Lawnwood’s new Emergency Room battles Cleveland Clinic for patients

Lawnwood's free-standing emergency room in Vero Beach. [Photo: Kaila Jones]

Indian River County’s first freestanding emergency room opened on South U.S. 1 last December under the banner Vero Beach Emergency Room – signage that didn’t clearly indicate the facility is owned and operated by Lawnwood Regional Medical Center, located 12 miles south in St. Lucie County.

For weeks after the Lawnwood ER opened, residents south of 8th Street with lower-level emergencies were automatically taken to that new facility when they dialed 911 for an ambulance. Only if they requested to go to Cleveland Clinic Indian River Hospital were they taken there.

That policy was enacted by county emergency management officials after meeting Lawnwood’s CEO, Eric Goldman, and touring the freestanding ER just before it opened.

Now that policy has changed, following protests by the Indian River Hospital District.

When EMTs pick up South County patients, they will explain ER options and let patients choose where they want to go whenever feasible, with Cleveland Clinic – not the new ER – being the default.

Residents will also get an explanation from ambulance drivers of just who owns the freestanding ER: Lawnwood. As it is, patients must squint to see the very fine print that explains that Vero Beach Emergency Room is a “campus” of Lawnwood.

Indian River County taxpayers continue to own the Indian River hospital, though Cleveland Clinic Florida now has the long-term lease on the property.

Marybeth Cunningham, chairwoman of the hospital district board, is the one who intervened in late January, along with the board’s executive director, Ann Marie Suriano, to have the EMS policy changed.

“As soon as we heard about it, we set up a meeting,” Cunningham said.

The two met with County Administrator Jason Brown and Dylan Reingold, the county attorney, Jan. 28 to discuss the ambulance policy.

“We are here because it’s our job to support the county hospital that we have, and the county hospital is Cleveland Clinic,” Cunningham told county officials, as she relayed the conversation to district trustees last week.

“We just spent two years to bring in the No. 2 healthcare [system in the nation] to take care of the residents in our county,” she said. “You cannot bring another county organization” – fire rescue, which handles ambulances – “and have them be automatically taking people” to the freestanding ER that could then transport patients to Lawnwood.

“In south county, there are a number of people who would qualify for Cleveland Clinic’s financial assistance program,” Cunningham said. “If they get taken to the [Lawnwood freestanding ER], they’re not going to be able to get that. If they are then transported to Lawnwood, you’re disadvantaging the residents.”

County officials quickly saw her point.

“The next day, they changed the policy,” Cunningham told the board. “I give Jason Brown a lot of credit for this.”

The change in policy “appears to be working properly,” she added. “[EMTs] will ask for a choice, and if somebody’s unconscious or it appears somebody is going to be admitted, they will go to Cleveland Clinic. Period.”

But the ER debate wasn’t over. The day after meeting with Brown and Reingold, the two hospital district leaders headed to the Sheriff’s Office to talk about another source of patients for the freestanding ER – those taken in for mental healthcare under Florida’s Baker Act.

Word had reached the hospital district office that deputies were taking those patients to the south Vero ER after being told by Lawnwood that the freestanding ER was a designated Baker Act receiving facility, a determination issued by the state. According to Cunningham, the ER was immediately transporting Baker Act patients to Lawnwood Pavilion on the Lawnwood campus.

District executive director Ann Marie Suriano wrote to the Division of Children and Family Services, the agency overseeing Baker Act receiving facilities, and was told the freestanding ER is not a receiving facility, though Lawnwood itself is, and by virtue of proximity, Lawnwood Pavilion.

Today, law enforcement is no longer taking patients to the freestanding ER, Cunningham told the board. Baker-acted patients are being taken to Cleveland Clinic Indian River’s Behavioral Health Center, the only designated receiving center in the county, according to a DCF official who emailed the county in response to the hospital district’s query.

But county administrator Brown says Lawnwood continues to dispute the matter. A Lawnwood spokesperson said the hospital was not able to comment on the matter by press time Monday.

For their part, some hospital district leaders believe Lawnwood is intentionally trying to confuse the public.

“I think the purpose of putting that unit where it is – and not identifying who it is – is to disrupt,” Trustee Allen Jones said.

Cunningham agreed. “Oh, [Lawnwood] understands that. I think a lot of people think it’s Cleveland Clinic. They do.”

“And it’s making it harder on patients,” Jones continued.

To remedy any confusion and drive the point home, Cleveland Clinic Indian River is mailing out 60,000 wallet-sized cards saying, “Take me to Cleveland Clinic Indian River.”

The cards are going out to neighborhoods within a 10-mile radius of the freestanding ER, including some homes in Fort Pierce. Hospital spokesperson Angela Dickens says another batch of cards is expected to go out in the months ahead to households in and around Sebastian.

“We want patients to be aware that they do have a choice of where they want to go,” she said.

Dickens added the caveat that with stroke or chest pain or some other serious conditions, patients should go to whichever ER is the closest. “Obviously we don’t want to delay care.”

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