MVC questions hospital leaders on plans

By Janet Hefler - November 23, 2005

Ignoring a detailed analysis from Martha's Vineyard Hospital officials justifying the economics and practicality of building a new facility at the hospital's present location, the Martha's Vineyard Commission (MVC) last week insisted that the search continue for a better site.

Tim Walsh, hospital chief executive officer, told the commissioners that the $42 million price tag for building a new facility on the present Beach Road site is one that donors and the hospital board support. Moving to a new site, assuming one can be found, and building a completely new facility would drive the costs up to an estimated $71 million, without including the price of land, Mr. Walsh said.

Tim Sweet, hospital board vice chairman, who accompanied Mr. Walsh during what was billed as an informational presentation, told the commission members, "We don't have the luxury of spending more. If the hospital is too large and expensive, we can't handle the deficit."

The meeting began with a detailed presentation by Mr. Walsh describing the circumstances that influenced the board's decision to rebuild on the present site. Those considerations included the difficulty of finding a suitable new site, the cost to completely rebuild a facility that includes clinical and office space, and to replicate Windemere, which now shares the hospital facilities and services.

Despite the detailed presentation, many members of the commission remained unconvinced by the array of financial and practical considerations marshaled by Mr. Walsh. The commissioners expressed concern about the hospital's present location, citing possible flooding, access, open space and parking.

"Trying to put another hospital on that site seems ludicrous to me," said Chris Murphy, a Chilmark commissioner and a retired commercial fisherman, who described the site as a knoll in a swamp served by a faulty drawbridge.

Another major consideration in relocating the hospital, said Mr. Walsh, would be the cost of moving the Windemere Nursing and Rehabilitation Center, the Island's only nursing home. In recent years Windemere has also expanded its rehabilitative services, which allow many Islanders to recuperate near family and friends rather than in an off-Island facility.

Describing the hospital as "joined at the hip" to Windemere, Mr. Walsh said the two facilities share several services and staff members. "Windemere could never make it on its own," said Mr. Walsh. He said that the nursing home, built in 1994, posted a modest profit for the first time in 2004.

"Leave Windemere behind," suggested Linda Sibley, MVC chairman. She recommended the hospital sell it to a company that would turn it into a combination assisted living and nursing home.

At that, Mr. Walsh, the hospital's former chief financial officer and the man credited with saving the facility from a sea of red ink, provided a quick primer on the difficulties of the nursing home business.

"Seventy percent of Windemere residents are on Medicaid. What you are talking about is for higher income people," Mr. Walsh said. Windemere is part of the hospital's mission as a not-for-profit facility, he explained.

Over the course of the three-hour meeting, the commissioners' discussion ranged from a critique of the hospital's organizational structure to the look of the façade for the new building.

Mr. Murphy chastised the two men for the way the not-for-profit hospital is organized. "Why aren't your board meetings public?" he asked. "You should be having a public board that is accountable."

Commenting on the building plans, Ms. Sibley said "it looks like a ski lodge - I don't like it."

"We want a maintenance-free façade. We can engage the public when we get to that point," Mr. Sweet told her. "We have a lot to do before then. I will be happy when we get to the point where all we are doing is looking at the building façade selection," he said.

Without addressing where the additional money would come from or a specific parcel, several commissioners suggested the hospital be built in a more central location, such as one near the four-way blinker intersection on Edgartown-Vineyard Haven Road. Mr. Walsh explained that there was no single alternative site of adequate size or in a more convenient location.

Although the existing hospital building is situated on eight acres, he said a new building would require 15 acres to comply with current zoning laws.

"If you know of a spot, let us know," said Mr. Sweet. "We're running out of time."

Ned Orleans, Tisbury MVC commissioner, said in his past career experience, it was standard practice to consider several sites.

Megan Ottens-Sargent, Aquinnah MVC commissioner, suggested a parcel might be available through the Oak Bluffs resident home site committee but did not provide any specific information on where that might be or why it would be available to the hospital.

Mr. Sweet said even if a parcel was available, which it is not, the hospital did not want to compete for land with any affordable housing project.

After much discussion by the commissioners regarding alternative sites, Paul Strauss of Oak Bluffs, the commissioner appointed by Dukes County, asked Mr. Walsh, "You've concluded that moving to another site is not feasible financially?"

"Yes," responded Mr. Walsh, "Although it's obvious I haven't convinced enough people."

With the commissioners still wanting to find another site, Jim Athearn, a farmer and Edgartown MVC commissioner, said that the commission "should just put up or shut up."

With that, Linda Sibley, MVC chairman, agreed to appoint a subcommittee to investigate possible hospital sites. No deadline was set for concluding the search.

"Searching for a perfect site gets me to focus on the disparity, from the idea of land use and community use as one issue and financial concerns another," said Ms. Sibley. "There may not be one site ideal for both."

The hospital officials were willing to let the MVC try to find a workable alternative where they had not. "Give us something viable, and we will work on considering it," said Mr. Sweet.

There was only a little discussion of where the money would come from to close the gap. Mr. Murphy and Ms. Sibley both suggested that Islanders would be willing to make up the difference. To date, the hospital has raised a little more than half of the $42 million it needs for a rebuild.

Following last Thursday's meeting, Mr. Sweet said although time is of the essence and the site search process cannot go on forever, it would be best to bring everyone to the same conclusion. "It's prudent, for everybody's total satisfaction, that everybody is convinced that it's not the most perfect of the scenarios, but it's the best that's available," he said.

In the meantime, Mr. Sweet said the hospital would proceed with its current plan. "The design process, permitting process and fundraising process are continuing," he said. "If something unexpected comes out of this that is so good that we need to take a second look, we will. But in the interim, we need to continue down the road we are going."

Once the MVC site investigation concludes, the hospital project will undergo a formal hearing process as a development of regional impact (DRI).