As our community continues to grow so do the health care needs of our community. Tahoe Forest Hospital System, which includes our own Incline Village Community Hospital, IVCH, is adapting to a challenging and evolving marketplace. Tahoe Forest management, staff, volunteers and even community members and patients are working together to ensure that Tahoe Forest, at each of its locations, can fulfill the priorities and needs of all residents in Tahoe as well as the smaller rural communities nearby.

Over the last 6 years, The Tahoe Forest Health System has grown tremendously, in fact, it has more than doubled in size. Throughout its network, Tahoe Forest has added Physicians, Nurse Practitioners, and Physician Assistants. In total, Tahoe Forest now has over 160 health care providers as well as a largely new management team including a new Chief Nursing Officer, Jan Iida, the new Chief Operating Officer and Administrator for Incline Village Community Hospital, Louis Ward, who was interviewed for this article. Beyond staff, facilities and beds, medical specialties have also grown. With this growth, has come an even higher standard of care. The governing boards’ vision is to be the best mountain healthcare system in the nation. All of this is relevant because the national medical landscape is ripe for change and as a critical access hospital, Tahoe Forest serves a key role in the larger system. 

The Tahoe Forest Healthcare system is a licensed critical access hospital. This is defined as a healthcare system that operates in a rural area and offers services to patients who might otherwise have a hard time accessing care. Given their geographic locations, critical access hospitals face a number of challenges that urban hospitals do not often encounter. Typically, in rural communities, the health insurance landscape is more varied between those who are insured and a larger number of residents who are not. Due to this, a higher percentage of patients often need financial assistance. High proportions of patients travel from long distances and this poses a challenge for providers in terms of regular engagement and also in preventative medicine programs. Fewer specialties and smaller staff often make certain healthcare challenges hard to treat. Things that challenge city hospitals such as drinking, drug use, and addiction, also plague smaller rural hospitals but in larger proportions. From an overhead perspective not directly related to care costs, smaller, rural hospitals typically face obstacles such as extreme weather, atypical building codes and smaller work forces to pull from for staffing. In the past, many of these things have been true of Incline and have historically helped contribute to healthcare challenges in our town. 

As Harry Weis, President and CEO of Tahoe Forest Hospital System, explained, one-third of hospitals system similar to the Tahoe Forest System are at risk of closing due to financial distress. Critical access hospitals offer similar if not the same services, hours and specialties as urban health care environments, but typically receive lower reimbursement rates despite similar overhead costs. Weis and his team have taken a lot of preventive measures to ensure that they are not at financial risk and can continue to serve the communities in which they also live. Integration into the community through schools, outreach programs and a number of partnerships that keep health on the forefront of residents’ minds are a part of these measures. This incorporation into the community is seen almost daily in Incline Village with lines blurred between community members and healthcare providers as providers are also residents and regularly socialize, work and cross paths with their patients. This seamless integration into residents’ lives makes initiatives like the Wellness Program even easier to integrate.  The Wellness Program is a perfect example of this proactive community base approach to help patients think of health in a multifaceted way focusing on diet, exercise, motivation, mental health and long term health care planning. 

The Wellness Program, as well as the way the entire Tahoe Forest system is run, is based on the idea that the future of healthcare is an Outpatient system, rather than an Inpatient one. The number of ER visits, typically an expensive method of health care delivery, have increased greatly in Incline due only to community growth. Overall though, within the entire system, ER visits have remained flat for the last ten years due to a preventive community based approach. Tahoe Forest wishes to have more consistent and less emergent interactions with patients in the system rather than infrequent high emergent visits. This line of thinking can be seen in the new specialties now offered at the IVCH Health Clinic, 7 in total. The concept of regular contact between patient and provider, based on a holistic healthcare approach is better not just for individual patients but also for the system and our community at large.

While critical access hospitals like our own IVCH, do face unique challenges, they also have exceptional buy in from community members and staff all of whom also double as patients and beneficiaries of the local health care system. “One can only wish to get so lucky as to have such a talented and dedicated staff in this community, as well as our volunteers,” noted Louis Ward. Ward explained how recruiting staff to meet demand has not been a challenge as people really seem to want to be in Incline. IVCH also has numerous volunteers who have logged hundreds, if not thousands, of hours helping around the hospital campus. Additionally, the IVCH’s new ER, finished in 2008, was largely possible because of community donations and volunteers. This type of investment from residents it not typical in a more urban setting where the healthcare system and its workers are not as interwoven into the daily fabric of the community. This experience makes outreach programs far more effective which in turn can improve healthcare outcomes and also keep costs down. 

As Incline, and the greater Tahoe region continue to grow, Tahoe Forest is expecting and preparing for additional growth. As this happens, the community hospital here in Incline will likely expand also. Upper management is cognizant of the community culture and the mutual respect between healthcare provider and patient in this small town. Maintaining this connected and caring culture is on the forefront of the new COO’s mind as he looks to the future, “As we grow and change, we are leaning in on staff that have been here a long time to set the trends and outlook. We are being very purposeful around our mindset about community healthcare and what it actually means.” He continued, “Our patients are not a number to us, we have relationships with them, we know them directly. They work in our kid’s schools, we see them about town. Any of those kind of things, lends itself to a healthcare experience that the patient can be confident in.” 

The belief in the importance and necessity of great healthcare for all, with a focus on evolving community needs is why Tahoe Forest exists and is at the forefront of every decision its management team makes. “Every human at some point will experience great pain and discomfort. We do not realize how important healthcare is until you need it,” said Harry Weis. “Outside of our families, timely access to great healthcare is the most important thing in life.”

Residents of Incline Village, Truckee and surrounding areas are lucky to have a healthcare provider and system as adaptable, personal and caring as Tahoe Forest. 

Visit Incline Village General Hospital and Tahoe Forest Health System online.

**This story was originally published in LIVE.WORK.PLAY., IVCBA’s magazine. You can read the latest edition as well as archived issues online.**

On a Wednesday morning, the Incline Village-Crystal Bay Township Justice Court has a full slate of cases.  The day’s schedule begins with Judge E. Alan Tiras working with clerks, lawyers, and the defendants before him.  And today he hears pleas and issues sentences for misdemeanors that occurred within Incline Village and Crystal Bay.   However, most of those appearing in court today are not within the township, they are before the court virtually.  

An Assistant District Attorney checks in to the hearing by Zoom from the Truckee Meadows.  The defendant is in custody in Reno but appears and participates virtually.  A defense lawyer joins with a blurred background.  Seated on the bench, Judge Tiras conducts this hybrid in-person and online court with the skill of a symphony conductor.  As camera focus shifts to those speaking at the time, the judge turns on and off mics confirming that all parties can hear and understand the proceedings.  One defendant requires a translator and Tiras calls on a court clerk to join in, adding to the complicated but smooth interaction.  

At the end of one case, he wraps up by confirming the defendant understands everything that has transpired.  “Now, don’t take this the wrong way but I hope I don’t see you again, at least not in this setting.”

Since 1980, the Incline Justice Court has provided a venue for residents and visitors to settle matters including traffic violations, evictions, and temporary protection orders, amongst others.  Tiras, who was elected to this position in 2006 and took office in 2007, explains that Justice Court is considered the people’s court.  

“The vast majority of interaction of courts and the public is at our level,” says Tiras.  “Generally speaking, we’re dealing with people that haven’t messed up too badly yet.  And it gives us an opportunity to help them so they don’t continue down the path to something more severe.” 

While the court hears citations and misdemeanors, cases can also involve more serious charges including felonies.  “What’s important is how can we help people…so they’re not making those same wrong decisions.  Punishment is a tool in the tool box but it’s the last one we want to use.”  

For Tiras, this position allowed him to continue a life of public service to the community.  In addition to his “wonderful relationship” with his wife of 41 years, Tiras credits his uncle as being, “a catalyst for my interest in public service.  His philosophy is that if he can work to make the community a better place then he is the beneficiary.” 

Following the public service lead of his uncle, Tiras served on the City Council of his hometown of Seminole, Oklahoma and was honored as Citizen of the Year.  Serving as an elected judge is “my way of trying to make things better,” says Tiras.

First visiting Incline Village in the mid-1980s, he decided to make it home, moving here in 1990 with his wife, Natalie and two young children. Judge Tiras thinks the community is a great place to raise children.  “They had amazing educational opportunities and could participate in extra-curricular opportunities as well,” he says. 

“When we first decided to move here, we loved the mountains, trees and, of course the Lake, but what keeps us here is the people,” Tiras says.  “We met many of our best friends through the schools and school events.”  He continued to follow his passion for public service by taking on leadership roles with Rotary of Tahoe Incline and the Incline Village Chamber of Commerce among others.

Judge Tiras also participates in We the People:  The Citizen and the Constitution Program of which Incline Village High School’s team is a perennial state and national contender.  He finds assisting program advisor Milton Hyams “very rewarding” but also educational.

“Not a week goes by when they don’t teach me something,” he says.  “It’s interesting watching the student progress from uncertainty to true constitutional scholars.”  With students learning to research, speak, argue, and support their positions with evidence, some former We the People students may soon be representing plaintiffs or defendants before Judge Tiras’s court.

In 2019, Incline Justice Court became the first court in the state to offer virtual options for traffic court defendants.  Holding court virtually was initially challenging but the process was gaining momentum before the COVID-19 pandemic suspended court services state-wide.  With experience gained from virtual traffic court, Judge Tiras and his team soon took the full court calendar online, becoming the only one in the state for several months.

“The virtual program is an unqualified success,” says Tiras.  He questions why defendants should take time away from work or their families to plead not guilty to a parking ticket.  “I don’t need to make it inconvenient to them to have access to justice.”  Defendants might attend during a lunch break at a job site or when they are physically unable to travel to Incline.  If the parties are participating and present wherever they are, the court can adjudicate the matter.  

“At this level we have the opportunity to figure out what we can do to help them.  It’s a really rewarding position to be in,” says Tiras.

Michael McNulty is a licensed drug and alcohol counselor whose clients have appeared at Incline Justice Court.  He says the benefit of having a local court in Incline is, “the efficiency of justice being satisfied promptly.”  McNulty states that Tiras offers, “kindness but with a firm hand.  I often hear him encourage defendants to use all of the resources that the Incline Justice Court affords,” such as attending counseling or participating in victim impact panels.

With the success and benefits of virtual court proceedings will there continue to be a need for the physical location of Incline Justice Court?  Due to a lack of technology access, virtual is just not an option for some parties.  “We need to be accessible to those people too.  There needs to be a physical space for live trials, hearings, and payment windows,” says Tiras.

More changes are in store for the court this year.  In February, the Board of County Commissioners voted 3-1 to abolish the office of the Incline Constable through an amendment to Washoe County code.  Constables provide court security, pre and post trial services such as drug testing, and process serving in addition to other duties.  The move by a Commissioner outside of District 1, which includes Incline Village, surprised Tiras.  “What bothers me is the process,” says Tiras.  He thinks the change to abolish the office of the constable is not good governance.  “Let’s talk to the stakeholders, find out what the goals of this change are.”

Some see the elimination of the constable office by the County Commission as a step towards eliminating the Incline Village township and therefore the court.  “I don’t think it would be appropriate for a judge not from Incline to adjudicate Incline matters,” says Tiras.  “They don’t have the understanding of the community, the community standards, the geography.  It would be a huge step backwards if we didn’t have a local judge.” 

The court will also move to a new location at 855 Alder Ave., the former library building and current Incline Village Community Center.  Since 1982, the court has held space at the Centerpoint Executive Offices building at 865 Tahoe Blvd.  The court will now move into a county-owned building for the first time in its history.

As the Incline Village-Crystal Bay Township Justice Court deals with transitions over the coming year, the court continues to take each opportunity to help its constituents.  “Consistency is fair.  And justice is that people are treated the same throughout the process,” says Tiras.  By using innovations like holding court virtually, Judge Tiras can offer the consistency of access to justice from Incline Village that reaches beyond the community.      

*This profile appeared in the Spring 2022 issue of LIVE.WORK.PLAY. magazine.