The timeless role of the exploding cigar
Procrastination's allure is that it always seems safer to dodge a problem than to solve it—until it blows up in your face
Oh! I didn’t see THAT comin’!
Frustrated local group calls Idaho Attorney General's attention to St. Luke's 'predatory' hold on McCall taxing district decisions
Dateline: June 11, 2019
"I believe that utilizing Donnelly and increasing their staffing for ground transfers would be the best possible use of the money, would be a more sustainable solution, and would have the biggest benefit county wide."—Email from a local Fire/EMS official to St. Luke's McCall Chief Operating Officer
"I have already presented to the Tax District work group the 3 options we previously discussed and Donnelly Fire and EMS was not one of them. I have concerns about changing the option for the tax district board so late in the game, I fear the Tax District Funding Committee will feel that we are unsure of what the best solution would be and would choose not to fund an option."—Reply from St. Luke's McCall Chief Operating Officer
THAT, dear readers, is all you need to know about how deeply cynical St. Luke’s is about its presumed “partnership” with the taxpayers of the McCall Memorial Hospital taxing district (MMHD). For nine months, a grassroots movement called Give Us A Vote! (GUV) has been running on a hamster wheel trying to convince MMHD trustees to allow an advisory vote on the district’s future. Such a vote would allow district patrons to judge the board's expenditures, which exclusively benefit St. Luke's Health Systems. GUV! announced this week that they are taking their case to the Idaho Attorney General.
Coming soon:
• An AI and history assisted theory on why so many locals didn’t vote in the May election
NEW READER or forgot what I said about something? Find past posts HERE
Disclaimer: This is a rare case in which I am writing about a topic in which I have taken a side (as opposed to my usual practice of presenting alternative voices). I am a member of the GUV steering committee. In this post, I will lay out the case we are submitting to the attorney general. There's a quite painless way my readers can help us fix the problems our group worries about. But first, let us tell you why we think you should care:
Since last August, members of GUV! have been working to inform the public of the unhealthy and questionable legality of MMHD/St. Luke's relationship. Longtime readers will remember my series on the subject starting with a jungle trek and ending with a Mark Twain fable (see Links section).
The subject of the 2019 email exchange that introduced this post was hospital ambulance/EMS services. Notice that the St. Luke's official's first priority was to secure public funding for an ambulance for the exclusive use of St. Luke's. She was not about to let anything get in the way of that—even what may have been a very sound proposal from Donnelly EMS. She wanted that freebie ambulance from the taxpayers and she wanted it now. What's best for the district's patrons? That wasn't within a moon landing of the top of her list.
Most importantly, note that St. Luke's was screening what proposals it allowed the MMHD board to entertain. The attorney general, like a daughter's ever-vigilant father, has already had to step in once to force some separation in the St. Luke's/MMHD romance. To be constitutional, he said in 2016, the relationship must be between two independent entities. But as the EMS email exchange proves, if these two are left in a car alone together, MMHD's taxpayers get taken advantage of.
Any of you who have been in management in a big business structure will recognize what the St. Luke's officer was/is doing. It's classic corporate bargaining behavior, especially in monopoly markets. The strategy is to tell citizen boards that whatever they desire can only move up the master priority list if the community makes 'a substantial contribution'. Then when they force the board's hand, the accounting office pencils the amount off their expense budget and the officer high-fives the corporate brass.
Don't believe us? Here's another recent example. In recent public meetings, MMHD board members have repeatedly asserted that, had board members not 'fought' for an urgent care clinic, McCall would have had to wait a very long time for that service. But when the tax-subsidized clinic opened, a Star-News reporter quoted the same St. Luke's operations officer saying that it would only have been "a few years" before St. Luke's would have built it on its own (the report is in Links). To add insult, she also gives St. Luke's credit, not the board, for the idea of the UCC in the first place.
The 'substantial contribution' for the UCC was about $2.6M from the district. A reasonable definition of 'a few years' is 2-3, right? If the board had asked its patrons if they would rather spend $2.6M to get a clinic now, versus wait 2-3 years for St. Luke's to finance it on its own, what choice would you have made? After all, the community has managed to muddle through without one for more than a century. What's the rush?
We want to point out that, in her email, the St. Luke's COO described the board as "extremely cautious about the tax payers funds." We truly believe they are. But the board is in the habit of delegating management of tax subsidized projects to St. Luke's, so it's not surprising that community agencies would submit proposals to them and not the board. Because of that, the MMHD board’s decision-making process is only playing with half the card deck (and we're not referring to their cognitive capacity).
Giving St. Luke's so much exclusive power violates the Idaho State Constitution. Idaho courts have said so. Note: there's a link to the full draft of our complaint after this post with all the legal references if you're really into that kind of thing.
We really tried to keep this in house, but we weren't sexy enough to pry MMHD from its main squeeze
We first asked the board to let patrons weigh in on their decisions last August. After nine months, despite 55 support letters and an online poll with 94% in favor of the idea, all we've gotten is a conga line of stall tactics. Even a turtle only makes progress when it sticks its neck out. They are not willing to do that. We saw hopeful signs of life in February, and again last month, when one of the workgroups assigned to 'study' our request actually recommended the advisory vote. It landed with a thud and the workgroup was sent back to write more filibuster material.
And, speaking of something 'sticking out,' what is the explanation for this glaring dichotomy? Why is a board that says it's supremely confident they are acting in the interests of the patron so afraid to find out if they are right? If we patrons need so much 'education' all of a sudden, why was that not necessary prior to nine months ago? Before the board can be believable on anything else, they need to convincingly answer that question.
So, as in August and in February, GUV! is playing the role of the exploding cigar. In the cartoons, the ageless pyrotechnic prank never fails to make heads turn. Maybe this third blast will do it in real life.
The only practical avenue left to the MMHD patron is an appeal to state's chief legal and law enforcement officer. We are a grassroots movement that can't afford MMHD’s snazzy tax funded lawyer (budgeted legal fees were $30,000 for FY'25). Even if we would choose to sue, the district would use our tax dollars to defend itself, so we would literally be suing ourselves.
Partnership? What Partnership?
The attorney general's office first had to step in and separate St. Luke's and MMHD in 2016. Then-AG Lawrence Wasden reworked the original merger agreement to 'give' the hospital campus that MMHD 'gave' to St. Luke's back to the taxpayers. Currently, St. Luke's leases the campus buildings for free. The other part of the bargain that stuck in Wasden's craw was that the agreement automatically compelled all the money the district could levy to be passed through to Luke's, no strings attached. The revised agreement gave the district board full discretion to grant funds to St. Luke's, including the annual option of no funding at all.
However, Wasden apparently did not make it clear to the board that, as a fully independent organization, they can entertain other funding requests too. In fact, Idaho law requires it. There is nothing in the district's bylaws or in the service agreement with St. Luke's that grants Luke's exclusivity. The bylaws simply say the district's funds have to be applied to the betterment of health care. The board can give money to any non-profit that promotes health. That's a porthole the Greenland Glacier could slide through.
But the board got it stuck in their heads that they are wedded to St. Luke's and vows are not to be broken. Look at the transcripts of any board meeting and you will see the word "partnership" being thrown around. Some board members literally get drippy when they talk about this 'special partnership' with Luke's. That's not the way Idaho law sees it and we doubt Wasden's successor as attorney general will either, if he takes the case. That's where you, dear readers, come in.
The cost of looking the other way
The price of whistling past the exploding cigar is that this improper tax subsidy will continue to merrily roll along. All we ask you to do is sign a petition backing the right of all district citizens to get answers to these questions. Even if you think the taxing district is necessary, wouldn't you feel better if these incongruities were resolved? We would hope that the MMHD board itself would like to know if they are operating within the law. While GUV! is devoted to dissolving the taxing district, the AG can't do that. Only citizens can. But the AG can reform the board's practices to comply with the law. And since the board's grants to St.-Luke's-for-St. Luke's-exclusive-benefit grow further and further from its own bylaws every year, only the AG can pry apart this lip-lock with St. Luke's.
Right now, the board is preparing to give the full amount it can levy (less operating expenses) to a workforce housing project that is, as usual, exclusive to St. Luke's employees.
GUV's complaint to the AG argues that this constitutes a clear wage subsidy to a private entity that is grossly unfair to other local private enterprises. Large employers in the area, such as Tamarack, Shore Lodge and Brundage Mountain have had to build worker housing as a business necessity. Wouldn't they have loved to have had it paid for with public funds! This project is favoritism and corporate cronyism clearly outlawed in Idaho law. These other private businesses are indispensable contributors to the area’s economy. Is job creation of lesser worth to ‘the public benefit’ than health care? If not, why do those businesses have to build worker housing without a tax subsidy? Especially since it's doubtful any of those businesses clear St. Luke's lofty $15M/year.
Just. Sayin’.
One of the board's favorite retorts when anyone criticizes their St. Luke's subsidies is, "you ingrate! They gave us a $60M new hospital!" If you're interested in GUV's truly ungrateful answer to this logically inept argument, join me in the Afterthoughts section.
Signing our petition only takes a minute.
I opened this post with the email exchange that gives district patrons a big reveal on what St. Luke's predatory priorities are. If that hit a nerve, it isn't going to stop stinging if patrons don't speak up. The attorney general's office gets a boatload of investigation requests. We are confident we have sound legal underpinning. But without you behind us, the AG might put our complaint in the bottom of a pile and the MMHD/Luke's romance will keep on truckin'. Promise: this petition will simply be an addendum to our 15 page filing. We're not going to parade your Hancock around in broad daylight or anything.
You have just read a summary of our arguments. Our objective is to get answers to these troubling questions. If you agree, we ask you to be a co-signer to our petition to the Attorney General.
PLEASE DO NOT REPLY TO THIS EMAIL TO SIGN!!! Follow these instructions instead:
If the email address link isn’t active, cut and paste the address set up for this purpose into the To: space in your email app: replytomigrote@gmail.com
Enter “Signature” in the subject line.
In the message field, please include your name and, if you are not a renter (renters are welcome), the address of the property within the hospital district that you own. This information will only be used for the purpose of the petition. If and when we get news from the AG’s office, we will pass it along to you via your email address. After six months, all information in this database will be purged. If you wish to read the full complaint before signing, it is available for download following this post.
—Thank you from the GUV! steering committee: Curt Meske, MD; Rep. Faye Thompson, Idaho District 8; Tomi Grote, local newspaper publisher (retired)
Scroll down for the juicy Afterthoughts after this commercial break:
Would you like to a)tell me how wonderful I am b)tell me to crawl back where I came from c)tell me about your summer BBQ? (no pictures please, we do enough grilling around here in the interrogatory sense). Write me a private email! Send your bribe observations to: tomigrote@substack.com. I promise I won't out your trash talk to your church congregation.
Know somebody who would be interested in this Substack? If you got this as an email, forward it. Tell the recipient to look for links within the post to subscribe for free. Or say something about it on social media and include the web address tomigrote.substack.com. Thanks so much for helping spread the word about this completely volunteer effort.
Afterthoughts, Observations and Authentications
• This week's Caught Ya Being Good goes to MMHD board members Mike Vineyard, Steve Clemens and Travis Leonard. They are the very capable workgroup members who, at last month's board meeting, advocated for an advisory vote sooner than later. Sadly, it fell on deaf ears. The majority of the board wants to stall any initiative until well into 2026. They even kicked around spending $25,000 in tax revenues on a survey. An advisory vote is free of charge but surveys are attractive to paranoids like the MMHD board because they can write the questions and frame the answers. A recent meeting of the district's PR committee revealed their impression of what patrons are concerned about. If that ends up guiding the survey, it's headed for Tomi's Gold Encrusted Trash Can for sure. Meanwhile, the meaningful legal questions we are trying to answer stay unanswered through another $1.5M budget appropriation.
• GUV's response to the argument that St. Luke's is richly deserving of tax subsidies because of their 'investment' in a new hospital in the community. First of all, the community didn't ask for a new hospital. St. Luke's built a profit palace as all private businesses wisely do. They saw a rich market. Their aim was to become a regional medical facility that draws revenue from a service area far larger than the older independent, McCall-centric hospital was built to handle. Pad that advantage together with decreased credit loss risk courtesy of Medicaid expansion and the overall wealth of the community. Second, the public had no say in the atrocious cost overruns and miserable project management (by St. Luke's own admission) that literally doubled the cost of the project. So the $60M figure proponents toss around should not be treated with much reverence, unless ineptitude is a badge of honor.
And strangely missing from this line of 'reasoning' is that in exchange for the 'investment,' St. Luke's effectively owns the hospital campus buildings. It's an option they will exercise if the taxing district dissolves. In fact, St. Luke's has so many options on the district's assets, that patrons will never see any equity to the district from the projects it subsidizes for decades to come. I could, and will if it becomes salient, write a whole post about this 'credit' arrangement. But suffice it to say for now that the whole Wasden-brokered 2016 agreement amounted to nothing more than a worthless shell game as far as the taxpayer is concerned. St. Luke's isn't going anywhere. Could anybody who reads that email exchange that opens this post be persuaded that SLHS is an altruistic teddy bear? I sure hope not.
• The Donnelly Fire/EMS proposal that never made it in front of the board would have provided an existing ambulance and an existing garage for a tiny fraction of the $2.6+M the district ended up paying for their own. As if we didn't have enough moving parts in the emergency services game in Valley County, St. Luke's added what looks to be a totally unnecessary one (if anybody were ever to take a serious pencil to it). There's a very weird, simmering, internecine tension between St. Luke's and local EMS/Fire agencies that erupted big time in a public forum at the MMHD board's February meeting. I don't claim to have a grip on it but if I ever get to the bottom of it, I will write about it. It would be nice if our local news media would take it on. It's not really what I set out to do. But it's there for a muckraker’s taking.
Links/Images
St. Luke’s takes credit for Urgent Care Clinic
The St. Luke’s/EMS 2019 email exchange:
St. Luke’s/MMHD Series (early 2025)
Downloadable Attachments
The Executive Summary is the short version, the Complaint is the long form
