Sorting Out Issue 64: Are Emergency Services Guaranteed Or Not?

At this point you’ve seen it in many places, on the city’s website, in the articles Councilpersons Bullock, Anderson and Marx have written for the Observer, in the new Lakewood Voters for Progress (the anti-hospital group) commercial called “Lakewood Emergency Services GUARANTEED!” which includes an introduction that states: “Mayor Summers warns Lakewood residents not to fall for scare tactics. The agreement requires the Cleveland Clinic to continue emergency care UNINTERRUPTED 24/7/365, and emergency services are GUARANTEED.”

Well, Citizens For A Strong Lakewood and the Save Lakewood Hospital groups say that emergency services are not guaranteed.

Which is it?

So I looked it up. You can too. Go to one.lakewood.com under Health Care in Lakewood and read the Master Agreement yourself.

You need to look at section 2.3: “Post-Construction Obligation of the Clinic to Operate FHC” and section 2.4: “Emergency Services at the FHC.”

Under 2.3, go six lines down and read: "The Clinic contemplates that the services available at the FHC (Family Health Center) upon the commencement of FHC operations will initially consist of the services described on Exhibit C."

Exhibit C (which is attached to the agreement) lists initial services offered. The first one is “Emergency Department (24/7/365).”

However… read one line further:

“Due to the uncertainty regarding and the potentially rapidly changing nature of the approach to delivering health care services, the parties acknowledge that it will be necessary for the Clinic to continually re-evaluate the services provided at the FHC.”

Section 2.3 ends with:“..the Clinic may modify the services listed on Exhibit C as necessary to address the results of such evaluation, subject to Section 2.4.”

So the Clinic will continually re-evaluate the services provided, and may modify those services.

Then section 2.4: Emergency Services:

“The parties recognize and agree that there is a present need for an emergency department in Lakewood, available on a 24 hours a day, 7 days a week, 365 days a year basis. The Clinic will address this need by opening the FHC with an emergency department that operates (a) on a 24/7/365 basis that has capabilities to treat emergency medical conditions, which are those conditions that rise to a level that manifest themselves by acute symptoms of sufficient severity such that immediate medical attention is necessary, and (b) at a level of service generally consistent with (or greater than) the level of service that is being offered in the Hospital’s emergency department as of the Effective Date.”

By that “Effective Date” the level of service at Lakewood Hospital’s Emergency Department had been severely diminished, in 2015 by the Clinic getting rid of the cath lab. A terrible blow was already dealt in 2010 when the Clinic convinced City Council that it would be a good idea to downgrade our Level 2 Trauma Care Center and move that to Fairview. In exchange, the Clinic offered something called “Vision for Tomorrow” which never came to be. Trauma centers make money, so how our City Council and Mayor (Fitzgerald) in 2010 thought that it was a good idea to lose that cash cow and also deprive citizens of the safety and peace of mind that comes from having a full service trauma center is hard to understand.

As for “level of service” right now, at our Emergency Services Center, services offered are NOT consistent with the service offered as of the Effective Date of the agreement, because at that time, late December 2015, the Hospital was still operational. If you needed to be admitted for surgery, and stay overnight or longer, that could still happen. Then they closed the hospital.

Now we have “Emergency Services,” an unspecific term that has no legal definition. We do know that if you need surgery quickly, you should not go to Lakewood because you will wait there for a transfer. However, with the loss of Lakewood’s legitimate Emergency Room attached to a hospital, Fairview’s has become overcrowded. The latest testimonial concerns a woman who broke her hip and waited more than 24 hours for treatment. When Avon’s new hospital, with its full service Trauma department opens, with all of Lakewood’s bed licenses and equipment, we can go out there. Another testimonial, closer to home, I took a friend to Lakewood’s Emergency Services Center with a high fever, which is dangerous because he is undergoing chemotherapy and has a compromised immune system. He was seen very quickly and the doctor there spoke to us harshly, and said with the severity of my friend’s condition, he should not be moved, and that we should never have brought him to Lakewood, and ordered a transfer to University Hospital downtown. I didn’t know that. I’m not a doctor. My friend had a very high fever. I brought him to the closest place that said “Emergency.”

But still, there is something there. We did see a doctor. Is whatever this service is, guaranteed?

Read the next paragraph:

“The need for emergency services may change with time and, given current industry circumstances, it is difficult to predict such change. The ongoing evaluation of emergency services will be done consistently with Section 2.3 above.”

Which says that “the Clinic will continually re-evaluate the services provided, and may modify those services.”

The last sentence reads: “For so long as the Clinic owns and operates the FHC, the Clinic agrees to provide emergency services on a 24/7/365 basis in Lakewood.”

This is no guarantee. This isn’t like the agreement in which the Clinic agreed to run our hospital in good working order until 2026. This says they will do what they want to do for as long as they want to do it, changing or eliminating services if they feel that it fits with "time and industry circumstances."

So why are we being told this is "guaranteed"? There is no safety here. We do not own this and cannot control it in any way. It is certainly not a state-of-the-art, full service “Emergency Department.”

“If We Vote Against Issue 64, We Will Have Nothing”

Then there’s voting Against Issue 64, and the threat that if we overturn the Master Agreement, “We will be left with nothing.”

The truth is if the agreement is overturned, Cleveland Clinic is still on the stick for the lease that they signed in 1996 to “operate a full-service hospital” until 2026. And to return that hospital to the city in good condition, says the contract. They can’t legally to “go away” and “leave us with nothing.” Right now they owe us a hospital or a lot of money or both.

Right now, the FHC and Emergency Services belong to the Cleveland Clinic, not us. It is not a gift to us. There is no guarantee or straightforward definition of what those emergency services are. There are 13 health clinics near us on the west side, not hospitals, “health clinics” like this one is supposed to be. The other cities that have them aren’t being asked to be grateful that there is a health clinic near them, and they certainly weren’t asked to trade their hospital for one.

If this Agreement is overturned, a better agreement will have to be arrived at. 

P.S. Read section 9.4, “Mutual Waiver” to see what else this agreement is about. Where the City hereby agrees to not bring suit against the Hospital Parties for causes of action that arise out of or relate to the Original Lease, the Definitive Agreement, the operation and management of the Hospital prior to the Effective Date, or the Transition, including closing of the Hospital, the cessation of services or programs at the Hospital, and the potential demolition, abatement and/or redevelopment of the Hospital building.”

That’s a mouthful. Every day we hear more about questionable behavior regarding the management of our hospital by the Cleveland Clinic and the Lakewood Hospital Association. Especially that move in 2010 when they removed our Trauma Center. (At the same time they removed our Labor and Delivery department—Why would families in Lakewood need that?)

This agreement will let them off the hook for anything that happened in the past.

While you’re at it, you should probably read the section about how Lakewood is not allowed to use our hospital building for a hospital ever again. The “non compete” clause. Though Cleveland Clinic is not offering us anything like a hospital, this agreement guarantees that we will never have a hospital again in Lakewood.

You can look up that section on your own.