The Hospital District in special session Monday night unanimously approved giving Cleveland Clinic Indian River Hospital $2 million in taxpayer funding in exchange for a commitment to keep its Labor and Delivery Unit here open at least another three years.

Hospital Vice President and Chief Medical Officer Dr. Richard Rothman did not attend Monday night’s special call meeting, but said: “We truly appreciate all the hard work from our Cleveland Clinic teams and the district that has been put into ensuring that Indian River County can thrive and provide top-tier maternity services for our growing community.”

But why this agreement was rushed to a special call vote – which was not even on the schedule when the Hospital District held its regular October meetings just two weeks ago – is still unclear.

The big unanswered question is whether the Hospital District – even if it took an extra month or two to negotiate  an agreement – could have fought harder and obtained a guarantee of maternity care in Vero long past the close of 2028.

Trustee Allen Jones, the district’s liaison on obstetrical and maternity care, acknowledged the obvious unfinished business.

“We want this to go forward in a sustainable way. We want mothers to be assured this service is going to be here. We want fathers to know their wives are going to be cared for in our county. It’s important to the public,” Jones said. “I’m ready to get off of first base and start heading toward home.”

Most of the agreement, which was written similar to a resolution, seems like window dressing.  It establishes a committee to discuss the maternity issue for three years; calls for continuing to explore creation of a neonatal intensive care unit here; and requires Cleveland Clinic to unveil its $7 million renovated Labor and Delivery Unit in the coming year.

That latter clause is almost a joke.  Construction of the Labor and Delivery Unit is nearly complete, with the ribbon-cutting scheduled for Dec. 15.

The only real concession Cleveland Clinic gave the Hospital District in exchange for the $2 million in taxpayer funding was waiving the “25-mile clause” in Cleveland Clinic’s 75-year lease on the taxpayer owned hospital property, which would have allowed it to cease maternity care should the same service be available within 25 miles.

Now, even though HCA Florida Lawnwood Hospital delivers babies in nearby Fort Pierce, Cleveland Clinic Indian River must also deliver babies in Vero until Dec. 31, 2028.

Hospital District Executive Director Frank Isele said, “Given the strong feedback we received from the community survey and the town hall discussions, it was clear that maternity care is both an important and timely issue for our residents and our trustees. The district dedicating a special meeting solely to this topic will ensure it receives the full attention and discussion it deserves.”

The Hospital District conducted a survey, and held three well-attended town hall meetings in August, to gauge the community’s interest in keeping Vero’s Labor and Delivery Unit open long-term.

The public overwhelmingly told district leaders they wanted Cleveland Clinic to continue to deliver babies in Vero, and the majority of those surveyed approved use of taxpayer money to prop up maternity care, since the hospital loses nearly $4 million per year operating that department.

Cleveland Clinic Indian River Hospital currently delivers roughly 75 percent of the county’s babies, with Rothman publicly stating earlier that the department was trending toward 900 babies for 2025.

But Rothman said the anticipated volume took a hit in September following the maternity town hall meetings. Misleading publicity in the Gannett daily paper and social media messaging pushed out by local nonprofits scared the public into thinking the maternity ward was in imminent danger of closure when no such danger existed.

District trustees subsequently voted to grant the Cleveland Clinic Foundation, which operates the hospital’s Partners in Women’s Health Obstetrics and Gynecology practice, $2 million in fiscal year 2025-26. But the release of the funds was contingent on the execution of the maternity services agreement voted through Monday night.

The agreement, as written, does not require Cleveland Clinic to establish a Level 2 neonatal intensive care unit within a certain timeframe – only to study the need for a NICU and report back findings once a year. But where the document really misses the mark is its failure to offer any guarantees of maternity services past Dec. 31, 2028.

Not only would this absence be of concern to local couples looking to start or expand families, but it would also undercut plans to utilize obstetrics and gynecology services at the hospital in training third- and fourth-year medical students – and eventually medical residents – from the Edward Via College of Osteopathic Medicine, commonly referred to as VCOM.

As VCOM specializes in training primary care physicians, having a Vero Beach Labor and Delivery Unit for training young doctors is important to its curriculum. Since the medical school and residency program won’t be fully built out for nine or 10 years, the agreement signed Monday does not extend Labor and Delivery long enough to help VCOM’s training programs get off the ground and accredited here.

Hopefully the rushed agreement is only the start of a larger negotiation that will end with a 20 or 25-year requirement that Labor and Delivery services remain available in Vero.

A wishy-washy, unenforceable clause addressing deliverables indicates that there may be more to come out of the new maternity committee’s work. “It is the intention of district to have a final deliverable detailing potential strategies for sustainable Maternity Services in Indian River County. While participation from CCIRH in the final deliverable is preferred, such participation is not mandatory.”

Each of the seven Hospital District trustees was afforded the opportunity to review the draft agreement privately last week with staff and legal counsel before the document was posted on the district website on Friday afternoon. These private reviews were conducted individually to avoid violating Florida’s Sunshine laws.