While the Hospital Corporation of America sees an opportunity to hop into the local health-care market by building Polk County’s first free-standing emergency room, some residents say the planned site on South Florida Avenue signals danger for their quiet neighborhood.
The prospect of more traffic cutting through their small subdivision prompted comments from four residents during the public comments portion of the Jan. 7 City Commission meeting and a request to be on the agenda at the Jan. 14 meeting.
While city commissioners can listen to comments and make suggestions that may ease the situation for neighbors, they cannot stop the project. Zoning regulations allow medical facilities in the current zoning: planned unit development-commercial.
City staff members are reviewing the site plan and the building plans for the 10,920-square-foot structure. It shows an ER building on the southern end of the lot, near the intersection of Florida Avenue and Eastway Drive. The main driveway entrance and exit is planned for the northern end of the parcel on South Florida Avenue.
A secondary entrance/exit is planned on Eastway Drive, which leads into the Raintree Heights neighborhood.
It is the secondary drive that concerns neighbors. Eastway Drive is a two-lane street that runs east-west between South Florida Avenue and Cleveland Heights Boulevard. It parallels two other neighborhood roadways, Westover Street and the curvier Carolyn Drive.
“We are an area of 253 families in a neighborhood established in 1952,” Helen Lingard told city commissioners. “We have children playing, people walking their dogs, people who exercise running” on what should be quiet neighborhood streets but already are being used as a shortcut for drivers going between Cleveland Heights Boulevard and South Florida Avenue.
There’s a traffic light at the intersection with busy South Florida Avenue.
Cars coming out of the neighborhood quickly stack up on Eastway, extending past the planned ER’s secondary driveway, which, according to the site plan, would be about 130 feet from the intersection.
And cars turning into the neighborhood can stack up behind vehicles that are turning in and out of the busy Amscot parking lot, whose driveway is 65 to 70 feet from the intersection – a distance that safety standards indicate could contain two, maybe three cars.
“You are stopped almost at the intersection and hoping someone turning off Florida Avenue does not rear-end you,” Lingard said.
Brandon Lang told commissioners that traffic speeds through the neighborhood, endangering playing children, and, he said, the hospital developers “should move the entrance and exit from Eastway because they are going to put more traffic on us.”
The neighborhood is located just north of the Polk Parkway interchange and is across Florida Avenue from Merchants Walk shopping center.
While there is heavy traffic on South Florida Avenue, “it is not failing from a service standpoint” and could handle the additional traffic, Chuck Barmby, the city’s transportation and development review manager, told LkldNow.
The city does not have local data on how much traffic is generated by a free-standing emergency room, however, the Institute of Traffic Engineer’s national database shows that for similar-size facilities 17 vehicles are typical for peak hours, Barmby said. That is less than half the peak- hour traffic, 37 vehicles, for a fast-casual restaurant, which was on the drawing boards for the property last summer before HCA purchased it from real estate developer Palmetto Capital Group.
The idea behind a secondary driveway for the ER is to help disperse traffic so it is not all coming in and exiting from South Florida Avenue, Barmby said.
Planners foresee the driveway on Eastway as used mostly by vehicles coming from the Cleveland Heights area, Barmby said.
Most people driving along busy Florida Avenue will see the sign by the main driveway and the parking lot adjacent to it and will turn in there and will exit from there, he said.
Barmby acknowledged there are issues with the Eastway Drive access but said city staff is working with HCA’s contracted engineering firm, S&ME Inc., of Orlando, to lessen the impact. The planned secondary driveway on Eastway would be located as far back as possible from the intersection, he said.
And Barmby said city staff is already working with neighborhood residents on a means to slow, perhaps even divert, traffic.
The city traffic operations division is planning a traffic count to ascertain if the volume and speed of traffic would justify additional traffic-calming humps, he said. Already there are humps on Eastway Drive, and the study will look at parallel Carolyn Drive and Westover Street and at other side streets in the neighborhood to see if humps are justified.
The standards for humps have been relaxed since the last traffic-calming study was done in the neighborhood a few years, Barmby said.
A free-standing ER is a hybird between a medical clinic and hospital emergency department, city Planning Director Teresa Maio said. As such, they would not generate the type of ambulance traffic seen at a hospital emergency department.
Typically patients drive themselves or are driven to such facilities. Most patients are treated and sent home. But if a patient needs hospitalization or more intensive care, the facility may call for ambulance transport to a hospital.
Raf Vittone, deputy chief of medical services for Polk County Fire Rescue, told LkldNow that the agency, recognizing that free-standing ERs are coming to Polk County, is considering revising its current protocol of not transporting patients to free-standing ERs.
Emphasizing that the protocol still is in the discussion stage, he said “only very low-acuity patients who had been assessed by a paramedic” would be considered for transport to a free-standing ER.
If the policy is developed, sirens and lights would not be activated for such transfers because the patients would have very minor injuries or illnesses, Vittone said.
Sirens and lights are used only for patients with critical injuries or illnesses where time is of the essence, he said. Those patients would continue to be transported to hospital emergency departments and trauma centers, such as Lakeland Regional Medical Center.
HCA, a Nashville-based, for-profit hospital chain, owns 179 hospitals nationwide, 50 of them in Florida.
Its West Florida Division, which includes Brandon Regional Hospital, has eight freestanding ERs, including one in Plant City. And its North Florida Division, which includes Poinciana Medical Center and Osceola Regional Medical Center in Kissimmee, has five freestanding ERs.
Between Aug. 3 and Oct. 26, Zack 1030, a limited liability company formed by HCA, purchased seven adjacent properties along Florida Avenue and Eastway Drive for a total of $5.35 million.
Debra McKell, spokesperson for HCA West Florida, said that while HCA is proceeding with developing the four southern parcels for the ER facility, the company has no immediate plans for the other three parcels.
Those parcels at 3510, 3504 and 3500 are occupied by modern office buildings.
HCA paid a total of $3.69 million to three separate landowners for the property – that is more than twice the amount paid for the parcels where the free-standing ER is planned.
Freestanding emergency rooms are popping up across Central Florida. In addition to HCA’s ventures, other hospital chains are making inroads in and near Polk County with the profitable enterprises.
Advent Health has plans to build such a facility on property it owns in far northeastern Lakeland near Florida Polytechnic University. And Community Healthy Systems’ Heart of Florida Regional Medical Center in Davenport established a free-standing ER just over the Polk-Lake County line at Four Corners.
The facilities typically operate 24 hours a day and are staffed by emergency medicine physicians, nurses and technicians.
And while free-standing ERs must contain the essentials of any hospital emergency department, including radiology equipment (CT, MRI and ultrasound machines) and an advanced laboratory, they are low-volume businesses.
HCA’s McKell would not comment about details of the company’s plans; however, industry standards indicate a facility of the size planned in south Lakeland would expect to see about 10,000 patients a year. That is a sliver of the 221,000 annual patient visits to Lakeland Regional Medical Center’s massive emergency department and level 2 trauma center.
Although HCA has not confirmed the figures, the math indicates the Lakeland facility could expect to see about 27 patients a day.
According to the American Academy of Emergency Physicians, a free-standing emergency department needs to see only 8 to 10 patients a day to be profitable.
The facilities can charge the same prices as hospital-based emergency rooms but do not have to maintain the expensive backup staff of onsite specialists, nor provide overnight care, meals and other amenities.
According to the National Center for Disease Control and Prevention’s Center for Health Statistics, only 9 percent of emergency department patients are admitted to the hospital.
Because freestanding ERs typically see patients capable of driving themselves to the facility, they transfer even fewer patients to hospitals. An article in the Oct. 24, 2016, issue of the New England Journal of Medicine placed the figure at fewer than 5 percent of patients being transferred to hospitals.
And according to the Academy of Emergency Physicians, the few patients that need hospitalization or more advanced care are typically transferred to an affiliated hospital. For HCA, the closest hospital would be Brandon Regional, which is a 38- to 40-minute drive from the planned facility in Lakeland.
How it started
On Dec. 19, 2017, Palmetto Capital Group went before the city’s Planning and Zoning Board with a plan to combine two commercial parcels at 3522 and 3526 S. Florida Ave. into a planned unit development so that a fast, casual restaurant, such as a Panera or Chipotle, could be built there.
Five months later, on May 15, Palmetto Capital came back to the Planning and Zoning Board with an enlarged plan that included two neighboring residential lots where a dry retention pond could be built to take care of stormwater issues.
At that time the owners of the four parcels were Florida Professional & Commercial Center LLC, Paul Heathman, Girish Suthar and Rekha Suthar and Phyllis Hinson. The property was zoned for low-impact office and residential-medium. Although the plan was to build a casual dining restaurant without drive-through service, the property could also be used for offices or other purposes allowed in PUD-commercial zoning.
Jeff Lazenby, representing Palmetto Capital Group, told the Planning and Zoning Board during the first of two public hearings that all the properties were under contract.
Just over three weeks later, on June 6, Palmetto Capital Group closed on the first of the properties, purchasing the tract at 3522 S. Florida Ave.
On June 19 the Planning and Zoning Board, with site plan and traffic study in hand, recommended the City Commission approve the PUD-C zoning.
The City Commission held two public hearings on the request and on July 16 approved the zoning change.
In early August, HCA’s limited liability company Zack 1030 started buying the adjacent properties.
Over the next few weeks, the Palmetto Capital Group signed off on its contracts to purchase the remaining three parcels in the PUD and flipped them, selling all four parcels to HCA’s Zack 1030.
And by Sept. 28, HCA’s Zack 1030 had assembled seven parcels covering 1.7 acres stretching between Eastway Drive and Pinellas Street.
Although HCA has remained mum about its plans for the properties adjoining its planned freestanding ER, its West Florida Division owns 14 freestanding surgery centers and other medical clinics and offices.