Ousted MetroHealth CEO Akram Boutros was going to ask county council for $7.6 million Tuesday for behavioral health care

Akram Boutros

Dr. Akram Boutros is president and chief executive officer of The MetroHealth System.


CLEVELAND, Ohio – Before the MetroHealth board fired CEO Akram Boutros, accused of giving himself more than $1.9 million in unauthorized bonuses, he planned to ask Cuyahoga County Council for more money.

Documents submitted to council show he was seeking an additional $7.6 million for the public hospital that would “only be used to pay for providing behavioral health and addiction services to uninsured and under-insured Cuyahoga County residents.”

It’s a topic he has been vocal about in the last year. During his last budget appearance in 2021, Boutros asked council for another $20 million to overhaul the county’s response to the opioid crisis, based on his “grave concerns about the delivery, coordination, and oversight” of the current treatment and services being provided.

Those concerns persisted.

“I truly believe the challenge of providing behavioral health care to our community is the challenge that will define us for at least the next decade, if not longer,” Boutros wrote in a prepared statement he planned to read Tuesday, a copy of which was obtained by cleveland.com. “Put bluntly, no one is coming to rescue us. It’s up to the County and MetroHealth to address the problem.”

The day before he was to make those statements, however, he was fired. The MetroHealth board of directors late Monday announced the decision after it said Boutros gave himself more than $1.9 million in unauthorized bonuses. Boutros, who has denied the allegations and accused trustees of retaliation, led the hospital system for nearly 10 years and was set to step down this month.

MetroHealth asked to reschedule the budget presentation Tuesday. It’s unclear when the new date will be.

Boutros’ statement gives an indication of what he hoped to discuss.

He touted the opening of the $759 million Glick Center acute care hospital and the $42 million, 112-bed Behavioral Health Hospital in Cleveland Heights, expected to treat about 5,000 patients a year for conditions such as bipolar disorder, depression, addiction, mood disorders and dual diagnosis, or having both mental illness and substance abuse.

He also praised the work the hospital has done to provide behavioral health care and addiction treatment in the county jail.

“But, of course, there is more work we can do,” Boutros wrote. “There is more work we must do.”

MetroHealth currently provides about $220 million of free care to county residents every year, paid for from $32.4 million in Health and Human Services property taxes. But those dollars are spent in the first three months of the year, he said, and MetroHealth has been absorbing the losses.

MetroHealth especially loses money on patients treated for mental illness or substance use disorder, he said. He estimated the hospital will lose more than $13 million on behavioral health care this year, and there has been an increase in psychiatric patients since St. Vincent Charity Medical Center closed its inpatient and medical emergency room.

Next year, he projected losses to grow to nearly $17 million.

“It’s not sustainable,” he wrote.

He planned to ask council to restore MetroHealth’s Health and Human Services tax levy appropriations to the full $40 million it was receiving before it voluntarily accepted a cut seven years ago, so the Alcohol, Drug Addiction and Mental Health Services Board would not lose any of its funding.

“The lack of coordinated access along the continuum leaves mental illness and addiction unaddressed, resulting in patients seeking help only after crisis strikes, with increases in preventable suicides, overdoses and arrests,” Boutros wrote. “Without meaningful planning and decisive action, the problems will grow and more patients will receive mental health and addiction care through more costly settings, such as Emergency Departments, in jail cells or through DCFS (the Division of Children and Family Services).”

His request came amid “staggering financial losses” across all hospital systems in 2022 that he expected to continue in 2023. His slideshow presentation referenced “unprecedented margin pressure and cash erosion,” with industry sources showing margins down 37% at best, relative to pre-pandemic levels, or 133% at worst.

MetroHealth was not immune to those pressures, he wrote.

The health system’s expenses grew nearly 9% this year, while revenue grew only 3.6%, he said. Rising labor costs and workforce challenges resulted in a $57.8 million year-over-year increase in salaries, wages and related employee benefits costs, according to the presentation.

MetroHealth was working to mitigate significant losses, including reducing capital expenditures by $10 million, and expected to end 2023 with a target of $160 million, but projections estimated it could also be roughly $60 million less.

“We would still be able to pay the bonds, and provide care, but we would also be facing tough decisions about the breadth and scope of services,” Boutros wrote in his statement.

Boutros expected it to be the last time he addressed council as MetroHealth’s CEO and president, and looked favorably on his stewardship.

“MetroHealth has accomplished so much over the past 10 years, to the benefit of our patients and our community,” he wrote, thanking the county for its support. “This partnership has saved lives. Full stop.”

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