volunteer community positions take enough from us without controversy and accusations of greed. The exchange of ownership will affect the real estate including the main campus, S. Ash clinics and parking lots across the street from the main campus, Nevada Medical Clinic, Now Care Clinic and Rich Hill Clinic buildings and the bonds and debts associated with them. It will also affect the organization known as “Nevada City Hospital d.b.a. Nevada Regional Medical Center.” That means furnishings, equipment, lease agreements and contracts with employees as well as bank accounts, debts to vendors and accounts receivable from a vast number of individuals, insurance companies and the Medicare and Medicaid governmental agencies. It is materially impossible to fully determine how the transfer will go until the parties involved are all present and can make the decisions. What we have to go on is predictions from people who work in this realm, from consultants, administrators and attorneys. There is no doubt that expert advice would be required to work through this process. It would take time. How much time probably depends more on the government agencies than anything else. They tend to move at the speed of continental drift when there isn’t a government shutdown and there have been several of those recently. If it were up to me the hospital district would assume ownership of all assets, debts, contracts and lease agreements from the city of Nevada and would hold title to the property while bearing responsibility for the debt. I don’t know how straightforward that seemingly simple solution is but I have to assume that most people in charge would strive for something of this nature. They would probably need to refinance the bond loan as a new borrower. This might be the opportunity to sunset the sales tax as it is tied directly to the bond. It could also get rid of BAM and the covenants associated with the bond. Of course the challenge would be to find a new lender. Here I’ve gotten back into speculation and there has been plenty of that regarding this question.
Much of the rhetoric on social media of late has focused on Jason McCormick, interim CEO of Nevada Regional Medical Center, who was brought to NRMC two years ago at the insistence of BAM and recommendation of the Stroudwater Group as chief restructuring officer. Mr. McCormick has worked with the current board and legal counsel to turn the organization around and secure its future. Part of that effort has led to the recommendation for the hospital district governance and associated property tax. There has been intense scrutiny of Mr. McCormick’s income, residence, financial interest in the organization and what appears to be a certainty that he has recommended this measure for his own personal financial gain. In an interesting irony, other critics in the community have expressed the opinion that no local person possesses the knowledge to lead the organization and that an expert should be brought in from elsewhere to do so. As it happens, Mr. McCormick is the outside expert that has indeed come in and brought about remarkable success in a short time. Those of us who worked at NRMC in 2023 and 2024 were seeing evidence that the financial ship was sinking. There were austerity measures put in place that caused a large number of employees to leave. Those who stayed were beginning to believe we would all need new jobs within the next year. It’s my understanding that we came within days of closing at least three times. Mr. McCormick brought some rather surprising suggestions. He was met with a lot of skepticism. But here we are, with the best 6 months or more of financial performance that we have seen in a number of years. He has objectively already succeeded in the job he came here to do. He can add this organization to the portfolio of dozens of rural hospitals he has successfully turned around, even if he leaves this week. I understand that his arrangement with the board is month-to-month, there is no long-term commitment. He doesn’t live in Nevada, he stays where he works until it is time for the next person to take over and then he goes to the next hospital in crisis. He won’t make more money if this measure passes. He probably won’t even be in Missouri by the time the first tax bill arrives in the mail. A hard cold fact here is that it won’t matter one bit to him on a personal financial level if this ballot measure passes or not and it really won’t matter to him if the hospital continues to operate or eventually does fail. He has absolutely turned it around from the near failure he found it in and has proved his approach works. I think he likes our organization and wishes it well but this vote is entirely not about him. I’m sure there are those who have been upset at some of their interactions with him or what they perceive as disingenuous answers. Mr. McCormick has no incentive to deceive anyone about anything as it relates to this measure. He is attempting to answer questions phrased in a variety of ways about an almost unlimited number of possible scenarios by a group of people who have become focused on the effects of an ad hominem attack, which is a debate tactic designed to discredit the idea by discrediting the person who defends the idea. Whatever NRMC is paying to Mr. McCormick and his advisory firm, it is much less than Quorum Health and their onsite CEO received from NRMC for a number of years before they were dismissed by the Nevada city council and replaced by Freeman’s administrative team during a very controversial season in NRMC’s history back in 2017. Competent hospital administrators are highly paid individuals. There are reference materials available from groups like the Missouri Hospital Association that give guidance about typical ranges. When Mr. McCormick has gone on to the next hospital in crisis and is replaced by a full time CEO the reimbursement for that position may not be any less than it is now. And there is no doubt that the administrators of the big hospital organizations in the cities are paid far more.
There are those who have expressed frustration that this ballot measure is being sold as a binary choice between voting for the measure or having NRMC close. It is not so simple as that. As I mentioned earlier, NRMC came perilously close to closing about two years ago. Those of us who were working there at the time are still holding our breath about it. We have indeed had excellent financial performance for more than 6 months in a row. This had not been seen for years before. But the vagaries of healthcare in the United States do not leave us with assurances about how the next 6 months or 5 years or anything else will be. There is no reason to assume that the doors will close on April 8 if the measure fails on April 7. But we are under a number of different threats over which we have little or no control. Much of the power and heat in all but the newest section of the building are controlled by equipment that was not quite state of the art during World War II. It is a credit to our maintenance department that we continue to have mostly normal use of that portion of the main campus. It cannot be easily replaced or upgraded as significant changes in the structure will lead to concerns about environmental agents common in that era of architecture. Fixing it will be a Big Deal when it goes down. Two years ago UnitedHealth suffered a cyberattack and got months behind on claims. Which meant organizations like NRMC that barely exist paycheck to paycheck were suddenly without big portions of expected income for an extended period. That was a time of particular risk for the organization. It could happen again at any time. While having the hospital district and available property tax in place would not prevent those problems from occurring, it is not an exaggeration to suggest that those measures could make the difference between NRMC surviving and failing. Yes, there was a $5 million employee retention credit that was realized due to efforts of numerous people. It has made paying back BAM for a loan that kept us going two years ago possible. The remainder is in reserves, giving us a few days’ cash on hand. A payroll of 400 employees, their health insurance and the utility bills alone make each day’s operation very costly for the organization. If we ever do close, it will likely occur because the organization couldn’t cover the payroll.
There are binary choices involved in this election. To state the obvious, there always are. To vote or not vote. To vote yes or no for this measure. These choices extend far beyond the ballot measure—to choose to use NRMC for available healthcare services or to bypass it on the way out of town. To take complaints to the quality department at NRMC for potential resolution or to take them to a local social media group for the satisfaction of airing grievances. Many people have their own stories of ways they have been disappointed by this hospital. And that’s too bad. None of us bring our best selves to work every day and I’m sorry to say that some of those stories involve me. I have close family members who have had experiences in a number of different hospitals and found some of the most frustrating ones elsewhere. A big tertiary care center with multiple specialists is where some of the most dismissive behavior by staff members occurred for that person. And yet we still use that hospital because it meets our needs and most interactions there are positive. But when possible we always choose NRMC because it meets our needs too and most of our experiences have been good ones. One of Jason McCormick’s planks in his plan for the NRMC turnaround was forgiveness, in that case the request that employees forgive the organization for letting them down. I questioned this and recommended that instead we ask for the capacity to forgive, the willingness in the presence of changed behavior and acknowledgement of wrongs to forgive and put the past behind us rather than blanket forgiveness without changes from the organization. Perhaps we need to ask this of the community too. To understand that we have put considerable efforts into addressing areas of the hospital where numerous complaints have been made and have made changes in staffing and employment with the realization that not all of our staff members were treating our patients as they should have done. This is an ongoing task, we have a quality department who leads in this effort. Sometimes we need education and feedback, sometimes we need to part ways. Sometimes there will be differences of opinion as to what constitutes appropriate treatment. It may not seem as though complaints make any difference, but they do. On behalf of NRMC, I’d like to extend an apology to anyone who has not been treated kindly, with respect and with careful consideration from any of our team. I hope we can continue to build a community relationship together and do better in the future.
Several individuals have suggested that we should vote no on this measure and then work to develop an arrangement with a big outside group. There have been hints that just such a potential partnership is to be introduced “very soon” for the past month or so. This is a situation that I view with caution. Every one of us who is deciding how to vote for this measure is doing so with one overriding principle in mind, “what does it do for me?” Let me be clear, big corporations do this on a much bigger scale than people do. They don’t have feelings or empathy at all. Any group that decides to make an arrangement with NRMC won’t be planning to dump a bunch of money here for the benefit of Vernon County. They will assess returns on investment and do cost/benefit analyses and determine what we will offer to their bottom line. They will have their legal team on staff to draw up contracts that protect their interests. They will hesitate to make any sort of guarantee. The governing body that exists now—city council and hospital board—can certainly work together to negotiate with such an organization to develop some sort of management plan or concession or however that would look. But if that is the right answer for our hospital an elected hospital district board could probably negotiate a much better arrangement. The best position to take in a negotiation is the ability to walk away if the deal isn’t beneficial. The current situation has two groups who haven’t done the best job of working together historically. The property tax would definitely increase the appeal to whichever big outside group was interested. A local tax is part of the package that attracted Coxhealth to Barton County and Freeman to Ft. Scott, KS.
This election is controversial. It has brought out strong sentiment. That has caused some rather unpleasant sparring on social media which is off-putting to many of us. I expect a couple of negative reactions to this post, perhaps some angry faces, a laughing emoji or two, some comments on the order of “just vote no” and maybe a challenge of why I’m wasting everyone’s time with this message. I don’t know how much impact any of that has on anyone. Mostly everyone is just so exhausted with the topic that they wish the whole thing would just vanish. If the measure fails maybe someone will have the energy to bring it back for another vote in two years, perhaps with the 50 cent levy cap. It really isn’t doable with no funding at all. And those are the three choices for the hospital district—0, 50 cents or $1.00. Maybe 50 cents would have been just as unacceptable to the critics the first time around but will be much more tolerable after the $1.00 option was presented. There are still some fundamental misunderstandings in the community. I saw one comment the other day that said the hospital should remain an government entity. It is owned by city government now and would be owned by a different government entity if the measure were to pass and be implemented. It seems impossible to break this down into pieces that are entirely understood. For those who complain that it was rushed to ballot, I can assure you that to those of us who watched the hospital nearly founder two years ago it seemed quite urgent at the time, haste was essential. Also, the discussion of the hospital’s struggling finances has been in the public spotlight often since at least 2018.
It’s true that giving an elected body the option to levy a substantial property tax seems risky, is it possible that they wouldn’t go for top dollar? It’s hard to get comparison data from around the state but it doesn’t appear that any hospital district or similar entity is currently levying the maximum rate allowed on their communities. Many people who don’t live in the city limits have been frustrated in the past that they had no say over the hospital, that the city council simply appointed board members by whatever metric they deemed appropriate and it seemed arbitrary. This measure would solve that problem completely. The six districts are supposed to break up the population of the county more or less equally and allow for that representation to take place. That new board would be able to hire the candidate they found to be the best fit to lead the hospital organization. It would be a much cleaner management structure.
Thank you for taking the time to read this lengthy message. I appreciate all the people who have considered this from different angles and searched for alternative solutions, all who have demonstrated a community spirit in interactions and engagement. I hope no matter the outcome of the election we will continue to work well together and elevate each other and our local resources.
