For your health

Dr. N. T. Enloe couldn’t have seen it coming.

When Enloe Hospital was built on The Esplanade back in 1937, the surrounding Vecino neighborhood was still taking shape. It’s a classic Chico neighborhood dating to 1889 on city subdivision maps, where 1920s bungalows, Victorians and nondescript ‘50s ranch houses happily commingle. Well-kept family homes sit alongside college rentals, and both grade schoolers and Chico State University students ride bikes down a narrow grid of streets as retirees keep up their lawns and talk over fences.

In 1913, the same year of the first planned building project in the Vecino neighborhood, Dr. Enloe built a hospital on Chico’s Flume Street. When it outgrew that site, the hospital was moved to The Esplanade.

Today, the sprawling hospital crosses The Esplanade and occupies the middle of the neighborhood. Enloe takes up three complete blocks plus parts of four others, mainly from West Fourth to West Seventh avenues and from the Esplanade to Arcadian Avenue.

The renamed Enloe Medical Center plans to tear down houses in the surrounding blocks and nearly double its footprint in a $60 million expansion that will include a five-story tower, two parking garages and other additions. Hospital officials also want to convince the city to abandon a block-long section of Magnolia Avenue between Fifth and Sixth avenues so the buildings can span the street.

By the time they’re done, the officials promise, the hospital will be the top-quality medical center for a six-county area, ensuring health care needs will be filled for the aging baby boomer generation and beyond.

“There’s genuine enthusiasm for what the expansion will bring,” said Judy Sitton, who serves on Enloe Medical Center’s board as a trustee-elect. “It really is an exciting move for the community.”

Architectural drawings of the new tower show detailed renderings of larger operating rooms, added observation rooms in the ER, more intensive-care beds, a labor-and-postpartum area, larger waiting rooms and more privacy for patients and their families. And it’s all being adjusted as Enloe gets more and more feedback.

“It’s still being tweaked. My architects go crazy,” laughed Carole Mickelson, project manager for the expansion and a 27-year Enloe employee.

The first phase of the project, one of the parking structures, could start construction as early as 2005, with the tower—a two-year project—following at the end of that year or in early 2006.

Amid the excitement of the medical community, some neighbors fear Chico’s health care needs will come at the expense of their quality of life. They have stuck anti-expansion signs in their yards and believe that, based on past meetings sponsored by Enloe, the hospital is only paying lip service to Avenues residents and will plow through with its plan regardless of how the project affects the neighborhood.

They’re lobbying to make sure Chico residents are aware of the scope of Enloe’s project and maintain that, besides subjecting their historical neighborhood to construction and round-the-clock medical activity, the hospital is growing in the worst possible place for the community.

“They’re sprawling the major medical center for six counties in the heart of Chico,” said Kasey Merrill, who lives on Arcadian Avenue (which would eventually front the hospital), has coordinated several neighborhood meetings on the expansion and is also a nurse at Enloe. “I’m all in favor of infill [development], but this is in the middle of a neighborhood.”

“We’re talking about affecting everyone who drives through Chico,” agreed Molly Amick, who lives on Citrus Avenue and spoke at a neighbors’ meeting in June. It doesn’t make sense, she said, to put a large medical center smack in the center of town in an area with limited access roads and well off Highway 99.

They worry about more helicopter flights and traffic affecting students going to and from Citrus Elementary School, Chico Junior High, Chico High and Chico State University.

What Enloe is banking on, and what Avenues residents fear, is that the needs of the many will outweigh the needs of the few.

Dr. Michael Baird, who has served on the hospital’s Board of Directors for more than two decades, said the lack of an expanded, upgraded hospital structure is already causing problems.

“You only need to walk upstairs in the hospital to realize that you need to do something about it,” he said. “That hospital was built for a different era. It no longer fits. … It was planned for a kind of medicine we don’t practice anymore.”

The face of health care has changed a lot since Baird came to Enloe in 1980.

Back then, Enloe was flush after successfully suing the state, which had withheld money from rural hospitals. Enloe was able to build a new tower, with advanced radiation and cardiac facilities. The medical staff doubled within a year, and Baird remembers the 1980s as “like a golden era for Chico. There was just plenty of money in the system. It became like a Camelot.”

Everything changed when the federal government re-evaluated how it reimbursed for Medicare patients, paying hospitals and doctors a set rate based on the injury or procedure being done rather than its actual cost. To counter this, hospitals shifted their costs to private insurers, who in turn jacked up their rates and created confusing HMOs.

“We’re in this whole era of fiscal medicine when the cost of care becomes critical in deciding what will be done,” Baird said. Nowadays, “only really sick patients get in the hospital. The whole hospital is becoming more of an intensive-care unit.”

To top it off, back in 1980 Baird was the second-youngest physician on staff. Now, pushing 60, he’s among the many doctors who “all came at the same time and we’re all getting old at the same time.”

The baby boomer problem has come full circle.

“Our biggest problem right now in this town is attracting physicians,” Baird said. In order to get new, young doctors, Chico needs to have a draw beyond its idyllic park and family-friendly atmosphere, he said, and offer things that will counter the lower pay and greater regulations that come with practicing medicine in California.

“Physicians will want to work in a newer, up-to-date, modern facility,” he said. “It will be a magnet for us to attract the next generation of doctors that we need to keep this thing going.”

Enloe started planning in earnest in the late 1990s.

“We knew that, in order to continue to serve Chico, our patients and the service area would have to expand,” Mickelson said.

In fact, that nonprofit hospitals keep pace with growing communities’ health needs is mandated under Senate Bill 697. Enloe’s 20-year Master Plan, staggered in four phases, banks on 40,000 new residents to the Chico planning area by 2025—a growth rate of 2 percent per year.

Enloe hired a firm to analyze the health care needs of the Chico area though 2020, even looking at age breakdowns, cancer rates, traffic accident rates and cardiac trends. The results concluded that the hospital needed not only more space, but also technological upgrades.

“You’d think with newer technology came smaller technology, but that’s not so,” Mickelson said.

Enloe also formed focus groups of patients, physicians and line staff—keeping the nonprofit’s board of directors apprised throughout. All that information led to the creation of the Master Plan.

In 1997, Enloe bought out its only in-town competitor, Chico Community Hospital, on Cohasset Road, and closed it down. It now uses the 7-acre site for things ranging from a wound center to a new cancer center to a prompt-care clinic. During the winter flu season, when Enloe’s beds are overloaded, it opens a wing at Cohasset for overflow patients.

In an earlier version of its Master Plan, Enloe proposed building the new hospital there and relocating the aforementioned services to the Esplanade site, but leaders have since changed their minds, mainly because the site is too small and would require extensive earthquake retrofitting.

Instead, Enloe wants to centralize services and add 72 beds to the main “campus” on The Esplanade, for a total of 346 beds. Along with that would come 24 observation rooms and eight emergency exam rooms. The hospital is also due for a state-mandated earthquake retrofit by 2008.

While the Master Plan speaks of Enloe’s desire to “centralize” services at the Esplanade location, Mickelson explained that that doesn’t mean much will change. “We’re not looking at moving anything from the outlying sites,” Mickelson said.

Besides the Esplanade and Cohasset facilities, Enloe Health System has an outpatient-surgery center located on 3.5 acres on Bruce Road, a homecare and hospice facility out toward the airport, and a rehab center on West East Avenue.

Occupying just 13.9 acres, the hospital is 30 percent too small for the area’s needs, according to industry standards mentioned in the Enloe Medical Center Master Plan Notice of Preparation done by the city of Chico. But the hospital also owns 12.5 acres spread out in the surrounding blocks.

The expansion, taking the hospital from 268,201 square feet to 439,201, would see the facility through the year 2025. Beyond that, the hospital would eventually like to take over land currently occupied by other medical facilities and stretch across The Esplanade and several blocks north and south.

One thing Avenues residents know is that stopping, or even managing, Enloe’s growth will be a tough sell in a community that needs increasing levels of quality health care.

Enloe, which employs more than 2,200 people, is a local powerhouse despite its nonprofit status. (In many ways it is run like a corporation, with a high-paid CEO and big-business management structure.) It contributes $200 million a year to the area’s economy and is lauded as a high-quality medical center with state-of-the-art equipment.

Construction could start as early as next year, and residents have already noticed drilling on the property. (It was for a soil survey, Mickelson said.)

Activity like that makes the expansion sound like a given, even though the plan has yet to reach Chico’s Planning Commission and City Council.

In May, Enloe hosted an “extreme makeover” so hospital staff and the public could look at the configuration of the rooms planned for the new, 171,000-square-foot tower that could be started as soon as 2006. The tone wasn’t, “This is what we want to do,” but rather, “This is what we’re going to do.”

But Enloe officials said that’s just smart planning, moving ahead with project design even as permits and such move forward on a “parallel track.”

“We’re not lobbying [elected officials],” said Ann Prater, Enloe’s public-relations director. “This is something the community has told use that we need.”

"[Enloe is] setting everyone up to think this is a done deal,” Merrill said. “When you make an emotional plea for a hospital, you’re going to get a hospital.

“But it’s [also] about the erosion of the neighborhood,” she added. “This is the wrong place for corporate health care to grow.

“They’re expecting this neighborhood to be given to them carte blanche to do whatever they want.”

For years, Enloe has been buying up houses around the Esplanade neighborhood, either tearing them down and building parking lots or filling them with offices or special medical services. The hospital now owns about 20 houses. Some, like the current Emergency Service Dispatch and Public Relations offices, will be torn down, while others, like those used for traveling nurses or out-of-town patients and their families, will remain.

Although neighbors have taken Enloe to task for running businesses in areas zoned residential, the city doesn’t seem to have a problem with the uses, with the exception of a print shop that was relocated after neighbors complained.

Some residents believe that, despite neighborhood meetings and other communication from Enloe, the hospital as a corporate entity just doesn’t care about the Avenues.

“They have a history of bad faith that goes back 20 years with this neighborhood,” said Ed McLaughlin, who has been suspicious of the plan from the start. He also spoke at the June neighborhood meeting and joked that his generation—the baby boomers—is largely to blame for the state of affairs.

Doubts about Enloe’s intentions seem to perplex and hurt administrators and board members.

For example, Sitton said, that Enloe redesigned its plans around the house of one woman on West Fifth Avenue who doesn’t want to sell “is clear evidence of what a thoughtful approach is being taken.”

Mickelson pointed out that Enloe is going above and beyond what’s required in the typical planning process.

Dr. Jeffrey Lobosky, a neurosurgeon who practices at Enloe, said it’s hard to reconcile the need for a better hospital with what it will do to the neighborhood.

“It’s inevitable that the growth is going to affect the surrounding community,” he said. “This doesn’t enhance the quality of life in the neighborhood. What it does is enhance the quality of life in the community as a whole.”

While Lobosky acknowledges that a hospital in a residential neighborhood is “an inconvenience,” he doesn’t think the expansion will compound the current situation that much.

A draft environmental-impact report, by the city-hired firm of Pacific Municipal Consultants, is slated to be published in October and followed by a neighborhood meeting and then public review. It will consider matters such as how the project would affect air quality, traffic, historical resources and existing zoning rules and how to mitigate those impacts.

One thing the city’s initial study notes is that the project will “result in substantial conflict with the established character, aesthetics or functioning of the surrounding community.” The final EIR will be presented to elected officials by April 2005.

Brendan Vieg, the city senior planner assigned to the Enloe project, said it’s a big one, of greater regional importance than most development proposals in Chico, and the EIR, at a cost of $300,000 paid by the applicant, will reflect that. “It will go into a little more detail than usual EIRs,” he said.

But while the EIR will weigh on a variety of matters, from a planning perspective one issue stands out.

“Traffic is certainly the wild card,” Vieg said. As the Enloe expansion added its impact to the neighborhood, it would be joining Chico State, Chico High and other area destinations in a cumulative effect of more vehicle “trips.” Just how many is something the EIR will reveal.

Even so, Vieg said, the project won’t come close to bringing the area over the Chico General Plan’s threshold for an acceptable level in terms of traffic.

An Enloe-commissioned February 2002 traffic study by Chico State University’s Civil Engineering Department determined that Enloe is responsible for more than 50 percent of the traffic on Magnolia between Fifth and Sixth.

In exchange for a break on mitigation fees, Enloe proposes going beyond its requirements and improving existing traffic problems in the area that aren’t deemed its fault. In mitigating impacts called for the in eventual EIR, Enloe could be required to restrict delivery times, Vieg mentioned as an example.

Enloe says its project will actually ease parking woes, by install various traffic-calming circles and stop signs, and make the neighborhood “more livable” by improving vehicle circulation and providing nearly double the current off-street parking spaces—1,159 altogether—so employees and visitors won’t park in front of residents’ homes.

“We want to keep the hospital’s flow on Enloe’s campus so we impact the neighborhood the very least amount that we can,” Mickelson said. “I think the circulation will be greatly improved.”

In response to neighbors’ concerns, “we’ve shifted a lot of our parking. We actually added the alley to keep traffic here,” she said. Also, ambulances are now dispatched from the Cohasset center rather than the Esplanade site.

The first three-deck, two-story parking garage, at the southwest corner of Magnolia and West Fifth, would come in between 2005 and 2009 and have 300 spaces. The second, by 2025, would add a 437-space garage to the northeast corner of Magnolia and West Sixth.

“How are two multistory parking lots going to blend with modest family homes?” Merrill asked. A better idea, she said, would be to create an off-site park-and-ride facility from which Enloe would shuttle its employees, which the hospital predicts will number 957 per day shift by 2025.

The expansion would also move the hospital’s main entrance from Fifth to Magnolia Avenue and widen an alleyway between Magnolia and Arcadian avenues to compensate for closing off Magnolia. Ambulances would enter on West Fifth Avenue instead of Magnolia, and there would be four entrances altogether at that westernmost end of the hospital.

The Master Plan also suggests adding a fueling station to the top of the hospital tower so the helicopters will have to take fewer trips to the airport. But neighbors aren’t sure about the safety such an operation.

“I don’t see planning here. I see incremental chaos,” said Avenues resident Charles Withuhn, speaking to the idea of traffic circles at the June neighborhood meeting.

Withuhn has made up signs with sayings like, “Stop Enloe’s industrial expansion into the Avenues,” and, “Chop, chop, chop,” with a drawing of a helicopter. Many are found in yards of houses surrounding Enloe.

All this will be weighed by the Planning Commission and then the City Council, which must consider and certify the EIR, following California Environmental Quality Act (CEQA) rules. At the same time, the council will consider amending the General Plan to rezone most of the land from low-density residential and offices to public facilities and services (PFS) and Public/Quasi Public (PQ). In the rules of development, “greater public good” can trump the impact to an existing neighborhood.

Vieg, of the city, believes that ultimately Enloe’s Master Plan will be “tweaked” to allow for neighbor and community concerns.

"[Enloe] believes they will have a project in the end, but I don’t think they believe they will have the project exactly as they proposed,” he said.

Lobosky, the surgeon, believes Enloe will do the best it can given the limitations it has. “[The Avenues] isn’t the ideal place for a hospital, but we don’t have a choice. This really is the best alternative plan.”

For nearly two decades, Enloe owned a prime 251-acre parcel at Bruce Road and East 20th Street, in southeast Chico, and in 1994 went so far as to secure city permission to build a whole new hospital there. Sometime in the mid-1990s, however, the hospital’s board decided it would cost too much ($223 million to $300 million) and officially abandoned the idea.

Baird, the doctor and board member, said Enloe purchased the land at a time when it had “excess money” and foresaw the need for more beds sometime in the future.

But the changes to Medicare and private insurance in the 1990s meant less money and certainly not enough to build a hospital from scratch. “It’s just too expensive,” Baird said. “The sale of that land [to developers for an estimated $18 million] will help to build the new hospital,” he said, along with a $10 million fund-raising campaign.

Still, some Avenues residents cling to the idea that the hospital can expand at the old Bruce Road location.

Tom DiGiovanni, president of New Urban Builders and leader of the housing project now planned for the Bruce Road site, said the sale is complete and there’s no way Enloe can back out on it now even if it wanted to.

If neighbors still see the site as a possibility for the hospital, he said, “I have no idea what they’re talking about. We are proceeding with our plan for a mixed-use neighborhood on the former Enloe property, now known as Meriam Park.”

The EIR is required by law to look at alternative sites, but even if a better location is identified, it could be trumped by the reality of available sites and cost concerns.

The Chico Avenues Neighborhood Association (CANA) is perhaps surprisingly measured in its approach. That’s because its members have seen other local efforts fail under too-emotional pleas and also because, in the end, most of them figure the hospital will expand anyway. Their best bet is a reasoned argument that would adjust the project to reduce its impact on the neighborhood.

It’s working on an even-toned position statement geared more toward making the community aware of the project than shutting it down.

A handful of members hope to stall the project on a technicality, such as something wrong in the EIR or the CEQA process. They’re grasping at anything, from the Bruce Road property to a possible Swainson’s hawk sighting that could affect the endangered-species element of the EIR. Others want to fight the abandonment of Magnolia, which they fear will funnel traffic off the pre-World War II grid and onto surrounding streets. They expect the expansion will become an issue posed to candidates in the November City Council race.

No one, one neighbor pointed out at the June meeting, wants to look like “selfish property owners” who care more about their quality of life than the North Valley’s quality of health care.

Dave Nopel, who has lived on West First Avenue since 1946, when he was just 2 years old and the Vecino neighborhood was considered “the edge of town,” acknowledges that Enloe isn’t entirely to blame for the residential area’s becoming heavily traveled.

Chico State’s growth has played a large role. And neighbors have also felt the impact of second-dwelling units and an increasing rental market adding to traffic and noise. “My main concern is an overall one that looks at what happens over time to the character and livability of this area,” he said.

Nopel believes in Enloe and its mission but no longer sees the institution as a family-owned enterprise. “I want Chico to have a good-quality hospital. I’m not sure I even strongly resist some kind of change right here in this spot. [But] if this has to get bigger, I’d like to see some positive change come to the neighborhood for it.”

Enloe planners and board members believe the hospital has just as much stake in maintaining the integrity of the neighborhood as anyone, and the expansion will reflect that.

The Master Plan, authored by Nevada City consultant Tom Parilo, who used to be a planner for Butte County, includes a “design principle” based on a desire to fit with the neighborhood.

The accommodations include: placing the tallest buildings at the center of the project, using a mission-style façade that could better blend with the neighborhood, landscaping areas where the hospital borders homes and reducing light and noise impacts with “shielding” measures.

Also, the Master Plan promises, the trees that line Chico’s trademark Esplanade will be preserved in place, the Esplanade façade will maintain its original 1937 look, the new buildings will mimic its Spanish style and the traffic will be directed in a way that “respects the peaceful rhythm of this grand boulevard.”

“This hospital has a heritage here, too,” Sitton said. “Enloe is part of this neighborhood. I believe [the expansion] is going to make this neighborhood better.”

Baird said Enloe’s only other choice—short of “shoehorning” in improvements at a high cost over time—would be to sell to a large chain, something the board believes strongly is not in the community’s best interests.

“We want to keep this hospital based in Chico,” he said. “Others shouldn’t be making decisions about what is best for Chico.

“I expect to get old in Chico, and I don’t want to get taken care of in a place that’s 40 years old."