Sale Or Sellout?
Hospital Buys Time

David Byrns is a lanky, chain-smoking Kentuckian with an air of permanent distraction. His mission, as he describes it, is to travel the country, rescuing rural hospitals from financial insolvency. His latest stop is Greensboro, Georgia, 35 miles southeast of Athens, where Byrns and his publicly held company, Pacer Health Group, scooped up the non-profit Minnie G. Boswell Memorial Hospital at virtually no cost. The hospital, with 80 percent of its total billings from Medicaid, Medicare and indigent care, was losing $300,000 a month, and was two days from shutting down its ER.

With his cowboy boots and well-pressed suit, Byrns seems an unusual prophet of privatized care, but then, he brought it to an unusual place: an old cotton-belt Georgia county full of new lakeside wealth, ground zero for President Bush's fundraising campaign. Rich and poor segments of the county have paid dearly for years to keep the hospital afloat - possibly as much as $8.6 million in cash, bond proceeds and outside investment in the last five years alone. (Critics of the sale say only a fraction of the alleged $8.6 million in expenditures actually reached the hospital or came from direct county expenses.)

"Sometimes counties and health care don't mix," Byrns says. "The thing that kills most rural hospitals is debt."

For more than half a century the hospital has served inhabitants of rural Greene County (population 14,406) tending to broken bones and more serious ailments. The last 20 years have been rocky, with the hospital authority turning to local government every year or two for a bailout. With massive community support, Minnie G. did better than many: nine rural hospitals in Georgia have closed in the last quarter century. Escalating medical costs, high levels of indigent care and problems attracting doctors have helped create the problem. Another drain comes from the 1996 Balanced Budget Act, which set new limits on Medicare reimbursements.

"Rural hospitals in Georgia and around the country are fundamentally having some difficulties," said state Rep. Mickey Channell (D-Greensboro.) "Those reimbursement rates have not kept up with inflation."

These days, the service and hospitality industry has given a boost to the old sharecropping county, a haven of high poverty rates and government spending, hit hard by closures in the textile industry. The booming Lake Oconee area, helped along by low millage rates, added $111 million in new taxable property values in 2002-2003 alone and has provided hundreds of much-needed jobs. The Ritz-Carlton that opened in 2001 employs about 450.

The exclusive lake district functions these days as a lucrative stop for President Bush on his fundraising campaigns. Mercer Reynolds, the Cincinnati financier who developed Greene's Reynolds Plantation lakeside resort, serves as the Bush-Cheney campaign's national finance chair. Homes are still selling briskly around the lake, with some valued as high as $5 million. With more than half of county revenues coming from taxes on the gated lake communities, the weekenders and retirees are increasingly having their say in government.

"As business owners they are better suited to recognize the waste and do something to stop it," Greene County Manager Byron Lombard says.

Minnie G was a ripe target for county-wide criticism, with its top-heavy administration and lax billing. The hospital chargemaster had not updated billing codes in six years, creating a backlog of unpaid bills. Equipment was broken or outdated. When surgeon Bo Cheeves returned to Greene from an African missionary trip, he had to schedule 30 scope procedures at Putnam General Hospital, 25 miles away.

"The scope was broken," Lombard says. Oversight at the hospital deteriorated to such a point, he says, that legally mandated audits have not been done since 2002.

"There's some concern about fraud," Lombard says, and ongoing probes by the county and Pacer of an off-the-books checking account and drop box. Some residents, including physicians, lost faith in the facility. Last month, closure seemed inevitable.

"The President can raise $2.5 million in less than two hours, and we can't raise enough money to keep the hospital open," says Dr. James Southerland, a Greensboro family doctor.

To some, the pending hospital sale is another sign that county authorities are working harder for the lake district than for those who rely most heavily on the hospital: the inhabitants of the town and surrounding rural areas. William Breeding, retired principal of the Greene-Talliaferro High School, says when $109 million in state transportation funds went to widen Ga. 44, the Lake Oconee Parkway, the county's dirt road residents grumbled. "They've been living on dirt roads, since dirt roads were invented," Breeding said. "To me that's not right."

Other complaints have been heard, about the Greensboro bypass, the passage of Sunday liquor sales and the $750,000 in sewer funds spent on a lake water tower.

Yet the notion, held by some, that hospital support is split along economic lines irritates Hospital Authority Chair Tom Mayers, a retired Motorola executive who lives on the lake. "I don't know of anybody who wanted this to close," says Mayers, pointing out that almost all of the hospital's "pink ladies" live in the lake communities. The annual Minnie G. fund-raiser is held at Reynolds Plantation, at no cost. Lake residents have also invested time and money in Habitat for Humanity, as well as the much-touted "Dreamers" educational incentive program, targeting Greene's 30 percent high school dropout rate.

"Everyone here on the lake would like to see [the hospital] stay," said Len Ebersberger, a Lake Reynolds resident who travels to Atlanta to see a cardiac specialist. "Morally, it's the right thing to do. But who's going to pay for it? The majority who pay for it would never go. Eventually the hospital will close."

"Maybe they see some gold with the lake people," says Doug Bachtel, a rural demographer with the University of Georgia. But to sustain a for-profit hospital, "there just isn't that critical mass there of people. It's a recreational development. Folks are part-time residents that have second homes there."

But county leaders like their chances now with Pacer. An 18-month old Miami-based company, it owns only four facilities nationwide, but has an experienced board and a good track record. "We move very fast," Pacer CEO Rainier Gonzales says. "Our job is to save the hospital and save the jobs."

Pacer was the only one of several contenders that allowed the county a cap on how much taxpayers would have to invest in the hospital's resurrection. The county will pay $6.2 million long-term to settle the debt; in exchange Pacer has promised to maintain indigent care at needed levels. That's key for Greene, where health statistics such as the infant mortality rate remain grim.

"This group seemed more flexible. They were willing to step up and participate," Mayers says. The fear is that Pacer won't balance community care with the interests of its stockholders, or that it will put the hospital into bankruptcy after only a brief attempt at turning a profit, but according to Mayers the hospital authority greatly minimized that risk, with Pacer agreeing to an 18-month, money-back guarantee on the $2 million the county will invest short-term during the ownership transition. "If it's a profitable operation, there's no incentive to sell," Mayers said.

Even some prominent opponents of privatizing the hospital, such as hospital authority member Dr. Bill Rhodes, are impressed with Byrns' early efforts (the needed scopes are on their way). Rhodes has contended that commissioners and lake interests "want something for nothing" and perhaps fail to recognize the low-profit, crucial aspects of rural hospital work, such as obstetrics.

Greene's hospital is the only county hospital in the Lake Oconee area to deliver newborns, a costly service requiring 24-hour staffing. The concern is that such services will be abandoned by a private operation. But Rhodes had little choice but to vote to sell: he says commissioners pressured the hospital board into signing the agreement with Pacer. "It was do that or we don't have a hospital — that impressed the hell out of me."

Rhodes acknowledges that things are happening.

"A for-profit is better than none," he says. "Everything was collapsing around us. He has gotten more ER doctors on board. We were in dire straits, for just surgical supplies, IV kits, fluids. Now they're there. The pharmacy has been straightened out. I think he's trying. We do not have a radiologist on board yet. He's talking to a couple of groups. I certainly have to give him credit. I think the important thing is to have a good hospital, and be here for everybody, for all people. I'm going to try to work with them. I think time will tell."

With the ink on the deal still drying, Byrns and Gonzales have been trying to convince other residents - with advertisements, press releases and word of mouth - that Pacer wants to keep the 15-bed hospital, with its 29-bed nursing home, open indefinitely.

A prime challenge will be simply getting more people into town and through the hospital doors, a difficulty for rural hospitals. Some 70 percent of Greene Countians travel outside the county for health care.

Most Greensboro doctors, following market forces, have shifted their practices outside Greensboro to the burgeoning lake area, seeking new, better-insured patients to help them offset rising healthcare costs. The Atlanta Cardiology Group has opened a branch near the lake, and a radiation and cancer center has announced plans to build a new 10,000-square-foot facility off the Lake Oconee Parkway. The Medical College of Georgia in Augusta plans a 24-hour clinic near the lake.

To insure its viability, Minnie G. Boswell Hospital may ultimately have to move toward the lake, too. "It's not whether Pacer is ready for that," Gonzales says. "It's whether the community is ready for that."

Joan Stroer
Joan Stroer is a local freelance writer.

Food Not Bombs
Garden Nourishes

"Food Not Bombs is a small way of doing things that make sense," says Sarah Himmelheber, a volunteer and organizer for FNB, "using food that is going to get wasted and cooking in a way that allows more people to eat and everyone to be healthy."

Because of the support of local businesses, citizens and the University of Georgia, anyone can walk down College Avenue and get a free vegan meal twice a week. The food handed out in front of Barnett's is often collected from restaurants or organic grocery stores that waste good food regularly. Though the produce collected by the FNB volunteers is past its expiration date, it is still edible and is of substantial use to the community.

"They [businesses] constantly throw things away mostly because of paranoia and they produce way too much," says Todd, a regular volunteer at the Community Garden and for FNB, who only provided his first name. "No one can buy as much as they produce."

"As long as the stores are making a profit, they don't give a shit about what they throw away," Himmelheber says.

While Food Not Bombs volunteers express gratitude for the support of local businesses in fighting hunger, many take steps to make the organization less reliant on outside support. Nowhere is the feeling of independence and communal effort more apparent than at the Community Garden. The several-acre plot donated for the garden on Odd Street has become a flourishing bed of fresh soil and crops. When the crops are harvested, they will be donated to the FNB efforts.

Today, the garden is home to a host of different organic fruits and vegetables: broccoli, okra, cauliflower, seven types of beans, watermelons, peas, squash and more. Despite the lack of extensive gardening knowledge among most all the volunteers, regular churning of the soil and watering of the seeds were all it took to maintain the garden.

"The soil is natural. Straight Athens-based soil, no pesticides," says Ross Heber, a caretaker of the garden. "To grow it, cook it and eat it - that's what food is to me… To this day I'm still pulling out rocks and glass, but the garden is beautiful, man. I love it."

The volunteers of Food Not Bombs do not intend to rely solely on the yield of the Community Garden to become more self-sufficient. The organization intends soon to cultivate an 82-acre farm in Oglethorpe County that produces a 25 percent surplus with each harvest. Himmelheber is confident that the yield from the farm will help fuel FNB for several weeks. But finding good food about to be wasted is not the greatest challenge of the organization. "We can get enough food to serve everyday, no problem, but we don't have enough [volunteers]," Todd says.

Though the few regular members of FNB may differ in their vision for the organization, they all maintain a common ideal in working together to feed the hungry. None of the members of FNB want to be identified as a leader or central organizer of the efforts. "Everyone has their own view," says Todd. "We are tightly organized, but everyone is equal."

While this grassroots organizational structure makes it difficult for FNB to receive government funding or grants, it leaves an open door for anyone, regardless of social standing or commitment level, to spend an afternoon giving back to the community. Anyone can show up at the Community Garden and pick up a shovel. Anyone can help collect food from donors or distribute it to the hungry, and there is little doubt that the organization could have a much more profound impact with more volunteer and community support.

Turner, who claims to have been homeless in every U.S. state except Hawaii. "This town is one of the most supportive of the homeless."

"Would you rather people eat out of the dumpster or have free, fresh food handed to them?" Heber asks.

Andy Grabel
Food Not Bombs distributes free meals on College Ave. Sundays at 12 noon and Wednesdays at 6:30 p.m.