In three years of covering almost every Boise City Council meeting, I’ve never seen its members wrestle with an issue like they did Tuesday night on St. Luke’s Boise Medical Center’s proposed Downtown expansion.
Most of them had written down what seemed to be heartfelt remarks explaining their positions by the time they came to a vote. Council President Maryanne Jordan and Councilwoman Elaine Clegg had both typed up their own lists of conditions they wanted attached to any approval.
In the end, Jordan’s proposal won out, though Scot Ludwig, the newest council member, made an important contribution to the decision to approve the St. Luke’s plan. At Ludwig’s request, Jordan allowed conditions to be tacked on to her original motion for approval. One condition anticipates a public process for allowing car traffic on Bannock Street between Avenue B and 1st Street — a stretch that was closed in the 1990s.
Clegg had offered a similar condition in her list. The idea was to offset the closure of Jefferson Street between Avenue B and 1st Street that St. Luke’s leaders insist is necessary to their Downtown Boise expansion plan.
The other Ludwig condition was taken straight from Clegg’s list: a requirement for some kind of commercial space to be included on the first floors of new St. Luke’s parking garages.
The most surprising thing that happened Tuesday night, though, was the statement Mayor David Bieter made. Bieter is usually fairly restrained during council meetings, content to let council members make their decisions. He asks questions sometimes and otherwise handles the chair’s duties, but he doesn’t interject very often.
Tuesday was different. Before the council started deliberating, Bieter read a statement that took St. Luke’s to task for what he considered disregard for the wellbeing of Boise and the surrounding community. He mentioned the antitrust litigation in which the hospital was recently mired, and a push in the state Legislature to relax requirements for its tax-exempt status.
Bieter also pointed out that, because St. Luke’s is a tax-exempt nonprofit, the public essentially subsidizes its operations.
A lot of people said similar things in the run-up to Tuesday’s decision. But it’s different when the mayor of your town says them in one of the most closely watched public meetings in Boise’s recent history.
Because Councilman Ben Quintana, a St. Luke’s employee, recused himself, there was an odd number of voting council members Tuesday, so there was no chance Bieter would cast a tie-breaking vote.
Bieter’s statement highlighted the ambivalence city leaders must’ve felt as they struggled through the biggest controversy they’ve ever been asked to settle. On one hand, they hated giving up a section of Jefferson Street. The fact that it was St. Luke’s, Idaho’s medical giant, asking for the closure made it even tougher.
On the other hand, they want St. Luke’s to succeed because they want a top-notch hospital in their crown jewel: Downtown.
Here’s the full text of Bieter’s statement (His remarks start at the 35:02 mark in this video recording):
“For the better part of 20 years, I have been watching with great concern the interaction of St. Luke's with the larger community. Let me give two examples of that.
When the issue of St. Luke's tax-exempt status came up several years ago, my opinion (was) that St. Luke's kind of muscled through the legislature a law removing the requirements of the tax exemption that I thought were a great benefit to the public and had served us well for around 100 years.
More recently, what I view as quite an aggressive approach to the litigation with the Idaho Attorney General and the Federal Trade Commission. I think that's placed a significant disruption into health care in our community.
Their approach in this application initially appeared to be all too familiar. But, in my opinion, when St. Luke's backed up, took the time and effort to explain the steps they've gone through, the different approaches and the various effects on clinical care, I saw in that the makings of the kind of approach that I — rightly or wrongly — expect from a tax-exempt, non-profit community hospital.
I have no idea if, in the council's eyes, that's going to be enough. And there were some missteps. Leaving aside what I thought was a major misstep in the PR efforts before the application, at times, the supporters and employees of St. Luke's seemed to me to be somewhat dismissive of the legitimate concerns of your neighbors as, to quote one such supporter, dismissing those concerns as "insignificant noise." I am an East Ender, too, and that's a troubling statement. And I know that we can all do better and did through much of these hearings.
What's clear to me is that St. Luke's is our hospital. It's not the board's hospital. It's not the doctors' hospital. It's not even, with all deference, the patients' hospital. It's ours. We are all shareholders that have invested millions in tax exemptions and indigent care. In a real sense, this $400 million plan is our $400 million. You are, it seems to me, St. Luke's, in essence a public hospital, and that carries with it, like our duties, a humbling duty to the common good.
The request for vacation of a right-of-way is a request for an act of faith, of trust in you. And the question, I think, before this council, is: Are you trustworthy? If the council chooses to vote yes, it'll be because the $150 million, if you accept that figure – more than it would cost – would be our $150 million. It'll be because the level of care that, in my opinion, you have compellingly held up will be care for our loved ones, all of ours. But it's also an act of faith in every subsequent decision you'll make, if that's where the council chooses to go.
But whether the council votes yes or no, it seems to me this has to be the beginning of a new and a far better community relationship, or we will all have failed. And we cannot fail. You cannot fail us because you are our hospital.”