Critical Care

When Jim Nathan stepped down as president and CEO of Lee Memorial Health System in 1997, he had plans to help change the troubled economics of American healthcare. Delivering keynote addresses on healthcare reform, testifying before Congress and consulting with politicians was at times very frustrating, says Nathan. It was also an experience that strengthened his resolve when he returned to Lee Memorial three years later.

"At the time I thought I could play a role in healthcare reform on a national level," says Nathan. "But it was the height of the Clinton era, and I found that it had become politically impossible to discuss major reforms. The Clintons understood some of the problems involved, but when I spoke to the Senate, everyone was more interested in hearing about Monica Lewinsky."

During this period, Nathan had also helped start a private consulting firm, but he never lost sight of Lee Memorial.

"It was a great experience for me because I was invited into some big problems as a consultant, and I was helping make some decisions," Nathan recalls. But I missed being part of the day-to-day team that lived with the risks involved in those decisions."

Since returning to Lee Memorial, Nathan, 59, has resumed a career marked by high-risk decisions that have paid off. In the past 26 years, he has spearheaded efforts to build HealthPark Medical Center, to buy Cape Coral Hospital and to expand services at outpatient and specialty-care centers across the county.

His aggressive plans have helped Lee Memorial grow into Florida's largest public, not-for-profit health system. With the recent $535 million acquisition of HCA's Southwest Florida Regional Medical Center and Gulf Coast Hospital, what is now the county's sole hospital system includes more than 1,500 beds and employs more than 7,500 workers.

"You can't be too aggressive when you're dealing with human health and people's welfare," says the Rev. James English, a longtime friend of Nathan and a former member of Lee Memorial's board of directors. "I think it's fair to say he has great vision. He is trying to position Lee Memorial to meet the needs of a hugely growing community, both for the immediate future and long range. When you're doing that you can't be content at the back of the line, or even at the front of the line, where Jim is now."

A lifelong calling With a natural talent for business and a lifelong interest in medical care, Nathan believes he was born to be a hospital administrator. Because his father suffered from a number of illnesses, including such respiratory ailments as asthma, tuberculosis and pleurisy, Nathan spent much of his childhood in healthcare facilities.

"My father was supposed to die before I was born," explains Nathan. "He lived to age 76, but at one point had 12 surgeries in two years. Early on, I learned about the economics of hospitals from a personal perspective, through the eyes of family devastation. If he was something of a professional patient, I was a hospital brat."

Born in Albuquerque, where his parents had moved for the dry climate, Nathan was four when his father's condition worsened and the family moved to Cincinnati to be near his grandparents. The move was permanent, though his father continued to travel to hospitals across the country.

Nathan's experience quickly went beyond flipping through magazines in waiting rooms and making trips to the hospital cafeteria. By the time he was eight years old, he was hosting a children's radio talk show that was broadcast into patients' rooms. One year later, the youngster organized his first healthcare fundraiser, a 16 mm movie presentation dubbed Fun in the Dark, benefiting the American Cancer Society.

Despite the debilitating illnesses, Nathan's father was a businessman who co-owned an automobile-leasing company in Cincinnati. As a teenager, Nathan worked at the business, helping with everything from car detailing to customer billing. After earning a business degree from Miami University in Oxford, Ohio, he returned to his father's company full-time and expected to take over some day.

"I worked there six years and enjoyed it, meeting with CEOs and providing companies with [automobile] fleets," says Nathan. "I also got to see how my father, even with his terrible health, was able to succeed in business and always find time to help others. But I was never really a car person-it just wasn't in my genes. I already had healthcare on my mind, but hadn't yet made a decision to start my life over again."

That decision came when Nathan attended a class reunion and encountered the husband of a high school friend.

"He was an emergency room physician in training at the University of Chicago," recalls Nathan. "He impressed me, what he was doing with his life. After speaking with him I decided that if I had a God-given aptitude for business, I wanted to use it helping people improve their lives. The hard part came when I had to go back and tell Dad."

With his father's encouragement, Nathan returned to school at Xavier University in Cincinnati, earning master's degrees in business and hospital administration. He completed his studies as an administrative resident at Lee Memorial in 1975. Within nine months, Nathan's work ethic and earnest approach impressed the hospital's leadership enough that he was offered a full-time job.

"He has always been the same man-honest and with a lot of integrity," says Linda Hammer, who arrived at Lee Memorial during that time and has worked as Nathan's assistant for approximately 30 years. "He lives the work, coming in on weekends and working at night. He genuinely cares about the hospital, the community and healthcare."

Nathan served as a vice president at Lee Memorial from 1976 until 1981, when the board of directors named him president and CEO. During those early years, he could already see big changes coming at the hospital.

"My first year here, 1975, the hospital was so busy we had patients in the hallways," says Nathan. "Fort Myers Community Hospital [now Southwest Regional] had been founded in 1974, and by my second year there were vacancies at Lee [as patients went to Fort Myers Community]. Competition had signaled a real shift for this organization."

A competitive streak Nathan has a friendly but modest manner that belies his competitive spirit and proactive vision. He says that kind of vision is sorely needed for public hospitals to succeed in the current economic climate.

"I've been told we shouldn't be this aggressive as a public, county hospital," says Nathan. "But you need to be when you have to pay for the care of those who cannot pay themselves. Independent healthcare entrepreneurs have no obligation to pay for the uninsured and underinsured, which puts us at a competitive disadvantage. As a non-taxing public institution we have to be creative finding other kinds of cash flow."

The development of HealthPark Medical Center is a good example of Nathan's ability to increase cash flow. During the early 1980s, Lee Memorial was looking to expand services and follow changing demographics by building a second hospital south of Fort Myers. Nathan saw the massive HealthPark project as an opportunity.

"When Fort Myers Community Hospital had opened, I had seen how entrepreneurs developed the land surrounding the hospital," says Nathan. "I thought that if we controlled the land surrounding our new hospital, we could use appreciation to increase our profitability. Ultimately, that profitability would help us increase our ability to pay for patients who can't pay for healthcare."

Quietly picking up options on more land than the initial project called for, Nathan and the hospital board envisioned a campus atmosphere around the new medical center, with avenues lined with the offices of medical specialists and other health-related businesses.

"It's like an industrial park for healthcare, with all the different links and health services in one neighborhood," says Nathan. "Some people were immediately negative but, through a community visioning process, many of those same people ultimately became the idea's strongest proponents."

Another touchstone in the growth of Lee Memorial arrived with the acquisition of Cape Coral Hospital in 1996, a transaction that posed new challenges for Nathan. During the purchase, investigators uncovered mismanagement and bookkeeping errors at Cape Coral. The resulting controversy made headlines.

"It was a mess, really," says Nathan. "We were very public during that transaction and during the due diligence process uncovered irregularities that were serious enough that some people went to jail. But the staff members at that hospital held it all together, somehow, through a very bad situation. Within eight months, a hospital that had been losing $1 million a month for the past two years turned a profit."

Jon Cecil, the hospital system's chief human resources officer, says Nathan's modesty and tendency to credit staff members is a key to his success. Cecil has worked at Lee Memorial for 35 years.

"He makes my job easier because he is the go-to person for our staff, even though we have almost 8,000 employees," says Cecil. "He's unique in that he's a visionary and really has a handle on national healthcare issues, but at the same time anyone can send him an e-mail or letter. He's responsible to everyone and that helps him build consensus among staff, administrators and the board."