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
