The sun wouldn't be up for another two hours. It was cold — the late January overnight temperature hovering around freezing — when a man walked to the former site of the emergency room at St. Vincent Charity Medical Center in Cleveland's Central neighborhood.
The ER was permanently closed and the man used the call box installed outside to call for an ambulance. The EMS dispatcher on the other end told him they wouldn't be coming.
"We cannot come to the hospital to take you to another hospital," the dispatcher said.
That's when the man, who said he was suicidal, homicidal and having chest pains, told the dispatcher — more than two months after the ER shut down — that the ER was closed, a recording of the 911 call shows.
After a few minutes, the dispatcher finally understood the man and sent an ambulance.
Earlier this year, Ideastream Public Media reported that for months many people continued to show up at the site of the former ER, which closed in November of 2022, in need of medical help after St. Vincent and the city's attempts to tell the community of the shutdown failed to reach them.
Now, recordings obtained through a public records request reveal more problems stemming from the closure.
Calls from a nearly four-month period after the ER closed show people who used the emergency call box installed near the doors of the former ER struggled to communicate with 911 dispatchers, who were themselves, at times, unaware that St. Vincent’s ER had closed.
In Ohio, there are rules outlining how hospitals should return medical equipment and handle medical records and follow employment laws when they close, but the state health department and local and state hospital associations don’t provide guidance on how to protect public safety when closing an ER.
That leaves local governments and hospitals on their own to plan for closures, said John Palmer, the Ohio Hospital Association's director of media and public relations.
Hospital closures are common across Northeast Ohio. At least nine emergency rooms have closed in the last 10 years, according to an Ideastream analysis.
City officials said after St. Vincent's ER closed they became aware of problems with service and made changes and provided additional training for dispatchers. Medical center officials said they tested the call box to make sure it was working.
But community members and leaders said St. Vincent and the city dropped the ball on the transition and have questions about how officials managed the removal of a resource many in the Central neighborhood relied on.
'I can't understand you'
There's a call box with a silver push button, the kind you'd find outside an apartment complex, mounted on the wall at the site of the former St. Vincent emergency room. It's there, so that when someone mistakenly shows up at the now-closed emergency room looking for care, they can call 911.
But 911 call recordings show many of the people who used it in the nearly four months after the ER closed struggled to communicate with dispatchers.
The recordings obtained by Ideastream show dispatchers and people calling for help had trouble understanding each other through the call box.
The fuzzy and distorted call quality made it more difficult to navigate the confusion over the former ER's address — which neither dispatchers nor callers, some of whom were in pain or had walked or had taken the bus to get there, had.
"I'm at the new urgent care at St. Vincent," one caller explains.
"Ask someone for the address," the dispatcher responds.
Sometimes a St. Vincent security guard assisted the callers, but even that didn't guarantee they could communicate easily.
"We need EMS. I'm at 2375 East 22 St. Vincent Emergency Room," a security guard told a dispatcher through the call box.
"Sorry?" a dispatcher interjected.
"A female is here with a broken wrist that requires EMS."
"OK, you're coming through kind of low," the dispatcher said. "Where did you say you're at?"
The callers often grew frustrated and panicked repeating answers to questions the dispatchers struggled to hear.
'Innocent people are going to die'
Yvonka Hall, of the Northeast Ohio Black Health Coalition, said the tapes show officials didn’t properly plan for and manage the ER's closure.
“The simple fact is, over these last 25 years of the closing of the hospitals, we have not learned our lesson," Hall said. "We have not learned that when we close hospitals and we don't give people the knowledge that they need, either the ones who are working on the phone lines or the communities at large, that in the end, innocent people are going to die. I would hope that our systems are looking at it the same way."
The city of Cleveland spoke to Ideastream about the closure, but officials would not say who was in charge or explain any plan that may have existed when pressed for details.
Cleveland's Division of Emergency Medical Service learned of problems after the hospital closed and made fixes, including automatically connecting the call box’s phone number with St. Vincent’s address in the EMS system and providing additional training for dispatchers, said Orlando Wheeler, the city’s EMS commissioner.
Cleveland City Council President Blaine Griffin told Ideastream that Councilmember Richard Starr was in charge of the city council’s response to the closure. Starr would not agree to an interview despite repeated attempts to discuss the issue with him.
After Ideastream brought these 911 calls to St. Vincent’s attention, medical center officials tested the call box for us on Oct. 25.
The 911 call taker was able to tell the location of the call and testers outside the closed ER could hear the dispatcher’s voice in the box clearly. But when a reporter spoke to the dispatcher from one or two feet away from the call box the dispatcher had trouble hearing.
“It sounds like maybe you’re in a factory," the dispatcher said.
St. Vincent officials said they tested the call box before the hospital closed, and said it works well.
"The combination of a physical officer there and a direct line to 911 EMS remains the best solution other than actually having a staffed clinical operation, which we're not capable of doing any more," said Brad Rauh, the chief administrative officer for St. Vincent. He said people should always call 911 if they are experiencing a severe medical emergency, rather than taking themselves to a medical facility, to ensure they get to the right hospital more quickly.
The box needed to be tested under the conditions in which people would actually use it, Hall said.
“If you're calling somewhere and you're like, 'OK, what's the number? What's the address? Well, let me go look this up.' And if somebody is in an emergency, what's the likelihood of that happening? So you thought that it needed to be something there, but you didn't test it," she said.
'The ideal world is not a 911 call box'
St. Vincent closed most of its services in November 2022. Community members said the loss of the ER was especially difficult in Cleveland's Central neighborhood, which is 90% Black and where about 70% of people live below poverty. The hospital has operated there since the Civil War.
At a city council meeting last year, before the hospital closed, Councilmember Starr talked about how important St. Vincent was to people in Central.
“One of the things that I think about when I grew up, living in Ward 5, one of the things that we always knew was to get to St. Vincent Charity if you need anything because it's within walking distance," he said.
In the same meeting, Starr shared concerns about how community members would be alerted that the ER had closed.
His comments appear to have been prescient. The call tapes show that, although St. Vincent and the city said they tried to tell residents about the closure, some people didn’t know the ER was closed. EMS records show ambulances were dispatched there 121 times in the 11 months after the closure, though some of those transfers were of patients who were treated in the urgent care and psychiatric ER, which are both open.
The confusion at the closed ER has also caused problems for people trying to access the psychiatric ER, said Sharena Zayed, a community organizer in Cleveland. That stacks trauma on top of trauma, she said.
“I've heard of somebody having a mental health issue and going there for services, and then no one being there," she said. "If you are suicidal, and you go there for help and no one's there, what do you do? And what headspace are you in after that?”
The public was not the only group to struggle to understand which services closed. Once Cleveland EMS learned the ER had closed it mistakenly stopped bringing people to the psychiatric ER for a period of time, said Rauh. That issue was eventually cleared up, he said.
Despite the problems, it was the right decision for St. Vincent to close the ER, said Cleveland’s Director of Public Health Dr. David Margolius. Health outcomes are better when people go to better-equipped and busier emergency departments, like those at University Hospitals and MetroHealth, he said.
“I do not think that there needs to be an emergency room at the St. Vincent location now," Margolius said. "Our challenges, our health outcomes, are not from a lack of hospitals and a lack of emergency rooms."
But some neighborhood leaders disagree. These kinds of decisions coupled with the rocky rollout can inflict further harm on community members who already feel left behind, said Rev. Napoleon Harris of Antioch Baptist Church, which is less than three miles from St. Vincent.
"It's violent, mentally, emotionally, spiritually, to say that you don't deserve health in your neighborhood," Harris said. "You shouldn't be here, this is not for you. All of those are acts of violence. Violence, I understand it as anything that mars my humanity."
The greater problem is a lack of resources
The greater problem is that the community as a whole is under-resourced, but efforts are underway to alleviate that, according to Margolius.
“The ideal world is not a 911 call box, absolutely not," he said. "In the ideal world, what would exist where St. Vincent is right now is primary care practice, outpatient mental health care, crisis care for mental health and a healthy grocery store. All those things are in the works.”
St. Vincent officials said they have opened an urgent care and provided outpatient mental health care in the 13 months since the hospital closed, while also continuing its outpatient addiction treatment and psychiatric emergency services. St. Vincent has also announced it will open a primary care clinic in the new year with Neighborhood Family Practice, a federally qualified health center.
"We haven't figured it all out yet, but we're working very hard to bring additional primary care resources to this site that can provide care and particularly to women and children," Rauh said. "That's something St. Vincent's has not done very (well). It just wasn't part of our makeup."
The city needs to make sure hospitals are sympathetic to the impact service cuts can have on vulnerable communities, said Cleveland Mayor Justin Bibb.
“Despite the fact that... a lot of these hospitals are having a hard time managing the financial fallout from the pandemic, they still have a responsibility to take care of the least among us and take care of our residents," he said.
Government and hospital officials need to get these transitions right because it’s likely more will close, according to Hall, of the Northeast Ohio Black Health Coalition.
In St. Vincent’s case, she and other community leaders feel it’s still not too late to reach residents where they are before it's an emergency.
