Where will Indian River County\u2019s next hospital be located? Out west, is presumably the answer as the county continues to expand in that direction. But exactly where, and when, is a third hospital likely to join Cleveland Clinic and Sebastian River Medical Center?\r\n\r\nSince the pandemic, not only have developers resumed construction in developments stalled during the Great Recession, but new homes, communities, apartment complexes and businesses are coming online.\r\n\r\nThat\u2019s not likely to stop as the County Commission mulls whether or not to expand the westward boundaries of the county\u2019s Urban Services Area. In time, an additional hospital almost certainly will be needed.\r\n\r\nThe Indian River County Hospital District began to scratch the surface of the issue at last week\u2019s Board of Trustees meeting, but the brief discussion closed leaving a great deal more questions than answers.\r\n\r\nThe timeliness in planning for the county\u2019s next hospital is twofold \u2014 the need to designate existing land holdings in west-central Indian River County for a medical center, or to secure a significant piece of land for a new hospital campus and ancillary medical offices before all the available, appropriate land is developed into housing or commercial buildings.\r\n\r\nThere are also the questions of how to finance a new hospital to serve the growing community, and who would take that project on.\r\n\r\nWould Cleveland Clinic design and build it? Would the Indian River County Hospital District build it and then lease it back to Cleveland Clinic on a long-term lease? Would it be some sort of public-private partnership?\r\n\r\nThe current hospital on 37th Avenue is owned by the hospital district but governed by a complex 75-year lease agreement, so the district and Cleveland Clinic are enmeshed financially for virtually this entire century.\r\n\r\nThe hospital district owns 45 acres of vacant land on 82nd Avenue, between the Heron Cay manufactured home community and Pointe West. Plus an adjacent 45 vacant acres are owned privately by an LLC. But that land does not have frontage on State Road 60, meaning the substantial traffic to and from a hospital would run through a residential area.\r\n\r\nThe western parcels were purchased decades ago to place a territorial claim on that geographic sector of the hospital market, to prevent another competing hospital or hospital chain from locating in that area. Due to Certificate of Need (or CON) laws, the construction of new hospitals must be approved by state regulators.\r\n\r\nAs explained by the National Conference of State Legislatures, these CON programs are in effect in 35 states and \u201cprimarily aim to control healthcare costs by restricting duplicative services and determining whether new capital expenditures meet a community need.\u201d\r\n\r\nThe two parcels the district owns on 82nd Avenue have a combined market value of just less than $2 million, according to the Indian River County Property Appraiser, but values stated by the county, due to the time lag of the assessment process, can run 12 to 18 months behind the market so a private appraisal would likely be higher.\r\n\r\nHospital district Trustee Paul Westcott said he\u2019s spoken to some reputable Realtors who told him that land could sell at a price between $4 million and $6 million. Should the district put the land up for sale and get a viable offer, the way the deed is written, Westcott said, Cleveland Clinic would then have the right to match that and purchase the land.\r\n\r\n\u201cOur assessment of the viability and use of the property should probably incorporate some long-term planning, that we discuss, too, where\u2019s our next medical campus going to be?\u201d Westcott said.\r\n\r\n\u201cI\u2019d just like for us to take steps to explore that as an option for us,\u201d he said.\r\n\r\nTrustee Karen Deigl questioned what the hospital district\u2019s role might be in planning for the next hospital that Cleveland Clinic might or might not want to open and operate in Indian River County.\r\n\r\n\u201cIs that really our format?\u201d she asked. \u201cWe\u2019re not the ones. If they\u2019ve got that land, got the first right of refusal on it, it\u2019s them,\u201d referring to Cleveland Clinic.\r\n\r\nDistrict Chairwoman Marybeth Cunningham said they could have the conversation \u201cin the spirit as partners.\u201d\r\n\r\n\u201cIf we\u2019re going to commit that property for medical use, we\u2019d be well advised to take a 30,000-foot look and coordinate with and plan where\u2019s the ideal location, and not let the tail wag the dog,\u201d Westcott said. \u201cIf the better location is out at the intersection of I-95 and State Road 60, and the County Commission believes so, or for planning purposes that\u2019s the better location as opposed to a mile and a half south of State Road 60, I think we need to know that.\u201d\r\n\r\n\u201cThe question then begs, are we an organization that only disperses money and we\u2019re not thinking strategically, or are we an organization that the public reasonably expects that we\u2019re going to be engaged in strategic planning? I think we\u2019re the latter, and that\u2019s what I\u2019m advocating for,\u201d Westcott said.\r\n\r\nThe matter came up as part of a discussion about purchasing property for a future sober living center, and how selling other land the district might offset the investment in the drug and alcohol rehabilitation center. Westcott first raised the issue in December and wanted to make sure it remained fairly high on the trustees\u2019 agenda.\r\n\r\nWestcott pointed out that the county\u2019s next hospital location would not just be a standalone hospital building, but an entire medical community, as doctors, imaging centers, diagnostic labs, physical therapy, pharmacies and other services would want to be near the new hospital.\r\n\r\nThe State Road 60 corridor near I-95 is home to about 5,000 manufactured homes in age 55-plus communities, a local resident told the trustees in public comment. Indian River Estates\u2019 100-acre senior community with assisted-living, memory care and skilled-nursing care is also about two miles from I-95 on State Road 60, but a full 7.2 miles or roughly a 20-minute drive in heavy traffic from Cleveland Clinic Indian River Hospital.\r\n\r\nDistrict Trustee Dr. William Cooney reminded the trustees of the need for emergent medical care in the western portion of the county. Cleveland Clinic Vice President Dr. David Peter told the district trustees last fall that the hospital\u2019s top fundraising priority right now is a total revamp of the main campus Emergency Department. The I-95 area only has a Cleveland Clinic Urgent Care center at Pointe West, where patients are evaluated and then transported across town to the hospital if needed.\r\n\r\n\u201cEvery hospital organization has a facilities plan, and we haven\u2019t seen it,\u201d said hospital district Treasurer Michael Kint. \u201cI\u2019d be interested to see if they\u2019ve got to the point where they\u2019re projecting 10, 20 years out.\u201d\r\n\r\n\u201cIf part of that decision from their perspective, Cleveland\u2019s perspective is location at this juncture, that land exists. I\u2019d kind of be interested to see what they say would be the best location, so that would play a factor,\u201d Kint said.\r\n\r\nDistrict Executive Director Fran Isele agreed with Kint that Cleveland Clinic should have a Master Facilities Plan. \u201cThey are not going to make an investment in expansion without doing a lot of work on needs analysis and all that. It\u2019s going to be very thoughtfully done, so I think a good place to start would be to get that Master Facilities Plan from Cleveland Clinic Indian River.\u201d\r\n\r\nCunningham said she would \u201cfeel better about Cleveland\u2019s plan than I would the county commissioners saying where the best spot (would be), personally.\u201d\r\n\r\n\u201cSo I don\u2019t know that it (the 82nd Avenue property) is off the table. I think there are uses and at this point and time the sale of that property would be something that I would even want to consider until we do understand what their vision is, and the whole housing situation is,\u201d Cunningham said. \u201cThere\u2019s a lot of community impact. I would hate to get rid of an asset that would have a huge impact.\u201d\r\n\r\nCunningham also noted that some representatives from an affordable housing coalition had asked about the hospital district\u2019s parcel on 82nd Avenue.\r\n\r\nDistrict legal counsel Jennifer Peshke said Cleveland Clinic holds a first right of refusal on many of the district\u2019s properties and any property offered for sale would need to be declared as surplus.