WARREN — Trumbull County commissioners and members of Warren City Council have approved conditional letters of support to commit up to $3 million each toward the effort to fend off the closure of Steward Health Care facilities in Trumbull County.

The votes Friday don’t appropriate the money, but rather buys them the weekend to determine what sources within their budgets can lawfully be tapped — whether it’s general fund, opioid lawsuit settlement funds, American Rescue Plan dollars or another pot — before coming back next week to vote on a final OK.

The moves also show a willingness to stand up for Trumbull Regional Medical Center, Hillside Rehabilitation Hospital and several affiliated satellite facilities, their employees and for the health care needs of the region’s residents after Steward Health on Wednesday filed motions in its Chapter 11 bankruptcy case to close the facilities, as well as some in Mahoning County, no later than Sept. 20.

“Time is of the essence. When we originally started this process, we had a two-fold goal — one was to create awareness and two was to create a sense of urgency. Everybody is aware and we are as urgent as it could be,” John A. Guarnieri, president of Warren City Hospital Inc., the nonprofit formed to acquire the assets and operate the hospital, said at Warren’s council meeting.

“We are looking for your support from a financial standpoint to help us bridge the gap with the organizations we are collaborating with to have the funding that allows us to go back to the court with a plan that has the ability from a financial standpoint to be approved,” said Guarnieri, who also is president of Trumbull Regional’s board. “Once we get that in place, we can turn this thing around, eliminate the closure, get back on track, take the hospital over (and) put it into a position to serve the community long-term.”

It’s estimated there needs to be an initial investment of between $20 million and $30 million to acquire the health care centers’ assets and keep the facilities operational for at least 90 days.

“The challenge of starting up what we would almost be calling a new operation, a new entity running a hospital, requires capital to be able to handle our lack of incoming cash,” Guarnieri said. “What we are going to have are bills going out for the first 60 to 90 days, but not much coming back until you’re able to collect, so we need to be able to finance payroll, other expenses on a monthly basis.”

Wednesday’s filing accelerated the efforts of the group, made up of elected officials, community and business leaders, consultants and other stakeholders, including Warren City Hospital Inc.

They’re targeting Monday to get the financial blueprint as well as objections to Steward Health’s closure notices filed with the bankruptcy court in Houston.

“If we don’t get this judge’s attention that we have the wherewithal, the desire to finance this, to show evidence of being able to finance a purchase, it won’t matter … we need to show, first of all, place our objection and show we have a local financing collaborative that is ready to step up and take action and allow for the sale of this hospital and a new operation,” Warren Mayor Doug Franklin said.

BACK-TO-BACK

Commissioners Mauro Cantalamessa, Niki Frenchko and Denny Malloy at their 2 p.m. special meeting unanimously approved their motions. The up to $3 million investment is conditional on a review of the plan and majority approval of the board.

“From a commissioners’ standpoint, we issued a letter of commitment that is contingent on some things, the biggest contingency on what is lawful and legal,” Malloy said at council’s meeting. “Our prosecutor is looking into that now … as far as we are concerned, we’re going to try to find the money anywhere and everywhere we can, turning over every rock and shaking every tree.”

Also, said Malloy, local foundations are looking into if grants can be used, banks are looking into if low-interest loans are available and the Ohio Auditor’s Office is looking into if other types of financing are available.

Gov. Mike DeWine’s office, as well as U.S. Sens. Sherrod Brown, D-Ohio, and J.D. Vance, R-Ohio, have been engaged in the effort to keep the facilities open as well.

About two hours after the commissioner’s meeting, council voted 8-0 because two members, Councilwoman Helen Rucker, D-at Large, and Councilman Gary Steinbeck, D-at Large, were absent.

“What we need to do is move now,” Councilwoman Honeya Price, D-6th Ward, said of filing the financial wherewithal statement by Monday. “I’m all in.”

Said Councilman James Shaffer, D-4th Ward, the ward that contains Trumbull Regional, “this is like a no-brainer. We have to somehow, some way save the hospital … we cannot let this happen here in the city of Warren.”

THE FACILITIES

Trumbull Regional employs about 700 people, has a payroll of about $70 million and contributes about $1.5 million to Warren in income tax.

“In essence, you’re not just saving the hospital, you’re saving the careers of 700 people and your saving … the only trauma hospital, the only heart hospital, 30,000 ER (emergency room) visits, so this is a community thing, not a Waren issue and not a Trumbull County issue,” Councilman Michael O’Brien, D-at Large, said. “I would hope in the future other entities are part of this same process.”

According to Guarnieri, the hospital’s emergency department had about 30,000 visits in 2023; it is the only hospital in Trumbull County that provides beds for behavioral health and “we would like to expand that if the hospital is not there going forward,” he said; and Trumbull Regional is a Level III trauma center that provides “awesome care for critical emergency needs that really only they can take care of.”

Also, Trumbull Regional is the Valley’s only accredited chest pain center.

Trumbull Regional, however, is the only facility that provides behavioral health beds at the moment.

Mercy Health, in a joint venture with Lifepoint Health of Tennessee, is building a 72-bed behavioral health hospital in Liberty. It is expected to open in 2025.

In addition, there is a residency program at Trumbull Regional. Operated by Western Reserve Health Education, Inc., it has residency programs in internal medicine, general surgery and primary care.

“Without the hospital, where are those residents going to go?” Guarnieri said.