The Key West Mystique

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Lower Keys Medical Center Mandy Miles Keys Weekly

Lower Keys Medical Center | Ownership fails the community and made $31 million last year

By Linda Grist Cunningham, editor and proprietor

Linda Grist Cunningham is editor and proprietor of Key West Island News and KeyWestWatch Media LLC. She and her husband, a park ranger at Fort Zach, live in Key West with their Cat 5s.


I’ve got a friend who refuses to call the Lower Keys Medical Center a hospital. He’s adamant that even calling it a clinic gives it too much credence. I’ll leave out his swear words, though there’s probably not a soul on the island who hasn’t used a few when it comes to Key West’s Lower Keys hospital.

To be fair, these same frustrated folks are as likely to tell you they had a decent, if not great, experience the last time they walked through the hospital’s doors on College Road. Healthcare works that way: Love your caregiver or doc; hate the bureaucratic swamp of billing, unanswered phones, staffing shortages, months of waiting and communication failures.

LKMC hospital administration touts Medicare’s four-star rating as proof it’s doing a good job. It doesn’t mention that the rating puts it right there with state and national averages, most of which aren’t exactly stellar. A four-star hospital isn’t the equivalent of a four-star resort. More like a 2.5 kinda budget motel.

Administrators don’t talk much publicly about the abysmal two-star rating from patients about their experiences — except to say that if those patient ratings were better, they’d get a bump to the five-star category. Nor do they talk about the existing 63 job postings, including physicians and surgeons. For a facility that says it has 144-200 employees, that’s a lot of empty spots.

Established by the legislature in 1967 as a special taxing district with board members appointed by the governor, the Lower Florida Keys Hospital District is supposed to “establish, construct, lease, operate and maintain a hospital or hospitals, medical facilities, and other health care related facilities and services as in its opinion shall be necessary for the use of the people of the District.” The district encompasses the Seven Mile Bridge to Key West and can levy additional taxes, which it has not done since 1999, when it contracted with a for-profit corporation to manage the facility.

Minutes from district board meetings indicate at least three openings on the board. Outreach to the governor for replacements has been unsuccessful, and the minutes reflect ongoing frustration about inactive or non-attending members.

Lower Keys Medical Center

Lower Keys Medical Center | A key decision in 2029

The hospital district board in 2029 faces a game-changing decision when the current 30-year contract with Community Health Systems of Franklin, TN, expires. Does it extend the lease with CHS? Contract with another health systems operator? Or begin levying taxes high enough to operate the hospital itself?

A for-profit company, CHS is carrying crippling debt and has sold off 165 of its original 206 hospitals. CHS is, at best, a questionable choice to operate our hospital. It’s also under investigation by the U.S. Justice Department for a Lower Keys complaint that includes “practices and procedures related to utilization review, inpatient admission and inpatient dialysis at our hospitals.”

In 2023 CHS reported $967 million in operating income, $822 million more than in 2022. Financial records reported by Key West City Commissioner Sam Kaufman to the City Commission last year indicate CHS pulled about $31 million in profit from Lower Keys. CHS also closed the one cancer treatment center in Key West and has been unsuccessful in finding a replacement.

Four things are clear:

  • (1) Going it alone in today’s messy, inefficient, bankruptcy-inducing healthcare world should be off the table. There aren’t enough unicorns and Keys taxpayers to consider that option.
  • (2) CHS as a corporate entity is struggling.
  • (3) Its profitability in the Lower Keys is helping sustain the corporate balance sheet in Tennessee rather than returning those funds to the community.
  • And (4) short of a breakthrough, the island could find itself without a hospital within five years.

If you think healthcare in the Lower Keys is hard to come by now,

just let that last one sink in.

There is hope. A grassroots organization, Our Hospital Key West, has pledged itself to be the advocate for what it calls “best-in-class hospital ownership.” It’s already taken on the heavy-lift of ensuring transparency in upcoming negotiations, laying out the complicated financial dealings and translating the bureaucrat-speak of healthcare ratings and processes. Commissioner Kaufman says he is committed to ensuring City Commission involvement.

OHKW wants you to become part of this effort, and you can do so by signing up on its website. And, by the way, they’re not asking for money.

Two of OHKW’s founders are among my friendly acquaintances, so you need to know I have a potential conflict of interest. More important, we all have a dog in this hunt. We’ve got less than five years to derail the destruction of healthcare in the Lower Keys.

EDITOR’S NOTE: Featured above image by Mandy Miles, Keys Weekly.

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