Two things jumped out at me when I finally got a look at the highly guarded Segal report, ordered released by a local court Wednesday morning.

One is how county supervisors or officials tried to get around public records laws by changing the title of the report to hide it under "labor negotiations" when it clearly has nothing whatsoever to do with labor negotiations.

(Ugh, I can't begin to tell you how fed up I am by the county's game playing with the public's information.)

And number two is how the county was blithely shooting itself in the foot with regard to Kern Medical Center, according to the report's actual details. More on that in a bit.

To catch you up on the basics, back in 2009 the county awarded Managed Care Systems (MCS) a contract to administer its largest employee health care plan. MCS oversees about $100 million a year in costs and is paid $5 million a year for its trouble.

MCS is owned by GEMCare, which is partnered with Dignity Health. Dignity, in turn, owns or controls both of the Mercy hospitals and Memorial Hospital.

Almost as soon as MCS got the contract, conflict of interest complaints began to surface. Hospitals and specialists outside the GEMCare family said they saw referrals for county employees fall off. They feared MCS was unfairly steering patients to GEMCare affiliated hospitals.

In April 2011, County Administrative Officer John Nilon engaged the Segal Group, the county's independent health care consultant, to look into these allegations.

A year later, Segal produced its first report titled "Review of Medical Claim Utilization by Hospital," looking at data covering Jan. 1, 2010 through June 30, 2011. It detailed which hospitals county employees were going to on both an in- and out-patient basis. A second phase of the report came out this July and looked at cost by hospital for in-patient stays.

That report (exactly the same as the April report only with the second phase included) was titled "Review of the Plan Design of County Provided Medical Benefits and Benefit Design Recommendations for Future Labor Negotiations." County officials used the "labor negotiations" part of the title to withhold both reports.

I said all along that argument was hooey and Wednesday Kern County Commissioner Linda Etienne agreed, for the most part.

She ordered the report released with the exception of Segal's recommendations, which she felt were covered under the deliberative process exemption.

In her order, she noted the phoney title change saying the labor negotiation issue "was developed in order to avoid disclosure of the reports."

No doubt.

If you can't smell the corruption steaming off that little trick then you must be hard of smelling.

I'd like to know on whose orders Segal changed that title. Because whoever that was obviously doesn't understand who they work for and should not be collecting a taxpayer funded paycheck any longer.

As to the content of the two phases of the Segal report, the upshot is that, yes, Dignity/GEMCare gets the lion's share of in- and out-patient dollars from the county plan. Dignity got 59 percent of the total in-patient expenditures over the time frame studied and 67 percent of the total out-patient expenditures, according to the report.

Expenditures for both Mercy and Memorial hospitals increased markedly in the first six months of 2011, but the report doesn't explain why.

Dignity hospitals also had the longest average length of in-patient stays in 10 of 15 different diagnoses studied by Segal. Length of stay is the dominating factor in evaluating in-patient costs, according to the report.

The head of MCS, Brent Boyd, was out of town but he emailed to let me know the company's attorney was still in the process of getting the Segal report.

There are lots of questions to be answered about how patients are moved to different hospitals and, more importantly, whether the county is getting the best bang for its buck with MCS and Dignity hospitals.

To me, the really sore thumb in the report was what happened to KMC over the time period studied by Segal.

Claims went from 20 percent of total county plan dollars to just 7 percent for in-patient stays. For out-patient work, KMC went from getting 19 percent of the health plan's dollars to less than 7 percent.

And, remember, this is just looking at an 18-month time frame. MCS has had the contract since 2009.

KMC's chief, Paul Hensler told me the hospital definitely noticed the drop in county employee referrals when MCS took over the county employee health plan.

But, he said, even such a significant drop didn't do that much monetary harm.

"County employees aren't a large overall portion of KMC's paying customers," he said.

Unlike Medi-Cal patients, he said. If KMC were to see such a drop in those patients, that would be huge hit.

Losing county employees to Dignity hospitals might be a big a financial swipe, but think how ridiculous this situation is.

Taxpayers are helping to provide good, solid health insurance to county employees. We're also paying a private company, MCS, which is apparently steering a large portion of those employees away from a publicly funded hospital.

And taxpayers are constantly being tapped to help prop up that publicly funded hospital when it can't pay its bills because it doesn't have enough well-insured paying customers.

No wonder supervisors wanted to keep this report under wraps. It stinks coming and going.

Opinions expressed in this column are those of Lois Henry, not The Bakersfield Californian. Her column appears Wednesdays and Sundays. Comment at, call her at 395-7373 or e-mail