- [Narrator] This is a production of WEDU PBS, Tampa St. Petersburg, Sarasota.

- It's good to be first in competition and business and in most things but it's usually not good to be first in times of trouble.

During the recent COVID-19 pandemic, Sarasota Memorial Hospital had the first reported case of COVID in Florida.

Like all of this region's hospital Sarasota Memorial was put to the test and focused on meeting this emergency head on.

Over the next three years, it greatly expanded care and had a much lower mortality rate than many hospitals across the country.

You're about to meet the chairman of the Sarasota Memorial Public Hospital Board whose military training and business acumen were great preparation for the challenges he's faced leading the hospital board.

Next on the Suncoast Business Forum.

- [Narrator] Suncoast Business Forum, brought to you by the financial services firm of Raymond James offering personalized wealth management advice and banking and capital markets expertise.

All with a commitment to putting clients' financial wellbeing first, more information is available at raymondjames.com.

(gentle music) (gentle music) - Sarasota Memorial Hospital was founded nearly a hundred years ago.

What started as a tent with a handful of beds has grown into a nearly one and a half billion dollar a year healthcare system.

That's the county's largest healthcare provider with more than a million patient visits a year.

It's ranked nationally and statewide for its quality medical care.

Sarasota Memorial is a nonprofit community hospital with a nine person elected board of directors.

Tramm Hudson is chairman of the Sarasota Memorial Public Hospital Board.

Tramm, welcome to the Suncoast Business Forum.

- Great to be here.

Thanks for inviting me.

- Now, let's go back three years.

March 1st, 2020 that's when the first COVID patient was admitted to the hospital and was admitted to Sarasota Memorial.

- You know, looking back on those, there were two early cases of COVID.

One was in Hillsborough County and was in Sarasota County.

When COVID first hit the radar screen in December of 2019 it was up on the west coast.

We had the doctor that was in charge of our infectious disease group started looking at that and started preparing for what's gonna happen when it comes east.

And our administrative staff put together a task force to look at how we can best face this.

And I would say that that was a key thing to start in December, collecting information from around the country preparing for the eventual COVID coming to Sarasota - Now it's times of trouble, times of turbulence that excellence emerges.

As you look back over that period of time from 2020 forward what are some of the things that really stand out in your mind about how Sarasota Memorial responded?

- I think number one, the incredible dedication of our staff.

Everyone from the top of the organization to the janitor at the bottom everyone was going into work every day knowing that they were facing this unknown disease.

And I think the resiliency of our population with in Sarasota was that we were able to deliver the kind of healthcare that they expect.

- Sarasota Memorial Hospital is about to celebrate.

Its 100th anniversary.

- [Tramm] Yep.

- Did did it really start in a tent?

- Actually it was originally called the Sarasota Welfare Association.

And it was a group of women in town who had identified the need to have a permanent structure for healthcare.

And they began raising the money.

And from a tent, we built our first building and there was a saying I read in the newspaper where that businessmen would be walking down Main Street and they would cross the street if they saw some of the women coming forward.

'Cause they had given all they could.

We had 32 hospital beds in that first building.

And we have grown to now over a thousand beds on two campuses.

We have a standalone emergency center in Northport along with 13 different facilities for urgent care.

Quite a different contrast to starting from a tent.

- So with over a thousand beds.

- [Tramm] Yep.

- And you have two locations.

- [Tramm] Yep.

- In Sarasota County.

The hospital has also been highly ranked on national level both in US News and World Report, Gallup, Newsweek a number of things.

What is it that has been identified and recognized?

- When we look at the accolades the hospital has received probably at the top of the list is the five star rating from the federal government the CMS Center for Medicare and Medicaid Services.

We have, they began rating hospitals with stars beginning 2016.

And we have had five-star recognition ever since then.

And that really addresses at quality.

There's another group called Leapfrog.

We're very proud of our rating.

We have an a plus rating and Leapfrog focuses on safety of the patient and we're very proud of that record.

We've had A rating also since 2016.

US News does a similar kind of rating.

Our urology and rehab efforts have been recognized with US News.

Newsweek does a rating on the top hospitals in the whole world.

And we have been fortunate to be listed in the Newsweek.

But the one that I really most proud of is the Magnet designation that we've received which really recognizes excellence in nursing care because people think that doctors run the hospital but they don't.

It's the bedside care delivered by our nursing staff that really makes the difference.

And a Magnet designation puts us really at the top.

There are only 42 Magnet hospitals in the country and we're very proud to be one of those.

- You are the chair of the Sarasota Memorial Public Hospital Board.

That's a nine person elected board.

- [Tramm] Right.

- You and your fellow board members are not paid.

You're not compensated for your services.

So you're volunteers-- - [Tramm] We're volunteers.

- Elected volunteers.

How would you say the normal processes and normal responsibilities of hospital board members was before COVID and since COVID?

- Good question.

You know, I say Jeff, that being on the hospital board is we're uncompensated, but there are two things, benefits that we get.

We get a parking pass where we can park anywhere on the campus and we also get served hospital food at our monthly board meetings.

So our board is composed of nine members who were elected in a partisan race.

We serve on staggered terms.

It had been a real honor I think, to be on the hospital board prior to COVID, a lot of the senior leaders in our community had stood for election and we were focused really at the 30,000 foot level, not to get into the minutiae.

- How did all that change after COVID?

- COVID was a eyeopener because everybody went to general quarters and the board met regularly during those initial months of COVID.

I can remember we had issues related to the budget.

We became incredibly under pressure in terms of putting money because elective surgery had been gone away.

And so how are we going to address the financial needs and continue the care?

One of the important things I remember is we also wanted to make sure that we were given incentives to our staff 'cause a lot of people didn't want to go to work and COVID and can you imagine being a nurse or being an orderly and every day you're going in being exposed to it and then going home to your family.

So we put in special incentives for our staff to stay the course and that was a big part of it.

And also giving guidance to management and how we communicated because in Sarasota County, there are only four hospitals.

Sarasota obviously is the biggest, but doctors is the HCA, the Inglewood Hospital is HCA and Shore Point in Venice is a large hospital, about 300 beds.

And so we really dominate the market and we became really the focus of communication and I think that we did a really good job in trying to address the questions the public had.

- Let's talk about your formative years.

Let's talk about your family where you grew up.

- I am a proud native of Montgomery, Alabama.

I tell my kids that I won the parent lottery.

I could not have asked for more loving set of parents but my father was a banker for 47 years.

He left the farm in 1924 and became a runner at the old First National Bank.

Montgomery, back then we didn't have internet or email.

And so the way officers would communicate is they'd have runners take messages from one office to another.

My mother was a registered nurse and she also ran a kindergarten.

So early on growing up in Montgomery important things that education and community involvement were things that were instilled in me.

I played football for our high school football team and you can't really tell how tall I am except we're about the same height.

I was five four and weighed about 150 pounds.

And I was at the starting center on our football team.

And one of the things I learned that the coach emphasized to me was that, you know it's not the size of the dog and the fight it's the size of the fight and the dog.

And that was something that I learned quickly playing sports and but the YMCA was an important part of my upbringing.

Their youth and government program in particular had really caught my attention.

I was active in student government affairs I was elected youth mayor of Montgomery my senior year.

But it was really something that I think that I learned early is that if we don't get good people to run for office we get the government we deserve.

And that has stayed with me for a long time.

- After high school you went to Vanderbilt University.

What did you study?

- I was a history major at Vanderbilt but I was fortunate I earned a Army ROTC scholarship which allowed me to go to Vanderbilt and I was involved in student government there as well and other kind of activities.

- You had an ROTC scholarship to Vanderbilt.

Did you intend to have a career in the military?

- Not really.

I knew that I'd wanna return to civilian life but it was a great experience.

I served on active duty for four years after that.

But my experience in the Army was rewarding, helped develop my leadership skills, allowed me to serve my country.

Also after my active duty, I stayed in the reserves, commanded an infantry company here in Florida and eventually retired as Lieutenant Colonel in 1996.

- In 1979, after you returned to the US, after your active duty in the military, you went to graduate school at Emory University.

- [Tramm] Right.

- Did you know what you wanted to do career-wise?

- I probably knew I was gonna be a banker.

You know, as my, I said earlier, my father was a banker for 47 years and he told me, he said, son, don't come back to Alabama to learn your banking, go elsewhere.

And Emory was a good preparation for that.

I earned and MBA and was recruited to go work for the old North Carolina National Bank in Charlotte and began my banking career with them in 1981.

- North Carolina National Bank was also known as NCNB and at that time it was led by a very charismatic ex-marine.

So tell us about joining an organization.

You just left the military, now you're with a very very prominent bank with a very prominent CEO.

- Well, I will tell you, other than my father Hu McCall is probably my role model for banking.

He was a charismatic leader.

I had the good fortune to be his travel aid for two months during my training period.

- Right about the time you joined NCNB, the banking industry changed dramatically.

And NCNB started making some major acquisitions as you point out here in Florida and elsewhere.

- They were very, very strategic.

They owned a trust company in Orlando that they had known for a number of years.

And at that time it was very important in terms of banking to try to branch as much as you could.

And we did not have interstate banking, but we used a loophole and the Florida law to use the trust company in Orlando to purchase our first bank at Lake City.

And then our second bank was the Gulfstream Bank over on the East coast.

And the third was the acquisition of the Exchange bank here in Tampa, which is how I got to Tampa.

'Cause my seven years with NCNB, I moved five times and I moved from Charlotte to Orlando to Tampa to Clearwater.

And then the last one was when we acquired the Ellis Bank in Sarasota.

And I moved to Sarasota and I looked around, I said this is the place where I want to raise my family, establish my roots, and make this my home.

And I was very fortunate to work with another banker and he and I left NCNB in 1988 and formed a small community bank called Enterprise Bank.

And we ran that for 10 years and eventually sold it.

But that's how we got to Sarasota.

- Once you were established in Sarasota, in addition to your active involvement in the banking community you were also very active in the business community and in the general community on a volunteer basis.

Tell us about that.

- Early on, when I moved to Sarasota I got involved in the Chamber of Commerce.

The Committee of 100.

And the first leadership role was chair of the Economic Development Group, the Committee of 100.

And from there I was tapped to be the chairman of the Chamber of Commerce and then did several other community things was on the board of the United Way the board of the YMCA, which was dear to my heart and became real involved in our community.

- You were also very involved in Republican party politics in Sarasota County.

- I got involved with Dan Miller's campaign in 1992 and in the gubernatorial race in 94 there were five Republicans in a really bloody primary.

And Jeb Bush won that primary but only had about 60 days to go up against Lawton Chiles.

And he did not win that general election.

And afterwards he got a group of us together and we were looking at lessons learned and he said, what we need to do is, we need to control the party apparatus.

And he encouraged us to get involved in local party Republican party politics.

And that was sort of the intro I had.

And it didn't take long.

I was a finance chairman and then I was elected chairman of the party.

And of course Jeb won convincingly in 1998 mainly because of control of the party apparatus.

- Then in 2007 you retired from banking for the first time, traveled the world, then 2008, the Great recession hit.

- Of course, with that recession really was just devastating the whole financial markets and banking in particular.

And as I was looking around, I said to my wife, I said I think I need to go back to work because one of the little banks that I owned the little bank branch, the bank had failed.

And so I said, I need to go back to work.

And I was lucky I was able to join a great banking company outta New Orleans, Whitney Bank.

And I served as their leader in Sarasota Manatee County.

And that was a good run.

- You also serve on several trust company boards in the Sarasota area, right?

- I do.

The Caldwell Trust Company is a private, a locally-owned, privately-owned trust company, headquartered in Venice and also in Sarasota.

We've got about billion five in assets under management.

And I've been on that board for a number of years and it's been a way for me to stay involved in business in my retirement times.

- In 2015, you ran for the Sarasota Memorial Public Hospital Board and you won, you're now the chair.

How has the hospital grown and changed and what were some of the priorities that you established back in 2015 and how has it grown since then?

- Back then, one of the biggest issues that we face was a pending doctor shortage.

We had an underserved market in South Sarasota County.

And then the third piece is that we had a issue of our mental health, needs were not being addressed properly.

And so on the first thing, Dr. Shortage, our board said we should invest and become a teaching hospital and we have a robust program for graduate medical education.

We have a residency program for internists for emergency care and also palliative care.

And this has been very helpful in making sure that the doctor shortage doesn't catch us.

I was talking to the woman who, or the doctor who's in charge of that, and she told me this morning that 42% of the original graduates, they do a three year residency.

42% of them remained in Sarasota in practice medicine.

So, that's helping.

So, that was a big community need that we had identified.

The second part as an elected board, we had to listen to our constituents and South Sarasota County felt like they were making paying their taxes, but the healthcare they had they weren't, you know, they're having to drive.

And so our board committed in 2015 to address that and build a new hospital.

And we just, during COVID, speaking of things to do we just opened it in 2021 and that hospital has just done great.

We have 110 beds there.

During COVID, we had the unfortunate Shore Point Hospital which was the old Venice Regional 300 beds.

They closed their hospital overnight and put incredible pressure on our Venice Hospital.

But that's one of those long-term things that I think made sense.

And the third is our trying to address behavioral healthcare.

It's not very profitable, but it is needed.

And I think particularly with COVID and the number of cases of depression, what have you, this has been very important.

In November of this year, we'll open our Cornell Behavioral Health Pavilion.

So we're very proud of those things.

- The Sarasota Memorial Hospital Board, public hospital board has the authority to levee taxes and it does levee taxes.

What are those taxes used for and what percentage of the overall one and a half billion dollar budget do these taxes cover?

- We have the ability to tax up to two mills on property taxes.

And in Sarasota County we have enjoyed a robust real estate market.

And so we earn about 70 million a year from tax payers.

And that can fund indigent care, charity care, we can spend it on buildings, we can spend it on programs.

Anything that we can use is used in Sarasota County.

At a billion five seventy million.

So it's 4%.

Maybe that's one of the things that the board does look at because we would like to reduce our reliance on the tax dollars to operate it.

- Since the pandemic healthcare delivery has been criticized by some, it's been politicized as well.

How has this phenomenon impacted healthcare delivery in the United States and Sarasota Memorial?

- Well, we've been pretty much at the epicenter of the medical freedom movement.

And I will tell you that beginning really in our November meeting, we have public meetings because we're an elected body, we allow the public to speak.

And here, before hardly anyone would ever come to the hospital board meeting it was more of a corporate board.

We would have our annual hearings for the tax that we were gonna levy but nobody would ever come.

They were pleased with it.

But beginning in November, I think as a result of the the anguish of COVID, we had 200 people show up and we heard gut-wrenching stories of people who lost their loved ones.

And because of the lockdowns they weren't able to visit their loved ones.

That since has been corrected with the state legislature passing a law that you can visit loved ones and hospitals during those lockdowns.

But it was one of the things that we felt like we needed to listen to what the people were saying.

And as a result, our board committed to doing a comprehensive review of our response to COVID-19.

This was a major effort.

We had over 70 medical professionals on our staff involved in it.

We hired an outside firm to help collect the data and compare our performance to other hospitals around the country, similar in size.

And the result of that was we found that our hospital did very well.

We treated 13,400 patients with COVID in our hospital.

Those were hospitalizations and we lost about 1400 of those, unfortunately.

But 91% of those were able to walk out of the hospital.

And we just feel like from our study of that we will be better prepared in the next pandemic.

It may not be in mine in your lifetime but I guarantee you we'll have a pandemic.

- So looking over the time you've spent as chair of hospital board, what is your outlook for the challenges that are facing our healthcare system?

- We still have challenges.

I think the doctor shortage is not gonna go away.

Nursing shortage is not gonna go away.

Those two items, I think are a key concern.

I think also the inflationary pressures that we have right now in terms of supplies, the supply chain on hospital stuff is really upside down.

And that is a continuing concern.

And the third is how do we listen to our citizens, you know, in terms of healthcare the advent of AI, how can we use that?

How can we use telemedicine to better serve our population?

We've a lot of challenges ahead but I believe Sarasota Memorial is up to the task.

We've got a great staff, great leadership in our management, our medical group, our nursing staff.

I'm just very, very proud of our hospital.

- Well, Tramm, I'd like to thank you so much for being our guest today.

- You're kind.

Thank you for letting me come and be a part of this.

- If you'd like to see this interview again or any of the CEO profiles in our Suncoast Business Forum archive you can find them on the web at wedu.org/sbf.

Thanks for joining us for the Suncoast Business Forum.

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