The Room Where It Happens

The city of Nashville has a long legacy of city leaders gathering in back rooms to determine the future of their neighbors. From the Watauga Club downtown to the West Nashville Mafia gathered in a booth at Wendell Smiths to the sheriff and his friends talking in the lounge of an East Nashville funeral home, Nashville has often been formed by people (usually white men) meeting in secret who think they know what’s best for everyone else.

Very often, the ones most harmed by those conversations were the marginalized – the poor, people of color, and others who weren’t blessed with economic prosperity or social status. One of the institutions sometimes affected by those backroom conversations was the Meharry Medical College, a school that has national prominence as the leader in training African-American doctors but is often overlooked and ignored in its home city.

With the recent crisis regarding the closing of inpatient services at Nashville General Hospital (a decision that in fact really means the closing of the hospital entirely) precipitated by our mayor, Meharry has learned from our past history and decided that it’s better to be “…in the room where it happens…” (to quote Aaron Burr from the musical “Hamilton”) than to be a part of an open process in which persons from all walks of life and backgrounds have an opportunity for dialogue on the future of healthcare in our city.

In the light of Mayor Berry’s announcement at a Meharry event that the General Hospital would be closing, Dr. James Hildreth, Meharry’s president, volunteered to create a “stakeholders group” that would consider the “future of indigent health care in Nashville.” This group, the mayor said in offering her stamp of approval on the process, would make recommendations to her on policy regarding the future of Nashville General. Invitations went out for participants, solely determined by the staff at Meharry rather than seeking input from others about expertise needed for this task. The conversations and work of the group, they said, would be closed to the public, in the hope that participants could speak more openly and honestly without the political scrutiny of the press and activists.

And the legacy of Nashville leaders meeting in back rooms to make decisions for others continues.

Several weeks ago I was asked by Councilwoman Tanaka Vercher to represent her at the Meharry Stakeholders Group. Councilwoman Vercher believed it inappropriate for her as a council member committed to transparency in government to participate in a closed process. However, she recognized that the Metro Council is the ultimate authority on what happens to the hospital, and wanted to make sure there was someone in the room to keep them in the loop, so she asked me as a long-time advocate of the hospital to represent her in the meeting. Yesterday, I was informed by Meharry staff that since Councilwoman Vercher was not willing to personally participate, I could not be present. “We prefer to reserve this seat for an elected council person,” I was told. When I asked who that person was they said they had been in touch with “the council” and that there was a conversation happening about who might serve. I also learned later that a Tennessean reporter was turned away at the door as well.

My participation in the group is not really the issue. The issue at hand is a process that will determine the future of an important city asset held behind closed doors by leaders who think they know what is best for all. More importantly, the problem with the Meharry “Stakeholders” group is that there are many “stakeholders” who have been left out of the room.

The group as currently formed includes representatives from the Hospital Authority, city government, the employees union, and a for-profit hospital chain. It includes elected officials at the state and local level, medical personnel, and Meharry employees.

One of the glaring omissions for me is the choice to not involve Dr. Joseph Webb, the CEO of Nashville General Hospital. This is the person who has been selected to represent the interests of our city in regards to the hospital, and who has the clearest understanding of the issues we face. Yes, there are hospital authority members and Nashville General staff in the group, but the decision to not involve Dr. Webb is clearly a political one which attempts to marginalize him in the eyes of the city.

But the most glaring omission is the lack of indigent persons and/or groups that represent the interests of the poor and marginalized in our community. This is, after all, a group tasked with determining the future of indigent health care in our city. But for some reason, involving actual stakeholders – those who use the hospital and the healthcare system – seems to be out of reach.

It is astounding to me that an institution that prides itself on its work with the underserved fails to recognize one of the most basic tenets of community organizing – that you must have actual members of the community at the table to fully understand the challenges you face. In the first meeting, Meharry staff painted a picture of a healthcare system where patients would have their medical records on smartphones that they could take from place to place as a means of avoiding fragmentation in care. As they spoke I couldn’t keep from thinking about Willie, Janice, and Will, some of the homeless folks I work with, who rarely have smartphones, have limited minutes and no data, and sometimes sell their phones so that they can buy a meal. Having persons intimately connected to the indigent patient community is crucial in determining what is actually feasible and what might be a good solution on the surface but will ultimately waste the city’s money in the long run.

Don’t get me wrong. I am not suggesting that Meharry has nefarious intentions behind the way they have structured their group or the decision to close the process to scrutiny. I believe that all the members of the Meharry staff have the best of intentions, and are trying to control the process to avoid what they would see as political entanglements.

But the fact is that this IS a political process because it involves an important and valuable asset for the city – the name, reputation and operation of Nashville General Hospital, and the effect that any decisions will have on the residents of Nashville. Attempts to avoid that reality by meeting in back rooms to avoid scrutiny will ultimately fail.

I absolutely support a citywide conversation about the future on indigent healthcare in Nashville, a conversation that is far overdue. We must determine if we as a city are committed to healthcare for all, and then how we will adequately fund that care. The conversation must include the place of Nashville General Hospital as well as Meharry’s own participation in what is seen now as a dysfunctional system. And most importantly, this must be driven by people who use the system and are affected by it.

You see, ALL of us should be in the “room where it happens.”