For more than 100 years, the Local Council of Women (LCW) has held significant control, on the community’s behalf, over Bloomington Hospital. On June 16 it gave up that power to pave the way for a friendly takeover of the hospital by Clarian Health Partners Inc., hopefully to improve local health care.

In return, LCW is supposed to ensure community influence through its appointments to a post-merger board. The events around the recent vote suggest LCW is not yet able to do that but could with increased community participation.

LCW founded, built and ran Bloomington Hospital throughout most of the 20th century. Eventually, the business of health care overtook the caring part, and LCW gradually ceded control to the professionals. In 1988, LCW gave Bloomington Hospital the property it was built on.


LCW board threatens Holly for speaking out


To keep the hospital accountable to the community, LCW kept important rights. The hospital could not sell, lease, mortgage or dispose of the property without LCW permission, for example. Changes in hospital rules about board structure and appointments were also subject to LCW approval.

LCW structure enables broad community participation. Anyone in Monroe and surrounding counties can join for $15, including organizations and men. They need join only five days before a vote to participate. They have the right to attend all meetings, ask questions, and join in discussions.

Members can call a special meeting with a petition signed by only 10 percent of the membership. Members now choose six of the 18 appointees to the hospital board. Important decisions require a two-thirds majority. This highly unusual arrangement allows for community influence in the private, not-for-profit Bloomington Hospital.

The community and LCW have mobilized at least twice in the past 12 years: to squash a move to privatize the hospital and then to veto plans to shrink the hospital board and community influence on it.

***

This promise of openness to the community makes the conduct of the recent vote all the more disappointing. If the merger goes through, and if LCW is to provide any meaningful role for the community on the new board, several problems need to be corrected.

First, LCW must assert and maintain its independence from the hospital. It never was intended to serve as a "ladies auxiliary." Its mission is to "exercise the responsibilities" arising from its organizational ties to Bloomington Hospital by making good appointments to the hospital board and "exercising vigilance" with respect to the powers it kept over property disposition and hospital board structure.

LCW lets the hospital do a lot for it. This is understandable. For decades LCW was the hospital. Now its role is more of a guardian. Its dependence on the hospital must end.

It makes LCW enormously susceptible to hospital influence in its decision making, or at the very least makes it appear so. For example, over months of discussion leading up to the June 16 vote, the only information the public got about merger issues came from the hospital administration or the hospital board, partly because of secrecy concerns.

Also, the hospital's timeline led to a rushed vote and near total dependence on the hospital to deal with the huge influx of new members (from 61 to 670 in three months) as the community caught on to what was at stake. The hospital made calls and sent notices to members about last-minute changes and used those for its own purposes without LCW authorization. The hospital got the convention center, an auditor and a security guard (!) for the vote.

Second, LCW's dependence on the hospital has blurred the lines between the two organizations, so the hospital acts as if LCW is an extension of the hospital.

I try not to see calculation in the actions I just described. Rather, I think about what the hospital already does or has done for LCW: file taxes, insure LCW directors, print and process bulk mailings, provide meeting space and refreshments for board meetings.

Is it any wonder that it used LCW communications to advance its agenda or that its attorney participated in squashing an attempt to allow member discussion before the vote on June 16?

Third, that dependence has weakened LCW. As late as March 2008, LCW had only 61 members. If everyone paid $15 a year, that would be only $915 going into the treasury in a typical year. True, LCW treasury still had about $20,000 from the halcyon days of yore, but that's only about a week's worth of attorney fees. With the hospital paying our bills, there was no pressure to even send out dues notices, much less recruit new individual and organization members.

Beyond exercising responsibilities vis-à-vis Bloomington Hospital, LCW's mission statement includes two other important roles: "to be a voice for community health and to collaborate and advocate for solutions to accessibility and delivery of health care."

Our community desperately needs the LCW to fill these roles, both for hospital issues and more general community health issues. Ten ordinary volunteers on LCW board of directors cannot do this. LCW needs an active membership to help set the agenda and participate fully.

***

The decline of the LCW shows the need for active participation in our community organizations whose decisions affect all of us. I regret I did not do a better job as a director of LCW. But do not judge the board too harshly. These problems were years in the making. The board did its best with meager resources in the context of how things have been done for many years.

Changes to the LCW bylaws passed overwhelmingly. Merger talks will go ahead, and if successful, LCW probably must give up its right to control hospital property. Would an open and democratic process in keeping with the bylaws and purpose of LCW have led to a different result? I doubt it. I think there is a good chance that joining Clarian will strengthen local health care institutions. I would have voted for the bylaws change if the process had been even a little better.

Was the vote illegitimate? I don't think so. If the hospital stacked the membership, it has as much right to do so as anyone else in the community. I doubt all hospital employees voted for the merger anyway.

What can we learn from all this? Secrecy is antithetical to informed decision-making in a community organization. Vigilance requires independence. Democratic process suffers when there is too much attachment to results.

A board that does not know its own power and does not use it has no power and will be drawn into the wake of those less patient with democracy. A board that does not cultivate and involve its members has no constituency. And underneath all this, a board's ethic takes on its own momentum over time, and it becomes very difficult to change or even recognize the need to change.

What now?

LCW membership is still open to everyone. While LCW has given up much of its power, its members continue to make appointments to the hospital board every December. Members elect directors to LCW board. Members can call special meetings if 10 percent of the membership petitions for it. Members are entitled to inspect LCW records, including minutes and the membership list. Members are entitled to attend all LCW meetings, which presumably include board meetings that normally occur on the last Tuesday of every month.

The community can still use LCW to impact hospital decisions as well as improve local health care. Whether LCW fulfills that role depends on all of us.

Chris Holly can be reached at cjholly@medicaidguide.com.