Nashville General Hospital CEO resigns amid tensions and an unflattering audit

While Nashville General Hospital’s board contemplated replacing the longtime CEO, he submitted his resignation.

Joseph Webb sent the letter to board members on Wednesday evening, according to a document obtained by WPLN.

“After careful consideration, I have determined it is in the best interest of all parties involved to allow the organization to move forward under new leadership,” the letter reads in part.

Nashville General has been mired in conflict lately. Tensions rose even further this week, when a hospital board subcommittee recommended replacing Webb as CEO just before his resignation.

The hospital is a public safety-net facility, which means it offers care regardless of a patient’s ability to pay. That’s an expensive mission, and the hospital’s finances have been a flashpoint for Metro officials for decades. It also serves as a teaching hospital for Meharry, relies on its faculty to care for indigent patients and operates in a leased building on campus.

The three institutions have been in conflict for years, and that has heated up as the hospital gets closer to the end of its lease. The building has several infrastructure issues, and there’s a push to move somewhere else.

Yet another issue arose on Thursday: Metro’s internal audit office released an investigation into the hospital’s management. The document was obtained by the Nashville Banner. It substantiated claims that hospital executives signed off on more than $4.5 million in contracts without board approval, and that they falsified documents provided to news media through open records requests.

The committee’s concerns

The Hospital Authority Board — a division of Metro — acts as a board of directors over the hospital, and the subcommittee has spent months reviewing Webb’s performance, with a charge to determine whether the hospital should retain him. This is a standard practice whether or not a CEO is in good standing. The group recommended that Webb’s contract not be renewed.

Several members who voted against Webb pointed to the issues between the hospital, Meharry and the wider Metro government.

“In terms of the relationships there, they’re fractured at best, broken at worst,” said Christina Smith, who headed up the evaluation committee. “And I don’t know that that wound … can be healed very quickly.”

Member David Esquivel said that’s especially troublesome, given the hospital’s need for a new building.

“Bottom line, there needs to be a new facility, and from what I have observed, Dr. Webb has not been able to amass the coalition that is needed to take that decision forward,” he said. “And it is a decision and a project that has to be done. There are key constituencies … that are not on board. One being the mayor’s office, two being Meharry Medical College, three being this board itself.”

Members also raised concerns about complaints from employees. Smith told the board the accusations paint a picture of a poor working environment.

“I get multiple … complaints from current employees that state there are, you know, inconsistencies,” she said. “There are retaliations. There is favoritism and nepotism. There is some nonfunctional medical equipment. Disparity in hiring practices. To me, that goes to culture.”

Although three of the committee’s four members voted against renewing Webb’s contract, several noted the successes throughout his decade-long tenure, including the creation of a food pharmacy that has dispensed 1 million meals to food-insecure patients. They all said Webb has a long track record of working toward health equity and serving marginalized communities.

Dr. Shindana Feagins was the lone vote supporting Webb. She said she’s been involved with Nashville General for 20 years, since she was a resident at Meharry Medical College. She said that gives her more insight into Webb’s performance, compared to other committee members who have been serving on the board for a much shorter time.

She also said that several of the problems under Webb’s leadership have been beyond his control.

“Being in a community hospital … we don’t have the resources that, say, Vanderbilt has or HCA has,” she said. “So he’s been able to navigate through those roadblocks, bringing new clinics to the community and providing services to those who are marginalized and who need those services.”

She said that instead of replacing the CEO, the board should be working to improve the hospital’s relationships. And one way to smooth things over with Meharry would be completing a new physician services agreement.

An oudated agreement

That has been a major sticking point between the hospital and medical school. The board discussed it at length during a January meeting.

Nashville General pays the medical school, and the money goes toward physicians’ salaries. Webb explained the arrangement in the meeting.

“Nashville General Hospital is paying Meharry for physicians to provide care for specific patients, namely the indigent population,” he said. “Remember, Meharry Medical College is a private institution and is not obligated to care for indigent patients. We pay them … for that work that they provide. Otherwise, they bill for the patients that they see.”

But the physician services agreement — a contract known as a PSA — expired in 2023. Webb said both parties are still adhering to the expired agreement and are working on drafting a new one.

Metro government officials have raised concerns that, in the meantime, the lapsed agreement could be creating ambiguity that puts the hospital in legal danger. They specifically raised concerns about federal laws that regulate physician referrals and payments.

Mayor O’Connell said replacing the contract is a top priority, and that his office is committed to facilitate those negotiations.

“I’ve maintained for months that a brighter future begins with the execution of a successful professional services agreement with Meharry Medical College as part of a renewed and restored partnership,” a statement reads in part. “From there, we can pursue a process to conduct a thorough review of what is needed to provide quality health care for our community through our safety net hospital for generations to come.”

The Nashville Banner interviewed Dr. James Hildreth, Meharry Medical College’s president and CEO, about his concerns. He said that in addition to allowing the PSA to expire, the hospital hasn’t been complying with it closely enough.

“We now have leadership at the hospital who quite honestly have not honored the terms of the PSA principally by hiring its own physicians and not having them be part of the teaching mission,” Hildreth told the Banner.

He also raised concerns about the hospital’s patient load. On some days, there are fewer than 30 people getting care at the teaching hospital, which he says makes it hard to provide students with learning opportunities.

Update: This story was updated throughout on Thursday afternoon to reflect new information, including that Joseph Webb has resigned as CEO of Nashville General Hospital.