The Observation Deck

Some people asked for a "serious section" to discuss Lakewood Hospital, and what could be
going on, so I am starting one. Even the Mayor has asked for a place to discuss the
Lakewood Hospital...

From his August 12, blog post...

Wondering about Lakewood Hospital?

... We will begin to address all of these issues and questions in 2013. This Fall, the Hospital Trustees will be shaping a framework to lead us to the best solution for Lakewood. Citizens will be engaged in a thoughtful manner. I believe it is appropriate to begin this thoughtful and complex journey while time is our ally. As news and information develops, I will share it...

Well fear not, real residents of Lakewood with real names waiting to her REAL THINGS from
Elected Officials.

As I search for background documents, and we pull some public records let me throw up
some of items I am running across...

[img]Lakewood%20Hospital[/img]

From City Charter Review 2014
Article XV is no longer applicable as Lakewood Hospital is a leased facility and will remain as such for the foreseeable future. It is improbable that the city would ever run the hospital as in the past as the structure of healthcare has permanently changed. Thus 11.1(e) permits the city to lease the hospital on terms set by council after the expiration of the current lease to the Cleveland Clinic-managed Lakewood Hospital Association. This could be a renewal of the current lease as well as a new lease.

This would do away with the structure for a "Lakewood Hospital SHOULD the contract be changed. The thought behind it was that the City of Lakewood is not prepared nor could
they in this day and age run a modern medical facility. This has been on the change list
for at least 3 charter reviews.

From City Charter
129.14 HOSPITAL FUND.

(a) Establishment. There is hereby established a special, separate and permanent fund which shall be known and referred to as the Hospital Fund. The Director of Finance is authorized and directed forthwith to take such action and make such records as may be necessary to establish the Hospital Fund and thereafter to show its existence and condition at all times upon the proper records of the City. (Ord. 3948. Passed 1-6-1941.)

(b) Revenues to Fund. There shall be paid directly into the Hospital Fund, when and as received, all income of Lakewood Hospital from its operation, except such income as shall be required to be paid directly into the Hospital Capital Outlay and Depreciation Fund or other special fund pursuant to ordinance adopted by Council; the proceeds of any special tax which may be levied for hospital purposes (other than for principal and interest on hospital bonds); all unconditional gifts or bequests of moneys received for the purpose of aiding the operation of the hospital; all other gifts, bequests, devises, trusts or the income therefrom, as the case may be, in accordance with and subject to the provisions or conditions of any such gift, bequest, devise or trust; all moneys from the General Fund appropriated by Council for the operating expenses of the hospital, and any money that may be transferred in any manner to the Hospital Fund from any other fund by Council or by order of court. All income from Hospital operations and all other moneys hereinabove ordered paid directly into the Hospital Fund are hereby appropriated to the Hospital Fund and to the payment of the cost of Hospital operation, including interest on the Hospital bonds described in Section 129.15(d).
(Ord. 36-54. Passed 7-19-1954.)

(c) Direction of Fund. The Hospital Fund shall be under the direction and control of the Hospital Board of Trustees, which shall have power to appropriate and expend it as they shall deem for the best interests of the Hospital. In appropriating and expending such Fund, the Board of Trustees shall give precedence over other items of expenses to the salaries and wages of hospital employees.

(d) Supervision of Accounts. The Director of Finance shall have the possession and custody of the Hospital Fund and the supervision of all accounts with respect thereto. Nothing in this section shall be construed as withdrawing such Fund or any part thereof from the protection of any bond given or that may be given by the Director. No further bond shall be required because of such Fund. No additional salary shall be paid the Director by reason of services to or in connection with such Fund.

(e) Annual Estimates of Income and Expense. On or as soon after July 15 as is possible in each year, or upon request by Council, the Hospital Board of Trustees shall transmit to Council for inclusion in the budget the amount of income expected from hospital operations during the next year, the amount expected to be required to operate the hospital, the amount of the appropriation from the General Fund expected to be required and such other information as may be requested by Council or provided by statute or ordinance.

(f) Annual Request for Appropriation. On or as soon after November 15 of each year as may be possible, the Hospital Board of Trustees shall prepare and submit to Council its request for an appropriation from the General Fund, together with such information pertaining thereto as may be required by the Charter, by statute or ordinance, or requested by Council. (Ord. 3948. Passed 1-6-1941.)

More coming, and we will try to put comments and wa white paper with this.

Jump in, if you have something to add.

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Shortly after your original article about the hospital was posted on line someone at Lakewood Hospital passed a link to other employees. News spread quickly. A little while later all managers were called to a special meeting. No other employees were invited so I don't know what was discussed.

I'll read between the lines a little later.

Someone is talking and everyone is afraid.

Bill Call wrote:Shortly after your original article about the hospital was posted on line someone at Lakewood Hospital passed a link to other employees. News spread quickly. A little while later all managers were called to a special meeting. No other employees were invited so I don't know what was discussed.

I'll read between the lines a little later.

Someone is talking and everyone is afraid.

Bill

I knew nothing of the meeting, and for all we know is they were discussing raises, and I
hope they were. I have no idea.

I have been through a couple large corporate layoffs, neither one effecting me but the
emotional stress it wrecks on the entire systems is terrible.

I believe the Cleveland Clinic to be fair in dealing with their employees, none of this is
about the Cleveland Clinic, I like the Cleveland Clinic, I like them all!

It is about a rumor that has floated for years, and I personally laughed off, that suddenly
got very, very, very real.

I am going to move this over to the other thread as I want to keep this more to the factual side than an "open" discussion as normal. Let's all see if we can get a person to stop by and use their words with no editing and explain what is going on?

Seems simple.

.

I have no idea where this figures into anything, but i post as rational that we might not need a hospital or even a large Trauma Center.

Most Emergency Calls have been going to Metro and Fairview for some time. So impact would
be small. I wanted to see just how close these other Trauma Centers were. When I was
looking at property in the country I checked time from ambulance to house to hospital before
buying, and I think that is a fair question when buying a house. In the country it was 20 minutes.


Downtown Lakewood, the start of each run.

So from Downtown Lakewood January 1 at 2pm, my wife and I recreated an Emergency Run
from Detroit and Warren Road, to the 4 closest Trauma Centers to Lakewood in order of
time it takes to get there. We drove a Honda, legally and kept track of time at lights, so we
could subtract for the ambulance no stopping at lights.

The results were amazing...

CLOSEST BY TIME taking only 6 minutes and 7 seconds was ...


Fairview Hospital.


This is not the old Fairview Hospital. Cleveland Clinic has been busy, and it is only
6 minutes away.


It reminded me of the airport with cars lined up at Emergency drop off.

Ambulance Time: 6:07.35
Driving Time: 8:07.35
- Stops 2:00.00

Second Closest Emergency Room with a time of 8 minutes and 43 seconds is...


Richard Jacobs Health Center In Avon


Though it lacks the ambiance of Fairview.

I know it is hard to believe but I drove it twice with a difference of 10 seconds! I guess
this proves the value of being right on a freeway access.

Ambulance Time: 8:43.46
Driving Time: 11:07.46
- Stops 2:20.00

The next closest trauma center, with a drive time of 12 minutes 40 seconds
Metro General Hospital, perhaps the only Level 1 facility of the group...


I might not have taken the route the ambulance takes.


Metro Health Care has come a long way, especially with trauma care.

Ambulance Time: 12:40.05
Driving Time: 14:413.83
- Stops 2:13.02

The final one we consider and farthest in terms of time at 13 minutes and 31 seconds is...


St. John's Medical Center


Two large doors can take 4 ambulances.

I also noticed...


Avon was using St. John's instead of Richard Jacobs, maybe Jacobs is not ready?

Ambulance Time: 13:31.03
Driving Time: 15:443.05
- Stops 2:13.02

This proves nothing but it did open my eyes. First I never imagined those hospital were that close, especially Avon Lake.
It also underlines just how important being on a freeway exit can be.

All of the trauma centers either feature helipads, or are building helipads, was Lakewood ready for that?

While talking with Fire Chief Scott Gillman months ago I asked about the technology in ambulances, and the level of service
one can expect from an ambulance ride from say an accident. His response was something along the lines of, "Better care
than in a hospital 10 years ago, and perfect for stabilizing and get a patient ready.

.

A couple of years ago lawyers from the Cleveland Clinic convinced Lakewood to agree to changes in the Hospital lease. They assured everyone that Lakewood would still be a first class Level two trauma center.

http://www.cleveland.com/medical/index. ... lth_s.html

What has changed in the last couple of years?

If Avon is only 10 minutes away why can't the residents of Avon drive to Lakewood for their medical care?

The State of New Jersey has three level one trauma locations. Isn't one enough for Cuyahoga County?

If you are in Westlake and need a life flight how long does it take to fly to Metro? Must every hospital have a helicopter pad?

Lakewood Hospital had nearly 37,000 emergency visits even after the Cleveland Clinic did all it could to degrade the emergency service. Is that evidence of need or evidence of lack of need?

What is the purpose of the Lakewood Hospital Board? What is the purpose of the Lakewood Hospital Foundation? Who do they serve?

Everyone at the Lakewood Hospital and the Cleveland Clinic knows about this discussion and the concern expressed by residents about the hospitals future. So far they have nothing to say to the people of this City or the employees of Lakewood Hospital.

Is that a sign of fear, contempt or indifference?

With all of those existing hospitals only minutes away from Avon does Avon even need a hospital?

Much of the money to build the new Avon facility came from Jacobs. Some of that money came from the proceeds of Tim Hagan's dirty Ameritrust deal and some came for the corporation itself.

The construction of the new freeway exit and the construction of the new hospital increased land values by 500% all around the area. Did Jacobs received anything of value for their donation? Of course they did? Did they report it to the IRS? Ha, Ha, Ha.

http://www.njnonprofits.org/giftsubs.html

Does the Clinic have any obligation to report the value exchanged? Does Jacob?

Poor Jimmy Dimora went to jail for petty theft. Will anyone investigate this dirty deal?

Bill would like to keep this thread to whatever facts can be gleaned, as opposed to a series of questions.

From what I have studied of all of the pieces is,

From Kevin Butler in 2010, "The Clinic hates to open the contract for renegotiation."

I do believe that the exchange at Avon, not really part of this thread, was built for with
payments from Jacobs Development, and the City of Avon for $12 million each. I cannot
answer where Jacob's funding came from, and I certainly will not comment on any
legalities of either Mr. Hagan or Mr. Dimora. Which is unfair to even use them in the
same sentence.

I also have been reading "Moody's Investor Services...

"MOODY'S DOWNGRADES BOND RATING FOR LAKEWOOD HOSPITAL ASSOCIATION (OH)
TO Baa2 FROM A3; NEGATIVE OUTLOOK MAINTAINED"
from 2011.

I quote...
"SUMMARY RATINGS RATIONALE:
The rating downgrade is based on continued significant declines in admissions, large and escalating operating losses (and negative operating cashflow), and significant decreases in unrestricted cash. Although the hospital has taken steps to restructure its operations, including closing certain services, progress is slower and less than anticipated and the hospital has been missing budgets. The extent of the challenges, including volume losses and continued increases in charity care and Medicaid, suggest the hospital's long-term viability is threatened without more significant strategies to restructure the operations.
Lakewood's fundamental credit profile - moderate size and limited service array in a competitive Cleveland-area market, challenging demographics, and physician turnover - suggests a rating level several notches below the current Baa2 rating. However, Lakewood's rating heavily incorporates what we believe is a very strong and integrated relationship with the Cleveland Clinic Health System (CCHS) (rated Aa2), as discussed below, which is the sole corporate member of Lakewood. Additionally, the lease agreement under which CCHS leases Lakewood includes a provision whereby if Lakewood Hospital's cash-to-debt (including bonds only) falls below one time, CCHS is required to transfer funds to Lakewood to meet that requirement.
The negative rating outlook is driven by challenges to reversing volume losses and improving operating performance and the likelihood that cash will continue to decline. In the absence of a more significant reduction of operating losses and stability of volumes, a further rating downgrade within the next year is possible. "

A summary would show the Hospital solvent through 2009, then started to lose money.

As I found out through 2010 everything was solid. Then the contract was reopened for renegotiation, I am looking for copies of the contract to see what changes were made.

I have no idea what the changes were, but I believe it was at this time, the Clinic agreed to the $1 million a year. One would have to think for the Clinic to open a contract and give up $1 million a year, they had to ask for concessions elsewhere, after all what would be gained for them?

Adult talk - The Cleveland Clinic is a business, that enjoys non-profit status. That does not make them a church. They have a bottom line and a future to worry about. I would expect the Cleveland Clinic or any Hospital to do what is right and smart for them. At the same time, the Clinic is a major player in Lakewood with help to schools, non-profits, downtown Lakewood etc. At one time Jack Gustin mentioned to me that the Clinic pumped another $6 million into the Lakewood economy the rough underwriting and health programs. The Cleveland Clinic will do what is right for them, and what they are legally obligated to do. I have no doubt of that, they have always been willing to put money where their health care is. Lakewood has to do what is right for the community on the whole. I hope, they figure out a way to serve both equally and fairly, and if not, then the city should be looking for what we need as residents. As the residents own Lakewood Hospital it would be nice to at least keep them up to date with information.

.

For the record, as everyone calls and says see...

I have read nothing from City Hall in the past 16 hours that contradicts anything I was posting about.

I do find it fascinating that the City is arguing to keep 100 beds as 200 are not needed
which would be a downsizing by 50% which in itself would be a BIG ANNOUNCEMENT OF
CHANGE at Lakewood Hospital.

The rest is the same comments issued earlier, "the look of health care is changing, and we..."

But that is only 50% of the negations, it takes two to negotiate.

The number one reason this project was started, in this format was, "The rumors on the
street were more truthful than the spin from City Hall." That was certainly trues in the
WestEnd Strip Mall project. And if you look at the major players in that, you will see them
on the Trustees of the Hospital and at City Hall.

Just saying.

We have a current contract with the Clinic. simple questions that should take seconds to answer.

1) Is the contract being negoaited again?

2) Does the Clinic stay, or as Council President Madigan indicated, "maybe Metro."

Two simple questions, that would end much of this speculation.

Now as elected official prefer to air our dirty laundry on a "larger" more county wide
format, and they seem to not trust themselves with their own words here, or the residents
media project, answer where ever we will find it and drag it back here, where we are
generating views as big as anywhere else.

It might be a great time to ask, If council does not trust themselves to say the right thing,
and they do not trust Lakewood's resident owned and run media project. WHY SHOULD
WE TRUST THEM?

.

Jim O'Bryan wrote:It might be a great time to ask, If council does not trust themselves to say the right thing,
and they do not trust Lakewood's resident owned and run media project. WHY SHOULD
WE TRUST THEM?
.

No.

The killing of the hospital was an inside job.

The Clinic intends to keep control of downtown Lakewood real estate to keep out the competition. The Clinic will use that control to turn Lakewood into a health care desert and City Hall, The Lakewood Hospital Foundation and the Board of Directors will help them do it.

The Mayor's announcement in a Friday, holiday weekend news dump was his way of telling us that Lakewood Hospital is closing. It's actually a very clever strategy.
Kill the hospital slowly in the hopes that no one will notice. Slowly degrade the service so that customers themselves make the decision to take their business elsewhere then use the lack of business as an excuse to make further cuts.

Isn't there anyone willing to stand up for the City?

What is one third of one billion dollars?

Bill Call wrote:
The killing of the hospital was an inside job.

The Clinic intends to keep control of downtown Lakewood real estate to keep out the competition. The Clinic will use that control to turn Lakewood into a health care desert and City Hall, The Lakewood Hospital Foundation and the Board of Directors will help them do it.

The Mayor's announcement in a Friday, holiday weekend news dump was his way of telling us that Lakewood Hospital is closing. It's actually a very clever strategy.
Kill the hospital slowly in the hopes that no one will notice. Slowly degrade the service so that customers themselves make the decision to take their business elsewhere then use the lack of business as an excuse to make further cuts.

Isn't there anyone willing to stand up for the City?

What is one third of one billion dollars?

Bill

This where you and I have always disagreed.

I have never expected the Cleveland Clinic to do anything that does not benefit themselves in some way. I am not sure where this concept of Hospitals
being loving open places to take the huddle masses came from, but it is long gone. With that being said the Cleveland Clinic did poor over $6 million a
year into things like North Coast Health Care and other projects that have added to this community. But to expect them to take one for Lakewood?

I would say the concept of all giving all loving health care came out of community hospitals, but that train has left the station. Costs of healthcare and
equipment and insurance means healthcare for those that have insurance. Something the ACA was trying to make happen. No matter, a hospital that
caters to those that don't or can't pay is a losing proposition.

Of course the Cleveland Clinic would want to remain the primary health care provider in the city. And with two of the next three closest hospitals to Lakewood
it is pretty well assured that will happen. It makes perfect sense for them to cut a quick $1 million(rent) from their budget, especially if there is a 2/3rds
chance you are still going to them.

The fault if any, would lie with the Trustees, that are our representatives in this, and City Hall who overseas the entire entity.

While the trustees should be worried about healthcare, the city should be worried about; jobs, taxes, healthcare, DowntowN, schools, safety.

To hear a major announcement is coming about the future of the Clinic and Lakewood Hospital, and to hear our elected officials answer with
"I have heard rumors too," "who knows maybe Metro" and "100 beds instead of 200" does not make me regret saying anything.

.

A short history on Lakewood Hospital and The Clinc.

The Charter of the City of Lakewood, article XV, details the establishment of the Hospital.

The reason the City got into the hospital business back in 1911 was because the founders of Lakewood wanted to assure residents of the availability nearby health care. For many years, the Hospital employees were actually City employees and members of the public employee pension system. This is no longer true. I believe that last one was about 6 years ago.

In the 1980s, Mayor Tony Sinagra sent his right hand man, Fred DeGrandis over to Lakewood to operate the hospital. Fred worked to integrate the hospital with our senior programs and with EMS, which at the time was a relatively new concept. These two departments, of course, added needed business to the hospital. As the hospital business became more and more competitive, and because any financial losses bourn by the hospital were required to be covered by the City, Sinagra acted to detach hospital liabilities and create a Lakewood Hospital Association, which would professionally operate the hospital and remove any financial liabilities from the City.

In the 1990s, it became clear the hospital could not be successful as a stand alone, community hospital. After researching a number of options, the Hospital Association, with Council and Mayoral approval (Cain), agreed to the 30 year Clinic lease. The lease payments began at $1,000,000 per year with incremental increases. Any changes in services would need City approval Capital investments were required by the Clinic every few years to keep the facility from deterioration.

Mayor Cain;s first big decision was what to do with the hospital EMS unit located within the hospital which was now leased by the Clinic. After a paralyzing year of presenting options, Councilman Tom George told her to put the EMS in the Fire Stations, which council agreed.

Now Mayor George was able to work well with Fred and Jack Gustin and the bond rating for the hospital actually improved during his tenure. Fred was even planning some major re-investments. When the Clinic called Mayor George to support the I-90/Lear Rd. interchange, He would not . They sent out the heavy hitters including Toby and Pudge Hinkle, their man in Washington D.C. to get Mayor George on board. They told him they were going ahead with the plans.

As Ed FitzGerald was sworn into office as mayor, Fred was "reassigned" and Lakewood hospital lost its internal Clinic champion. It has been reported that Mayor FitzGerald was eager for a deal with the Clinic and signed off on the hospital downsizing measures choosing to ignore ignored the I-90 interchange. This would be the 2010 Agreement with the Clinic.

The Cleveland Clinic does not like turmoil, as underlined by Kevin Butler’s comment about them hating to open contracts for renegoatiations. Their hope was for a minimum of theater while downsizing the hospital.It has been the Clinic has been explaining for years the story that Lakewood's demographics won't sustain the hospital Yet, Fairview, Euclid, Lutheran, and Marymount within the Clinic system have worse demographics.
How do these hospitals survive when Lakewood doesn't? Why? Because Lakewood has been intentionally stripped and downsized and the taxpayers' asset damaged in order to consolidate Clinic services. The value of this publicly owned asset has been reduced.

And that brings us to today, and the rumors from elected officials, 100 beds instead of 200, and “maybe Metro.”

Good stewardship, you decide?

.

From Jim Obryan:

And if you look at the major players in that, you will see them
on the Trustees of the Hospital and at City Hall.

My question is who were the members of the Board of Trustees of Lakewood Hospital when this change began to happen?

Who sits on this board currently?

Are they required to be Lakewood residents to sit on the Board of Trustees for the hospital?

How were they appointed to the Lakewood Hospital Board of Trustees? Did the Council appoint them? What process did they go through to be appointed?

Rhonda Loje

Jim O'Bryan wrote:
I have never expected the Cleveland Clinic to do anything that does not benefit themselves in some way. I am not sure where this concept of Hospitalsbeing loving open places to take the huddle masses came from, but it is long gone. With that being said the Cleveland Clinic did poor over $6 million a
year into things like North Coast Health Care and other projects that have added to this community. But to expect them to take one for Lakewood?

I never doubted that the Clinic intended to destroy Lakewood Hospital. However, I always thought that the Mayor, Council, the Hospital Board of Trustees and the Hospital Foundation intended to fight for the hospital. It never occurred to me that they intended to help the Clinic destroy an institution. It's kind of like Pearl Harbor; after it happens it all seems so obvious.

The question I have is why? The Clinic had a long term strategy that served its interests.

Years ago someone at the Clinic told me it was the "String of Pearls Strategy".

1. Expand within Cuyahoga County and use your tax exempt status to bankrupts and destroy and degrade the competition.

2. Starve locations within Cuyahoga County to gather resources to expand outside Cuyahoga County.

3. Build just outside Cuyahoga County and close and debilitate facilities inside Cuyahoga County.

This serves them very well. Just like General Motors they use economic and political power to destroy competition, raise prices and degrade service.

That policy also encourages people, business, jobs and economic activity to leave Cuyahoga County.

The big question is: Why are Cuyahoga County politicians and institutions all in?

The smaller question is: How does it benefit our Mayor and Council to degrade Lakewood's economy?

The smallest question: How did I miss the most important part; Lakewood public officials were in on the scam for years.

Rhonda loje wrote:From Jim Obryan:

And if you look at the major players in that, you will see them
on the Trustees of the Hospital and at City Hall.

My question is who were the members of the Board of Trustees of Lakewood Hospital when this change began to happen?

Who sits on this board currently?

Are they required to be Lakewood residents to sit on the Board of Trustees for the hospital?

How were they appointed to the Lakewood Hospital Board of Trustees? Did the Council appoint them? What process did they go through to be appointed?

Rhonda Loje

Rhonda

I am trying to find the original Trustee paperwork, so that I can write the timeline. Many are missing, perhaps historical society.

Some of the names I know have been on for some time, some of the names make sense, others are troubling.

What jumped out at me the names that worked to pour millions into Downtown for the hospital through various means
that they were also either on the board of or got paid through.

This is often a problem is small towns, but a city of 51,000, some separations is needed.

.

LAKEWOOD HOSPITAL - The Encyclopedia of Cleveland History

LAKEWOOD HOSPITAL, at 14519 Detroit Avenue, opened in October 1907, the first hospital in the Cleveland SUBURBS. It is a private acute care, community-based, not-for-profit hospital. Lakewood began as a private hospital founded by Dr. C. LEE GRABER† and located in a double frame house on Detroit and Belle Avenues, with fifteen beds and three doctors. A modern hospital was built in 1917, with remodeling and additions in 1940, 1950, 1967, and 1970-71. The City of Lakewood purchased the hospital in 1931; the hospital has again been privately managed between 1986 and 1997. In 2006 it offered 400 beds, a medical staff of 564, and a full and part time staff of 1,060. The Hospital also offered all customary diagnostic and therapeutic services, as well as some specialty services, including Lakewood Hospital Heart Center. In the past, Lakewood sponsored schools of NURSING (1910-37) and practical nursing (1955). The hospital closed its obstetrical-maternity unit in June 1972, but reopened it in 1991 as the Birthing Center, affiliated with Rainbow Babies and Childrens Hospital of UNIVERSITY HOSPITALS CASE MEDICAL CENTER. In 1987 Lakewood Hospital became a founding member of the University Hospitals Network of affiliates; these connections ceased when the Hospital became part of the Cleveland Clinic Health System. In 2006 the executive director was Fred M. DeGrandis, and Jack Gustin served as chief administrative officer.

This video is very informative take the time to review: