Hospital Siting in the Tri-County Basin
The Tri-County Health District will build one 60-bed hospital for a population of 120,000. Three sites are under review. Site A is near downtown, 1.2 miles from an interstate interchange, on 12 acres at the edge of FEMA's 100-year floodplain (Zone AE); 18,000 residents live within a 15-minute drive. Site B is in the eastern suburbs, on 20 acres in Zone X; 8,000 residents live within 15 minutes, but 45,000 live within 25 minutes. Site C is near a western industrial park, on 15 acres in Zone X, three miles from a Superfund site with a groundwater contamination plume; 22,000 residents live within 15 minutes, but ambulance travel from eastern towns takes 35 minutes. Two small clinics are closing. About 28% of residents are over 65, and 12% of households have no vehicle. The district's criteria are safety, access for vulnerable residents, and cost; a flood-protection levee at A would add $4 million.
1. Which site best satisfies the district's three criteria? Explain how you would rank the sites and what tradeoffs you accept.
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Safety is the first filter. Site A sits in FEMA Zone AE; a levee would add $4 million and still leave residual risk, so A is the weakest on safety despite strong downtown access. Site C is in Zone X but three miles from a Superfund groundwater plume; without hydrogeologic testing, the district cannot rule out contamination or costly remediation. Site B is in Zone X, has 20 acres, and avoids both known hazards, so it ranks first on safety. On access, A serves 18,000 within 15 minutes; B serves only 8,000 within 15 minutes but 45,000 within 25 minutes; C serves 22,000 within 15 minutes but leaves eastern towns 35 minutes away. Because 28% of residents are over 65 and 12% have no vehicle, the 15-minute threshold matters, but B's larger 25-minute catchment and lower risk may outweigh A's downtown advantage if transit is added. My ranking is B, then A, then C, with B conditional on a transit and shuttle plan and C eliminated unless testing clears the plume.
2. What additional data or analytical methods would materially improve the siting decision?
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Drive-time rings are too crude. The district should use traffic-aware isochrones for peak and off-peak hours, not straight-line distance. It should map transit routes, paratransit, and walking access, because 12% of households have no vehicle. It should overlay age, disability, income, and current clinic closures to identify underserved pockets. For Site C, it needs Phase I and Phase II environmental site assessments and groundwater modeling; for Site A, a flood-risk study that includes levee failure and insurance costs. A cost-benefit analysis should compare land, construction, levee, remediation, and transport subsidies. Public health data on travel time and outcomes could help. Finally, the district should test whether a central site plus satellite clinics outperforms one hospital. These methods would not remove value judgments, but they would make the tradeoffs explicit and defensible.
3. How should the district address the 12% of households without a vehicle if it selects Site B?
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If Site B is chosen, the district must treat transport as part of the project, not an afterthought. It can fund a frequent shuttle from downtown and the eastern towns, coordinate with the transit agency to reroute buses, and subsidize paratransit for older and disabled residents. It can place satellite clinics or urgent-care outposts in the two neighborhoods losing clinics, with telehealth links to the hospital. It can negotiate with employers for vanpools. The district should set an access standard-for example, no resident more than 30 minutes from emergency care by 2030-and report against it. It should also consider that B's 25-minute catchment includes many residents who will still need a car; without a concrete transport plan, the site's safety advantage could become an equity failure. The plan should be funded in the capital budget, not left to a later phase.