<em>Editor's Note: This article ran as part of a two-story package. You can read the companion story <a href="https://veronews.com/2026/10/15/proposal-seen-moving-forward-but-three-may-be-too-many-for-county/">here</a>. </em> In an effort to strengthen its position in Indian River County, Cleveland Clinic plans to open two new standalone emergency rooms in early 2028 to serve North County and South County mainland residents. The South County location will be on the southwest corner of Oslo Road and 27th Avenue SW behind the Dollar Tree store. The Sebastian emergency room will be built on vacant land between the east- and westbound spans of County Road 512, at 200 to 203 Sebastian Boulevard just east of South Wimbrow Drive. Cleveland Clinic’s new Sebastian ER will be only 3 miles from Orlando Health Sebastian River Hospital, which has its own busy emergency department. “Each year, one in five residents from North Indian River County travels to Cleveland Clinic Indian River Hospital for emergency and specialty care. Many travel past other healthcare facilities to receive care at Cleveland Clinic,” hospital Vice President and Chief Medical Officer Dr. Richard Rothman said. “That demand highlights the need for additional access to Cleveland Clinic services in the northern part of the county. The proposed Sebastian standalone Emergency Department will bring 24/7 emergency care closer to where these patients live, expanding access while reducing travel and transport times,” he said. “The facility will accept both ambulance and walk-in patients and provide access to advanced emergency care and specialty services available at Cleveland Clinic Indian River Hospital when needed.” Though Cleveland Clinic had entered into a contract to purchase properties for the new facilities, and its builder Anchor Health Properties had already filed pre-application paperwork with the county in August and September for the sites, Rothman had not announced the expansion plans prior to the last week’s County Commission discussion of the possibility of a new third hospital being built here. County Commission Chair Deryl Loar forced Cleveland Clinic’s hand, saying he had stumbled upon the information while checking on the status of a new Starbucks that was slated to be built on a site in his neighborhood. He said the county planner told him “it was no longer going to be a Starbucks, that a new emergency room was going in there.” Loar said it would have been nice to find out about the new ER planned for his district directly from Cleveland Clinic, which hastily announced the Oslo Road project the next day – and then shared details of its plan to also build a Sebastian Emergency Room with Vero Beach 32963. Rothman said the two free standing emergency departments are part of Cleveland’s long-term strategy for Indian River County. “Building on the recent expansion of our main Emergency Department, these facilities will bring 24/7 emergency care closer to where people live, help reduce travel and transport times, and improve access to Cleveland Clinic services throughout the county,” he said. Rothman said he was unaware his builder had filed pre-application packets which are public record with the county, and that he held off on announcing the two ERs because Cleveland Clinic had not yet closed on purchasing the properties. “The proposed standalone Emergency Departments in Sebastian and South Vero were still in the planning and pre-application stages and were not yet ready for public announcement when the County Commission began discussing a potential third hospital,” Rothman said. “These projects are separate from those discussions and are part of Cleveland CCIRH’s broader long-term goals to expand access to care across Indian River County and bring Cleveland Clinic services closer to where patients live.” Cleveland Clinic aims to get patients into the Cleveland Clinic primary and specialty physician system pipeline for follow-up care with “real-time discharge follow-up appointments,” Rothman said. “Follow-ups at the time of discharge and facilitating access to the appropriate physicians nearest to the patient's home are aspects of care we are very focused on – improving continuity of care and care transitions while reducing travel time for patients. “We will work to create greater continuity between emergency treatment teams and ongoing care with the patients' existing community physicians,” Rothman said. Even without the prospect of a new hospital coming to Indian River County, Cleveland Clinic faces fierce competition from HCA Florida’s Lawnwood hospital and Orlando Health Sebastian River Hospital. While Cleveland Clinic frames its planned emergency care expansion as a service to the community, there is a huge financial elephant in the room. Cleveland Clinic is under major pressure to solidify its market share in Indian River County as the hospital’s free-rent arrangement with its landlord, the Indian River County Hospital District, ends in 2029. It also must invest $90 million over the next two years upgrading the aging hospital’s power plant and emergency generator system, tying together five decades of expansions and patches. Under its 75-year lease for the taxpayer-owned hospital buildings and 80-acre campus, Cleveland Clinic was granted free rent for 10 years in 2019, in exchange for $250 million in capital improvements, plus a promise not to shutter certain essential services like maternity care. No fair market rent has been set for 2029 and beyond by the Hospital District, but it’s expected that Cleveland Clinic begin paying taxpayers substantial rent in 2029. Cleveland Clinic Foundation, which operates all the Cleveland Clinic hospitals, has lost nearly a quarter billion dollars operating Indian River Hospital since taking over in 2019, but under Rothman’s leadership, the hospital is heading toward an expected break-even 2026 fiscal year end. <em>Photos by Joshua Kodis</em> [gallery ids="237214,237215,237216,237217,237218,237221,237222,237223,237224,237225,237226"]