Challenge of transitioning Indian River hospital to Cleveland Clinic exacerbated by the pandemic


As Marybeth Cunningham begins her fifth year as chairman of the Hospital District board, she concedes not fully anticipating the impact a pandemic would have on the concurrent challenge of transitioning the old Indian River Medical Center to the new Cleveland Clinic Indian River Hospital.

“Back in April 2020, if you’ll remember, everybody was in lockdown and thought we’d be through this in a month or two,” Cunningham recalled. “People were nervous, but they didn’t grasp the severity of it. We were being told to just take the proper measures and it’ll go away, and it didn’t. It got worse.”

Cunningham’s phone jangled with agency directors trying to cope with the emergency. “There was a lot of scrambling to get prepared. We were running out of PPE because nobody knew how to deal with that.”

All the while, the public was panicking. “By May and June, the hospital and a lot of the support staff at Whole Family Health and Treasure Coast Community Health were just buried with people trying to get COVID tests and trying to figure out what kind of mask you needed, and just what was going on.”

That turmoil would only get worse as divisiveness set in and conspiracy theories blossomed in a presidential election year.

“It was a health crisis. Then, unfortunately, it turned into a political crisis,” said Cunningham.
When surrounding counties adopted mask mandates, the Hospital District urged local officials to take action, too.

“We pushed the county commissioners,” she said. “I personally sent emails and talked to a number of county commissioners. We wrote a resolution supporting masks, for what good that would do, asking them to please, vote for the mandate. And that was really as much supporting the hospital as anything to be able to say, ‘Look, people. They’re not going to be able to take care of strokes and cancer if we don’t stop this.’

At the worst points, Cunningham and Cleveland Clinic Indian River Hospital CEO Greg Rosencrance spoke “almost daily” as the district sought to stay on top of what was happening at the hospital, and offer whatever help it could. Rosencrance’s main request? “He was looking for support in getting the message out on masking and distancing.”

Through it all, the Hospital District staff and trustees kept in close contact with the agencies they fund, doling out close to $1 million to deal with urgent and unanticipated needs.

When vaccines became available a year ago in December and January, political points of view grew only more intrusive on individual healthcare decisions. While lines formed at podiums at the County Commission and School Board meetings to protest cautious government policies, few people came to Hospital District meetings.

It was the same when the Hospital District had tried hard a couple years earlier to involve citizens in the decision to partner with Cleveland Clinic. The Hospital District operates under the Sunshine laws, which require an extraordinary amount of openness – a torment for a large company like Cleveland Clinic. But the public seldom took advantage of the forced candor; there was never the interest they anticipated.

“We tried very hard to get community people to come give feedback and talk to us,” Cunningham said. “We held four community meetings and we rarely had more than 10 people.”

The merger took place with minimal controversy, as did Cleveland Clinic Indian River’s first year, when changes were intentionally kept to a minimum. The next year, though, was 2020; the hospital along with every health-related agency became engulfed with problems when COVID-19 hit.

Despite having to battle a string of COVID surges and staff shortages, Cleveland Clinic forged ahead with policy implementation, a switch to electronic records software, and heightened expectations of employee conformity to Cleveland Clinic corporate standards. Those included for doctors the time-intensive logging of data amassed by the new Epic software for systemwide quality metrics and insurance reimbursement.

Some doctors complained it was time spent at the expense of patients whose visits had to be shortened to make time for notes and data input. Some of the hospital’s most respected – and highest earning – employed physicians became disenchanted, to put it politely. Many of them left by choice or otherwise.

At the same time, dozens of new doctors were recruited to take their places. But some among Vero’s older population resented the unfamiliar faces. Patients who had gone to the same doctors for many years were upset, to say the least.

“The consultants (on the merger) all said that the second year was going to be chaotic,” recalled Cunningham. “It always is, in any of these kinds of changes. It turned out to be more chaotic than anybody would have guessed.”

Those physician departures were often not communicated to patients until weeks later, when the hospital sent out letters suggesting a replacement physician. That news was not taken well by the thousands of patients affected.

It didn’t help that many of those stranded patients were already enraged by phone system foul-ups that had stretched on for months after the hospital changed out its electronic records system. Cunningham herself was fielding calls as patients told stories of spending hours dialing various numbers, getting busy signals, getting disconnected, or leaving messages that were never returned. Many drove in person to offices just to book an appointment – only to find long lines of people waiting to do the same.

Teams of experts could not solve the appointments desk problems, complicated by a flood of separate calls for COVID-19 testing and vaccination.

“They were dealing with it frantically, absolutely frantically,” said Cunningham, who said in the middle of the worst of it, she was getting calls herself and questioned every time she went out.

“Cleveland Clinic did at some point take out full-page ads apologizing for the phone system,” Cunningham pointed out.

“Some of what we found out was there were a lot of things in the old hospital that didn’t work as they should and so when the demand increased so much for vaccines or for services, it was just overwhelming. But people looked at Cleveland Clinic and said, ‘You guys are No. 1 or 2 in the world for healthcare and you can’t even get your phones working?’ ”

Cunningham believes the hospital may have underestimated the effects of Epic, the new electronic health records system.

“In my automotive world life, I went through major changes in IT structure, and it was painful – very painful. So I have some sympathy for Cleveland Clinic. In the middle of a pandemic, and in the middle of a transition – they bit off a lot.”

At the same time, nurses and other employees were leaving voluntarily, part of the nationwide exodus due to the stress and risks of COVID. In their place, pricey agency nurses who traveled the country from surge to surge were hired.

Twice in 2021, elective surgeries were paused, including for eight to 10 weeks during the Delta surge.

In the past year alone, the hospital lost $29 million as operating expenses exceeded budget by $41 million, according to Rosencrance, who gave an update to the Hospital District board in December.

Cunningham felt relief in that revelation. “That tells me, Thank goodness you’re here and that Cleveland Clinic can weather that. Because our community hospital could never have weathered that.”

Rosencrance, for his part, is quick to show appreciation for Cunningham. He called the collaboration with Cunningham and the Hospital District “instrumental in helping us maintain the health and safety of the community we serve.”

“We are grateful for Marybeth’s support of Cleveland Clinic Indian River Hospital,” he went on. “Her vision for providing residents with access to high-quality care will have a long-lasting benefit in Indian River County for years to come.”

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