Two decades ago, when their local hospital partnered up with Mayo Clinic, people in Lake City envisioned a boost to the quality and prestige of local medical care.

Today, some are having second thoughts. The hospital's labor and delivery services were phased out two years ago, and then last year three physicians and a nurse abruptly resigned from Mayo's Lake City clinic — including one who had served the community for two decades.

Now, one of the physicians has filed an employment lawsuit against Mayo and some members of the City Council are wondering how they can maintain a hospital that serves the community's needs.

"The handwriting on the wall seems to suggest that we are going to have an emergency room that just funnels people out to bigger facilities, which would be Rochester or Red Wing," said Council Member Phil Gartner. "People don't like that. They want to be in their hospital where people can visit them and support them."

The City Council is studying a request from Mayo to amend an affiliation agreement that wed the city's hospital to Mayo management in the late 1990s. Mayo owns or manages several small hospitals in southeastern Minnesota, and has proposed to replace the various local hospital governing boards, including Lake City's, with one regional board.

Some local leaders fear that would leave Lake City powerless to shape the future of the hospital.

"Mayo is highly respected and we feel fortunate to have them in Lake City," said Council Member Greg Schreck. "But we don't want them to take advantage of the reputation … and slight us to [the point] where the care is where it shouldn't be."

Mayo insists it is committed to Lake City. It noted several changes to improve patient care, including an investment of over $1 million to upgrade the hospital's emergency department.

A Mayo spokeswoman said residents of Lake City will still have input under a new board structure. "We want to assure our patients and the Lake City community that they have and continue to receive safe, high-quality care at Mayo Clinic Health System in Lake City," said Asia Zmuda, a Mayo public affairs manager.

Hospitals and health reform

The discord in Lake City comes as Mayo transforms its care model in a number of clinics and hospitals that it absorbed into its regional health system, which radiates out from Rochester and stretches into northern Iowa and western Wisconsin.

Like Essentia in northeast Minnesota and Sanford Health System in central and western Minnesota, Mayo relies on its network to bring referrals to its larger medical centers, where a bevy of specialists and sophisticated imaging and laboratory equipment can treat the most complex medical cases. It's part of a strategy announced two years ago by Mayo CEO John Noseworthy to emphasize primary care at its smaller partner hospitals.

The strategy also allows Mayo to exercise greater control over all levels of patient care, a priority under the Affordable Care Act, which holds hospitals accountable for quality of care rather than just paying for services provided.

But the changes have rankled a number of doctors. Dr. John Renelt said he and other Lake City physicians faced retaliation after they voiced concerns about changes at their hospital. Specifically, Renelt said he objected to proposals that would have replaced physicians in the Lake City emergency room with nurse practitioners, eliminated nighttime surgeries and cut back on the use of certified registered nurse anesthetists on nights and weekends.

"I didn't think it was safe," Renelt said. "Why would we go from what is proven now to something that is less safe?" Renelt sued Mayo in Goodhue County court in early February.

Dr. Steven Adamson, who also left Mayo Lake City last year, said he shared Renelt's concerns. "I had planned on finishing my career there, it was really disappointing. They were extremely disrespectful to us," Adamson said.

Mayo said it could not respond to specific allegations because of the pending litigation, but Zmuda said: "We understand Dr. Renelt's lawsuit raised concerns in the community about the care our patients receive. Mayo Clinic Health System denies the allegations in the lawsuit and will mount a vigorous defense."

Long drive

Whitney Niebeling of Kellogg, Minn., found the changes troubling as she prepared to have a baby. Niebeling first tried to schedule her delivery at the local hospital in Wabasha, which was staffed by Mayo physicians. But Mayo stopped performing deliveries there, so Niebeling tried to make arrangements at Lake City, which soon followed suit. She eventually had her son, 18 months ago, at Winona Health.

Now, she said, it's hard to get primary or specialty care locally. She said doctors don't stay long at the smaller local clinics, and getting specialty care usually involves a long drive. "It would be really great for myself and for my children to be seen by the same doctor," she said. "It is kind of a pain to reschedule and travel to Rochester and see the specialist, or even in Red Wing."

Mayo said labor and delivery services were eliminated in Lake City and at several smaller hospitals partly because the number of births was declining in those communities.

Last week, registered nurses in Lake City joined the dispute, staging an informational picket outside the hospital to protest proposed staff cuts. Mayo's Lake City operation is negotiating with the Minnesota Nurses Association over a new contract, and Mayo wants to drop a clause that currently calls for the emergency department to be staffed by two registered nurses.

Mayo said it respects the rights of its workers to picket, but said safe staffing levels should be set in response to actual needs, rather than a "one size fits all" contract clause.

Both sides are scheduled to go into mediation next month, according to the union.