Taps for a Community Hospital

CLEVELAND — A railroad bridge separates Huron Hospital, one of the last remaining institutions in the impoverished neighborhood of East Cleveland, from the city’s downtown and its two major hospitals.

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David Maxwell for The New York Times

The nurses' station at Huron Hospital's medical intensive care unit, which closed recently as the hospital's losses mounted.

The New York Times

These days, boarded-up houses and empty, overgrown lots surround Huron Hospital, which was built on part of the former estate of John D. Rockefeller, the founder of Standard Oil. Like residents in other areas with declining populations, this neighborhood, largely African-American, has relied on the hospital as a safe haven. Residents worry about crime and the lack of even a grocery store.
Facing mounting financial losses and sharply declining patient admissions, the Cleveland Clinic, which owns Huron and eight other community hospitals, announced on Monday that it would close the 211-bed hospital, opening a much smaller family health center in its place.
The decision by one of the nation’s leading health care systems to close a neighborhood hospital, once a relatively rare event, reflects a stark new reality that is likely to play out across the country at hundreds of other hospitals that can no longer afford empty beds or wings and unused medical services. The federal health care law, which is likely to reduce payments for in-patient care, as well as changing demographics and a lessening dependence on hospitals, are converging into a death knell for longstanding health institutions. While many hospitals will be bought and converted into clinics or other health care centers, a lot are likely to be closed.
“I think we’re going to see a lot of this activity over the next three to five years,” said Chas Roades, chief of research for the Advisory Board Company, a firm that works with hospitals.
Closing a hospital remains an exceedingly difficult proposition, with the potential for a strong reaction from community leaders and politicians, who oppose the move, as well as the threat of local doctors who send their patients to competitors.
The clinic’s announcement was quickly followed by denunciations from community leaders.
“Needless to say, I am very disappointed,” said Representative Marcia L. Fudge, a Democrat, who added that she worried about health systems choosing to rid themselves of hospitals in communities of the greatest need. “Care goes beyond dollars and cents.”
Cleveland officials, who had already been upset by the trauma unit closing, say they were blind-sided and talked of possible legal action, according to a statement by the City of Cleveland.
“It rips the soul out of the community,” said Gary A. Norton Jr., the mayor of East Cleveland. He added that residents would be left without 24-hour emergency care and in-patient services.
Dr. Delos M. Cosgrove, the chief executive of Cleveland Clinic, defended the decision, and insisted that the clinic was not abandoning East Cleveland. Huron had already lost its trauma center, nursing education program and its separate medical intensive care unit, and had “really outgrown its useful life,” he said in an interview.
Aside from maintaining the cutting-edge medical care at the clinic’s main campus, this health system also needs to concentrate services in fewer community hospitals, where they will have the kind of volume and expertise necessary to deliver quality care, he added. “When we took over the hospital, we signed up to look after this community,” he said.
The clinic estimates it will continue to lose as much as $8 million operating the family health center at Huron, which is costing about $25 million to build and is expected to open in October.
At a time when the health sector is one of the few that has steadily added jobs as the rest of the economy continues to struggle, closing any hospital is a significant blow. Huron Hospital is the largest employer in East Cleveland, and the city stands to lose about $700,000 a year in tax revenue, even with the addition of the health center. The clinic says it will offer a job to any current employee and plans to work with officials on finding ways to make up the lost income.
“I think the hard thing for us to appreciate, and we try to, is the sense of abandonment. It’s real,” said Dr. Gus Kious, a family physician who runs Huron and has watched the decline accelerate in the last few years. Admissions for acute care dropped below 7,000 in 2009 from about 8,000 and were projected to fall below 6,000 this year.

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