Council Wants Guarantees On Hospital's Vision For Tomorrow

[Bill Call]

Some members of Council are asking that the Cleveland Clinic
guarantee continuation of the services offered in the Vision For Tomorrow Plan.

From the document:

Focus under vision for tomorrow:

"geriatrics, orthopedics, neurological services
and diabetes/endocrinology"

"WHEREAS, the Cleveland Clinic has not given the City any written assurance that
those services to be provided under the Vision for Tomorrow plan will be provided for
the duration of the lease; and

WHEREAS, absent such an assurance, the Cleveland Clinic has refused..."

Is the Vision For Tomorrow really a subterfuge for the ellimination of lease provisons that guarantee certain services?

Why is the Clinic seeking removal of those provisons?

Why is the Clinic seeking to remove Council's ability to review services offered by the hospital?

If the Council loses the ability to challenge changes in services offered at the Hospital what guarantees are there that there will even be a hospital?

Is there a hidden agenda?

[Will Brown]

I would imagine that any competent hospital system, or business, for that matter, would be very reluctant to allow a bunch of politicians to dictate how they do business? Things change, and no business wants to be locked into a business plan who's time has passed.

The city would have to offer some very generous terms, and have the only available property, to get a deal like that.

One would hope that the poseurs in the council would ask themselves what they will do with an old empty building if they decide to play hardball and the clinic takes its business to another facility. I guess we could sell a lot of burgers in a building that big!

[Bill Call]

I would imagine that any competent hospital system, or business, for that matter, would be very reluctant to allow a bunch of politicians to dictate how they do business? Things change, and no business wants to be locked into a business plan who's time has passed.

The provisions for oversight by council were in the lease from the very begining. Those provisions have never been an issue before. The oversight provisions are in the lease to insure that the owners of the hospital (the taxpayers of Lakewood) have some assurance that at the end of the lease term we still have a hospital.

Since the provisions don't prohibit the ADDITION of services the Clinics desire to remove that oversight must be based on the desire to further reduce service.

The Clinic can easily create the "need" to move employees and services and equipment to the new facility in Avon.

What will be left in 10 years? Should the owners of the hospital be concerned? Should we insult and denigrate members of council who ask:

"You are asking Lakewood to transfer services to Lutheran and Fairview. In return you have promised the transfer of services from Luthern and Fairview to Lakewood. Are you willing to guarantee that we will keep those services?"

What happens in six months when we find that the geriatrics, orthopedics, neurological services and diabetes/endocrinology services will be closed down?

Should we speak now or later? Or should we remain silent?

[Bill Trentel]

Our city leaders have a very weak barging position in their fight to protect the community's asset. Basically they have three options. 1) deny the requested reductions in service and require the CCF to abide by the lease and deal with the results when the lease expires in 5 yrs. The CCF will continue to direct resources and patients away from the Lakewood facility which is now operated as annex of Fairview Hospital. This will expand the financial losses at Lakewood and when they walk away it will be worthless. 2) Allow the reductions in services and allow CCF to turn our community hospital into a nursing home and stroke and broken hip rehab facility. But require new guarantee's that might make the hospital financially viable in some sense even as CCF continues to direct real hospital services to Fairview and Avon. 3) Let the CCF do whatever they want and in 5 yrs. figure out what to do with a vacant hospital.

It seems to me that option 2 is their only option, what they need to account for is the fact the reduced services will bring with it reduced income tax collections and the resulting budget problems. And it is still highly probable that the CCF will walk away in 5 yrs. but with 3 bad choices it may be the only one that protects our asset in any way.

While some posters to this board are impressed with the CCFs minimal investments in new generators recently rolled off of trucks and the CCFs generous advertising budget the facts are the CCF has chosen to invest much, much more at Fairview (planned 75+ million dollar ER and ICU) and Avon (95+ million dollar new hospital). They have chosen to make Fairview their westside ER, Heart, Peds, and Cancer hospital. They have chosen to direct physicians and patients away from Lakewood resulting in the operating loss that they now site as the need to further reduce services.

Hopefully are leaders are giving some serious thought of what the future might be for our hospital in 5 yrs. I would suggest a community rec. center but that's what we're going to do with the soon vacant Grant school. LOL

Bill

[Bill Call]

They have chosen to make Fairview their westside ER, Heart, Peds, and Cancer hospital. They have chosen to direct physicians and patients away from Lakewood resulting in the operating loss that they now site as the need to further reduce services.

Your analysis is spot on.

About 50 doctors who had a long history of working and referinig to Lakewood Hospital have recently retired. A hospital lives on referals. I'm pretty sure that the people who run the Clinic know that.

Younger doctors are being stationed at Fairview. The few that remain at Lakewood Hospital are encouraged to refer to other Clinic facilities.

The Clinic will invest close to $200 million in its Avon facility. We are supposed to get excited on $3 million dollars invested on replacing an outdated and malfunctioning AC system.

[Jim O'Bryan]

From Lakewood Hospital / Cleveland Clinic.

Dear Members of the Community Advisory:

It is with great pleasure we inform you the Lakewood City Council adopted a resolution last evening at a special meeting which supports the Lakewood Hospital Association’s Vision for Tomorrow plan.  

As you know, we have been working closely with City Council in moving our Vision plan forward to better position us to be a successful, sustainable community hospital providing the highest quality of care possible for the changing needs of our community.  

Earlier this week,  Dr. Bronson sent a letter to the City indicating that Lakewood Hospital Association would provide 60 days advance notice to the City before it discontinued or transferred (by Board action or otherwise) any of the following four services during the remaining term of the lease: neurosciences, geriatrics, endocrinology/diabetes, and orthopaedics. 

This letter also offered that our trustees would meet with City officials upon request to discuss and provide requested data about the hospital’s operations.  We believe that this proposal provides you, our Board, with the flexibility to respond to changes when needed, while also affording the City an opportunity to be heard regarding any proposed changes to these services.

This is a significant time for Lakewood Hospital and its wonderful community, and we appreciate the careful attention of City officials to our Vision for Tomorrow plan. 

We would like to thank you again, as our Board members, for the extraordinary review that you have provided in formulating and approving the plan, and we look forward to your continued support as we continue to implement the plan.


Sincerely,

David L. Bronson, M.D., FACP            
President, Cleveland Clinic Regional Hospitals                            

Janice Murphy
President, Lakewood & Fairview Hospitals

Mousab Tabbaa, M.D.
Chairman, Lakewood Hospital Association Board of Trustees







.

[Bill Trentel]

Looks like the Mayor and our council politicians went with my option #3.

3) Let the CCF do whatever they want and in 5 yrs. figure out what to do with a vacant hospital.

Hopefully they are coming up with a plan after CCF leaves.


Bill

[Kevin Butler]

Much clarification is in order. To begin, the Clinic is 13 years into a 30-year lease for Lakewood Hospital, whose physical facility is owned by the city.

Under the provisions of the lease, when the Clinic seeks to eliminate a service it is required to provide -- in this case, inpatient pediatrics and Level-2 trauma services -- it must first notify the city, and Council then has 60 days either to object or do nothing.

If Council objects, the service must be continued at the hospital. If it does nothing, the Clinic may then eliminate the service.

Inpatient pediatrics averaged one or two patients a day in a 12-bed unit. Trauma averaged one patient a month. The Clinic demonstrated it lost significant money staffing and equipping these two units at the hospital, enough that the hospital's board (to which the city appoints 10 people) unanimously supported combining those two services with those already provided at Fairview Hospital. Under the circumstances, it would be difficult for Council to object to the reduction of a service that impacts the hospital's ability to remain afloat.

The better news is that the Clinic has identified four services to be begun or augmented at Lakewood Hospital -- what they're calling "Centers of Excellence." These are orthopedics, diabetes/endocrinology, geriatrics and, perhaps most exciting, neurosciences. The Clinic's other western hospitals, Fairview and Lutheran, will now send most of these cases to Lakewood, and its doctors will be aligned to do the same.

There is no provision in the lease that gives the city authority to require the Clinic to provide additional services, other than those defined as "required" under the lease. (Other examples of required services are emergency room services, obstetrics and surgical services. That list is not exhaustive.) Regardless, Council used whatever leverage we had under the existing provisions of the lease to engage the Clinic in a discussion of its commitment to these new Centers of Excellence. The result is what appeared in Dr. Bronson's letter above.

The bottom line: (1) Inpatient pediatrics and trauma will be discontinued at Lakewood Hospital. (2) The Clinic must continue to provide all the remaining required services in the lease for the duration of the lease. (3) We gain four new or augmented services. (4) If the Clinic should wish to eliminate any of the four new Centers of Excellence, it has agreed first to involve the citizens of Lakewood, through their elected officials, in the discussion. That discussion would occur well before any vote were to be taken by the hospital's board -- something not previously required under the lease.

I am very satisfied with the city's position after these discussions, which were at all times amicable although not always easy. Any suggestion Council and the mayor did not do everything possible to protect the citizens of Lakewood -- short of vetoing operational changes that, almost without exception, we agreed were necessary -- is not accurate, and does not account for the hours and hours we spent on the matter on behalf of no one else but our constituents.

[Bill Trentel]

There is no provision in the lease that gives the city authority to require the Clinic to provide additional services, other than those defined as "required" under the lease. (Other examples of required services are emergency room services, obstetrics and surgical services. That list is not exhaustive.) Regardless, Council used whatever leverage we had under the existing provisions of the lease to engage the Clinic in a discussion of its commitment to these new Centers of Excellence. The result is what appeared in Dr. Bronson's letter above.

The bottom line: (1) Inpatient pediatrics and trauma will be discontinued at Lakewood Hospital. (2) The Clinic must continue to provide all the remaining required services in the lease for the duration of the lease. (3) We gain four new or augmented services. (4) If the Clinic should wish to eliminate any of the four new Centers of Excellence, it has agreed first to involve the citizens of Lakewood, through their elected officials, in the discussion. That discussion would occur well before any vote were to be taken by the hospital's board -- something not previously required under the lease.

I am very satisfied with the city's position after these discussions, which were at all times amicable although not always easy. Any suggestion Council and the mayor did not do everything possible to protect the citizens of Lakewood -- short of vetoing operational changes that, almost without exception, we agreed were necessary -- is not accurate, and does not account for the hours and hours we spent on the matter on behalf of no one else but our constituents.

I for one respect the time and effort that you and our other politicians devoted to this issue and all of the necessary work you do in the name of the citizens of Lakewood. And as I have previously stated the city was and is in a very weak position in regards to securing the future of Lakewood Hospital, a public asset. I also thank you for adding your prospective to this forum. I do have several questions that perhaps you have answers to.
1) The new services have not been added to the lease as required services and can be eliminated at anytime only a 60 day notification is required, not a vote? Y/N
2) Why has the CCF chosen to invest tens of millions of dollars more in the Fairview and Avon facilities than in Lakewood? Was this question asked?
3) How much income tax revenue will the city lose with the reductions? Was this studied?
4) What will the additional cost to the city be in staffing and out of service time that will be required due to the need to transport critical patients to Fairview or Metro. Was this studied?
5) Are you comfortable that 12 citizens or a member(s) of our safety forces could lose their lives due to the increase time needed to access critical emergency services over the next year and for years to come?

Bill

[Kevin Butler]

1) The new services have not been added to the lease as required services and can be eliminated at anytime only a 60 day notification is required, not a vote? Y/N

Correct. The lease won't be affected. The vote would be that of the Lakewood Hospital Board, not Council. Council would have 60 days to intervene with that board before the board makes any decisions. I believed this struck a good balance between opening what would've been protracted lease negotiations with the Clinic and still ensuring the City has a say in any decisions to be made.

Remember, this is for the new services only under the Centers of Excellence strategy (orthopedics, neurosciences, geriatrics and endocrinology). The City still has the right to veto any changes to the services (ER, obstetrics, surgical services, etc.) currently required under the lease.

2) Why has the CCF chosen to invest tens of millions of dollars more in the Fairview and Avon facilities than in Lakewood? Was this question asked?

It was asked. One response pursuasive to me is that Lakewood Hospital is subject to its own borrowing limits because it's owned by the city and leased to the Clinic. When the hospital struggles financially, it lacks the bonding capacity to generate the same capital afforded to Clinic-owned facilities backed by the entire system's revenues.

3) How much income tax revenue will the city lose with the reductions? Was this studied?

I'm under the impression the city will not lose income tax revenue beyond any normal recession-related losses. (FYI, between 2006 and the present, the staffing level at Lakewood Hospital, still the city's largest employer, dropped from 1,144 to 1,078.) The Vision for Tomorrow plan was adopted because the hospital board believed it will position the hospital economically better than it's been positioned in the past. The Clinic will continue to make its $1 million-plus annual lease payment to the city under the terms of the lease, regardless of the change in services.

4) What will the additional cost to the city be in staffing and out of service time that will be required due to the need to transport critical patients to Fairview or Metro. Was this studied?

I don't anticipate any additional cost to the city, which, incidentally, already transports critical patients to Fairview or Metro depending on the circumstances of the injury encountered. Only 1-2 trauma patients per month were transported by Lakewood EMS to Lakewood Hospital in 2008 and 2009.

5) Are you comfortable that 12 citizens or a member(s) of our safety forces could lose their lives due to the increase time needed to access critical emergency services over the next year and for years to come?

Respectfully, let me answer a question I view as hyperbole with some hyperbole. Should we build a trauma unit in every Lakewood neighborhood in an attempt to eliminate every possible eventuality? Have a police officer standing on every corner to prevent petty theft? Build and staff a several more fire stations in town to cut down on an already-fast response time?

There are obvious risks to every action we take regarding our emergency services. At the city level, we provide as much insurance against this risk as we can afford -- some might argue more than we can afford. That analysis is also applicable to trauma services at Lakewood Hospital, which is very close in proximity to Fairview's (much more active) Level-2 trauma unit and which will nevertheless will continue to provide an ER for the stablization of patients deemed by the ER staff as trauma cases -- many of whom are currently being transferred out to other hospitals and other hospital systems anyway. (A good example of this.)

[Bill Trentel]

1) The new services have not been added to the lease as required services and can be eliminated at anytime only a 60 day notification is required, not a vote? Y/N

Correct. The lease won't be affected. The vote would be that of the Lakewood Hospital Board, not Council. Council would have 60 days to intervene with that board before the board makes any decisions. I believed this struck a good balance between opening what would've been protracted lease negotiations with the Clinic and still ensuring the City has a say in any decisions to be made.

Remember, this is for the new services only under the Centers of Excellence strategy (orthopedics, neurosciences, geriatrics and endocrinology). The City still has the right to veto any changes to the services (ER, obstetrics, surgical services, etc.) currently required under the lease.

2) Why has the CCF chosen to invest tens of millions of dollars more in the Fairview and Avon facilities than in Lakewood? Was this question asked?

It was asked. One response pursuasive to me is that Lakewood Hospital is subject to its own borrowing limits because it's owned by the city and leased to the Clinic. When the hospital struggles financially, it lacks the bonding capacity to generate the same capital afforded to Clinic-owned facilities backed by the entire system's revenues.

3) How much income tax revenue will the city lose with the reductions? Was this studied?

I'm under the impression the city will not lose income tax revenue beyond any normal recession-related losses. (FYI, between 2006 and the present, the staffing level at Lakewood Hospital, still the city's largest employer, dropped from 1,144 to 1,078.) The Vision for Tomorrow plan was adopted because the hospital board believed it will position the hospital economically better than it's been positioned in the past. The Clinic will continue to make its $1 million-plus annual lease payment to the city under the terms of the lease, regardless of the change in services.

4) What will the additional cost to the city be in staffing and out of service time that will be required due to the need to transport critical patients to Fairview or Metro. Was this studied?

I don't anticipate any additional cost to the city, which, incidentally, already transports critical patients to Fairview or Metro depending on the circumstances of the injury encountered. Only 1-2 trauma patients per month were transported by Lakewood EMS to Lakewood Hospital in 2008 and 2009.

5) Are you comfortable that 12 citizens or a member(s) of our safety forces could lose their lives due to the increase time needed to access critical emergency services over the next year and for years to come?

Respectfully, let me answer a question I view as hyperbole with some hyperbole. Should we build a trauma unit in every Lakewood neighborhood in an attempt to eliminate every possible eventuality? Have a police officer standing on every corner to prevent petty theft? Build and staff a several more fire stations in town to cut down on an already-fast response time?

There are obvious risks to every action we take regarding our emergency services. At the city level, we provide as much insurance against this risk as we can afford -- some might argue more than we can afford. That analysis is also applicable to trauma services at Lakewood Hospital, which is very close in proximity to Fairview's (much more active) Level-2 trauma unit and which will nevertheless will continue to provide an ER for the stablization of patients deemed by the ER staff as trauma cases -- many of whom are currently being transferred out to other hospitals and other hospital systems anyway. (A good example of this.)

So to recap:

1) No. The citizens of Lakewood or it's elected representatives have zero assurances that the promised new services will stay or for that matter even be established. The Hospitals boards track record isn't very good. They have sat by as the CCF has directed service away from Lakewood creating it's current fiscal deficit that is sited as the reason to further reduce services. And do we remember the land deal that was going to bring "state-of-the-art" heart cath to Lakewood? Well the heart program is at Fairview.
2) CCF (which controls the market) chose to direct patients, doctors and services away from Lakewood hence creating the fiscal deficit and the inability to invest in Lakewood.
3) No. The number of employees and the amount of the payroll are apples and oranges. I would contend that removing services that require staffing by highly paid professionals and replacing them with lower paid staff in the promised new rehab service units will result in a significant loss of income tax to the city.
4) No additional cost anticipated. What are the cost of the current out of town trips, out of service time, labor overtime, fuel cost, equipment cost and increased response times. How many additional out of town trips can we expect. There has to be some costs related.
5) Yes. Obviously there are cost for everything and you are comfortable with the health risks to the citizens associated with the reduction of services at Lakewood Hospital. Your response did bring to mind all kinds of budget saving possibilities. We can't possibly have more than 12 life threatening fires annually and RR Fire Department is less then 2.5 miles away...
Oh the budget possibilities if we would only reduce our health and safety expectations.

Bill

[Bryan Schwegler]

Speaking of Lakewood Hospital, here's a great infographic on national hospital performance. You can dig down by state to individual hospitals. A little worried about Lakewood's surgery performance numbers if accurate:

GE : Measuring Hospital Quality
http://bit.ly/9LDYBH

[Bill Call]

An oldie but a goodie!

[Bill Call]

Some members of Council are asking that the Cleveland Clinic
guarantee continuation of the services offered in the Vision For Tomorrow Plan.

From the 2010

[Brian Essi]

Bill Call,

Thanks for resurrecting this nugget of history that demonstrates the same “leaders” who failed us in 2010 are doing it all over again with their failed plan to demolish Lakewood Hospital:

1. It is clear that our elected leaders back in 2010, feared the Clinic, appeased the Clinic, falsely believed they “had no leverage” with the Clinic, gave valuable rights away to the Clinic in exchange for flimsy promises, failed to hold the Clinic accountable and crowed about “protracted lease negotiations” with the Clinic if they had actually stood up for the people and did their jobs.

2. The problem with many elected leaders is that they generally give the public’s rights and money away too easily. Do you think Mike Summers might have negotiated harder when he was selling his grandfather’s business, Summers Rubber?

3. A core problem now is that the theoretically most important advisor to the Mayor (Law Director Butler), believed in 2010 and believes now that we have no leverage—Butler is defending (as a lawyer) his prior positions (as a politician) in giving stuff away back then which directly relates to the current problem. Their solution to absolve themselves is to give even more away. These guys are like the Lion and the Scarecrow in the Wizard of OZ. If we could only convince them to muster up some courage and use their brains to attack the problems instead of defending prior bad decisions, bowing to the Clinic and thinking that they are the ones with the only answers, we could move this thing forward.

4. I say that Butler is “theoretically” the most important advisor to Summers, because Summers continues to be very chummy with Michael Meehan. Esq.—the Clinic’s in house mouthpiece who gave legal advice to LHA back on May 24, 2010 (the minutes Meehan penned evidencing his advice are on OneLakewood.com). Meehan is in on almost all of the most confidential deliberations of LHA Trustees where Summers is a key player. Summers has been on LHA's board since before the 2010 fiasco.

5. Exactly 5 years ago today Bill Trentel wrote above: “Looks like the Mayor and our council politicians went with my option #3. 3) Let the CCF do whatever they want and in 5 yrs. figure out what to do with a vacant hospital. Hopefully they are coming up with a plan after CCF leaves.” Summers, Butler, Madigan and Bullock were all there then. Ouch! We now see their “plan”. Ouch!

6. It is truly astounding that Summers and Butler actively resist Attorney DeVito’s help in fulfilling the very legal duties these guys are sworn to uphold, i.e. hold the Clinic and LHA accountable --- Summers and Butler are now fighting against the citizens of Lakewood and siding with the Clinic in that fight--all the while trying to avoid accountability and using taxpayer dollars to do so.

It is beyond debate that good leadership is all about accountability—without accountability there can be no change. If Summers and Butler don’t change course, they can expect a lot of change and it won’t just be the titles they currently hold.

The posts above are “Deja Vu” all over again---Bill Call and Bill Trentel should be thanked for their service and critical thinking---Thank you guys! As depressing as all of this is, I have great hope that more citizens will act as these two gentlemen have to educate and guide us in our deliberations going forward.