Save Lakewood Hospital

I feel like I ought to make a few notes here about Lakewood Hospital, and the grassroot campaign to save it, since I have been assisting said campaign for several weeks now.

Logo for Save Lakewood Hospital; links to campaign site

My work. Probably not destined for any design annuals, but my clients are pleased and I can argue for everything going on here.

At the risk of me-centrism, I think there are some notable aspects to the fact that I am interested in and supporting this effort.

I certainly do not seem to be from central casting, based on the other people I have met. Most of the people exercised about keeping Lakewood Hospital in business are middle-aged or older, and long-term residents. Many were born in the hospital, most have at least some personal interest in it. More than a few have longstanding axes to grind with city hall, as well.

This is not me. While it feels like I have been in Lakewood for a remarkably long time, at this point, my seven years still make me new guy compared with residents of 40, 50 or more years. Despite the fact that I have had more than enough run-ins with local healthcare, I have never been inside Lakewood Hospital for any reason; others’ fretting about having to travel a few extra miles for non-emergency care seems rather abstract to me, at best.

Frankly, I tend to think that (like most communities) the people of Lakewood are given to reactionary bitching, a lot, about things that really don’t warrant it. As distasteful as I find McDonald’s, I mostly rolled my eyes at “Save the Detroit Theater.” Likewise regarding plans to convert Madison Avenue from four lanes for vehicles, to two plus a turn lane and bike lanes. For the love of god, anyone worrying about traffic capacity in Lakewood needs to get out, more.

Until recently, I have felt like Lakewood was run quite will, and it really just wasn’t worth the time to give ongoing close attention to local politics. On balance, I think most of what Mayor Mike Summers has overseen or proposed is very good. I not only like the bike friendliness, I think it’s a sound idea, certainly. (If Lakewood is going to attract and keep people in a stagnating region, it will not be through catering to motorists, because the city just isn’t designed for that and never has been.) The Detroit Road commercial thoroughfare looks visibly improved from when I moved here, and I have hopes for a similar upgrade to Madison Avenue. I’m also intrigued by a floated municipal fiber-optic rollout. I’ve met Summers and he seems affable enough. All told, it seems like at the very least he should have my neutrality here, if not my support. Instead, I’m trying to help torpedo his plans for Lakewood Hospital, and hoping for a successful challenger at this fall’s elections.

If there’s any simple, single reason for how this happened, it’s probably that I don’t like being bullshitted.

If Mayor Summers has made any significant mistake in offending me (a large if), here, I think that it was in bullshitting the community. Not that I’m sure he’s doing so intentionally, but as best I can tell it’s what he’s doing.

To summarize the arguments briefly, Lakewood owns the hospital but currently leases it to the Cleveland Clinic. The mayor, the city’s hospital board and the Clinic have basically been acting as one in pushing a plan to close the hospital, then replace the building with a smaller facility offering fewer services. The argument is that maintaining a full-service hospital in Lakewood has been losing money, that the future of healthcare is leaner and more agile instead of traditional hospital beds, and Lakewood should get rid of its white elephant in favor of an efficient “health center.”

Honest to god, there is nothing here that offends me, by itself, and I would probably be willing to buy this line and write off objections as more reactionary nostalgia, except—! The hard, physical evidence all around me says that both the Clinic and University Hospitals are, judging by what they do with their money, expecting a healthcare future that involves more and bigger facilities. I’m not sure that the world has seen a building campaign to match the Clinic’s since the days of the pharaohs. On all fronts, the Clinic is expanding, and yet, somehow, just in Lakewood the future is nimble and petite?

Um, something is amiss here.

To date, I have yet to see any convincing explanation for this curious anomaly from Mayor Summers, et al. Meanwhile, there is an alternative narrative that I find very persuasive.

The proposed closure of Lakewood Hospital is not, in this version, about a changing healthcare landscape. It’s about the Cleveland Clinic’s strategic plan. The Clinic is—again, quite obviously if you spend any time driving around this region—planning on a very big scale. In their big strategic plan, big full-service hospitals are very much the future, but for one reason or another they don’t feel like continuing to operate one in Lakewood. I can’t say exactly why; the argument that Lakewood Hospital is under-capacity is a symptom, not a cause, given the fact that my own experience confirms that within a large hospital system, patients and doctors mostly go where we are pointed.

I regret that this sounds conspiratorial. But it is simply not credible for the Clinic to say activity at Lakewood Hospital is down—within an overall flourishing system—and act like they have no say in this. Again, I’m not sure what precisely would motivate deprecating Lakewood Hospital, but I suspect that from the Clinic’s perspective this would be less a matter of “why” than of “why not?” It isn’t their building, which fact might motivate moving away from it and certainly wouldn’t seem to argue against. Meanwhile, they plan on a pharonic scale; in this context Lakewood Hospital may just have the bad luck to be located outside what the Clinic’s algorithms indicate as the most profitable sites for them.

Which would really be fair enough, up to a point, if they weren’t trying to defend the rear of their advance by demolishing the hospital—preventing any rival from nibbling at the master plan’s projected returns—on the basis of a bullshit argument.

Again, this may seem like it involves a good deal of conspiracy, and I actually cringe when certain participants in Save Lakewood Hospital stray into what seems rather more, and excessively, conspiratorial speculation. Short of that, though, I feel that this is an instance where Occam’s Razor points to a clearly more likely scenario when no story is entirely straightforward.

Mayor Summers requires us to believe that there is some reason why Lakewood Hospital is untenable, even though Cleveland Clinic is building eagerly on three sides of Lakewood. (And would be building on four if it weren’t water.) Lakewood is in a long-term population decline, admittedly, but so is all of Cuyahoga County; again, this seems not to scare the Clinic away from expanding except in Lakewood. The mayor’s scenario also requires us to believe that declining revenue from Lakewood Hospital is simply a fact of life, rather than something the Cleveland Clinic could exercise control over, given that its system as a whole makes money and that it has considerable influence over where doctors and patients go within that system.

The alternative to which I subscribe requires believing that the Cleveland Clinic is a giant for-profit corporation which doesn’t give two figs about Lakewood, and makes decisions on a scale where it might nonetheless pursue the elimination of Lakewood Hospital simply because it has no place in the strategic plan. Given that the Clinic’s location map currently has dots throughout not only northeast Ohio but many parts of north and central America, plus locations in the Middle East, this does not seem farfetched to me. Particularly when combined with long-established patterns of behavior by large American corporations.

This alternative also requires an explanation for why, then, Lakewood’s mayor and hospital board would take interest in advancing the Cleveland Clinic’s strategic plan. Here, I’m afraid that the only explanation does resemble conspiracy, but I think it would be better to describe it as collusion. Yes, I believe that Mayor Summers and the hospital board are working together with Cleveland Clinic; they aren’t really concealing this. I also believe that the mayor and the board are doing a better job advancing the Clinic’s interests than those of Lakewood, but I don’t think that they believe this, or need to believe it for their actions to be plausible.

This kind of low-level collusion is, I submit, all around us all the time. There’s nothing mysterious, here. When you have an issue that does not usually receive general discussion, like Lakewood health care, it seems inevitable than something of a bubble develops around those people who do discuss the issue with one another. I suspect that this is at least half the explanation for “regulatory capture,” as much as any malicious plot; when you have close personal ties between most people in a private sector activity and most of the people tasked with regulating that activity, it doesn’t seem farfetched that the regulatory agents will have more sympathy with the interests of the regulated party than with the interests of the public as a whole.

This, I suspect, is what’s going on here. The Clinic presents complicated figures to back up its proposal; the mayor and board elect to continue trusting them, and to go along rather than make a big stink.

Obviously, this is a judgment call. There may, however, be a potential further test that could help sort things out. The mayor claims that the city tried to find other healthcare organizations interested in taking over Lakewood Hospital from the Clinic, but found no takers. Given that, as outlined, the rest of the mayor’s claims seem logically inconsistent, I’m inclined to doubt this assertion; you can say truthfully that you attempted to find something without proving that you really tried.

Certain associates of Save Lakewood Hospital are trying hard to prove that there are viable alternatives to the Clinic, and to persuade Lakewood City Council to test the mayor’s claims here. I don’t know whether or not they will, and in the meantime I remain dubious toward an argument that seems like it still has to involve unnecessary bullshit somewhere.

For now, there are just too many holes in the mayor’s scenario. I think I might be inclined to give him the benefit of the doubt, at least by not taking any side, even with the other unanswered questions if I heard a convincing plan for how closing Lakewood Hospital would not be just another hole in the city’s economic base. I have heard no such plan. The eager noises from some local business interests that “hey, this will open up land, that we can develop and open stores” do not seem to persuade me that Lakewood is better off surrendering its hospital to the Clinic. Lakewood has plenty of commercial real estate going unused. It isn’t all in the middle of Detroit Road, but I really do not see why treating that area (of a town that’s barely three miles at its widest point) as a special zone, outside of which commercial investment is just not worthwhile, is either necessary or compatible with a prosperous future for Lakewood.

As noted, there certainly are people involved with Save Lakewood Hospital who are given to conspiracy theory and persecution complex. But I just don’t believe I’m one of them; so far as I can tell I am more than willing to give Mayor Summers (if not the Clinic) the benefit of the doubt, but he’s just asking too much from me.

4 Thoughts on “Save Lakewood Hospital

  1. Cheryl Mooney on April 14, 2015 at 9:08 pm said:

    Well put! A complex problem worded simply. We have been bullshitted. This is classic of what “big business” does. As an employee at Lakewood Hospital, we call CCF “the Borg”, from Star Trek, as they like to call themselves “the Enterprise”. Conquer, consume, absorb. It’s what they do. Through the years the LHF has put money into the hospital to upgrade it for new services. CCF brought the services in…then slowly moved them away. Cardiac Care, New ER, Orthopedic Services and lastly Specialized Neuro Services. The doctors were just as shocked as the staff when the Clinic told them they had to go to FGH or Avon. It’s just sad.

  2. Thanks. It seems like this kind of thing works more often than not, honestly… but this episode feels like a reminder that “you can’t fool all of the people all of the time.”

    When Clinic flacks talk with a straight face about a “commitment to Lakewood” I don’t think they are convincing many people, any more.

  3. on July 6, 2015 at 5:50 pm said:

    Thought your comments were intelligent and well-reasoned. I’ve been reading a lot about this lately and do fault both the Lakewood city administration and the Hospital Foundation remiss in communicating with the citizenry. However, I have to give them the benefit of the doubt and suggest that maybe they really are trying to do the right thing; they’re just lousy communicators.
    The other worrisome (and inexorable) fact that I’ve glommed from this mess is that there seems to be no alternative to the Clinic’s proposal – Metro said no; UH is clearly not remotely interested, and no matter how well meaning all this “Save the Hospital” stuff is, we cannot go it alone. No one, save the lousy communicator Mayor and the Hospital Foundation, has offered any means to achieve the end of “Saving Lakewood Hospital.”

    • re: “no alternative”

      Insist on the Clinic living up to its responsibilities seems like a valid alternative to me. They signed a lease to run the hospital, and provide specific services, through 2026. It’s 2015; a lot can happen in a decade. Therefore, even setting aside serious doubts about the sincerity with which the “poor communicators” actually attempted to find a new partner, I cannot regard “there’s no alternative to the Clinic” as a valid argument.

      I have tried to imagine the situation reversed; I believe that if the city of Lakewood had written to the Clinic saying “this lease isn’t working out as well as we had hoped, we need to you abandon it 11 years early and replace it with a new deal more favorable to us” the laughter would not begin to subside for several minutes. Then they would call lawyers; by contrast, the Summers administration flatly refused an open call to sue the Clinic for evading its responsibilities. I cannot regard the vision of Mike Summers as offering any kind of viable option for Lakewood, at all.

      The reality is that we have lots of time, so long as we choose to make use of it, rather than putting all of our cards on the table and folding the instant that the Clinic and its lapdog newspaper scowl at us for our temerity at being in the game at all.

      I still can’t assume that preserving Lakewood Hospital as it exists will happen, particularly as the mismanagement of the Hospital Association and Clinic continue to strangle the life from it. If it is to happen, it won’t be easy, certainly. But that’s the reality of Lakewood in the 21st century, far beyond just the hospital. Lakewood is in a declining region, and is neither a growing exurb du jour like Avon nor one of the chosen “comeback” showpieces sustained through subsidies, like downtown Cleveland. In this context there are ultimately two alternatives: 1) pull together and fight back, tooth and nail, or 2) politely go along with the conventional wisdom of an elite with zero investment in what happens to Lakewood, and eventually run up the white flag like East Cleveland.

      I plan to keep voting for 1) thank you.

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