On one side of a wall inside the Truman Medical Center cafeteria in Kansas City, Missouri, the menu features low-calorie, low-fat and low-sodium meals. On the other side of the wall is a McDonald's, featuring hamburgers and french fries.

The pairing is a sore point for hospital CEO John Bluford who, as chair last year of the American Hospital Association, issued a call to action urging hospitals to eliminate unhealthy food in cafeterias as one way to create a culture of wellness. Serving fast food inside Truman Medical Centers sends "an inconsistent message" to patients, staff and the community, Bluford says.

In 1992, Truman agreed to a 25-year contract with McDonald's, at a time when the financial benefit of having a stable food service client in the hospital outweighed any potential health concerns.

But times have changed, and now other hospitals interested in replacing fast food with more healthful options may find it isn't as easy as it seems. In Ohio, the Cleveland Clinic tried in vain to terminate its contract early with McDonald's 10 years ago. At the time, the clinic's lead heart surgeon (and now hospital CEO), Delos Cosgove, proposed removing all fast food vendors.

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