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