Friday, February 16, 2007

The Milton Hospital Imbroglio

Milton Hospital has been an important town institution for over a hundred years. For 55 years it has occupied the current site on land purchased from the Pierce Estate in 1944. In the ensuing decades numerous expansion projects were undertaken to enhance the healthcare services provided to residents of Milton and surrounding communities.

The benefits of a community hospital are many. The most obvious involve crucial medical services for residents. Treatments for any number of emergency medical conditions benefit from the close proximity of patients to competent emergency facilities and personnel. For victims of strokes, heart attacks, and serious accident traumas the length of time between the onset of an emergency and its proper treatment can be the key to survival. Every household in Milton is within a few minutes of the emergency department of Milton Hospital. Over 18,000 visits were made to it in 2006.

We also enjoy the convenience of a broad range of other medical care. Altogether about 7,100 Milton residents were cared for at the Hospital in the past year –over 25% of the town. During 2005, 42% of residents requiring inpatient acute care obtained it at Milton Hospital. Free medical care of $ 250,000 was dispensed in 2006 to residents who simply didn’t have the means to pay. In addition, the Hospital sponsors weekly educational lectures on health related issues and trains both its staff and others in emergency preparedness in the event we need to respond to a terrorist attack or other significant event.

The Hospital is also a business, of course. It employs a large number of people, 93 of whom are Milton residents. Although it is a non-profit institution, it pays property taxes on the office buildings that are part of the medical complex. It is one of the largest commercial taxpayers in town, contributing over $115,000 in tax revenue.

During the past year the Hospital has been much in the news, and often a topic of discussion at Selectmen’s meetings. Recently the story took on a more serious tone when the Town’s new Building Commissioner issued a stop work order for the Hospital’s current construction project. The Hospital has appealed the order. The stop work date was amended to the end of March, and Board of Appeals will hear the appeal on March 13.

So what exactly is going on?

The Hospital has had a number of construction projects over the past 50 years. As with all such projects, issues of neighborhood impacts will occur. And there have been a relatively small number of Hospital neighbors who strongly feel that not all that could be done to mitigate impacts has been done.

Around the time that the current Board of Selectmen took office following last spring’s town elections, some members of the Board began to adopt the rhetoric of some abutters – arguing that the Planning Board should have reviewed the project [they don’t have the authority], that the town should have done more to represent the interests of the neighbors, that the Board of Appeals should have somehow acted differently. Underpinning these comments were thinly veiled charges of impropriety that involved former elected officials who have political views opposed to those of members Mullen and Shields.

The subject became a key issue in the interview process for a new Building Commissioner. The interviewees were offered it as an example of the kind of issues that the new Board wished to be dealt with more effectively by the Building Department. After Mr. Prondak was selected for the position he was directed to intervene on behalf of the Board and investigate the claims made by abutters. Mr. Prondak undertook a three-month compliance review involving a review of the documents and plans dating as far back as 1944; held a series of meetings with abutters; and made visits to many abutter homes to check on their complaints.

His report was issued at the end of December. As an abutter, I received a copy of it. Apart from some obvious mistakes it was a balanced review [the report claims the Hospital purposely introduced Japanese Knotweed as part of its landscaping plans, a ridiculous idea. A common means of introduction is through landfill. Even a tiny fragment of a root can give rise to this incredibly invasive plant]. It made no final determination of compliance, but described a number of measures taken by the Hospital to mitigate neighbors problems and noted other issues which needed to be dealt with.

During this time of course the Hospital was undertaking the construction project for which the Board of Appeals had issued a Special Permit and Variance on September 16, 2005. Ten days after Prondak issued his report he issued a stop work order on the project on entirely new issues. He claims that changes made to the design plans violate design plan approval given by the Zoning Board of Appeals. This is a curious assertion given the following points:

*The Zoning Board of Appeals did not approve a design plan and is not in the business of approving such plans.

*What the Board of Appeals did was approve a Special Permit and Variance which dealt with the height of the planned new addition, the location and size of additional parking, and the total square footage of the new addition.

*Subsequent changes to the design plan were made to cut the costs of the project and did not involve the specifics of the Special Permit and Variance.

*These changes were reviewed by the Town’s Building Department, and were found to be in compliance with all applicable zoning.

*The Building Department issued a permit for the project which the Hospital is legally obligated to adhere to.

Two changes made by the Hospital are at the core of the Building Commissioner’s order. The original plan called for two mechanical units to be built on the roof of the two story addition. This was reduced to one, somewhat larger unit. The remaining unit was rotated 90 degrees and set back 42 feet from Highland Street. This reduced the width facing Highland Street by 46 feet and placed the room adjacent to the present Hospital building, substantially blocking its visual presence from Spafford Road.

Why would the Building Commissioner seek to stop work on a project which is not violating any legal requirements, over changes that reduce the impact on abutters of the new Hospital addition? It increasingly appears to be an exercise in political intimidation.

So while we’re spending money for outside counsel for what appears to be an exercise in legal bravado, the Hospital must deal with the potential impact of a Stop Work order. Even a small delay can have substantial consequences. The Hospital has spent $8 million to date and has already made design changes to control rising costs. A delay threatens the loss of sub-contractors to other projects resulting in costs of delay and subsequent startup.

The additions the Hospital seeks to make with this project will enhance the medical care it can provide people in this area. But a more fundamental impetus drives this effort. Milton Hospital has been losing money for some years now. Substantial sums of money. In many cases millions of dollars a year. The Hospital’s reserves have been covering these loses, but the magnitude and duration of them will not permit this to continue. There is no way to cut costs within the Hospital’s core functions and still fulfill its core mission. The current project and those of recent years add greatly needed outpatient services that also happen to be strong revenue producers. Along with other initiatives that have been undertaken it is vital to creating a financially viable Hospital at a time when Community Hospitals are disappearing from the landscape of medical care in this country.

The current action against the Hospital strongly resembles harassment. It’s hard to come up with a more inappropriate way to treat such a valued institution at its time of need. I trust the Zoning Board of Appeals will vacate the Building Commissioner’s order in keeping with the very clear approvals it gave over a year ago.

Blog Update: In the 24 days since my last post approximately 250 people have clicked on “View My Complete Profile” – presumably new visitors to the blog who have come because of electronic or other referrals. I hope this indicates a growing awareness of the current political state of our town and that it will translate into individual activism between now and election day on April 24, 2007.

Article Update: At the Selectmen’s meeting a week ago the Town’s auditor presented highlights of last year’s audit report. Two points touched on topics I addressed in my last post. The auditors are concerned about the low and declining level of reserve funds available to the Town. Also addressed was the town’s debt level. Member Shields attempted to get Mr. Sullivan to agree that the town had a high and growing level of debt. Mr. Sullivan responded that in fact the town had historically maintained too low a debt level, around 2-3%, and that only recent needed borrowing had raised it to the 7-8% range. He stated that the debt should be at least 10%, or in a range of 8-12% of expenditures, and that once this level was obtained it should be maintained to avoid spikes in such needed expenditures.