Building A New VA Hospital— What Would Robley Rex Think?

The lengthy and tortuous planning process to build a replacement Robley Rex Veterans Administration hospital came into public view again these last three weeks. On January 15, dual afternoon and evening public hearings were held at the Clifton Center to allow public comment on the site-specific draft environmental assessment of the former farmland. It is my understanding that these were expected to be the last public hearings to held for the relocation project.

I estimate that some 60 people attended each session, but I could not completely differentiate program development and VA staff members from the public. There were probably some, like me, that attended both hearings. An initial (and certainly futile) request was made to keep the session on topic— to focus comments on the draft environmental assessment. Although some general questions might be answered, it was made clear that the intent was not to fully answer questions so much as to collect them for incorporation into the final environmental assessment.

Each session was begun with a welcome and introduction of the new VA director, Martin J. Traxler, and a presentation from planning staff member Mary Peters summarizing the environmental assessment. That presentation, the full environmental assessment report, and its summary are available from the Louisville VA website. The large bulk of environmental questions and comments related to concerns about traffic and disruptions during the multiyear construction process itself.

The home team was present.
Judging from applause and other audience reactions, virtually all in the audience were either neighbors of the proposed hospital location, or advocates for a downtown location. Most of the comments and objections were recycled from earlier forums including assertions that the quality of medical care available downtown was better than that in the suburbs, that a downtown location would be more convenient for the medical school, and that a downtown location would give a boost to economic development. Other “non-environmental” concerns were raised. Questions were asked about the impact on veterans if existing community outpatient sites were consolidated, or about the ability of veterans and their visitors without cars to reach the hospital. A new scripted comment arose at both forums as speakers pointed out that several new VA hospitals under construction were running well over budget. It was not made clear why that was an obstacle to going ahead in Louisville as opposed to being a general criticism of the federal Veterans Administration. I saw the presentation of this new avenue of criticism as an indicator of coordination of community opposition. This was not a forum for rebuttal of arguments that have been going on back and forth for more than 10 years. Readers can review in earlier articles my thoughts on some of the issues.

Although the audience was for the most part more polite and less openly hostile than at some previous forums, this was not a crowd friendly to the proposed Brownsboro Road location. Much distrust of the process was expressed. Evidence of continuing opposition was apparent including a threat to pass a new neighborhood law to impound the personal vehicles of contractors who might park in neighborhood streets, and a suggestion that a River Field type lawsuit such as was used successfully to delay the building of an eastern bridge over the Ohio River “would be a very good thing.” Some of the same community groups seem to be involved. It was also suggested that the environmental assessment under discussion was insufficient, and that a full-blown environmental impact statement was necessary. That strategy may have legs. See below.

NIMBY and Traffic.
There is no question that the bulk of objections are coming from people living near the proposed location. I would probably be upset too and might rather the land remain as a farm than undergo any future development. In my assessment, the most justifiable argument of the neighbors relates to traffic. At every location where a radial artery from central Louisville must cross the Watterson Expressway, traffic is a problem during rush hours. The crossing at route 42/22/Brownsboro Rd. is no exception, but in my experience, it is not the worst. Certainly since the adjacent Westport Road interchange was opened, and after improvements to the Brownsboro Rd./I-71 complex were made (including the exit slip-ramp to Route 22/Old Brownsboro Rd.), traffic on Brownsboro Road has been better. I no longer get stuck in the long backups of eastbound traffic that used to start in midafternoon. Last fall I made several weekday visits to the intersection when school was in session during the morning and evening rush hours. I took videos. I could not conclude that traffic was onerous. Granted I do not make the trip every day, but clearly some residents are guilty of hyperbole, such as the individual who warned that veterans and their visitors might have to wait two hours in their cars. Perhaps understandably or excusably, the neighbors expressed distrust of the traffic studies done to-date, or of the promised additional future mitigating improvements that will be part of the hospital construction process. Certainly the neighbors and the Louisville community as a whole deserve to have confidence that a reasonable assessment was made of what traffic is like now, and what it would be like with or without future changes to the roadways and traffic patterns. The audience was reminded that traffic is going to increase at the intersection regardless of whether or not the hospital is built there, or no matter what kind of development will be placed on the former farmland.

What do doctors really think?
Much was made of a Kentucky Medical Association resolution that a downtown location is preferable. Getting this resolution out of last year’s KMA annual meeting was a real coup for Grow Smart Louisville, a single-issue corporation set up to lobby for a downtown VA hospital and to keep an avenue open for University of Louisville Pres. Ramsey to advocate for a location near the medical school. I believe the degree of KMA support is being overblown. I previously reported that the initiative came from one of the founding members of Grow Smart Louisville who was also a member of the legislative affairs committee of the Greater Louisville Medical Society. He pushed very hard to get to the committee to pass a resolution for a downtown VA which would then automatically go before the KMA annual meeting. I do not know if the member revealed his association with Grow Smart Louisville, but I do know that committee voted against his proposal, perhaps more than once. One committee member told me that they were finallly just plain worn down. Once a local resolution is placed on the statewide agenda, unless there is substantial opposition from out-in-the-state, passage is generally assured. I am confident that no KMA muscle was put behind the resolution, and that the assertion of one forum speaker that the KMA “overwhelmingly” wants a downtown location is overstated. This would not be the first time that local politics found its way into medical policy at the Medical Society as for example some years ago when the same government affairs committee passed a resolution expressing concern about the decline in the quality of the clinical departments of the medical school. Claims that the best quality medical care is only available downtown are unsupported, and at least as judged by current (albeit imperfect) metrics, incorrect.

It’s good to have a public official advocating for you.
The opponents to the new location are savvy and well organized. It is not surprising that in Sunday’s Courier-Journal we learned that Angela Leet, the Louisville Metro Councilwoman representing the area surrounding the proposed location, is calling for an environmental impact study focusing on issues of traffic. It is not clear to me that a full-blown environmental impact statement need to be done to address only traffic issues, but the controlling regulations in this area are often used to delay projects that some consider undesirable. This raises the costs of projects as well. At present, the Veterans Administration has stated that it intends to issue a finding of no significant impact unless there are no substantial comments that warrant further evaluation. Opponents are hoping that traffic will be that the substantive trigger.

Back to Robley Rex.
I began this article with a reference to Robley Rex, one of the last two remaining WWI Veterans. He was born in Hopkinsville and died in Louisville in 2009 at the age of 107. Louisville’s VA hospital is named after him. Mr. Rex was still alive and may well have been aware of early stages of the replacement process. He was a great supporter of Louisville’s VA Hospital and its veterans. I cannot know what he would say today. I do know, that almost to a veteran, every one who spoke out at the public hearings I attended over the years would have preferred the hospital to remain at Zorn Ave., but failing that, and for rational reasons, were equally united in opposition to relocating downtown. I have written extensively about these hearings. To my observation, those few veterans at public forums who advocated for downtown attended as part of the UofL delegation, or were former UofL faculty members.

However, Mr. Rex may have had a proxy in the audience last month– an almost 90 year-old navy veteran who said he had been well engaged in the relocation reprocess since before it was public. He claimed to have spoken to over 200 veterans personally “of whom hardly any wanted downtown… they preferred the Zorn Ave. location, but if we can’t have that, this location is a little better than downtown.”  The elderly combat veteran pointed out the ubiquity of bumper stickers supporting veterans but commented pointedly that “the vets also suffered some inconvenience… If we are going to support the vets we must also suffer a little bit.” He acknowledged that if he lived next door he might think differently, but he hoped not. “We’ve got to make the bumper stickers more than bumper stickers.”

I am not a veteran, but I have served as a VA physician most of my professional career. I too heard what the veterans had to say and what they have asked for. Who would disagree that our veterans are due more than “ritualized reverence?” In my opinion, they are not simply fodder for economic development by downtown boosters, nor a captive group of patients for teaching services and research, nor new business for a given healthcare system. I do not think we as a community must necessarily suffer, but I do think we need to listen to what our veterans had to say. I personally believe that our veterans can be well served at the Brownsboro Road location that emerged from a long and careful if not cumbersome process as the best place for the new Robley Rex Veterans Administration Hospital. Verify the traffic situation and the planned traffic mitigations and move on.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
February 8, 2015