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Dear Gail…

January 19, 2010

Dear Gail Kerr,

This morning I was interested to read your commentary about the things to come on Mayo Karl Dean‘s agenda, as if anyone needed to point out that there are many issues ahead that need to be considered; issues in fact that have needed to be addressed but haven’t seen the light of day with all focus on the MCC. It is good, of course to get this behind us and move on, but I found it interesting that the lead paragraph of your commentary focused on a project near and dear to my heart, Metro Nashville General Hospital. You wrote:

With the exodus of the Metro parks director and director of hospitals, Dean gets to hire replacements that he wants, not that former Mayor Bill Purcell wanted. This is huge for him, particularly when it comes to picking who will run General Hospital. Dean has been quietly trying to figure out what do with the money-losing city hospital that is supported by Metro Council’s black caucus.

I know that you can’t be expected to be an expert on the issues you are addressing and sometimes have to draw on materials from all sorts of sources. I also don’t expect that you could give much time to researching the background of the issues you are writing about so since I and my friends at Nashvillians for Metro General have spent the past year delving into the hospital situation from all angles, let me help you out.

First of all, let’s consider the issue of hiring the new CEO of the Nashville Hospital Authority. By statute, the Hospital Authority is an independent body composed of persons appointed by the mayor, but with several having to fill specific medical roles. Yes, there are some on the Authority that were appointed by Dean, but there are several who aren’t, and it is the Authority that will decide who will run the hospitals. Oh, I know the mayor will have a lot of input, but can we at least try to maintain the illusion of independence that was expected with the legislation creating the Hospital Authority was created? Beyond that, currently Vanderbilt University has a contract with the city to provide the executive leadership for the hospital and unless something changes, Vanderbilt will be charged with running the search to find the most competent executive to run the hospital. Again, will the mayor have a voice in hiring? Probably, but let’s not over simplify the process and claim that the mayor will have the sole voice in selecting the director of hospitals, since that person works for the Authority, not for the mayor.

Second, about quietly discerning what to do. Maybe you weren’t aware that there was a task force appointed by the mayor to oversee a consultant’s report on indigent healthcare in Nashville. I’m surprised they didn’t ask you for input because they seemed to interview most anyone in town with an opinion on the issue, and there many of us that have been waiting with anticipation for the report, which seemed to become less of a priority due to some other project that seemed to get in the way. It hasn’t gotten much press, because frankly the issues are complex and there isn’t much of a horse race at this point, but be watching for public conversation to come, and trust me that there will be some noise made when the report is released.

It’s the last sentence that really bothered me, the one about the hospital being “money losing” and implying that the only support for the institution in by the Black Caucus. Yes, the hospital is running at a deficit this year, but it is a deficit that Rich Riebling approved. The hospital has worked hard during the past four years to become as efficient as possible. When they mayor demanded a 10% cut in the hospital subsidy last year, the hospital informed the mayor’s office that they could not meet that target without cutting services, such as the outpatient cancer chemo clinic, which is the last line of treatment for the poor who have cancer. The mayor’s office did not want to be accused of harming poor people, so the hospital was told to leave the $1.5 million dollar deficit in the budget, and that they would deal with the shortfall later in the year through other means. This year, the hospital is in better financial shape than it’s been in for many years, however their budgeting was on the money and they are still projected to have a $1.5 million deficit, mainly because we as a city would not adequately fund the health care needs of the poor. The big problem facing the hospital, a problem that you have never addressed, is the $10 million dollars in TennCare cuts facing Metro General and the $25 million in TennCare reserves due to the hospital that are not being shared by the governor. Yeah, Metro General has huge problems ahead, but they aren’t of their own making.

As for the support for Metro General, I think the 70 plus pastors, imams, and rabbis from throughout Nashville who signed a letter of support for the hospital would be surprised to learn that the black caucus was the only supporting agency. I think the 200 folks who gathered on the steps of the Metro Courthouse would likewise be surprised, as would the members of SEIU who have a personal interest in the well being of the hospital.

Gail, Gail, Gail… it’s hard to understand why you seem to want to come after the hospital. Could it be that poor folks don’t buy your paper? Or maybe there are folks in the administration that have an ax to grind with certain community leaders who have pushed hard against the administrations ambivalence toward the need for a city supported (not run) safety net hospital, and have sold you a bill of goods.

I don’t know.

All I know is that closing our hospital will certainly lead to some people dying, and I’m not willing to support any entity that would let people die in the streets.

Hyperbole? Maybe. But given the stories from other cities that have cut hospital services or closed public hospitals down, it really isn’t that far from the truth.

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4 Comments leave one →
  1. January 25, 2010 8:20 pm

    Hi, Jay:

    I’m not familiar with the $25 million in TennCare reserves for the hospital. Is there something you can point me to that would explain this?

    Thanks,
    Anita Wadhwani,
    freelance reporter
    awadhwani@caa.columbia.edu

    • January 25, 2010 8:38 pm

      Anita, the best person to talk with regarding this is Gordon Bonnyman at the TN Justice Project. While I am no expert I’ve been given to understand that there are $25 million in funds that are supposed to be disbursed as DSH (Disproportionate Share Hospital) for indigent care that are being held by the state.

      • January 27, 2010 10:37 am

        Thanks – I’ll ask him. – Anita

  2. Mike Hodge permalink
    January 26, 2010 3:30 pm

    Thanks for a thoughtful response. (Yes, I do over-use the word “thoughtful” — but in this day of slash and burn blogging, it is quite refreshing to find someone being thoughtful.)

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