The day after Christmas last year a lottery ticket expired.  Sold at a West Georgia Pilot truck stop, the winning ticket was worth $77 million, but somebody didn’t know what they had.  Another lottery player, Napolean Elvord, a Wisconsin military veteran in need of a kidney transplant, had misread the numbers on his Lotto ticket and didn’t know what he had either, until it was almost too late.  Because of the persistence of the clerk who sold him the ticket, he became $14 million richer a few days ago.

Hamilton County has won a lottery of sorts and I am afraid that many of our residents do not realize it.  We have many great and valuable assets in our county, but none of them really compare to an institution that many of us just refer to as “Erlanger”.  Several years ago a man who is very knowledge about hospitals told me that if Erlanger was sold and the proceeds distributed equally to every man, woman and child in Hamilton County, we each would  be getting a check in the mail for at least two thousand dollars, maybe closer to three.  That is a real return on the $50,000 the Baroness’ family gave to found Erlanger over a century ago.  Before you go to the mailbox or call your county commissioner, you need to take a closer look at your lottery ticket; there has never been a more critical time for you to do so and I think you will like what you see.

With all the publicity surrounding the CEO change and the financial difficulties facing Erlanger, it is much too easy to lose your perspective.  First it is important to remember that every hospital has a clinical side, that is caring for the patients, and the management and goverance side, and which for Erlanger means at least some politics. 

Erlanger’s clinical side has never been stronger; just look at any credible rating agency, whether it is U.S. News, Thompson-Reutgers, or the Joint Commission which actually accredits hospitals.  Erlanger is top quality health care.

It is also important to remember that when other hospitals experience management problems the issues many times remain in the board room until we read about it on page 2 of the business section, when a change is quietly being announced.  But at Erlanger management issues are another story (or stories), and it is difficult if not impossible to keep secrets.  Since the hospital is owned by the citizens of Hamilton County and the hospital is subject to the sunshine laws, inevitably publicity will and should follow, including the unflattering kind when managers make mistakes. 

While management as well as the board are and should be scrutinized, some other issues are hardly noticed.  For instance, other cities and counties pour millions of dollars to keep their public hospital afloat (at one time Atlanta was spending over $100 million each year on their public hospital; Nashville and Memphis annually spend tens of millions of taxpayer dollars to keep their public hospital in business.)  This is not the case in Hamilton County because with only a $1.5 million governmental appropriation this year, the public money in Erlanger’s budget is less than one percent (actually .0025%), and all that comes from Hamilton County since the city of Chattanooga no longer contributes any money to support Erlanger.  For this investment Erlanger provides almost $90 million in uncompensated care.  (Contrary to what some have said that $90 million is actual cost, not charges, and does not include over $400 million more in contractual write-offs.)  If Hamilton County was fully funding Erlanger for indigent costs, your county tax bill would increase by at least 30 percent this year.  Furthermore, the money that the taxpayers are not having to spend at Erlanger can be used for our schools, infrastructure or other pressing needs. 

And there is more.  One hundred percent of Erlanger’s profits, such as we have, go right back into the hospital, providing care for those who cannot afford it, buying new technologies, and generally investing in the health care of our people.  Other hospitals use their profits to subsidize the operations of sister institutions out of state or pay shareholder dividends, neither of which I am criticizing, but conversely I want our taxpayers to know that every dollar at Erlanger stays in our community. 

Erlanger’s impact goes far beyond being a valuable asset financially and avoiding what could otherwise be a huge tax increase to fund the hospital.  Erlanger is an important teaching institution within the University of Tennessee system.  The great majority of doctors practicing in this area did most if not all their residency training at Erlanger.  Regardless of where your doctor is based, he or she probably trained at Erlanger.

I know of two individuals who had surgery at other hospitals, but when they woke up they were at Erlanger. Problems during their operation necessitated their transfer to the hospital which neither originally chose.  There are many medical services Erlanger provides that other hospitals, for various reasons, do not provide.  Erlanger’s stroke center is world class; the President of the United States a few years ago came to view it; doctors from around the world have come to Erlanger to be trained.  I have seen the employees in the Trauma Unit go into action; it is a wonder to behold.  And it is those employees, and others just like them, which makes Erlanger a special place.

Because Erlanger is a campus of the University of Tennessee Medical School, numerous clinical trials are in place there, and almost every medical procedure you can name was first performed in our area at Erlanger.

With over 4,000 dedicated employees Erlanger has a powerful economic impact on our entire region.  With a payroll approaching $300 million, the economic impact in our region is well over one billion dollars.  I am told that when outside business and industry leaders are looking to locate or build here, inquiry is always made about the health care delivery system, and the answer won’t be completed without the mention of Erlanger, because there is no better place to obtain high quality medical care.  The reason Erlanger is having some problems is not quality of care, but totally solvable managment challenges.

Although Erlanger’s ability to provide these specialty services for all our citizens, regardless of their ability to pay, is being stretched to the limit, Erlanger is still fulfilling the mission.

Try to imagine this community without Erlanger: there would be a substantial tax increase, or citizens would not be getting medical treatment or both; many specialty services like the level one trauma unit and possibly even Children’s would disappear; UT College of Medicine’s training programs for almost 200 doctors in residency programs at Erlanger would be gone, which sadly means those doctors might never come here to practice.

There is much more I could say, but I don’t have to imagine that world, because we do have Erlanger.

Occasionally someone will tell me that Erlanger is not “their hospital.”  “Oh, have you moved to another county?” I ask.   Don’t get me wrong, there are other fine hospitals here, but Erlanger is “our hospital” and I hope it always will be.  And as long as it does, Hamilton County will continue to win the lottery every day.

Russell King

russell@rtking.com