Serious, fundamental change must come to the DCH Health System for its hospitals in Tuscaloosa, Northport and Fayette to survive, area leaders agreed in a spirited discussion Thursday.

The difficult but unrestrained conversation about DCH took place during an impromptu breakout session at the Next Level Summit, an ongoing three-day retreat hosted by the Chamber of Commerce of West Alabama at the Renaissance Birmingham Ross Bridge Golf Resort in Hoover.

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Initially, the Summit's nearly 30 breakout sessions focused exclusively on aspects of the seven topics addressed in the Chamber's Next Level Series -- Public Safety, Diversity & Inclusion, Area Infrastructure, Barriers to Entering the Workforce, Economic Diversification, Quality of Life and Public Education.

Chamber President and CEO Jim Page reserved one of the 29 sessions for a "wildcard" topic, though, and by popular demand, the discussion centered on public health.

The unmoderated session prominently featured Tuscaloosa Mayor Walt Maddox, Northport City Administrator Glenda Webb and county Probate Judge Rob Robertson, the leaders of West Alabama's three largest government bodies.

Each session at the Summit has led to healthy debate, disagreement and discussion as more than 100 area leaders attempt to plan solutions for the biggest challenges facing the Tuscaloosa area. Still, even in this sometimes contentious environment, everyone crowded in the conference room for the public health session agreed -- major change is immediately necessary in the DCH System.

"We have to recognize that the status quo cannot be accepted," Mayor Maddox said near the end of the meeting.

The Blockbuster Problem

Before beginning to relay the litany of concerns public and private sector leaders raised about DCH Thursday, it is important to note that none of the dozens of people crowded into the conference room spoke ill of the doctors, nurses, surgeons and support staff who work in the System or of its nine-member board of directors.

Instead, the group's frustration centered on the DCH governance model, which Maddox said has not been meaninguflly updated since the Tuscaloosa hospital was incorporated by state law as a health care authority in 1982.

"I know we have talked about models a lot, but 16,17 years ago, Blockbuster was the leading digital entertainment provider worldwide, with 83,000 employees and 9,000 stores across the world. Today, they're gone," Maddox said. "The model of health care has changed just as rapidly as the digital content market."

As the Thread previously reported, the DCH System is bracing for losses up to $60 million this fiscal year, and with UAB's state-of-the-art, nine-story Medical West Hospital Authority set to open in McCalla in 2024, leaders say DCH must adapt and improve the patient experience or risk going the way of Blockbuster Video.

(Stephen Dethrage | Tuscaloosa Thread)
(Stephen Dethrage | Tuscaloosa Thread)

"A Drainage Basin for Indigent Care"

As this report will show, the DCH System is facing a number of serious challenges, but chief among them is a particularly difficult combination blow.

First, DCH does not turn away patients, and no empathetic individual in the area should want them to.

No members of the DCH System administration or its board of directors attended the Summit this week, but Lewis Fitts, who has served on the board of the DCH Foundation for 12 years, was in the room Thursday and served as the System's staunchest defender.

"We're fortunate to have a community hospital because we give health care regardless of [ability to pay,]" Fitts said. "Each year, we put up $30 - $40 million in free health care to our community, because that's what you do when you're a community hospital."

To exacerbate that, Maddox said 18 rural hospitals in Alabama have closed in the last 10 years, many of which were in or near West Alabama.

The result, leaders at the Summit said, is that the DCH System has become a "drainage basin" for providing health care to the entire region.

Those services are often provided to patients without insurance or the ability to pay for treatment themselves, and without any significant financial support from the governments whose constituents are now coming to Tuscaloosa for care.

To make matters worse, area residents who are insured or capable of independently financing their treatments are increasingly opting to go to other hospitals for non-emergency care.

At the same time, the cost of combatting the COVID-19 pandemic are still extreme, but funding from the state and federal government to finance that fight is rapidly running out.

Those factors and others combine to mean the DCH System, although technically a not-for-profit hospital system, is hemorrhaging money.

Long ER Waits, Antiquated Regulations

Several leaders attending the health care session shared their own DCH emergency room horror stories that are likely all too familiar to anyone who has been hospitalized in the last few years, stories of hours-long wait times in rooms full of suffering people, watching as ambulances arrive with more patients but end up stuck waiting for space to clear for their passengers.

Like essentially every other part of the DCH problem, the ER issue is a multifaceted one.

Tuscaloosa city councilman Lee Busby said too many people in the community are using ambulance services as an Uber ride to the hospital, seeking emergency care for minor issues that could be better addressed elsewhere.

At the same time, Northstar Paramedic Services is struggling with the same kind of staff shortages that are plaguing countless other businesses in the area, state and nation.

Judge Rob Robertson said it's also a little-known fact that by law, when an ambulance picks up a patient, the only place they are legally allowed to transport that patient is to a hospital. An EMT is not able to make their own judgment about where an ambulance passenger should be treated, so everyone goes to DCH.

"There are some legislative remedies on some of this that I think are longer-term, but it's part of what our discussions with the legislative delegation need to entail," Robertson said. "You know where an ambulance can take you once they pick you up? Only to the ER."

"What if you don't need to go to the ER? What if you could go to a clinic?" Robertson continued. "Once you're loaded, they have got to take you to the ER to fix your toe, by law. There are things like that we have to start looking at in this era of healthcare that will take some legislative remedy to address."

That's all well and good, but this year's legislative session has already ended and Montgomery is hardly known for its ability to quickly solve a pressing issue.

Stack those problems on top of the global pandemic, staff shortages at the hospital and a limited number of beds within the ER department and in the hospital overall, and the result is consistently long wait times that local leaders say are no longer acceptable.

The impact is felt throughout all three governments, too -- when all of Northstar's ambulances are stacked up waiting to admit patients to the ER, it falls to those governments to pick up the responsibility of transporting patients to the hospital.

Chief Randy Smith said the Tuscaloosa Fire Rescue Service is manning its own ambulances and, in some cases, even using engine trucks to transport patients to the hospital, reducing their ability to respond to fires in the area.

The county sheriff's office and the city of Northport are also running a couple of their own ambulances whenever ER wait tines leave Northstar unable to meet the needs of the day, which leaders said is happening more and more often.

A Veil of Secrecy

So what about that nine-member board of directors who could impact meaningful change at the DCH Health System? The city of Tuscaloosa appoints two of those board members to six-year terms. The county seats two more, and the city of Northport appoints a fifth.

With local governments appointing five of the nine board members and leaders in all three bodies openly dissatisfied with the status quo at DCH, one solution seems as simple as their five appointees uniting to affect change in hospital policy, in administrative leadership or even in the ownership of the DCH System.

Maddox, Robertson and Webb all agreed, though -- it's not that simple.

"I say this kiddingly, but sometimes DCH is like hugging a porcupine -- it's not easy," Maddox said. "For whatever reason, there's been this culture built up over the last couple of decades, it appears to me, where there's this veil of secrecy, where [the board] just doesn't want to be open about who [they] are and what [they] do."

Maddox said a culture that lacks transparency and accountability may be acceptable at a private hospital, but not at DCH.

"When you enjoy tax-free status and taxpayer money, you have every obligation to be as open and transparent as the law allows [...] and to engage the community in which you serve," Maddox said.

Maddox said he still believes the two members the city appointed and the entire DCH board are good people with good intentions but said there is a disconnect between what they hear in the boardroom and what is shared with patients, elected officials and the general public.

Webb and Robertson agreed.

"We have one appointee, who is new, and I have regular communication with him -- usually through my city attorney," Webb said. "I will say that there is a veil that exists between the information at the board level and what gets transmitted to the city of Northport."

Three Paths Forward

The Next Level Summit is, at its core, about finding solutions to the biggest problems the area faces, and the DCH problem is a serious one -- in an earlier address to the entire Summit, Maddox said he believes the two biggest threats to Tuscaloosa's future are violent crime in the area and the public health crisis.

With the hospital developing a bad reputation and more and more residents traveling to a UAB facility or Grandview or St. Vincent's for non-emergency care, the issue becomes about more than reliable health care. It's hard to attract new businesses and industries and workers to an area where residents often joke that DCH stands for "Don't Come Here."

Maddox said the three governments began working together to make a plan to force improvement at DCH in early 2020 -- just in time for COVID-19 to put those conversations firmly on the backburner until the worst days of the pandemic had passed.

Robertson praised DCH for its efforts during those unprecedented times, for becoming a regional hub for COVID testing, treatment and eventually vaccination.

Now, though, government leaders are bringing the hospital's problems back to the forefront of their joint conversations and Robertson said he sees three ways the situation could unfold.

"One, we figure out a solution and DCH becomes viable economically, but the challenges -- the headwinds are strong," he said. "Two, you're bought by a large, national health care entity, and it is not a pretty picture when you talk about that kind of cost-driven, very difficult model. I don't see how that works well for our community."

"Three, you affiliate with a research arm, like the University of Alabama System or something," Robertson said.

The third option was overwhelmingly the best-received at the Summit. The University of Alabama's Capstone College of Nursing is literally across the street from DCH Regional Medical Center on University Boulevard, and the UAB Health System has a proven track record of successfully operating or managing hospitals in the state.

"In my opinion, we would be foolish as a community to not explore options with the UA System," Mayor Maddox said. "UAB Healthcare is the national flagship of health care. Is there a possible partnership there? I don't know. But we need to explore partnership, whether it's with the University of Alabama System or somebody else, while we still have value."

That solution comes with its own obstacles. Would the UA System even be interested in acquiring the DCH System? Would the DCH board willingly allow such a move? If so, what happens to the more than 3,000 people who currently work for DCH?

All those questions and more will have to be answered moving forward, but the government leaders in the Thursday meeting said conversations with board members and DCH administrators in the last six weeks have been relatively amicable, and major change may soon be on the horizon for the System.

"What I do know is that we're all kind of to a point where it's absolutely our duty to explore and start looking at what the future is going to look like for this community," Robertson said.

For ongoing coverage of these issues and more, stay connected to the Tuscaloosa Thread.

UPDATE: Less than four hours after the publication of this report, the DCH Board of Directors announced the retirement of longtime CEO Bryan Kindred.

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