GREENVILLE — Inextricably linked to Prisma Health before it went private four years ago, an Upstate governing board's relationship with the health system has cooled significantly in recent months even as area lawmakers have sharpened their criticism of what they say is the system's outsized pursuit of profits.
The Greenville Health Authority (GHA), a 14-person board whose members are largely chosen by state legislators, last week changed their bylaws to exclude anyone working for Prisma Health to serve as the authority's president.
The GHA board, which has taken control of $1 million in annual administrative funds from Prisma, has also hired its own attorney. Until recent months, that $1 million stayed in Prisma's hands and was only paid to GHA in the form of requested reimbursements.
The changes are significant in that the GHA board owns the facilities from which Prisma runs healthcare in the Upstate. Among those facilities is Greenville Memorial Hospital.
Prisma Health in Greenville on Friday, July 30, 2020. File/Bart Boatwright/Special to The Post and Courier
Prior to GHA's bylaws change, the GHA board's president and sole employee was John Mansure, who simultaneously was running Prisma Health's Greer campus and has been a hospital employee for more than 40 years.
With his exit, the GHA board voted unanimously on Feb. 10 to hire one of its own — former board chairman Phillip Liston — to take on the organization's presidency.
Mansure's removal comes just ahead of Prisma's annual report to the GHA board on Feb. 26 and less than a month before the entities sit down for a five-year review of the hospital lease in early March.
Stacey Mills, GHA's board chairman as of Feb. 10, is pastor of Mountain View Baptist Church, a predominantly Black congregation in Greenville's Southernside neighborhood near downtown. He said Prisma's "business model" triggered GHA's changes in leadership.
"I've been there for the last 24 years," he said of his church, "and I've watched over those decades the difficulty that people have with gaining access to quality care, some of the barriers that are in place. And I just think that GHA is in a position, working with the legislative delegation and with health officials, to always keep the public in mind when it comes to delivering health-care services."
That language — "keeping the public in mind" — was echoed by lawmakers last week who criticized Prisma Health for its decision in November to close its emergency room at North Greenville Hospital. On Feb. 15, a group of state and local representatives joined with leaders at Medical University of South Carolina and Bon Secours St. Francis to announce they would figure out another way to bring emergency services to northern Greenville County.
Mills agreed this week that closing the emergency room was one of his board's "big three" concerns with Prisma. The others: pausing work on a new cancer center and withdrawing its plans to build a new psychiatric hospital. While much needed, these services have tended to generate financial losses for hospital systems.
"Those are major," Mills said. "And as the need for services continue to mount, we certainly look forward to having discussions with Prisma's leadership in terms of their plans for the future and what their vision is for that scope of care. And those are questions that we certainly will be asking."
The GHA board, albeit volunteer, carries a potentially powerful punch when holding Prisma Health accountable. Prisma Health-Upstate is a $2 billion operation and the largest employer in Greenville County, but GHA is its landlord.
Taylors-area state Rep. Mike Burns, a vocal critic of Prisma Health for years, said the change in bylaws was overdue.
"The way it was, in actuality, you had a person working for Prisma who was also the president of the GHA board, and it seemed like the board in practicality was subservient to Prisma instead of the other way around," Burns said. "That culture has changed this past year."
The Post and Courier reached out to Prisma Health to request an interview with Mansure, but the system declined.
"We don’t have information about the Greenville Health Authority, since it is not part of Prisma Health," a spokeswoman wrote in an email. "I suggest you reach out to the GHA Board chair."
Rep. Burns and other state and local lawmakers have said Prisma Health ought to keep more of the profitable health system's revenue inside Greenville County to pay for some of those services, like psychiatric care, that do not typically make money. He said that as much as $100 million a year is likely being diverted to Prisma's less profitable operations in the Midlands.
Stacey Mills of Greenville was named president of the Greenville Health Authority on Feb. 10, 2021. Provided
"We have a lot of questions, like the most important one is how much money? We want to know how much money has left the Greenville economy to prop up the Midstate?" Burns said. "Which they won't answer."
Prior to a 2016 merger with Palmetto Health in Columbia that created the entity now known as Prisma Health, the Greenville Health System was a publicly governed agency established through state legislation dating back to the 1940s. That agency and its Board of Trustees were charged with delivering health-care services within Greenville County, according to the GHA website.
Prisma Health today is a private, nonprofit entity whose operations and finances here and elsewhere in the state are far less transparent than what they were when it was a government agency. Prisma Health now has facilities from Orangeburg to Oconee.
A summary of the organization's finances are reported annually to the Internal Revenue Service via a Form 990. But those annual records do not spell out how profits are shared between Greenville and Columbia, and they are typically delayed by a year or more. The most recent 990 available for Prisma was for the fiscal year that ended Sept. 30, 2019.
The old Greenville hospital system's public Board of Trustees, now doing business as GHA, has continued to exist as landlord because of the public money that originally helped pay for the system's buildings and because the 80-year-old legislation that created the system is still on the books.
That legislation — Act 432 — established "an institution with an independent board of trustees, free from the control of either city or county authorities, which would be charged with the duty of operating the hospital and its expanded facilities for the benefit of the taxpayers and residents of all Greenville County."
GHA's Mills struck a positive tone when The Post and Courier spoke with him.
Prisma Health in Greenville, SC on July 30, 2020. File/Bart Boatwright/Special to The Post and Courier
"I think that the community can look to these developing, I guess, trends to make sure that, you know, they have the best care that's possible, given the field," Mills said. "And, you know, I for one, I'm happy to be a part of this. And my colleagues on the board are fantastic leaders, and I think that we can trust safely, that the right questions will be asked."
The GHA board will hold its annual performance review meeting with Prisma executives on Feb. 26.
The five-year review of GHA's lease with Prisma Health will take place March 9. Under the lease agreement, Prisma Health has agreed to pay GHA $6 million a year for 34 years. GHA shares those lease proceeds directly with the community in the form of grants and assistance to local governments.
That grant money has, for instance, been a critical component of the Greenville County government's stepped up support for the GreenLink bus system over the past two years.
Liston, the new GHA president, said the flow of that money into the community is "an incredibly positive story." Mills added that his board understands it has a "great responsibility" to remain on good terms with Prisma Health given its importance to the general welfare of Greenville County.
"So there is definitely an evolution of identity for GHA in healthcare, understanding what our role is, with respect to how we've done business previously, and what Act 432 asks us to do, and what we've been appointed by the state legislative delegation to do in this community," Mills said. "And unapologetically, that is to keep a public facing lens on access to healthcare in Greenville County."