ED BRIGHT
Past Member
Pitt County Board of Commissioners

April 26, 2000

Interviewer: Marion Blackburn

Marion Blackburn: Would you like to start with the recap of the hospital's privatization or would you prefer to lead in to how you became involved with the hospital because you were, of course, a County Commissioner?

Ed Bright: Well, of course, I had been busy in the County and aware of the development all the way from the before the medical school so I have understood and observed somewhat its evolution and so when the privatization question up I guess I was more aware of the potential for good than some might have been.

Marion Blackburn: When did you become a County Commissioner?

Ed Bright: In 1990 and served until 1998, two terms.

Marion Blackburn: At that time, were you particularly interest in health care?

Ed Bright: Well, only in the general fashion. I understood and appreciated the growth the hospital already had at that time with the increase in services and the specialized procedures and so forth that they already had much more than they had in the past. I became more aware as I served as a County Commissioner and as they appeared before us from time to time to go over both health care matters as well as business matters.

Marion Blackburn: In 1990, did you at that time have any specific issues that you felt very strongly about?

Ed Bright: Well, yes and no. Of course education always is one and health care is always one and public health and safety is always one. It was only in a general fashion that I was aware of needs to make progress among all those areas, but a specific agenda I did not have.

Marion Blackburn: I guess what I was sort of looking for and I, of course, would want you to tell me about it, what I had heard is that you really were so involved in especially the privatization issue in an effort to help people to understand and in an effort to do what you believed was the right thing, I think that what I was interested in-if you had any sort of passion.

Ed Bright: I guess in looking back I probably did not do enough to inform the public in my own district here; however, I guess I had the feeling that really there was information available, and enough information had been published in the papers and in handouts, that if one wanted to learn and understand there really was the information there but so many just refused to understand and distorted and this sort of thing.

Marion Blackburn: I suspect a lot of people who should know better distorted and confused the issue. Would you like to jump ahead to privatization or would you prefer to maybe speak about some other hospital issues that you dealt with as a Commissioner before we get to privatization?

Ed Bright: Well, I guess by the time the privatization thing came forward and, of course, when CEO, Dave McRae and the Chairman of the Board had touched on it two or three or several years before it really became a real focus and in that process I guess I had begun seeing the difficulties of operating as they were with the changing demands in health education and services.

Marion Blackburn: Anything specific that maybe was cut and dry for the need for change?

Ed Bright: I could see the frustrations of the hospital's staff and the Board in working with a large County Commission Board

Marion Blackburn: Please explain so that I will make sure I understand it. Before the so-called privatization the hospital and the Board had to come to the Commissioners for approval of their budget.

Ed Bright: Well, yes and no. We could not veto a budget or anything like that. My understanding is that since the advent of the medical school it had been operating as a public not for profit corporation, leasing the facility from the County. This is what the public didn't understand. Since that time, we really could not make demands on the hospital and require that they be met because they were already a leased public, not for profit institution, whereas, now they are a private, not for profit. I don't think the public ever got a real grasp for that. They felt like you can take from the hospital what you want to and you can tell them what to do. That hadn't been true for thirty years or twenty-five years.

Marion Blackburn: I'm going to need educating here. Tell me about the difference between 1977 and once the privatization was accomplished. It was public, not for profit and now it is private, not for profit.

Ed Bright: My understanding again is that so far as their managing of the monies, they were more restricted as a public entity in how to handle and invest their monies, and now they can invest in securities of a nature that they could not invest in then in order to make their reserve money work for them better. The primary thing that they had to get approval from us for was any time they needed to bond for raising funds for capital or that sort of thing and then when the agreement between the UNC System, the med school and the hospital came up, I guess they called it a Memorandum of Agreement we had to approve that and, of course, it was a long process to go through agreeing on specific terminology and that sort of thing. I could see that this was an additional burden on the hospital to have to go through all of those things.

Marion Blackburn: Was that in 1977 or a little later?

Ed Bright: It was renewed while I was in my second term, I believe it was in the nineties when the second twenty year agreement was renewed and that is when I saw the complications of trying to work it out. That was either around the end of my first term or the beginning of the second.

Marion Blackburn: I have to say that despite having spent a lot of time reading about the hospital and doing work for the hospital, I never could myself understand exactly what was going on and even now, I struggle sometimes. I thought it was still public, not for profit and you are saying it is actually a private, not for profit hospital and that has to do with the kinds of securities they can invest in and who they need to get permission from.

Ed Bright: They no longer have to have the Commissioners approval for bonding and individual agreements with various entities and so forth.

Marion Blackburn: And that is how they were able to create University Health Systems?

Ed Bright: That's right. Of course, they were in the process, in fact it was almost accomplished that if it did become University Health Systems before the privatization actually occurred but making it work appeared to be harder than under the present organization.

Marion Blackburn: That from what I have seen has just been a tremendous area of growth for the hospital and in visiting the affiliate hospitals it seems that are real pleased too because they are getting a whole lot of support now.

Ed Bright: I guess you might call it the political attitude of many in Pitt County was and in some corners is that this is a Pitt County hospital, this is our hospital and they ought to serve us and not worry about everybody else. It is hard for some people to understand that in order to serve us better we have to serve others to get the volume to support various specialized procedures that are made possible and is better service to us right here. That is a little hard for some people to understand. I was talking to one person this morning that had problems in that area but now I think that person is seeing it in somewhat of a different light but how many are doing that is the question.

Marion Blackburn: I think that just in talking to people, I still think there are a lot of misconceptions and I still think there is a sort of lingering effect of the feeling of a bad taste maybe or discontent; yet at the same time, like you say, nobody can deny the extremely high level of services and skills that the hospital is continuing to develop.

Ed Bright: Right, and some people said the Commissioners were giving the hospital away and, of course, this wasn't true. If you get $30 million for something and you get $1.2 million a year in lieu of taxes, you are not giving anything away. The thing they really couldn't understand was that while they were making the transition to private, not for profit, that the County still has ownership in a sense. You know what a Deed of Trust is, I sell you a piece of property and you make partial payment and I take a Deed of Trust and if you ever sell this property then I get mine first. I tried to explain to a few people that the agreement for transition acted like that, even though the transition was made, the Trustees of the hospital can't sell it. The agreement provides that it may be sold but only if it is the agreement of the Trustees and the County Commissioners. If that should ever be done who would get the proceeds? The County does.

Marion Blackburn: So there is a possibility that the hospital could be sold to VHA or others?

Ed Bright: Well, I could not conceive that it ever would be but if conditions ever came to the point that it was desirable it would have to be a joint decision between the Trustees of the hospital and the County Commissioners. Both would have to concur, but when the sale was consummated, the proceeds, anything left, goes to the County.

Marion Blackburn: Okay, so there is sort of this Deed of Trust, which means that the Commissioners still have say.

Ed Bright: They have a hold on it. On operational details they do not have a lot of hold but the bottom line is they have the hold on it.

Marion Blackburn: How long does this hold last?

Ed Bright: Forever.

Marion Blackburn: Does this last even when the hospital pays off its $30 million debt?

Ed Bright: Oh yes but they have already paid that. They made the last payment either this spring or last spring. That agreement is forever.

Marion Blackburn: I guess that was sort of written in the terms and conditions. I wonder how many people out there know that.

Ed Bright: Many have been told who either don't understand it or choose not to accept it and some others may not have really been exposed to it enough, perhaps.

Marion Blackburn: So, the County Commissioners beforehand were receiving $1.2 million a year in lieu of taxes?

Ed Bright: No, the County was receiving nothing from the hospital except services.

Marion Blackburn: Was there any lease payment?

Ed Bright: The County was receiving no monetary consideration from the hospital until the transition. In that agreement for the transition the five that voted for it required that payments in lieu of taxes be a part of it and that started off at $1.2 million a year; however, it was also stipulated that as the value in the County increased as it was revalued, that it increase. Of course, we had no hold on holdings outside of the County and made no attempt to.

Marion Blackburn: So in addition to the $30 million it is $1.2 million a year in lieu of taxes.

Ed Bright: Yes, and this is to increase as the value of the property in Pitt County increases. The medical side of that now didn't like that so the five who voted for these conditions were sort of in a position of they were not going to please the County folks who wanted it to be a local County hospital and not let it grow and we were not going to please the medical folks because they did not want to strap the budget by paying anything to the County so we really were in an almost no win situation but the five of us saw that this was good for the hospital and this was also good for the County but it could be better for the County if there is financial consideration. What made it harder for everybody to accept on the medical side was that really I think we were the first transition in the state, no there were one or two others that required a cash payment but not continual payments, I think, so really we really were sort of pioneering in benefits to the County and the transition in the state, I think.

Marion Blackburn: You mentioned there were five. Bear with me, as I have never written much about the County Commissioners. There is a Board of nine members and there were five of nine and it was you and who were the other four?

Ed Bright: Kenneth Dews, Tom Johnson, Mark Owens and Edith Warren. Here is the interesting side. A political cost, only one really paid a political cost. One of the five is in the Legislature now, two are still on the Board and one retired and one was opposed who was I. Of course the reason was that the opponent down here played the fact that they were giving away the hospital thing to high heaven and I did not work on it enough. I did not count any of it.

Marion Blackburn: Were you probably a little bit exhausted after fighting a very important battle?

Ed Bright: Well, not as much that as lured into a false sense of security in that even people who were friends with the opponent were saying well even his friends aren't going to vote for him but they did when he stirred them up on this question. Another question that was important was that the opposition to the Global Transpark was played up a great deal. Anyway, the five could not foresee whether any or all would have penalties at the time but I think we all were ready to say and do that this was best for the County and this is best for the hospital and so on.

Marion Blackburn: It sounds like you were surprised but in a way it almost sounds like you could have considered it could have happened.

Ed Bright: Yes, I considered it could happen but as I did go around in the campaign and so forth people said we didn't have a thing to worry about and said that even my opponent's friends were not going to vote for him.

Marion Blackburn: It's hard to underestimate the power in negative campaigning. I return to some of those questions, I wanted to ask you of the five, it sounds like you all had a very, very intelligent visionary agreement. Did you have some help putting that together or did the five of you just sort of put it down?

Ed Bright: Well, the whole Board itself voted to be paid by the hospital rather than the County pay and be reimbursed by the hospital and consultants were to look at was it best to make the transition or was it not best. Those consultants had been experienced in these things all over the country, really, and they were invaluable to me in my thinking because they did point out some other transitions in other places that have required some financial remuneration's and even guided into the ball park area what size, what extent would really not handicap the hospital excessively and yet be beneficial to the County. We required just a little bit more than they recommended but they got us in the ballpark.
Some of those that voted against this, one or two said they might vote for it but we were not getting enough.

Marion Blackburn: Can you tell me a little bit about, and I am fascinated by this concept of a political struggle like this, behind the scenes work that maybe people aren't aware of? Did you go out to eat with your fellow Commissioners, did you call them at home, and did you see them at church or see them on the street and try to convince them?

Ed Bright: Well, the five who remained steadfast I think we tried to do this in County session. Occasionally we would have lunch or something but we did our discussions in session primarily.

Marion Blackburn: So, once you finished talking about it for the day you didn't go home and burn up the phone lines?

Ed Bright: I didn't.

Marion Blackburn: Did you ever feel that there was a chance of swaying these other four Commissioners or did you feel they were pretty well decided?

Ed Bright: I felt that three were very decided and one might possibly go with it but never did.

Marion Blackburn: How did you get that majority? You had it almost from the start it sounds like.

Ed Bright: Well, almost and of course some of the critics would speak to the Board almost every meeting but we were trying to just do what was best for the County.

Marion Blackburn: That took place, was it 1998 when it was approved?

Ed Bright: The campaign in South Pitt was I guess the only one that really this was that much of an issue and the promise was a vote for me was save the hospital; however, after the election things were really concluded but they still couldn't stop it.

Marion Blackburn: The vote had already been taken?

Ed Bright: Well, preliminary votes had been making steps along the way and, of course, there were several votes taken on several matters inching toward the final conclusion. Some of the preliminary votes had been taken but the final had not. If the Board had been constituted as it was after the election, before paperwork was at a point where it couldn't be stopped, we would have been stomped.

Marion Blackburn: So in other words, the final vote was actually taken after you left the Board but everything was already in place?

Ed Bright: No, see the election, the primary is in May, and of course in November there is the general election but the person is not really elected completely until after the general election but the Democratic primary candidate had a little problem in the general election against the Republican. Really the precarious point was from November to December because you take office in December.

Marion Blackburn: You had been defeated in the primary but you were still sitting on the Board?

Ed Bright: Oh yes, from May to December.

Marion Blackburn: So, in December they took office and everything was finished by then. Okay, so you are saying if things had not been far enough along, things could have been stopped in May because you had been defeated and were considered a lame duck candidate or something? Your opponent would have had certain rights?

Ed Bright: After the new Board started in December they even tried to get some members of the hospital Board to move and all that sort of thing.

Marion Blackburn: They were pretty angry, I guess.

Ed Bright: Yes, apparently some of them are still angry with me and maybe others too.

Marion Blackburn: Wow, do you ever feel any of that backlash in the community?

Ed Bright: Well, an example of that is the new members allied with some of the old members and tried to remove me from the Global Transpark Board. I am Vice Chairman of the Global Transpark Board. The term had not ended so it would have been removing someone in the middle of their term. I just went before the Board and appealed to them and told them that this would be a very unusual precedent. I don't think anyone in the County knows of any time that this Board has ever removed any appointee to a Board in mid-term and why should that ever begin-unless the service is absolutely not acceptable. One of the new members, David Hammond, had expressed an interest to be on the Board himself but when he heard all this he said he didn't want it that bad and that they should not try to do this and the motion was made to terminate and it failed.

Marion Blackburn: It almost sounds like you were making an appeal to professionalism.

Ed Bright: Right, I just thought it would be a terrible principle to set to remove people in mid-term from Boards that the Commissioners had made appointments.

Marion Blackburn: Did you feel stressed at any time, worn out, irritated, angry, irritable?

Ed Bright: Sad in a sense, I guess and disappointed that so many of the public were apparently swayed by negative things that were distorted and so forth but understanding that none of this would change anything I said or did anyway.

Marion Blackburn: I have to complement you on your sense of deciding what is the right thing and on sticking with it.

Ed Bright: I could never play a political game of putting off a decision because of votes or making a different decision because of votes, I could not do that. Why I felt so strongly to do otherwise would not be the best thing.

Marion Blackburn: I have asked you a lot of questions about the issue and I don't necessarily have to but I feel it was one issue that I certainly needed to learn the most about and to try to help people out there maybe one day to understand it better.

Ed Bright: Well, I think early on in the transition it was brought out that the hospital itself was built with very narrow margin in the bond vote so that still you have to think about well, democracy is a tedious process and sometimes there are close calls and sometimes the best decisions are not made but often the best decisions are made with narrow margins. I don't know the number of votes but it was a very close vote. Just suppose it had never been built!

Marion Blackburn: It seems like to me that Henry Leslie was telling me something about at some point the State Certificate of Need Office said that we cannot renovate this place and you have to build a new place. They would not allow the old hospital to be renovated.

Ed Bright: If we had not built the hospital there would not have been a medical school. We would still have been a tiny County hospital.

Marion Blackburn: Are there any other hospital related issues you would like to talk about, things you remember such as battles, important decisions, anything during your time as a Commissioner or even before that you would like to touch on?

Ed Bright: Not really, I guess, unless you can think of something.

Marion Blackburn: Well, the area I was kind of curious to get to would be you spoke a little bit about trying to imagine the future and I guess I would like to ask you what you see as the most important issue for Pitt County Memorial Hospital and the System?

Ed Bright: Well, I'll start by saying I think the hospital Administration and all personnel just have a big challenge because of this inherent negativism of some people in the County that if there is any lapse in service or any small things that they can criticize, they will say that is because they got this status, so I think there is a real challenge to give the very best services in all aspects, promptness, attention, sophisticated procedures, all of these things in order to win the public more and more and more. I will cite a personal experience, my wife is not in good health at all and she has been there a number of times and the biggest thing that has bothered us personally about that is the waiting sometimes and I know that in a big organization that is a real bugaboo to beat. We go over early in the morning to be checked in and wouldn't get to a bed until several hours and that sort of thing. I really think, and they are probably aware, that this is the kind of thing that causes one who is negative already to be more negative.

I see that they will work on those things and I see that they will get more and more of the very sophisticated procedures so people won't have to go to Duke or Durham or Chapel Hill or Johns Hopkins or Birmingham or wherever to have them done as we always used to have to do. Some people have pointed out that not all these satellites are really profitable, however, it is still channeling to this hospital so it is actually profitable. You have to look at the whole picture.

Marion Blackburn: The way I have heard it expressed is that if you can help the folks in the extremely rural areas, if you can help them to stay healthier, you don't want to put a bottom line on it, but ultimately it is better for the hospital because they are not going to see them extremely sick in the Emergency Room where they have a condition that is going to be very, very costly. They try to address if you could have taught someone about nutrition or diabetes care or another issue, you could have prevented that. I have seen just a little bit of how complicated it can be.

It sounds like you are saying that now and in the future they need a commitment for constant improvement which will be very important.

Ed Bright: I think they have that.

Marion Blackburn: Any other issues that you think are going to be really important now or in the future?

Ed Bright: I think the increasing sophistication and technology and procedures is really going to be fascinating. I went to the Mini-Med School classes they had and they invited prior graduates back to a meeting with those that were graduating and to see the last session and they had a reception afterwards and so forth. Demonstrations were given on new technology that was both in use now and rapidly coming of use and it was just fascinating.

Marion Blackburn: One of the things you talk about, sophisticated technology and procedures, that for better or worse is something that distinguishes a hospital, I think, and I have heard it said more than a few times about physicians that if I had cancer or if I had heart disease or many things, that this is where I would want to get treated-I wouldn't go to Duke, I wouldn't go to Chapel Hill.

Ed Bright: You know this contradiction of things even people probably who criticized and may still be actually opposed to the transition that was made, I hear people time after time who have gone to other hospitals, and the nearest one, of course, Kinston, they say they have nice facilities, very clean, very restful, but when they have someone really, really critically sick, something really bad, they want Pitt. In fact, some people have moved from Kinston to Pitt.

Marion Blackburn: Any other issues maybe down the road. Do you think money will ever affect the nature of health care, financial considerations?

Ed Bright: Money always affects health care just what do you mean precisely?

Marion Blackburn: Well, I don't know, I guess any thoughts that you might there because you are absolutely affects health care, I think. You hear about efficiency, you hear about trying to contain costs and actually had Mr. McRoy to talk about the fact that at some point there will have to be a ceiling on how sophisticated a hospital procedure can become simply because there won't be enough money to support the ongoing development and I thought that was a very interesting perspective that you just can't keep getting better and better. Maybe you disagree with him.

Ed Bright: I can see that possibility. I am not familiar enough with details of sophisticated treatments to be able to address that in any detail but I can see that as a problem.

Marion Blackburn: I think the whole Country at some point will have to face that problem. Health care costs continue to spiral upward and insurance keeps going up almost yearly or every other year and it has to be paid for somehow. It is definitely an interesting issue.

This has been very interesting and I appreciate your candor and your thoroughness.

Ed Bright: I appreciate your interest in anything I might say.