City Council Responds to Residents’ Frequently Asked Questions
After more than 11 months of diligent and deliberative study and negotiation regarding the future of Lakewood Hospital and health care in the city, Lakewood City Council has fielded a number of questions, comments and concerns.
Terms of the agreement allow for the creation of a new outpatient health facility and 24/7/365 emergency department in the heart of downtown Lakewood, and the repurposing of city-owned property where the current hospital sits for new economic development. In addition, the agreement also creates an innovative community health foundation that will ensure access to needed services for all of our community.
The lengthy document known as the “Master Agreement Among the City of Lakewood, Lakewood Hospital Association and the Cleveland Clinic Foundation Regarding the Future of Health Care Services in the Lakewood Community” is available for public review on the City’s website, along with the ordinance in front of City Council.
Below are the most commonly asked questions during the past several weeks and months.
What makes you think this is a good deal for Lakewood?+-
The more we’ve studied Lakewood’s health, the more convinced we are that this deal puts Lakewood on the leading edge of personalized medicine and a wellness movement, the kind of care that is most responsive to the needs of our community. For example, there will be focused services for people with diabetes and other common health problems. And this deal creates an innovative community health foundation that will ensure access to needed services for all of our community.
What makes you most excited about this deal at this point?+-
For many of us, it’s the fact that there will be continuous emergency care provided to our community. That was a big concern among our residents. The emergency department at the hospital will remain open 24/7/365, providing all the services of a comprehensive emergency department, until the brand new emergency department opens in the family health center across the street. And as a bonus, the Clinic has agreed to make its mobile stroke unit available to Lakewood, which means high tech diagnostic and treatments options available to patients suffering from a stroke, as close to home as possible.
What makes this deal more promising for our future?+-
We have been facing a real danger that our hospital would become a shell, leaving us without inpatient or emergency services. That’s happened in many communities throughout the country. The new deal means guaranteed emergency services, with no interruptions, and the promise of a brand new outpatient health center that is attractive to patients and health care providers, and delivers all the services we really need. Another plus is that we get to develop the land where the hospital sits now for other kinds of services that could bring more businesses into the heart of downtown.
Why is Council making a decision this month? Why not wait a bit longer?+-
City Council has diligently studied the options and hosted dozens of public meetings on this issue. We’ve done our homework. We’ve gathered all the facts. We’ve heard from the residents we represent. We are ready to make our recommendation on how to improve the health of our community.
Also, Lakewood Hospital Association (LHA), which is responsible for operating the hospital, is losing money at an astounding rate. With funds dwindling and LHA reaching a point of insolvency, there is urgency. We must act decisively and wisely so that taxpayers receive the greatest value for our assets, and we continue to receive health care, including emergency care, without interruption.
Why can’t you just leave the hospital as it is, and leave it open?+-
We really have no such choice. If the hospital were to remain open, it simply could not survive. It is losing millions of dollars each month. We can’t force people to go to the hospital and bring in new business. That’s ridiculous. What we can do is redirect the assets we own — the hospital building and the land — to better uses that will bring new development to our city. And we can do that while still ensuring that an emergency department remains available to our community through this transition and beyond. If we don’t move forward, we will go backward. We can’t stand still and do nothing.
Recently, a group out of Tennessee expressed interest in the hospital property. How will the timing of that inquiry impact this agreement?+-
There is no reason to delay Council’s consideration of the agreement. We have a hospital that is failing. We need to preserve as much of the hospital assets as possible and maintain health care despite the hospital’s decline. Our review of all of the facts, including multiple consultant reports — has convinced us that the most viable approach to delivering health care to the citizens of Lakewood is the one we have been negotiating with the Cleveland Clinic. It meets the needs of our community, and most importantly preserves continuity of care.
We will continue to consider any and all legitimate proposals to provide quality health care services to the citizens of Lakewood.
How is this new agreement different from the letter of intent announced back in January?+-
- Most significantly, the new proposal makes better use of community assets. By moving the proposed family health center across the street to the southwest corner of Belle and Detroit, it frees up more than 5 acres of land where the current hospital sits for redevelopment. This funds our future, producing revenue-driving opportunities, economic development and a visionary downtown district.
- This proposal also creates a demolition/redevelopment reserve for the hospital property. The city has negotiated a reserve of $7 million of LHA assets to be used as the city sees fit in conjunction with the redevelopment of the hospital site.
- Funding for the community health foundation has been preserved at $32.4 million, even though LHA assets have dwindled since the original agreement was presented.
- The city negotiated a two-fold increase in the payments to be made for use of the hospital during the transition period.
- As a result of these negotiations, we’ve received the Clinic’s assurances to provide 24/7/365 emergency care in Lakewood, work with the city to deploy a mobile stroke unit here, bring the family medicine residency and LGBT programs to the new health center, and a work with a community advisory board to include citizen input into new services.
Some people worry that the emergency department will be just a glorified urgent care center? Can it handle heart attacks and strokes and accidents and broken bones?+-
Every day, every hour, doctors and nurses will be ready to treat emergencies like heart attacks and strokes. This proposal makes certain that as long as the Cleveland Clinic operates a family medical center, it will include 24/7/365 emergency services. This agreement ensures the continuity of care in Lakewood.
The fact is that most emergencies involve treatment and discharge to home within 24 hours. If inpatient care is needed beyond 24 hours, patients arriving to the Lakewood emergency department will be transported to the closest, most appropriate full-service hospital.
This new agreement also contemplates the deployment of a mobile stroke unit operated by the Cleveland Clinic, which can take advanced stroke care directly to the patient in trouble.
What’s going to happen in the transition? What if I need to be admitted to a hospital?+-
The emergency department at Lakewood Hospital will remain fully operational until a new emergency department is built at the new family health center across the street. There will be no disruption in emergency services. If you need to be admitted to a hospital, you will likely be transferred to another hospital within 10 miles of Lakewood.
If someone needs to be transported to another facility, won’t longer transports hurt medical care?+-
Patients are assessed either on the scene by paramedics, or in the emergency department by doctors, nurses, and other medical personnel. Decisions to transport are made to make sure patients are receiving the most appropriate care in the most appropriate place. Lakewood Fire Department medics provide high-quality patient care throughout the transport. The increased transport times from Lakewood to Fairview or MetroHealth are less than transport times from cities like Strongsville and North Royalton to Southwest General, or from Brecksville and Broadview Heights to Parma, Marymount or Akron.
It is simply not true to suggest that these kinds of transport times endanger patients.
How can patients with mobility challenges get where they need to be?+-
The same way they get to the hospital currently, whether that’s by ambulance, by wheelchair assistance, by walking or by being dropped off. If patients need non-emergency transportation to another health care facility, patient transport is often arranged by medical providers, and the city is interested in exploring the idea that a new community health foundation could help fund these types of needs. The agreement also requires the Clinic and city to work together on grant funding for future transportation needs.
Tell us more about this new community health foundation. What makes you so convinced it’s a good thing?+-
We’ve heard from experts about some of the transformative changes those foundations can achieve in improving a community’s health. We have a great deal of faith in our own citizens’ abilities to shape a foundation that truly addresses our own health care needs. It’s also well funded; there’s a $32.4 million commitment in this agreement — with the possibility of more. We haven’t yet engaged the right mix of leaders, consultants and health care professionals to help us put shape to that foundation and we are looking forward to getting started in 2016.
During the past several years, many services have been moved from Lakewood Hospital to other Cleveland Clinic facilities. Many people are upset with Council about this issue — how do you respond?+-
Let’s make something clear: City Council is not in the business of running a hospital. It’s our job to make Lakewood as safe a city as possible, a vibrant place to live, and a community that keeps growing. There are market forces that are changing health care delivery in Every City USA. We will not speak for the Clinic about how it has chosen to respond to these market forces. The Lakewood Hospital Association, which is our tenant on our property and is responsible for operating the hospital, has found no violation in its agreement with the Clinic; and we have found no violation in the city’s lease with LHA. While no one is happy that Lakewood Hospital isn’t thriving, we will not assess blame to any particular party.
Why is there a need to close the hospital to inpatient care when the Huron report suggests that Lakewood can support a hospital?+-
It is important to set the record straight on the conclusions of the Huron Consulting report. The Huron report noted that the city could ONLY support a hospital if that hospital could capture 100 percent of the market share for inpatient care. That means every resident who currently goes to a hospital outside of Lakewood (think of all your friends who go to Metro or Fairview or the Clinic) would have to go to Lakewood Hospital for it to stay in business. That’s a wholly unrealistic assumption.
Doesn’t this kind of plan hurt those who do not have financial resources?+-
This plan, including the continued provision of emergency services, helps all our residents receive the health care they need. We know that the array of services to be offered upon the opening of the family health center is robust and targeted to meet the needs of all of our residents, no matter what their income. Access to these kinds of services throughout our community does not discriminate. Furthermore, the new family health center will be subject to the Cleveland Clinic’s system-wide Cleveland Clinic financial assistance policies.
The closing of the hospital will mean the loss of hundreds of jobs. How can the city recover from this?+-
The hospital jobs represent no more than 3 percent of Lakewood’s total resident workforce. We are not a one-employer town, and that makes Lakewood a strong community that can overcome the loss of these jobs. The agreement we negotiated makes clear that the employees who work for the Clinic at the hospital will be offered other positions in the Clinic’s health system.
We understand that some Clinic health system jobs will move into Lakewood from other cities.
Also, a new family health center bringing more people into our city for care is a promising alternative to 6 acres of abandoned property and an empty Lakewood Hospital. That’s the reality we believe we would face if we do not move forward now.
We keep hearing that this plan will be an economic disaster for Lakewood. Will it threaten any city services?+-
We envision handling these changes without any changes to city services. In any case, the city is well prepared to absorb income tax losses and has incorporated provisions into the agreement that mitigate any financial losses to the city. The employees of Lakewood Hospital — many of whom are residents — are ensured the opportunity for continued employment in the Cleveland Clinic system.
The Clinic seems to be controlling this whole thing. Why are you allowing the Clinic to force this on Lakewood?+-
The fact is that this agreement is the product of several months of intensive negotiations. All parties gave a little and gained a lot and all negotiations took into account the parties’ respective legal rights and obligations under the 1996 governing documents. The result is a better deal for the City of Lakewood and for our residents, to meet their health care needs today and into the future.
There’s been a lot of talk of a secret plan to decant the hospital and put it out of business. What do you say about that?+-
We do not buy into the theatrical viewpoint or allegations that the Cleveland Clinic kept secrets from our tenant, Lakewood Hospital Association. We do believe the Clinic’s internal business plan resulted in patients getting care at other sites. And we don’t agree with every business decision that has been made by the Cleveland Clinic. But again, we’re not in the business of running a hospital and we will not answer questions for the Cleveland Clinic. We are in the business of dealing with reality and making the best deal for the citizens we represent. We must look forward, not backward.
There are many Save Lakewood Hospital signs still posted on lawns throughout Lakewood. What do you say to all those people who still believe you could, and should have done more to preserve the hospital?+-
We appreciate the sentiment and the heartfelt passion these citizens have for history and tradition. But that is not going to help this city grow and thrive in a new era of health care delivery and economic development. Saving Lakewood Hospital — continuing business as usual — is not going to make our residents physically healthier and may in fact threaten the economic health of this city. We hope the residents who care so deeply about the hospital, as we do, will refocus their energies on how new health care services and programs can meet the needs of our citizens.
This seems like the corporate control of government. Do you see it differently?+-
We see this agreement as an economically viable proposal that meets the long-term health care needs of all our residents. Further, the agreement provides new opportunities for economic growth to our city while satisfying concerns expressed by our citizens in many surveys.
Was there any consideration for environmental impact?+-
The city of Lakewood never ignores the environmental impact in any of project that it undertakes — and in fact, we have a great opportunity in the redevelopment of the hospital site to make sure that we are fully thinking through all of our best integrated planning options for our environmental needs. The Clinic’s new family health center will be built as LEED-eligible, a high environmental standard.
Some people say Council has been forced into this agreement. Do you feel that way?+-
Absolutely not. We have all been negotiating in good faith and at an arm’s length. We are dealing with the reality that our tenant, Lakewood Hospital Association, is operating a hospital that is failing. Like any landlord with a tenant that’s failing, we have to respond. We also recognize that health care is a dynamic force and we must respond to changes with some level of urgency in order to protect and preserve Lakewood’s assets.
Why can’t you detail all the services that will be available at the new health center?+-
The city doesn’t want to be in the business of micromanaging any health care providers’ services, but the initial services to be provided at the health center have been listed in the agreement, and we do have assurances for some programs and services that will be provided on the site and in Lakewood: the family medicine residency program, LGBT services, a mobile stroke unit, and 24/7/365 emergency services. The Clinic is allowing for the community to have a say in the health care needs of the community with the creation of a community advisory board.
What makes you trust the Clinic?+-
We are making our decisions and recommendations based on facts and our best judgment and a well-negotiated deal. Trust doesn’t enter in this. It’s about the numbers and the assurances in the legally binding agreement. We do believe that the agreement before us — a binding contract — recognizes the Clinic’s commitment to the future of health care in Lakewood.
Why not just enforce the current contract with the Clinic? You say you want to hold them accountable. Why not hold them accountable to that contract?+-
This question goes to the heart of persistent misconceptions about Lakewood Hospital. The city has not been a party to any agreement with the Clinic prior to now. The parties to the 1996 lease are the city and Lakewood Hospital Association. Under the lease, LHA makes a commitment to run a hospital. The Clinic is not a party to that lease and does not have any rights or obligations under the lease.
The agreement to which the Clinic was a party is the 1996 definitive agreement. LHA and the Clinic are the parties to the 1996 definitive agreement. The city was never a party to the definitive agreement.
There is a widespread misperception that LHA’s operational, maintenance and other obligations associated with the hospital under the 1996 lease were passed through to the Clinic in the definitive agreement. This perception is not reality. While the Clinic did have some obligations under the definitive agreement, requirements to operate the hospital for the lease term (or any term) or provide specific services at the hospital were not among them. The party with those affirmative obligations was LHA, not the Clinic, pursuant to the terms of the lease. Given the hospital’s failing condition, it would be irresponsible of the city to assume that LHA would be able to fulfill its lease commitments. Proactive leadership is needed now to ensure the delivery of health care in Lakewood.
What will happen to the community health building and childcare center located to the south of the current hospital parking garage?+-
The three-story building south of the hospital parking garage is owned by the city and was leased to LHA in 1996. Control of that building will return to the city soon after the agreement with LHA and the Clinic is approved. The city administration is currently working with prospective and current tenants, including the well regarded childcare center now onsite, to ensure an active tenant mix that best benefits the residents of Lakewood as the vibrant new family health center is built just to the north.
How does the pending lawsuit involving the hospital affect Council’s deliberations?+-
The people who filed the lawsuit, which is pending in the Cuyahoga County Common Pleas Court, have tried several times without success to prevent City Council and Mayor Summers from negotiating any agreement with LHA and the Clinic. The lawsuit should have no bearing on Council’s deliberations and its legislation now that an agreement has been reached among the parties.