At an Oct. 25 meeting with the Santa Fe County Indigent Hospital and Healthcare Board, Alex Valdez, CEO of Christus St. Vincent Regional Medical Center, made a presentation asking the county for money.

Valdez asked the board to approve the largest possible contribution to a supplemental fund to compensate the hospital for providing care to poor northern New Mexicans.

On its face, the plea seemed reasonable. The hospital is classified as Santa Fe County's "sole community provider," meaning it's tasked with serving everyone who walks through its doors, whether a patient has health insurance or not. But the board members—who ultimately approved only a $165,000 transfer to Christus—weren't appointed yesterday. Developments in the past year alone put Christus' demands in context and undermine its claims of penury.

In April, the federal Centers for Medicare and Medicaid Services released an audit of Christus' financial activities from fiscal year 2009, questioning the manner in which it obtained $23.7 million in state and federal money [news, April 6: "Wheel of Wrongdoing?"]. Christus, along with six other hospitals statewide, "donated" money toward the state match that helps it draw down federal dollars—an arrangement explicitly forbidden under federal law. As of press time, CMS was still holding up some of Christus' federal dollars for this fiscal year, pending a resolution of the issue.

The audit report also revealed that the hospital's claims for indigent care fell far short—to the tune of $19.2 million—of the funding it received in FY 09. Christus has yet to explain where the remainder went.

In June, Christus finally turned in its Form 990 tax document for FY '09—more than six months late. Though the hospital never explained what took so long, even a cursory glance at the document reveals a couple of possible explanations. With questions lingering about where the $17 million in "extra" indigent care money went, the 990 reveals Christus had $21 million in revenue over the same time period. It also revealed Valdez' salary for the time to be $615,000 [news, April 13: "Information, Please"].

"When you're talking about growing your assets, I have to be a little concerned," Santa Fe County Commissioners Liz Stefanics tells SFR.

In September, Christus bought a new Santa Fe clinic, Physicians Medical Center, for $14.8 million [, May 11: "Christus Hospital to Buy New Medical Center"]. Although Valdez told SFR, when the hospital first announced the purchase negotiations, that the new clinic would help relieve overcrowding by adding another 24 beds, National Surgical Hospitals, PMC's parent organization, shed doubts on that explanation. NSH Corporate Vice President Charlie Smith said the PMC clinic focuses on elective outpatient surgeries, and any changes to that structure would be "news to me."

In November, Valdez and other Christus brass met with members of the Santa Fe County Indigent Hospital and Healthcare Board to answer, at long last, some lingering questions about the hospital's finances. Stefanics and Santa Fe County Commissioner Kathy Holian had long decried the dearth of information provided by the hospital about its finances and its refusal to allow a county rep to sit in on financial discussions. At that meeting, Holian says, she asked Valdez why Christus built its budget around large indigent health care sums from the federal and state government when it's becoming clear that that level of contribution is unsustainable.

"I am not sure that he had an answer to that question, other than it seemed like a good idea at the time," Holian writes in an email.