A Heart to Serve Read online

  Dad loved practicing medicine and he devoted himself to it. Soon, he became the busiest and most sought-after doctor in Nashville, with patients sometimes waiting months for an appointment to see him. He never turned patients away, welcoming rich and poor alike. Over time, he became the personal physician to the governor of Tennessee, then later to six other governors, as well as Grand Ole Opry stars such as Sarah Cannon (better known as Minnie Pearl), and many other celebrities. He never lost his humility.

  “Dr. Tommy,” as Dad was affectionately known by his patients, had a marvelous gift for making his patients feel comfortable and special, as though each individual was the most important person on his busy schedule that day. Dad was as much counselor as he was physician, although he had no professional degree in the realm of psychology; he simply had compassion and common sense. He was comforting and reassuring; he gave people hope. He treated the whole patient and the whole family. When a young patient was to be married, it was usually Dad who brought the couple in for marriage counseling.

  When Dad began his practice, the specialty of cardiology did not really exist. But Dad gravitated to the study of the heart, attending courses taught by the famous Boston heart specialist Dr. Paul Dudley White. He soon developed a reputation as the doctor to see when patients experienced heart ailments.

  At the same time, Dad was quick to embrace new and better technology, constantly seeking to improve care to his patients. When the electrocardiograph (EKG) proved reliable, he became the first doctor in Nashville to have the new machine, outside of the teaching hospital at Vanderbilt. At the time, the EKG machine was the size of a large wheelchair, cumbersome and not easily transported. But Dad didn’t merely use the machine in his office for patients referred to him. Quite the contrary, he took the machine to patients all over the region. Furthermore, he began reading EKG strips for doctors from rural areas all around Nashville, and eventually for hospitals across Tennessee. Runners brought a fresh batch of EKGs each day. Dad would read the tests and send back the results the following morning.

  A few years later, in the early 1960s, the technology evolved so a newfangled listening device allowed instantaneous, real-time diagnosis over the telephone line. It was revolutionary. At the bedside a hundred miles away, a doctor could hook a patient up to an EKG machine, then attach the machine to a telephone that in turn would transmit the signal to a special printer in Dad’s office in Nashville. Dad could read the strip and immediately tell the doctor the diagnosis and recommend treatment. Still later, Dad was the first in town to get a machine that translated the blips over the telephone into a readable EKG strip printed out in his bedroom in our home on Bowling Avenue. That way, Dad could read EKGs any time of the night if a doctor needed his help. I remember hearing that telephone ring regularly through the night during my boyhood.

  Forty years later, these vivid memories of Dad’s willingness to leverage new technology as a means to improve health care led me to join forces with then-Senator Hillary Clinton in drafting a major health information technology bill taken to the floor of the Senate in 2005. And today, that same spirit moves me to support President Obama’s leadership in modernizing information technology as a way to reduce medical errors, improve quality, and lower the costs of health care in America.

  With the U.S. economy booming after World War II, Dad’s practice grew as well. He and Mom were also slowly growing more financially stable, so Dad developed an interest in real estate investing—a natural sidelight for the doctor with entrepreneurial instincts. He gradually acquired and renovated most of the small houses surrounding his medical office across from Vanderbilt on West End Avenue.

  In the early 1970s, successful Nashville businessman and entrepreneur Jack Massey and some other investors felt it was time for Nashville to have a luxury hotel just outside of downtown. They approached Dad to join their group in part because of friendship but also because, by then, he owned most of the properties in the block they considered the perfect location for their hotel. Dad got in on the investment with almost no cash, instead putting up the land he had put together over the years. Today, Loews Vanderbilt Plaza Hotel stands on that property. Dad was proud of the contribution he and his friends had made to the expanding midtown of Nashville by building the hotel, which still remains as one of the best hotels in town.

  IN 1952, THE YEAR I WAS BORN, OUR FAMILY MOVED INTO A COMFORTable five-bedroom house on four acres on Bowling Avenue just outside the city limits—a handsome place Dad had long dreamed of owning. Karyn and I live in that very house almost six decades later in part to honor and preserve the fond memories of a close family of seven, meaningful traditions, and the enduring legacy of Mother’s and Dad’s simple values.

  During the 1950s, Dad scrambled constantly to make the mortgage payments. He did whatever was necessary to keep his family’s home. The home and the land around it were important to Dad, not merely as property, but for what they represented—love, security for the family, and memories and values for the next generation. The home saw the family grow. A white barn out back soon housed three horses, and the field enclosed a pen with white turkeys and even a billy goat for a while.

  Dad always said that his interest in hospitals originated with him being an orderly when he was twelve years old. But his more contemporary interest in hospital operations and construction began as two trends merged in his life. The first was a growing interest in the demographics of America’s aging population and the impact they were having on society. The second trend was the increasingly wasteful way in which hospitals were run at a time when technology was advancing and costs were continually escalating.

  In 1959, Dad was appointed to the American Medical Association’s (AMA) Committee on Aging and was subsequently named to the President’s National Commission on Aging. He went to his first AMA committee meeting, which included five former presidents of the organization. At the conclusion of the gathering, Dad, a humble family doctor from the southern town of Nashville, rose from his chair and boldly said, “We should do something tangible about aging, instead of just talking about it.” Dad liked action.

  Taking his own advice, he returned to Nashville and almost immediately opened a retirement home affiliated with our Presbyterian church, a few miles from our home. As his interest in helping the aging grew, Dad later founded the American Retirement Corporation, which ultimately grew to become one of the largest retirement-living chains in the United States. (Today it’s part of Brookdale Senior Living.)

  About that same time, he and a group of doctors were experiencing difficulty finding beds for their patients in Nashville hospitals. Although the city boasted several large hospitals, all the beds were full. Moreover, having worked at all the local hospitals, even serving as chairman of the board for most of them, Dad knew firsthand that most hospitals were not well run. One Nashville hospital at the time was run by a retiree with no management experience at all—the director was simply a political appointee. Many of the employees received subpar pay and worked in crowded, antiquated, and unappealing facilities. Much of the equipment was outdated, and the hospitals had no access to capital to modernize.

  Dad envisioned a different kind of hospital for his patients: a well-managed facility, with well-trained and appropriately paid staff who looked forward to reporting for work each day, a hospital where the patients received excellent care and good, nutritious food and were embraced by a sense of warmth, compassion, and hope. He wanted the patients’—and employees’—immediate environment to be uplifting and conducive to healing, believing that attitude plays a vital role in health. Dad’s initial idea was to combine a single fifty-bed hospital facility with a one-hundred-bed nursing home. He originally wanted to create a nonprofit hospital, but he could not interest the local government or any organizations in putting up the money for it. Finally, Dad found seven doctors willing to sign for a loan jointly to finance the facility. When it came time to name the hospital, Mother suggested, “It’s right across from Centennial P
ark. Why don’t you call it Park View?”

  Park View hospital opened in 1961, marrying two of my father’s great passions—serving the aged, through the nursing home side of the facility, and serving the sick, through the acute care medical hospital side of the facility. Unfortunately, Dad’s seemingly great idea failed. The reason was understandable: Those in the nursing home side ultimately wanted the same level and intensity of care as what they saw on the hospital side. And that was financially impossible to do because of the high intensity of care that was demanded on the acute medical side.

  Others would have thrown in the towel and given up. Not Dr. Frist. Dad simply said, “My initial idea was a bad one; I was wrong. So let’s make the necessary adjustment, now, quickly, and convert all the beds in the facility to be a hospital only.” Within six months, Park View was a thriving, bustling, acute-care hospital, meeting the high standards of quality and efficiency that Dad set out in his initial dream. It still thrives today, now renamed Centennial Hospital. Dad understood how to learn from his mistakes.

  Although it was not yet apparent to anyone at the time, Dad and his partners had planted the seed for a revolution in health-care services that would be felt all over America and indeed around the world.

  WHILE DAD WAS BUSY DEVELOPING PARK VIEW HOSPITAL, MY brother Tommy attended college at Vanderbilt, followed by med school, first at the University of Tennessee in Memphis, then at Washington University in St. Louis. I was a young teenager and as yet, no one in our family had done anything significant in business. We lived comfortably as a middle-class family of seven, Dad making ends meet on his medical practice income and beginning to save for the future.

  Tommy had the entrepreneurial instinct in the family, influenced I’m sure by all the odd jobs that Dad had created during his years in school. To my father’s great chagrin, Tommy left college for a while, long before that became the fashionable thing to do (now called a “gap” year, but then called “dropping out”) to expand his tiny college desk blotter advertising business—the same concept that Dad had proved successful thirty years before at Ole Miss. Now, Tommy dreamed of selling blotters not just at Vanderbilt, but at a hundred colleges around the country. He dreamed big. He formed a company called Collegiate Advertising, had some business cards printed, mixed in his own love for flying, and bought an old cloth-covered, wooden-propeller Stinson airplane to fly around the country setting up his franchises. Dad made it work, first at Ole Miss, then at Vanderbilt. Tommy dreamed to take it nationwide. The venture was a success for the twenty-one-year-old, because it brought him a fair income. And he surpassed his goal, putting out blotters at 112 colleges. It was a success to me, because Tommy brought me home a college pennant from each institution he served. Every night I’d fall asleep as an eight-year-old kid under the shadows of thirty college pennants pinned to the wall at the foot of my bed.

  Selling desk blotters, however, was a seasonal business, so Tommy turned to catch the wave of the latest craze around the country—outdoor trampolines—setting up two outdoor trampoline centers in communities just outside Nashville. I spent many a summer afternoon and evening with Trisha, at the time Tommy’s steady girlfriend (and now wife of almost fifty years), collecting fifty cents from boys and girls for each thirty minutes of jumping on the trampolines in two nearby towns, Donelson and Madison. Trisha and I would be manning one trampoline center, Tommy the other. A year later, as happens with all fads, the trampoline business folded, and our ever-supportive and always patient mother inherited the responsibility of selling Tommy’s thirty, used, green nylon trampolines, stacked for months behind the home on Bowling, through the newspaper classified ads.

  Tommy watched from afar with great interest as the fledgling hospital that Dad had put together took hold and flourished in Nashville. Franchises and chains of businesses were much in the air in those days, and following his surgical internship in Nashville, Tommy ruminated on the possibility of creating a chain of hospitals like the one Dad had created. Most hospitals at that time were nonprofit entities operated by religious organizations or local governments. Doctor-owned hospitals of the past had a poor image generally because they were typically underfinanced, and thus had to cut corners wherever they could. But Tommy’s dream was different. And it, too, was big.

  One of Tommy’s fraternity brothers at Vanderbilt just happened to be Spence Wilson, son of Kemmons Wilson, founder of the Memphis-based Holiday Inn hotel group, a relatively new and thriving hotel chain, the first of its kind. Holiday Inn had mastered the concept of a chain of facilities across the country, standardized to a level of dependable quality and service, all at a reasonable price. Tommy wondered why similar principles had not been applied to health care, especially when quality of care for patients in hospitals was so uneven and service so variable from one facility to the next.

  In talking with Spence about the launching and growth of Holiday Inns, Tommy began to dream of developing a company that could spawn a group of hospitals, owned not by doctors but by investors, similar in quality and standards to Park View: new, privately financed, clean, and well-equipped facilities. The investor-owned concept, using the marketplace through a public stock offering, would guarantee the capital to provide high-quality, modern, consistent service. Tommy imagined how those hospitals might join together for mass purchasing of medical supplies and equipment, creating bargaining power that simply could not exist with unaffiliated, free-standing facilities. Tommy saw it all so clearly, yet it had never been done before. It required thinking out of the box.

  Although Dad’s passion was caring for patients and not hospital administration, with the success of Park View he became regarded as an expert on the development of high-quality, for-profit hospitals responsive to doctors and centering on patients’ needs. Tommy knew his dream could only be accomplished with the help and experience and reputation of his father.

  Tommy had also always admired the entrepreneur Jack Massey, a close friend and patient of Dad’s. Mr. Massey was a pharmacist and had owned a pharmacy and surgical supply company back in the 1930s. Dad bought all of his medical supplies from his company over the years. Mr. Massey was also the marketing genius behind Kentucky Fried Chicken, which he had purchased from Colonel Sanders for $2 million, then grew into a chain known worldwide, wisely keeping Colonel Sanders as the figurehead and primary pitch man. Mr. Massey also had an understanding of hospital management and was serving as chairman of the board of the large, highly respected Baptist Hospital in Nashville. Tommy knew neither he nor Dad had the necessary business experience; that role could only be filled by Mr. Massey, who could provide the franchising expertise, while Dad could be the physician in charge who was the master of building a hospital that focused on the quality of care for the patient.

  After his surgical internship at Vandy, Tommy and Trisha entered the Air Force, where they were stationed at Robbins Air Force Base in Macon, Georgia. With his vision still being formulated, he approached a hospital near Macon and discussed the potential for a private, for-profit hospital partnered with a chain of other investor-owned hospitals. He discovered a surprisingly receptive audience. Buoyed by the encouraging response in Georgia, Tommy knew his next step was to broach the subject with Dad.

  Returning to Nashville one weekend and sitting around the kitchen table at the home on Bowling, Tommy explained his ideas to Mother and Dad. Much to my brother’s dismay, Dad didn’t want to listen to the idea. Not that he couldn’t grasp the concept; he simply didn’t want it to be his son who would make the dream a reality. “Doing surgery is the best job in the world,” Dad declared. “It’s something I always wanted to do. You’ve worked hard to be a doctor. It’s the greatest privilege in the world. Why would you want to give that up?”

  I would hear these same words thirty years later.

  This was a tense time for both Dad and Tommy. But Tommy was determined. He approached Mr. Massey directly about the possibility of launching a chain of hospitals. A disciple of private enterprise an
d the advantages that the market brought to bear, Mr. Massey responded better than Tommy imagined, not only with ideas and suggestions, but with the sort of enthusiastic support Tommy had hoped to find in Dad.

  It moved Mother, and she brought her oldest son’s case to Dad. “Tommy wants to do this. He feels it is the right thing to do. It’s his dream. He believes in it. He believes he can care for more people by serving this way than being a surgeon. And if it doesn’t work out, he can always go back and take care of patients. Tommy, I think we should help him do it.”

  And that’s all it took. The initially reluctant father would follow his son’s dreams.

  Mr. Massey provided the business acumen and the financial backing; Dad had the medical expertise and embodied the values; Tommy had the crystal clear vision and provided the driving energy. They turned to a patient of Dad’s, Nashville lawyer Henry Hooker, to handle the legal matters. They needed a name. Tommy simply imitated the name Holiday Inns of America and called it Hospital Corporation of America (HCA). Together they laid the foundation for what was to become a new multi-billion-dollar industry that would forever change the health services sector.

  Dad became president of the nascent organization. He made it clear, however, that his involvement was contingent upon the company’s maintaining high-quality care as inexpensively as possible, in pleasant and patient-friendly surroundings—precisely what Tommy hoped to do. Forever the patient’s doctor, Dad would continue his busy clinical practice, but he would serve as president of HCA at the same time.

  Dad was good for HCA. In addition to his experience of working with hospitals and his skill in managing their medical staffs, he possessed the intangible appeal of a genuine, humble, hometown doctor whose sole motivation was to heal. People trusted him, and he always kept their best interests at heart. He worked indefatigably to make HCA successful, calling on his physician colleagues around the country, many of whom he had taught at Vanderbilt or known in military service, and bringing one hospital after another into the fold. Dad especially loved the small hospitals, the ones in which it was possible to really get to know the people working there. His favorite was among the first, a forty-bed hospital built in Erin, Tennessee, in a community that previously had no regional care. Using the private market to build hospitals in regions where there was no care—it made so much sense, yet was so revolutionary.