Flagstaff City Council focuses on transit as it approves regional plan amendments for new FMC campus

Flagstaff City Council approved four minor regional plan amendments related to the proposed new campus for Flagstaff Medical Center (FMC) during its meeting Tuesday. 

During the public hearing, Council also discussed some details of the proposed project, focusing mainly on public transit to the new location.

After hearing presentations on the proposed amendments and discussing the project, city council voted to adopt the changes. Five councilmembers voted in favor of the amendments — Vice Mayor Miranda Sweet, and members Khara House, Jim McCarthy, Regina Salas and Adam Shimoni — while Austin Aslan voted against the changes.

Mayor Paul Deasy recused himself from the discussion due to a potential conflict of interest.

Aslan said while he saw the need for a new hospital and supported it overall, he voted no to reflect the conflicted views on the project he’d seen in the community, including public comments heard earlier in the meeting.

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“I very much wish [the process] well and I will absolutely remain engaged throughout it,” he said. “ … At the same time, I believe our community deserves a historic record on this that reflects the dissatisfied and dispirited voices out there. I don’t think it’s appropriate for this project to launch with unanimous support from Flagstaff City Council. I need to make sure that those who see this big development as troubling feel heard and respected, and I’m casting a dissenting vote so the tension inherent in this monumental development is accurately represented.”

Northern Arizona Healthcare (NAH) first proposed moving FMC to a new location next to Fort Tuthill County Park in the spring of 2021, and since then it has been developing its plans, holding public meetings and, most recently, working with the city on its approval process.

In addition to a new hospital and ambulatory care center (ACC), the proposed campus is designed as a “health and wellness village” that would eventually include research space, additional medical services, hotels, shops, at least 315 residential units and more.

FMC is the only Arizona level-one trauma center north of Phoenix, serving almost a million patients across northern Arizona. The move has been proposed because the hospital is outgrowing its current location’s capacity, with Steve Eiss, NAH vice president for construction and real estate development, citing in a presentation that it is 25% smaller than benchmarks for modern facilities based on square foot per bed.

“[The existing FMC] has served this community very well in its time, but where we stand right now is at a teetering point, where we are unable to continue to grow to respond to the needs of the community and the region from a healthcare perspective,” he said.

In the past year, Eiss said, FMC has needed to defer 5,600 patients elsewhere due to a lack of capacity in the building rather than its ability to provide the service needed.

The amendments discussed by city council on Tuesday had first been brought to the city’s planning and zoning commission on Nov. 9, when the revisions were unanimously forwarded to city council with a recommendation for approval.

A total of four changes to the city’s 2030 regional plan make up the minor regional plan amendment approved in the meeting.

The first two have to do with a future suburban activity center at the site of the new location. Its place type designation would change from a neighborhood to regional scale, while its center point moves over the hospital’s proposed new location.

Area type designation for a 28-acre section in the proposed project location would change from area in white (typically used to denote areas that have not been assigned a place type) and existing rural/future suburban to existing employment.

The regional plan had previously included a future realignment of Beulah Boulevard to allow for an underpass connecting to S. Pulliam Drive. This amendment instead leaves Beulah in its location while conditioning its intersection with Purple Sage Trail (lowering it) and adding a collector road to accommodate the future addition of the underpass.

Planning and Zoning hears minor regional plan amendments for Flagstaff Medical Center campus

Transit discussion

After presentations from Tiffany Antol, the city zoning code manager, and NAH leaders Josh Tinkle (acting CEO) and Eiss, the meeting moved to public comment and city council discussion, which mostly focused on details of the project rather than the amendments.

While several recurring concerns were voiced, transportation needs related to the project were the main focus.

Mountain Line CEO and General Manager Heather Dalmolin made a comment that addressed the need for transit to the new location.

“Transit and health care are inextricably linked, and since the new NAH location was proposed nearly three years ago, Mountain Line has maintained that the region’s largest medical facility should be served by public transit,” she said.

According to Dalmolin, the nearest Mountain Line route to the new location is about 1 1/2 miles away. The current location has two nearby routes with a 15-minute frequency — which she said were among the top 10 in the system for ridership.

About 100 FMC employees regularly use Mountain Line’s ecoPASS (averaging 12,000 total trips each year), and the hospital purchases the 1,500 maximum each year from the organization’s discounted day pass program.

Based on its analysis of current funding sources, Mountain Line has determined that its current transit tax does not have capacity to fund expanding transit to the hospital’s new location.

“Our current system is built around rider and community needs. Serving the area’s population, economic hub and expansion of this service is just not possible without additional funding,” Dalmolin said.

While the new location is near the Flagstaff Pulliam Airport, another area of the city not currently serviced by Mountain Line, Dalmolin said the two would need to be served by separate lines due to differences in frequency and types of transit use needed by each location.

Research from Mountain Line’s professional transit planning team has determined that it could cover the capital cost required for the expansion (including three new buses and construction of a new stop). It is also “committed to a portion of the operating costs by reprioritizing funds from streamlining routes to remove duplicate service.”

“We are willing to make this commitment,” Dalmolin said. “However, we still need financial partnership to pay for the remaining operational cost.”

She said last week NAH informed Mountain Line that it did not have the financial capacity to provide the remaining cost and proposed that it be sought from the city.

Mountain Line is currently working to update its five-year transit plan, which would include service to the new hospital location and would be brought to city council and voters in 2024.

In response to a question, Eiss said NAH hopes to partner with Mountain Line to provide transportation to the new location, but that it has concerns about “appropriate funding.”

The current request from Mountain Line, he said, would have NAH as the only funder for the new line. NAH would like to have other partners involved in the funding because both the line and the hospital would serve the wider community.

“We feel it does serve other parts of the community and the greater good of the community,” he said, “and we feel we are bringing direct impact to the community, not only through the $100 million plus that we have in charity care per year, but also all of the economic development stimulus and taxes that we’re going to have brought into the city.”

NAH’s presentation to city council noted that the development is expected to bring $387 million in economic benefit to the community each year (by the full build-out in 2045) and $1.5 million in taxes to the city annually through the course of the project and afterward. 

“At the end of the day, that’s where we would like to be, is in an agreement with Mountain Line and other partners that are going to directly benefit in that part of town to make that line operational,” Eiss said.

Specific commitments he mentioned in regard to this are working with Mountain Line on entry and road design, and building bus stops on the campus, as well as finding alternative ways to get patients and staff to the new campus if needed.

Eiss noted that NAH is also “dedicated to patient transportation for those who need it.”

In addition to its work with Mountain Line, he said, the hospital has other transportation support, including Guardian Air and Medical and paratransit. It also gives Lyft rides (more than 700 this year) to help patients access places such as the shelter that are not currently served by public transit.

Tinkle added that 70% of NAH staff live closer to the new campus, suggesting current ridership numbers may change with the move.

“We are committed to make sure that our employees and the people we service can get to and from campus, and we’re open to looking at how to do that in something that is more sustainable,” he said.

“Mountain Line is proposing a proportional share for the cost,” Shimoni said during the discussion. “ … For capital, [a] 50% split and then two-thirds for NAH for operational and one-third Mountain Line. So it isn’t fully on NAH, though I can see how you might call that fully on NAH.”

Shimoni also noted that if the question goes to and is approved by voters or another funding source is found, NAH would be “off the hook” in paying for transit.

“It’s just a matter of making sure there’s something in place until we find additional funding,” he said.

Tinkle said NAH is willing to spend about $860,000 each year (in perpetuity) on transit for the project, 13% of its profit margin.

“What we’re suggesting is that we want to work together with the city and transit to make sure that we have an effective system to get people to and from medical care,” he said, noting that 60% of patients serviced come from outside of the City of Flagstaff by air, ambulance or personal vehicles.

He added: “We’re committed again to working with the city and Mountain Line on what that access looks like. We’re just suggesting that we think there may be a better way to do it.”

When asked what NAH saw as its responsibility in transit, Eiss again referred to the idea of an appropriate amount of funding.

“I think we do have some responsibility,” he said. “I think we have to get to a place where the numbers and the proportionality makes sense, and I also think we need to look at how this topic is discussed for future developments, because I’m not familiar, outside of Snowbowl, of any private company that is participating in the public transportation system. I do think it’s a larger conversation that I’d like to continue talking about with you all on how to make that an equitable discussion and not just something tied to this one particular project.”

Community concerns

Aslan was not the only councilmember who expressed a desire to represent the tension within the community and to address concerns about the unknowns still present in the plans.

“I feel like there needs to be that voice and recognition of community concern, that those concerns are valid,” House said. “It is a very weighty tension that we bring to this discussion and it’s not an easy process to move forward with those still out there.”

She added: “It’s the level of not seeing the outcomes, not knowing exactly where the path forward is that leads to hesitation. What we’ve heard over and over is that there is general approval, there is general sense of this project being needed for a number of reasons, but those concerns also have a lot of validity. So I just ask that as we continue in these conversations, we keep those things in mind, keep hearing those different voices in the community.”

The themes were reflected in several of the public comments made on the project.

“Overall, I think it would be wonderful for this development to move forward, but all I’ve heard is this talk of development and not of concern for doing development properly,” said Ponderosa Trails resident Alex Shenkin, who had also commented at the planning and zoning meeting.

He said he supported the project overall, but wanted to see community concerns like noise, traffic and environmental impacts addressed.

“The council is there to hear from the community and make sure we’re heard by the developers, so I hope you can step into this role, because I don’t see any place where we’re going to be guaranteed to be heard in this process,” he said.

Friends of Flagstaff’s Future Executive Director Michele James also commented about concerns at the meeting, specifically that NAH has not made written commitments to investments related to the project, including roadway and intersection design, public transit and plans for the existing campus.

Like Shenkin, she asked Council to work with NAH as soon as possible to address questions and concerns and to get written commitments from NAH.

“This is an extremely important project,” she said. “Our community needs to know that NAH has committed in writing to fulfilling mitigation measures identified as necessary by staff and the community. NAH is proposing a huge development within city limits. The long-term impacts on Flagstaff are too important not to be addressed adequately.”

Eiss responded to the comment in the discussion after public comments.

“We are committed to a redevelopment of the existing campus that is community-forward but also has an economic stability that can last the test of time for Flagstaff,” he said. “That is something that we do plan on putting in writing in our development agreement. … The application process is not the right time to put those things in writing, it is through the development of the development agreement, which our team and the city team are currently in the middle of.”

Flagstaff resident David Hayward commented at the meeting, asking about the results of the traffic impact analysis and report on fire response. The latter seemed to have an inflated representation of the amount of resources that would be needed to respond to an incident, he said, due to the contractor NAH hired to complete the report. 

“We need to design our fire department to serve our community, not our community to serve our fire department,” he said.

As with the other commenters, he was in favor of the project but wanted to make sure a small amount of unresolved critical problems were properly addressed as the process moved forward.

He said he saw the need for a new hospital as his wife is a pediatrician (at a non-NAH provider in Flagstaff) and he has seen how spiking flu and RSV rates this year have created a lack of pediatric bed space across Arizona and the region.

“I am obviously in favor of the regional plan amendments for moving the hospital, but we need to look forward to the issues that we’ll be seeing when the project comes up for rezone,” he said. “We need, quite frankly, [city council and staff] leadership when it comes to resolving those issues.”

A recording of Tuesday’s city council meeting can be found online. The public hearing on the regional plan amendments begins about 45 minutes into the video.

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