ER Physician Says Hospital Plans Not in Best Interest of this Region's Kids

Must-Read: Comments from a doctor working on the growing Eastside who sends many young patients to Children's Hospital (highlighting added):

"...As an emergency medicine physician practicing in Kirkland, I have witnessed firsthand the growth on the Eastside and in Snohomish County of the need for inpatient pediatric care. Young families with young children are not, in general, settling in Seattle, but in outlying communities where the median home price is more affordable. The vast majority of these children who need admission to a hospital do not need highly specialized care, but rather ongoing care of relatively simple disease processes such as asthma and dehydration.

As it stands, these children often require transfer to CHRMC because of the paucity of inpatient pediatric beds in this service area. This adds further stress to families who are already faced with the emotional and financial burden of hospitalization. Adding inpatient pediatric beds to the Eastside, or South Snohomish County would be a vastly better approach to the need for inpatient resources.

Statistics provided by CHRMC show that the majority of their admissions do not require specialty care and that the majority of patients admitted do not resided in Seattle. These facts argue against the logic of expanding at the Laurelhurst campus. While cost has been sited as a reason not to expand elsewhere, CHRMC's original plan to erect massive towers above the existing campus would have cost more than construction at an alternative site. Creating a partnership with an Eastside hospital with land and space, where zoning is appropriate for a hospital expansion and nearer to where the growing pediatric population actually lives, is a far more logical means of addressing the region's needs for expanded inpatient pediatric care. For example, the land and buildings recently vacated by Eastside Group Health would provide more land (with an onsite healthcare facility already established) for less money than the deal to acquire the Laurelon property.

Any operating costs secondary to 'redundancy' would quickly be offset by the income generated by admission at an Eastside facility. I believe more Eastside doctors would admit children if they didn't have to worry about the inconvenience to families of doing so in Seattle. Why else would Swedish have submitted a certificate of need to establish an inpatient pediatric presence on the Eastside?

Not only would establishing a separate campus provide more comprehensive care for the children and families of the region, it would serve more practically in the event of a mass casualty incident [(MCI)]. At the most recent meeting of the Central Region Trauma Council, of which I am a member, the Triage and Critical Care Task Force announced [the results of] a study to optimize care to the region's pediatric population in the event of an MCI. They found 'the current centralized system for care of hospitalized children in King County' to be an obstacle to this goal. Maintaining inpatient pediatric care only at the existing CHRMC campus could have dire implications if the hospital itself, or transportation routes to it were damaged by a natural disaster, or terrorist attack.

As the medical director of [a large Eastside city]'s Medic One, I also worry about the implications for transport of critically ill children from the Eastside. With Highway 520 becoming increasingly congested, the creation of worse traffic congestion on Montlake and along the arterial roads serving CHRMC has potential lethal implications when timely transport is essential. While CHRMC has suggested that they can mitigate traffic concerns by expanding use of alternative modes of transportation, it is impractical to believe that staff that need to arrive during off hours will use bikes and public transportation and ludicrous to believe that families with sick children will be able to use any transportation other than their own vehicles.

...CHRMC has yet to provide an explanation for its desire to add ten times what the State's formula for need has determined to be the necessary number of beds. It has also failed to mount an effective argument against creating inpatient beds at an alternate site (one that would better serve the needs of the region's children). Without these essentials, the City and the CAC cannot, in good conscience, approve any of the existing alternatives. At least three new alternatives must be created: 1) no build (until CHRMC can explain its need to expand inpatient services despite falling use of such services since 2004); 2) limited expansion to meet bed necessity set by a certificate of need issued before creation of another draft master plan; 3) creation of an additional campus in a location better suited to serve the region's growing pediatric population."

Professional Traffic Consultant Pans the DEIS

This just in: a professional traffic consultant's scathing evaluation of the Draft EIS. Remember, the last day for sending your comments on the EIS is this Friday, July 25th.

Impacts of a 1.5 Million Square Foot Expansion (A Columbia Tower) are Not Mitigatable

Frustrations from this week's CAC meeting are still reverberating. Many neighbors feel that the voices of people who live in the immediate community are not being heard, particularly after the elimination of many near neighbors from the committee, largely due to the Hospital's pending acquisition of their homes. One neighbor asked us to share his suggestions for the CAC:

At the latest CAC meeting (7/15/08) I was very concerned to see how those who feel that a 1.5 million sq ft expansion is unmitigable in any form were effectively silenced by the committee chair after the break, the discussion resuming completely on the Hospital's terms. The word "unmitigable" was said often enough that it seems time for the committee to address the obvious question: in order to bring the height, bulk, scale, and traffic down to more manageable levels, what size expansion can be livable?

Based on simple arithmetic, a very crude estimate can be obtained for the square footage that the Laurelon site can accommodate to maintain the scale of the other Hospital buildings: six acres = a 250,000 sq foot footprint. Reduce this to 150,000 sq ft to allow access and open space (perhaps 125,000?), then a stair-step design contoured to the hillside built 6 stories high (similar to the other hospital buildings) would put the effective square footage per floor to be about 100,000. Multiplying by 6 stories gives 600,000 sq ft. Add some more for parking, etc. This puts it in the neighborhood of 750,000 sq ft -- half of the 1.5 million that are currently proposed.

Therefore I would suggest that the CAC consider a motion to reduce the proposed expansion by approximately one half on the basis of height, bulk, and scale. A further reduction of about 700,000 sq ft could be accomplished by moving the 190 psychiatric beds to a separate site, as suggested by Nancy Field.

Arterial Benchmarks & Balancing Needs

As we discussed in the last post, the intent of a Major Institution Master Plan is to "balance the needs" of the institution and the community. On the issue of transportation, the needs of the community and the institution substantially overlap. The CAC can take advantage of common interests in transportation to identify checkpoints for institution growth that help achieve "balance."

When it comes to transportation, the community and the Hospital really are in the same boat. If 42,000 daily car trips to/from the Hospital materialize before major transportation infrastructure improvements occur, we'll all be at a standstill -- patients, neighbors, doctors, hospital staff, UW staff... the list of impacted parties will extend as far as the traffic backups.

Members of the CAC are struggling to find appropriate benchmarks for growth increments of the Hospital. How about linking growth increments to the existing/projected "Level of Service" (LOS) grade of intersections along major arterials surrounding the Hospital? Once key intersections reach (optimistically) "A" grades and models predict that these intersections would only decrease to "Bs" during the next increment of growth, that increment could go forward.

Yes, this requires some coordinated improvements by government entities that will be partially out of the Hospital's hands. To achieve its goals, the Hospital will need to move arterial solutions forward within the context of a complex, regional transportation planning framework. This won't be easy, but the real transportation mess we face does not have easy solutions. Encouraging employees to bike/bus is great, but it doesn't take a large enough chunk of hospital trips off the roads year-round to solve the transportation problem for patients and families.

Remember, growth that plugs all nearby arterials will not "meet the institution's needs." Patients and families will not be able to reach whatever incredible new facility is built if this facility is surrounded by multi-mile traffic backups. Growth that oversteps transportation capacity also won't keep nearby communities functional -- View Ridge, Bryant, Ravenna, Laurelhurst, the U-District... the list will grow with the backups. [Yes, we'd all love to take mass transit all the time, but it's not practical for all trips for all families.]

The CAC should call for transportation benchmarks for growth increments based on arterial function.

EIS Comment Reminder: Remember, you are encouraged to send comments on the Draft EIS to the City DPD through July 25, 2008. Instructions are here.

Intent of Master Planning Process: "balance the needs" of the institution and community

In light of the discussion at tonight's CAC meeting, it is useful to reprint the core section of the city code governing Major Institution Master Plans. SMC 23.69.025 states:

"The intent of the Major Institution Master Plan shall be to balance the needs of the Major Institutions to develop facilities for the provision of health care or educational services with the need to minimize the impact of Major Institution development on surrounding neighborhoods."

The CAC is tasked with a far more difficult job than simply "figuring out how to meet the needs of the Hospital." The CAC must advise the council on how to "balance the needs" of the community and the institution. We discuss in the next post one idea for seeking out this balance.

Redwoods taken off the chopping block

Kudos to the Hospital's architects -- they have redesigned their plan for the Hartman site to leave the grove of Redwoods standing. Hospital representative Ruth Benfield's letter to the CAC states (bold added):

"Children's architects provided you with a redesign of the site which shows that the Redwoods will be protected on the Hartman site."

Reminder: CAC Meeting Tuesday, July 15

6:00- 9:00 PM. Talaris Conference Center Dining Room. 4000 NE 41st Street

How to save the Redwood grove at Hartmann

Did you know that the Hartman site hosts a grove of Redwoods, right along the Burke Gilman? You sure wouldn't find out by reading the Hospital's EIS.

Unfortunately, the proposed Master Plan implies that this grove would be eliminated by the northwest corner of the 65 - 105 foot "big box" building planned for the Hartman site:The Hartman neighbor who spoke at the EIS forum on Thursday put together a terrific slide deck showing the grove and a practical plan to save it. The deck contains full details and a great set of photos/slides (many are used in this post). The grove has:

• 6 Redwoods > 3' diameter
• 2 Redwoods > 8' diameter

The speaker proposed a modified Hartman plan that keeps the grove intact, adds an access point to the trail and uses a "wedding cake" instead of "big box" design for the building.
Loss of open space and trees at Laurelon too: As far as trees, the EIS mentions impacts only to 1) Street trees (on parking strips) and 2) The 225 trees on the Hospital's existing campus that the Hospital would "remove, relocate, and/or replant" to accommodate Alternative 3 or6.

The EIS makes no mention of the Redwoods, or existing large trees at at Laurelon (see the Hospital's photo to the left). The EIS should clearly state the fate of these trees, the acreage of open space lost with Alternative 7 and the mitigation measures planned by the Hospital.

Patients, hospital staff and neighbors will all benefit from good planning for green space.

Addendum: In case you're curious about the city's vegetation plan for the stretch of the Burke Gilman near Hartman, there's actually a web page for Management Unit 4: 36th Ave NE to 40th Ave NE. This page does not mention the redwood grove, but you'll enjoy this quote from the plan: “Pure blackberry section should be retained for picking by trail-users.”

For further info on the vegetation plan, see the Burke-Gilman Trail Vegetation Management Guidelines

EIS Comments: Remember, you are encouraged to send comments on the Draft EIS to the City DPD through July 25, 2008. Instructions are here.

Laurelhurst Community Club's Preliminary Comments on the EIS

The LCC shared some of its preliminary review of the EIS tonight at the EIS forum. You can read the LCC's review here. Particularly noteworthy were the LCC's comments on traffic:

• "The DEIS appears to grossly underestimate the number of vehicle trips per day. The DEIS estimates 8,400 vehicle trips per day; however, using the standard Institute of Transportation Engineers formula, the number of trips per day would be 42,000.The final EIS should provide trip generation data, employ standardized calculations regarding vehicle trips and provide sufficient parking."
  
• "An increase of 8,400 vehicle trips per day to the Children’s campus will result in major congestion along Sand Point Way and in the vicinity that cannot be mitigated. The level of service (LOS) at five locations under Alternatives 3 and 7 would be at “E” or “F.” These locations include: Five Corners, Montlake Boulevard and NE 45^th, Montlake Boulevard and the SR 520 eastbound ramps, 40^th Avenue NE and NE 55^th Street (by the Metropolitan Market) and 40^th Avenue NE and NE 65^th. Alternative 1 includes one additional failing location—25^th Avenue NE and University Village."

Remember, you are encouraged to send comments on the Draft EIS to the City DPD through July 25, 2008. Instructions are here.

Public Forum on the Draft EIS: Thursday, July 10th

The Department of Planning and Development is soliciting public comments on the Hospital's Draft EIS (available on the Hospital's Master Plan site). You can provide comments in two ways:

• Attend the Public Forum for the DEIS. July 10, 6-8 p.m., at the Center for Urban Horticulture. For further details, see the flier prepared by the Laurelhurst Community Club.
• Submit written comments to Scott Ringgold, City Planner. You also may wish to send your comments to the Citizen's Advisory Committee. Deadline for DEIS comments: July 25, 2008.

Your input will shape the next round of discussion of the Hospital's plans. For those who care about both outstanding health care for our regions' kids and the well-being of NE Seattle neighborhoods, please take time to comment. Your ideas will shape a better plan.

Carol Eychaner's Review of the Draft EIS

Seasoned land use planner Carol Eychaner has made her initial review of the Draft EIS available for CAC review. You may find it helpful to you in composing comments on the EIS (due July 28th). She provides:

• Additional Comments on the Draft EIS (from June -- very specific)
  
• Comments on the Preliminary Draft EIS (from January -- provides best overview)
• Supporting Materials:
• Hospital's letter to the Department of Health objecting to additional pediatric beds at a Swedish facility (see excerpts here)
• Field Study on Bed Needs
• Map of Hospital's Property Acquisitions

Carol finds that car trips to the larger hospital could increase by a factor of 2.9 (from 9,200 to 26,680), far more than the increase factor of 1.9 used by the Hospital in its EIS:

"Under all the DEIS alternatives, hospital facilities and beds would increase by more than the factors projected by CHRMC and used for the trip generation... Applying these factors to the number of existing average daily trips of 9,200, would result in a range of 22,080 to 26,680 total trips at full build out - many more than the 17,600 trips estimated in the EIS."

Additional items of interest provided in Carol's documents:

"The requested 160-foot height increase is more than five times the height allowed by the campus' underlying and surrounding zoning." (Comments on the PDEIS)

"The magnitude of CHRMC's proposed on- and off-campus expansion -- in a low scale, low density area outside of any urban village -- is wholly in conflict with the urban village growth strategy that is the foundation of the City's Comprehensive Plan. The impacts of the development proposal ... on the character, scale, land use, viability and livability of the surrounding community are significant and unmitigatable. CHRMC has also made it clear that its plans will not stop with this master plan proposal, but that it is the building block for more to come." (Comments on the PDEIS)

"When CHRMC proposed its current master plan for the Laurelhurst campus, adopted in 1994, it argued that it was essential to have its clinical and research space in close proximity on the same campus... Apparently the need was not so essential after all, since all of CHRMC's research is now located off campus at or near the Denny Triangle site. " (Comments on the DEIS)

"CHRMC has ... proposed... 194 psychiatric beds. This large a psychiatric facility would likely have economies of scale allowing for a viable separate campus or co-location with one of the other existing psychiatric hospitals in the Seattle area... a reasonable discussion of alternatives would include CHRMC’s establishment of a pediatric psychiatric hospital at a location separate from the current campus." (Field Study)

“In Seattle, Swedish Hospital’s inpatient pediatric services now care for more King County children than does CHRMC.” (Field Study)

“The need for Swedish’s pediatric beds is essentially nonexistent” -- CHRMC , May 2005

We've previously covered the Hospital's opposition to Swedish's expansion of inpatient care on the Eastside. Now available and fascinating to read is the Hospital's own letter to the Department of Health objecting to the addition of any pediatric beds at the Swedish facility. In May 2005, two years before CHRMC proposed adding 350 beds to its site, the former CEO of CHRMC wrote the following:

“Children’s is strongly opposed to Swedish’s proposal to establish a dedicated 8 bed inpatient pediatric unit. All available data suggests that the demand does not exist for such a unit, and that rates for inpatient pediatric care continue to decline within the service area...

The need for Swedish’s pediatric beds is essentially nonexistent."

Huh? Remember, Issaquah's population just grew 26% in one year alone (Seattle Times). Perhaps the the Hospital should reconsider adding beds where the kids are if bed need projections have changed so dramatically?

30% of Perimeter Homes Already Acquired by Hospital

Two weeks ago, land use planner Carol Eychaner provided the CAC with updates on the Hospital's purchases of adjacent homes. The materials she provided:

• Summary Memo
• Table of Acquisitions
• Map of Acquisitions

From her Summary Memo:

• "CHRMC has purchased 9 (or 30%) of the 30 single family homes that are on streets around the perimeter of its campus (the 5 houses associated with Talaris on NE 45th Street are not included in this calculation). Of the 17 houses that are on NE 45th Street, between 40th and 45th Avenues NE, 11 are owned by or associated with CHRMC or Talaris. All CHRMC purchases were made since June 2007 and the most recent was on May 23, 2008...
• CHRMC has purchased 43 units in Laurelon Terrace, representing 32.1% of total ownership. All purchases were made since October 2007 and the most recent was on June 9, 2008. "

University Village Proposes 25% Expansion

While commenting on the nearly-3X expansion/rezone proposal from the Hospital as part of the EIS process, you may wish to consider another nearby proposal that will strongly impact transportation corridors. From the May 8th Seattle PI: Seattle's University Village plans big expansion:

"Plans call for about 25 percent more retail space at the upscale open-air Seattle shopping center, and a similar increase in the number of parking stalls.

...When all the work is done, the plans say, the number of parking spaces would increase about 28 percent, from 1,938 to 2,474."

It isn't a stretch to imagine that a 28% increase in parking stalls will produce a 28% increase in car trips to this location, along the same arterials used by Hospital traffic.