TONOPAH -- A monster $919,535.28 hospital bill was presented to Nye County by representatives of Nye Regional Medical Center for uncompensated indigent care dating back to 2004.

Commissioners denied payment Tuesday after Nye County Health and Human Services Director Shirley Trummell explained the majority of the bill was due to patients not submitting the required applications.

Nye Regional Medical Center Assistant Administrator Jennifer McMillan said, "We were instructed to stop sending the bills and only to send the bills when they were requested."

She added hospital officials were instructed by the county not to assist patients in filling out the forms.

A spread sheet showed $752,238.79 of the uncompensated funds were because patients didn't request the county application for indigent funding. Another $97,440.82 was withheld because the application wasn't returned and $43,785.70 wasn't paid the hospital because applications were incomplete.

"I realize you're not their baby-sitters, and neither are we. If that's the case and they do not bring these papers back, how do you determine they're indigent?" Commissioner Roberta "Midge" Carver said. She added, "Of all the people in this room, I absolutely do not want anything to happen to that hospital. I'd be devastated to be in Reno if my husband needed that hospital."

"Most of these people are indigent, they don't have jobs, they don't have insurance so they don't attempt to pay the bills," McMillan said.

Attorney Jeff Whithead, representing Nye Regional Medical Center, said, "They're following the same procedures out-of-county hospitals are following. Yet in the indigent care, Nye Regional has received zero dollars for all the indigent care in 2005 and 2006."

"Each hospital in the state has been paid out of the indigent care fund," he said.

But Nye County Assistant Manager Pam Webster said, "The bulk of them have been denied as being indigent because we can't verify that they are."

Trummell also corrected hospital officials, pointing out Nye Regional was paid $24,000 for indigent care by the county.

State law requires the indigent patient provide all information to the county, she said, verifying their financial status. Nye County allows a more generous $623 of gross income per month to qualify as indigent, instead of $438 required by the state, Trummell said.

"We are not required to pay E.R., the emergency room bills, but we do," Trummell said.

Trummell said Desert View Medical Center in Pahrump has the same problem with indigent patients not Whitehead said "Many of the agencies assist the patients because many of these patients are not that sophisticated in the paperwork. They need assistance because what might seem to a commissioner a simple matter might not seem simple to them.

"We're simply doling out uncompensated care, losing a million dollars of uncompensated care and I don't know how many organizations could continue to bleed at every pore and continue to operate efficiently as well as deliver the care that Tonopah and Nye County needs."

Commission Chairman Gary Hollis said, "We're not here to just hand money over" without going through state law and county policy.

Commissioner Joni Eastley said she could understand why government entities wouldn't want hospitals assisting the patients in the paperwork, speculating there could be an attempt to "fudge it a little on the income so it falls below the level, so the hospital is sure the claim gets paid."

Eastley noted she's been a resident of Tonopah for many years and understands the value of Nye Regional Medical Center.

But in making the motion to deny the payment, Eastley said of Nye Regional Medical Center, "It is absolutely critical to the well being of this and other communities in the area. I want to see them paid for services that they provide but unfortunately in this case I'm also the caretaker of the public, the taxpayers money. As much as I'd like to say yes and write you a check for $900,000 I can't do it. Legitimate proof doesn't exist in my mind these are legitimate expenses."