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

Former ACHD Commissioner speaks out

Kudos to the Statesman for publishing a contrasting voice to their own unsigned editorial.

Guest Opinion: St. Luke’s should reconsider expansion and use South option

BY GARY E. RICHARDSON

June 29, 2015 

Read more here: http://www.idahostatesman.com/2015/06/29/3875070/guest-opinion-st-lukes-should.html#storylink=cpy

Gary Richardson

St. Luke’s alternatives analysis for its master plan is incomplete, misleading, unconvincing and somewhat disingenuous. At least one other alternative exists that would meet emergency and other service criteria without closing Jefferson Street:

A southward expansion, replacing or built over the existing parking garage, meets the horizontal-service, connectivity and continuum-of-care objectives of the hospital’s proposed northward expansion.

It also obviates the need to take two more blocks of public right-of-way beyond that already vacated on Bannock and Avenue A.

Most of the hospital’s objections to expanding southward relate to placing the medical office building and parking garage eastward, across Avenue B. (St. Luke’s doesn’t own much of that land.) However, there is a way to keep those facilities north of Jefferson:

Expand southward, connecting the main expansion to existing hospital floors and corridors as desired.

Relegate parking, central plant, shipping and receiving facilities to the Front/First/Jefferson “island,” where they are more accessible to thoroughfares and farther from residential areas.

Locate the office building across Jefferson from the existing medical “plaza,” which can expand to the west as shown and/or provide additional parking.

The new facilities can easily be connected to the main buildings across Jefferson — underground, overhead or both.

The hospital also criticized southward expansion because it would move the main entrance and emergency department: “Expansion to the south causes redevelopment of the entire front of the existing hospital. Patient and visitor access to front door is problematic.” However, St. Luke’s preferred, northward expansion envisions just that: redeveloping the entire front of the hospital by moving the main entrance to the Fort Street side of the expansion.

Southward expansion offers several workable options for locating the new entrance and the emergency department without vacating Jefferson. There are two emergency options: a grand entrance at the corner of Jefferson and Avenue B (or farther west on Jefferson); or an entrance on Avenue B across from East Bannock.

Other St. Luke’s objections to the southward expansion were not stated in the plan but came up in discussions: The inconvenience of closing the hospital’s main entrance during construction, and the additional cost of dealing with the existing parking structure. These objections are not insurmountable.

Alternate entrances can be provided during construction — a temporary inconvenience, which should be weighed against the permanent inconvenience to the public of disregarding the important connectivity built into the city’s comprehensive plan.

The possibility that the garage location could block optimal expansion alternatives should have been considered before the hospital built it; the public should not pay for the hospital’s shortsightedness.

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.

This entails identifying at early planning stages everyone who might be affected by a proposed action and involving them deeply in the decision-making process so they have all the information upon which the ultimate decisions are based.

While they may not agree with the ultimate outcome, having been heard and understanding how costs and benefits were weighed, they are more likely to assent.

More importantly, these stakeholders actually may contribute to a better decision.

St. Luke’s “my way or the highway” attitude has turned out to be a two-way street. It has generated sentiment that perhaps St. Luke’s should move some of its services to the population center of the Treasure Valley: Meridian.

The city should send St. Luke’s back to work with their neighbors — with a copy of the city’s comprehensive plan — to guide them toward better integrating health services with neighborhood needs.

Gary E Richardson is a former Ada County Highway District commissioner (1997-98) who has lived in the St. Luke’s neighborhood for more than 30 years.


See the full Guest Opinion here.
Read more about Gary Richardson here.

Read more here: http://www.idahostatesman.com/2015/06/29/3875070/guest-opinion-st-lukes-should.html#storylink=cpy

A Local Physician's Perspective

Ann Cordum‎Keep Boise Connected, Inc.

St. Luke’s provides excellent care and top-notch expertise. Hospital executives argue that expansion is necessary because in emergencies, seconds matter. Closure of Jefferson Street would connect emergency services to interventional radiology and save lives.

What save lives are the following: adequate staffing on the front lines of patient care, clinician competence, well-designed processes, and effective communication across the care team. Physical space does not save lives. The larger an organization, the more logistical challenges, and the greater the delays in care. Physical grandeur and proximity do not equal better care. In fact, studies show that patients who have a stroke while in the hospital suffer long delays in getting thrombolysis and life-saving care. Larger facilities are also typically associated with greater overhead which translates into higher costs that are ultimately passed on to us all. Outpatient care costs are substantially higher at a hospital than at a physician’s office.

Only a tiny minority of emergency room patients need interventional radiology. Most hospital admissions are for infections, congestive heart failure, drug overdoses, emphysema, blood clots, surgical issues, and the like. What good is it to whisk someone away for intervention while Mrs. Jones lies on a gurney for hours awaiting admission for her pneumonia? The reality is that cardiac and stroke patients are outnumbered by general medical/surgical patients who often sit in emergency rooms for hours awaiting admission and higher level care. Their lives are every bit as important as the stroke patient’s.

I would ask our community: Has access to your physician improved as a result of expansion, i.e. by hospital acquisition of local physician groups? Did the quality of your health care improve? Has it become more cost effective? Would you prefer to navigate a larger hospital campus?

St. Luke's has a large enough footprint to reconfigure on its existing acreages without closing tax payer owned roads and encroaching on historic properties to expand intersections and roadways. Options include building upward from the existing hospital parking lot or relocating outpatient services to its other Boise properties. This would leave plenty of room at the existing downtown campus for inpatient services and future growth.

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.

In conclusion, while I am thankful to have St. Luke’s in my neighborhood, there are better ways to spend $400 million improving heath care in Boise than the proposed campus expansion.

Ann Cordum
East End resident
Internal medicine physician

KBC Community Meeting

A simple update from last night's standing-room-only community meeting hosted by KBC members. The room was packed, the conversation lively and engaged.

See coverage of the meeting:

Citizens host workshop on St. Luke's plan (KTVB)

Neighbors pitch alternative ideas on St. Luke's expansion plans (KBOI)

Comments from someone who showed up out of curiosity sum it up well:

"you guys hit it out of the park! Speakers were passionate yet humble and not at all preachy.  The dots were masterfully connected and the concept of a health district and the rationale behind it were compelling."  

We hear that pretty often these days, and the support is greatly appreciated. Our aim is to present available facts and reasonable conclusions without fluff or distractions, because Boise citizens are smart enough to see through spin and draw their own conclusions.

Some in the audience wished a representative from the Mayor's office or City Council had been in attendance. We know they have busy schedules these days; we also think they would benefit greatly from a second opinion and hearing a more citizen-oriented conversation along with more robust alternatives analysis. 

We're all stakeholders in this process, and we all support Mayor Bieter's goal of making Boise the most livable city in America; we just can't get there relying on old thinking.

We were able to document the entire meeting and will share the video with City leaders.

See the videos below for additional information and alternatives.