Illinois regulators are scheduled to decide the fate of Mercy Hospital on Tuesday, about five months after the historic medical center on the Near South Side announced that it wanted to shut down during a pandemic.

Mercy — the first chartered hospital in Chicago — says it has been treating fewer patients and operating in the red for years. Located in the Bronzeville neighborhood, Mercy tried to merge with three other South Side hospitals. But Illinois lawmakers wouldn’t help foot the billion-dollar bill, so the deal ended.

“The decision to discontinue Mercy Hospital was not an easy one … but rather, the culmination of a multi-year, multi-factorial process that ultimately resulted in the consensus that Mercy Hospital needed to be at the forefront of transforming the health care options available on the South Side of Chicago and needed to move forward with a new model of care,” Mercy attorney Edward Green wrote in July to state regulators.

Ever since, patients, physicians, health advocates and activists have rallied against the closure.

The majority of Mercy’s patients are Black, and doctors there also treat many Cantonese-speaking patients from nearby neighborhoods, including Chinatown. During COVID-19, Black and Latino Chicagoans have gotten sick and died the most, public health data show.

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And a new state report shows that Mercy’s closure would create major health care access issues for people who need emergency care, in particular. Patients who would have gone to Mercy would have to travel at least five miles to another hospital emergency department. That’s according to the report from the staff of the Illinois Health Facilities and Services Review Board, which is the regulatory board that’s scheduled to vote on Mercy’s closure.

“The loss of emergency care services will result in health risk to the population that Mercy Hospital serves,” according to the report.

Late Friday afternoon in the wind and light rain, dozens of people formed a giant circle in front of the Thompson Center downtown and called for lawmakers, including Democratic Illinois Gov. JB Pritzker, to stop the closure.

“How are we supposed to provide patient care when you cannot support us on the other end,” Dr. Anudeep Dasaraju, an emergency medicine physician who treats patients at Mercy, shouted from the middle of the circle. “We are fighting two battles here, and we feel like we are losing. Despite what happens on the 15th, we will continue to fight.”

The group then walked on to Randolph Street and briefly shut it down as they formed another large circle, chanted and prayed.

Why Mercy is closing

Before the pandemic, hospitals across the country watched their beds empty out as they treated fewer patients — losing the money they would have generated. Many advances in medicine mean patients no longer need to be hospitalized. Family doctors have been working to prevent people from getting sick in the first place and from winding up in expensive emergency departments. Meanwhile, immediate and urgent care centers have become convenient and cheaper alternatives to hospital emergency departments.

The ripple effect on the South Side is evident in the services hospitals have cut over the years, particularly obstetrics.

Consistently, Mercy has only staffed just under half of the roughly 400 beds in the hospital.

In his letter to regulators on behalf of Mercy, Green underscored how health care has changed, and how the hospital’s patients disproportionately suffer from chronic medical conditions and need more preventative care, rather than expensive hospital care.

“The COVID-19 pandemic has further highlighted these disparities,” Green wrote.

Mercy’s proposal: close the hospital and its half a dozen clinics, then open a new outpatient center with urgent care services that would treat some 50,000 people a year. Doctors there would focus on prevention.

There’s also a financial reason to close. Green wrote that Mercy needs at least $100 million in the next five years to “maintain a safe and sustainable acute care environment.” The hospital has said it’s losing about $4 million a month.

Mercy pushes back

The review board that plans to vote on Mercy’s closure is a nine-member board appointed by the governor. It currently has just six members — there are three vacancies — and needs five votes to approve or deny a project.

The board regulates the health care industry to prevent the duplication of medical services. Hospitals come before the board when they want to acquire another hospital, start or stop providing a medical service or, in Mercy’s case, close.

Board staff members review the proposals to make sure they meet state guidelines, but board members are known for not always following their staff’s findings.

In Mercy’s case, board staff members found that the hospital does not meet some standards to close.

For example, Mercy has one of the busiest emergency departments in Chicago, treating on average about 57,000 people a year. Other hospitals would have to absorb those patients. Mercy’s closure would also leave a hole in intensive care beds for the sickest patients, and no hospitals in the area would have physical rehabilitation beds for patients. Mercy staffs 16 physical rehab beds.

Mercy also treats a large portion of patients who need outpatient care, like a check-up at the doctor’s office. Over a five-year period ending in 2019, Mercy averaged about 360,000 outpatient visits a year — accounting for more than one in every four visits among all hospitals in the area.

The report also reveals some other details, including that Mercy was slightly profitable in 2020.

Mercy is pushing back on the board staff members’ report. In a letter to the board, Green said other hospitals in the area have enough beds to treat Mercy’s patients. In fact, he said Mercy’s closure could help other hospitals, including Cook County-run Provident Hospital about three miles south, by sending patients (and the money they generate) their way. The county recently downgraded Provident’s emergency department to a stand-by department, and Provident is laying off staff amid a budget crunch.

“Transformation is the only feasible path forward for Mercy Hospital,” Green wrote. “And, just as importantly, it will hopefully motivate the State of Illinois, Cook County, and the other healthcare providers in the region, to begin to transform how healthcare is delivered on the Southside of Chicago so the disparities and inequities can start to abate.”

Green added that Mercy was profitable in 2020 only based on a one-time cash infusion from the state and federal governments

Mercy has already started transitioning patients to other hospitals. If approved, Mercy plans to close by May 31.

Ann Guild, a compliance analyst with the review board, said she couldn’t recall a time when the board rejected a hospital’s request to close.

But if the board does vote no, Mercy could come back for a second vote, followed by an administrative hearing if the board rejects Mercy’s bid to close a second time.

Ultimately, Mercy could take the state to court, or the hospital could just close and be fined.

The fine is $10,000, plus another $10,000 for every 30 days the hospital stays closed without permission from the board.

Kristen Schorsch covers public health on WBEZ’s government and politics team. Follow her @kschorsch.