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Thursday, 07 April 2016 16:59

Hospital Expansion

By | Business

A Decision for Many is in the Hands of a Few

Saratoga Hospital is a private, non-profit entity that is responsible for providing much of the wellness, chronic, urgent and life-saving medical care needed in a county with a population of more than 226,000 people. Anticipating future medical care needs, the hospital recently proposed an expansion. The neighborhood and some City Council members oppose it. Who speaks for the other 200,000 people?

SARATOGA COUNTY – The Saratoga Hospital is a private, non-profit entity that is responsible for providing much of the wellness, chronic, urgent and life-saving medical care needed in a county with a population of more than 226,000 people, as of the 2015 U.S. Census estimate. Anticipating future medical care needs, the hospital recently proposed an expansion.

Members of the neighborhood surrounding the proposed expansion near the hospital’s Church Street location have raised concerns about the impact the expansion would have on their property values, the noise level, the traffic, and quality of life concerns.  

The hospital and the neighborhood have had their lawyers appear before the Saratoga Springs City Council, and both have had their representatives and allies speak at public hearings, standing up and explaining their views in hopes of finding common ground.

The one group that the City Council has not heard much from, however, is the largest group – the two hundred thousand people who do not reside in Saratoga Springs, yet count on Saratoga Hospital to be at peak performance 24 hours a day seven days a week. 

“I represent the 28,000 people of Saratoga Springs,” said Saratoga Springs Mayor Joanne Yepsen. “We have a very active population of residents and for my part that’s a good thing. But we also have to balance that out as legislators. Anyone wanting to weigh in is welcome to come to the public hearings or reach out to us.” 

But as a service provider for the county, part of the job of a hospital administrator like Angelo Calbone, president and CEO of Saratoga Hospital, is to determine what that peak performance looks like today and in the decades to come.

He and his staff painstakingly follow the ever-changing regulations coming down from the federal and state government; pay attention to the changing demographics and other healthcare predictors of the region they serve; weigh the national shortage of primary care physicians and other provider shortage areas; and track the snowballing advances in medical research and technology in order to anticipate the medical needs of their service area and be ready to meet them.

The hospital has nearly tripled in size in the last decade according to Calbone. “We’ve been here for over a hundred years, long before the neighborhoods existed,” said Calbone. “It’s not like we woke up yesterday and decided to expand on Morgan Street.”

Saratoga Springs Commissioner of Public Safety Christian Mathiesen disagrees. “Our message is the parcel on Morgan Street has always been zoned residential, and that property continues to be residential.”

Nevertheless, the hospital’s rate of growth and other healthcare factors had the hospital weighing expansion options for some time. Matt Jones of Jones Law Firm, representing Saratoga Hospital, said an opportunity presented itself in 2014 with the availability of the property on Morgan Street.

The City of Saratoga Springs was working on its Comprehensive Plan at the time, and the hospital asked the Comprehensive Plan Committee to consider expanding the zoning designation there to INST [institutional] so as to bring the physicians and staff all under one roof in a medical facility near the hospital. 

“There were many things the Comprehensive Planning Committee disagreed on internally,” said Jones, “but not this. It was unanimously agreed upon by the committee, so it went to the City Council.” 

Ultimately, the City Council approved the Comprehensive Plan in June of 2015 with the redesignation intact. According to Mathiesen, however, the Council didn’t fully understand what they were voting on. 

“The change in the comprehensive plan map in 2014, and approved in 2015,” said Mathiesen, “was done without an awful lot of attention paid to that change. We weren’t awfully aware of what happened until the hospital came forward with its proposal.” 

Believing that so far everyone was on the same page, the hospital filed an application in August 2015 to amend the PUD to build a 75,000 square foot medical office, providing further detail on its vision for expansion. Then it met with neighbors, the mayor and other members of the City Council in early September, and the amendment went before the planning board for an advisory opinion in October. 

“They found no adverse environmental impacts,” said Jones, “and they issued a favorable recommendation for the rezoning.”

The matter returned to the City Council in early December and the public hearing process began. Then two councilmembers, Commissioner John Franck and Mayor Yepsen, recused themselves January 19 of this year, 15 months after the expansion proposal process was brought to the attention of the City Council. 

“Recusals are very rare,” said Yepsen. “This is the first time I’ve had to do so in 11 years. The process is there for good ethical reasons.  I was disappointed in not being able to take part in a vote on the proposal. I think the hospital is a critical entity of the community. We want to do what we can to help them grow. The neighbors didn’t like the proposed size or location, so my planning staff has offered to meet with the hospital to help with options.”

According to Mathiesen, the matter is simple. “Build up,” he said. “Looking at other campuses – Albany Med, St. Peter’s, Ellis – they all face the same problem of being inner city hospitals, and they solved it by building up.”

Mathiesen believes the hospital has plenty of room to build parking garages rather than create large areas of surface parking. “They could save money with bulldozing and blacktop, but cheaper is not always better.”

According to Calbone, the hospital is near done on its current footprint, and has already considered building up and adding parking garages. “Walk around here, and there aren’t a lot of options that aren’t very disruptive or expansive. When I say more expensive, we’re talking in the range of some $8 million plus.”

Calbone is looking many years down the road and has to consider where to put infrastructure investments that will have the most community support long term. Should the Comprehensive Plan be changed to make the zoning around the hospital exclusively residential, that decision will not only impact the current proposal, but proposals to come.

“My broad reaction to where we ended up is that I can interpret this message to us as one general message,” said Calbone. “‘We want Saratoga Hospital to stop growing in the City of Saratoga Springs.’ We think that’s the message. No one has said it specifically, but we’re being told this is a residential neighborhood and we want to keep it residential. So what does that mean for us? We have to look elsewhere. We own a 140 acres in Malta. Do we need to look at our investments in that campus, as we look at our future development? I don’t mean that as a threat, it’s just a reality. We have to figure out what this means in terms of five year, ten year planning.”

The hospital, like any other entity, understood its responsibility to go through the proper channels for this expansion, and spent time educating city officials and meeting with neighbors to meet that responsibility.

“Is there the expectation that everyone understands what we are doing,” asked Calbone, “or just the individuals, decision makers like the City Council, appreciate the broad scope of our decisions and how it impacts the broader community and how it impacts the greater good?” 

Mathiesen said this expansion is really more about neighborhood impact than county-wide services impact. “The proposed location is convenient but not necessarily crucial,” he said. “If they are able to provide these services in other ways, this is definitely not affecting healthcare county wide. I think this is being overblown.”

Mathiesen believes the hospital has not yet exhausted its options in Saratoga Springs, however. “They’ve [the hospital] made a significant commitment to being in Saratoga Springs, given the surgery center and new ICU,” said Mathiesen. “People have donated millions of dollars to bring about these changes assuming they are committed to that location. I think it would be irresponsible after all those donations to move to Malta.”

Yepsen believes it’s possible to work something out. “This community needs a strong medical operation and we will be very hurt as a community if the hospital doesn’t find a way to foster all their services and medical operations here,” she said.    

“What’s different here,” said Jones, “with two member having recused and with a number of neighbors having filed a protest petition, the hospital or anyone else would need four affirmative votes from the City Council. But, there are only three members available to vote on the zoning.” 

Calbone added, “Clearly we’re also frustrated by the fact that the loudest voices seem to carry the most sway in a conversation that has much broader implications.” 

With four votes not possible due to the recusals, the proposal remains unresolved.  

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