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'

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 on proposed St. Luke's expansion

Residents packed the Fort Boise Senior Center Wednesday evening to participate in a frank and open exploration of the proposed St. Luke's master plan. The emphasis was on understanding likely impacts and presenting/analyzing alternatives that would allow for expanded health care services in Boise while preserving the community and neighborhood values reflected in Blueprint Boise.

As always, we encourage careful review and consideration of all available materials on the topic. Our goal is an informed and inclusive decision-making process that supports the entire community, and keeps Boise connected physically, socially and culturally. We want a livable city that contributes to the health, safety and prosperity of all citizens.

Introduction/overview

Traffic

Alternatives Analysis

Getting Involved

Questions and Answers