Women & Children's Hospital this summer wants to start a $102 million reconstruction that is considered vital to the future of the pediatric facility.
But the project is upsetting residents in the Elmwood-Bryant-Hodge community, even those who fought in 2002 to keep Kaleida Health from moving the hospital.
They worry that plans to upgrade significantly the outdated medical campus to modern standards will harm the character of the vibrant urban neighborhood.
The hospital has come a long way from that fight five years ago to keep the hospital on Bryant Street, but if it is to survive, let alone excel, it must improve core medical programs, ensure an adequate number of cases to train new doctors and make itself more attractive to patients and physicians, officials say.
"We need a campus that's easier for patients to access care and for doctors to provide care in a team approach," said James Kaskie, chief executive officer of its parent organization, Kaleida Health System.
This much seems certain: Finances at Women & Children's, which was founded in 1892, have improved, but not without hard decisions about what services to make priorities. It also faces the challenge of increased competition and a declining population of children.
The proposed work would bring noticeable changes, including:
*Demolition of four unoccupied homes on Hodge Street, as well as the Hodge Pediatrics office, to make space for a five-floor, 177,000-square-foot outpatient center with pedestrian bridges to the main hospital across the street and a city-owned parking ramp in the rear.
*Consolidation of physician offices, eight of 12 operating rooms and a dozen clinics now spread among five hospital buildings into the new outpatient facility, making Hodge the center of activity for patients and traffic.
*Razing of three of the hospital's older buildings -- the annex at 239 Bryant, the MH building and 140 Hodge -- leaving the newer Variety Tower, Tanner Building and Alfiero Building.
*Moving the hospital's power plant and liquefied oxygen tanks, making good on a promise to residents concerned about the tanks' closeness to the helipad atop the Alfiero Building, to a site now used as a small parking lot next to the dental clinic near Elmwood Avenue.
*Development of 224 parking spaces on Hodge where the razed buildings stood and in a plaza on Utica Street that currently includes a bank and drugstore.
"It's a must to move forward. We need our people in one building. That will make it easier to keep and recruit doctors," said Allegra Jaros, vice president of hospital operations.
In a handful of neighborhood meetings in recent months, officials at Women & Children's have attempted to respond to concerns. Some residents still harbor suspicions and hard feelings over the helipad, which was built in 2005 despite opposition from nearby homeowners and continues to generate complaints about flight paths.
"We know we can't please everyone, but we want the hospital to be careful," said William Sunderlin, president of the Bryant-Oakland-Summer Association. "We'd like to reach the best consensus we can reach before they start work and avoid a bitter fight to the end.
The major concern: The hospital will plop a "big-box," suburban-style development made of cheap-looking materials in the middle of a street lined with Victorian homes that, despite the presence of a hospital on 7.5 acres, still maintains much of its architectural integrity and residential quality.
Sunderlin and others consider the surface parking planned for Utica and Hodge ugly, out of place and a magnet for litter. They also worry about increased traffic on Hodge.
"We applaud the hospital for coming to us, and don't oppose the plan in theory. The problem is it will totally change the fabric of the street, and it all boils down to parking," said Ellen Malone, head of the Hodge Avenue Homeowners Association.
"We want them to follow a process with us to make sure we get smart growth, but fear it's a done deal," she said.
Hospital officials said more parking is badly needed, but the city-owned John C. Gallagher Sr. parking ramp on Hodge can't be expanded. Parking on Utica will help accommodate the hospital's 1,200 employees, many of whom now park on the streets, they said.
Hospital officials reject suggestions to build the outpatient center or a parking ramp on the spot of the razed buildings. Such an approach is considered too costly and problematic, with so many services in the older buildings that must move into the new center.
"To put the building on Elmwood would require phased construction and move us farther from the existing parking ramp. It would complicate traffic flow and wouldn't allow us to connect our operating rooms and radiology services to the new building," said Cheryl Klass, president of the hospital.
She and Jaros defended the proposed building, saying it incorporated residents' design ideas and tried to capture the look of Delaware Avenue row houses. The building will use brick on all sides and an assortment of design features to avoid a big-box effect, Klass said.
Plans call for landscaping the surface parking lots with berms and edging them with wrought-iron fences, Klass and Jaros said.
In a 2002 agreement to prevent the move of Women & Children's, Kaleida promised pediatricians it would build a new outpatient center. Kaleida put off the project while it focused on improving finances and figuring out a more viable business model.
In recent years, the pediatric hospital closed a breast center that opened in 2003 as part of a plan to broaden women's services. It also closed a handful of other services, including a popular early intervention program that evaluated preschoolers.
"The feeling was always that the new ambulatory building was going to save the hospital," Klass said. "The problem is that we needed a more successful clinical-financial story to be able to build it."
The hospital has adopted a strategy of concentrating on four core services: cardiology and heart surgery, hematology and oncology, the neurosciences, and obstetrics and neonatology. It seems to be working.
The hospital posted a $6 million surplus in 2006, excluding money raised by its foundation, after years of losses. Inpatient admissions and deliveries also are on the rise.
"We got out of businesses we should not have been in and focused on those that we consider our core. Other departments want more support, but the idea is that these services will raise all boats," said Jaros.
Frauenshuh Cos., a Minneapolis developer with a large number of medical office projects nationwide and expertise in allowing hospitals and physicians to be equity partners, will finance the $51 million cost of the outpatient center.
"These kind of projects allow hospitals to use their capital for other things," said John Herman, a Frauenshuh principal.
Other funding includes $14 million from the hospital's fund-raising foundation for a new entrance, demolition and parking, and $16 million from the foundation for other expenses. Kaleida will provide $21 million for such improvements as renovation of labor and delivery facilities. The foundation support includes money from the 2005 settlement Kaleida reached with the federal government in a dispute related to the merger that created the hospital system in 1997.
Officials want to start this summer with relocation of the power plant. Construction of the new building would begin next spring and demolition in 2010, pending approval.
Permission from the state is needed to relocate medical services. The hospital Wednesday submitted a draft master plan to the city, which must approve demolition and construction. Once the hospital seeks permits to start the project, the city will require the hospital to complete a long, rather than a short, environmental assessment form, said Richard M. Tobe, the city's development and inspections commissioner.
Municipalities use the form to decide if a costly environmental impact statement is required, which hospital officials expect to be the case.
"We intend to run a very good environmental review with public input," Tobe said. "Our job is to try to find common ground."