Robert E Seymour

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Reverend Robert Seymour sat on the University of North Carolina at Chapel Hill Hospital Board of Directors from 1980-1984 and after that was an active lobbyist for improving healthcare accessibility in the Chapel Hill, North Carolina Community. The Reverend is noted for his knowledge of the University of North Carolina at Chapel Hill Hospital system and is often a critic of how the Hospital’s internal structure prevents them from following through on their mandate of being an accessible, public hospital. This interview is part of Danny Hogenkamp's ongoing investigation of how the Affordable Care Act affects the undocumented Latino population and how the undocumented Latino population consequently affects local hospitals. This interview, in particular, was aimed at discussing the ramifications of large uninsured populations—specifically, how a hospital like the University of North Carolina at Chapel Hill's is dealing with the current medical finance climate after North Carolina’s rejection of Medicaid, and the Affordable Care Act’s rejection of healthcare for the undocumented.



Danny Hogenkamp: Hello, I am Danny Hogenkamp and today I am interviewing Mr. Robert Seymour in 219 Carol Woods Retirement Community in Chapel Hill North Carolina. We will be talking about the administration at UNC Hospitals and how the possibly deal with finances and, yea, so I am going to start the interview. Thank you so much for speaking with me today, and I guess my first question, for what I want to know, is what position did you hold in the hospital, and what role did you hold working in the UNC hospitals?
Robert Seymour: I have to backtrack a little. I regret that Florence Silbus (adjusting how he holds the mic). I regret that Florence Silbus is not available for you to interview her because my role at UNC Hospitals was initiated through my contact with her. Florence Silbus had a dual appointment with the School of Social Work and the School of Medicine and she was very much aware of the, what she judges to be the failure of UNC Hospitals to measure up to their stated mission. And, she felt so strongly about this that she circulated a petition in Chapel Hill, she got over 2,000 people.
DH: When was this?
RS: This was, in 1980. She circulated this petition that people who felt there was (what) at UNC Hospitals, that the UNC Hospital was acting more like a private hospital than like a public hospital— to whom they were responsible, the people of North Carolina. And, she gave this petition to the Chancellor, at that time, who was Erskine Bowles. Subsequently, I received a telephone call from Bill Roper, who was the current Executive of UNC Hospitals saying that he had been instructed by the Chancellor to appoint someone from the community to the board. This was one way of having a person on the board aware of all that was happening there, and also, a contact person on the board for people in the community, like Florence, who felt that things were not as they should be. That led to an interesting conversation. I said, “Mr. Roper, you know that I am 80 years old”. Then he said “yes I know you are 80 years old but I sense that you are functioning fairly well”. I said, “You do also know that I signed this petition that perhaps is circulating in the community”. He said, “Yes. I am aware of that”. And I said, “How long is the term?”. And, they said “4 years” and I said, “I’ll make a deal with you. If you keep me alive for 4 years, I’ll do it”. And, I am now 89 so he kept his part of the problem. (Laughing)
DH: Alright. So you served on the Board for 4 years?
RS: For 4 years.
DH: From when?
RS: From 1980 to 1984.
DH: Ok.
RS: And that was, a time when the board was very sensitive to some of the criticisms that had come from the community. It was also a time when Bill Roper needed to have a re-evaluation of his work to get a new extended contract in his job. I was asked to be on the committee that brought in a special consultant to evaluate the work of Bill Roper as the CEO, and it turned out that this person brought in was a personal friend of Bill Ropers (laughs) so the end result was pretty well anticipated from the word go. But in any case, there was one singular thing that happened. One of the things that the consultant pointed out was that when people call the hospital to ask for an appointment the recorded message ended with “and bring cash when you come”.
DH: Must have turned a lot of people away.
RS: And she (the consultant) said that this may have been a turn off to poor people or people who may have been hesitant about coming to the hospital for revealing who they were as an undocumented person. So in response to that, they got the panel to change the message. Also, the issue of large bonuses to top administrative officials was something else. It was a thorn in the flesh for a lot of folks. Why should these people be getting such huge bonuses? Then Erskine Bowles ordered that that practice seek for the top administrative people in the society. That at most turned out to be a symbolic gesture because of course what was done was to do away with the bonuses and to increase the salaries (laughing). I must say, I have a very positive impression of the careful work that is going on at the hospital and the work of the healthcare board. It is a large board made up of a lot of people including the person or whatever he is called of the university.
DH: Tom Ross?
RS: No, I am talking about the man that has gone to Louisville.
DH: Who?
RS: Not Tom Ross. He is the President of the whole UNC University System. The man, the Chancellor of Chapel Hill.
DH: Oh, the, Holden Thorpe.
RS: Holden Thorpe, Holden Thorpe was on the board?
DH: He still is?
RS: No he is gone.
DH: He is gone now? But he was there when you were on the board?
RS: Yes. But most of the people on the board were people from outside— and most of them were people who were presidents of bank or industry, carrying very much a point of view that would not have automatically made them sympathetic to some of the issues that were on the table.
DH: So they were pretty biased towards corporate interests?
RS: Yes, that’s right. I was required to be, able to be on the board and designated as a community representative, and this was made public, and I would occasionally get people who wanted to have a gripe against the hospital or a hospital bill or something. They would call me. And, I would in turn share it with the Vice President of Public Relations in the hospital who would usually succeed in smoothing over things. For example, there was one very bad situation where a patient in Apex had such a big hospital bill that he was selling his house to pay off his hospital bill. And when that fact became known, the hospital quickly responded and deleted the cost of his bill so that they could save his house.
DH: Yea. Ok. So one of my big interests is what happens when, because this happens all the time especially with the undocumented population. They go into the hospital because they have an emergency, maybe they have a heart attack. And so, you know, the hospitals don’t ask questions, they wheel them into the emergency room, they give them this emergency service, could cost, you know, hundreds of thousands of dollars. And then at the end, you know, like can you pay? And if the person cant pay, how does that get paid for because it’s not like the cost disappears.
RS: It is paid for by the excessive bills of those that can pay, pay. Yes. That is why hospital bills for those that could pay got to be so large, because we were subsidizing those that could not pay. And how well do you know Piedmont Health Center?
DH: I am pretty aware of it. I have looked at it a lot.
RS: It is a federal clinic in Chapel Hill and several neighboring counties. They are owned by a man named Brian Tunney, T-U-N-N-E-Y. And I think he is a person to who you should speak. Because I think low income persons generally tend to go to Piedmont Health Center. The word is out that this is the place for primary care if you don’t have any money or if you are undocumented. And I think there was a gentleman’s agreement. The hospital could refer primary care patients to Piedmont and Piedmont in return for crisis situations and surgery, would refer them to the hospital. So there was a working relationship there. Beyond that, I really am not personally aware of the problem as it is experienced by the undocumented population.
DH: Yea. It’s. I guess the best way to quickly describe it is that they just don’t have healthcare.
RS: That’s right. And they are afraid to come for healthcare to fail the question or to reveal that they are undocumented.
DH: Exactly. The guy I just interviewed yesterday who has some type of visa, lives in a house, with like 5 other undocumented friends. He is a young man…
RS: That itself is breaking the law. Chapel Hill has a law that says only four persons that are not related can live in the house. If it’s the five, they are breaking the law.
DH: Why is that, by the way?
RS: Ask the town board by the way.
DH: I am breaking the law.
RS: (Laughing). Don’t worry, I won’t report you.
DH: Please don’t. Please don’t. So, yea. All of these undocumented people he lives with, even when there are emergency situations where they should go to the hospital, they don’t go because what happened to two of his friends in the past is that they went to hospital, they got emergency care, and then as soon as their care was done, and they were well enough to be discharged, the immigration people were sitting right at the door.
RS: I really wish I was more aware of that personally because that is something that…
DH: No, it’s alright. I was looking to you to describe some of the hospital situations.
RS: Yes.
DH: I want to go back to something you said earlier. Piedmont Health Centers. Ok, so can you elaborate more on the structure and what…
RS: It is primarily a federally funded clinic.
DH: What type of funding is that? DSH funding?
RS: Federal government.
DH: Ok. What do they classify the spending as?
RS: I am not sure of the technology. That’s is why I think you should speak to Brian on that. He is the CEO, Brian Tonney, if I am remembering T-O-N-N-E-Y, Tonney.
DH: Ok, cool. So the Piedmont Health Center.
RS: He is still there.
DH: Ok, just as far as the health community in Chapel Hill.
RS: I think he could tell you more about the undocumented community.
DH: No, I will look into that. I have to go back and type this all out so I will definitely go back, listen to his information and try and contact him.
RS: This is an aside, but I think it will give you an illustration of what can happen. UNC Hospitals is supposed to be a public hospital, and that puts it in a special category of having an obligation of having to provide care to whomever needs it in North Carolina. UNC healthcare purchased a private hospital in Raleigh, Rex Hospital in Raleigh. And, my question was, if UNC purchased a private hospital in Raleigh with tax funds, why is it not also a public hospital?
DH: Is the one in Raleigh not a public hospital?
RS: It’s not a public hospital; they don’t have the same mandate to take care of the poor. And, it’s sort of a cash cow for UNC Hospitals.
DH: That’s interesting.
RS: Yea. Now there is a legal relationship there that has made Rex Hospital a private hospital owned by a public hospital. And, I think something is wrong with that picture.
DH: So, this mandate you’re talking about, just like getting back to how it would affect the poor populations in the community. So you are saying that UNC has this mandate, and Rex doesn’t. So how does that manifest itself on the ground when an undocumented person comes in?
RS: I think it manifests itself by not feeling the same obligation to take care of as many people who are uninsured, who can’t pay. Whereas Wake Hospital, across town, is a county owned hospital. My son is a physician there, and he says that Wake Hospital has a huge intake of uninsured people coming from all over Eastern North Carolina.
DH: Oh. Ok.
RS: And they are showing a deficit at this point.
DH: That is interesting because that is actually one of the things I am researching. Do you know, I am sure you have kept up on the Affordable Care Act?
RS: Oh yes.
DH: Ok. So the Affordable Care Act is obviously assuming that there are going to be less uninsured people. So they are cutting Discretionary Spending for Hospitals, DSH funding. I don’t know if you have ever heard that word get thrown around, but that is this giant hospital slush fund that pays hospitals for their deficits they ring up and for paying Medicaid patients and for uninsured patients. And, so that slush fund is getting smaller year by year under the Affordable Care Act because they are assuming the uninsured population is going to go down. But, in North Carolina, the state decided not to expand Medicaid.
RS: Medicaid. Yea, and they are getting more and more criticism about that, and I think the pressure will still be on until they move.
DH: And the other thing, the kicker, is the huge undocumented population. So, the Federal Government is thinking, “Hey, the number of uninsured will go down”. But actually, in North Carolina, there is no Medicaid expansion and we still have a ton of these undocumented immigrants and who can’t get healthcare. So can you talk a little bit about the deficit that is created at the hospital that your son works at?
RS: Well, I really can’t say much more than I said. Have you read the paper today?
DH: I have not read the paper today.
RS: You should see one of the lead pages in the New York Times is a revelation about how much doctors are being paid from Medicare. And, it turns out that there are many doctors who are being paid as much as ten million dollars a year by the Medicaid system.
DH: Really?
RS: Yes. And, it’s in the news today.
DH: Because it was always...
RS: I think I may still have the paper. I can give it to you.
DH: But in the past, people thought that doctors who treated Medicaid patients didn’t receive that much money?
RS: That’s right. And obviously that’s not the case. People know how to work the system. Yes. There was great shock when they made these figures public, because no one thought that doctors could be so rich from Medicaid. But, its happening all over the country.
DH: Can I check this to make sure it is still recording?
RS: I really think that that is essentially about all I can share with you unless you have some specific questions.
DH: I do have some more specific questions. I was just trying to get a background for what you have been working on, what I guess you have been working in. So you were on the UNC Healthcare Executive Board for what years?
RS: I was on the UNC Healthcare Board from 1980-1984.
DH: Ok. But Holden Thorpe was on the board then?
RS: Yes.
DH: Because he was a professor here?
RS: We he was the CEO of UNC. He was the Chancellor of UNC Chapel Hill. Ross was the head of the whole University System in the state and Thorpe was in charge of the Chapel Hill campus.
DH: Ok.
RS: I think the word is Chancellor, isn’t it?
DH: Yea. Chancellor. Ok. So, just some specific things. When you are at a board meeting, do they discuss finances?
RS: Oh Yes.
DH: Can you just.
RS: There are many committees that meet simultaneously, and I was never that close to the Finance Committee, but the final budgets always came to the whole board. And, money was always a concern—the bottom line. And, there wasn’t much transparency between consistency from one hospital to another about surgeries and how much you pay for it. A recent study revealed that you could have a colonoscopy for as little as $200 or $10,000 depending on which hospital you went to.
DH: Wow.
RS: So, the disparity of costs, but the public doesn’t know that. So with the Affordable Care Act, the public needs to know in advance how much money is required for this procedure, that procedure or another. Not that you intend to go shopping when you are sick, you just think of going to the nearest hospital.
DH: Ok so the finances. When they make the budget, does it just come out even? Or do they keep a surplus? Or do they run a deficit?
RS: Oh, they keep a surplus. Yea, they have enough surplus to purchase Rex Hospital in Raleigh (laughing).
DH: Do you think that is an every year thing? Or is that just an 80’s thing? Because 80-84, that was a good economic time.
RS: I really cannot remember or speak within the authority on that but I can tell you that the concern was always cost. You need to look around Chapel Hill, and everywhere you will look, you will see the outreach of UNC Healthcare. And, that’s the really the whole hospital system that looks like a giant corporation. That kind of mentality is very much in the forefront of the management of our healthcare system.
DH: Yea. Ok. So, the board, I want to talk about lobbying. Because one way people have talked about fixing, or maybe re-expanding Medicaid in North Carolina, or maybe trying to get some sort of healthcare to the undocumented, is through this huge hospital lobbying power. So, do you have people on the board that would lobby, like for changes in policies and laws?
RS: I don’t remember anything specific like that.
DH: Ok, but did you have, was there a makeup of people with political influence?
RS: Well, I can tell you that my primary focus for the board was concern for the rapidly growing senior population and also the emergence of the Affordable Care Act. The hospital was projecting population statistics and possible growing deficit and a major concern was that the population in North Carolina was rapidly aging now that the Boomers have come on board. And so how does this affect the hospitals in terms of its potential deficit? Those were the types of questions that were frequently asked.
DH: Do you think that was another reason they were raising costs?
RS: Probably. Also, another concern that I have had. And, this may be of interest to you. I retired 26 years ago and quickly became involved in issues affecting older people, working with the department on aging. And, we succeeded in getting the county commissioners built here and in Hillsborough. Have you seen these?
DH: Uh. I think I have seen the one on Chapel Hill.
RS: It’s on Homestead Road. It bears my name.
DH: Really? I guess I had never connected the dots. Wow.
RS: Yes. And it’s because I harassed the county commissioner for twenty years to build it. Because that’s, see, the healthcare of seniors is to some degree, dependent on nutrition and socialization. And the Senior Center serves meals to a lot of low income seniors. And it is a place where older people who live alone can come to have socialization. And that is totally separate from the hospital but from having been on the board of the hospital, I was able to advocate that the Gerontology part of the Hospital sponsor the geriatric evaluations at the Senior Center. But, that took place for about five years and now we have trouble finding enough funding to pay for it. But, we have a wellness center as a part of the Senior Center. And, we frequently refer people from the Senior Center to the hospital. Now that the concern I had as a member of the board was that many. Incidentally, now Bill Roper is not just the head of the UNC Hospital System but he is also the Dean of the Medical School. He wears two hats. So, one concern that I had had, was that many medical students do not have a very good image of the senior population in our culture, because the seniors that they see in their medical education are seniors that are ill and disabled and, an experiment. What percentage of seniors do you think are in nursing homes?
DH: Well, I don’t know. If I had to guess I would say like 40%, 50%.
RS: Five percent, five percent.
DH: Why is that?
RS: Well, it’s that people have a stereotype image of seniors. I’m 89 years old and I am living independently. I’m not in the hospital. I’m not in an assisted care community. People are living longer. But, most Medical Students would have given the answer that you have given. But, the reality is by far the most number of seniors are living an independent life. In Chapel Hill, we have over 10,000 seniors. We have more seniors than children in the public school system. So, I succeeded in getting the Medical School to start a new program requiring first year medical system to be teamed up with people like me and to make six visits in the course of their freshman year to understand the senior experience and to realize that their career will require some gerontology. Any doctor in the future, should know that seniors require a special dimension of their education. But, the curriculum sometimes does not affect that need.
DH: Yea. This is actually really important, because you said the baby boomers are getting older, and we are witnessing that right now. But, as you know, the Hispanic population boom began in the eighties, and like they are all around their fifties, all the people that came when the population exploded are around fifty. So we have all these undocumented, and some documented, Hispanic people that are about to become a huge part of the…
RS: That’s right. You might want to go to the Senior Center and interview the person that is responsible for the Wellness part of the center. And, you would have a visual impression of one dimension of medical care that is rapidly becoming a priority in the healthcare system. Not only the poor, but aging affects everyone. Nobody escapes aging as they live.
DH: So the Wellness Center, hypothetically if I was an undocumented immigrant and I went to the Wellness Center. How would that work?
DH: Well, I don’t think anyone would ever ask for your identification at the Senior Center. Maybe if you were referred to the hospital, for special needs, and that may be another situation where it could be revealed.
DH: But the Wellness Center would provide, is it subsidized or does it cost money first?
RS: Well, it was subsidized by the hospital.
DH: No, if you were to go to the Wellness Center would you have to pay?
RS: No.
DH: It’s free?
RS: It’s free.
DH: Wow, do you have to be a certain age?
RS: Yes. Usually we think of seniors as anyone who is beyond 65. Yes.
DH: So if there was a Hispanic undocumented senior they could go and receive free preventive care?
RS: Yes, that is right. And, that is one of the whole ideas, preventive care. And, that of course in tune with the Affordable Care Act, more preventive care. The Wellness Center sponsors all kinds of exercise classes, physical therapy, and activities that adds to one’s sense of wellbeing.
DH: That’s a great resource for the undocumented community. Especially for the…
RS: And the meal, the meal is for, a noon day meal, a noon meal, and it meets the nutrition requirements of the Federal Government. The meal makes sure that these seniors that come to the Senior Center get one good meal a day. One doesn’t know what else they have. The majority of the people who come to the Senior Center for meals are living on the edge.
DH: Do you go a lot? Or?
RS: I used to go more than I do now.
DH: So the meal is free? Right?
RS: You can pay. Nobody tells you how much. You can make a donation or it’s free. You don’t have to pay.
DH: So it could be free?
RS: And for many people it is free. It is subsidized by the town of Chapel Hill, Carrboro, and Hillsborough.
DH: Can you speak at all, I mean I am sure you do stop by on occasion still. Can you speak at all to the demographics?
RS: No the wonderful thing about the Senior Center is that it has an ethnic variety. We have a large number of Asians that are there. They are the best ping-ball players in the place (laughing). And, we have quite a few middle class people because we have lectures, university lectures, and bridge. So there is everything from university lectures to Bingo. So the one thing that pleases me most about the Senior Center is that Black, White, Asian, Hispanic, Middle Class, Low Income. They are all in the same building and everyone feels at home at the place.
DH: Can you briefly touch on? Is there a definitive Hispanic population there?
RS: You know I am not always sure that I know who these Hispanic population is. But, I am sure they are there.
DH: Yea. Yea. Sometimes it is hard to discern.
RS: They don’t stand out sometimes.
DH: Yea, yea, for sure. But, but the demographic exists.
RS: Yes, I have been aware of El Centro that used to be in Carrboro, but now they moved to Durham.
DH: Yea, so is the Senior Center. How accessible is the Senior Center? How accessible is that? I guess are there like, busses that go to it?
RS: The town bus goes there.
DH: Ok that’s what I thought. Yea, that is a great resource. I really think I should share that with, I do a lot of work with Community Empowerment Fund.
RS: The Senior Center here was built five years ago. One in Chapel Hill and one in Hillsborough, attached to Sportsplex. Do you know Hillsborough?
DH: No I do not. I stay in Chapel Hill.
RS: Well they built two of the first Senior Centers in North Carolina. Worth a visit.
DH: So do you think the Affordable Care Act will do more to sponsor these Senior Centers?
RS: Well, I’m, I don’t know. But I think the Affordable Care Act at this moment is primarily concerned with the expansion of Medicaid.
DH: Yea, yea. Hopefully that goes through.
RS: I think eventually all the states will come on board.
DH: Yea. It is ridiculous …
RS: I think the Republicans will, ya know, well I don’t want to impose upon you my personal preferences. People are without Medicaid because they don’t like Obama.
DH: Yes. No I think that is partly true. Yea, ok great. I don’t have any more questions, but if you have any more final thoughts, please share them now.
RS: Well, my final thought is that I’m 89 years old and I am very much aware of healthcare issues, and I have just had a request from our Wellness Center to go get a prescription of Tamiflu and take it, even though I have had a flu immunization. And, I, as an aging person, I feel like I am living on borrowed time. But, we have a sizable population, 4 or 500 people here at Carol Woods, and quite a few of them are not only in their eighties but some are here beyond their hundredth birthday. You are part of a generation that will live longer than any in history.
DH: Yea, I am pretty excited (laughing).
RS: But the good thing is that young people need to dispel this notion that old people don’t have an enjoyable life. The last 25 years of my life have been, I would say, have been the best years of my life. After I retired. I had 25 years of freedom in terms of setting my own agenda. And I have no serious health hurdle. I have been able to maintain a reasonably good health.
DH: And maybe, just like your last thoughts on your opinion of like, how you see UNC healthcare and healthcare policy in general for the poor and the undocumented under the Affordable Care Act.
RS: And I would add to that— the poor, the undocumented, and the booming population of older people.
DH: Yea. And that. So you do you have any thoughts on that moving forward? What do you think is going to happen, basically?
RS: Well, I think Bill Roper is a man who is regarded as one of the best informed healthcare people in America. He was in Washington at the time of Medicare’s coming into being. But, the thing that disturbed me as a member of the board was that there is so much competition in healthcare and I see that as wasted money. UNC built this magnificent Cancer Hospital. It looks like a hotel. You know, no expense was spared during that. And, because it was at UNC, the very day we celebrated the opening of the UNC Cancer Hospital, our neighbor, Duke University announced that they were building one. Now we have two, within ten miles of each other. It’s a waste. It’s a great waste. Well, competition. And you see this everywhere in the triangle. UNC reaching out to Ghana and Apex and everywhere and Rex Hospital has just stolen the heart surgery team from Wake to Rex.
DH: Yea, that is silly. A lot of wasted expense. Alright. Thank you so much.
RS: Well, I am glad you came and I wish I could have helped you more, but maybe that will stimulate some further questions.
DH: Yea. No worries. I really think this helped guide me in the right direction and it was great to hear what the Board did and the community relations and stuff like that.
RS: Well, there are now two seats on the board for community representatives.
DH: Well, there are now two seats on the board for community representatives. Wow. That’s great. Why do you think that they added more?
RS: I can’t speak to that, but I think that they realized how important it was to have good public relations with the community. Most county hospitals have a county hospital. We don’t have one. So the UNC Healthcare, which is a state hospital, has in effect become a county hospital for those of us who live in Orange County. And, you may not know that UNC has just began building a new hospital in Hillsborough.
DH: Yea, I heard about that.
RS: Yea. So, they are outsourcing care as if they were responsible for Orange County. Which in fact they are.
DH: Yea. Wow. That’s crazy (laughing). Alright. Ok.
RS: If you have any further questions you can call me, or email me.
DH: I will make sure to do that. I see the computer, a nice Mac.
RS: Let me encourage you to go to the Senior Center before you finish your project.
DH: Ok. Yea. I will definitely try and go check out the Senior Center. You know, I have been trying to check out all these free, community clinics and resources.
RS: And I would especially implore you to go to Piedmont Health.
DH: Piedmont Health, because that is where most of the undocumented population goes.
RS: I think that is where most of the poor people go.
DH: Yea, alright, I will do that for sure. Yea, I am excited to visit there. Alright. That is all. Thank you very much. And yea, I look forward to staying in touch.