Tuesday, June 21, 2016

Mixed Messages

 “News is what someone wants suppressed. Everything else is advertising.”

 — Katharine Graham, Publisher of The Washington Post during the Watergate scandal

The following was submitted by a Boise business leader:
Monday June 20, Boise resident Bob Kaiser submitted the following letter to the editorial board at the Idaho Statesman.  The letter challenges the editorial board's published opinion that all of the proposed St Luke's expansion's medical office buildings (nearly half of the project) should be located on their downtown hospital campus, to provide proximity and convenience. Ironically, this position directly contradicts the newspaper's own reporting by its health care business reporter, who has won national and state awards for her reporting on health care and public affairs. 

Here is the rebuttal letter:

Dear Statesman editorial board:  

I would like to introduce you to newspaper reporter Audrey Dutton.  Audrey is an award winning Healthcare reporter for the Idaho Statesman, your very own newspaper. Over the last 4 years, Audrey's in-depth healthcare articles have educated many readers in Southwestern Idaho about the reasons behind the high cost of healthcare.

In Sunday's editorial regarding St Luke's expansion, you wrote, "Though some have suggested that the St. Luke’s plan includes an inordinate number of medical office buildings that could be located elsewhere in the city, we don’t buy that. To the contrary, we feel the proximity and convenience in the new plans serve patients trying to get well." 

Yet, in one of Audrey’s articles printed in the Statesman on October 28, 2012 she summarized, "HOSPITAL-BASED = HIGHER CHARGES" and in that article she went on to detail why that is the case.  Per your own newspaper's investigative reporting it has been shown that outpatient visits, procedures, labs, imaging, all cost significantly more when delivered on a hospital campus. 

The question I’d like to ask the editorial board is this; do you read your own newspaper reporting or just the corporate press releases and paid advertising?

Bob Kaiser, Boise

The proposed St Luke's expansion includes nearly 300,000 square feet of medical office buildings, which includes outpatient services and doctor offices. In many cases, outpatient doctors do not provide inpatient care, which is typically handled by a hospitalist. All three Medical Office Buildings and associated parking could be easily built on St Luke's 5.6 acre downtown Boise property on Fairview Avenue, between 25th and 27th Street, or their Americana property or their Meridian Campus. A new medical office building complex could provide outpatient visits, procedures, labs, imaging, and offer affordable off-campus healthcare with proximity and convenience.

If the proposed St Luke's expansion were completed, it would have nearly 100,000 square feet more space in just Medical Office Buildings than the entire square footage of the St Luke's Meridian Campus.

In an October 30, 2015 IdahoStatesman article, Audrey wrote about a cancer patient's out-of-pocket costs increasing 490 percent after her doctor joined St. Luke's.

"When a cancer patient wrote an email to St. Luke’s CEO David Pate saying her costs for blood work spiked from $40 to $236 after her doctor joined St. Luke’s, she prompted a string of emails among St. Luke’s employees and leaders.

Her blood work was suddenly billed as occurring in a hospital, and her insurance plan wouldn’t cover that, leaving her with the full charge."

Middle-class families are experiencing rising healthcare costs first-hand through ever increasing employee contributions, larger deductibles, and co-pays.

Given a choice, most Treasure Valley residents would choose affordable healthcare that is closer to the county's population center over the hardship of surprise hospital-based blood work costs that may increase 490 percent and having to cover the cost themselves because their health insurance does not.

Keep Boise Connected, Inc. has never been against better or more convenient health care.  What we have opposed is the taking of our public streets for the primary purpose of generating more profit for a supposed not-for-profit entity, particularly when there appear to be obvious and better options for the community.  It doesn't help when the very institutions that are supposed to act as a safeguard on the public's behalf, namely our government and our local press, have seemingly "sold out" on their responsibilities.


Public Isn't Served by More Street Closures

What do independent thinkers have to say? 

Read the comments below, then let ACHD Commissioners know what you think about diverting their time and resources from pressing infrastructure needs throughout Ada County. Tellus@achdidaho.org

St. Luke's has been pouring money into local nonprofits, political campaigns and heavy rotation media buys, with predictable results. These funds come out of the pockets of patients, public and private insurers, and taxpayers.

But there are still many Ada County residents and independent experts whose endorsements aren't for sale—at any price. They speak out not for personal or political gain, but because they believe citizens and taxpayers—not private corporations—should have a say in the future of our community.


"St. Luke's Boise provides an invaluable service to the community, however their growth has over the years had a negative impact on the surrounding neighborhoods. The time has come to draw the line at Jefferson St. and redirect St. Luke's future growth to the Meridian campus."
—Peter Angleton, M.D.

"Most troubling is the high-handed way St. Luke’s has approached its proposed master plan. Apparently its administrators haven’t heard of strategic development of informed consent."
—Gary Richardson, Former ACHD Commissioner



"Citizens who devote substantial time and effort to work within the system only to see its requirements for honest, constructive give-and-take ignored by policy makers will be disillusioned and unlikely to use this avenue again. The consequences of citizen disengagement are subtle but ultimately devastating to creating the "livable city" our leaders say they want."

—Diane Ronayne, Former Boise P&Z Commissioner



“Hospitals have this implied mission of ‘do no harm’…but by fundamentally creating a superblock in a choke point in your city, they (St. Luke’s) are in fact, harming the city...I think a cycle track is a great exercise amenity...it's not necessarily about connectivity and healthy community planning and design."
 —David Allison, FAIA, FACHA—Alumni Distinguished Professor and Director of Graduate Studies in Architecture + Health at Clemson University

"For community health, it benefits all to have a safe route of access to downtown, whether on bike, foot, or car. Jefferson Street is the safest route for a child, commuter or family to access downtown. The solution to growth is reconfiguration, avoiding duplication of services (leave the trauma care to St. Al's), adequate staffing, and reduction of costly executive and managerial positions."

—Dr. Ann Cordum, Internal Medicine Physician

"…there is absolutely no way I could advocate for, or be in favor of shutting down Jefferson St. It really boils down to safety and connectivity, and the closing of Jefferson presents significant problems to both of these."*

 Jimmy Halyburton, Boise Bicycle Project (League-Certified Bicycle Safety Instructor, Participant in St. Luke’s Cycle Discussion) 
^ Update 6/23/16: apparently, there was a way he could advocate for shutting down Jefferson, since he reversed this position and endorsed St. Luke's application at the crucial ACHD hearing; although nothing had changed re: safety or connectivity.

"The logic of small blocks suggests that no further block consolidations should be allowed, such as the one currently considered at St. Luke’s, which will significantly undermine the effectiveness of the street grid in that location.” 
 —Jeff Speck, AICP, CNU-A, LEED-AP; Author, 'Walkable City: How Downtown Can Save America, One Step at a Time'


Friday, June 17, 2016

Jefferson matters to everyone; not just cyclists


One misconception about closing Jefferson is that it's only about bikes. St. Luke's and their surrogates have promoted this idea, suggesting that a 'cycle track' can mitigate the lost connection.

But that's not the case.

Currently, Jefferson is the only direct, low-speed connection between everything to the east of Avenue B and Boise's downtown and West End.


The only one.

Jefferson is currently used by commuters who drive, bike, or walk to and from work or downtown businesses. That direct connectivity touches every commuter: the parent driving a child to school, the pedestrian or wheelchair user attempting to negotiate the busy intersections, etc.

Cars can't use a cycle track, and neither can pedestrians—or wheelchair users. That's why they call them 'cycle' tracks.

A classic example of the Jefferson user is a gentleman who went out of his way to talk with us during our 'person-on-the-street interviews' on Jefferson. The 38-second clip speaks to the many daily users whose voices haven't been heard over the din of P.R.



Pretending you can replace that last direct connection (for all modes of travel) with a 'cycle track' is like saying we can 'mitigate' for killing the last white rhino by substituting a whitewashed pig.


Use the quick and easy survey to tell ACHD Commissioners that keeping Jefferson public serves the public good and maintains safety for all commuters.
Connectivity in and of itself also represents a tangible and sought-after asset for urban planners and community developers, and it determines whether a place feels safe, accommodating and unified or unwelcoming and isolating. Building a megastructure over Jefferson would create a fortress that isolates neighborhoods and commerce.

Many feel the problem all along is that St. Luke’s has not truly explored options that do NOT assume closure of Jefferson. As Professor Allison pointed out early on in his testimony to the Mayor and Council, their master plan seems designed to support a foregone conclusion.

https://www.youtube.com/watch?v=NF5R5P9Ekx8 (min. 2:03)

As Mayor Bieter* pointed out, St Luke's has a poor track record of respectfully engaging and compromising with citizens who think differently or challenge their views. Some think their arrogance and unwillingness to truly cooperate will only strengthen once they get the go ahead on Jefferson.
*"...St. Luke’s seemed to me to be somewhat dismissive of the legitimate concerns of your neighbors...to quote one such supporter, dismissing those concerns as “insignificant noise.” I am an East Ender, too, and that’s a troubling statement." —Boise Mayor Dave Bieter, 6/30/2015
Coincidentally, below is a comment received via our online survey from an Ada County resident (not a KBC member):
"Before Jefferson can be vacated, there must be a revised overall transportation plan for the entire near East End — the area from Fort & Washington to 6th & Myrtle to the W Park Center bridge—a pinch-point for all travel east of downtown on the north side of the river. Current plans do not account for a major medical campus in the center of this transportation nexus."
This is a key point: ACHD also plans to convert Jefferson to a two-way route in the near term, a change that should be evaluated before committing to street closure along the route

Here's a thoughtful letter sent to ACHD recently from a local physician:
Dear Commissioners:
I am writing to oppose St. Luke's request to close Jefferson St.

St. Luke's has the wherewithal to find alternatives to its current plan which will further impede traffic through the East End and degrade the surrounding neighborhoods. Tunnels, skybridges and a shift in expansion to the south incorporating the existing parking garage are all possibilities.

More importantly, as a regional medical center, St. Luke's needs to align its expansion with the needs of the greater Treasure Valley and southwest Idaho. Clearly the population center of the Treasure Valley has progressively shifted westward, a trend that will undoubtedly continue. St. Luke's Meridian campus is ideally situated to accommodate future growth; its ER is already the busiest on the state. It's time that St. Luke's acknowledge that its flagship hospital will ultimately need to be in Meridian rather than hemmed in between a residential neighborhood and downtown Boise.

St. Luke's Boise provides an invaluable service to the community, however their growth has over the years had a negative impact on the surrounding neighborhoods. The time has come to draw the line at Jefferson St. and redirect St. Luke's future growth to the Meridian campus.

Thank you for your consideration.

Regards,

Peter Angleton, M.D. 

Use the quick and easy survey to tell ACHD Commissioners that keeping Jefferson public serves the public good and maintains safety for all commuters.

Thursday, June 9, 2016

Independent experts agree: closing Jefferson is not in the public interest

How many more streets can we afford to lose?
On June 22, the ACHD Commissioners will take public comment on a straightforward—and strictly legal—point pursuant to Idaho Code Section 40-203:
"the ONLY justification to vacate Jefferson is if a majority of the commissioners find that keeping it open for use by the public is NOT in the public interest."

Given what independent experts have stated publicly about this issue, that finding sets a high bar; one that involves a legal, not political consideration. See a few examples from the public record:


ACHD 2013 Downtown Boise Redevelopment Plan 
ACHD's plan refers to Jefferson Street as a corridor that "...provides key east-west connectivity east of Broadway-Avenue B and west of 16th Street (which Bannock does not)."

Planning and Zoning (P&Z) Commission
Boise P&Z Commissioners recommended denial of St. Luke’s application “for the reason that it does not comply with substantial elements of the comprehensive plan.”

The final vote was six to deny and one to defer. (2/9/15 P&Z Transcript). Each Commissioner outlined specific reasons for denial; here are a few excerpts from their comments.
  • "I do think the case has been made by the public that an undue burden is placed on transportation…by the closure of Jefferson.” —Commissioner Demarest 
  • "We’re now trying to combat chronic diseases, obesity, diabetes, all of the things that you all are experts in. I believe that this exacerbates that problem."—Commissioner Danley 
  • “St. Luke's is an important part of our community but it is a part of the community. We’ve heard tonight from many people, we have legitimate concerns about closing Jefferson, and I have those same concerns. It’s a close call for me, but I think connectivity has to trump design issues in this case…”—Commissioner Just 
  • "...what is the real cost of closing Jefferson? That analysis has not been presented yet...Against that, I set the clear, public loss of an important street. So for that reason alone, I can’t support the plan." —Commissioner Gillespie 
Safety Concerns 
The so-called 'cycle track' can not and will not compensate for the loss of the existing contiguous east-west connection provided by Jefferson. Increased traffic congestion and hazards aside, routing bike and pedestrian traffic around the proposed superblock and megastructure presents numerous conflict points from patient, hospital staff and visitor traffic (cars, bikes, wheelchairs and pedestrians) crossing the proposed lane of travel of the 'cycle track.'
  • "…there is absolutely no way I could advocate for, or be in favor of shutting down Jefferson St. It really boils down to safety and connectivity, and the closing of Jefferson presents significant problems to both of these."* —Jimmy Halyburton, Boise Bicycle Project (League-Certified Bicycle Safety Instructor, Participant in St. Luke’s Cycle Discussion) 
^ Update 6/23/16: apparently, there was a way he could advocate for shutting down Jefferson; but nothing has changed re: safety or connectivity.

Walkable and connected street grid values
The 2013 Boise, Idaho Downtown Walkability Analysis commissioned by the Capital City Development Corporation (CCDC) found that:
  • "Downtown Boise benefits from a quite small block size—about 300 feet square—and almost none of these blocks have been consolidated into superblocks, which tend to decrease walkability by focusing traffic on fewer streets, causing them to become too wide. The logic of small blocks suggests that no further block consolidations should be allowed, such as the one currently considered at St. Luke’s, which will significantly undermine the effectiveness of the street grid in that location.” —Jeff Speck, AICP, CNU-A, LEED-AP, Honorary ASLA Principal; Author, 'Walkable City: How Downtown Can Save America, One Step at a Time'
Health Care Architecture and Planning Perspective
In the absence of any independent analysis of the proposed expansion commissioned by local government, Ada County residents and taxpayers sought and secured the expertise of one of the country's foremost experts in the field of health care design to review and analyze the Master Plan and proposed street closure. The following is an excerpt from Professor Allison's testimony before City Council on 6/30/2015:
  • “Hospitals have this implied mission of ‘do no harm’…but by fundamentally creating a superblock in a choke point in your city, they (St. Luke’s) are in fact, harming the city.” 
  • "I think a cycle track is a great exercise amenity...it's not necessarily about connectivity and healthy community planning and design." —David Allison, FAIA, FACHA—Alumni Distinguished Professor and Director of Graduate Studies in Architecture + Health at Clemson University
"...as a regional medical center, St. Luke's needs to align its expansion with the needs of the greater Treasure Valley and southwest Idaho. Clearly the population center of the Treasure Valley has progressively shifted westward, a trend that will undoubtedly continue. St. Luke's Meridian campus is ideally situated to accommodate future growth; its ER is already the busiest on the state.
It's time that St. Luke's acknowledge that its flagship hospital will ultimately need to be in Meridian rather than hemmed in between a residential neighborhood and downtown Boise.
St. Luke's Boise provides an invaluable service to the community, however their growth has over the years had a negative impact on the surrounding neighborhoods. The time has come to draw the line at Jefferson St. and redirect St. Luke's future growth to the Meridian campus." —Peter Angleton, M.D.
Economic impacts
A common argument used by proponents of expanding in place involves the presumed economic impact for Boise. We sought out a professional with expertise in fiscal impact analysis, real estate development feasibility analysis and regional economics. As a bonus, we found someone with deep knowledge of the Treasure Valley, impact fee design and market research. Here's what he had to say after reviewing St Luke's Master Plan:
  • "There are many reasons to be for or against the hospital proposal, however, the economic arguments the hospital is promoting in its printed material are not valid."
  • "The hospital will bring the same economic benefit to the Boise region whether the hospital is fully in Boise or in several communities in the region. No jobs will be lost, no hospital services will be lost, and no difference in economic benefit will be discernible if select hospital services move just several miles away."
  • "This is not a new story in the evolution of cities. Hospitals are often built on the edge of a city and they outgrow their location as the city fills in around the facility and the hospital builds a modern campus in a nearby suburban community. The doctors remain in the region; the patients remain in the region; and the economic benefits remain in the region." —Adam Orens, Managing Director, BBC Research and Consulting in a letter to KBC.

Blueprint Boise
Goal DT-C 2:
Continue to develop a framework of streets, paths and open spaces that builds upon existing networks and strengthen connections to the Boise River and Downtown subdistricts.

DT-C 2.1: BLOCK PATTERN:
(a) Retain a high level of connectivity in Downtown by maintaining the traditional street grid and block pattern (260 feet by 300 feet).

(b) Where superblocks exist, work with property owners and developers when redevelopment is proposed to re-establish the street grid and create blocks that approximate the traditional block size…

(c) Avoid development of megastructures on superblocks that create either real or perceived barriers to connectivity.

ACHD represents all Ada County constituents; together we bear the responsibility for the transportation infrastructure needed to accommodate traffic congestion.

Let ACHD Commissioners know that keeping Jefferson intact as a functioning east-west corridor is in the public interest and serves the public good.

Complete the quick and easy survey here:
https://www.surveymonkey.com/r/KeepJeffersonPublic

Or send them and email directly to tellus@achdidaho.org

Independent experts agree: closing Jefferson is not in the public interest

How many more streets can we afford to lose?
On June 22, the ACHD Commissioners will take public comment on a straightforward—and strictly legal—point pursuant to Idaho Code Section 40-203:
"the ONLY justification to vacate Jefferson is if a majority of the commissioners find that keeping it open for use by the public is NOT in the public interest."

Given what independent experts have stated publicly about this issue, that finding sets a high bar; one that involves a legal, not political consideration. See a few examples from the public record:


ACHD 2013 Downtown Boise Redevelopment Plan 
ACHD's plan refers to Jefferson Street as a corridor that "...provides key east-west connectivity east of Broadway-Avenue B and west of 16th Street (which Bannock does not)."

Planning and Zoning (P&Z) Commission
Boise P&Z Commissioners recommended denial of St. Luke’s application “for the reason that it does not comply with substantial elements of the comprehensive plan.”

The final vote was six to deny and one to defer. (2/9/15 P&Z Transcript). Each Commissioner outlined specific reasons for denial; here are a few excerpts from their comments.
  • "I do think the case has been made by the public that an undue burden is placed on transportation…by the closure of Jefferson.” —Commissioner Demarest 
  • "We’re now trying to combat chronic diseases, obesity, diabetes, all of the things that you all are experts in. I believe that this exacerbates that problem."—Commissioner Danley 
  • “St. Luke's is an important part of our community but it is a part of the community. We’ve heard tonight from many people, we have legitimate concerns about closing Jefferson, and I have those same concerns. It’s a close call for me, but I think connectivity has to trump design issues in this case…”—Commissioner Just 
  • "...what is the real cost of closing Jefferson? That analysis has not been presented yet...Against that, I set the clear, public loss of an important street. So for that reason alone, I can’t support the plan." —Commissioner Gillespie 
Safety Concerns 
The so-called 'cycle track' can not and will not compensate for the loss of the existing contiguous east-west connection provided by Jefferson. Increased traffic congestion and hazards aside, routing bike and pedestrian traffic around the proposed superblock and megastructure presents numerous conflict points from patient, hospital staff and visitor traffic (cars, bikes, wheelchairs and pedestrians) crossing the proposed lane of travel of the 'cycle track.'
  • "…there is absolutely no way I could advocate for, or be in favor of shutting down Jefferson St. It really boils down to safety and connectivity, and the closing of Jefferson presents significant problems to both of these."* —Jimmy Halyburton, Boise Bicycle Project (League-Certified Bicycle Safety Instructor, Participant in St. Luke’s Cycle Discussion) 
^ Update 6/23/16: apparently, there was a way he could advocate for shutting down Jefferson; but nothing has changed re: safety or connectivity.

Walkable and connected street grid values
The 2013 Boise, Idaho Downtown Walkability Analysis commissioned by the Capital City Development Corporation (CCDC) found that:
  • "Downtown Boise benefits from a quite small block size—about 300 feet square—and almost none of these blocks have been consolidated into superblocks, which tend to decrease walkability by focusing traffic on fewer streets, causing them to become too wide. The logic of small blocks suggests that no further block consolidations should be allowed, such as the one currently considered at St. Luke’s, which will significantly undermine the effectiveness of the street grid in that location.” —Jeff Speck, AICP, CNU-A, LEED-AP, Honorary ASLA Principal; Author, 'Walkable City: How Downtown Can Save America, One Step at a Time'
Health Care Architecture and Planning Perspective
In the absence of any independent analysis of the proposed expansion commissioned by local government, Ada County residents and taxpayers sought and secured the expertise of one of the country's foremost experts in the field of health care design to review and analyze the Master Plan and proposed street closure. The following is an excerpt from Professor Allison's testimony before City Council on 6/30/2015:
  • “Hospitals have this implied mission of ‘do no harm’…but by fundamentally creating a superblock in a choke point in your city, they (St. Luke’s) are in fact, harming the city.” 
  • "I think a cycle track is a great exercise amenity...it's not necessarily about connectivity and healthy community planning and design." —David Allison, FAIA, FACHA—Alumni Distinguished Professor and Director of Graduate Studies in Architecture + Health at Clemson University
"...as a regional medical center, St. Luke's needs to align its expansion with the needs of the greater Treasure Valley and southwest Idaho. Clearly the population center of the Treasure Valley has progressively shifted westward, a trend that will undoubtedly continue. St. Luke's Meridian campus is ideally situated to accommodate future growth; its ER is already the busiest on the state.
It's time that St. Luke's acknowledge that its flagship hospital will ultimately need to be in Meridian rather than hemmed in between a residential neighborhood and downtown Boise.
St. Luke's Boise provides an invaluable service to the community, however their growth has over the years had a negative impact on the surrounding neighborhoods. The time has come to draw the line at Jefferson St. and redirect St. Luke's future growth to the Meridian campus." —Peter Angleton, M.D.
Economic impacts
A common argument used by proponents of expanding in place involves the presumed economic impact for Boise. We sought out a professional with expertise in fiscal impact analysis, real estate development feasibility analysis and regional economics. As a bonus, we found someone with deep knowledge of the Treasure Valley, impact fee design and market research. Here's what he had to say after reviewing St Luke's Master Plan:
  • "There are many reasons to be for or against the hospital proposal, however, the economic arguments the hospital is promoting in its printed material are not valid."
  • "The hospital will bring the same economic benefit to the Boise region whether the hospital is fully in Boise or in several communities in the region. No jobs will be lost, no hospital services will be lost, and no difference in economic benefit will be discernible if select hospital services move just several miles away."
  • "This is not a new story in the evolution of cities. Hospitals are often built on the edge of a city and they outgrow their location as the city fills in around the facility and the hospital builds a modern campus in a nearby suburban community. The doctors remain in the region; the patients remain in the region; and the economic benefits remain in the region." —Adam Orens, Managing Director, BBC Research and Consulting in a letter to KBC.

Blueprint Boise
Goal DT-C 2:
Continue to develop a framework of streets, paths and open spaces that builds upon existing networks and strengthen connections to the Boise River and Downtown subdistricts.

DT-C 2.1: BLOCK PATTERN:
(a) Retain a high level of connectivity in Downtown by maintaining the traditional street grid and block pattern (260 feet by 300 feet).

(b) Where superblocks exist, work with property owners and developers when redevelopment is proposed to re-establish the street grid and create blocks that approximate the traditional block size…

(c) Avoid development of megastructures on superblocks that create either real or perceived barriers to connectivity.

ACHD represents all Ada County constituents; together we bear the responsibility for the transportation infrastructure needed to accommodate traffic congestion.

Let ACHD Commissioners know that keeping Jefferson intact as a functioning east-west corridor is in the public interest and serves the public good.

Complete the quick and easy survey here:
https://www.surveymonkey.com/r/KeepJeffersonPublic

Or send them and email directly to tellus@achdidaho.org

Wednesday, August 26, 2015

St. Luke's process moves forward, despite questions about cost, connectivity and public safety

East End neighbor Heather Steele voices her opposition to closing Jefferson while St. Luke's executives and board chair Skip Oppenheimer (center) look on. Steele was describing injuries her husband suffered after being struck by a car on one of the already traffic-burdened nearby streets. St. Luke's took full advantage of a last-minute schedule change to fill Council Chambers early with staff and board members; residents like Steele—unable to leave work early—wound up waiting up to seven hours to testify.
Note. The following information and links are based on information in the public record and/or available to KBC members and believed to be reliable; corrections are welcome as needed to ensure accurate accounting. KBC members have never taken issue with development on privately held land. We have consistently expressed concerns about changes to Boise’s comprehensive plan and the taking of a public right-of-way by a private corporation without a transparent, credible and defensible public process with meaningful input from stakeholders most impacted by the changes.

What City Hall said
In the aftermath of the City Council’s four-to-one decision to approve St. Luke’s Master Plan (to include loss of two blocks of Jefferson Street between Ave. B and N. 1st), two formal statements have been issued:

See the most recent Council discussion on the topic here:

See Planning Director Simmons’ 7/23/15 letter to Jeff Hull at St. Luke’s here: http://boisecityid.iqm2.com/Citizens/FileOpen.aspx?Type=4&ID=7427&MeetingID=1940


What others have said
As was made clear by residents and independent transportation, walkability and health care design professionals, losing two blocks of Jefferson would permanently sever a historic and direct connection between those living east of Avenue B (basically everyone in the 83712 zip code) and the rest of Boise. It also robs all commuters of a critical ‘pressure-relief valve’ that serves as the only practical route into or out of the East End during gridlock associated with special events at Dona Larsen Park, the Botanical Gardens/Outlaw Field, or construction projects.

The importance of street grid integrity in this area was specifically referenced in the 2013 Downtown Walkability Analysis commissioned by CCDC. National Walkability expert Jeff Speck couldn’t have been any clearer:
“Downtown Boise benefits from a quite small block size—about 300 feet square—and almost none of these blocks have been consolidated into superblocks, which tend to decrease walkability by focusing traffic on fewer streets, causing them to become too wide. The logic of small blocks suggests that no further block consolidations should be allowed, such as the one currently considered at St. Luke’s, which will significantly undermine the effectiveness of the street grid in that location.”
Boise’s P&Z Commissioners were also clear on this issue when they denied St. Luke’s application “for the reason that it does not comply with substantial elements of the comprehensive plan.” The final vote was six to deny and one to defer.  (2/9/15 P&Z Transcript).

Justifications, conditions and assumptions
Justifications. St. Luke’s subspecialists and consultants argued repeatedly that ‘seconds count’ when patients need to move within their proposed ‘contiguous main floor plate’ to be built to the north of the existing hospital on what is currently Jefferson Street. However, this argument fails for the vast majority of patients throughout the 350-mile service area who can’t conveniently access a suburban-scale hospital in the first place, either because of its isolation from projected population growth centers or due to traffic congestion.

Another factor presented as a justification from City Hall involved economic impacts from a $400M development and another 400–600 jobs. What wasn't discussed was that as St. Luke’s has acquired massive real estate holdings, those properties are taken off the tax rolls. More importantly, residents heard a very different perspective from an independent economist familiar with the Treasure Valley and specializing in economic impact analyses of hospital expansions. After reviewing the St. Luke’s Master Plan, he concluded, “the economic argument the hospital is promoting in its printed material is not valid.”

Here’s what he had to say about the importance of defining the appropriate study area for an economic impact analysis, in this case, for a ‘regional medical center' drawing patients from a multi-state market:
"The study area is the lens through which all economic results are interpreted. The study area is usually what I like to call a ‘functioning economic unit.’ The Treasure Valley is a complex and integrated economy that is not divided materially by political boundaries. Goods and services, workers and supplies flow freely from Boise to Meridian to Kuna to Caldwell and beyond virtually unimpeded. In order to talk about economic benefits to the city of Boise, one must talk about economic benefits to the regional Boise economy, because the Boise economy extends beyond the city boundaries.
The hospital will bring the same economic benefit to the Boise region whether the hospital is fully in Boise or in several communities in the region. No jobs will be lost, no hospital services will be lost, and no difference in economic benefit will be discernable if select hospital services move just several miles away."
KBC shared these observations with the Mayor and Council prior to their decision, but are not aware if they took them into consideration.

Conditions. Council’s decision did propose certain conditions: chiefly the re-opening of Bannock Street to (at a minimum) bicycle and pedestrian traffic between Avenue B and N. 1st Street. The second condition involves working with various stakeholder groups to develop a plan for a more diverse health district and ‘activated’ ground-floor space around parking and other structures. This means including some public retail activities that engage surrounding neighborhoods.

A little research into ‘urban health districts’ provides examples of development compatible with an urban form. KBC members—with generous support from Boise residents—were able to bring the country’s foremost expert in hospital and health district design to Boise for some much-needed perspective on this topic. We hope Council found it of value.

Assumptions. Naturally, any conditions may be unwelcome by St. Luke’s. Planning Director Simmon’s 7/23/15 letter to Jeff Hull notifies St. Luke’s of its options to request a ‘regulatory takings’ analysis—ostensibly for placing conditions on the plan’s approval. These involve restoring Bannock Street to a public right-of-way as partial compensation for the ‘taking’ of Jefferson from the public, and council's recommendation to incorporate best practices in health district design in the master plan (as described by Professor Allison). We are not aware whether this is in response to a suggestion* that St. Luke’s would pursue a regulatory takings lawsuit or simply standard practice. See below:

*St. Luke’s did ‘suggest’ it would move operations to Meridian if Boise didn’t hand over Jefferson, and subsequently implied that ‘people would die’ if they couldn’t have Jefferson "because seconds matter" (we assume they were only referring to people in Boise’s East End, living next door to the hospital and arriving through a ground-floor entrance and not via LifeFlight, which involves an elevator ride we were assured would add more seconds). In a dispute with Blue Cross over reimbursement amounts for certain procedures, St. Luke’s also threatened to close its Wood River Valley facility. See more on that story here: http://tinyurl.com/oajzd2b

A takings lawsuit would fly in the face of Mayor Bieter’s admonition to hospital executives that the burden is on them to re-establish badly damaged public trust:
“When the issue of St. Luke’s tax-exempt status came up several years ago, my opinion (was) that St. Luke’s kind of muscled through the legislature a law removing the requirements of the tax exemption that I thought were a great benefit to the public and had served us well for around 100 years.
More recently, what I view as quite an aggressive approach to the litigation with the Idaho Attorney General and the Federal Trade Commission.* I think that’s placed a significant disruption into health care in our community.
 “The request for vacation of a right-of-way is a request for an act of faith, of trust in you. And the question, I think, before this council, is: Are you trustworthy?” 
“…Leaving aside what I thought was a major misstep in the PR efforts before the application, at times, the supporters and employees of St. Luke’s seemed to me to be somewhat dismissive of the legitimate concerns of your neighbors as, to quote one such supporter, dismissing those concerns as “insignificant noise.” I am an East Ender, too, and that’s a troubling statement.”
Read more here: http://tinyurl.com/qfnznox

*Here Bieter references concerns about St. Luke’s evolving antitrust saga. Ninth Circuit Judge Winmill has ordered the hospital to hand over its divestment plan for Saltzer Medical Group. Reading between the lines, the Justice seems skeptical of St. Luke’s promises. You can form you own opinions here: http://tinyurl.com/pg6oswu)

Give the Mayor credit for plain talk on the increasingly dysfunctional aspects of the relationship between new St. Luke’s leadership and Boise’s lawmakers and residents.

Corporate Access to Local Government:  
These were tough words—and a tough stance—from the mayor, particularly in light of the ever-widening revolving door and entanglements between City Hall and Saint Luke’s:

·      Mayor Bieter’s wife works for St. Luke’s
·      Mayor Bieter’s former media relations assistant was hired by St. Luke’s to serve as the expansion spokesperson.
·      Mayor Bieter’s current assistant is married to a St. Luke’s physician
·      City Councilman Ben Quintana also serves in a leadership position at St. Luke’s.
·      City Councilman T.J. Thompson’s “Healthy Communities” project receives significant support from St. Luke’s, including one-on-one work with hospital executives.
·      Most recently, the Boise Parks and Recreation Community Relations Manager was hired as St. Luke’s Communications Manager.

Influence Beyond City Hall
No one questions the integrity of individuals involved. At the same time, it’s easy to see why the public is increasingly cynical about this process, particularly when they see the vanishing line between City Hall and St. Luke’s, and they learn of the many personal, professional and financial relationships extending beyond City Hall.
  • Idaho Statesman Publisher Michael Jung also serves on St. Luke’s Strategic Initiatives Committee. (This was not disclosed to KBC members meeting with the Statesman’s Editorial Board, but seemed consistent with the way neighborhood opposition was portrayed by the Statesman early on. To be fair, the Statesman’s Audrey Dutton has done an admirable job covering issues of antitrustmonopoly and the impact on Idaho’s health care industry and cost inflation)
  • St. Luke’s launched a massive ad campaign in an effort to burnish its image and present its version of the project. Radio and TV ads continue on heavy rotation following a social media blitz and printed mailers implying a Utopian combination of happy children, ponies and cycling families frolicking on Bannock Plaza.
  • Local nonprofits, media outlets and city council projects have been the beneficiaries of this investment. Those who express their opposition to the hospital’s tactics and goals in private are unwilling to speak freely as they feel it would risk sponsorship and revenue.
The above strategies are standard practices when corporations want to gain access/advantages or compensate for an image problem, but can have a chilling effect on open and objective analysis of a major development with many unanticipated side effects. That frustrates taxpayers and voters who can’t possibly gain the levels of access that St. Luke’s enjoys.

Public opinion of St. Luke’s has definitely taken a turn in the past few years, particularly as St Luke’s began its aggressive acquisition of independent practices. A search for local news stories involving the hospital and a review of the comments section offers a clear feel for public sentiments. As one local public relations professional pointed out, "You can’t make good P.R. out of bad policy; promotional budgets are often inversely proportional to public trust."

What’s next?
As of mid-August St. Luke’s still needs to sign off on the deal as proposed by Council in order to move forward. And a key decision rests with the Ada County Highway District (ACHD). ACHD Commissioners are responsible for transportation and storm water infrastructure, which would involve committing taxpayer dollars to accommodate St. Luke’s desire to expand in an already traffic-burdened area.

Independent analysis suggests alternatives. To date, only residents and independent economic, land-use, transportation and hospital expansion professionals have questioned what they see as a completely inappropriate location for expansion. They suggest distributing medical office buildings instead to areas with existing infrastructure that are easily accessed by a broad cross-section of Ada County residents—and currently owned or controlled by St. Luke’s near Americana and Boise’s’ new Westend development.

ACHD Commissioners won’t likely be persuaded by the kind of overtly emotional  appeals heaped on City Council, described by one reporter as “…something you might see on the St. Luke’s Children’s Miracle Network Telethon.” (Boise Weekly 4/1/15)

Independent bike safety and transportation experts feel the resulting increase in traffic volume, coupled with complex, costly and compromised mitigation attempts may in fact threaten public health and safety.
“…there is absolutely no way I could advocate for, or be in favor of shutting down Jefferson St. It really boils down to safety and connectivity, and the closing of Jefferson presents significant problems to both of these. For those who don’t know, Jefferson at Ave. B is a preferred and heavily used bike route for accessing the East End Neighborhood from Downtown Boise and vice versa.”
—Jimmy Halyburton, Boise BicycleProject (League-Certified Bicycle Safety Instructor, Participant in St. Luke’s Cycle Discussion)

Even P&Z Commissioner Danley’s comments to St. Luke’s suggested that commuters may in fact switch from bikes to cars rather than risk mall-like traffic and impatient drivers trying to beat signals. In his words, “We’re now trying to combat chronic diseases, obesity, diabetes, all of the things that you all are experts in. I believe that this exacerbates that problem.”

So, the process moves forward.

Sunday, July 5, 2015

Testimony from Professor David Allison

Thanks to neighbor Bob for capturing Professor Allison's testimony to Boise City Council. We are grateful for the opportunity to hear from one of America's “most influential people in healthcare design.”

We hope his presentation helped City Council and others recognize that Boise can improve on the current proposed hospital expansion and street closure, simply by setting boundaries. We think enough questions exist to justify hitting the pause button on St. Luke's current proposal; more robust collaboration could help achieve needed expansion, better community relations and Mayor Bieter's goal of 'making Boise America's most livable city.' We can do better.

See more on David Allison here.

KBC invited Professor Allison because we think Boise deserve the very best in planning and design for what will be a significant development affecting generations of residents and visitors alike.

We hope city leaders also believe the future of this city is worth this consideration.


David Allison Testimony