It ain’t over until the cornerstone gets laid.
The Veterans Administration held its most recent (but certainly not last) public hearing yesterday evening at the Clifton Center on Payne Street here in Louisville KY. The purpose of the meeting announced in the paper the day before was to discuss “concerns or considerations related to design or layout” of the replacement for the existing Robley Rex Veterans Affairs Hospital to be built on land recently purchased by the VA near the Brownsboro Road exit of the Watterson Expressway. The announcement below of the hearing on the website of the Robley Rex Hospital (reproduced in full here) accurately anticipated that there would not be very many specifics to discuss!
“The purpose of this meeting is to provide the general public, interested stakeholders, affected governmental agencies and other interested parties timely information regarding the proposed action of the VA relative to the present progress of the Facility Master Plan for replacement of the Robley Rex VA Medical Center (VAMC). … The master plan is conceptual in nature and will neither establish a design for the construction or implementation of the new medical center nor institute benchmarks for the same purpose.”
It became apparent immediately that there was a mismatch between the goals of those moderating the hearing and the audience. The neighbors of the future hospital wanted to know what was going to be built in their backyards, but the presenters were still very much in the conceptual stage and had no details to offer. This was a recipe for a bad-tasting meal. The result was continuing frustration on the part the residents who feel information-starved, and not as much substantive input as the master planners must have wished for. Nonetheless, the hearing revealed a few new twists in what is sure to be a continuing organized campaign to delay and/or to build the hospital elsewhere. I will present these below. Additionally, local and regional VA officials attended the hearing and provided me with additional information.
I estimate that some 80 people attended, and from the comments and reactions of the audience, I judged that the majority of attendees were residents living in the immediate area around the new Brownsboro Road site. The meeting was led by a team of experienced planners, architects and engineers from Oculus Inc. and Perkins & Will who have been awarded the contract to develop a master plan for construction of the new 120 bed hospital on the Brownsboro Road site now owned by the VA. The only handout was a timeline for the master planning process. In November, the planners will forward their final recommendations to the VA, and to the design and construction team who will flesh out the details.
Much to the frustration of the audience who had probably expected some actual details of what was going to be built in their backyards, none were to be had. The only slides shown related to the topographic and drainage characteristics of the site, the directions of prevailing sun and winds, and schematics of existing roads. This mismatch of what was expected from each other led to a rather unproductive session. In my opinion, little meaningful information was exchanged. This is not to say that the meeting was without value or uninteresting, at least to me.
The leaders of the meeting obviously wanted to move beyond the controversy of where the hospital should be located to what the hospital should look like. They opened the meeting with statements such as “the site has been selected,” … “we don’t want to rehash the decisions that have been made.” They were unable however, to repulse the tidal wave of opposition to the job they were asked to do. Most of the time was taken up by a reiteration of the old, and some new arguments why the hospital should be built elsewhere, either at the Chamberlain Lane site further out in the suburbs or in Downtown Louisville. The opponents obviously came loaded for bear. I think a genuine attempt was made to be polite, but emotions were high. One argumentative resident who claimed to be in marketing himself stated, “you are trying to calm us down, but I know BS when I hear it.” He tried to bully the panel into admitting that as honorable men they knew building on this site is not the right thing to do. I do not think he was successful in anything other than further establishing an adversarial tone.
All the previous arguments and concerns, real or inflated, about why Brownsboro site is wrong for both veterans and residents were advanced. I have summarized these before. [Click the "Veterans Hospital" link at the end.] They include limited ability to expand, traffic, light and noise pollution, security, trucks and ambulances, helicopters, the taking of houses in the future by eminent domain, 24 hour operations, dangers from medical gases and utilities, blocking of air and light, biohazards, threats from suicide truckers with explosives, and more. The neighbors have been thinking about this for a long time. For these concerns and most of the other questions asked, no answers were available. The generic response was along the lines of “we haven’t got that far yet.”
There was much haggling about how many acres were needed for a 120 or so bed VA Hospital. (The availability of more land at the Chamberlain Lane site underlay this tactic.) What the audience heard could certainly have not been reassuring to them. When pressed about the size of the site, the panel admitted, “it will be cozy, but it will work.” It was also said that the majority of the land would be occupied by one structure or another, be it hospital, parking facilities, or utility support building. Although some new VA hospitals have apparently been built on larger pieces of land, other new VA hospitals handling more patients than in Louisville were said to have been built on smaller sites.
Hopes for a “pastoral” setting by some may have been dashed, but the planning team includes people well experienced in building hospitals and I have no reason to doubt their assertions that they share the same values as the Louisville community at large. I have seen pictures of some of their other hospitals. I take them at their word that they want to build the most beautiful facility possible and to be good neighbors. To this end, the regular meetings and updates with the mayors of the nearby micro-cities are planned.
Some Positive Contributions.
In this meeting of over two hours, a few specific suggestions or comments were actually offered by the audience. Most of these were related to what kind of wall or barrier might be erected, setbacks for buildings, and the nature of parking facilities. Some wanted to make sure that the hospital rooms were bigger than those at the current VA, that parking for both employees and patients would be adequate, and that some accommodation for lodging for families be might available. Concerns were expressed about the adequacy of public transportation and that more than one access point to the hospital grounds would be helpful, if not necessary. Some discussion of which direction the hospital should face occurred. A memorial to area veterans was suggested. One brave neighbor expressed again his preference for a VA hospital in his backyard instead of the shopping center and high-density apartments that had been planned previously. The panel would obviously have liked to have heard more, but in fairness to the audience, there was very little of substance on the table on which to comment.
What did not happen.
Some of the things that didn’t happen were also interesting. There was not much coverage from the traditional news media. I saw a team from Wave TV, but none other. Despite the agitation by the editorial board of the Courier-Journal about the profit made on the sale of the land to the VA, and a suggestion that some skullduggery must have occurred, little was said at the meeting. There were not very many veterans present who did not live near the new site. These folks made up the majority of the audiences at the early site-selection hearings where they were overwhelmingly clear that they did not want the hospital to be built downtown. If they now assume that the new location is a done deal, they need to stay alert!
A new advocacy effort to change site location.
I did not see a contingent from the University of Louisville but I had my suspicions about one commenter. He was an articulate and dispassionate speaker who identified himself as Eric Gunderson, claimed not to be a neighbor at Brownsboro Road, and who was there representing the organization Grow Smart Louisville. He stated that his group believed that the master planning process should come to a halt and asserted that the hospital should be built downtown. His arguments had little to do with the quality of patient care, but were couched in the economic development terms we have heard before from the University and other downtown boosters. These were: enhancing the downtown campus, greater growth potential, ability to more easily obtain federal research grants, a more accessible site with existing infrastructure, and in short, a better return on investment. He wanted to know if the new site was set in stone, or under what circumstances the site selection process could be reopened. I later asked Mr. Gunderson if his organization included the University of Louisville, and he said no. As I came to learn, Mr. Gunderson also has leadership roles in organizations in which the University also has major involvement and which also advocate for downtown development.
A quick Google search later revealed that Mr. Gunderson runs a Louisville marketing and consulting company for physicians and healthcare organizations. He is on the Board of Directors of the Health Enterprises Network which is the healthcare-related business arm of Greater Louisville Inc. (Louisville’s Chamber of Commerce). He is also on the Board of the Louisville Arena Authority that manages the Yum Arena where UofL plays basketball. Upon learning this, I was not surprised at the businesslike and business-oriented nature of his presentation.
I had not heard of Grow Smart Louisville before, but it was obvious Mr. Gunderson was working in a coordinated way with the unhappy residents who were handing out Grow Smart’s material at the meeting. I looked at the website listed on that recruiting handbill, www.growsmartlouisville.org. The physical address listed is that of the Shelbyville Road Plaza where Trader Joe’s and the St. Matthews Post Office is. There is no information provided about the membership or sponsorship of the organization. The website itself was registered less than month ago. The only issue it concerns itself with is the location of the new VA Hospital. Several opportunities to make donations are provided. I have no information at present about who might be supporting the organization financially, but I can think of several organizations with similar goals.
Grow Smart Louisville is actually the business name of a brand-new Kentucky non-profit corporation, “Citizens For Smart Growth, Inc.” According to the Kentucky Secretary of State, it was incorporated only three weeks ago. Mr. Gunderson and several residents of the Crossgate community are listed as Directors of the corporation. Another is one of the officers of the City of Glenview. The corporation’s mailing address is within the City of Crossgate. In my opinion a person might easily conclude that Mr. Gunderson had recently been hired by, or volunteered to help Crossgate and perhaps other nearby neighborhoods to help them delay or derail the building of the new hospital on the new VA-owned land. Perhaps they will be successful. I am reminded of how organized and connected community members were able to successfully derail Louisville’s Ohio River Bridges project these many years.
I was able to talk with several VA officials, some of whom I have known for some time. I learned the following.
The new hospital will serve the same mission as the old in our regional coordinated VA network service area. That is not to say that all possible services will be offered. Some specialty cases will be sent to other hospitals with which the VA has contracts. Such is the case now when cardiac surgery patients are sent to Norton. Other cases will go to VA hospitals in the regional system that have been designated as specialty centers. This makes sense from a quality point of view and avoids duplication. Wouldn’t it be nice if UofL and UK could play more nicely together and be a better combined asset to Kentucky. Do you think that will ever happen?
Staffing of the hospital will be essentially the same as it is now. The VA is hiring its own primary care doctors and hospitalists for continuity, consistency, and quality of clinical care. Many specialty services will continue to be provided by University of Louisville faculty. Residents and students will participate as they do now.
Rejection of Downtown site.
Some of the reasons are already known. These included lower cost of land and the ability to build faster and for less money on undeveloped land. I learned that the hostility of veterans to the downtown site was indeed the major factor I thought it might be. I was not surprised that major problems with acquiring individual pieces of downtown property by purchase or eminent domain was also an important issue. I had not previously heard that issues of being on the flood plane were so important.
Why Brownsboro and not Chamberlain?
The Brownsboro site met the necessary criteria of size, ease of acquisition, and readiness for construction. What I did not realize was that Brownsboro was also in part a concession to the Medical School so that its faculty and trainees would not have to travel so far from downtown. This must have been the fallback request from the University should they have failed, or yet fail in the future to secure their first choice.
And so this saga continues. Lawyers and lobbyists are still being recruited. Because a downtown location means big bucks for some connected players, decisions will continue to be threatened. Costs and deadlines may grow and lengthen. I am sure arms are still being twisted. I do not doubt that elected officials are being asked for their influential help. As Dave Houvenagle in LouisvilleKY.com has written, this same political and financial battle has been going on since before the Zorn Avenue Hospital was built. The players’ names have changed, but not their positions.
What is your prediction? What do you know that the rest of us do not?
Peter Hasselbacher, MD
Emeritus Professor of Medicine, UofL
16 Aug 2012