Lindsey Bradley never intended to stay here long.
When he arrived in Tyler to take the helm of Mother Frances Hospital, he was known as a turnaround artist - an executive who specialized in bringing hospitals back from the brink of bankruptcy.
He wasn't even recruited by the hospital itself; it was a group of investment bankers who had been approached by Mother Frances Hospital for financing that reached out to Bradley.
That was more than 35 years ago. He'll retire Friday from a growing hospital system facing fundamental changes.
"I wasn't really looking for a job," Bradley, 73, said. "I thought I would just come in long enough to get the ship righted and then move on after three or four years."
But he stayed.
And the hospital, which in 1981 had just 240 beds in one facility, has grown to a health care system that encompasses 14 hospitals and more than 40 Christus Trinity Clinic locations throughout a 41-county region.
A MAJOR ROLE
In 1986, the East Texas economy was devastated by a precipitous drop in oil prices. As the economy began to recover, city leaders were adamant that it must diversify beyond the oil and gas industry. In many ways, the medical industry filled that gap.
"One of the big stories from that part of our history is the growth of the medical industry," Mayor Martin Heines said. "And that can be directly attributed to the entrepreneurial spirit and the competition that was taking place at the time between Trinity Mother Frances and the East Texas Medical Center system. A lot of people had questions about that competitiveness over the years, but it really led to Tyler being the hub for health care in this part of the state."
And Bradley played a major role in that, Heines said.
"He'll always be tied to the history of this community," Heines said. "That forward-thinking really transformed our community and made it better."
Bradley says it was his team, and one particular partnership, that was crucial to the success of the hospital system. He praised the late Ray Thompson, the system's chief operating officer, who died in 2016.
"Ray and I worked together in Houston, and I brought him along," Bradley said. "We borrowed the money, we built the new building, and we got things going in the right direction. But we knew we needed something more to really make the hospital a success."
Mother Frances Hospital needed a niche, Bradley said.
"We noticed there were no practicing cardiologists in town in 1981," he said. "Texas had certificate of need laws then, so it wasn't easy."
Certificate of need laws were in place to quash competition and keep prices low - at least in theory. Texas has long since repealed those laws, but at the time, hospitals such as Mother Frances had to demonstrate a need before any hospital could expand its facilities or scope of practice. It was a long, expensive process.
"With a lot of help, we put together a proposal for a cardiology and cardiac surgery facility. That's what has led to us becoming one of the best heart hospitals in the country."
That was just one of the changes Bradley initiated. When he arrived in 1981, physicians and hospitals had a complicated relationship.
"Physicians and hospitals needed each other, but it wasn't a trusting relationship," he explained. "There was always tension. But I didn't know how to make a better hospital without working with the physicians. The key was allowing them to work with us more closely. In 1995, we created this health system with Trinity Clinic. And we put doctors in the executive suites and on the boards. The doctors were co-leaders. We became partners."
Dr. Steven Keuer, president of Christus Trinity Clinic and chief medical officer of the Christus Trinity Mother Frances Health System, was there at the beginning.
"Many of the best health systems in America are integrated health systems, in which physicians and administrators share leadership and governance, develop a trusting relationship, and work together to provide exceptional health care for their patients," he said. "This relationship requires trust and for each to work as a team, keeping the care of the patient as the ultimate goal."
The only real constant throughout his career has been change, Bradley said.
"In the 1980s, the payment methods changed," he explained. "We had a cost-based system, in which the insurance companies or Medicare or Medicaid would pay based on what something cost. But we saw that change to a fixed reimbursement system."
Those fixed reimbursement rates haven't kept up with the provider's actual costs, Bradley added.
And overall, health care has gotten astronomically expensive, he said.
"We are at a point that people can't afford the care they need," he said. "There's not enough money in this whole country to keep doing it the way we're doing it now. We have great challenges."
Real health care reform must take place, Bradley said.
"We've got to look at the amount of care we're providing, using outpatient care as much as possible, and focus on population health," he said. "As a health system, we're going to have to work at keeping people as healthy as possible, rather than just providing them with procedures when something is wrong."
What's driving the rising health care costs? There's no mystery, Bradley said.
"Our population is aging," he said. "Baby boomers are retiring. And in Northeast Texas, we have an older and sicker population. And a lot of the health issues people have are made worse by behavior choices - smoking, not keeping up with normal wellness care. And our diets aren't good in Northeast Texas."
And because many patients lack insurance, hospitals are forced to bill more to those who do.
"That's what we have to do in order for us to be here to provide people the care they need," he said. "Otherwise, we would be out of business."
The Patient Protection and Affordable Care Act - the ACA, or Obamacare - has complicated matters, but not fixed a broken system.
"The grand compromise was that hospitals would accept lower growth in cost profiles" - in other words, slower inflation of costs - "in exchange for more people having Medicaid," Bradley said. "And maybe that worked in states that expanded Medicaid. But Texas didn't expand Medicaid. So hospitals in Texas got the worst of both worlds. The numbers of people with access to insurance has not gone up, while the payment from government has gone down."
And the system is hopelessly complex.
"Don't worry, it's not just you," Bradley said. "Health care really is complicated. I'm trying to get on Medicare Part B and I can't figure it out. And I've been doing this for years."
But he points out that while heath care financing remains a mess, the American health care system is "marvelous."
"We live in a marvelous time," he said. "We can offer sustaining and preventive care. I feel really good about that. The downside, of course, is that it's terribly expensive, and not everyone has easy access to the care that's available."
One change in health care Bradley is clearly excited about is the creation of health teams - doctors, paired with other practitioners and something new called "nurse navigators." They're able to follow up with patients and track their care.
"A physician isn't going to have time to call all of those patients to see how they're doing," Bradley said. "But a nurse navigator or care coordinator can. Sometimes it can be as simple as finding out that a patient isn't taking his medicine because he couldn't afford it. So instead of that patient getting sicker, his care team will find a way to get him what he needs."
The photos in Bradley's office are of his family - his wife, his children, his grandchildren - and his cars.
Bradley is a Mustang and Shelby nut.
"I love restoring old Mustangs to the condition they left the factory in," he said. "I've restored a lot. I also have done two custom builds - a '65 Mustang Fastback, and a 1951 Ford F1."
He even sounds like a gearhead.
"For the '65, I designed the motor," he said. "I started with a Boss302 block, and I stroked it to a 347. And I put in a very unique cross-ram fuel injection. I tried to picture what Ferrari would do if it built a Mustang. It took me four or five years to put together, but it was fun."
He even met racing legend and car designer Carroll Shelby a couple of times.
"He was very… colorful," Bradley said.
Family is important to Bradley. His father was an Army doctor and the family lived all over the world. Bradley's daughter is an advance practice nurse in the Dallas area, and his son is a physician in Colorado. He has a total of six grandchildren now.
Bradley says the health care system in America will continue to change. But it should be guided by some basic fundamental principles, he said.
"I believe people need care and they need access to care," he said. "And I believe the providers need fair payment, so they can be here and in business when they're needed. I don't know what it's going to look like. But I am optimistic. We can do better."