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Cook County Board President Toni Preckwinkle is offering tough legal talk as a state regulatory panel weighs whether to reverse course and allow Oak Forest Hospital to be turned into a clinic.

The new county leader penned a letter to the Illinois Health Facilities and Services Review Board, which rejected the hospital closing idea in March. In it, Preckwinkle, who supports the conversion to a clinic, notes that state law allows the county to maintain a hospital but doesn't legally require it to do so.

"One concern with a denial … is that it may ultimately be deemed an attempt on the part of a state agency to require Cook County to maintain certain inpatient serves which are not within its budget and, thus, would be tantamount to an unfunded state mandate," Preckwinkle wrote in the April 12 letter to the state board's chairman, Dale Galassie.

In a statement to the Tribune, Preckwinkle said she wrote the letter "upon the advice of counsel."

A spokesman for the county health system's independent board went a little further.

"This is a potential legal theory we may pursue and wanted to reserve so we felt it was appropriate to bring it to the (state) board's attention," spokesman Lucio Guerrero said.

Preckwinkle's comments are expected to be read Monday by William Foley, the hospital system's outgoing chief executive, at a state hearing requested by nurses concerned about potential job losses if the county plan goes through.

Galassie said Preckwinkle's letter will be taken into consideration, but that the board needs to consider the community's perspective as well. The county's plan has drawn criticism from patient advocates and medical professionals about lost services and jobs in the area.

"(Preckwinkle's) opinion is respected, and part of the record and part of the process," Galassie said. "There's a significant process. …They're not talking about closing the services there. They're talking about altering the type of services that they believe will ultimately be more comprehensive. And that is yet to be determined by this board."

The Monday hearing comes before a May 10 state board meeting where members could vote for a second time on the county's request to replace the expensive inpatient hospital care in Oak Forest with an outpatient center, including primary care doctors, specialists and diagnostic testing.

County officials have been working on the plan for more than a year, and the hospital system's budget is contingent on Oak Forest operations being discontinued by June 1.

eslife@tribune.com