Vero Beach Magazine
April 2024
BY JEFFREY R. PICKERING
Do you know the difference between Cleveland Clinic Indian River Hospital (CCIRH) and the Indian River County Hospital District (IRCHD)? What about how the two work together with philanthropy and our local nonprofit sector to meet the needs of the community? If not, do not feel bad. Most people whom I pose those questions to have a limited understanding of this system of care that is so critical in Indian River County. Here’s a quick primer and my thoughts about why both are so essential to our community’s health and well-being.
CCIRH is a 332-bed not-for-profit hospital that serves as the main medical center for Vero Beach and the surrounding Indian River County community. The hospital began operating under the Cleveland Clinic health system in January 2019, after an 18-month process to secure the future of the former independent community hospital, Indian River Medical Center.
Today, the hospital is led by Dr. David Peter and offers preventive, primary, acute hospital care and a broad array of specialty services to the community. In 2022 it cost $481 million to operate, an unusually high amount affected primarily by COVID and labor-related expenses. An additional $42 million in capital improvements were made during the same year, $7 million of which came from philanthropy through donors to the Cleveland Clinic Indian River Foundation.
The IRCHD is a special taxing authority that provides funding to organizations that deliver essential medical, dental, and behavioral health programs and services to all Indian River County residents, regardless of their ability to pay. The organization also convenes providers and other stakeholders to identify and address gaps in the community’s continuum of care.
Currently, the IRCHD is led by executive director Frank Isele and an elected board of trustees chaired by Marybeth Cunningham. In 2022, it directed more than $13 million in public funding from property tax assessments to health care programs throughout the community.
The relationship between CCIRH and its predecessors and the IRCHD is longstanding and evolving. When the IRCHD was created by the Florida Legislature in the 1950s, and for several decades to follow, it owned and operated what was once known as Indian River Memorial Hospital. In the 1980s, the IRCHD began using public funds to support indigent care at the hospital and beyond; it retained ownership of the hospital building, while management of the hospital was turned over to a separate community not for-profit corporation.
With Cleveland Clinic’s eventual acquisition of the hospital in 2019, most of the financial responsibility for providing in-hospital care to uninsured and underinsured patients has been assumed, leaving more tax dollars available for the IRCHD to distribute for similar purposes throughout the community. These dollars are not wasted. They are critical to supporting the health care safety net provided by the various
beneficiaries of IRCHD funding, including Treasure Coast Community Health, VNA of the Treasure Coast, Whole Family Health, and the Healthy Start Coalition, to name a few. Without these organizations, our community would be in a much more fragile state, and human suffering would be exacerbated.
Take our community’s infant mortality rate, for example. In 2011, the proportion of infants that died prior to reaching 1 year of age was 12.5 per 1,000 live births among whites, and 33 per 1,000 live births among Blacks. These were some of the worst statistics in the entire country and resembled those typically seen in developing countries.
One decade later, because of early access to prenatal care provided by CCIRH’s Partners in Women’s Health Program and additional supportive services delivered by the Healthy Start Coalition, these terrible statistics have been reduced by more than 50 percent. Both proven programs are supported by financial resources from the IRCHD and local philanthropy.
Or consider our community’s hospitalization rate for adolescents for mood and depressive disorders as another example. In 2015, more than 1,500 youth and children under age 18 were hospitalized due to anxiety, depression, or suicidal thoughts. For some, inpatient hospitalization was necessary to stabilize and prevent further harm to themselves or others. For many, however, a less severe form of treatment may have been better. Unfortunately, other than drop-in or weekly counseling, no programs existed for intermediate care.
Since 2020, with more than $250,000 in annual funding provided by the IRCHD, Indian River Community Foundation, the United Way, and the John’s Island Community Service League, an intensive outpatient program at CCIRH’s Behavioral Health Center is now available to meet this need. As a result, uninsured and insured adolescents alike can receive the care they need close to home, avoiding risky behaviors, improving mental health, and preventing the most adverse outcomes, such as involuntary hospitalization, overdose, or suicide.
Since moving to Vero Beach in 2015, one of my family members or I have been cared for by CCIRH and its affiliates almost a dozen times. These interactions have ranged from simple diagnostic procedures in the Department of Gastroenterology and Nutrition to treatment in the Department of Emergency Services for several broken bones, an adverse reaction to medication, and an unplanned appendectomy. Despite some of the recent inconveniences with telephone access or the perennial challenges with emergency
room privacy, the actual medical care we have been provided has been exceptional. I hear much of the same from numerous friends and clients.
One personal testimonial about the care provided by CCIRH caught my attention in the most unusual of settings. Because Indian River Community Foundation provides supplemental financial support to many of the programs funded by the IRCHD, I regularly attend or watch online the monthly board of trustees
meeting. At the end of each, time is allocated for public comment.
From time to time, citizens use this public comment agenda item as an opportunity to advocate for a particular matter being considered by the trustees. Other times, taxpayer advocates use this time to encourage a reduction of spending and a return of tax dollars to taxpayers. On November 16, 2023, Indian River Club resident Sharon Wolf used this opportunity to say “thank you.”
Wolf thanked the IRCHD trustees for their past leadership to secure Cleveland Clinic as the new owner and operator of our community hospital. During a recent trip to the emergency room, Wolf received an assessment, observation, and care after feeling heart palpitations. While her condition did not develop into something more severe, the peace of mind she received from a full evaluation and referral for follow-up care made all the difference. She also expressed gratitude for the excellent treatment and follow-up care she received from CCIRH’s Scully-Welsh Cancer Center.
Curious to understand more about Wolf’s experience, I contacted her to schedule an interview.
“When I was being treated, after seven hours of chemo, all I wanted to do was go home and be surrounded by my Indian River Club friends,” she says. “The Hospital District’s leadership made that happen.”
I ask what made her decide to drive from her home in south Vero Beach to the Indian River County Complex to attend the meeting. ‘Couldn’t you just send an email or a personal note?’ I ask.
“This is our community,” Wolf tells me. “Since Cleveland Clinic took over, through COVID, and even now, I hear people complain. My experience has been different, and I thought the trustees … and whoever else might be listening … needed to hear that.” Wolf knows how hard CCIRH is working to overcome challenges and succeed. She was invited to serve as the volunteer chairwoman of a patient experience committee named Healthcare Partners. The group, made up of hospital leaders and community members, meets monthly to listen and learn about ways to make the patient’s experience better.
“I know there is more work to do,” Wolf shares. “I think they do too, and I trust the people I have gotten to know at the hospital and the Hospital District will ensure that happens.”
I ask Dr. Peter about some of the other challenges CCIRH is facing in the near future. Specifically, I am curious about the hospital’s $70 million operating loss last year.
“With the height of COVID’s impact behind us, we have stabilized our workforce and will rely less on costly contracted staff, such as traveling nurses,” he tells me. “Continuing to collaborate with community health providers like Treasure Coast Community Health, for example, will also help by reducing unnecessary visits to the emergency department. It will take a community effort, but I am confident in our ability to get there.”
For many of the challenges we face as a community, it has been my experience that improvements come when engaged and invested citizens choose to be a part of the solution instead of only complaining about the problems. Several years ago, when our community hospital was on life support, the past chairman of Indian River Medical Center, Dr. Wayne Hockmeyer, and IRCHD chairwoman Marybeth Cunningham modeled that behavior, along with a number of stakeholders who were engaged in the process of securing our community’s health care future. Today, community volunteers like Sharon Wolf and public servants like IRCHD trustee Dr. William Cooney continue in that same spirit.
Building a healthier community will not be easy, but the alternative—losing Cleveland Clinic as our local hospital partner or reducing the critical dollars that flow through the IRCHD, as some have advocated— is unacceptable. In health care terms, it is simply bad medicine, and patients deserve better.
