Howard, president and chief executive of the hospital since day one, is retiring March 31 and together with his wife, Debbie, will soon be hopping on a plane to Manila, the Philippines, to lead a three-year mission for the Church of Jesus Christ of Latter-day Saints.

No stranger to Asia, Howard started his career in Vietnam as a hospital administrator for the U.S. Air Force. He also served as an executive in several roles for Intermountain Healthcare, a nonprofit health care system in Utah, for 21 years before moving to MountainView.

His career has also landed him on several public and organizational boards and committees and he's been recognized with many community and military awards.

Howard speaks with In Business Las Vegas about MountainView's growth, the state of the hospital industry and his ideas on health care reform.

MountainView Hospital was an open field when I started 13 years ago. You look at it now and it's a great hospital, tremendous reputation. We opened the original hospital the 1st of February 1996, and we've had two major expansions since then. Now we're a licensed, 235-bed hospital with an additional 12 beds in observation. Little did I think in 1996 we'd end up where we are in 2008.

It's exciting. We have 1,200 physicians on staff, a tremendous employee base that has been very loyal to us. We're one of the few nonunion hospitals in Las Vegas, and, in fact, right behind you is the election vote where those two yellow pads are, showing we won both of the elections, nurses and technical employees. Tremendous, hard-working, dedicated employees and over the 13 years, I know most of them by their first name. I was going to come here for three years, and 13 years later I'm still here.

We always wanted to go on a mission, but we never thought we would be called to preside over a mission. There are 344 missions in the Church (of Jesus Christ of Latter-day Saints) and, at this time, there are a third of them, or 124, opening (with leadership vacancies). When they talked to us, they said it could be in Ghana, it could be in the Philippines, or it could be somewhere in the United States. (Recently) our call came and it was to Manila, Philippines, which I love because I know a little bit of Tagalog and that's where I served my mission as a young man. So I'm going back home 40 years later to the same place, the same part of the city I served in. I'll be over all the missionaries there, whether they be proselytizing, health, humanitarian or education missionaries, or the medical side. We're just thrilled. What a way to finish off a great career here, to be able to go back and serve other people - that's what it's all about. I think that's why MountainView has been so great because the employees and the hospital has such a great reputation. I talk to patients who are being discharged, and it's always positive. They just say the nurses and the employees are the best, and they are, so it's great.

The biggest challenge right when I was going into it was that Medicare was new. In 1974, when I got out of the Air Force, the Medicare costs were skyrocketing. The diagnostic related groupings came in in 1984. You had the challenge of reimbursement even back then, but we did not have all the HMOs, the PPOs, the huge health insurance companies you have now, you know, the per diems, and the DRGs and all those type of things. So, to me, the biggest thing back in those days was just trying to control the large, growing numbers of Medicare patients. Now you look at it with the baby boomers coming in, some 22 years later, and it's a whole new challenge. And then, I think, you always have that struggle to find the quality employee and to keep the quality employee.

These days, I think the biggest challenge, again, goes back to finding qualified employees and having a strong medical staff. You don't have the people going into medicine you had in the past.

I worry about some of the new programs, the HMOs, the PPOs. Are they restricting the patients too much? Are we killing the patients? Are we providing the right type of care at the right time? I personally think we're doing an excellent job here in this area. But I hear stories of other areas.

The biggest challenge we have right now is what's going to happen with the next election. No matter who is running for president, they have a special health care plan they want to present to the country. What type is it? Is it going to work? Do we have the dollars available? Are we going to be caught like the Canadian and British health care system of killing people then?

I spoke at the Ontario Hospital Association in 2000, when I was chairman of the American College of Healthcare Executives. This was the first Tuesday night in November, which was the elections, and they announced at that time that the Canadian government was out of money for any elective surgery. So there was no money left in Ontario, the (Canadian) province, for elective surgery for the first of the year - and this is the first Tuesday of November. So I'm saying we still have the greatest health care system in the world here, and I don't want to see it hurt.

I'll share with you that we lost our daughter to leukemia about 2 1/2 years ago. She was a senior at BYU (Brigham Young University) in nursing when she came down with it. I can tell you that I will match Sunrise (Hospital) and MountainView against any of the Utah hospitals where she was at. And there were a lot of hospitals - LDS Hospital, Primary Children's and University of Utah Medical Center. The doctors down here and the nurses down here were outstanding. So it really frustrates me when people say, "Well, we're leaving to get care someplace else" - because I'm a CEO and I know the type of care that she got in Utah and the type of care that's down here, and it was just as good, or better down here. When people say they're leaving, I get frustrated.

We had a great case that was covered in a lot of magazines. This was in the year 2000 when we had an individual come in with flesh-eating bacteria and we saved him. The company he worked for had a specialist fly in from UCLA, and when he finished looking at the guy and talked with all of the attending physicians, he turned to him and said, "You keep him here because he's getting as good of care at MountainView that he would get at UCLA." And we saved him.

Do we have challenges? Yes. But I think we have met the challenges. Health care is great. Now, people say the health care system is broken and it brings me to the next challenge we have and that's 20 percent of the population that does not have health insurance. Well, guess what, the hospitals and the doctors are taking care of that 20 percent. It's society that's broken by not covering them. We as the health care system are coming in and are taking care of those individuals. We never turn anybody away from the emergency center - we've stepped up and tried to take care of them. It's difficult.

Having my daughter go through it - people don't know how wonderful it is to be in Las Vegas. The leukemia manifested itself via a tumor on the spinal cord and she had gone paralyzed, so they rushed her to Salt Lake where she was operated on at LDS Hospital to have the tumor removed. They told us at that time she had acute juvenile leukemia, and she was then transferred to Primary Children's University of Utah Medical Center. About four weeks later, when she was discharged from the hospital, at the Ronald McDonald House (a temporary residence for patients' families), my wife went to pay, and they said it's already paid for. The employees and the physicians and the volunteers at this hospital had taken up a collection and paid for her chemotherapy for two months. Then, once she started her chemo pathways, we were able to get her transferred down here. When she passed away, one of the employees said, "Let's start a nursing scholarship in Amanda's name, in lieu of flowers."

We had $50,000 come in from the community, the hospital, the employees, the physicians, the church. Then HCA (Hospital Corp. of America, the parent company of MountainView) said, "We'd like to help also." They asked, "How much to endow a scholarship at Nevada State College?" And we said $105,000. They donated $420,000 - there is $470,000 in five scholarships at Nevada State College School of Nursing, so Amanda's love for nursing will live on. Is Las Vegas a great place to live? You bet it is. I've watched the other side of health care. I just talked with all of our CEOs at HCA and at a recent meeting in New Orleans, I said I want to stand up and tell how great people were when we went through the tragedy of losing our daughter to leukemia. Was the care-giving great? She had beaten the leukemia - it was the pneumonia that had come back that finally took her on her fifth and last chemo.

I've had the great opportunity to not only serve as chairman of the Nevada Hospital Association but chairman of the Utah Hospital Association, and then I've also held several national positions. There are three states that have the lowest number of nurses-to-population ratio: No. 1, California, No. 2, Nevada, No. 3, Utah. These states that have fast growth - we just don't have enough nurses. As an association, we sit down and look at the problems, and we say, "How do we get medical professionals, not only nurses, but physicians, into Nevada?" And we've got a double-edge sword because we used to recruit people and say, "Look at home prices, they're great." Now, in the last five years, with home prices going up, people can't come in and buy a home, and at the same time, those who bought homes five and 10 years ago, can sell their homes, go to the Midwest or Texas and buy huge homes and still have money left over. In the associations we talk about that - we talk about all the political issues, the bills that are being passed. Some organization might want some type of bill, another organization might want another. And it comes back to delivery of health care.

Just look at what is happening in the news with United(Health Group) taking over Sierra Health (Services). Is that going to be good? Is that going to be bad? We don't know. We gotta wait to see what happens. But there are these mergers taking place all along.

Well, you're talking to the hospital side, so yes. I think that the insurance companies do have too much power and sometimes they tell the physician when to hospitalize a patient, tell the physician when to discharge a patient, and we've seen problems with that in the United States. I think we've had great working relationships here at MountainView with the insurance companies because they know they're getting a very quality product here. They know our length of stay here in the West is a lot lower than in the East. Are they controlled too much? I would say yes, but we don't have the problems that some other areas of the country have.

That's key because you should know what type of care you're getting. I look at the grades we have here and I'm very pleased. Can they improve? Absolutely. But overall, I'm very pleased with the scores that MountainView Hospital has, and we're continuing to improve.

I truly feel that someone should be looking over our shoulders. We have the responsibility to do it ourselves, because the one thing we have built MountainView Hospital on is quality. Are we the only hospital in Las Vegas that requires all of the membership of the medical staff to be board qualified? Yes. Board certified? Yes. So is that a start in providing quality? Yes. Any way we can look at improving quality, we will. The step of having everybody board certified is a step of saying, "OK, what's the average length of stay for this diagnosis? Are we, at MountainView, in the range where we should be?" And, if we're not, then I have personally sit down with physicians and say, "Look, this is the length of stay in the United States, this is the length of stay in Las Vegas, this is the length of stay at MountainView, this is where you are." So it's no different than the training they receive in medical schools and residencies and fellowships. They're compared against each other. Whether we like it or not, we're compared against other hospitals not only in Nevada, but in the United States.

The profit margins continue to drop because of the 20 percent of the population that's uninsured, and they'll continue to drop. A third of the hospitals in the United States are losing money. A third are breaking even, and a few are doing all right.

MountainView, because it's a new hospital, has the latest type of technology, but we still write millions off every year for the uninsured. Yet as a community hospital, that's our responsibility, we'll accept that, but so far, we've been able to do all right.

I think, and I'd have to look it up, we budget about $1.8 million a month for those who do not have insurance coming through. Some of those we write off just as charity, some of those we write off as bed debt, others, if they qualify, we'll get them signed up for Medicaid and other programs where they are eligible. We deny no one care once they step foot on this property. And the thing that I like about it is that the nurse on the floor has no idea if that patient they're treating has insurance or not. Everyone is treated the same.

In fact, someone called me this week, had a VIP coming in and could they get the VIP treatment? I thought, we don't have any VIP treatment. The only thing that's different is, at the end of the hall, some of our beds are semiprivate. The only thing we could do is say, "Yeah, we'll make sure you'll get a private room, but most of our rooms are private anyway." Everyone is a VIP here.

I don't know if we have a lot of programs. One of the things that I like is to educate people on what they should do. As a good example, (recently) when I was coming through the hospital, I was walking through the emergency center and a patient came in and said, "I've had a cold for three weeks. I'm here to be taken care of." The hospital emergency center is the wrong place to come for a cold. So the programs I would like to see is to educate people to receive the right care at the right place. There are a lot of programs we have to educate and we have the volunteers and others trying to do that.

My answer is to educate not only the uninsured but everybody on how to take care of yourself. Preventive health medicine, getting your check-ups, exercising and getting sleep. Know your body fat. Know your cholesterol. In 35 years of work, I've missed 10 days. Why? I exercised, and yes, I've put on a few pounds when Amanda was sick and died, and I've got to get the 20 pounds off. But to go 35 years and only miss 10 days of work, I think, is because I watch what's going on and my wife has good, well-balanced meals. It comes back to us on the preventive side. We can't have someone else take care of our personal health. We have to be responsible for our own bodies.

I would be very, very interested in (the fact that) 20 percent of the population is uninsured. First of all, if you're a business of 25 people or more, you should be required to pay for your health insurance. The No. 1 retailer in the world (Wal-Mart) does not have good health insurance for their entire employees and families. Employees' families need to be included at the time of employment.

In a Senate hearing about four years ago, there was a state back east, where one out of every four children on state welfare had a parent or parents who worked for Wal-Mart. That's terrible. I worry about so many of the businesses in this town that hire a lot of part-time people so they don't have to do it. So I would require all businesses sharing in it.

We exhaust so much of our business, Nike and others, going to Indonesia or Thailand or China. Well, to answer your question, just as we have a customs tax, I would have a health care tax on (import) items coming in. Now, we know that a car produced in the United States, the average health benefits cost of that car is about $1,800. A car coming in from Japan, it's about $800. So I would tax those Japanese cars coming in $1,000 for health care benefits for those who don't have it. So then, the $1,800 is the same on health care benefits if it comes in from a foreign automaker or if it's produced here in the United States.

Any product that is coming in from anywhere outside the United States, that comes in for a lower produced cost because of the lower salaries and wages, should still pay for the health care to help reimburse those who don't have health insurance here.

When we were building the hospital, you don't know how many people came to me and said, "Mark, you're building it too far to the north." Now everybody comes in and says, Why didn't you build it farther in the north? I'll never forget in June of 1995, driving down to Sunrise Hospital, and on the radio I heard that we had hit a million people. Well, three months ago, driving down to Sunrise Hospital. I heard that we hit 2 million people. So it's the growth.

You know, we used to take the boys camping up to Kyle Canyon. You could go 3 miles before the Kyle Canyon turnoff without homes. Now, there are homes there. I think we have, as I mentioned, two major additions. We've stayed very current with what's happening with the open-heart and valve replacement of neurosurgery, of level two (neonatal) nurseries. As we have grown as a hospital, we've become more mature, too.

And, my goal, which I hope it comes through, is to have a third tower put on, so that we have more women's services, so we have more children's services to meet the needs of the northwest. As the valley continues to grow, we were the first of the new suburban hospitals. Now there's eight new suburban hospitals. Where else in the United States are you going to have growth like that. It's amazing.

I think it is an organization you want to have a relationship with, in this case, because of the growth of the hospital and neurosurgeons who live here. A couple of neurosurgeons just wanted to come here and they happened to be associated with NNI. In the last few months, those two surgeons came here and said this is a good way of letting people know that we now have neurosurgery coverage at MountainView Hospital. It's a lot like when the open-heart surgeons started doing their cases out here in 2001, and when we started to do all of the new procedures as we get new equipment in and new technology. This is just another chapter of a long book of where, excuse the term, super-specialist neurosurgeons have decided to come here and do most of the work here.

I would change the preventive health care. I think we wait too long to tackle diseases. In a perfect world, I would say, we should be checking everybody every year to find out if they are susceptible to diabetes, especially juvenile diabetes. We could stop a lot of juvenile diabetes if every year we checked the young people coming through.

You know, breast cancer, prostate cancer, if you had that yearly exam, it would save the delivery system millions of dollars because you could take care of early diagnosed condition, and whether it's cancer, whether it's AIDS, whether it's any type of disease, the earlier you find the disease, the better the outcome is. So I would put a lot more emphasis on preventive health care, of early check-ups. Early detection is what I would want.

One of the big changes taking place is the length of stay of surgeries. I remember in the '60s, when you had cataract surgery, you were in the hospital for about a week, and the first two days you had sandbags alongside your head. I remember when my mom had her cataract surgery in 1986 (or) '87, she was in the hospital for three days. Now I know of people who have had cataract surgery and made it to the senior citizens center for lunch that day. That tells me two things: No. 1, technology is a lot better (and) No. 2, you feel good enough to have a lunch after.

So the amount of time that it takes us to treat a disease is becoming shorter because we're becoming more efficient at it. I think with all of the ways we can scope into a body without having to open them up, our length of stay is becoming shorter. We're hearing - we just sent a physician back to Chicago to look at doing total hip joints on an outpatient basis - and you know an open-heart patient goes home in four to five days. I mean, it used to be two to three weeks, 20-30 years ago.

I think the major changes, and I think with a lot of the genetic research, we're going to be able to detect cancer a lot faster. It comes back to the preventive stuff. You can't detect it unless you're probably somebody who knows how to do the procedures. So the length of stay will continue to go down. We're hitting a point now where you really have to be sick if you are in a hospital. Most of the things we can take care of on an outpatient basis. The acuity level has raised as the expertise level has raised, as the knowledge of providers, whether it be physicians or nurses, has raised.

The employees and the medical staff and the volunteers. They are so dedicated. I just feel this medical staff, these employees, the volunteers, make the hospital what it is today because they are tremendous. I enjoy making rounds every single day, including Saturdays and Sundays, to thank everybody. This hospital is what it is because of those three groups.

Serving and just knowing people, working with people, walking through labor and delivery and seeing a family excited. And yet, at the same time, walking by the emergency center and seeing a family coming out in tears because of the loss of a loved one. You know, you have both sides to it, so you have to adjust yourself, but I look at the many who come through the emergency center that we return to normal health and strength. It's my association with people I will miss the most because you learn to respect and love people for the training and education.

I had the privilege of living with physicians for a year in Vietnam and Thailand, and I saw the pressure that they were under, of being called to the hospital any time during the night when the wounded started to come in, and how dedicated those providers are. I tell people, I can come to this hospital any time of the day or night and there are physicians who have left their home to come in here to try to help patients out. That, I will miss.

When you love a job, you always look at the 95 percent positive, and not the 5 percent negative. I think one of the major things I will miss (least) is just the political environment that goes on with all of the HMOs, and the PPOs, and the state government with restrictions and regulations. The amount of time it takes us to get a new program started, because of the licensing and that type of thing, and yet, they're doing their job. I remember the amount of time it took to license this hospital when it was new to the amount of time it takes just to bring a new service on. So I think bureaucracy is the thing that I will not miss.

I just think, what a great place to be, and then the other thing, I'm receiving a national award (March 10). It's called the Gold Medal Award (from the American College of Healthcare Executives), it's given to the top health care administrator in the United States. Never did I think that I would get an award like that. When they called, I was just emotionally taken because there are so many outstanding people out there to receive that award. And then there's some other awards that have come down, to be classified as one of the five most respected CEOs in the state of Nevada. That meant a lot to me because it comes back to integrity and what you leave to the community.

I hope I have left some of my love for health care, love for people in this community because I have been through the military to Africa on a medical humanitarian, and I know how wonderful it is to live here. How great health care is here. How generous people are. To have $470,000 - I didn't even mention another scholarship that's been donated at Brigham Young University School of Nursing in Amanda's name. Then to have BYU College of Nursing give Amanda an honorary nursing degree, to have, a month later, Nevada State College give Amanda an honorary degree in nursing. Is this a great place we live and work in? You bet it is. So it's the people I'll miss.

Nicole Lucht covers health care, workplace and banking issues for In Business Las Vegas and its sister publication, the Las Vegas Sun. She can be reached at 259-8832 or nicole.lucht@lasvegassun.com.