The Hospital Ate My Neighborhood!
A new city policy promotes institutional creep
by Chris Busby
If the doctors at Maine Medical Center treated their patients the way the hospital is treating its neighbors these days, I imagine a scene like this…
INTERIOR: EXAMINATION ROOM
The PATIENT, a 30-year-old man of average build, sits on the examination table wearing boxer shorts. The DOCTOR, a distinguished older gentleman with a stethoscope around his neck, enters stage left.
DOCTOR: Hello, John. I’ve got some good news. All the test results indicate you’re as healthy as a horse.
PATIENT: That’s great, Doc. So I’m good to go?
DOCTOR: Well, not so fast. We need to do some long-range planning today. Lie down and let’s get started.
PATIENT reclines on the table as DOCTOR takes a black marker out of his shirtfront pocket.
DOCTOR: Let’s start with your left foot.
PATIENT: What wrong with my left foot?
DOCTOR: Oh, it’s fine right now, and I think it’ll be fine for the next five, ten, maybe even twenty years, but after that the prognosis gets hazy. As you know, we’re running out of fossil fuels, and it’s far from certain whether other energy sources will be sufficient to heat your apartment during the long, brutally cold winters that climate scientists predict for Maine come the 2030s. That raises the risk of frostbite considerably. If I had to guess — and the city now requires me to guess — I’d say we’ll be amputating your frozen, gangrenous left foot by 2040 at the latest.
DOCTOR draws dotted line around PATIENT’S left ankle.
PATIENT: What the fuck?
DOCTOR: Hold still now, we’re just getting started. You’re clearly an emotional guy, John, which leads me to believe you won’t handle all the chaos to come in a healthy way. You’ll start drinking heavily, your wife will split, you’ll engage the services of the prostitutes who conduct business in our parking garage, and bingo — you’ll get hepatitis C. So out comes the liver.
DOCTOR draws dotted line around PATIENT’S liver.
PATIENT: This is insane! I can’t live without a liver!
DOCTOR: Don’t worry. The city requires that we perform a liver transplant if we have to remove your old liver — or, to be legally accurate, that we make a good-faith effort to find a new liver for you. There’s no guarantee, of course. No telling what the market for human organs will be like decades from now, not to mention how sky-high your deductible will be. But we can do something to make life more bearable for you. The breakdown of civilization will make Portland a very smelly place — garbage will pile up, food will rot, fish guts everywhere. We can remove the nose…
DOCTOR brings marker to PATIENT’S face.
PATIENT: Whoa, whoa! No fucking way…
DOCTOR: … but that probably won’t be necessary. Instead, we can permanently plug your nasal passages so you won’t smell a thing, and you’ll still have a perfectly viable air-intake and exhalation passageway through the mouth.
DOCTOR draws dotted line across the bridge of PATIENT’S nose.
PATIENT: But if I can’t smell anything I won’t be able to taste anything either! I won’t be able to drink beer without a liver or dance without a foot. All the pleasures of life will be gone! Except…
PATIENT peers warily down toward his boxers.
DOCTOR: Relax, John. We’re not gonna go there today. And like I said, this is all pure speculation. We’re just spitballing ideas, tossing darts at the wall. No one has any idea what’ll happen 30 days from now, nevermind 30 years into the future. But the city wants to make sure everyone’s prepared in the event we have to carve you up like a Thanksgiving turkey. This process has been very inclusive and transparent, wouldn’t you agree?
PATIENT: These dotted lines aren’t transparent. Can I wash ’em off now?
DOCTOR: No, it’s permanent marker. You’ll have to live with these new lines. That’s why they’re there — so that in the distant future the robo-doctor will know exactly where we planned to make the incisions. But again, everything changes, nothing is predictable, and it’s possible you’ll never go under the knife. You feel good about this process, right?
PATIENT: I’m calling a lawyer, you quack!
DOCTOR: Don’t blame me, John. I’m just doing what the city requires me to do. And as they say at City Hall, just because you don’t like the outcome doesn’t mean your objections weren’t heard. I heard your objections. I’m simply choosing to dismiss them. And you get to keep your nose and your testicles — at least for now — so you can’t say I haven’t compromised. We’ll just have to agree to disagree. Ipso facto, we’re in agreement! We’ll do this again in ten years. Or maybe five. Or four. Or three. Like I said, who knows what the future holds?
The absurdity of this scene is based on an actual urban-planning method that the Portland City Council unanimously endorsed last May. It’s called Institutional Overlay Zoning, and it’s intended to help predict and guide the growth of Portland’s two hospitals (Maine Med and Mercy) and its two universities (the University of Southern Maine and the University of New England). It’s premised on the idea that these institutions are destined to continue to expand into the neighborhoods around them, so city officials and the institutions, with input from neighbors, should develop long-range plans to anticipate and manage that growth.
Sounds harmless enough — until the IOZ threatens to turn your neighborhood into a DMZ. That’s what Maine Med is doing to the small, up-and-coming neighborhood in its shadow to the west: the St. John Valley. For those neighbors, this means war, and the big battle will take place this month, when the City Council will decide whether or not to approve or amend Maine Med’s IOZ. It’s the first zoning plan of this kind in the city, and the furor it’s caused may be a harbinger of struggles to come in other neighborhoods that border or contain an institution.
Maine Medical Center traces its history back to 1874, when Maine General Hospital opened on Bramhall Hill, in Portland’s West End. Through a series of expansions and mergers, the institution has mushroomed within and around its Bramhall campus and into other parts of the city and surrounding towns. It currently owns or leases over 60 properties in Portland.
Institutions like Maine Med grow very slowly, over the course of generations, and this growth isn’t always as perceptible as, say, the construction of a big new wing. Single-family homes, apartments, and retail and office space in the surrounding area get converted to institutional use through purchase or lease. Urban planners and worried neighbors have a term for this type of growth: institutional creep. Left unchecked, it decimates the housing stock and erases the character of a community, turning it into a ghost town of empty buildings every night and weekend, when all the workers go home.
In a story we published seven years ago [“Getting the Institutional Creeps,” February 2010], reporter Emily Guerin wrote about the ways Maine Med’s neighbors, working in tandem with city officials, had tried to contain the expansion of the hospital’s Bramhall campus. For example, city approval of Maine Med’s Charles Street Expansion Project — “named in recognition of the street it erased from the map,” Guerin noted — was contingent upon several major concessions, including payments to the city totaling $1.1 million for “public improvements” and for the replacement of housing units demolished to make way for the project.
The most consequential part of that 2005 agreement was the stipulation that Maine Med limit its future growth in the area to property it owned at the time. The hospital was also required to hold quarterly meetings with a council of neighborhood representatives to address issues impacting their quality of life.
In the fall of 2009, Maine Med informed the neighborhood council that its board of trustees had decided to buy a parcel of land on Congress Street, formerly occupied by the Sportsman’s Grill, and develop it for hospital use. Moses Sabina, a member of the then newly formed St. John Valley Neighborhood Association (and co-proprietor of the West End eatery Hot Suppa!), pointed out that the 2005 agreement clearly prohibited such an expansion — and, Guerin reported, “the city backed him up.” The head of Portland’s Planning & Urban Development Department, a lawyer named Penny Littell, told the hospital that it could buy the Sportsman’s lot and lease it to another party, but could not use it itself. Maine Med withdraw its bid, and the lot is now home to Salvage BBQ, a popular restaurant, music venue and gathering place for neighbors and visitors, including fans of the Portland Sea Dogs and Maine Red Claws, minor-league sports teams that play a couple blocks away.
Had Maine Med been allowed to develop the Sportsman’s lot, it most likely would be as dark and lifeless every night as the other medical buildings the hospital owns in that area. Salvage “contributes to the safety of the neighborhood,” Sabina told The Bollard last month. “Having Salvage’s lights turned on, it’s huge in this corridor. There’s all kinds of [bad] shit that goes on down here.”
The boundary set by the 2005 agreement hasn’t stopped the hospital from growing. In 2015, it added new operating rooms and beds atop the LL Bean Building on its Bramhall campus. And in September of last year, the hospital announced the biggest expansion in its history: a $512 million project that will add 20 operating rooms, provide 128 new single-occupancy patient rooms, create a new building and main entrance facing Congress Street, and greatly increase parking for visitors and employees. The expansion will increase the size of the campus by roughly 25 percent without taking an inch of land that the hospital doesn’t already own.
But what a difference a decade makes. Twelve years ago, the city responded to Maine Med’s expansion plans by working with residents to limits its encroachment into the surrounding neighborhoods. This year, the city’s response has been to push Maine Med beyond that boundary, over the vociferous objections of the neighbors who’d be most directly impacted by that growth.
“When Maine Med came forward with this proposal, we fully intended to abide by our existing contract zone and stay within the geographic boundaries,” one of the hospital’s lawyers told the Portland Planning Board during a workshop last March. “We were told by the city at that time that those geographic boundaries were an artificial hindrance to any further development of the institution and that the IOZ was intended to do away with that artificiality.”
Maine Med’s lawyer was already quite familiar with those boundaries and the very real reasons they were established, because she’s the same attorney who enforced them in 2009: Penny Littell, who now goes by Penelope St. Louis and, since 2011, has been corporate counsel for legal affairs for MaineHealth, the hospital’s parent organization.
Since the zoning boundary is now just an “artificial hindrance,” Maine Med came up with a wish list of lots it would like to purchase and develop in the future, drew dotted lines around those properties, and submitted the map as part of its IOZ application. The list includes pretty much every full-service restaurant and bar in the St. John Valley, including the real estate occupied by Salvage BBQ (Up in smoke!); the family-owned neighborhood bar and eatery Pizza Villa, which celebrated 50 years at that location in 2015 (Arrivederci!); Margarita’s Mexican restaurant, in Union Station Plaza (Adios!); and the Fraternal Order of Eagles’ club and banquet hall on St. John Street (So long, brother!). About 20 apartments would also be wiped out of the neighborhood if Maine Med fully realized this vision, along with the Greyhound bus station on the corner of St. John and Congress streets. Scores of offices occupied by social workers and independent health practitioners in the historic Maine Central Railroad Building, where Margarita’s is located, would be taken over by Maine Med. (Some of those suites are also rented to musicians for use as practice space at night.) In fact, the hospital is already in the process of leasing office suites there.
“It’s almost as if they pointed at all the spots where people gather and they said, ‘We’re gonna take that one, and that one, and that one, and that one,’” said Tim McNamara, a St. John Valley resident who’s been a thorn in Maine Med’s side for years, pushing the hospital to honor its obligations and clean up its act. “It almost felt like they were trying to snuff a candle.”
Between a rock and a health place
St. John Valley is the smallest and poorest neighborhood in Portland, and has long been one of the most racially diverse. During the first half of the 20th century, before the Union Station train depot on St. John Street was demolished in 1961, this was “Portland’s Harlem,” the home of African-Americans who worked as porters and held other jobs related to the railroad, according to local history buff (and Bollard contributor) Cliff Gallant.
A big reason residents are concerned about Maine Med’s encroachment into the neighborhood is that there isn’t a lot of room to spare. St. John Valley is squeezed between the steep cliffs of the Western Promenade and Maine Med’s campus to its east, and the train tracks and Interstate 295 to its west. The Barber Foods frozen-chicken factory is on the neighborhood’s southern flank, and Hadlock Field and the Expo occupy the northern end. Between them you’ll find a mix of apartment buildings (including lots of subsidized housing), some single-family homes, Asian and African grocery stores, fast-food joints and mom-and-pop shops.
The neighborhood association has striven over the past decade to make St. John Valley a more welcoming and livable place. They’ve worked with city officials to improve sidewalks and street lighting and create landscaping on median strips, among other projects. Association member Sarah Martin doubts Maine Med would have ever wanted to move its main entrance to this area had the neighbors not made it a safer and more attractive part of town. “In the past, nobody would’ve wanted to enter the hospital on ‘our side of the track,’” Martin said. “They’re like, ‘Oh, hey, thanks for cleaning this up. We’re gonna take it over now.’”
Despite the quarterly meetings they’re required to hold with residents, Maine Med officials have been aloof and unresponsive when neighborhood leaders have brought problems to their attention over the years. Graffiti, construction debris, prostitutes using their unmanned parking garage to service johns, addicts shooting up in the shadows of their monolithic buildings, a no-smoking policy on the campus that pushed puffers onto the sidewalks in front of homes — the list is long and many of the problems are ongoing. “They still have to be nagged for anything to get done,” Martin said.
“I totally share the frustration with that process, which has been very unresponsive and frustrating,” said Anne Pringle, a former Portland city councilor and mayor who, as president of the Western Promenade Neighborhood Association, has attended those quarterly meetings.
Given the hospital’s abysmal track record as a neighbor, it’s no wonder residents greeted news of its half-billion-dollar expansion last fall with some alarm. Their main concerns were how the hospital will manage the construction project, which is expected to last for five years, and the institution’s intention to erect a 13-story parking garage on the corner of Congress and Gilman streets — a bad idea the hospital has since nixed in favor of building structured parking behind the Maine Central Railroad Building, atop the parking lot its employees already use.
When Maine Med announced its big project last fall, Portland Planning Director Stuart “Tuck” O’Brien met at Salvage BBQ with Martin, Pringle, McNamara and other neighbors. “There was just so much anger towards Maine Med, and mistrust,” O’Brien recalled. “People didn’t feel like [hospital officials] were being transparent” about their plans, “and Maine Med felt that they were.”
O’Brien’s solution to this acrimony and lack of trust: push Maine Med to disregard the previously agreed-upon boundary and choose more properties in the neighborhood to occupy in the future.
An attorney who served on Portland’s Planning Board before being hired by the city in the fall of 2015, O’Brien touts this new institutional-zoning method as being “more predictable and coherent” and “transparent” than the contract-zoning process previously applied to Maine Med. Hospital officials are now required to provide more information about their current and future infrastructure needs, as well as transportation data and projections of future growth. And details like the allowable height and density of buildings on the properties Maine Med hopes to acquire have been established — for what that’s worth.
As the IOZ process itself demonstrates, zoning lines were meant to be crossed.
The battle over this zoning change is unique among the many squabbles that have preceded it in Portland in recent years, in that those disagreements involved actual development plans. In this case, there are no plans, and there is no project, to debate.
Maine Med will presumably be fully occupied with the task of completing its latest massive expansion over the next five years. In the Institutional Development Plan the hospital submitted to the city as part of the IOZ process, it identifies two “long-term projects” it can envision undertaking by the year 2042. Neither project would require the hospital to build outside the current boundary.
The hospital’s current expansion plan will not add any additional patient beds; it just converts double-bed rooms into private rooms. In a graph submitted as part of the Development Plan listing “projected campus growth and change,” Maine Med reports that by 2026 it expects the number of daily inpatient discharges to rise by just 10, and the number of inpatient visitors to rise by 20 people per day. The outpatient numbers are about the same. The largest growth over the next decade is projected to be in the number of employees (300 more) and parking spaces (an additional 780).
Maine Med did not make any of its top administrators available for comment for this story, but John Porter, MaineHealth’s marketing and communications director, agreed to answer questions on the record.
I asked Porter, the former editorial-page editor of the Portland Press Herald, why Maine Med was identifying properties for future projects that don’t even exist on paper. “We were asked [by the city] to be as inclusive as possible and to think as far out as possible,” he said. (By “inclusive,” Porter doesn’t mean including neighborhood input; none was sought. He means including every potential plot of land in the neighborhood that Maine Med might want to develop. The direction from the city was “blue-sky it out,” he said.)
“It’s tough,” Porter added. “It’s so dynamic in health care right now that our firm plans go out about three years. That’s about all we can do. It’s a really tough exercise to say what could you ever possibly have an interest in. We tried to meet that requirement, but you’re right — a lot of what we can see right now is planning that fits within our current footprint.”
Problem is, even if Maine Med doesn’t buy and build on those properties for years, the fact they’ve publicly expressed interest in acquiring them raises the properties’ market value and may prevent or dissuade other parties — like housing developers — from buying and developing the land. The loss of 20 housing units is thus compounded by the loss of the potential to build homes for hundreds of new neighbors. The non-profit hospital — whose purchase of these prime on-peninsula properties would also take them off the city’s tax rolls — has very deep pockets, as evidenced by the fact it can finance a half-billion-dollar expansion without breaking a sweat. Knowing Maine Med wants a property you own, would you sell it to anyone else?
Maine Med has “totally undermined everything that we’d been doing to try to make our neighborhood better and try to get some positive economic development going on down here,” said resident Garry Bowcott, who oversees the management of Salvage BBQ, Local 188, and sister restaurant Sonny’s. The hospital’s long-range expansion plan “strangles positive development in the neighborhood,” added Bowcott’s wife, Jenny MacKenzie.
“We want neighbors,” said Martin. “We don’t want people who are all leaving at five o’clock.”
The neighbors have few allies in this fight so far.
Pringle supports the IOZ plan. Maine Med’s pending expansion shifts traffic and institutional creep away from the posh Western Prom neighborhood, but Pringle didn’t cite that as a reason she supports the new zoning process. She said it’s preferable to have Maine Med think long-term about its future growth. “I’d rather have them think in those terms than pop up in four years once [the need for expansion] is upon them,” she said, echoing a point O’Brien also made. “We’re better off knowing where the boundary might be.”
Spencer Thibodeau, the young lawyer who represents the West End and St. John Valley on the City Council, is also in favor of the IOZ plan, though he intends to introduce some amendments. One would require that money Maine Med pays the city to replace housing demolished by future expansions be dedicated to housing projects in the St. John Valley neighborhood. Thibodeau also wants to require Maine Med to make the ground floor of any new medical buildings in the neighborhood available for use by retail businesses or restaurants.
St. John Valley residents say that if they can’t stop Maine Med from further expanding into their neighborhood, then requiring them to provide ground-floor commercial space would be a must. But there’s disagreement about this, too, and Maine Med’s track record in this regard is also awful.
When the hospital completed its most recent major expansion last decade, it left a lengthy “dead zone” of empty street-level space beneath its parking garage along Congress Street. There was room for commercial development there, and at the neighbors’ insistence Maine Med made some of that space available for lease through a local broker.
Actually, “made” may be too strong a word. The hospital neglected to even pour a concrete floor over the dirt, and it set the lease rate higher than what Martin said she pays to lease space for her café, The Bar of Chocolate, on Wharf Street, in the heart of the Old Port. To no one’s surprise, the space was never rented.
Sabina said that during a private meeting a couple years ago with Maine Med President and CEO Rich Petersen, Petersen admitted to neighbors that the hospital never really had any intention to lease the Congress Street space. Incredulous, Sabina said he replied, “Then what have I been talking about for eight years?” (Porter said he could neither confirm not deny that Petersen made that comment.)
Requiring the hospital to rent or sell space on the ground floor of new medical buildings to the same restaurants on those sites now, or to similar establishments, could be tricky for several reasons. (Can health professionals keep their Hippocratic Oath while promoting the consumption of barbeque and hard liquor?)
The St. John Valley residents do have an ally in Mary Davis, the attorney and activist behind the referendum question on this month’s Portland ballot (Question 2) that would empower neighbors to stop zoning changes within 500 feet of their homes — even retroactively — by signing a petition in opposition. Developers would then have to convince at least half the residents who live within 1,000 feet of the new zone to allow it.
This experience has convinced the St. John Valley neighbors that the city can’t be trusted to write or enforce zoning laws in the public’s interest. “For twelve years we’ve lived under the protection of the current contract zoning, and then out of nowhere we’re told that this current contract zone is an ‘artificial hindrance’ on expansion for the hospital,” said McNamara. “Well, there’s nothing artificial about the protection that we’ve realized.”
“What’s the point of going into an agreement with the city if they just turn around and take it away?” said Martin. “That was an agreement made by the city and the neighbors and the hospital, and then whoever comes into Planning next decides, ‘I don’t like that agreement you made with the neighbors, so we’ll just call it an “artificial hindrance” and take it away.’
“Why make any agreements ever?” Martin added. “And they wonder why this people’s referendum is here.”