STARKVILLE — On a recent Wednesday night, Bricklee Miller sat in her car outside a Walgreen’s. Just two lamps illuminated the parking lot, casting her face half in yellow light, half in shadow.

Minutes earlier Miller had left a local debate on the upcoming vote on selling the county’s only hospital, OCH Regional Medical Center. In her year-plus as a county supervisor, Miller has earned a reputation as the sale’s biggest proponent. Plenty of Oktibbeha residents oppose the sale, however, and that night the forum had been full of them.

Now, as Miller pulled documents from a torn manila envelope — evidence, she said, that the hospital was hemorrhaging far more money than its leadership would admit — her voice remained steady. But she was rattled. The Nov. 7 referendum, in which the county will vote to either sell or hold onto OCH, was just a few weeks away, and tensions in Oktibbeha County were rising.

“I’m just showing this to you because I haven’t done anything wrong. You wouldn’t believe the stuff they’re saying about me,” Miller said. “Anything that they can say.”

These rumors, first whispered at town halls, then given eternal life in Facebook comments, have ranged from the banal (conflicts of interest) to scandalous (bribes and kickbacks).

To be clear, evidence to support these claims does not exist, but when it comes OCH, that doesn’t always matter. Many county residents were born there. Others had their children there. With 691 employees, second in the county only to Mississippi State University, nearly everyone who spoke with Mississippi Today said they know someone who has worked at the hospital.

“We own this hospital, the people of Oktibbeha County. In every sense of the word, it’s a community hospital,” said Allen McBroom, a member of anti-sale group Friends of OCH. Its Facebook page, at just over 1800 members as of Tuesday, has become the online ground-zero for the sale’s opponents and their theories and frustrations.

Of Mississippi’s 102 hospitals, 25 are stand-alone, county hospitals, meaning they are publicly owned and not part of a system. But changes to health care on the national and state levels have made the hospital business an increasingly risky one in the last decade, especially for small hospitals.

Since 2010, five Mississippi hospitals have closed. Four of these were county-owned. And some industry experts have argued that the best way to keep these public hospitals alive is to make them private, usually by selling or leasing to a larger health system.

“I think we could have a small little hospital that could rock on forever,” said Orlando Trainer, the president of the board of supervisors and, along with Miller, one of the biggest advocates of the sale. “But health care is changing so much that if we don’t (try to sell when the hospital) is at its best value … if we don’t pay attention to the indicator lights, we’re going to end up in a situation where the other communities do, with a hospital that’s not worth what it was.”

While some argue that selling OCH could stabilize the hospital, there’s little debate that the fight over selling has sown instability within the county.

“I know this is a controversial issue, it’s been an emotional issue,” Trainer said. “But it’s because it’s probably the biggest thing this county’s ever done. It’s a game-changer, that’s for sure.”

For McBroom, whose wife works at OCH, labeling the issue “emotional” sidesteps a bigger point.

“This (sale) feels like a betrayal. You have these people trying to sell something that’s ours, and we don’t even know, really, who they are,” McBroom said.

While opponents of the sale have been a vocal group — posting on Facebook, knocking on doors, passing out yard signs and buttons when they pump their gas — those in favor of it have been far less visible. But Miller says plenty of residents want to see the hospital sold, too. She calls them her “silent majority.”

“They can’t speak up. Every time they do, they get attacked,” Miller said.

While those opposing the sale may be less visible, there’s evidence that some of them have deep pockets — and may even be outside of Oktibbeha County. In the last month alone, pro-sell messages have come in the form of a nationally organized push poll, email surveys, robocalls and dozens of television and radio ads.

On Monday, the County Clerk’s office confirmed that two of the groups paying for the radio ads had still not registered with that office, a violation of state campaign law.

Within the county, arguments for selling OCH have come primarily from Miller and the two other supervisors who voted for the sale. But county officials are prohibited from spending money to influence a referendum, and when asked, none of the members said they had authorized any of this or knew who had. All of which has left some Oktibbeha residents asking just who wants to sell their hospital and why?

Who wants to buy a hospital?

Politics is a new game for Miller, whose full-time job is running Mississippi State’s Horse Park. And while Miller knows her stance has been deeply unpopular with some of her constituents, when she talks about her reasons for selling, it’s clear she believes them.

“Apparently I’m not a very good politician, according to most people. I may not get re-elected. That’s fine,” Miller said. “I’m trying to do what’s right for the county. The fact that everyone’s taking this out on me just shows that I’ve been doing my homework.”

But political naivete might also explain how, in just over a year, Miller has become the face of the sale, even though the president of the board of supervisors, Orlando Trainer, has been working to privatize OCH for more than half a decade.

In 2013, Capella Healthcare offered a 50-year lease on the hospital for an undisclosed sum. Trainer pushed hard for a deal, but ultimately rallied just one other vote on the five-person board of supervisors. Since the hospital is county-owned, selling or leasing it requires approval from a majority of the board. And Trainer didn’t have the votes.

That changed in 2015, when Miller defeated incumbent Daniel Jackson in the District 4 race.

Starkville resident Allen McBroom

“Bricklee Miller suddenly is the poster child for selling OCH after she’s elected. She ran on a platform of, ‘I have an open mind.’ Then, when she was elected she changed. Not quite overnight but close enough,” said McBroom.

When asked if she might be taking the blame for someone else’s cause, Miller pauses. She looks down, then takes a deep breath.

“When I ran for office, one of my things was transparency. I am the only supervisor that has a social media page where I try to share every single (hospital-related document),” Miller said. “So I think it’s mainly because I’ve exposed myself through sharing the information.”

According to Miller, her overnight change, was more like one eye-opening day. Three months after she took office, in April 2016, she attended an event in Jackson billed as Gov. Phil Bryant’s Rural Health Summit. The governor’s office did not respond to multiple requests for comment on the summit or his interest in rural health.

While the governor may have been the name on the marquee, those who attended said he was not the main event. Nine speakers followed his introduction. Five of these are part of a health care consortium that advises counties and municipalities on how to privatize locally owned hospitals.

“To call it a rural health summit, that’s probably a little extreme. It was good information. I won’t necessarily say they were wrong. But it was more of a sales pitch on the benefits of privatization,” said Ryan Kelly, executive director of the Mississippi Rural Hospital Association.

While Kelly didn’t buy what they were selling, Miller did. She returned to Starkville, she said, convinced that Oktibbeha’s hospital needed a thorough evaluation.

“Gov. Bryant and the speakers stressed that you need to assess your hospitals. Health care changes are coming, so go and assess your hospitals. You can’t keep doing what you’re doing or standalone hospitals aren’t going to survive,” Miller said.

The county hired the health care firm Stroudwater to conduct the assessment of the hospital, its finances and its future. The report, released in late 2016, concluded that while the hospital had ended five of the last six years in the black, the hospital will need more capital, to the tune of $3 million a year, to keep current. And it said the best way for the hospital to do this was through a sale or long-term lease to a much larger health care system with more money.

In March, the supervisors approved a sale. As the bidding process got underway this summer, the county ordered a second audit. The results, which Miller posted to her own Facebook page, showed hospital losses over $5 million for the first 10 months of fiscal year 2017.

End of year numbers, released last week, painted a slightly rosier picture, showing cash earnings of nearly $1 million, bringing the total loss for the year to $4.4 million. Industry experts have also pointed out that while the total sounds dire, it’s technically a “paper loss,” meaning the losses come from a decline in the value of the hospital’s equipment.

The hospital has also challenged the Stroudwater report, arguing its assessment was biased and pointing out that one of the firm’s principles had been a vice president of acquisitions at Capella Healthcare when it tried to lease OCH in 2013. Some industry executives have argued that few hospitals, if assessed today, would fare well.

“I wouldn’t say one bad year in about six is anything to go ballistic over especially with all the uncertainty in the healthcare industry,” said Paul Black, the CEO of Winston Medical Center, a community hospital in nearby Louisville.

But what angers Miller the most, she said, is not the numbers themselves, but the fact that the board of supervisors had to come looking for them.

“We’ve tried to be transparent and make people understand that the hospital is losing money. I can’t say the same for them,” Miller said.

Secret Money

Miller may have tried to be transparent, but others pushing for the sale have kept their efforts and their motivations deeply shrouded.

In the last two weeks, a series of radio ads promoting the sale of the hospital began airing on two local stations, WKOR 94.9 FM, which plays country music, and WMXU 106.1 FM, which plays R&B.

Documents obtained by Mississippi Today show that the ads were bought by Carol Stern, who lives in Ridgeland, two hours from Starkville. According to the Columbus Dispatch, Stern spent a total of $5,112 on the ads on behalf of two groups, Nothing but the Facts and the Education Association of East Oktibbeha County Schools.

Neither group is registered with the Oktibbeha County Clerk, a violation of state law.

Mississippi Today obtained a clip of one ad that aired on 106.1. It seems to target the station’s largely African American audience, linking a vote for the sale to the struggle for civil rights.

“Go to the polls and make history,” a woman’s voice says. A second woman follows, saying, “You couldn’t keep me away after all the people who have fought for us to have the right to vote. We’ve got 9 African Americans running (for office on Nov. 7) and we’ve got to choose a hospital that truly believes in promoting minorities in administrative positions, not just housekeeping and food service.”

A chorus of voices then closes out the ad, saying, “It’s time to make history again.” In the background, a bell rings as a final voice sings, “Praise the lord.”

The Columbus Dispatch reports that the ads on the country station discuss the hospital’s finances and alleged tax liability on the county.

A Facebook message to Stern went unreturned. The publicly listed phone number for Stern’s company C Stern Strategic Marketing has been disconnected.

A flyer, distributed at African American churches in Oktibbeha County last month, urges residents to vote for the sale of OCH Regional Medical Center.

Two Sundays ago, a series of fliers were distributed anonymously at African American churches, also suggesting that selling OCH would increase opportunities for minorities. In an echo of the radio ad, the flier listed “7 Reasons to Vote Yes.” The seventh read “Baptist and Tupelo (the two hospitals bidding) have minorities in administration and other key positions (not just janitorial).”

The head of OCH’s janitorial department, Kennedy Neal, is African American.

Other efforts without obvious backers have appeared in the last month. In mid-October, Gravis Marketing emailed several residents a push poll. The poll contained questions such as “Do you find it troubling that the hospital hid (its financial losses) until a few days ago?” Gravis Marketing, which is based in Orlando, describes itself on its website as “an award-winning public relations firm.”

Miller and Trainer have vehemently denied any involvement in the media buys, flier or the push poll. They’ve also said they don’t know who could be involved.

Rather than alleviate anxieties, however, the fact that these efforts have not yet been tied to anyone in the county has rattled several hospital supporters.

“It’s weird. I think that’s the polite way of putting it,” McBroom said. “Why (is) someone who’s not in Oktibbeha County involved in what happens to our hospital?”

A question of transparency

It’s impossible to overestimate the role that transparency — or lack thereof — has played in increasing the animosity on each side of the hospital debate.

OCH Regional Medical Center Credit: Larrison Campbell

Miller likes to point out that she took office on Jan. 1, 2016, the same day that Senate Bill 2407 went into effect. That bill, which increased transparency for community hospitals, passed in the wake of revelations that Singing River Health Systems, a public hospital in Jackson County, had tried to conceal losses totaling tens of millions of dollars.

But if transparency is important to Miller, it is also, she notes, bitterly ironic that accusations of shadiness have stuck to her. Back in her car that Wednesday night, she admitted that as much as she tried to ignore the rumors, they had gotten under her skin.

Earlier that evening she’d returned from a meeting with her attorney, the former U.S. Secretary of Agriculture Mike Espy, in Jackson. After months of trying to rise above the comments on her Facebook page, she decided to get hard evidence that everything she had done for the sale of OCH had been above board. Now, she said, she had it. And in the next couple of days, the rest of Oktibbeha County would, too.

“I have documentation to validate that I have never done what these people are saying. And I have proof of it. Proof,” Miller said. “Proof.”

That proof, it would turn out, were the results of a lie detector test, administered by a former FBI agent and passed by Miller, according to his report, with flying colors. She posted the results to her Facebook page the next day, along with a verse from the Gospel of Matthew, “Blessed are you when others revile you and persecute you and utter all kinds of evil against you falsely on my account.”

The lie detector results did little to vindicate Miller among those already furious with her for wanting to sell. Others saw it as evidence that the debate over the hospital’s future, and the level of vitriol it has produced within Oktibbeha County, had gone inexorably off the rails.

“I can’t believe she felt she had to take a lie detector,” said Melissa Fulgham, a lifetime Starkville resident, who said she is on the fence about the sale. “They’re raking Bricklee over the coals. I’ve never seen anything like it.”

While this vitriol has caught some residents off-guard, those who have experience with the sale of county-owned hospitals say it shouldn’t.

On the website for Preserving Healthcare, which was put together by three of the firms behind Gov. Bryant’s Rural Health Summit in 2016, a series of videos offers a road map for not only why community hospitals will fare better if sold, but also how county officials can best tackle the issue.

One video details what happens when the community feels the process has been taken away from them.

“It’s got to be a transparent relationship (between the supervisors and hospital administration), and it’s got to be one based on trust,” said Colin Luke, a partner at Waller, a health care law firm, which provided three of the nine speakers at the governor’s summit. “… It’s got to be a partnership. If it becomes an acrimonious situation, one that plays out in the public, where it’s all about political standing and the next election, it will not, in most cases, be a successful outcome.”

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Larrison Campbell is a Greenville native who reports on politics with an emphasis on public health. She received a bachelor’s from Wesleyan University and a master’s from Columbia University's Graduate School of Journalism.Larrison is a 2018 National Press Foundation fellow in public health, a 2019 Blue Cross Blue Shield Foundation of Massachusetts fellow in health care reporting and a 2019 Center for Health Journalism National Fellow.

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