CLC Meeting Minutes: June 2007

Community Liaison Council Meeting Minutes
June 21, 2007, 4:00–6:00 p.m.
Visitor Information Center, Building 45 (Natcher Building)
Conference Room D
National Institutes of Health

CALL TO ORDER AND ANNOUNCEMENTS

Dennis Coleman, Community Liaison Director and CLC Co-Chair opened the meeting at 4:05 and welcomed members, liaison representatives, NIH staff and Suburban Hospital guests. He then made the following announcements:

Daryl Lemke (Parkview Citizens Association) is recovering from a stroke and is unable to attend.
Dr. Ozarin invited Mr. Coleman to attend the Whitehall Condominium Association meeting on 6/26/07. This will be the fourth member association meeting he will have attended this year.
On June 30, from 10:00 AM to 2:00 PM, household hazardous waste will be collected at Westland Middle School, 5511 Massachusetts Ave., west of Little Falls Turnpike. Local collections are a real convenience compared to neighbors taking such waste to the County’s main drop off location in Gaithersburg

Brad Mossannounced that the West Drive and Cedar Lane entrance gate hours have been extended until 7:00 PM on a trial basis. This gate is reserved for patients and their visitors.

Tony Cliffordsummarized progress on the South Lawn drainage issue. According to Michael Mitchell, manager of the Capital Projects group within the County’s Public Works Department (DPWT), addressing this issue does not fall under his group’s purview, nor has any funding been programmed for it. The fact that DPWT’s Maintenance group has a similar interpretation, means that resolution of the issue appears to have no owner and is now officially “stuck”.

Mr. Clifford plans to compile a “handoff package” of the most relevant and telling information and provide it to members of the South Lawn Committee for possible escalation at their discretion to inform local elected officials about the South Lawn drainage issue. The information will be provided to committee members in electronic form to facilitate whatever content and distribution they chose

Discussion

Various suggestions were made concerning the most effective audience for raising the issue to a political level. These included the local Council member, the Council President, the entire Council and the County Executive. Mr. Coleman reiterated that such a decision is not up to NIH, since federal agencies are not supposed to participate in lobbying or otherwise attempting to influence state and local elected officials on legislative or spending matters. Nothing prevents CLC members however, from using information provided at CLC meetings for whatever purpose they deem appropriate.

Prior to CLC members having to consider taking independent steps with local elected officials, Mr. Clifford agreed to bring the matter to the County’s attention at the highest relevant staff level; namely, Art Holmes, Director of the Public Works & Transportation department.

Finally, Joan Kleinman asked Mr. Clifford to provide her with documentation of prior contacts on this issue between NIH and County staff. She will evaluate whether her own contacts in County government could get more visibility and remedial attention on this issue.

PRESENTATIONS

Daryl Lemke (Parkview Citizens Association) is recovering from a stroke and is unable to attend.
Dr. Ozarin invited Mr. Coleman to attend the Whitehall Condominium Association meeting on 6/26/07. This will be the fourth member association meeting he will have attended this year.
On June 30, from 10:00 AM to 2:00 PM, household hazardous waste will be collected at Westland Middle School, 5511 Massachusetts Ave., west of Little Falls Turnpike. Local collections are a real convenience compared to neighbors taking such waste to the County’s main drop off location in Gaithersburg

Brad Mossannounced that the West Drive and Cedar Lane entrance gate hours have been extended until 7:00 PM on a trial basis. This gate is reserved for patients and their visitors.

Discussion

Facilities

Route 355 Campus Frontage: Streetscape Improvement Planning

Ron Wilson, Acting Director, Facilities Planning Division, ORF gave an update on preparations for engaging a consultant to help enhance appearance of the most visible side of the campus along SR355. A consultant is needed since such enhancement is likely to require revision of the NIH Master Plan, which means formal submittal to the NCPC review and approval process.

The first step is for the planning group to identify the issues to be addressed and problems to be solved by the streetscape improvement initiative. They can then set preliminary objectives for what the plan will specifically accomplish; namely, to provide a framework for improved site planning and landscaping along route 355; to enhance the area’s visual quality; to establish a unified landscape theme; and to screen unattractive, cluttered or industrial views from surrounding residential and institutional areas and traffic passing by. Existing NIH activities on the east side of the campus will not change, so any streetscape improvements must not compromise those activities. For example, security and visitor facilities will remain and continue to operate as designed, despite the addition of trees and other measures to make them more visually integrated and attractive.

Although no funding has yet been established for streetscape improvements, the above planning framework is a necessary prerequisite. Mr. Wilson envisions a process similar to the master-planning process, which includes research and evaluation, state highway policy, goal formulation, alternative development concepts, selection of preferred alternatives, development of a conceptual plan and guidelines, NIH management review and approval, and implementation as funding permits. Planning is expected to require a 6- to 9-month process, and Mr. Wilson hopes to have a contract in place during FY08. Planning will solicit CLC feedback at various stages, and monthly activity updates will be provided at CLC meetings.

Discussion

George Oberlander noted that 3 trees next to the newly opened CVIF building appear to be dead. Mr. Wilsonwill speak to the project officer and seek their replacement under whatever landscape contract performance guarantees are available.
Mr. Oberlander also asked whether the red and green lights over each CVIF inspection lane can be turned off at night when the building is not in operation. Theses lights point up and down SR355 in the same direction of traffic and can be distracting, not to mention an unnecessary waste of energy. Mr. Coleman asked Mr. Moss to investigate what solution options are available and report back at the next meeting.
Debbie Michaels was concerned about BRAC transportation issues, mitigation of which could include intersection changes at Cedar Lane and widening of SR355. Such expansion could compromise whatever streetscape improvements are accomplished. Mr. Wilson noted that NIH is monitoring the BRAC process, has provided EIS Scoping input, has a seat on the County BRAC Committee, and is likely to provide additional comment on the Draft EIS. Moreover, early 2008 publication of the Final EIS, which would identify a complete list of potential BRAC mitigations, is scheduled to precede completion of any streetscape plan, so the plan would incorporate knowledge of such mitigations.

Information Forum

Miscellaneous Handout Information

Mr. Coleman noted that the following information is expanded upon in the meeting handout:

The OCL Web site has been updated, including contact information for the community issues most likely to require contact with various NIH information sources.
Some 400 NIH employees participated in the recent Bike to Work Day and, for the second straight year, NIH received an award from MWCOG for the highest federal agency participation in the Washington region.
The pedestrian walkway on the south side of the campus has been repaired per the request of Dr. Ozarin.
On June 4 through 6, NIH hosted the 6th annual Federal Environmental Symposium, which drew some 700 attendees from most if not all federal agencies.
EPA has recognized NIH for its mercury reduction and conservation efforts.
A new Arizona cancer center is requesting a cutting from NIH’s “Tree of Hippocrates”, which continues a 2500 year old series of plantings initially started from a tree in ancient Greece, under which tradition holds that Hippocrates lectured medical students
The county executive seeks 4 members for the Noise Control Board.
Hardcopy, audio and graphic transactions from the County’s growth management speaker series have been posted on the County’s web site.
The County is offering to provide community groups with expert speakers on various land-use topics; Mr. Coleman will ask the Agenda Committee if there is any interest in getting such speakers for future CLC meetings.
MWCOG published a DC Regional Air Quality Improvement Plan; such a plan is required by the Clean Air Act because portions of the DC area are characterized as “non-attainment” areas (i.e. air pollutants exceed recommended limits).
Minutes of the May 14 meeting of the County’s BRAC Committee are in the handout, as is Volume 4 of the BRAC news summary, which covers the period 5/18/07 to 6/20/07.

Suburban Hospital Expansion Plans

Leslie Ford Weber, Executive VP of the Suburban Hospital Foundation summarized the history of Suburban Hospital, its position in the community, and plans for renovation and construction.

Suburban Hospital was established in 1943 as a collaboration between the federal government, which needed places for convalescing soldiers, and local citizens. After the war, it was converted to a not-for-profit institution. The hospital, licensed for 228 beds, serves a countywide area with a population near one million. It is also the County’s designated regional (level-2) trauma center. The hospital employs some 1700 full- and part-time staff and has ~400 volunteers and 900 physicians with privileges to practice there. In addition, Suburban Hospital has established several off-campus centers in recent years to provide wellness, rehabilitation and other out-patient services.

There is value to both NIH and Suburban Hospital in being adjacent to each other. For example, Suburban has partnerships with several NIH institutes (NHLBI, NINDS, NIMH and NCI), as well as being a participant in the Bethesda Hospitals’ Emergency Partnership. Also, since NIH is not a traditional treatment hospital, it needs access to Suburban Hospital patients with various conditions of research interest, as well as to tissue samples and an emergency room.

Hospitals are different from other organizations because they are supposed to be kept open and accessible, regardless of building projects and improvements. Suburban’s Emergency Department been closed to certain kinds of patients for more than 900 hours over the past year due to space limitations, which clearly demonstrates the need to expand.

Maryland is the only state where hospitals do not set their own rates. The state sets these rates as well as regulating the number of beds hospitals can have.

Suburban serves an average of 13,000-16,000 in-patients and 40,000 Emergency Department patients annually not to mention hundreds of thousands of outpatient visits.

Challenges for Suburban include:
- Disaster preparedness (every county hospital is expected to be able to serve at least 100 victims beyond the norm);
- Workforce issues (the 10% nursing shortage is growing, as are shortages of pharmacists and other healthcare workers, all of which are exacerbated by affordable housing and commuting issues; this means that access to modern facilities is increasingly important in attracting and retaining trained staff);
- Aging facilities (the Hill Burton Act provided money for hospital additions decades ago, but those facilities are wearing out as they approach their design lifetime; Suburban’s last major clinical addition was done in 1979).

Suburban Hospital’s land holdings consist of about 15 acres, including an original 2-block area plus a couple dozen lots purchased over the years from adjacent residential property owners.

For the current volume of patients, the hospital is about one-third too small. For example, the Surgery Department operating room is 380 feet2 per room, while the industry standard is now 650 feet2 per room. Formerly the desired ceiling height was about 10 feet, but to accommodate new information technology, medical equipment and heat/AC/purification systems, the current standard is 14 feet. About 44% of Suburban’s beds are semi-private, while the current standard of care encourages a family member to be present 24 hours per day, so patients now need larger private rooms. Private rooms are also necessary for infection control.

Suburban Hospital is now replacing 6 of its 15 operating rooms and upgrading its air-handling system, but renovation alone cannot solve inadequate space issues. In short, a building program is also needed. Planning activities for new construction have reviewed the County’s permit requirements and procedures, the long-range land-use forecast for Bethesda, various approaches to maintain service during construction, the effect of construction phasing on continuity of service and staff, how to best manage hospital traffic, post 9/11 security needs, and availability of parking.

The expansion plan proposes to concentrate primary functions and services within the existing 2-block campus area. Architectural drawings of preliminary campus expansion concepts were presented to the community in the spring of 2006. This plan included closing one block of Lincoln Street, improving access to McKinley Street, and constructing new patient care and physician service wings and a parking garage. They are continuing to refine the plan in terms of periphery treatments to reduce residential area impacts, the optimum number of beds (which is subject to state review and approval), and analysis of traffic counts. Two regulatory processes are required, land-use approvals (a county process) and certification of need (a state process).

Discussion

Suburban Hospital is the only county hospital that has not expanded in recent years. It cannot meet new standards of care by renovation alone because that would not allow the required increase of floor-to-ceiling heights without shutting down services. In the past, they have closed units (OB-GYN, long-term care) and might be forced to look at this alternative in the absence of new construction. They also need to physically expand to install MRI, robotic, and other modern services, but the total bed count would only increase minimally. (The final number is a matter of state regulation.) Suburban Hospital remains committed to its present location, partly because of NIH, and partly because of the people in the community, who are familiar, aging and dependent on its services and proximity.
All hospitals are experiencing staff shortages, and Suburban is no exception. To help deal with this challenge, Suburban is counting on community support for its effort to attract staff with attractive working conditions. Suburban will do its part by providing upgraded medical facilities and services. Suburban Hospital is also quite interested in other Country and regional initiatives to create affordable housing that would be attractive to nurses and other healthcare workers.
Suburban Hospital operates under a “special exception” to a residential zone. In short, since there is no such thing as hospital zoning in MD, establishment and expansion of such uses requires a County hearing and review process. Suburban’s plan must therefore pass muster with the County Board of Appeals, Park and Planning Commission, and community, so anything that results will be widely reported and thoroughly vetted.
At public hearings, Suburban planners expect to deal with: permission to abandon a one-block stretch of Lincoln Street, screening buildings via landscaping, and putting the parking garage along Old Georgetown Road, which has become a 5-lane thoroughfare, regardless of its quaint name.
Many requirements are unique to health-care facilities, particularly for infection control. For example, any new buildings must be certified as toxin and pathogen protected.
Suburban Hospital gets more complaints about noise than light, and current internal renovations will further decrease light emissions.
To counter noise from air handlers in the new building, fans will point towards Old Georgetown Road instead of straight up, as it is now the case. They will also install custom-designed louvers and other noise reduction measures.
For safety reasons, the expansion plan seeks to separate vehicular traffic, bus stops, pedestrians, ambulance traffic and helicopter traffic. In addition, the Department of Homeland Security says that critical care facilities should not allow traffic to pass underneath them.
Phase 1 will cost between $140 and $150 million. This will come from hospital reserves, borrowing, and fund raising. The escalation factor for every year of delay is 7%. With the current time table, phase 1 may be completed in about 5 years, with permitting expected to take place during the first 18 months of that period.
As for the impact of expansion on the numbers of people coming from and going to Suburban Hospital, little change is expected. For example, staff and volunteers are a function of the number of patients, which is not expected to change radically, but will slowly increase as the local population ages. Staffing would grow similarly, even with new services being added. They would expect physician traffic to actually decrease, since improved facilities will allow physicians to remain on site longer.
Those seeking further information on the expansion plan can consult Suburban’s web site <www.suburbanhospital2020.org> or call the dedicated hotline at 301-896-3552

ROUND ROBIN

Comments & Concerns

Debbie Michaels announced that a Glenbrook Village resident had died of carbon monoxide poisoning and her husband has been hospitalized as a result of a car left running in a garage. She recommended that everyone read the carbon monoxide information page on the Suburban Hospital’s web site.
Randy Schoolsreported that the business community has come together to support soldiers returning from Iraq for treatment at Navy Med. They are providing programs, meals, and other amenities for them and their families. They especially need items, such as DVDs, appropriate for 17- to 22-year-olds. Randy will talk to Ginny Miller about this.

ADJOURNMENT

Dennis Coleman thanked the participants for attending, thanked Amy Blackburn for substituting for the vacationing Sharon Robinson, and adjourned the meeting at 5:58.

CLC Members Present
Marian Bradford, Camelot Mews Homeowners Association
Lesley Hildebrand, Huntington Terrace Citizens Association
Marilyn Mazuzan, Town of Oakmont
Deborah Michaels, Glenbrook Village Home Owners Association
Ginny Miller, Wyngate Citizens Association
George Oberlander, Huntington Parkway Citizens Association
Lucy D. Ozarin, MD, Whitehall Condominium Association
Ralph Schofer, Maplewood Citizens Association

Liaison Representatives
Joan Kleinman, Rep. Van Hollen’s Office
Kira Lueders, NIH Alumni Association
Randy Schools, NIH Rec. & Welfare Assn.
Sue Tabach, Sen. Mikulski’s Office

NIH Staff
Amy Blackburn, OCPL
Anthony Clifford, ORF
Dennis Coleman, OCL
Tom Hayden, ORS
Howard Hochman, ORF
Mark Miller, ORF
Brad Moss, ORS
Mike Spillane, SER

Ronald Wilson, ORFDO

Guests
Leslie Ford-Weber, Suburban Hospital Foundation Exec. VP
Ronna Borenstein-Levy, Suburban Hospital Mktg. & Communication Director

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