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For the week of Mar. 29 through Apr. 4, 2000

Where is the justification for St. Luke’s proposed medical office building?

Commentary By STEVE WOLPER


St. Luke's CEO, Edwin Dahlberg, made several assertions in this paper last week regarding the need for the proposed medical office building at the new hospital site. No one can dispute that the construction of St. Luke's new hospital is necessary to improve medical care in the Wood River Valley. However, the same may not be true for the proposed 40,000-square-foot medical office building.

Jon Moses, while officially representing St. Luke's, stated to the Blaine County Commissioners several months ago that the hospital had no immediate need for this medical office building; and yet, only weeks later, he told the Ketchum City Council that there was overwhelming demand and support for this building from the medical community. Which version are we to believe?

What is clear is that the building will be convenient for physicians and some patients (and inconvenient to many other patients) and a source of income for St. Luke's. The question is, what will the cost be to the community for that convenience? What will happen when the projected additional 1,500 vehicle trips (not including McHanville!) are added to the highway?

Where is the outcry from the local medical community for a 40,000-square-foot building to improve the quality of medical care? Where are all these tenants to come from? Or, are we enabling an "if we build it, they must come" scenario. At best, this building is unjustifiably large. At worst it is simply unjustifiable.

If response to the medical office building is less than predicted, will St. Luke's pressure local physicians to move into their building and/or will there be the very natural instinct to open up the space to other tenants and physicians from outside the community?

How will the county monitor rental practices? There are already too many examples in our valley of "creeping retail," where light industrial space has unofficially transposed into retail locations. There is no change in zoning. Parking becomes inadequate as businesses move from the city cores, increasing traffic and frustrating the planning process.

St. Luke's argues that any decision not in their favor will adversely affect the hospital's fiscal health. This is the same argument they have made at every juncture. The overall height of the hospital, the size and quality of the Highway 75 intersection or even whether to trench or bore under the Big Wood River, we are always warned, in the most dire terms, all of these delays and conditions are going to increase medical costs. One would hope their financial planning was not so tenuous.

Is there documented data to describe what has happened to patient costs in other areas where there is no competition, when the majority of physicians are renting offices from a hospital? What has happened to patient costs for laboratory or x-ray services? Is there a subtle but increasing control by the hospital over the medical delivery system?

It has been argued by St. Luke's that the building is necessary for the delivery of medical care. Is there compelling, objective, scientific data that there is a significant difference in patient outcome with an on site medical building? If there is any significant difference, is that alleviated with an office in the hospital for an on-call surgeon to see their private patients without patients incurring emergency room charges?

Absent in St. Luke's arguments are some additional issues:

  • St. Luke's has developed a paramedic program and the county has approved training. This program is designed to provide better on scene medical care. It will provide better patient assessment to the hospital, prior to transporting the patient.

  • St. Luke's proposes to have on staff, in the emergency room, board certified emergency room physicians who are trained to triage and initially treat all but the most very rare and severe emergency cases. If necessary, with paramedics transporting patients, a specialist could be at the hospital before the patient.

  • The proposed medical building will only be staffed by participating physicians during regular doctors' hours. This will leave the building effectively vacant at least 128 hours out of a possible 168 hours per week (77 percent of the time). This assumes that the physicians all work a minimum of eight hours per day, five days each week in the medical building.

If St. Luke's can demonstrate that patient care will be seriously compromised without having consulting specialists on the hospital grounds, then they should hire or have on call the necessary physician specialists to staff the emergency room 24 hours a day, without the need for a 40,000-square-foot medical office building.

This proposal is a prescription for sprawl. How long will it be before the adjacent property owners are before the county asking for relief because their dwellings are no longer habitable as a direct result of the hospital and medical building? They already are! There must be a master plan in place for this area before the building is considered.

Even though this is a hospital that will provide an invaluable service to the community, we must recognize that it is also operated by a large urban commercial corporation, and like any other commercial developer not all of their goals and plans may be consistent with the primary goal of our comprehensive plan—to try to the utmost to maintain the rural character of our community.

The real cost of this facility will not only be measured in dollars but in the irretrievable loss of rural character from the inevitable development this project portends.

Please attend the county hearings and comment before the entrance to Ketchum is turned into a medical shopping mall, surrounded by a huge lighted parking lot.

Steve Wolper is president of Blaine County Citizens for Smart Growth

 

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