Why Should Delaware Care?
In their opposition against a state-appointed hospital review board, Delaware hospital officials have maintained that their boards of directors are best qualified to fulfill the needs of local communities. The boards of the largest hospitals in the state, however, only represent a fraction of the growing diversity in the First State.
Delaware hospital leaders have argued that their boards of directors are best suited to serve the state’s increasingly diverse communities, despite only a fraction of their boards being composed of medical professionals or people of color.
Hospital officials contended that the replacement of their local community boards with a politically appointed oversight board under House Bill 350 would be detrimental to health care quality in the First State. The legislation would reduce health care access to people in vulnerable and historically underserved communities, officials argued.
Dr. LeRoi Hicks, the campus director for ChristianaCare’s Wilmington Hospital and one of the leading Black doctors in the state, wrote a recent op-ed that argued HB 350 could worsen health equity in the state.
“While the goal of bending the cost curve in health care may be well-intentioned, this bill will have horrific consequences for Delaware’s most vulnerable populations, including Black people, Hispanic people and other groups that have been traditionally underserved in health care. We can and must work together to solve this problem and provide the right care, in the right place, at the right time,” he said.
The boards of Delaware’s major hospitals, however, only reflect a small percentage of the growing diversity of the state while retaining a handful of medical professionals, according to a Spotlight Delaware analysis. About 21% of the board members of the four largest health systems are people of color, and of those only six of 57 total members are Black.
About 40% of Delaware’s population identifies as non-White, and nearly 24% are Black, according to the U.S. Census Bureau.
The lack of diversity in those who make the financial decisions at the state’s top medical systems is stark due to the disparities in health outcomes between white and non-white patients. University of Delaware research in recent years found that Black residents in Wilmington had much lower life expectancies than many of their white neighbors, sometimes up to 16 years. Black mothers also continue to face disproportionately high mortality rates in childbirth throughout the state.
The board of directors for the health system of ChristianaCare, the largest health system and private employer in the state, has only one person of color and one medical professional among a 13-person board.
Jennifer Schwartz, ChristianaCare’s chief strategy and legal officer, acknowledged that the hospital’s health system board only included one medical professional and one person of color but pointed to their 13-member health services board, which includes four people of diverse ethnicities and four medical professionals.
“At ChristianaCare, we look for board members who possess the right capabilities needed to monitor a complex budget and highly regulated operations while also serving a diverse community,” Schwartz said in a written statement. “It is important that our board members represent the communities we serve, including with regard to gender, ethnicity and life experiences.”
Beebe Healthcare, which primarily serves Sussex County, doesn’t have a Latino or Hispanic board member, despite the county’s rapidly growing Latino community.
Still, hospital representatives maintain that the composition of the board accurately reflects the demographics and needs of the communities it serves.
“Beebe is led by an executive team and volunteer community board that understands the needs of this community,” said Ryan Marshall, strategic communications manager at Beebe Healthcare, in a written statement. “They have invested a lot of their time and vast experience developing and executing a strategic plan that is focused on increasing access and quality for our growing community.”
Nearly all the members of the three largest Delaware-centric hospital systems were based in the state, while Nemours Children’s Health, which has grown from its Wilmington roots to Florida too, now has a largely non-resident board.
Bayhealth’s board, which is the largest of any Delaware system with 18 members, includes seven people of color and six medical professionals.
“Our nonprofit hospitals and health systems ensure that their Boards of Directors are representative of the communities they serve as well as reflect a diverse range of expertise needed to oversee hospital governance,” said Brian Frazee, president and CEO of the Delaware Healthcare Association, which represents the interests of the state’s hospitals, in a written statement.
Bayhealth and Nemours Children’s Health did not respond to questions and requests for comment.
While roughly 26% of the largest systems’ board members are medical professionals, other members from non-medical backgrounds include lawyers, bankers, corporate executives, and accountants, as well as restaurateurs, developers, medical device developers and marketers.
Senate Minority Leader Gerald Hocker (R-Ocean View), who has been adamantly opposed to HB 350, also serves as a board member for the Beebe Medical Foundation, which works to raise philanthropic support for Beebe Healthcare. He was the only state legislator identified by Spotlight Delaware as serving on a health system board.
While hospital system officials were staunchly opposed to HB 350 as it has moved through the legislature, they have dropped their active opposition following a compromise on some components of the bill this week.The Senate is expected to consider and vote on the amended HB 350 on Thursday.
The analysis included a board review of ChristianaCare, Beebe Healthcare, Bayhealth, TidalHealth and Nemours Children’s Health. The data gathering was conducted by analyzing publicly available board information, documents and news releases.
The two smallest health systems in Delaware – TidalHealth, which operates Nanticoke Hospital in Seaford, and Trinity Health Mid-Atlantic, which operates St. Francis Hospital in Wilmington – declined to provide the names of its local board members. None are publicly listed.
When reached for comment, a TidalHealth spokesperson said the organization doesn’t publish the names of board members and advised that a list of TidalHealth Nanticoke board members, based on 2022 Internal Revenue Service tax return documents, was not up-to-date.
TidalHealth Nanticoke had at least three people of color and four medical professionals on its board as of June 2022, according to the 2022 IRS tax documents. The numbers may not reflect the demographics of current board members, as the board’s composition may have changed in the time since and members’ names were not made publicly available.
Trinity Health Mid-Atlantic does not list its regional board of directors on their website and did not provide current board member names when reached for comment. Vincent Gordon is the chair of the regional 15-person board whose members prefer not to “self-disclose their board member status,” according to Jeff Winslow, spokesperson for Trinity Health Mid-Atlantic.
Lawmakers and hospital leaders hammered out a deal on HB 350 on Monday, with the bill now moving toward final votes and the expected signing by Gov. John Carney. It would create the Diamond State Hospital Cost Review Board, which will be composed of seven health care quality experts tasked with reviewing and approving hospitals’ budgets every year.
The review board members would be appointed by the governor, confirmed by the State Senate and include the head of the Delaware Healthcare Association as a non-voting board member. The board, which will be paid a salary and will be required to have representation from all three counties, will be tasked with ensuring that Delaware’s largest hospitals align their pricing with yearly benchmarks.
In 2027, the review board will begin comparing hospital pricing to the annual Delaware Health Care Benchmark, established by a subcommittee of a panel of state officials and economists who forecast the state government’s budget projections.
If a hospital exceeds the benchmark, it would be required to submit a performance improvement plan that details specific next steps to curb costs. If the plan doesn’t control prices, the review board can extend the timeline of the plan or require a hospital to modify its budget.
The legislation is expected to have a final vote in the House this month before heading to Carney’s desk.
Editor’s note: A chart on this story originally reported that Beebe Healthcare had four people of color on its board of directors, but it actually has three. We regret the error.
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