With the public eye now trained on the Indian River County Hospital District, several district trustees want Cleveland Clinic officials to tell them in detail why the Vero hospital is faltering financially and how they intend to right the ship before they pull out a checkbook to fund a $13.6-million bailout.

Trustees want to see detailed local financials for Cleveland’s Vero hospital – not just  consolidated for all of Cleveland’s hospitals, or even the five Florida hospitals. They want a copy of Cleveland Clinic’s strategic sustainability plan – a document that’s been referred to, but not yet produced.

They also want to know how much the Vero hospital sends upstream to the Florida mothership in Weston, and corporate headquarters  in Ohio, to see if those charges are fair, or if they’re setting Vero’s hospital up to fail.

Trustee Kerry Bartlett wants to know how any potential multi-year grant to Cleveland Clinic will impact county hospital district finances as a whole.

Bartlett also wants a deep dive into the numbers Cleveland Clinic put forward on indigent care and uncompensated care – since nothing was put on paper last month. And finally she wants to know what accountability and reporting the district would require in exchange for the funds.

Last month, Cleveland Clinic executives proposed taxpayers fund a portion of what the hospital writes off each year due to insufficient Medicare reimbursements and indigent care. Initial numbers floated in the Cleveland Clinic ask are $4.275 million for the current fiscal year 2024-25, followed by a projected $3.86 million in 2025-26, a projected $3.15 million in 2026-27 and $2.31 million in 2027-28. The funds would come from property owners, through their Indian River County Hospital District property taxes.

The big ask comes at a highly inconvenient time, as the hospital district just spent nearly $4 million from its reserves on a property to house a women’s sober living facility, on top of hiking its property tax rate by double digits to expand access to primary care, mental health counseling, prenatal care and other needed services countywide through its funded agencies.

Up until now, the hospital district has largely enjoyed a free pass in terms of public scrutiny of its business, but further tax increases in 2025 and beyond might not sit well with local taxpayers, or with the bicameral Joint Legislative Audit Committee in Tallahassee tasked with cracking down on special taxing districts across the state.

Three of the elected hospital district trustees – Board Treasurer Michael Kint, Bartlett and Paul Westcott – each submitted a robust set of questions they want answered by Cleveland Clinic officials.

Dr. Bill Cooney and Karen Deigl submitted a few brief questions of a general nature, with Deigl’s main concern being the need for a more granular analysis of the very large numbers Cleveland Clinic is tossing out as losses for indigent and uncompensated care.

Cooney minced no words with his comment about the funding request. “Cleveland Clinic agreed to cover indigent care. Now they are going back on that signed agreement,” Cooney said along with his emailed questions. He said it’s “OK that we help them out, but I would want something back.”

A champion of primary care and emergency care, Cooney at the last meeting proffered the idea of requiring Cleveland Clinic to hire more primary care physicians if they want more money from the district. Cooney also had concerns about the hospital district committing four years of funding. “I would also prefer one to two years, not four, to see where they are going,” Cooney said.

Board Treasurer Michael Kint, like Cooney and Bartlett, wants to see the hospital’s oft-referred to turnaround plan that would have Cleveland Clinic Indian River turning a profit in five years. He also said his max funding number is $12 million over four years.

Kint, like Cooney, wants something in return for the funding – specifically to tack on four years to Cleveland’s existing commitment to support the behavioral health center and Partner’s in Women’s Health obstetrics and gynecology care.

Should the hospital district agree to help fund Cleveland Clinic’s losses on a short-term basis, this would be a departure from the district’s 75-year lease for the hospital business and buildings. As part of that deal, Cleveland Clinic does not pay rent for the first 10 years, or until 2029, at which time the market rent will be set going forward.

Westcott, who was not a trustee when the lease was signed, thinks this approach is a bit backward. Prior to leasing the hospital to Cleveland Clinic, taxes collected by the hospital district funded indigent care directly.

If the “free rent” is supposed to offset Cleveland Clinic’s annual investment in indigent care, and the trustees don’t know what the fair market rent on the hospital would be, there’s no way to know if county taxpayers are asking too much of Cleveland Clinic for footing the bill for more than $17 million annually in indigent care and uncompensated medical bills.

Outgoing trustee Barbara Bodnar, whose term ends this month, submitted no questions that were included in the district’s response to Vero Beach 32963’s public records request.

Chairwoman Marybeth Cunningham, who has publicly stated she wants the trustees to vote to approve the funding plan in December before she ends her tenure as a trustee, submitted no questions by email. Cunningham possesses more inside knowledge about Cleveland Clinic finances as she serves as an ex-officio member of the Cleveland Clinic Foundation board.

Given the scope of the questions posed and the documents requested by the hospital district trustees, it would seem virtually impossible for Cleveland Clinic to fully respond in writing by the 10 a.m. Wednesday hospital district  chairman’s meeting, or the 4 p.m. Dec. 19 business meeting.

Cunningham has warned her fellow trustees that Cleveland Clinic might be leery about putting so many financial, operational and strategic details out in the public – even though they approach the trustees with hat in hand.

The public can still weigh in on the decision. “We welcome and encourage the public to attend District meetings and utilize the public comment portion of the meeting,” said district Executive Director Frank Isele.

The district is in the process of setting up individual email boxes for each district trustee, but Isele said those won’t be live until Jan. 1. Isele refers citizens to the district’s contact page to fill out the contact form, irchd.com/contact-us/