It's Time To Put This Issue To Bed

St. Alexis, St John’s, Grace Memorial, St Lukes, Booth Memorial, St. Anns, Huron Road, Bay View, St Michaels. That’s an incomplete list of Cleveland area hospitals that have closed in the past twenty five years. Please: if you think that the Cleveland Clinic, like the Borg in StarTrek, conspired to secretly seize and assimilate each of these hospitals into its evil web, then save all of us the trouble; stop reading right now and go put up yard signs. But if you think that these hospital closings are possibly the result of dramatic changes in the way medical services are delivered now, compared to 50 years ago, compounded by the area’s dramatic population losses, then you are in good company - read on.

The closing of Lakewood Hospital is no anomaly. In just five years, between 2008 and 2013, nearly 130 community hospitals closed across the country, based on data from the 2013 AHA Annual Survey.[i] But we don’t need academic white papers to tell us what has happened and why, because our personal experience tells us: we don’t spend nearly as much time in hospital beds as we used to. I was hospitalized – an admission and an overnight stay – when I had my tonsils removed in the 50’s.  My wife spent less time in the hospital when she had her hip replaced, and that was 5 years ago. It’s all about outpatient services and homecare now, and for good reasons. We don’t want to be admitted to a hospital anymore; it’s really expensive, it’s loud, impersonal and infectious.

Look, we all loved Lakewood Hospital. Having it so close made us feel good, even if we actually got our hips replaced or valves reamed at the big downtown centers – at the Clinic, Metro or UH - where they did complicated procedures 10 times a day using state of the art equipment. But we all loved having Lakewood Hospital here because we born there, or worked there, or our loved ones died there. That’s probably why for years we ignored the growing list of similar community hospitals that closed. We hoped our community hospital was different and somehow immune to what was happening to health care, even as the population dropped and other similar hospitals closed one by one.

Actually Lakewood did do something different. Unlike most communities in the same position, we actually had political leadership that tried to be proactive, to get out in front of the inevitable … to make lemonade out of our dear lemon. First the hospital association, then the mayor, then (after a year of study) the city council each came to the conclusion that our community’s best option was to terminate our hospital’s management contract with the Clinic early, while there was still some serious money left in the hospital foundation and while we still had some negotiating leverage with the Clinic – which clearly wanted to get out of a money and resource draining arrangement sooner rather than later. Hey, for all you Clinic-as-Borg believers; I agree with you! Did the Clinic “decant” services to Fairview? Yes, they probably did. The Cleveland Clinic is not run by amateurs and I have no doubt that someone determined that they could do more procedures, cheaper and better in Fairview, Westlake or downtown than they could do at Lakewood. Considering the obscene costs of American healthcare can we really have a problem with that? I also agree with the "transparency" wish. Could the City have employed less “confidentiality” and more “transparency” in the negotiating process? As our public servants, they certainly had an obligation to be reasonably transparent, but in their defense; it’s hard enough negotiating with the humongous Clinic in semi-private, much more difficult when your moves and bottom lines are telegraphed (and second guessed) in public throughout the process. In my book, it was more important that, for once in the Rustbelt, we were looking down the road, considering our real options and taking a course around the pending train wreck ahead of us. That’s being proactive.

Did we deserve “a better deal”? After a long, complex, negotiated deal there is nothing easier to say as a critic and more frustrating to hear as an “in the trenches” negotiator than an outsider’s second guesses. I know this from 25 years as a litigator. This deal dealt with; building maintenance and demolition expenses, property values, terminated contract obligations, tax issues, new construction, future medical services and shared expenses, to name just the obvious. Each of these issues can have different values for the different parties but they must all be negotiated into one final deal. “You want more for the real estate? OK, but I want less for my share of the demo costs.” Get the picture? That’s why it’s unfair to cherry pick single items and announce, “I could have gotten more for the parking lot!” Frankly, that’s a Trump-like claim; easy to say and impossible to prove.

Closing a community hospital in 2016 is like putting your pet down. No one wants to even suggest it, much less do it.  What’s more, the prospect of a community hospital closing can be nearly irresistible bait to a politician looking for an emotional issue that they can appear to champion – even if an analysis of the issue would lead to the opposite – unpopular – conclusion. “Don’t let them murder your dear, aging dog - Save Fluffy!” Kucinich took the bait when the news of St Michael Hospital’s pending closure hit the news in 2000. His “Save St Michael’s” campaign succeeded in keeping it open for another 2 years until – with all funds exhausted - a bankruptcy judge in 2003 approved its sale and closure. If Kucinich and other local politicians had objectively analyzed the facts in 2000 and shepherded a creative but realistic alternative to a full service in-patient facility would the Broadway community have been be better served?

Today, on former site of St Michaels, there is no 34 million dollar 24/7 ER facility nor is there a state of the art family health community center and there is no 30 million dollar pot of foundation money dedicated to improving health and wellness issues for the local residents. The St. Michaels hospital site is now a vacant urban field.

We all loved the old hospital. It’s hard to be objective, realistic and proactive when your aging pet is suffering. It’s easier to live in denial and beat the “Save Fluffy” drum. But for how long can we beat it?  We now have the opportunity to make some pretty attractive lemonade from our lemon because we had the foresight and courage to be proactive on an emotional issue. It’s time to put this issue to bed and move forward. Vote For 64.

[i] Read more: More Hospital Closed Due to Empty Beds as Providers Succeed in Reducing Hospital Admissions: Pathologists Should Respond with Outpatient/Outreach Services | Dark Daily

Thomas Wagner

30 year Lakewood resident, Attorney in private practice

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Volume 12, Issue 22, Posted 5:52 PM, 10.25.2016