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Idaho Statesman$2 MAY 3, 2015

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IDAHO STATESMAN: A McClatchy Newspaper, 1200 N. Curtis Road, Boise, ID • P.O. Box 40, Boise, ID 83707 • (208) 377-6200 • © 2015 Idaho Statesman, Vol. 150, No. 282, 5 sections, 44 pages

FEDS MUST GET NUKE WASTE CLEANUP ON TRACK EDITORIAL, D1

Mostly

PARTLYCLOUDY

78° / 49° SEE A16

INSIDE TODAYA NEWS Catching Up A2-3 | Local news A4-6 | Business A6 | Nation/World A7-15 | Idaho History A4 | Weather A16

D DEPTH Editorial D1 |Opinions D4-8 | Letters to the Editor D5 | Guest opinion D7-8 | Editorial Cartoon D5

E EXPLORE Heart of the Treasure Valley E1 | TV E2 | Carolyn Hax E3 | Horoscopes E3 | Puzzles E3 | Books E4 | Religion E5 | Obituaries E8-9 | Calendars E10 | Recipe E6

S SPORTS NFL Draft S1 | Letters to the Sports Editor S2 | SportsTV/Radio S2 | Golf S2 | NBA & NHL playoffs S4 | MLB S4 | Scoreboard S5

MICHAEL DEEDS

Gambling withweather for

spring festival funEXPLORE, E1

BOXING

MAYWEATHERBEATS PACQUIAO

The undefeated champ winsthe sport’s richest fight ever

SPORTS, S1

CONCEALED CARRY

Holster makerfinds success

in HaydenNEWS, A6

THE WATCHFUL EYEOF VALLEY HOSPITALS

DARIN OSWALD

/ Idaho Statesman file

St. Luke’s MeridianMedical Center, whichopened in 2001, wasdrawing Canyon Coun-ty maternity patientsfrom Saint Alphonsus’older hospital insouthern Nampabefore Birkelandopened.

KYLE GREEN / Idaho

Statesman file

Saint AlphonsusHealth System

opened the Birke-land Maternity

Center in Nampain January 2014. Itsupplemented the

maternity up-grades Saint Al-

phonsus made toits main Nampa

hospital — in-vestments made

in part by a desireto keep women

from going to St.Luke’s in Meridian

to give birth.

Idaho’s two largest health systems fought a lengthy court battle

in 2013 over St. Luke’s Health System’s purchase of a Nampa

medical practice. But the media and public were ushered from

the courtroom, not allowed to hear hours of testimony or see

hundreds of documents. The Idaho Statesman, joined by other

news organizations, sued for access and won the release of more

than 8,000 pages of records — a rare glimpse into how Idaho’s

health care industry operates. Business reporter Audrey Dutton

spent four months reviewing the documents and testimony.

This is the first story about what she found. DEPTH , D1

THE BUSINESS OF IDAHO HEALTH CARE

INSIDE OUR

HOSPITALS

What the St. Luke’s

antitrust trial

documents show

The favorite in the 141st running

of the Derby came from behind

on the homestretch to win by

one length. Firing Line, ridden by

52-year-old, Idaho-born Gary

Stevens, finished second.

SPORTS, S1

KENTUCKY DERBY

AMERICANPHAROAH WINS

DAVID J. PHILLIP / The Associated Press

Following the failed experiment on a statewideeducation information system, what’s next forstudents, districts, vendors and taxpayers? Tostart with, district decision-making. NEWS, A4

STUDENT DATA

AFTER $61M SCHOOLNETFIASCO, SCRAMBLING BEGINS

BALTIMORE UNREST

IN PAST, POLICE HAVE USED‘ROUGH RIDES’ AS PAYBACK A12

The growing trend has infuriat-ed outdoor enthusiasts — in-cluding many who are other-wise fans of street art. Officialsare looking for ways to discour-age the practice. DEPTH, D1

ENVIRONMENT

GRAFFITI APPEARSIN NATIONAL PARKS

Jay Ajayi waited two days tofind out where his professionalcareer would begin. It will com-mence in Miami, which took theformer Broncos’ running backin the fifth round with the 149thoverall pick. SPORTS, S1

BSU FOOTBALL

AJAYI DRAFTED BYMIAMI DOLPHINS

HEART OF THETREASURE VALLEY

BASSIST LOOKS TOKEEP LIFE IN TUNELately, it’s been the same oldsong and dance for Tony Elam.But through drug court and hismusic, he’s determined to stayon track this time. EXPLORE, E1

D LETTERS TO THE EDITOR D5 SUNDAY, MAY 3, 2015

Depth Inside: OpinionsTIME TO BREAK A DEADLY WATER CYCLE D4

STOP WASTING MONEY ON OUTDATED ROAD SYSTEM D8

After considering the con-cerns and proposals to bringspent nuclear fuel into Idaho

for research in light of the 1995Settlement Agreement, and theoverall nuclear energy mission ofthe Idaho National Laboratory inthe last six months, we concludethe most pressing matter is for theDepartment of Energy to get itscleanup programs back on track.

With all due respect to thecomplicated national and in-ternational security matters thatEnergy Secretary Ernest Monizhas been attending to in recentmonths, his agency signed on tothe settlement agreement 20 yearsago with cleanup provisions thatare not in compliance. Theenergy.gov website states the DOEis “committed to a safe, completecleanup of the environmentallegacy of five decades of govern-ment-sponsored nuclear weaponsdevelopment and nuclear energyresearch. As part of this mission,we safely and cost-effectivelytransport and dispose of low-levelwastes; decommission and decon-taminate old facilities; remediatecontaminated soil and ground-water; and secure and store nucle-ar material in stable, secure loca-tions to protect national security.”

Though there are other cleanupissues, we believe the most criticalINLone involves the failure tomeet a Dec. 31, 2012, deadline totreat sodium-bearing liquid high-level waste. There is roughly900,000 gallons of this still beingstored at INL— some of it goingon 60 years. The processing plantthat would convert it from liquidto a powdery substance that couldbe stored safely is yet to be madeoperable. DOE is working on it.

Reports and updates on pro-gress or promises to get this pro-ject up and running are not thesame as actually doing it. The1995agreement clearly states thatIdaho’s sole remedy in light ofDOE’s failure in cleanup matters isto suspend DOE spent fuel ship-ments to INL. The Idaho AttorneyGeneral’s office has no choice butto block any said shipments untilcleanup resumes, and we supportthat stance.

We also support the state’soption to “waive performance byfederal parties” when circum-stances change. In other words, ifDOE gets its equipment and pro-cess back in action to mitigate thedangerous liquid waste, there is alegal path for a conditional waiverand to allow new spent fuel roadsback into the state for research inthe lab. John Grossenbacher, di-rector of INL, points out that the200 pounds of spent fuel INLwould like to bring in to Idahoover the next two years is notwaste. “It is a small sampling ofmodern, commercial reactor fuelthat has high research value.”

We would argue that the nation,INLand Idaho need this nuclearresearch to continue. INLis thecountry’s premiere nuclear energyresearch facility. To strip it of itsmission makes no sense strate-gically or financially.

INLcan not perform its re-search mission without the spent

See CLEANUP, D6

STATESMAN

EDITORIAL

Cleanupshould be

DOE priority

JOSHUA TREE NATIONALPARK, Calif. — Andre Saraiva is aninternationally known graffiti art-ist. He owns nightclubs in Paris andNew York, works as a top editor ofthe men’s fashion magazine L’Offi-ciel Hommes and has appeared incountless glossy magazines as a

tastemaker and bon vivant.Two months ago he showed up

on the decidedly un-fashionistawebsite Modern Hiker, along witha photo of a boulder he tagged inJoshua Tree National Park. Sincethen, Saraiva, who lives in Franceand is known by his fans as Mr.Andre and Mr. A., has been scornedby American nature lovers andthrust into a highly charged debate.

Saraiva is of a new generation ofgraffiti artists who regard nature —not just the built environment — astheir canvas. They tag national

parks, then post photos of theirwork on the Internet.

Those acts infuriate outdoor en-thusiasts, many of whom are other-wise fans of graffiti art.

“This is a very complex issue,”said Casey Schreiner, editor ofModern Hiker. “How different isgraffiti in national parks than streetart? If street art is OK, is this OK? Isthere a correlation?”

Schreiner said his readers “thinkit’s a problem because graffiti

ENVIRONMENT

IRFAN KHAN / Los Angeles Times

George Land of Joshua Tree National Park checks out rocks defaced bygraffiti in the park’s Cap Rock area on April 10. The park is one of manypremier federal wilderness areas struggling to curtail a new generationof vandals who deface rocks and historical structures with graffiti.

Graffiti’s arrival at national parksinfuriates outdoor enthusiasts

Many fans of street artbelieve that painting similarworks in nature goes too far.

BY LOUIS SAHAGUN

LOS ANGELES TIMES

See GRAFFITI, D3

The Nampa hospital was a half-century

old by 2010, and it had a perception problem.

Executives watched as patients left the

county to have babies in a competitor’s hos-

pital.

The perceptions weren’t necessarily

wrong. Saint Alphonsus Medical Center-

Nampa had an outdated maternity unit at the

time. The unit had “a patient safety issue,”

posed a “danger for transport of emergency

C-sections” and caused dissatisfaction

among maternity patients, staff, doctors and

families. Canyon County women were in-

stead going to a St. Luke’s Health System

hospital in Meridian.

St. Luke’s was concerned about its mater-

nity services, too. St. Luke’s noticed a dip in

business from pregnant women, according

to a hospital report written in 2012. Births at

St. Luke’s hospitals were down 7 percent in

Boise and 6 percent in Meridian.

Why? The economic downturn was part

of it, St. Luke’s surmised. But executives also

suspected it was due to competition from

Saint Al’s, which unlike St. Luke’s had a mid-

wife program for expectant mothers.

Both hospitals would go on to make

changes to maternity care.

The competitive outlook that helped spur

those changes was revealed by 8,300 pages

of records released in response to legal ac-

tion by the Idaho Statesman and other media

groups during the 2013 antitrust trial against

St. Luke’s Health System. The documents of-

fer a glimpse into the inner workings of Ida-

ho’s health care industry — and in some

cases how decisions are influenced not just

by medical need, but by St. Luke’s and Saint

Alphonsus’ desire to compete with one an-

other.

THE BUSINESS OF IDAHO HEALTH CARE

St. Luke’s, Saint Al’sjockey for the edge

KYLE GREEN / kgreen@idahostatesman.com

Helene Reusser, a certified nurse midwife, and patient Trista Whitaker, who is 36 weeks pregnant with a girl, talk about options for delivery atSt. Luke’s Meridian Medical Center. “The midwives are a great example” of St. Luke’s responding to demand that St. Luke’s wasn’t meeting,said regional CEO Kathy Moore. “We didn’t provide midwife care until a year ago.”

Documents from a hospital trialpaint a picture of sharp

competition, but leaders saythat’s not what drives them

and their decisions

BY AUDREY DUTTON

adutton@idahostatesman.com© 2015 Idaho Statesman

See HOSPITALS, D2

INSIDE OUR

HOSPITALS

What the St. Luke’s

antitrust trial

documents show

KYLE GREEN / kgreen@idahostatesman.com

Both of Idaho’s largest health systems showcase their maternity care on billboardsand other advertisements. This billboard from Saint Alphonsus Health System isaimed at drivers on Interstate 84 in Boise.

D2 l SUNDAY, MAY 3, 2015 IDAHO STATESMAN l IDAHOSTATESMAN.COM

The records show jockey-ing for customers and mar-ket share by both health sys-tems. The two tax-exemptnonprofits are also powerfulTreasure Valley businesses.St. Luke’s is the biggest non-profit and the biggest privateemployer in Idaho, withmore than 13,000 employees,about $1.8 billion in annualrevenue and seven hospitals.Saint Alphonsus has morethan 4,000 employees andfour hospitals in the Trea-sure Valley, and is part of a$13.6 billion Michigan-basedsystem

“We believe competitionis good,” said Saint Alphon-sus Health System Chief Fi-nancial Officer Blaine Peter-sen. “We always want to becompetitive. We assume ourcompetitor wants to be com-petitive. ... Wal-Mart andTarget compete. Everyone’sgoing to compete.”

BEHIND THE VEILIdaho’s two largest hospi-

tals, federal and state anti-trust regulators and a Boisesurgical center went to courttwo years ago to argue overwhether St. Luke’s brokelaws meant to protect faircompetition when it boughtNampa-based Saltzer Medi-cal Group. U.S. DistrictJudge B. Lynn Winmill ruledin January 2014 that St. Luke’shad violated antitrust lawsby capturing too much ofNampa’s primary-care mar-ket when it acquired Saltzer,and he ordered the two tosplit. St. Luke’s appealed andlost.

The court gathered thou-sands of pages of documents— PowerPoint presenta-tions, emails, board-meetingminutes, text messages —from the hospitals and other

businesses. Many were keptfrom public view during thetrial, because the judge gavelawyers the ability to saysomething was so competi-tively sensitive that itcouldn’t be released.

After news organizationssued for access, Winmill or-dered the release of morethan 300 previously sealeddocuments and hours of tes-timony. He allowed some toremain closed because theycontained trade secrets.

THE BABYMARKETPLACE

Some of those trial docu-ments describe strategies re-lated to competition — caseswhere the health systems fo-cused instead on helping Ida-hoans become healthier, onbracing for monumentalshifts in health care or on of-fering safer patient care. OneSt. Luke’s document positsthat it’s better to wait untilyou have a “quality product”than to simply beat a com-petitor to market with some-thing inferior.

But many of the recordspertain to the “competitiveedge.” For maternity, bothhospitals were paying closeattention to data about eachother.

The St. Luke’s action planwas to do a better job of mar-keting and “gain any marketshare that can be steered ourway,” and to create a midwif-ery program “where we’dhire certified nurse mid-wives to work collaborative-ly with physicians” — a pro-gram that Saint Al’s had beenoffering.

Saint Alphonsus HealthSystem and its owner, theCatholic nonprofit TrinityHealth, came up with a planto recapture some of the ma-ternity business they werelosing at then-newly ac-quired Saint AlphonsusMedical Center-Nampa:

They would spend $4.3 mil-lion to upgrade the materni-ty unit at the Nampa hospital.

“Volumes will increase bykeeping deliveries local rath-er than transferring to ourcompetitor 14.1 miles downthe road,” said a late-2010Saint Al’s presentation pitch-ing the idea. The competitordown the road? St. Luke’sMeridian.

They also built a new ma-ternity unit as part of a $34million construction projecton land Saint Al’s had pur-chased at Interstate 84 andGarrity Road. In planningdocuments, officials expect-ed to scoop up “a muchbroader market” by puttingmaternity suites within min-utes of Idaho’s fastest-grow-ing cities.

“Market share at SAMC-Nampa has declined to ap-proximately 29 percent aspublic and physician percep-tion of the existing facilityhas declined and after St.Luke’s built a full-servicehospital in Meridian, east ofNampa,” a business plan forthe project said.

Leaders said in planningdocuments that they wouldmeasure the success of hos-pital improvements in parton maternity admissions ris-ing from 120 in 2014 to 151 in2018.

The new maternity suitesnear the freeway, describedin the Nampa Health Plazabusiness plan, could capturefor Saint Alphonsus “an ad-ditional 1,289 potential OBpatients in two Meridianpostal codes.” And the pro-ject’s success would be mea-sured in part by admissions—with a projected 70 mater-nity discharges in fiscal year2013, rising to 803 in fiscal2022.

The project had five goals,spelled out on the last page ofthe presentation, Petersenpointed out: Keep care closeto home; improve communi-ty perception; increase vol-umes, market share and ser-vice lines; increase patient,physician and staff satisfac-tion; and increase patientand staff safety.

“That’s what we reallythought was going to be thevalue of the project,” he said.

CEO Karl Keeler said theupgrades achieved theirgoals.

Business at the NampaHealth Plaza is even betterthan expected, Keeler says.But when they were pitchingthe idea, Saint Alphonsusleaders worried that withoutbuilding, they’d keep losingdoctors and patients to St.Luke’s.

“SAMC-Nampa must im-prove community and physi-cian perception of their facil-ities and reposition them tocapture more market shareor the Canyon County mar-ket will be forfeited to St.Luke’s,” the 2011 businessplan for the Nampa HealthPlaza said, in bold italics.“Physicians may continue tomigrate their practices to St.Luke’s Meridian, and SA-Nampa will continue to see adecline in volumes and mar-ket share if SAMC-Nampadoes not act to align physi-cians through improved fa-cilities and access to servic-es.”

EYE ON THE OTHER GUYA thread of us-versus-

them runs through dozens ofdocuments released fromthe trial. They talk of “com-petitive intelligence efforts,”“dominance” and competi-tors as a “threat.”

“In order to keep our mar-ket share and increase ourvolumes locally we mustkeep up with our competi-tor,” an internal Saint Al-phonsus strategic presenta-tion said.

St. Luke’s spread its rootsfurther into Canyon Countythree years ago with St.Luke’s Nampa Medical Pla-za, a $25 million project thatincluded an emergency de-partment. At the time, it wasnegotiating the Saltzer dealand sketching early plans fora full-scale hospital.

“As market share for (the)new St. Luke’s Nampa facil-ity grows, market share ofcompeting hospitals will de-cline,” the Milwaukee con-sulting firm Wipfli told St.Luke’s in 2011.

The antitrust laws courtssay St. Luke’s violated aremeant to protect competi-tion, based on the idea thatbusinesses going head-to-head with each other is goodfor society. Competitionkeeps one company fromsetting prices for all thecrude oil or tobacco in theU.S., and it drives innova-tions like those that turnedboxy computers that onlythe wealthiest could affordinto $100 smartphones.

Some trial documentsshow that competition hasbeen good for the TreasureValley. As the hospitals com-peted for customers, theytried to innovate and in somecases become more afforda-ble.

And some documentseven cite a lack of desire tocompete at times. A formerSt. Luke’s insurer-relationsexecutive said in emails thathis hospital system shouldn’tget into a bidding war withSaint Alphonsus over a Mi-cron health insurance con-tract.

Saint Alphonsus execu-tives sent emails about a“sense of urgency” they feltwhen St. Luke’s announcedin September 2012 a new alli-ance to bring Utah insurerSelectHealth into the Idahomarket. The alliance woulduse a network to which SaintAlphonsus doesn’t belong.

“The pace of change justaccelerated,” wrote Peter-sen, the chief financial offi-cer, after learning of the alli-ance a week before it waspublicly announced. “We aregoing to have to do quite a bitof work that we are not fullyready for. If we wait until weare fully ready, the bus willhave left the station and wewill be so far behind we maynever catch up. From all Ihear, St. Luke’s is also notready, but ready or not herewe come.”

Both health systems wereworking at the time towardtighter, quality-driven dealswith insurance companies,Petersen told the Statesman.

“I don’t think in retrospectit was as much of a disruptionas I thought it was when Iwrote these,” he said.

Asked if Saint Alphonsusactually jumped into some-thing it wasn’t ready for, hesaid no. Petersen said thehospital system was feelingdeadline pressure fromMedicare, Medicaid and oth-er forces, not just St. Luke’s;and it wasn’t a sign of com-petitive panic that the emailonly mentioned St. Luke’s.

“It was something thathappened in the market,” hesaid. “I was just trying tomake sure that we, as a man-agement team, understoodwe’ve got to get moving for-ward.”

THE WEST VALLEYKathy Moore, the St.

Luke’s western-region chief,has spent most of her life inCanyon County and callsherself a “Canyon Countygirl.” She worked as CEO ofCaldwell’s West ValleyMedical Center before join-ing St. Luke’s in 2010.

She said it’s “refreshing”to work for St. Luke’s, whichshe said is competing withitself to become better.

What about that “actionplan” — to compete withSaint Alphonsus by offeringmidwives?

“We don’t want to losemarket,” she said. “We stillwant to make sure we areproviding, and we are stillthe provider of choice, of ob-

stetrics services. That’s adeep and rich part of our his-tory. ... It’s a natural tendencyto say, ‘Why are we seeing adip? Are the births downoverall? Have we lost marketshare? Are we not deliveringa product or a care experi-ence that people are askingfor?’ ”

St. Luke’s launched itsown midwifery programabout a year ago, she said.

“If that’s what the commu-nity is asking for, then weprobably need to open oureyes and say, ‘How do weprovide those services?’ ” shesaid. “That was a reflectionof us not being as attuned towhat the community wasasking us to do and respon-ding based on seeing de-creased volumes.”

Still, documents pro-duced by St. Luke’s don’t shyaway from us-versus-themideas.

A 39-page marketing re-port from 2011 is titled “Howthe West Was Won.” It sug-gests “tactics” such as: “In-crease St. Luke’s brandawareness and preference inour western service areas,”and “Coordinate marketingacross all service lines andfocus messaging; St. Luke’s isthe ‘hero’ brand, i.e. if theconsumer chooses ‘St.Luke’s,’ we win!”

The context for the latterstatement, according tospokeswoman Beth Toal,was a discussion about “St.Luke’s” being the universalor “hero” brand used formarketing, as opposed to us-ing sub-brands such as “St.Luke’s Children’s.” It wasn’tabout St. Luke’s being a “he-ro” compared with its com-petitors, she said.

Keeler said competition isin the bottom half of issuesSaint Alphonsus leadersthink about when they’remaking big plans. “Competi-tion doesn’t drive our strate-gy,” he said.

Moore said the hospital’smain competitor isn’t at thefront of her mind, either,when she’s talking about thefuture.

“We don’t define our strat-egy based on our competi-tors,” she said. “You’re notknee-jerking based on whatyour competitors are doing,but you’re defining the vi-sion and what you hope tohave those outcomes be.”

Yet one Saint Alphonsusdocument with Keeler’sname on it portrays competi-tion for health care in theTreasure Valley — at least inJuly 2012 — as a never-end-ing battle.

“Historically two systems(Saint Alphonsus & St.Luke’s) have been locked in‘war of attrition’ that hasspilled over into Nampa andrural communities. ... Oligo-poly structure will persist in-to the foreseeable future (no‘winner’).”

Audrey Dutton: 377-6448;

Twitter: @IDS_Audrey

HOSPITALSCONTINUED FROM D1

KYLE GREEN / kgreen@idahostatesman.com

Helene Reusser uses a heartbeat rate detection instrument on Trista Whitaker. Birth rates are one indicator that Idahohospitals use to measure competition.

Saint Alphonsus

document from

December 2010

Saint Alphonsus

document from

July 2012

St. Luke's

document from

July 2009

St. Luke's

document from

January 2013

AUDREY DUTTON

Audrey has coveredIdaho’s health careindustrysince 2011.She brokethe news in2012 thatthe FederalTradeCommission was in-vestigating St. Luke’s andwent on to cover theresulting lawsuits, thetrial and the aftermath.8

READ THE FULL DOCUMENTSQUOTED IN THIS STORY AT

IDAHOSTATESMAN.COM