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:

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:

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:

*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:

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.

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