The closing of Baylor Garland Hospital was signaled nearly a decade ago, but most missed the warning signs

Garland's Salvation Army was the first location for Hope Clinic, but almost as quickly as it started there, the Army's commander ousted the clinic, creating much uncertainty about the clinic's future. Few then knew the interplay that would soon occur between the new charitable clinic and Garland's only hospital.

The recently announced closing of Baylor Scott & White Medical Center at Garland, the city's only hospital, didn't happen overnight. The direction the hospital was heading for the past decade wasn't difficult to spot.

How were the clues missed? Why didn't someone loudly sound the alarm bells before the medical institution's doors were ready to shutter? Why did so much optimism and a view through rose-colored glasses seem to rule the day?

It's a story that began more than a decade ago, dating to the time when another medical facility for the city—a charitable institution promising hope for the city's oversized uninsured and poverty-level population—was being birthed.

As an early board member of that charitable medical institution—Garland's Hope Clinic—I remember too well the empty bank account, the eviction from the Salvation Army facility, the overwhelming needs of the uninsured and undocumented in Garland, and the lack of public support.

Those first board meetings of the nonprofit in 2002-2004 were filled with excitement for the project but concern because of the odds at success.

Slowly but surely the board began, with the help of some local downtown Garland churches and the brilliant leadership of ace volunteers Ed Seegers and Barbara Burton, to pull itself "up by the bootstraps".

Then something rather miraculous—but also very unusual—happened: Hope Clinic was "discovered" by Baylor Garland. A little grant here. A gift of equipment there. Then more grants. And more equipment. And then the first representative from Baylor Garland was elected to the board. Others soon joined the parade.

Soon the support from Baylor Scott & White Medical Center at Garland seemed like cascading waterfalls. Money and equipment and personnel poured in. The once-scarce volunteer medical team flourished. Doctors affiliated with Baylor Garland began volunteering by the droves. Services moved from one night a week to weekdays.

All seemed so wonderful. God's blessings were pouring out in abundance on the clinic—and in such a short span of time, we said.

I well remember one of my last board meetings, with dinner served in the board room of Baylor Garland Hospital's president, Tom Tennery, who retired this past February 1. My head swam with contrasting memories of the early days when we could hardly find a place to hold a one-night clinic, let alone pay the bills.

Hope Clinic had come so far so quickly—thanks largely to Baylor Garland.

While Baylor Garland Hospital was dying, it breathed new life into Hope Clinic. But did this also send out distress signals about a situation that would lead to the hospital's downfall?

While not wanting to "look a gift horse in the mouth", a few of us trustees wondered quietly why the hospital was being so generous. Behind the scenes, some said that the hospital needed a way to siphon off to a charity situation its burgeoning collection of needy patients who couldn't pay their medical bills but desperately needed care. Hope Clinic seemed like the perfect answer.

That explanation seemed reasonable given the huge underserved, uninsured, needy population in Garland. It seemed like a win-win for the clinic and the hospital. With 27 percent of Garland without health insurance and 47 percent of Garland families living below the government-established poverty level of $48,600, certainly some solution was needed.

With the Clinic's board and operation filled with so many truly qualified top-notch medical personnel, as a non-medical person I believed it was time for me to move on and to devote my talents to other worthy community endeavors, so I resigned as a Hope Clinic board member in 2011.

I curiously took note soon thereafter that even more Baylor Garland people, including a former board chair and other board members, were swarming onto the Hope Clinic board and into its operation, too. I wondered what that meant.

On the other side of the equation was Baylor Garland itself. Friends on the hospital board reported that despite the phenomenal growth of Hope Clinic, the problems at the hospital did not stop but continued to grow. This was seen in the growing number of people unable to pay for the hospital's services. In recent years the hospital's uncollected debt has risen from 5 percent to 16.5 percent—frightful statistics for any business. Some are reporting the loss to have reached as much as $20 million a year.

Simultaneously our nation was going through the upheaval in the medical community nationwide, thanks to Obamacare, the Republican rebellion against it, and related issues, such as the Great Recession and its aftermath. 

Without Baylor Garland's support, can Garland's Hope Clinic provide for the city's 27 percent uninsured and 4 percent living below the poverty level? That won't be easy.

And the rumors—oh, the stories we were hearing—in the doctors' offices surrounding the hospital and elsewhere in the city! Could our city's leaders and average citizens and voters have missed them? One physician told us he would not do any referrals for tests to Baylor Garland. He was fed up with the hospital located across the street from his practice. Every time we would visit the Baylor medical complex, more and more vacant office space was obvious at the hospital and in the surrounding medical buildings. Nurses, staff, and other medical personnel whispered that they knew the situation at the hospital and in the whole medical center was growing dire. The website, Nextdoor, lit up with rumors about the troubles at the hospital.

In downtown Garland we celebrated when Veritex Bank, situated southeast across the street from the hospital, purchased the property bounded by North 11th Street, Main Street, 10th Street, and State Street, to build its new beautiful facility to relocate in our neighborhood. At the same time we knew that was just another nail in the coffin for the Baylor Scott & White Medical Center at Garland complex.

And then came the announcement earlier this year that Baylor Scott & White had put the hospital up for sale. The Dallas Morning News ran the story. Rumors circulated wildly and widely.

At that time one knowledgeable source close to the situation told me that shortly before hospital President Tennery retired on February 1 and before Baylor Scott & White put the hospital up for sale in early March that key Garland leaders met with Tennery and other hospital management and were told that a real possibility existed that the hospital might have to close, if a buyer could not be found. 

Simultaneously cheery optimism also made the rounds among many in the city's establishment about at least four entities vying to purchase it. Some even smugly said they knew which entity it would be. That frankly seemed a little illogical to me, since the overall Baylor system is wealthy and filled with talented people who should have been able to find the right formula for the hospital's future. Why would four other entities, some identified as groups of medical professionals, be willing to take on the challenge when the Great Baylor had failed?

Garland City Council finally put the hospital on its public agenda for May 1 of this year. When the hospital representatives failed to show up for the meeting (a rare occurrence) to give their report, council seemed surprised but were obliged to move on to the next agenda item. I wondered why no council member later publicly pressed to insist to know where the hospital representatives had been and why they went AWOL—and to schedule them on the agenda again promptly!

Sleepy little Garland (the 12th-largest city in Texas and 87th in the U.S.) seemed to be nodding off as yet another earthquake was ready to rattle our windows!

Several days before the official announcement last week, a hospital board member told me privately that a solution had been reached. It sounded as though he was saying a sale had been negotiated, but he was adamant that he would say no more. His body language told me the situation wasn't good. His uneasiness led me to sense that at best it would be a partial sale, perhaps of only the hospital's emergency room.

Now, as we all know, Garland's third largest employer—after the school district and city—will close at the end of February. The fallout will be significant, particularly on the south side and central portions of the city.

The postmortem has begun. The "Why-didn't-we's?" are already flying on Facebook, on websites, and everywhere you look right now. And the pragmatists among us are already counting the emergency clinics and other medical facilities still available in the immediate area and hoping—and praying—for the best.

At the heart of the issue lies some of the same old issues that have plagued our city for decades:
1. secrecy,
2. failure to face reality quickly, and
3. the ever-requisite "positive" spin on whatever is happening regardless of how negative its impact might be.

Ever heard of the expression, "you can't cure the problem until you know there is a problem"? I've heard it stated a dozen different ways, but all means the same thing: You've got to know what the problem is in order to fix it.

Like the proverbial "elephant in the living room" many seemed to know that the hospital was in deep, deep trouble, but no one seemed to want to talk publicly about it—at least beyond a few sparse words and occasional comments on social media.

Instead of allowing the hospital to just slowly die over the past five years—covered over with unrealistic optimistic rumors until the bitter end—the public needed to know early on in clear and certain terms that the problem was real and that unless a real solution could be found, the south and central parts of Garland would once again take another powerful blow to its mid-section.

No, the City of Garland doesn't have enough money to bail out an institution like Baylor Garland, especially after the Baylor Scott & White empire ruled it a financial failure. I am not—and would not—suggest that. The time for solutions to "fix" the hospital is over. The window of opportunity has long passed.

Now we once again have to pick up the pieces and move on! Like the long-empty Hypermart, the soon-to-be-empty buildings at and surrounding Baylor Scott & White Medical Center at Garland will remind us once again for a long time that we MUST face reality directly and quickly—despite how bad it might feel at the moment.

I was delighted to see the information released Monday by the City of Garland that the city will work to create a Tax Increment Financing (TIF) zone in the hospital area to stimulate redevelopment. That process will involve a public hearing and an ordinance, which will take time to roll out. However, the socio-economic problems that caused the issues at the dying hospital still remain. 

Barbara Burton, left, one of Garland's most powerful fundraisers, helped lift Hope Clinic to its current status as the leading provider for Garland's uninsured residents. Kay and I were pictured with Barbara a year ago in front of plaques acknowledging the clinic's leading donors. Will that donor base be sufficient with Baylor Garland Hospital gone?

A corollary to this story is, can Hope Clinic survive without Baylor Garland? Hopefully yes. The clinic has attracted some of the best minds and best donors in the city.

But at the same level? With the same financial strength? Let us all hope that it can. Without that lifeboat, our huge uninsured and poverty-level population will face an even bleaker future.

Meanwhile, Garland continues on its road to a "Tale of Two Cities" divided by a east-west line mostly along approximately Belt Line, with the wealthier population to the north and the poorer population mostly to the south.

Until we address that dividing line head-on and roll up our sleeves and go to work to eliminate the problems it creates, other earthquakes will rattle our windows again! Will we be alert and ready to act quicker next time?