MVC approves hospital project

By Nelson Sigelman - December 14, 2006

Ending a marathon review process that began more than one year ago, Martha's Vineyard Commission (MVC) members voted unanimously Thursday to approve the construction of a new Martha's Vineyard Hospital building on the hospital's current Eastville site in Oak Bluffs.

The vote by the Vineyard's powerful regional land use permitting body on the development of regional impact (DRI) followed a detailed and at times painstaking review of a 21-page report that began shortly after 6:30 pm and ended just before 11 pm.

That the review was completed in one evening owed much to the completeness of the report prepared by the MVC's Land Use Planning Committee (LUPC) and its chairman Christina Brown of Edgartown, and the determined efforts of MVC chairman Linda Sibley of West Tisbury to push ahead in one evening through seven pages, which listed the conditions (68 total) attached to the project, and five pages listing what the MVC deemed its benefits and detriments (31 benefits and 27 detriments).

Ms. Sibley began the meeting by noting the hard work of the LUPC, an amorphous MVC subcommittee made up commissioners who decide to attend its meetings, and staff in preparing a report that closely resembled an MVC written decision, the final step in the permitting process. The implied message was that there was no need for the commissioners to reinvent the wheel.

For the most part, the commissioners appeared to agree. Despite some editing here and there and the accompanying wrangling over definitions, frequent questions and comments from Aquinnah representative Megan Otten-Sargent, and brief discussions on subjects that included light spillage, global warming, alternative energy, and bicycle use, the review moved steadily forward. When it was time for the 16 commissioners present to vote on a project that hospital leaders said could withstand no delays, there were no surprises.

But there were statements. Several commissioners expressed reservations about the decision to rebuild on the current site rather than on a new site in a less congested part of the Island - something hospital leaders insisted was not financially feasible - but all who spoke agreed that the new facility was badly needed and would improve the delivery of health care on Martha's Vineyard.

Dr. Martin Crane of Hingham, the governor's appointee and a seasonal resident of the Vineyard, said that he had worn many hats in his public and professional life. While agreeing that "...in some sense the location is not ideal here," the physician added, "The thing that I see, and I have to put on my healthcare hat now with this, is that the benefit to improved health care to people on the Island and the consequences of an improved quality of life here are indisputable, they're very clear, and they're compelling, and they far outweigh and override, as far as I'm concerned, any of the detriments I have seen in this project.

Dr. Crane added that the Island will be well served by the hospital administration in years to come. "They know their demography, and they know what their hospital should be doing and so far serving the community, and I can't see anything other than approving this and letting them get on to build and letting them get first-class health care on this Island, which you all deserve. And I'm going to certainly vote to support it," Dr. Crane concluded.

Mark Morris of Edgartown said that in a perfect world it would be nice to move it, but he said, "It is not a perfect world."

Ms. Sibley noted that it was the commission's job to weigh the benefits and detriments of this particular project. She drew a distinction between projects presented by private developers and the hospital.

John Best of Tisbury, who ends his term this month, maintained the skepticism he had shown throughout the process regarding the hospital's claim that this was the only viable plan. He said the hospital location represented a failure to plan for the future, but that it was better to have a hospital rather than no hospital and he would grudgingly vote to approve.

Road-block removed

This week hospital chief executive officer Tim Walsh estimated that the MVC review process cost the hospital approximately $100,000 to complete. Those costs include various drawings and presentations by hospital architects Thomas Miller and Associates and a risk assessment study of the site prepared at the urging of the MVC.

The MVC's DRI review began with an informal presentation on Oct. 21 by hospital building committee chairman Tim Sweet and Mr. Walsh. The formal review, which began on Nov. 17, 2005, included numerous meetings with the LUPC, an exploration of possible alternative sites by an MVC subcommittee, meetings with MVC staff and three public hearings in November.

Hospital officials were pushing for a decision by the end of the year to avoid escalating building costs. The MVC schedule was designed to meet that goal.

But last week it appeared that the inclusion in the plan of an off-site employee parking lot, which was not part of the formal application under review and had attracted the ire of neighbors, would forestall an expected vote. The MVC took steps to reopen the public hearing in order to correct the procedural misstep.

Instead, the hospital decided to unhook the parking lot and the MVC agreed not to make it an issue. That informal agreement paved the way for last week's vote and provided the hospital with more time to find a solution for its parking needs.

Conditions, conditions

When making a decision to permit a DRI, the MVC is free to add conditions to its approval that can significantly affect a project and add to the developer's costs. Possible conditions are often discussed among the LUPC and may arise from staff or commission recommendations. Often, as was the case with the hospital, the applicant, anticipating what could be an issue, offers specific conditions.

But commissioners may also propose conditions during the discussion prior to a vote. The condition can be based on new information or simply a notion that occurred to an individual commissioner at the time.

If a majority of commissioners agree, the condition is added. The applicant has no opportunity to object or provide any qualifying information. If the applicant considers the condition onerous he or she must wait until the MVC issues a written decision and then reappear and ask that it be altered.

On Thursday evening, Ms. Brown reviewed the LUPC report and the list of conditions ranging across the board. The list includes a requirement to elevate the emergency generator and fuel tank 18 inches and to return to the MVC with a landscaping plan for its approval.

Noting the detailed work by the LUPC, Ms. Sibley proposed that she read the main headings beginning with the findings of fact and the commission only stop on request.

With brief stops to discuss punctuation, sea level rise and language, the finding of facts was laid to rest and the commissioners moved to the conditions. Mimi Davisson of Oak Bluffs noted that most of the conditions were offered by the hospital. MVC veteran that she is, Ms. Brown pointed out that they would probably have been conditions if they had not come as offers.

As the review proceeded, the commissioners tinkered. Jim Powell of West Tisbury asked that the word "remove" be added to an "offer" by the hospital to decommission and demolish its existing on-site wastewater treatment plant.

"I will add remove if it makes you happy," said Ms. Sibley.

While acknowledging that it would be "a novelty" Ms. Sargent suggested adding a condition that the hospital report to the MVC on incentives designed to promote bicycle use. She also questioned whether the MVC should reference the type of brick to be used on the building façade.

Ms. Sibley pondered asking the MVC to add a condition to minimize light spillage from unused hospital rooms at night. She settled on a recommendation.

Mr. Best wanted the MVC to put more stringent conditions on the hospital to promote alternative energy use. Kathy Newman of Aquinnah pointed out that the hospital plan would qualify it for certification in the Leadership in Energy and Environmental Design certification program, possibly the first such certified hospital in the state.

"Remember what we have before us is a motion to approve with conditions," Ms. Sibley said at the end of the benefits and detriments discussion. "We have beaten the conditions to death, to the point of needing life support."

Mr. Best, with support from Ms. Sargent and Jim Athearn of Edgartown, pushed for additional language, to explore the cost-effectiveness. He recommended an energy audit by a third party, possibly Kate Warner of West Tisbury, and a report back to the MVC. This week, the MVC staff drafted a letter containing that recommendation, along with several others, which will be sent to the hospital but will not be included in the commission's written decision.

One proposed change that was welcomed by the hospital concerned the requirement to provide off-site parking. After some discussion, the MVC agreed to require a parking plan prior to the issuance of a certificate of occupancy rather than the issuance of a building permit.

This week Mr. Sweet and Mr. Walsh said they were happy with the vote and anxious to keep moving forward. Both men said that they were disappointed that some commissioners implied that they were not being forthright regarding the financial calculus that led to the decision to build on the current site.

Mr. Sweet said it was hard to hear the data presented by the hospital questioned and in some cases dismissed outright. But he added, "Overall, I felt pretty good."