By Mark Waite
Nye County is on the verge of being dropped from its public insurance pool due to a lack of follow-up documentation on employee physicals and wellness programs, Human Resources Director Donelle Shamrell warned county commissioners last week.
Commissioners were considering a proposal from ARC Health and Wellness Center, which has contracts with nine law enforcement and fire department agencies statewide serving 5,000 police and firefighters. But they decided to give local medical providers, like Desert View Hospital and Nye Regional Medical Center, time to address the inconsistencies.
Wayne Carlson, executive director of POOL PACT, the state health insurance pool, said ARC Health and Wellness had a physical that was compliant with the physicals Nye County is required to perform under Nevada Revised Statutes, Shamrell said.
State law requires firefighters, law enforcement officers and arson investigators to undergo an annual physical. The employer is required to pay for the examination and the employee is required to correct conditions that could lead to heart or lung disease, when ordered to do so by the physician.
“There are requirements under the NRS that says if there is an issue with you that can make you healthier, there is a requirement under NRS to make you do that. That is not being done,” Shamrell said.
Paul Granstrom, executive vice-president of ARC Health and Wellness, said his company has mobile medical units, 39-foot recreational vehicles equipped to do physicals, including chest X-rays, blood work, stress treadmills, EKGs and doctors’ visits. It would save the county employee time in having to travel to Pahrump or Tonopah, he said.
ARC Health and Wellness proposed a $44,000 contract. Nye County is currently spending $44,413 on the physicals, based on 109 employees in the program.
But Shamrell said, “we’ve paid over $800,000 in heart claims from 1998 forward. If we were compliant with our physicals, there could have been a very good chance we would’ve paid nothing and these lifetime claims, once it is recognized as a heart-lung claim, we’re paying for life on these employees.
“So when this person has a heart attack that could’ve been avoided, if they made changes, we’re liable,” she said.
Physicals were reviewed by a doctor, but there wasn’t a lifestyle change, addressing risk factors like high cholesterol, or smoking, Shamrell said.
Granstrom said ARC has cardiologists and pulmonologists on call that can respond in a couple days if there are abnormal test results. Physicals have to be reported within 10 business days, he said.
Granstrom said their intent isn’t to become an urgent care or primary care provider.
“The conversation that could’ve taken place with Desert View with the doctor that is actually providing the physical now is not necessarily communicating the things that will keep them in compliance,” Shamrell said.
Commissioner Joni Eastley liked two things about the company, the fact ARC is an occupational health specialist, the second is they would travel to the user.
But Eastley said sheriff’s deputies or firefighters seeking employment would still have to travel to Las Vegas for a physical.
“We tell them they need to work on these risk factors. They are to take it on themselves to go to their primary physician to get them corrected. Failure to do that can result in failure of approval of their heart-lung claim,” Granstrom said.
Shamrell said, “recently we started getting copies of physicals that were being done but before that we had to beg, borrow and steal to get these physicals.”
James Oscarson, marketing manager for Desert View Hospital, asked Nye County to enter into discussions to find out what hasn’t been done properly. He said up until now no one has expressed the concern to the hospital, adding it may just be a communication issue.
Oscarson said if somebody’s cholesterol is high, for example, they need to follow up with a cardiologist. He said those specialists are available locally.
“Obviously, the hospital can’t hold somebody’s hand and say you’ve got to stop smoking or you can’t do this or you can’t do that. That’s a responsibility down the line,” Oscarson said. “If there’s a lack of reports or counseling, I would simply say we’ve not been made aware of that.”
Physical exams were a sore point among Amargosa Valley volunteer firefighters when Nye County imposed the physicals in 2009.
“It’s so difficult to get volunteers and one of the problems we had is for an individual to come on they have to have a physical before we can even start training them on a self-contained breathing apparatus. The accessibility has been a nightmare for us from time immemorial, from when the law was passed regarding heart, lung testing,” said Nye County Emergency Services Director Vance Payne. “There’s been many fights over these physicals for quite some time.”
The problem is finding time for volunteers to take the physicals and industry standards, he said.
“If this happens, this is going to give us the availability for our personnel to get these tests within their time frames and secondly, you’ve got a group where their primary business is this particular test. It’s streamlined. It’s fast,” Payne said.
But Granstrom couldn’t guarantee Eastley ARC would travel to remote locations like Gabbs or Currant Creek to do two or three exams. But he said they just tested six volunteers in Esmeralda County recently and traveled to Gerlach in the northwestern tip of Nevada to do physicals for seven Washoe County firefighters.
“When we drive four hours with a physician that’s making $100 per hour and only charging $350 for an examination, it doesn’t make a lot of sense. So we work with the counties to coordinate times,” Granstrom said.
Commissioner Butch Borasky wanted to know when this problem first surfaced. Eastley said at a spring meeting of POOL PACT “other counties and other organizations, they brought up they wanted to kick Nye County out of the program because of the cost of the claims coming from Nye County law enforcement were so high.”
It took time for Shamrell to come up with a proposed solution, she said.
Assistant Sheriff Rick Marshall said his department wasn’t aware the physicals conducted at Desert View Hospital were out of compliance, but said some employees didn’t show up for physicals.
“Sometimes the employee wouldn’t show up. We wouldn’t know they didn’t show up. So Desert View set up a single point of contact where they would notify us these employees didn’t show up and we would take action against those employees and mandate they get on the next mandated physical,” Marshall said.
He suggested a simple fix: having the physicals hand-delivered from the hospital to the county HR department.
Granstrom said his company has doctors with years of experience in heart and lung disease.
“Our objective is not to take business away from local doctors. Our goal is to level the playing field and most important to the public entity, to make sure you folks are staying in compliance with these important physicals,” Granstrom said.
County Manager Pam Webster suggested keeping an open dialogue with POOL PACT so the county doesn’t jeopardize its coverage.