The agency is also facing a dilemma common to public hospitals across the country: how to pay for health care it provides to people who make too much money to qualify for state or federal medical aid, but do not have their own private health insurance. Williams estimates that care provided to this type of patient is costing the county about $20 million a year.
Outside consultants have been called in to find a way to make the hospital and other health-care programs more efficient, speed the collection of outstanding bills and trim the agency's deficit.
But the agency's greatest problem, officials and onlookers agree, has been the havoc wreaked by three years of budgetary game-playing.
The costs of running the hospital and other programs have always been fairly easy to predict, officials say. It is no great secret, financial expert Medis points out, that the hospital needs about $40 million a year in tax money to do its job.
But the hospital got caught in a whirlwind of financial maneuvers launched by Bruner, Pederson and the Board of Supervisors, County Treasurer Doug Todd points out.
"They used very convenient maneuvers to move debt off the [general fund] budget," Todd says. "It was political expedience."
As the county's budget problems grew during the past three years, county records show, political expedience was quite the fashion.
At one point, in February of 1993, the county reached the point where it was almost literally broke, records show.
County leaders, including then-Board chairman Bruner, were on their way to a conference of government officials in Washington, D.C., when they received startling news--the county was out of cash and was on the verge of bouncing checks.
Before leaving town, Bruner had to rush to Governor Fife Symington and ask him to release more than $60 million in state health-care funds on an emergency basis, so the county could pay its bills.
The series of accounting tricks has now come to an end, Supervisor Tom Rawles says, but the piper must be paid.
Debt is debt, Rawles points out, no matter what set of books it is posted to, and the pool of red ink that has been allowed to grow at the Health Care Agency must be paid off.
"We understand that this is not a Health Care Agency problem," Rawles says. "It's a general fund problem. We are not going to make them pay for the general fund obligations that have been shifted on them."
@body:Sitting in his office, Williams, the head of the Health Care Agency, makes an astonishing statement. On the table before him lie documents, including a financial report prepared by the Health Care Agency, outlining the financial games that have been played with the department over the past three years.
The very fact that the county is now admitting what happened, Williams says, is indicative of a "metamorphosis" in county government.
In effect, Williams says, the county has decided to stop lying to the public about the gravity of its budget problems.
"That you even see this is indicative of openness and the desire to deal with the facts instead of trying to hide things," Williams says.
Still remaining, though, are questions about whether hiding debt in the Health Care Agency was legal, Williams says.
In less than a year on the job, Williams says, he has found no law that allows the health-care funds to carry debt from year to year the way they have been carrying it.
An opinion from Maricopa County Attorney Rick Romley's office in 1993 concluded that the health-care funds could legally carry over debt, but only if there was a specific plan in place to pay it off. The opinion laid down narrow guidelines allowing debt only for short periods of time.
The county's officials, Williams says, appear to have taken that narrow authorization and used it for a carte blanche debt spree that may have gone well beyond the legal guidelines set by Romley's office.
But for now, Williams says he is more interested in fixing what's broke than worrying about the past. "My role is not to assess blame," he says. "My role is to fix the problem."
Among many possibilities, the county is now considering solutions ranging from the simple--like cutting waste in the Health Care Agency--to measures as drastic as selling the county hospital or contracting with a nonprofit group to operate it.
The agency is awaiting suggestions from various consultants, and in the meantime trying to find ways to consistently slice away at its overhead, Williams says.