West River Questions Primary Care Move

Yale-New Haven Hospital’s planned new $15 million primary care center sounds great, West River neighbors said. But how will people without cars get there?

That persistent concern emerged at a neighborhood meeting Tuesday night dealing with a Yale-New Haven plan to move its primary care center for tens of thousands of low-income New Haveners from current locations on York Street, on Chapel Street, and on Whitney Avenue to a consolidated new facility at 150 Sargent Dr. on Long Wharf.

Yale-New Haven is seeking state permission to modernize and expand the Long Wharf facility (currently an ambulatory care center) as a state-of-the-art new home for primary care, to be managed by the Fair Haven Community Health Care (FHCHC) and the Cornell Scott Hill Health centers. (Click here for a previous story detailing the plan.)

Hospital and Fair Haven and Hill Health officials laid out the plan Tuesday night for 30 people attending a meeting of the West River Neighborhood Services Corporation (WRNSC) at Barnard School.

Attendees generally supported the plan as an improved one-stop-shop for primary care.

But they expressed deep concerns about the difficulties patients without cars will have getting to the new location, especially low-income New Haveners who rely on the city’s notoriously unreliable public transit to get to appointments.

“Imagine you’re a young mom with two kids with ear infections, you now have to schlep, stand outside for a bus instead of walking to” one of the current primary-care facilities near Yale-New Haven’s St. Raphael Campus, said Stacy Spell, WRNSC’s vice-president. ​“Is it going to be a win-win for the community?”

His wife Virginia Spell, who chairs the WRNSC, invited FHCHC Executive Director Dr. Suzanne Lagarde, Cornell Scott Executive Director Michael Taylor, and Yale-New Haven Hospital Senior Vice President of Operations Cynthia Sparer to the meeting to make their case and to field questions.

“When someone’s ill, traveling extensive periods might deter people getting there,” offered John Gaudet. He was one of three medical students attending the meeting set to graduate from Yale School of Medicine this spring. He said he intends to choose primary care medicine as his specialty.

“It seems very silly to me to move the primary care center away from the neighborhood it serves. It’s going to make it hard for people to get to their doctor,” added his colleague Karri Weisenthal.

Their teacher, Dr. Tracy Rabin, who coordinates the medical school’s primary care residency program, upped the ante of concern about transportation. She and her students mapped out the long and circuitous CT Transit bus routes and projected times for patients journeying to Long Wharf from the West River neighborhood.

She also argued that the move would leave four neighborhoods — West River, Dwight, Edgewood, and Westville— ​“with no clinic, and will cause more people to go to the E.R.,” she suggested.

That, of course, is precisely one of the issues the plan hopes to address — the lower use of the emergency departments of hospitals by connecting more New Haveners to the community health clinics.

Virginia Spell said that she had been in touch with city traffic officials, who told her there are no plans to increase the number of buses running along routes that would transport West River patients to their Long Wharf docs.

“And the Grand Avenue buses are the most crowded. You’ll increase the traffic, but you won’t increase the opportunity to get to your doctor,” she added. (The Yale-New Haven plan would give people choices to see primary care doctors at, say, the Fair Haven clinic or Hill Health if they’re more accessible than Long Wharf.)

One suggestion offered at the meeting: How about adding a route to the Yale shuttle system to transport doctors and patients to the Long Wharf facility? (Yale Medical School interns and residents work at the primary care center.)

“A lot of details remain to be worked out,” replied Lagarde. ​“We want to involve community voices and [those of the] patients,” she added.

Yale’s representative Sparer said the shuttle suggestion and others would be digested and taken into consideration as plans take shape over the coming year and a half of bureaucratic regulatory approvals required before licenses are granted and the new facility opens.

Taylor said in the three years this plan has evolved among the three organizations, they’ve looked all over town for potential new sites. No other site had sufficient space — and parking — to accommodate the centralized and expanded care contemplated, along with the opportunities for Yale to teach primary care to its future young physicians on the site, he said.

“We [already] had the Sargent building,” Sparer said, and the St. Raphael’s site, which Rabin had suggested might be upgraded, ​“did not lend itself to a solution” to expand there.

Sparer added that the roof-top trailers at St. Raphael’s, which were intended to be a temporary site for Yale’s primary care center, are no longer suitable for treating patients.

Audience members echoed neighbor Mark Monk’s assertion that the move of the primary care center to a location requiring people ​“to cross a bridge and tracks to get to” will raise a perception problem: Will the Long Wharf facility feel like a welcoming neighborhood kind of place?

Stacy Spell said the WRNSC has worked for years to motivate local people on Medicaid to use the Chapel Street primary care site, as opposed to emergency rooms. ​“Finally when they are connected, you move,” he said.

Dr. John Moriarty, who helps direct the primary care residency program at the Yale School of Medicine, concurred that perception is important if people are to connect to their primary care.

He said he likes the planned facility at Long Wharf but agrees that transportation and neighborhood feel will pose challenges.

“How can we maintain the connections despite the distance?” he asked.

He cited a range of programs, like ​“Walks With Docs,” that Yale’s primary care centers have already been running, partnering with groups like the WRNSC.

Instead of spending all the projected $15 million on turning the Sargent Drive facility into a patient-centered one-stop primary care center, maybe Yale could get by with $10 million, he suggested. That would save $5 million for continuing and increasing community programs in the vacated neighborhoods.

Stacy Spell and Board of Alders President and West River Alder Tyisha Walker-Myers, who was also in attendance, bemoaned that the Long Wharf plan appears ​“set in cement” while transportation and other issues remain to be discussed.

“This is disrespectful to the community. This move goes against it and the community will resent it,” added Rock, who also said he plans to practice primary care when he finishes his training.

The hospital has just submitted its application to the state’s Office of Health Care Access (OHCA). Thirty days after OHCA deems Yale-New Haven’s application ​“complete,” members of the public can request a public hearing within 30 days and/or submit written comments to state Deputy Public Health Commissioner Yvonne Addo. This web page gives details about all that.