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CHAPTER TEN
It was a neighborhood in need of transformation.”
“
When Akram Boutros, MD, arrived as the new President and CEO of MetroHealth in June 2013, he made one thing perfectly clear to the Board of Trustees: He was not going to build a new hospital to replace the aging, iconic towers on MetroHealth’s main campus.
“I’ve run hospitals in New York where the buildings are over 120 years old,” he explained later. “I had no intention of following through on their plans to build a new hospital tower.”1
Six months later—on January 6, 2014—a polar vortex nearly paralyzed Cleveland. Temperatures plunged to 11 degrees below zero. Winds gusted to 30 miles an hour, making the air feel as cold as 48 below. Across the country, schools closed. Airlines canceled thousands of flights. And more than 20 people died. Inside MetroHealth’s aging hospital, temperatures fell, pipes burst, and scalding hot water shattered ceiling tiles, gushed into patient rooms, cascaded down stairs, and spilled into the hallways. Nurses scrambled to move patients to warm, dry rooms, and emergency plans kicked in.
“I came close—twice—to evacuating the hospital,” Dr. Boutros explained. “And if you evacuate a hospital due to structural issues, you lose complete confidence. The public loses confidence, the doctors, the nurses lose confidence. It really is the beginning of the end.”
In this case, it was the beginning of the beginning—of The MetroHealth Transformation.
Later that year, MetroHealth announced it would begin constructing a Critical Care Pavilion, two new floors on top of its Emergency Department with 85 private rooms, to care for the most seriously ill and injured patients. It would be a lifeboat until the health system could rebuild its main campus hospital, which had anchored the Clark-Fulton neighborhood for decades.
First, though, the Board had to decide where to build the new hospital.
Again, Dr. Boutros called on his experience in New York.
“When St. Vincent’s Catholic Medical Center closed there [in New York], it was terrible for the community,” he said, “and that was Manhattan. So, I said to the Board and the county, ‘this would be an economic Chernobyl.’
“Once we made that decision [to stay in the Clark-Fulton neighborhood], we said spending a billion dollars just to create a facility for us didn’t make sense. We needed to use it as a catalyst to transform the neighborhood.”
It was a neighborhood in need of transformation.
Back then, there were signs that a renaissance was about to start in Clark-Fulton, on the near West Side of Cleveland. But much of the neighborhood bore the scars of a troubled past: boarded-up windows, rusty padlocked metal gates barring storefront doors, houses with peeling paint and sagging porches. In May 2013 came the deepest scar of all: the arrest of Ariel Castro for holding three young women captive inside his home for ten years—just a few blocks from the hospital.
There were signs that a renaissance was about to start in Clark-Fulton, on the near West Side of Cleveland.
Its more than 12,000 residents include the densest population of Latino residents in Ohio.
Bordered roughly by I-90 to the north, West 25th Street to the east, Woodbridge Avenue to the south, and West 44th Street to the west, the neighborhood covers nearly one square mile of houses, apartments, and small businesses. Its more than 12,000 residents include the densest population of Latino residents in Ohio.2 For decades, residents, many of them new immigrants, considered Clark-Fulton a temporary home. As soon as they could afford to, they would move out. And they would take their families with them.
For good reason.
Forty percent of the residents lived in poverty. Sixty-nine percent of those older than 25 had no college education. And the median family income was $28,175 a year, less than half the national average.3
Many institutions would have seen those statistics as reasons to leave Clark-Fulton. For MetroHealth, they were reasons to stay—and the perfect way for the public health system to continue fulfilling its mission of creating a healthy community for everyone.
Five months after the polar vortex, MetroHealth unveiled its campus transformation plan and announced it would rebuild on West 25th Street. Instead of using tax dollars, it would finance the project on its own credit, selling bonds instead of spending taxpayers’ money. The sale of nearly $1 billion in hospital revenue bonds was completed in 2017, a year after the new Critical Care Pavilion opened. Construction of the new hospital, just feet away from the existing building, began in 2019.4
While the planning was underway, MetroHealth found other ways to help improve its neighborhood.
Long before work began, in 2016, when the historic Lion Knitting Mills were being converted into 36 affordable loft apartments two blocks from its main campus, MetroHealth threw its support behind tax credits and other incentives that helped finance that project. Those apartments opened in 2017, the same year MetroHealth invested in the Greater Cleveland Regional Transit Authority (RTA) bus route, which runs past its West 25th Street hospital and four other MetroHealth locations. MetroHealth supported the line, the second-most used in the RTA system, to provide safe, affordable transportation for patients and employees and to boost economic development, in the same way the RTA’s Public Square–to–University Circle HealthLine reinvigorated Euclid Avenue.5
Then, in January 2018, the Plain Dealer announced MetroHealth’s plans to become the nation’s first hospital in a park by surrounding its new 11-floor hospital with 25 acres of green space. The main feature of that green space would be a 12-acre park along West 25th Street. The park would be open to the public and would connect to the Towpath Trail, a 101-mile hiking and biking path that offers scenic views of the Cleveland skyline and the Cuyahoga River.6 That same article explained that the project would also be part of an EcoDistrict, new urban regeneration that puts people and the environment at the center of change, making sure growth and development focus on community well-being and equity. MetroHealth sought that designation for a number of reasons: to ensure housing remained affordable so current residents were not forced out of their neighborhood; to give residents a voice in the changes that would be made; and to improve the physical, emotional, and financial health of the Clark-Fulton neighborhood.
In the process of seeking an EcoDistrict designation, MetroHealth officials met with representatives of the Metro West Community Development Organization, a nonprofit dedicated to preserving the history of and revitalizing Clark-Fulton and two adjoining neighborhoods. Its executive director, Ricardo León, had a neighborhood master plan in the queue, and Greg Zucca, MetroHealth’s Director of Economic and Community Transformation, suggested they collaborate. The City of Cleveland and Cleveland Ward 14 Councilwoman Jasmin Santana hopped aboard, and the project drew the interest and financial support of the Cleveland Foundation.
MetroHealth announced three more construction projects that would invest another $60 million or more in the neighborhood.
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“Once we made that decision [to stay in the Clark-Fulton neighborhood], we said spending a billion dollars just to create a facility for us didn’t make sense. We needed to use it as a catalyst to transform the neighborhood.”
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Steps toward launching the master plan were underway when Dr. Boutros walked on stage on June 28, 2019, at MetroHealth’s Annual Stakeholders Meeting and announced three more construction projects that would invest another $60 million or more in the neighborhood. The first, he said, would be 72 low- to moderate-income apartments on MetroHealth’s main campus, for those earning 30 to 80 percent of the area’s median income. Much of the credit for that project, he made clear, belonged to Cleveland Mayor Frank Jackson, Councilwoman Santana, County Council President Dan Brady, and the Metro West Community Development Organization. The affordable apartment building, he said, would be home to an Economic Opportunity Center, a place where people could learn resume writing and interviewing and job preparation skills; a place that would help them find work, finish school, and start new businesses; a place where futures would be nurtured.7
The other two apartment buildings, he said, would include commercial space for a coffee shop, grocery store, childcare center, and restaurants. One would also house MetroHealth’s police department. The officers’ presence, along with increased activity generated by the new homes and businesses, he said, would forge a safe, healthy environment.8
The public health system understood the connection between affordable housing and a person's health. Families that spend more than 30 percent of their household income on rent often must choose between other necessities, such as food and medicine.9 To MetroHealth, affordable housing was just as essential as the long-term health of Clark-Fulton.
“Our aim is to help people moving up [the economic ladder] to stay here, instead of moving to different communities,” Mr. Zucca said.10 That help, he explained, includes offering affordable rental property to people of all ages, including seniors, as well as down payments and other assistance to those interested in buying new single-family homes.
To give shape to that vision, MetroHealth enlisted the NRP Group: a developer, owner, builder, and manager of best-in-class multifamily housing units. In February 2021, MetroHealth and NRP broke ground on Via Sana (Spanish for Healthy Way), the $15 million low- to moderate-income apartment building Dr. Boutros announced earlier. In October of that year, after two years and more than 20 public meetings, the Clark-Fulton master plan was presented to the Cleveland Planning Commission, which approved it unanimously. The blueprint is designed to achieve eight goals that include preserving and creating housing opportunities without displacement; fostering healing, health, and inclusivity; and building community prosperity through equitable economic and educational empowerment.
The public health system understood the connection between affordable housing and a person’s health. Families that spend more than 30 percent of their household income on rent often must choose between other necessities, such as food and medicine.
“Collaborative leadership is an important part of community building,” Councilwoman Santana noted. “The stakeholders may not have all agreed on everything . . . but we shared the vision of a higher quality of life for residents and homeowners.”11
Two months later, the Clark-Fulton/MetroHealth EcoDistrict was certified and became the first in the nation by a major healthcare system.12
And, in the summer of 2022, residents began moving into Via Sana.
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In February 2021, MetroHealth and NRP broke ground on Via Sana (Spanish for Healthy Way), the $15 million low- to moderate-income apartment building.
“We were very disenfranchised,” said Councilwoman Santana, who represents Clark-Fulton and has lived in the neighborhood for 30 years. “This area was neglected. No one heard us. Now we have a voice.
“We’re not there yet, but we’re moving toward a healthier Clark-Fulton, our quality of life is changing. I’m seeing more kids walking, people moving in, there’s definitely more development, more economic vitality. I can see that in Clark-Fulton now. I see people wanting to stay. Now, there’s a sense of pride in our neighborhood.”
What MetroHealth is doing in the Clark-Fulton neighborhood is just one example of the way it builds hope for those often overlooked by others.
The new Behavioral Health Hospital that MetroHealth is building in Cleveland Heights is another example. The 112-bed hospital opens in the fall of 2022 with separate floors for adolescents, adults, and elders struggling with addiction and depression, mood disorders, and other mental illness. Before the project was announced, experts estimated the greater Cleveland area needed more than 200 additional beds to provide care for those illnesses. The new MetroHealth hospital set out to meet approximately half that need.
Another example is The Moms House, which MetroHealth opened in January 2021. The well-furnished duplex near the main campus provides safe, supported housing for women who are pregnant or have recently given birth and who are recovering from opiate and other substance use disorders. It is part of MetroHealth’s Mother and Child Dependency Program and is one more way the public health system provides nonjudgmental medical care that helps moms and babies stay healthy. One study, using a social determinants of health framework, found that housing insecurity during pregnancy increased the chances of a preterm birth by 20 percent, a longer hospital stay by 60 percent, and hospital readmission within three months by 170 percent.13
These projects—The Moms House, the Behavioral Health Hospital in Cleveland Heights, and MetroHealth’s work to make the Clark-Fulton neighborhood a vibrant, welcoming place for people of all backgrounds and incomes—stand as proof that MetroHealth has not strayed from its original purpose. In 2022, it is still committed to helping those in need, those forgotten by other institutions, those who’ve been pushed aside or misunderstood.
In the same way that City Hospital, back in 1837, put an end to sending the poor out into the cold wilderness to survive on their own (those like the penniless Mrs. Betsy Wood and her four children), MetroHealth continues to create opportunities for people who are convinced theirs have run out.
Hope, health, and humanity.
They are the ideals that City Hospital was founded on, the ideals that live, all these years later, in the hearts of MetroHealth employees today, the ideals that sustained it as it grew into one of the longest-serving institutions in the history of Cleveland.
MetroHealth is proud of that history. But it is prouder still that those same ideals are shepherding it into the future, a future made brighter by the compassion and foresight that the leaders of Cleveland brought to life 185 years ago.
The new Behavioral Health Hospital that MetroHealth is building in Cleveland Heights is a 112-bed hospital that opened in the fall of 2022 with separate floors for adolescents, adults, and elders struggling with addiction and depression, mood disorders, and other mental illness.
The Moms House provides safe, supported housing for women who are pregnant or have recently given birth and who are recovering from opioid and other substance use disorders.
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