COUNTY OF ALBEMARLE
Charlottesville Free Clinic Building Proposal
Request Board approval to proceed with preliminary plans to build a new Charlottesville Free Clinic facility adjacent to the Health Department
Tucker; White; Peake,
LEGAL REVIEW: Yes
December 6, 2006
ACTION: X INFORMATION:
The Charlottesville Free Clinic (CFC) was founded in 1992 to provide high quality health care to working people who did not have health insurance or access to free care elsewhere. The CFC founding Board of Directors initially hoped that an increase in viable health insurance options would allow the CFC to close its doors within 5 years, although the CFC is now in its fourteenth year of operation with annually increasing demand for services. In 1997, the County and City agreed to allow the CFC Board to construct a 1400 square foot second floor addition to the Health Department on property which is jointly owned by the City and County and was paid for with funds raised by the CFC Board. This space was then sub-leased from the Health Department. The CFC also used the Health Department dental and medical clinic spaces, including some waiting areas, in the evenings when the space was not being used by the Health Department. This arrangement has been extremely beneficial to the community and has been an effective and efficient use of public medical space.
Due to an increasing volume of patients and limited space for expansion, the CFC Board is proposing to build and maintain at its expense a 12,600 square foot building on land adjacent to the Health Department. The CFC Board is asking at this time for preliminary concept approval for the building idea so that it can move forward with the design and engineering work to determine how a new building could work on this current Health Department site. The CFC Board did not want to proceed any further with plans without first determining if the Board of Supervisors and City Council approved of this direction.
This executive summary provides information on the need for additional space and the preliminary building proposal. Attachment A describes the services provided by the CFC, its benefit to the community and its resources. Attachment B is a sketch showing the proposed changes to the site for the new building. Attachment C is a sketch showing the current parking and building configuration of the Health Department
Goal 1: Enhance the Quality of Life for County Residents
The partnership between the CFC Board and the Health Department has been a successful one on several accounts. In particular, it provides patients with a convenient, central location to access a variety of their health care needs. With the growth in recent years, the CFC has begun to experience limitations in the current space. In particular, the 1,400 square feet of administrative space does not adequately accommodate the growing staff (7 full-time) and daily interns and volunteers. Additionally, pharmaceutical services have more than doubled and the current pharmacy space is not adequate to accommodate the increased prescription volume.
Finally, dental services for adults are the most significant unmet health need in the community. The CFC has stopped adding people to its waiting list of over 400 and estimates that it would take more than three years to see and treat everyone on the list at the current service level. The new facility would allow the CFC to create a suite for a full daytime dental program as opposed to offering dental clinics 3-5 times per month. The CFC Board has already had discussions with MCV/VCU about the possibility of serving as a placement for MCV/VCU dental students, and if this program were implemented, the number of adult dental patients could increase by at least 500 percent.
Beyond those immediate concerns, the clinical space will not be adequate to meet the projected increase in patient volume within the next 3-5 years. With the addition of a nurse practitioner and daytime clinics, the current capacity has increased. Although the number of exam rooms and waiting rooms are adequate today, patient numbers have increased between 3 -12 percent almost every year. If patient numbers continue to increase at this rate, the clinic will be at capacity within 3 -5 years. With additional space, the CFC would be able to significantly increase its capacity for serving medical patients, as well as utilize the increasing number of volunteers, particularly retirees, who are interested in volunteering during the day. Representatives from the UVa nursing school have approached the CFC Board to serve as a practicum placement for nurse practitioners in training, but the CFC is not able to accommodate this request within the current space. With the additional proposed space, the CFC could increase its daytime clinic capacity by at least 100 percent.
To address the space shortage and increase services to the community, the CFC Board is looking at several options for expansion of the CFC. Because of the successful partnership with the Health Department, it would like to maintain the beneficial relationship. After carefully reviewing and discussing possibilities, including adding onto the existing building, the CFC Board and the Health Department have decided that a separate building on the site would be the most advantageous to both the Health Department and the CFC. The primary reasons are:
· Each partner would have what it currently needs, as well as space to grow (HD would acquire 1,400 sq. ft. from the CFC administrative suite; Free Clinic would build a 12,600 sq. ft facility with a 4,200 sq. ft. unfinished basement for future expansion or partnerships; HD would have access to additional conference room space in CFC building);
· There would be less disruption of service to patients while the construction took place;
· The cost would be less to build a free standing facility than to expand the current space.
The CFC Board is proposing to build this separate facility at the front of the existing property between the sidewalk and into the parking lot as shown on the attached sketch (Attachment B). The existing parking spaces would not only be replaced, but the proposed plan includes adding 26 additional spaces. The CFC Board would assume the cost for all of the construction and would not require any funds from the City or County. The CFC Board would also be responsible for all of the maintenance and repair on its separate facility.
During several discussions with City staff, two major concerns were expressed: 1) adequate parking for the new clinic during daytime hours when the Health Department’s own lot is often full; 2) the Health Department itself may need to expand its clinic and administrative space in the next ten to twenty years and the land may not be adequate for that expansion and the new CFC building.
The attached sketch, Attachment B, shows that an additional 26 parking spaces will be added during the construction of the 12,600 square foot CFC, which is one more space than required by City Code. Daggett & Grieg Architects have indicated that it may be possible to add more parking spaces at the back of the building if needed in the future, although additional fill would be needed due to the steep slope of the land.
To ensure that there is adequate space on this three-acre site to accommodate future space needs of the Health Department, a master plan will be prepared for the whole site during the site review process. Based on the results of this site analysis, the location, alignment and footprint of the CFC building may change in the final site plan that will be submitted to the City and County for approval if changes are needed to accommodate the future Health Department growth on the same site.
City Council will hear the request at its December 4th meeting, and if it approves the concept, will be prepared to offer the CFC Board a 40-year lease with certain construction and maintenance conditions to be determined. . Pursuant to Virginia Code, the City is not permitted to lease public property for more than five years unless it publicly advertises and considers bids for the use of the property. If the Board of Supervisors favors this proposal, the County must hold a public hearing on leasing public property to the CFC Board as required by Virginia Code.
There should be no fiscal impact to the County. The CFC Board will raise private funds to build the clinic and will also use mainly private funds to maintain and operate the CFC. The CFC receives tremendous support from over 1,200 donors
each year. During FY2005, there were 152 “major donors”, individuals who gave $500 or more, including 72 gifts of $1,000 or more. The majority of its funding comes from individuals and special events, as well as foundations, businesses, churches, civic groups and public funds.
Staff recommends that the Board grant preliminary concept approval of the CFC Board’s request to proceed forward with its plan to build a 12,600 square foot building on County and City jointly owned property adjacent to the Health Department. If approved, the CFC Board will work with the City’s development office to develop a site plan, which will be presented to both the City and County for final approval. The Board’s preliminary approval at this time does not commit the Board to final approval of the project, but it will allow the CFC Board to move forward both with the site plan and with its fund raising campaign for the construction and maintenance of a new building. The Health Department is in full support of the CFC Board’s request with the understanding that a master plan will be prepared prior to any final approval to ensure that the future space needs for the Health Department can also be met on this site. If that condition is met, the Health Department believes that an expanded CFC facility will be a valuable asset to the community in providing desperately needed comprehensive health services to the County and City’s working citizens.
CFC Board members, the CFC Director, Erika Viccellio, and the project architect will be at the Board meeting on December 6th to address any questions.
A – CFC mission and service information
B – Proposed new HD/CFC site plan sketch
C – Existing HD/CFC site plan sketch
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