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: testimony reversed during final ACHD hearing, although nothing had 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: testimony reversed during final ACHD hearing; nothing had 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

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

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