By Brett Boese, Rochester Post Bulletin

Minnesota Attorney General Lori Swanson will meet Monday with officials from Freeborn County and Albert Lea regarding Mayo Clinic’s plans to consolidate services at its Albert Lea campus.

Freeborn County Attorney David Walker formally contacted Swanson’s office July 25, and a staff member has been assigned to “look into” the complaint for nearly a month, according to AG spokesman Ben Wogsland. Walker raised concerns about whether Mayo’s “past and ongoing business practices violate any state or federal laws,” in addition to anti-trust and monopoly concerns.

The Albert Lea City Council and Freeborn County Board both voted unanimously this week to follow Walker’s lead. Wogsland confirmed Wednesday that Swanson will be in Albert Lea next week for a private meeting with city and county officials.

Additionally, the Post Bulletin obtained a copy of a four-page letter sent to Mayo on Wednesday by Benjamin Velzen, assistant attorney general and manager of the charities division, which oversees nonprofits. It was also sent to the local officials Swanson plans to meet with next week.

The letter confirms a review of Mayo’s consolidation plans in Albert Lea, while also requesting information or data via 23 specific questions broken down under two categories — “Questions regarding governance and decision-making process” and “Questions regarding use of restricted assets.”

Swanson’s office requested Mayo’s response by Aug. 30.

While most of the questions are related to financial issues, nine focus on Mayo’s governance body, which highlights what has been a simmering local dispute.

According to bylaws established when Mayo Clinic Health System acquired Naeve Hospital in 1995, a supermajority vote — 10 of 13 members — is required of the MCHS-Albert Lea and Austin Board of Directors before discontinuing “major medical services” at the corporation.

It’s not believed that such a vote was ever held. Walker said Mayo officials have told him it wasn’t, but Mayo did not respond to the Post Bulletin’s question on that point.

“We are confident that we have complied with all the requirements of our bylaws and the law,” Mayo spokeswoman Ginger Plumbo said Wednesday via email.

Walker anticipates Mayo will contend that services aren’t technically being discontinued since Austin and Albert Lea were merged into one legal entity in 2013, but he feels that argument “does not pass muster.”

“That is the defense I would expect, but I don’t know that I would call that a reasonable argument,” Walker said Wednesday. “It does not pass muster in my mind. The determination of what a major medical service is should include the location of service, aside from whether it’s considered one corporation.

“The bylaws were put in place to protect Albert Lea and Freeborn County from a reduction in service.”

That legal debate follows Mayo’s June 12 announcement that it would be consolidating most inpatient services from its Albert Lea campus to Austin, starting with the intensive care unit in October. Mayo has since explained its decision by pointing to ongoing staffing shortages, a 50-percent reduction of inpatient stays over the last decade, and financial woes — both at the merged Austin and Albert Lea campuses as well as across the entire Mayo Clinic Health System.

Those concerns mirror national trends that have caused many experts to characterize rural health care as being at a crisis point.

“Crisis seems sort of un-Minnesotan — let’s just say there are challenges,” said Allan Baumgarten, an independent health care analyst based in Minneapolis. “There are big challenges to large provider systems, and that’s what Mayo is responding to.”

Mayo made its decision to consolidate services after an 18-month internal review. However, it did not consult with any local officials during that period. Many have claimed to be blindsided by Mayo’s decision. Thousands of residents have rallied around the grassroots “Save Our Hospital” group, which led to a picket outside Mayo’s Rochester campus last week attended by about 150 people.

Rep. Peggy Bennett, R-Albert Lea, hosted a private forum Monday that included representatives from Albert Lea, Freeborn County, Save Our Hospital and Mayo. Democrats Tim Walz and Dan Sparks have previously issued critical statements on Mayo’s plans, but Bennett called the meeting “productive.”

“There’s understandably a great deal of anxiety and fear about Mayo’s plans to shift services out of Albert Lea — I share those concerns and I too am frustrated by how the decision was communicated to the public,” Bennett said. “(Monday’s) meeting was productive, and there seemed to be a shared desire to continue conversations as this process moves forward.”

Mayo said it plans to continue meeting with community leaders about rural health, including a number of one-on-one meetings already scheduled. Albert Lea has a population of 18,000, but its hospital serves nearly 60,000 in the region, which stretches into Iowa.

“Our primary interest is to partner with the community and its leaders in providing access to high-quality health care and to work together to make certain that the citizens of Albert Lea have complete and accurate information about the future of the medical center,” Plumbo said via email.

The letter sent by the attorney general’s office can be viewed here.