Farwell Questions Primary Care Move’s Impact On Poor

Don’t let the city’s largest primary care services for the poor move to an area largely inaccessible to those without cars. The result: higher transportation costs, in both time and money, for those who can least afford that burden.

So argues a local urban planning expert and alternative transportation advocate in testimony she submitted to the state agency charged with reviewing the proposed primary care move.

On Monday afternoon, New Haven Urban Design League President Anstress Farwell submitted a six-page letter to state Office of Health Strategy (OHS) Director of Health Systems Planning Kimberly Martone. The letter details Farwell’s opposition to Yale-New Haven Hospital’s proposal to move its three primary care clinics from facilities on York Street, Chapel Street, and Whitney Avenue to a single building at 150 Sargent Dr. on Long Wharf, and then to hand over management of those services to Fair Haven Community Health Care and to Cornell-Scott Hill Health Center.

Channeling the central critique made by the state and by members of the public at last week’s public hearing on the matter, Farwell argues in her letter that moving primary care clinics that serve 25,000 mostly low-income New Haveners each year to a relatively remote and inaccessible area of the city will only hurt the city’s poorest patients. A primary reason: New Haven’s limited, inconvenient bus service.

“Moving the PCC [primary care center] to Long Wharf would leave the poorest people, or people who cannot drive due to a disability, shouldering the greatest transportation challenge,” Farwell wrote. Therefore, she argues, the state should turn down the hospital’s proposal.

Click here to download Farwell’s complete letter to the state.

Wednesday, Dec. 5, is the last day that the state will accept public testimony on the hospital’s application for a Certificate of Need (CON) to close its existing primary care facilities and relocate them to Long Wharf. Click here to submit testimony to OHS.

At last week’s hearing, YNHH Vice President of Operations Cynthia Sparer argued that two-thirds of the hospital’s primary care patients currently drive to the clinics, and therefore the ample free parking available at the proposed Long Wharf site is a huge boon. In consideration of the other third of patients who do not drive, she said, the hospital will advocate for improved public bus routes and will explore a potential on-demand rideshare service contract with Uber.

Officials of the hospital as well as of the Fair Haven and Hill Health Center clinics — partners in the proposed new facility — argue that the consolidation will improve care for the poor, in part relying on the clinics’ primary care expertise.

The state ordered the hospital to provide by Dec. 12 a ​“detailed strategy that addressed planned initiatives to alleviate transportation barriers to patients that do not have access to a personal vehicle to travel to 150 Sargent Drive.” In particular, the state is requiring the hospital to provide details on the provision of shuttle services to appointments; current bus routes; specific public transit changes the hospital will advocate for; the viability of a contract with Uber; and a timeline for the implementation of transportation initiatives.

In her written testimony, Farwell argues that the city and medical area developers should adopt a ​“healthy hospital / healthy community” standard for its medical centers. ​“Basic to this model is walkability,” she wrote, ​“clean air, public safety, green space, shared public spaces, and a walk-to-work environment joined with a good transit system.”

The current primary care facilities downtown, in Dwight, and on Whitney Avenue are better models for this type of medical center-neighborhood relationship than the 150 Sargent Dr. site, she wrote.

For even if the hospital is correct in its assessment that 66 percent of its current primary care patients drive to receive care, how many of those drive out of necessity because of an inadequate public transportation system, which is only compounded by a hospital-run private transit system.

“Taxis are expensive,” she wrote, ​“and My Ride and other medical taxis require at least a two-hour wait from the time a patient calls and asks for service to when the medical taxi arrives.

“We ask that the Office of Health Strategy consider the barriers to medical care,” she continued, ​“that would be created by the combined impact of increased transportation costs (a patient’s time and money) with the impact of changed fee structures and billing policies to be instituted by the new PCC.”

Farwell noted that the city is indeed focusing on putting together a Long Wharf development plan that would increase residential, commercial, and recreational density for the currently underused waterfront part of town. But, she predicted, until the area is rezoned and more buildings and activities are established there, the hospital will almost certainly fail in its attempts to expand CT Transit bus service based on the needs of the primary care center alone.

The whole proposed move raises a question that the Urban Design League grapples with in all of its advocacy that champions people-centered developments, Farwell wrote:

“Are we designing an isolated single purpose facility, or building an urban place for people?”

In addition to the oral public testimony provided at last Wednesday’s hearing, the other two written public testimony submissions regarding this proposal have come from the Connecticut Health Policy Project’s Ellen Andrews and Planned Parenthood of Southern New England President and CEO Amanda Skinner.

Andrews argues in her testimony, which can be downloaded here, that the primary care move will result in higher costs and transportation concerns for low-income patients. Skinner argues in her testimony, which can be downloaded here, that the move could endanger women’s access to reproductive health services.

And click here to read an overview of the primary care proposal as written by the proposal’s applicants.

Below are links to previous articles about the proposed New Haven Primary Care Consortium.

• Primary Plan’s Obstacle: Broken Bus System
• Plan Reimagines Primary Care For Poor
• West River Questions Primary Care Move
• Harp Backs Primary Care Move

Also below are Facebook Live videos of portions of Wednesday’s night’s public hearing, and of an interview earlier this year with Lagarde and Taylor on WNHH’s ​“Dateline New Haven.”