City chatter became divisive very early though, as this particular one bore out the truth. Much of the early reaction was emotional — either from those who wanted the hospital to remain open or from those who were eager to take advantage of whatever opportunities came with a new wellness foundation and health center. But then there were those who pushed and prodded against the headlines, who sought and received public documents that painted a more deliberate path to the hospital's doom. When the lawsuit (filed by former Lakewood City Councilman Ed Graham, Save Lakewood Hospital chairwoman Marguerite Harkness, William Grulich, Deborah Meckes and Amy Dilzell) dropped in May, the $400 million in damages sought by the public became hard to ignore.
The general story touted by the city is that "changes in health care" and "declining patient volumes" had forced the mayor's hand. But as the opposition described to Scene, the Cleveland Clinic can pretty much dictate who goes where — i.e., which and how many Northeast Ohio patients take their health care business to which Clinic outpost. With services like pediatrics and trauma care being shipped elsewhere in the Clinic network from Lakewood Hospital, patient volumes began decreasing ipso facto. What patients were left were more often enrolled in Medicaid and Medicare, kicking Clinic profits down another notch.
Very quickly, residents chipped away at claims that "changes in health care" were driving the losses. Puzzle pieces began locking into place. The data points that were being used to justify the hospital's closure were direct consequences of the Clinic's evolving policies over the past 10 years.
The city would be entertaining a different conversation entirely if the move was about health care. But residents like O'Bryan and others who post frequently on the Observer's online forum — "The Deck" — called the deal out on its one-sided financials and market consolidation. City council members and LHA supporters fired back, calling the Deck's posters "nasty" and "mean-spirited." But the citizen journalists of the Observer kept digging.
What was in it for Lakewood? A wellness foundation with $32 million in cash?
O'Bryan likes to reference Bridgegate, the scandal that roiled out of New Jersey governor Chris Christie's office, the one where he, allegedly, created traffic jams in Fort Lee, N.J., as political retribution. "This is like if Chris Christie sold the bridge and gave the money to his best friend's new nonprofit," he says.
There's the rhetorical process, which plays out at council meetings weekly and online every day. There's the political process, which will play out within the mayoral race, two council races, and the charter amendment issue on Nov. 3. And there's the legal process, which is bumbling along as a civil case in Cuyahoga County, a massive contract violation suit brought by taxpayers and leveled against the city, the LHA, and the Clinic.
"We think the lawsuit is going to be a long-term point," Monahan says, adding that an election day victory of Skindell over Summers — or the passage of the charter amendment — would change the course of the Clinic's actions entirely. Skindell has promised to do what he can to keep the hospital open and functioning. There's been almost no movement in the mayoral campaigns and there are no scheduled debates, but there's more at stake this time around than in elections past.
As the city trips toward Nov. 3, the lawsuit plays like a droning bass line. The case was brought by five Lakewood residents who, in their words, "represent a large and growing group of City residents and Lakewood Hospital employees who are disgruntled by the lack of diligence by the City to enforce its rights against LHA, CCF, and LHF under the Lease and [Definitive Agreement]."
"With the dawn of new plans to help Lakewood Hospital adapt to alleged changes in health care," the legal complaint alleges, "a series of events contrary to the best interests of Lakewood Hospital occurred." The argument set forth in the lawsuit — and by plenty of anecdotal evidence bandied about town — is that the declining patient volumes and revenues are a "'created reality' manufactured by CCF for the sole purpose of pursuing its self-serving strategic plan to support its wholly owned hospitals, including its new Avon Hospital and existing Fairview Hospital and Lutheran Hospital."
Health care consultants Subsidium, paid by the city and also named as a defendant in the suit, reported that the "[n]ew Avon hospital will likely cannibalize significant inpatient volumes from [Lakewood Hospital]."
What the hospital administration blames on the market, the plaintiffs are calling a deliberate plan to skin back hospital services. (More than one person has referenced the "chicken and the egg" riddle in talking about this.) And while the discovery process is progressing slowly before Judge John O'Donnell, several illuminating records have surfaced among more than 7,000 documents subpoenaed to date, including the 2012 "decanting" plan, part of a Master Plan commissioned by the Clinic in 2011.
The three-phase decanting plan outlines everything: Vacate the current hospital, open up the family health center, demolish what's left. (According to the 2012 documents, the final demolition phase was anticipated to begin in August 2016, much like Summers' eventual announcement indicated.) In vacating the hospital of its physical assets and medical services, the Clinic had orchestrated a timetable of moving beds or the catheterization lab or inpatient surgical procedures to Fairview Hospital and other Clinic hospitals.
Part of the lawsuit will involve deciding whether this was a "secret plan to siphon valuable medical services and equipment so as to cripple the viability of the hospital," or just precautionary planning for the future of an ever-expanding health care system.