Louie B. Nunn Center for Oral History

Interview with Lee D. Keene, July 7, 1987

Louie B. Nunn Center for Oral History, University of Kentucky Libraries
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00:00:00 - History in hospital administration

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Partial Transcript: --eene, if you'll say your name, I'll check the volume.

Segment Synopsis: Keene shares details of his life and how he got into hospital administration. After 4 years of service in the Air Force, he began as business manager of an outpatient clinic in Harlan, Kentucky. Next, he established a similar outpatient clinic in Clintwood, Virginia, and then worked at Wise County Memorial Hospital. To complete his higher education, he completed his Bachelor's of Science degree and then went on to get his Master's in healthcare administration. After completing his schooling and residency, he returned to Pikeville, Kentucky.

Keywords: Air force; Business administration; Clinics; Harlan County (Ky.); Healthcare administration; Hospital administration; Knoxville (Tenn.); Miner's Memorial Hospital Administration; Outpatient care; Pikeville (Ky.); Residencies; Wise County (Va.); Wise County Memorial Hospital

Subjects: Children; Education; Families; Higher education; Rural health services; Rural health--Kentucky; Traditional medicine

00:05:55 - Hospital administration before the strike / Problems with financing healthcare services

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Partial Transcript: Well you know, we're--one of my objectives here is to talk to you about how you run a hospital when it's under siege.

Segment Synopsis: Keene discusses hospital administration prior to the strike. He explains the functions of the hospital's Board of Directors and how Keene is responsible for day to day operations. He explains their response to the letter informing them of the unionizing among their employees and communicates the importance of the hospital's mission. Keene stresses the importance of uninterrupted health service as provided by the hospital. He discusses the increases in cost of operating and the process of cost shifting, as well as an erosion of their financial base as the coal economy experiences a downturn.

Keywords: Availability; Blue Cross Insurance Company; Board of directors; Cost shifting; Debts; Diagnosis Related Groups (DRG); Finances; Healthcare business; Hospitals; Independent Coal Operators; Labor management relations; Medicaid; Medicare; Services; Union representation cards; United Methodist Hospital

Subjects: Charity; Coal-Kentucky; Labor union members; Rural health services; United Mine Workers of America

00:27:04 - Hospital management team / Proposed nursing program

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Partial Transcript: How do you stay up on top of this yourself?

Segment Synopsis: Keene explains how the management team ensures that employees are aware of changes in reimbursement policies. He also discusses the negative effects of a proposed training program for nurses that requires higher levels of education that are not available in eastern Kentucky.

Keywords: College programs; Department heads; Hospital boards; Hospital operations; Licensed Practical Nurse (LPN); Meetings; Nurses; Programs; Registered nurse (RN); United Methodist Hospital; Workshops

Subjects: Charity; Education, Higher; Hospitals -- Administration; Rural health services; Rural health--Kentucky

00:38:15 - Strike of non-professional staff

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Partial Transcript: So back, fifteen years ago though, um, you had--was it your non-professional staff, right?

Segment Synopsis: Keene discusses adjusting hospital operations during the strike by closing one of the floors. He explains that the hospital was in a state of crisis for several months, enlisting help from the community to gather volunteers and materials. Keene states that the hospital was never shut down but instead had to limit its services, and also shares the financial effects of the strike on the hospital.

Keywords: Hospital administration; Hospital boards; Hospital services; Negotiations; Professional staff; Strikes; Unfair labor practices; Union representation; United Methodist Hospital; Volunteers

Subjects: Hospital administrators; Medicinal care--Kentucky; Strikes and lockouts--Kentucky; United States--Trials, litigation, etc.

00:44:28 - Role of the Methodist Church

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Partial Transcript: It strikes me that it was a local situation, it was a local board trying to respond to it...

Segment Synopsis: Keene explains the connection between the Methodist Church and the hospital; because the hospital is Methodist, the majority of the hospital board must be Methodist. Keene states that the Methodist Church took a hands-off approach to running the hospital and allowed the hospital board to control the day to day operations.

Keywords: Hospital operations; Interruption of services; Kentucky Conference of the United Methodist Church; Labor Management Relations Act; Methodist Church; National Labor and Relations Board; Non-profit healthcare services; Taft-Hartley Act; Unfair labor practices; United Methodist Hospital

Subjects: Administrative courts; Strikes and lockouts; United States--Trials, litigation, etc.

00:53:03 - Running the hospital / Security threats

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Partial Transcript: So once you got past your crisis stage, you were trying to run the hospital and being interrupted by the strike sometimes...

Segment Synopsis: Keene shares the provisions made by the hospital so they could continue providing healthcare services to the community. Keene recounts several instances of having to pick up hospital supplies himself as many trucking companies are union and would not make deliveries. Keene shares the challenges of maintaining hospital security during the labor dispute and even one incident of dynamite on the property. He and his family received threats and Keene shares that he was disappointed that his workers would take actions like these to try to get a labor union.

Keywords: Brookside; Churches; Deliveries; Dynamite; Hospital administration; Hospital operations; Hospitals; Labor unions; Patients; Picket lines; Security; Supplies; Threats; Unions; United Methodist Hospital

Subjects: Children; Communities; Demonstrations; Families; Labor disputes; Labor unions--Organizing; Picketing; Pike County (Ky.); Strikes and lockouts; Threats of violence

00:57:42 - Context in Pike County, Kentucky

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Partial Transcript: Why do you think it happened?

Segment Synopsis: Keene explains the events surrounding the hospital strike; that it had occurred in the midst of "union fever." Labor unions had been on an organizing drive in the health field, and Communications Workers of America was attempting to increase its membership.

Keywords: "Union fever"; Coal mines; Communications Workers of America (CWA); Eastern Kentucky; Health field; Labor union membership; Nursing homes; Union membership; United Methodist Hospital; Walkouts

Subjects: Appalachian Region--Social conditions; Coal miners--Labor unions; Communications Workers of America; Community organization; Industries; Labor unions; Pike County (Ky.); Strikes and lockouts

01:00:00 - Defending the decision of the hospital board

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Partial Transcript: Well, is it fair to say that your all's principle objection was the--avoiding interruption of services?

Segment Synopsis: Keene explains that the major concern of the hospital board was the interruption of hospital services. He emphasizes the importance of continuous health services and how they must always be available. The hospital board also publicly invited all of the non-professional employees on strike to return to work and had to keep their full staff in addition to the employees who returned.

Keywords: Board of directors; Committees; Contracts; Employees; Grievance procedures; Health services; Hospital administration; Hospitals; National Labor Relations Board (NLRB); National Management Relations Act; Non-profit hospitals; Taft-Hartley Act; United Methodist Hospital; Volunteers

Subjects: Appalachian Region--Social Conditions; Communities; Medical care--Kentucky; Pike County (Ky.); Rural health services; Traditional medicine; United States. National Labor Relations Board

01:09:49 - Contrasting non-profit and for-profit hospitals

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Partial Transcript: This makes me wonder about how do you contrast this work with the profit hospitals, the for-profit hospitals.

Segment Synopsis: Keene discusses the differences between non-profit and for-profit hospitals, highlighting the importance of always providing patient services. He explains how the reimbursement system works in non-profit hospitals and how it helps them provide healthcare services in their community.

Keywords: Business; Charity; Economics; For-profit hospitals; Industries; Lawsuits; Lexington (Ky.); Local hospitals; Money; Non-profit hospitals; Profits; Services; Tax exemptions; United Methodist Hospital

Subjects: Ethics; Philosophies; Religion; Rural health services; Traditional medicine

01:16:44 - Future goals for the hospital / Kentucky Hospital Association

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Partial Transcript: Well, let me ask you this, what do you want to do with your hospital?

Segment Synopsis: Keene shares his goals for the future of the hospital and explains his goal of providing the best quality care for an affordable price. Keene outlines the role of the Kentucky Hospital Administration in connecting non-profit hospitals and promoting the sharing of technology. Keene describes his long range plan of expansion and explains that there is a projected increase in future demand for hospital services in Pike County.

Keywords: Affordable; Benefits; Business; Competitive labor; Economics; Employee benefit programs; Hospital administrators; Infrastructure; Insurances; Kentucky Hospital Association; Lexington (Ky.); Louisville (Ky.); Money; Non-profit hospitals; Quality care; Services; United Methodist Hospital

Subjects: Communities; Industries; Medical care--Kentucky; Rural health services; Traditional medicine