Tennessee Bill Averting Medical Monopolies Dies In House Subcommittee

The bill, brought on by issues at Ballad Health, was stopped before anyone could testify.

Photo: Protesters at Holston Valley Medical Center, a Ballad Health hospital, in 2019. Photo Credit: Dani Cook

By Sam Stockard [Tennessee Lookout -CC BY-NC-ND 4.0] –

Despite escalating emergency room times at Ballad Health hospitals, legislation to stop further medical monopolies suffered a quick death in the House Health Subcommittee Tuesday.

Three people were set to testify in favor of Democratic Rep. Gloria Johnson’s bill, driving five hours to Nashville from upper East Tennessee, before Republican lawmakers derailed it with a procedural move.

That move came after the bill’s Senate sponsor, Sen. Heidi Campbell, D-Nashville, tried to keep the measure alive last week by asking for a separate procedural move in the Senate Health Committee where it wasn’t expected to fare well.

Dani Cook, a health care advocate from the Tri-Cities area, was animated after the measure failed to advance Tuesday, saying she was prepared to speak out against the future formation of Certificates of Public Advantage by the Legislature.

“This COPA experiment has failed,” Cook said Tuesday.

As Mountain States Health Alliance and Wellmont Health System faced high debt in 2018, lawmakers granted the merger and monopoly to block competition and keep hospitals operating where Tennessee and Virginia state lines meet.

Since then, however, the health system has hit a litany of problems, in many instances failing to meet guidelines set by the state, according to KFF Health News reports. Nursing and other personnel shortages are reported to be part of the downfall, even though Ballad showed net income exceeding $143 million in 2022 and $63 million in 2021 when it landed $175 million in federal COVID-19 pandemic relief money.

Not only has Ballad Health come up $191 million short on charity care obligations over five years, its treatment rates are poor, Cook said. She said reports show one in five stroke patients admitted at Johnson City Medical Center die within 30 days, and nearly 17% of heart failure patients at Johnson City Medical and Bristol Regional die within 30 days.

KFF Health News also reported this week that Ballad hospitals’ emergency room times increased from three-and-a-half hours in 2018 to 10 hours and 45 minutes in 2023. 

Under the agreement reached by the Legislature six years ago, the Department of Health and Tennessee Attorney General’s Office are tasked with making sure Ballad meets health care mandates. In spite of several shortcomings, those two offices have taken no action, although Attorney General Jonathan Skrmetti told the Tennessee Lookout last fall “there has to be a lot of thought given to where things are moving” because people “are not happy with the current situation.”

Cook pointed out the bill that failed Tuesday wouldn’t do anything about the Ballad Health situation but would prevent people statewide from “enduring” the same poor health-care treatment those in upper East Tennessee are experiencing. She also argued the setup violates the state Constitution, which says “monopolies are contrary to a free market and shall not be allowed.”

Johnson, a Knoxville Democrat, said she took on the bill because no lawmakers from upper East Tennessee want to deal with it, even though they are aware of problems. Her bill also might have struggled because she was nearly expelled last year for participating in a House floor rally against gun violence.

“These people in upper East Tennessee need health care. They need good, reliable health care. They don’t need to have doctors and nurses being threatened and fired,” Johnson said. 

Ballad officials have claimed the system’s creation saved hospitals from being closed. In addition, they say they are making improvements on health care requirements.

Johnson, who is running for a U.S. Senate seat and re-election to the state House simultaneously, said she plans to keep pushing the bill. 

The Crowe effect

Cook and other critics of Ballad Health operations also took issue Tuesday with state Sen. Rusty Crowe, who contracts with the hospital system to run bariatric treatment services, saying he had a conflict of interest as chairman of the Senate Health Committee where the bill was stymied.

Campbell said she understood her version of the bill was going to be killed in the Senate Health Committee, so she made a move to keep it alive. Johnson said Tuesday she believes Crowe was involved in “orchestrating” the bill’s demise.

Crowe, a Johnson City Republican who sponsored the monopoly legislation six years ago, defended himself Tuesday, saying he was contracting for bariatric services at upper East Tennessee hospitals long before the merger that created Ballad. Crowe said he planned to declare a conflict of interest during the Senate Health Committee meeting and allow the bill to be discussed before Campbell made her procedural move.

“Our community as a whole asked us to please put these two (hospital systems) together to be able to control the health care destiny of the region,” Crowe said.

He contends the Certificate of Public Advantage protects the region from a “true monopoly” and pointed out the Department of Health and Attorney General’s Office must approve any moves related to Ballad Health, in addition to determining whether the hospital company is meeting state mandates.

“They have not done that,” Crowe said.

Skrmetti, however, issued a statement to the Tennessee Lookout last year saying, “If the structure of the COPA or its terms and conditions is an impediment to effective healthcare in upper East Tennessee, all involved need to work to fix the problem. Getting this right is important.”

About the Author: Sam Stockard is a veteran Tennessee reporter and editor, having written for the Daily News Journal in Murfreesboro, where he served as lead editor when the paper won an award for being the state’s best Sunday newspaper two years in a row. He has led the Capitol Hill bureau for The Daily Memphian. His awards include Best Single Editorial from the Tennessee Press Association. Follow Stockard on Twitter @StockardSam