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HomeMy WebLinkAboutZOA-18-04City of Wheat I�icige ITEM NO: D� DATE: August 13, 2018 REQUEST FOR CITY COUNCIL ACTION TITLE: COUNCIL BILL NO. 22-2018 - AN ORDINANCE CREATING A NEW SECTION 26-643 OF THE WHEAT RIDGE CODE OF LAWS PROHIBITING THE USE OF FREESTANDING EMERGENCY ROOM FACILITIES ® PUBLIC HEARING ❑ ORDINANCES FOR 1 ST READING (7/23/2018) ❑ BIDS/MOTIONS ® ORDINANCES FOR 2ND READING (8/13/2018) ❑ RESOLUTIONS QUASI-JUDICIAL: ❑ YES M City Attorney I►1� - atw��j City Manager ISSUE: This ordinance revises the Wheat Ridge Code of Laws to prohibit freestanding emergency room facilities throughout the City. PRIOR ACTION: The Council adopted a moratorium on new freestanding emergency rooms to enable the staff and council to review the city's regulatory options. The moratorium was extended to August 27, 2018. On June 18, City Council directed that an ordinance be brought forth prohibiting this use throughout the City. FINANCIAL IMPACT: The potential loss of license, permit, application and similar fees associated with applications for freestanding emergency room (ER) facilities is nominal. BACKGROUND: Freestanding ERs continue to increase in number and popularity. In Colorado, the number of freestanding ERs rose from two in 2012 to at least 35 by mid -2016. These facilities provide emergency medical treatment and care similar to a hospital-based ER. Ambulances deliver to these freestanding facilities and many offer more sophisticated on-site services — such as radiology and lab services — than urgent care facilities. These types of facilities continue to be unregulated by the state. Council Action Form — Prohibit Use of Freestanding ERs August 13, 2018 Page 2 Freestanding ERs likely generate land use impacts that are more akin to hospitals than to other medical facilities, such as clinics, doctor's offices and urgent -care facilities. Unlike these other types of medical facilities, freestanding ERs accommodate ambulance and other emergency - vehicle traffic and they are often open 24/7. They produce light, noise, glare and traffic beyond that of a non -emergent medical care facility. It is therefore appropriate to study and evaluate whether the City's existing zoning regulations adequately address freestanding ER facilities. In the past, there have been media stories on freestanding ERs and patient confusion between freestanding ERs and urgent care facilities. Because freestanding ERs are not currently licensed or regulated by the state, patients may also be uninformed about the relative costs, benefits, advantages and disadvantages of visiting a freestanding ER versus a hospital-based ER. It was therefore appropriate for Council to study and evaluate whether the City should enter the licensing arena specific to these facilities and adopt some local licensing requirements for them. The Council has the authority to prohibit this use throughout the City. The attached ordinance does so. RECOMMENDATIONS: Council options include: 1. Approve the ordinance as presented on second reading 2. Approve the ordinance on second reading with amendment(s) 3. Postpone consideration of the ordinance indefinitely 4. Extend the temporary moratorium Staff recommends approving the ordinance as presented. RECOMMENDED MOTIONS: "I move to approve Council Bill No. 22-2018 - an ordinance creating a new section 26-643 of the Wheat Ridge Code of Laws prohibiting the use of freestanding emergency room facilities, on second reading and that it takes effect immediately upon Council adoption." Or, "I move to postpone indefinitely Council Bill No. 22-2018 — an ordinance creating a new section 26-643 of the Wheat Ridge Code of Laws prohibiting the use of freestanding emergency room facilities for the following reason(s) " REPORT PREPARED/REVIEWED BY: Gerald Dahl, City Attorney Kenneth Johnstone, Community Development Director Patrick Goff, City Manager ATTACHMENTS: 1. Council Bill No. 22-2018 CITY OF WHEAT RIDGE, COLORADO INTRODUCED BY COUNCIL MEMBER DAVIS Council Bill No. 22 Ordinance No. Series 2018 TITLE: AN ORDINANCE CREATING A NEW SECTION 26-643 OF THE WHEAT RIDGE CODE OF LAWS PROHIBITING THE USE OF FREESTANDING EMERGENCY ROOM FACILITIES WHEREAS, the City of Wheat Ridge ("City") is a home rule municipality operating under a charter adopted pursuant to Article XX of the Colorado Constitution and vested with the authority by that article and the Colorado Revised Statutes to enact laws to govern and regulate the use of land within its territory; and WHEREAS, pursuant to this authority, the Wheat Ridge City Council ("Council") previously adopted local land use regulations, codified as Chapter 26 of the Wheat Ridge Code of Laws ("Code"); and WHEREAS, City staff has previously interpreted the City's current zoning regulations as permitting freestanding emergency room facilities to locate within the Mixed Use -Commercial and Planned Hospital Development zone districts only; and WHEREAS, the Council found that freestanding emergency room facilities may cause land use impacts that are different than those caused by other detached health care facilities due to the extended hours that emergency facilities may be open; and WHEREAS, approximately two years ago, in response to the increase in the number and popularity of freestanding emergency room facilities over the past several years, the Council determined that it was necessary and desirable to examine the City's zoning laws and business licensing regulations governing freestanding emergency room facilities; and WHEREAS, additionally, the Council and City staff held a reasonable belief that the state legislature might adopt statewide legislation governing freestanding emergency room facilities that could potentially affect the desired parameters of local regulations on the topic, during either the last few legislative sessions; and WHEREAS, as a result, by and through the adoption of Ordinance No. 1595, the Council previously acted to impose a one-year moratorium on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility; and WHEREAS, the Council and City staff learned that it was unlikely that the state legislature will adopt such legislation during the current session; and ATTACHMENT 1 WHEREAS, the Council therefore found it prudent and desirable to extend the moratorium, to permit the careful study and evaluation of various local regulatory options with an expectation that such regulations would operate without an additional state regulatory gloss; and WHEREAS, the Council has now determined that it is in the best interests of the safety, health and welfare of the citizens of Wheat Ridge to prohibit the use of freestanding emergency room facilities within the City. NOW THEREFORE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF WHEAT RIDGE, COLORADO: Section 1. Findings. The above and foregoing findings are hereby incorporated by this reference as specific findings and determinations of the Council. Section 2. Chapter 26 of the Wheat Ridge Code of Laws is amended by the adoption of a new section 26-643 as follows: Sec. 26-643. — Freestanding Emergency Room Facilities. A. For purposes of this Section, freestanding emergency room facilities shall mean and include a medical facility that is not physically attached to a hospital facility that has the capability of providing medical care and services to patients with emergency medical conditions in a manner similar to emergency rooms located within hospitals. Features of a freestanding emergency room facility may include, but are not limited to, expanded hours of operation, drive -lanes or vehicle bays to accommodate ambulance arrivals and departures, board-certified emergency physicians, board-certified emergency nurses, on-site lab and imaging capabilities and similar equipment, services and treatments not commonly available in urgent -care facilities. B. The use of freestanding emergency room facilities, as defined in this Section, is strictly prohibited in all zone districts within the City. Section 3. The "Table of Uses — Commercial and Industrial Districts" Chart set forth in Section 26-204 of the Wheat Ridge Code of Laws, regarding "zone district use schedule," is hereby amended by inserting a new row in the appropriate alphabetical order concerning freestanding emergency room facilities as follows: Table of Uses — Commercial and Industrial Districts Uses Notes NC RC C-1 C-2 I -E Freestanding emergency room facilities Section 4. The "Permitted Uses" Chart set forth in Section 26-1111 of the Wheat Ridge Code of Laws, concerning permitted uses in mixed-use zone districts, is hereby amended by inserting a new row in the appropriate alphabetical order concerning freestanding emergency room facilities as follows: Permitted Uses Use Group MU -C MU -C Interstate MU -C TOD MU -N Freestanding emergency room facilities NP NP NP NP Section 5. The moratorium on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility imposed by Ordinance 1595 and extended by Ordinance 1616 and Ordinance 1634 is hereby repealed, upon the effective date of this ordinance. Section 6. Effective Date. This Ordinance shall take effect upon adoption and signature by the Mayor and City Clerk, as permitted by Section 5.11 of the Charter. INTRODUCED, READ, AND ADOPTED on first reading by a vote of 8 to 0 on this 231d day of July, 2018, ordered published in full in a newspaper of general circulation in the City of Wheat Ridge and Public Hearing and consideration on final passage set for August 13, 2018, at 7:00 o'clock p.m., in the Council Chambers, 7500 West 29th Avenue, Wheat Ridge, Colorado. READ, ADOPTED AND ORDERED PUBLISHED on second and final reading by a vote of to , this day of , 2018. SIGNED by the Mayor on this day of , 2018. Bud Starker, Mayor ATTEST: Janelle Shaver, City Clerk Approved As To Form Gerald E. Dahl, City Attorney First Publication: July 26, 2018 Second Publication: Wheat Ridge Transcript Effective Date: City of `1Vheat j�i jge ITEM NO: DATE: July 23, 2018 REQUEST FOR CITY COUNCIL ACTION TITLE: COUNCIL BILL NO. 22-2018 - AN ORDINANCE CREATING A NEW SECTION 26-643 OF THE WHEAT RIDGE CODE OF LAWS PROHIBITING THE USE OF FREESTANDING EMERGENCY ROOM FACILITIES ❑ PUBLIC HEARING ® ORDINANCES FOR 1 ST READING (7/23/2018) ❑ BIDS/MOTIONS ❑ ORDINANCES FOR 2ND READING (8/13/2018) ❑ RESOLUTIONS QUASI-JUDICIAL: ❑ YES ly� 0 `/� /' City Attorney 16= City Manager ISSUE: This ordinance revises the code of Laws to prohibit freestanding emergency room facilities throughout the City. PRIOR ACTION: The Council adopted a moratorium on new freestanding emergency rooms to enable the staff and council to review the city's regulatory options. The moratorium was extended to August 27, 2018. On June 18, City Council directed that an ordinance be brought forth prohibiting this use throughout the City. FINANCIAL IMPACT: The potential loss of license, permit, application and similar fees associated with applications for freestanding emergency room (ER) facilities is nominal. BACKGROUND: Freestanding ERs continue to increase in number and popularity. In Colorado, the number of freestanding ERs rose from two in 2012 to at least 35 by mid -2016. These facilities provide emergency medical treatment and care similar to a hospital-based ER. Ambulances deliver to these freestanding facilities and many offer more sophisticated on-site services — such as Council Action For n — Prohibit Use of Freestanding ERs July 23, 2018 Page 2 radiology and lab services — than urgent care facilities. These types of facilities continue to be unregulated by the state. Freestanding ERs likely generate land use impacts that are more akin to hospitals than to other medical facilities, such as clinics, doctor's offices and urgent -care facilities. Unlike these other types of medical facilities, freestanding ERs accommodate ambulance and other emergency - vehicle traffic and they are often open 24/7. They produce light, noise, glare and traffic beyond that of a non -emergent medical care facility. It is therefore appropriate to study and evaluate whether the City's existing zoning regulations adequately address freestanding ER facilities. In the past, there have been media stories on freestanding ERs and patient confusion between freestanding ERs and urgent care facilities. Because freestanding ERs are not currently licensed or regulated by the state, patients may also be uninformed about the relative costs, benefits, advantages and disadvantages of visiting a freestanding ER versus a hospital-based ER. It was therefore appropriate for Council to study and evaluate whether the City should enter the licensing arena specific to these facilities and adopt some local licensing requirements for them. The Council has the authority to prohibit this use throughout the City. The attached ordinance does so. RECOMMENDATIONS: Council options include: 1. Approve the ordinance as presented on first reading 2. Approve the ordinance on first reading with amendment(s) 3. Postpone consideration of the ordinance indefinitely 4. Extend the temporary moratorium Staff recommends approving the ordinance as presented. RECOMMENDED MOTIONS: "I move to approve Council Bill No. 22-2018 - an ordinance creating a new section 26-643 of the Wheat Ridge Code of Laws prohibiting the use of freestanding emergency room facilities, on first reading, order it published, public hearing set for Monday, August 13, 2018, at 7:00 p.m. in City Council Chambers, and that it take effect immediately upon Council adoption." Or, "I move to postpone indefinitely Council Bill No. 22-2018 — an ordinance creating a new section 26-643 of the Wheat Ridge Code of Laws prohibiting the use of freestanding emergency room facilities for the following reason(s) " Council Action Form — Prohibit Use of Freestanding ERs July 23, 2018 Page 3 REPORT PREPARED/REVIEWED BY: Gerald Dahl, City Attorney Kenneth Johnstone, Community Development Director Patrick Goff, City Manager ATTACHMENTS: 1. Council Bill No. 22-2018 CITY OF WHEAT RIDGE, COLORADO INTRODUCED BY COUNCIL MEMBER Council Bill No. 22 Ordinance No. Series 2018 TITLE: AN ORDINANCE CREATING A NEW SECTION 26-643 OF THE WHEAT RIDGE CODE OF LAWS PROHIBITING THE USE OF FREESTANDING EMERGENCY ROOM FACILITIES WHEREAS, the City of Wheat Ridge ("City") is a home rule municipality operating under a charter adopted pursuant to Article XX of the Colorado Constitution and vested with the authority by that article and the Colorado Revised Statutes to enact laws to govern and regulate the use of land within its territory; and WHEREAS, pursuant to this authority, the Wheat Ridge City Council ("Council") previously adopted local land use regulations, codified as Chapter 26 of the Wheat Ridge Code of Laws ("Code"); and WHEREAS, City staff has previously interpreted the City's current zoning regulations as permitting freestanding emergency room facilities to locate within the Mixed Use -Commercial and Planned Hospital Development zone districts only; and WHEREAS, the Council found that freestanding emergency room facilities may cause land use impacts that are different than those caused by other detached health care facilities due to the extended hours that emergency facilities may be open; and WHEREAS, approximately two years ago, in response to the increase in the number and popularity of freestanding emergency room facilities over the past several years, the Council determined that it was necessary and desirable to examine the City's zoning laws and business licensing regulations governing freestanding emergency room facilities; and WHEREAS, additionally, the Council and City staff held a reasonable belief that the state legislature might adopt statewide legislation governing freestanding emergency room facilities that could potentially affect the desired parameters of local regulations on the topic, during either the last few legislative sessions; and WHEREAS, as a result, by and through the adoption of Ordinance No. 1595, the Council previously acted to impose a one-year moratorium on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility; and WHEREAS, the Council and City staff learned that it was unlikely that the state legislature will adopt such legislation during the current session; and ATTACHMENT 1 WHEREAS the Council therefore found it prudent and desirable to extend the moratorium, to permit the careful study and with an expectation that such regulations regulatory gloss; and evaluation of various local regulatory options would operate without an additional state WHEREAS, the Council has now determined that it is in the best interests of the safety, health and welfare of the citizens of Wheat Ridge to prohibit the use of freestanding emergency room facilities within the City. NOW THEREFORE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF WHEAT RIDGE, COLORADO: Section 1. Findings. The above and foregoing findings are hereby incorporated by this reference as specific findings and determinations of the Council. Section 2. Chapter 26 of the Wheat Ridge Code of Laws is amended by the adoption of a new section 26-643 as follows: Sec. 26-643. — Freestanding Emergency Room Facilities. A. For purposes of this Section, freestanding emergency room facilities shall mean and include a medical facility that is not physically attached to a hospital facility that has the capability of providing medical care and services to patients with emergency medical conditions in a manner similar to emergency rooms located within hospitals. Features of a freestanding emergency room facility may include, but are not limited to, expanded hours of operation, drive -lanes or vehicle bays to accommodate ambulance arrivals and departures, board-certified emergency physicians, board-certified emergency nurses, on-site lab and imaging capabilities and similar equipment, services and treatments not commonly available in urgent -care facilities. B. The use of freestanding emergency room facilities, as defined in this Section, is strictly prohibited in all zone districts within the City. Section 3. The "Table of Uses — Commercial and Industrial Districts" Chart set forth in Section 26-204 of the Wheat Ridge Code of Laws, regarding "zone district use schedule," is hereby amended by inserting a new row in the appropriate alphabetical order concerning freestanding emergency room facilities as follows: Table of Uses — Commercial and Industrial Districts Uses Notes NC RC C-1 C-2 I -E Freestanding emergency room facilities 2 Section 4. The "Permitted Uses" Chart set forth in Section 26-1111 of the Wheat Ridge Code of Laws, concerning permitted uses in mixed-use zone districts, is hereby amended by inserting a new row in the appropriate alphabetical order concerning freestanding emergency room facilities as follows: Permitted Uses Use Group MU -C MU -C Interstate MU -C TOD MU -N Freestanding emergency room facilities NP NP NP NP Section 5. The moratorium on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility imposed by Ordinance 1595 and extended by Ordinance 1616 and Ordinance 1634 is hereby repealed, upon the effective date of this ordinance. Section 6. Effective Date. This Ordinance shall take effect upon adoption and signature by the Mayor and City Clerk, as permitted by Section 5.11 of the Charter. INTRODUCED, READ, AND ADOPTED on first reading by a vote of to on this 23rd day of July, 2018, ordered published in full in a newspaper of general circulation in the City of Wheat Ridge and Public Hearing and consideration on final passage set for August 13, 2018, at 7:00 o'clock p.m., in the Council Chambers, 7500 West 29th Avenue, Wheat Ridge, Colorado. READ, ADOPTED AND ORDERED PUBLISHED on second and final reading by a vote of to , this day of 12018. SIGNED by the Mayor on this day of , 2018. Bud Starker, Mayor �C] ATTEST: Janelle Shaver, City Clerk Approved As To Form Gerald E. Dahl, City Attorney First Publication: Second Publication: Wheat Ridge Transcript Effective Date: City of W heat-j�idge COMMUNITY DEVELOPMENT PLANNING COMMISSION LEGISLATIVE ITEM STAFF REPORT �F '�t' li ��•�� �'_'1V U� � `' ' r�' rte. MEETING DATE: July 19, 2018 TITLE: An ordinance creating a new section 26-643 of the Wheat Ridge Code of Laws prohibiting the use of Freestanding Emergency Room Facilities CASE NO. ZOA-18-04 ® PUBLIC HEARING ❑ RESOLUTION ® CODE CHANGE ORDINANCE ❑ STUDY SESSION ITEM Case Manager: Kenneth Johnstone, Director of Community Development Date of Preparation: July 12, 2018 SUMMARY: Freestanding emergency rooms (FERs) are a relatively new land use / business model. Traditionally, emergency rooms (ERs) have been directly associated with hospitals. In the last several years, the concept of having FERs has emerged in Colorado and elsewhere around the country. Because it is a new land use concept, the City's zoning code is silent to the land use. As directed by Council, the City is proceeding to regulate this land use through this code amendment. BACKGROUND: As noted above, the City's municipal code is silent to the concept of freestanding emergency rooms. As staff understands it, the concept originally was designed to meet a need in more sparsely developed and populated areas, where access to a hospital might be many miles away, causing time sensitive ER visits to sometimes be greatly delayed. More recently, the concept has moved into more urbanized areas, including the Denver metro region. From a land use perspective, the facilities have the potential for greater impacts, associated with 24/7 operations and the occurrence of numerous ambulance arrivals and associated noise impacts. The Colorado state legislature has discussed potential regulation over the past several years. Because of that, City Council has previously adopted and extended multiple moratoria on the acceptance and processing of any and all applications for said uses, awaiting regulations that might have been developed at a state level. It was believed that any state regulations might inform a local regulatory approach. Ultimately, the state has not adopted any substantive regulations for these facilities and City Council recently made the decision to move forward with a local regulations. City Council has discussed the topic at numerous study sessions over the last several years. Most recently at the June 18, 2018 Council study session, Council's consensus motion was to direct staff to draft an ordinance prohibiting such facilities throughout the City. As with any Chapter 26 legislative code amendment, the Planning Commission is required to conduct a public hearing and forward their recommendation for Council's consideration. STATEMENT OF THE ISSUES: Under current regulations, it has been determined that FERs are most similar to "hospitals" versus "medical offices" and as such are a permitted use in Planned Hospital and Mixed Use -Commercial zone districts. The use would not be allowed in lower intensity commercial zone districts nor in the Mixed Use -Neighborhood zone district. Because the City has a centrally located hospital campus (zoned Planned Hospital), the need for these facilities may be less so than in other communities. Additionally, given the more intensive land use impacts associated with hours of operation and manner of patient arrivals (often involving fast moving ambulances with sirens), they likely would be incompatible with other permitted uses in those commercial and mixed use zone districts. Based on this, the proposed ordinance would simply do two things: 1) define "freestanding emergency room facilities", and 2) disallow them in all of the City's Mixed Use and Commercial zone districts. RECOMMENDED MOTION: "I move to recommend approval of Case #ZOA-18-04, an ordinance creating a new section, 26-643, of the Wheat Ridge Code of Laws, prohibiting the use of Freestanding Emergency Room Facilities." Exhibits: Ordinance CITY OF WHEAT RIDGE, COLORADO INTRODUCED BY COUNCIL MEMBER Council Bill No. _ Ordinance No. Series 2018 TITLE: AN ORDINANCE CREATING A NEW SECTION 26-643 OF THE WHEAT RIDGE CODE OF LAWS PROHIBITING THE USE OF FREESTANDING EMERGENCY ROOM FACILITIES WHEREAS, the City of Wheat Ridge ("City") is a home rule municipality operating under a charter adopted pursuant to Article XX of the Colorado Constitution and vested with the authority by that article and the Colorado Revised Statutes to enact laws to govern and regulate the use of land within its territory; and WHEREAS, pursuant to this authority, the Wheat Ridge City Council ("Council") previously adopted local land use regulations, codified as Chapter 26 of the Wheat Ridge Code of Laws ("Code"); and WHEREAS, City staff has previously interpreted the City's current zoning regulations as permitting freestanding emergency room facilities to locate within the Mixed Use -Commercial and Planned Hospital Development zone districts only; and WHEREAS, the Council found that freestanding emergency room facilities may cause land use impacts that are different than those caused by other detached health care facilities due to the extended hours that emergency facilities may be open; and WHEREAS, approximately two years ago, in response to the increase in the number and popularity of freestanding emergency room facilities over the past several years, the Council determined that it was necessary and desirable to examine the City's zoning laws and business licensing regulations governing freestanding emergency room facilities; and WHEREAS, additionally, the Council and City staff held a reasonable belief that the state legislature might adopt statewide legislation governing freestanding emergency room facilities that could potentially affect the desired parameters of local regulations on the topic, during either the last few legislative sessions; and WHEREAS, as a result, by and through the adoption of Ordinance No. 1595, the Council previously acted to impose a one-year moratorium on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility; and WHEREAS, the Council and City staff learned that it was unlikely that the state legislature will adopt such legislation during the current session; and WHEREAS, the Council therefore found it prudent and desirable to extend the moratorium, to permit the careful study and evaluation of various local regulatory options with an expectation that such regulations would operate without an additional state regulatory gloss; and WHEREAS, the Council has now determined that it is in the best interests of the safety, health and welfare of the citizens of Wheat Ridge to prohibit the use of freestanding emergency room facilities within the City. NOW THEREFORE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF WHEAT RIDGE, COLORADO: Section 1. Findings. The above and foregoing findings are hereby incorporated by this reference as specific findings and determinations of the Council. Section 2. Chapter 26 of the Wheat Ridge Code of Laws is amended by the adoption of a new section 26-643 as follows: Sec. 26-643. — Freestanding Emergency Room Facilities. A. For purposes of this Section, freestanding emergency room facilities shall mean and include a medical facility that is not physically attached to a hospital facility that has the capability of providing medical care and services to patients with emergency medical conditions in a manner similar to emergency rooms located within hospitals. Features of a freestanding emergency room facility may include, but are not limited to, expanded hours of operation, drive -lanes or vehicle bays to accommodate ambulance arrivals and departures, board-certified emergency physicians, board-certified emergency nurses, on-site lab and imaging capabilities and similar equipment, services and treatments not commonly available in urgent -care facilities. B. The use of freestanding emergency room facilities, as defined in this Section, is strictly prohibited in all zone districts within the City. Section 3. The "Table of Uses — Commercial and Industrial Districts" Chart set forth in Section 26-204 of the Wheat Ridge Code of Laws, regarding "zone district use schedule," is hereby amended by inserting a new row in the appropriate alphabetical order concerning freestanding emergency room facilities as follows: Table of Uses — Commercial and Industrial Districts Uses Notes NC RC C-1 C-2 I -E Freestanding emergency room facilities K Section 4. The "Permitted Uses" Chart set forth in Section 26-1111 of the Wheat Ridge Code of Laws, concerning permitted uses in mixed-use zone districts, is hereby amended by inserting a new row in the appropriate alphabetical order concerning freestanding emergency room facilities as follows: Permitted Uses Use Group MU -C MU -C Interstate MU -C TOD MU -N Freestanding emergency room facilities NP NP NP NP Section 5. The moratorium on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility imposed by Ordinance 1595 and extended by Ordinance 1616 and Ordinance 1634 is hereby repealed, upon the effective date of this ordinance. Section 6. Effective Date. This Ordinance shall take effect upon adoption and signature by the Mayor and City Clerk, as permitted by Section 5.11 of the Charter. INTRODUCED, READ, AND ADOPTED on first reading by a vote of to on this day of , 2018, ordered published in full in a newspaper of general circulation in the City of Wheat Ridge and Public Hearing and consideration on final passage set for , 2018, at 7:00 o'clock p.m., in the Council Chambers, 7500 West 29th Avenue, Wheat Ridge, Colorado. READ, ADOPTED AND ORDERED PUBLISHED on second and final reading by a vote of to , this day of 2018. SIGNED by the Mayor on this day of 2018. Bud Starker, Mayor 3 ATTEST: Janelle Shaver, City Clerk Approved As To Form Gerald E. Dahl, City Attorney First Publication: Second Publication: Wheat Ridge Transcript Effective Date: CITY OF WHEAT RIDGE, COLORADO INTRODUCED BY COUNCIL MEMBER Council Bill No. _ Ordinance No. Series 2018 TITLE: AN ORDINANCE CREATING A NEW SECTION 26-643 OF THE WHEAT RIDGE CODE OF LAWS PROHIBITING THE USE OF FREESTANDING EMERGENCY ROOM FACILITIES WHEREAS, the City of Wheat Ridge ("City") is a home rule municipality operating under a charter adopted pursuant to Article XX of the Colorado Constitution and vested with the authority by that article and the Colorado Revised Statutes to enact laws to govern and regulate the use of land within its territory; and WHEREAS, pursuant to this authority, the Wheat Ridge City Council ("Council") previously adopted local land use regulations, codified as Chapter 26 of the Wheat Ridge Code of Laws ("Code"); and WHEREAS, City staff has previously interpreted the City's current zoning regulations as permitting freestanding emergency room facilities to locate within the Mixed Use -Commercial and Planned Hospital Development zone districts only; and WHEREAS, the Council found that freestanding emergency room facilities may cause land use impacts that are different than those caused by other detached health care facilities due to the extended hours that emergency facilities may be open; and WHEREAS, approximately two years ago, in response to the increase in the number and popularity of freestanding emergency room facilities over the past several years, the Council determined that it was necessary and desirable to examine the City's zoning laws and business licensing regulations governing freestanding emergency room facilities; and WHEREAS, additionally, the Council and City staff held a reasonable belief that the state legislature might adopt statewide legislation governing freestanding emergency room facilities that could potentially affect the desired parameters of local regulations on the topic, during either the last few legislative sessions; and WHEREAS, as a result, by and through the adoption of Ordinance No. 1595, the Council previously acted to impose a one-year moratorium on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility; and WHEREAS, the Council and City staff learned that it was unlikely that the state legislature will adopt such legislation during the current session; and WHEREAS, the Council therefore found it prudent and desirable to extend the moratorium, to permit the careful study and evaluation of various local regulatory options with an expectation that such regulations would operate without an additional state regulatory gloss; and WHEREAS, the Council has now determined that it is in the best interests of the safety, health and welfare of the citizens of Wheat Ridge to prohibit the use of freestanding emergency room facilities within the City. NOW THEREFORE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF WHEAT RIDGE, COLORADO: Section 1. Findings. The above and foregoing findings are hereby incorporated by this reference as specific findings and determinations of the Council. Section 2. Chapter 26 of the Wheat Ridge Code of Laws is amended by the adoption of a new section 26-643 as follows: Sec. 26-643. — Freestanding Emergency Room Facilities. A. For purposes of this Section, freestanding emergency room facilities shall mean and include a medical facility that is not physically attached to a hospital facility that has the capability of providing medical care and services to patients with emergency medical conditions in a manner similar to emergency rooms located within hospitals. Features of a freestanding emergency room facility may include, but are not limited to, expanded hours of operation, drive -lanes or vehicle bays to accommodate ambulance arrivals and departures, board-certified emergency physicians, board-certified emergency nurses, on-site lab and imaging capabilities and similar equipment, services and treatments not commonly available in urgent -care facilities. B. The use of freestanding emergency room facilities, as defined in in this Section, is strictly prohibited in all zone districts within the City. Section 3. The "Table of Uses — Commercial and Industrial Districts" Chart set forth in Section 26-204 of the Wheat Ridge Code of Laws, regarding "zone district use schedule," is hereby amended by inserting a new row in the appropriate alphabetical order concerning freestanding emergency room facilities as follows: Table of Uses — Commercial and Industrial Districts Uses Notes NC RC C-1 C-2 I -E Freestanding emergency room facilities 2 Section 4. The "Permitted Uses" Chart set forth in Section 26-1111 of the Wheat Ridge Code of Laws, concerning permitted uses in mixed use zone districts, is hereby amended by inserting a new row in the appropriate alphabetical order concerning freestanding emergency room facilities as follows: Permitted Uses Use Group MU -C MU -C Interstate MU -C TOD MU -N Freestanding emergency room facilities NP NP NP NP Section 5. The moratorium on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility imposed by Ordinance 1595 and extended by Ordinance 04-2017 is hereby repealed, upon the effective date of this ordinance. Section 6. Effective Date. This Ordinance shall take effect upon adoption and signature by the Mayor and City Clerk, as permitted by Section 5.11 of the Charter. INTRODUCED, READ, AND ADOPTED on first reading by a vote of to on this day of , 2018, ordered published in full in a newspaper of general circulation in the City of Wheat Ridge and Public Hearing and consideration on final passage set for , 2018, at 7:00 o'clock p.m., in the Council Chambers, 7500 West 29th Avenue, Wheat Ridge, Colorado. READ, ADOPTED AND ORDERED PUBLISHED on second and final reading by a vote of to , this day of 2018. SIGNED by the Mayor on this day of 2018. ATTEST: 3 Bud Starker, Mayor Janelle Shaver, City Clerk Approved As To Form Gerald E. Dahl, City Attorney First Publication: Second Publication: Wheat Ridge Transcript Effective Date: 14rn'r, l City of Wh6attkAc COMMUNITY DEVELOPMENT Memorandum TO: Mayor and City Council FROM: Kenneth Johnstone, Community Development Director THROUGH: Patrick Goff, City Manager J�.4 DATE: June 8, 2018 (for June 18, 2018 study session) SUBJECT: Freestanding Emergency Rooms BACKGROUND: A temporary moratorium on the submission, acceptance, processing, and approval of applications and requests for a permit, license, land use approval or other approval for a freestanding emergency room facility is currently in place until August 27, 2018. At the May 7, 2018 study session, Council's consensus was to begin drafting local regulations for Council's consideration, prior to the moratorium's expiration. To that end, staff has tentatively calendared an ordinance for consideration on 1St reading on July 23, 2018 and for public hearing on August 13, 2018. If amendments to Chapter 26 are proposed, those would also require a public hearing be held before the Planning Commission. A range of potential regulatory approaches was discussed at the study session and those are summarized later in this memo. Council expressed interest in various potential options, up to and including an outright prohibition, based in part on the small size of the City and the existing presence of emergency facilities centrally located within the City. Existinz Regulations The concept of freestanding emergency rooms is relatively new and has only emerged in the state of Colorado in the past few years. The business model has existed in some other states for somewhat longer. Because it is a relatively new land use concept, the municipal code is silent to this specific use. The City's zoning code defines hospitals and allows them in certain zoning districts. The City's zoning code also defines medical offices and allows those in certain zone districts. These freestanding emergency rooms have characteristics of both of these uses and likely fall somewhere between the two in terms of the intensity of the use and associated impacts. With the code being silent to this specific use, the Community Development Director has determined that the use is most similar to a hospital emergency room and therefore allowed to be located in the same manner. Hospitals are not permitted in any of the City's "straight" zoning Freestanding Emergency Rooms June 18, 2018 Page 2 districts, based on those use charts being silent to hospitals as a use group. However, hospitals are allowed in the City's Planned Hospital Districts (PHD) upon approval of a rezoning of a property to that district. Currently only the Exempla Lutheran hospital campus is zoned PHD. The recently approved Clear Creek Crossing Planned Commercial Development also allows hospitals in certain planning areas. Hospitals are also listed as a permitted use in the City's Mixed Use Commercial (MU -C) zone district, which is most prevalent along the Wadsworth corridor. Hospitals are not allowed in the Mixed Use Neighborhood (MU -N) district. Potential Code Amendments Local regulations could include: • Modifications to Chapter 26 (Zoning and Development Code) defining freestanding emergency rooms and allowing them to be located in specific zoning districts. Some of the zoning approaches that might be considered would include: o Defining freestanding emergency rooms and disallowing them in all zoning districts o Limiting the number of zoning districts within which they would be allowed o Requiring a special use permit or conditional use permit to authorize these uses o Limiting the total number of such facilities within the City o Establishing certain spacing requirements between such uses and/or between such uses and other existing emergency room facilities or otherwise requiring the demonstration of "need" for such a facility o Establishing other operational requirements such as limiting hours of operation Modifications to Chapter 11 (Licensing) creating unique licensing and permitting requirements for freestanding emergency rooms. Certain operational requirements could also be located in this chapter, including the possibility of allowing such licenses only upon a demonstration of "need," relative to the location and spacing of other similar medical facilities. RECOMMENDATION: Staff seeks direction from City Council on how to proceed regarding freestanding emergency departments. Based on discussion at the May 7 study session, and given the limited timeframe within which to adopt local regulations, staff recommends an ordinance that would create a definition of said use and prohibit them in all zoning districts, perhaps with the exception of PHD, where they are already permitted. STUDY SESSION AGENDA CITY COUNCIL CITY OF WHEAT RIDGE, COLORADO 7500 W. 29th Ave. Wheat Ridge CO June 18, 2018 6:30 p.m. Individuals with disabilities are encouraged to participate in all public meetings sponsored by the City of Wheat Ridge. Call Sara Spaulding, Public Information Officer 303-235-2877 at least one week in advance of a meeting if you are interested in participating and need inclusion assistance. Citizen Comment on Agenda Items 1. Freestanding Emergency Rooms 2. Outside Agency Recommendations 3. Wheat Ridge Environmental Sustainability Committee Report 4. Clear Creek Crossing Financial Agreement 5. Staff Report(s) 6. Elected Officials' Report(s) ADJOURNMENT City of WheatFjdge COMMUNITY DEVELOPMENT Memorandum TO: Mayor and City Council FROM: Kenneth Johnstone, Community Development Director THROUGH: Patrick Goff, City Manager ')� DATE: May 2, 2018 (for May 7 study session) SUBJECT: Freestanding Emergency Rooms :Peft 6-, BACKGROUND: On April 11, 2016, City Council adopted Ordinance 1595 placing a 365 -day temporary moratorium on the submission, acceptance, processing and approval of applications for "freestanding emergency rooms." As defined in Section 3 of the ordinance, such facilities were defined as follows: "a medical facility that is not physically attached to a hospital facility that has the capacity of providing medical care and services to patients with emergency medical conditions in a manner similar to emergency rooms located within hospitals. Features of a freestanding emergency room facility may include, but are not limited to: expanded hours of operation, drive -lanes or vehicle bays to accommodate ambulance arrivals and departures, board certified emergency physicians, board-certified emergency nurses, on-site lab and imaging capabilities and similar equipment, services and treatments not commonly available in urgent care facilities." The ordinance was effective on April 28, 2016 and was set to expire on April 27, 2017. Prior to the moratorium's expiration, at a March 6, 2017 study session, staff updated City Council on the status of state level discussion of possible regulation of this industry. Subsequently, Council adopted Ordinance 1616 extending the temporary moratorium for an additional year through April 27, 2018. The state legislature did not take any action during the 2017 legislative session. Staff had heard from industry representatives that state level legislation may be gaining some headway for the 2018 legislative session. On December 18, 2017, City Council discussed the possibility that the State was considering taking legislative action on this matter during the 2018 State legislative session. Based on that understanding, on January 22, 2018, City Council passed Council Bill 02-2018, an ordinance further extending said moratorium to August 27, 2018, to be able to draft any local regulations in context with any adopted state level regulations. Freestanding Emergency Rooms May 7, 2018 Page 2 With the moratorium again expiring on August 27, 2018, it is time to begin discussing what, if any, additional regulations the City wishes to adopt regarding freestanding emergency rooms. If Council wishes to adopt additional local regulations, those of course need to go through the standard public hearing ordinance process. If such regulations were to amend the City's zoning regulations in Chapter 26 of the Code, such amendments would require review and a recommendation from the Planning Commission. The following text is generally repeated from previous memorandums and is included as additional background for reference and context on this topic. ExistingRomlations The concept of freestanding emergency rooms is relatively new and has only emerged in the state of Colorado in the past few years. The business model has existed in some other states for somewhat longer. Because it is a relatively new land use concept, the municipal code is silent to this specific use. The City's zoning code defines hospitals and allows them in certain zoning districts. The City's zoning code also defines medical offices and allows those in certain zone districts. These freestanding emergency rooms have characteristics of both of these uses and likely fall somewhere between the two in terms of the intensity of the use and associated impacts. With the code being silent to this specific use, the Community Development Director has determined that the use is most similar to a hospital emergency room and therefore allowed to be located in the same manner. Hospitals are not permitted in any of the City's "straight" zoning districts, based on those use charts being silent to hospitals as a use group. However, hospitals are allowed in the City's Planned Hospital Districts (PHD) upon approval of a rezoning of a property to that district. Currently only the Exempla Lutheran hospital campus is zoned PHD. The recently approved Clear Creek Crossing Planned Commercial Development also allows hospitals in certain planning areas. Hospital are also listed as a permitted use in the City's Mixed Use Commercial (MU -C) zone district, which is most prevalent along the Wadsworth corridor. Hospitals are not allowed in the Mixed Use Neighborhood (MU -N) district. Potential Code Amendments Local regulations could include: • Modifications to Chapter 26 (Zoning and Development Code) defining freestanding emergency rooms and allowing them to be located in specific zoning districts. Some of the zoning approaches that might be considered would include: o Defining freestanding emergency rooms and disallowing them in all zoning districts o Limiting the number of zoning districts within which they would be allowed o Requiring a special use permit or conditional use permit to authorize these uses o Limiting the total number of such facilities within the City o Establishing certain spacing requirements between such uses and/or between such Freestanding Emergency Rooms May 7, 2018 Page 3 uses and other existing emergency room facilities or otherwise requiring the demonstration of "need" for such a facility o Establishing other operational requirements such as limiting hours of operation • Modifications to Chapter 11 (Licensing) creating unique licensing and permitting requirements for freestanding emergency rooms. Certain operational requirements could also be located in this chapter, including the possibility of allowing such licenses only upon a demonstration of "need," relative to the location and spacing of other similar medical facilities. NEXT STEPS: Staff seeks direction from City Council on how to proceed regarding freestanding emergency rooms. Option 1: Do nothing. The moratorium would expire on August 27, 2018 and these businesses would be regulated under existing codes, and allowed in locations as discussed above. Option 2: Begin the process of adopting local regulations for freestanding emergency rooms, beginning with initial policy direction at this study session and subsequently with a study session to review draft regulations in June 2018. As noted, if any regulations amend Chapter 26, Planning Commission would need to conduct a public hearing, which could occur in late June or early July. It would be important to receive input from Council on how much, if any, additional public input you would desire beyond the standard public hearing processes for adopting an ordinance. Option 3: While it is also possible for Council to consider adoption of an ordinance extending the existing moratorium, staff does not recommend that approach. With the state legislature's inaction on this topic in the past 3 sessions, it seems less likely the state will adopt regulations anytime soon. Therefore, the logic of waiting at a local level in order to be aligned with state regulations is becoming less compelling. Kenneth Johnstone From: Patrick Goff Sent: Monday, May 7, 2018 4:10 PM To: Kenneth Johnstone Subject: FW: FSED tonight's study session FYI Patrick Goff City Manager City of Wheat Ridge 7500 W. 29th Ave. Wheat Ridge, CO 80033 303-235-2805 (office) 303-995-6465 (mobile) www.ci.wheatridee.co.us Cil), of _�9"`W heat j�c CITY MANAGERS OFFWE From: Salzmann, Carol <Carol.Salzmann@sclhs.net> Sent: Monday, May 7, 2018 3:28 PM To: Patrick Goff <pgoff@ci.wheatridge.co.us> Subject: FSED tonight's study session Hi Patrick, For tonight's study session if needed, below is a summary of the relevant FSED related bills and the only bill related to licensure was PI'ed. H618-1212, Freestanding Emergency Departments Licensure —the bill creates a new license, referred to as a 'freestanding emergency department license', for the CDPHE by 2021 (PI'd in Senate State Affairs last Tuesday) HB 18-1282 Health Care Provider Unique Identification Per Site or Service — requires facilities to obtain unique national provider identifiers that are used on claims submitted for reimbursement and allows both government and private insurers to track more accurately the prices they are paying specifically for services in free-standing emergency departments. (Governor signed, 4/25) SB18-146 Freestanding Emergency Departments Required Consumer Notices—the bill requires a freestanding emergency department (FSED), whether operated by a hospital at a separate, off -campus location or operating independently of a hospital system, to provide any individual that enters the FSED seeking treatment a written statement of patient information, which an FSED staff member or health care provider must explain orally ... (Governor signed, 4/25) 1 plan to attend and listen to the discussion. Thanks, Carol Carol Salzmann VP of Community and Government Affairs Lutheran Medical Center P: 303-425-2414 M:303-204-8849 Carol.salzmann@sclhs.net Ji SCL Health LUTHERAN �1 Top 1% in the Nation %%000 Freestanding Emergency Departments • The City has had a series of moratoria in place regarding the permitting or licensure of Freestanding ERs since April 2016 • The moratoriums have been in place in large to see if the state might adopt regulations on these uses and said state action might either pre-empt or at least impact what a local approach might be. • The state legislature has taken some action this session and 2 laws have been signed by the governor that will require certain cost monitoring and patient information disclosures • A 3rd bill that would require specific state licensing is in committee • As noted in our staff memo, staff has made the determination that these facilities are most similar to hospitals in our zoning use charts, and as such are allowed in zoning districts where those are allowed, which is in our Mixed Use -Commercial zone district and our Planned Hospital District • The CCC project also now allows hospitals in PAI of that project • We've provided 3 options for you to consider in providing direction to staff this evening o Do nothing, allowed in PHD and MU -C o Begin the process of adopting local regulations — several possible approaches are briefly discussed in the memo o Extend the moratorium — not recommended, given that the state actually is taking action this session Kenneth Johnstone From: Kenneth Johnstone Sent: Tuesday, May 8, 2018 11:14 AM To: Kenneth Johnstone Subject: City Council - May 7, 2018 City Council - May 7, 2018 All present Michael Pate, EGD/Camping World - described technology Charley Meyers - e -bikes, supports change in policy, bike JEFFCO, Mike Rabor, Evergreen, e -bike technology description Al Gallo, District I, e -bike rider on CC trai Joyce, e -bikes, Scott, Harlan Streetscape maintenance, - Pond, need to figure out long term maintenance, identify resources - Mathews, joint maintenance with Lakeside - Fitzgerald, historic maintenance understanding - Duran, cooperative solution - Urban, - Davis, happy medium, - Dozeman, burden should not fall too heavily on homeowners/property owners SUPS - Fitzgerald, duration of approvals - Hoppe, recent approvals in Fruitdale subarea plan, automotive uses recently - Duran, orchard district, - Urban, opposed - Mathews, what exactly is an orchard district?, - Pond, loosen up the language of substantial compliance language - "generally consistent with applicable sections of adopted subarea plans and the city's comprehensive plan" - Dozeman, comp plan is a guiding document, not a regulatory document, 44th is a very commercial road and land uses are consistent with that - Hoppe, discretionary uses - Duran, - Fitzgerald, unhappy camper, duration of SUP is a concern for him, - Pond, don't be afraid to place time limits - Mathews, - Hoppe, consensus to direct staff, new language Electric Fences - Pond, doesn't like the legislative solution, Dahl response, possibly SUP for these fences - Mathews, clarifying comments on design details of fence - Urban, wants to support business, find a way to move it forward, SUP possibly - Hoppe, any other options? - Dahl, - Davis, find a solution, curious whether other cities allow these as "electric alarms", - Mathews, we allow barbed wire fences, which are more dangerous - Dozeman, crime a real issue in the area, school willing to compromise, supports SUP - Mathews, how quickly - June 11 1st, June 21st PC, June 25 PH - Fitzgerald, EGD not compromising, - Dozeman consensus for SUP Freestanding ERs - Duran, cost for out of network care. - Davis, need is questionable, restrict if not completely disallow, - Mathews, two pronged approach, would support total prohibition - Hoppe, limited amount of land left to "use" - need to use it correctly, possibly don't allow at all, - Dozeman, why not expressly define them as prohibited - Pond, look at options, up to an including prohibition, - Urban, regulate and license, statement of need, operating requirements, emergency medical treatment and labor act - Fitzgerald, - Duran, look at Arvada's reg's - Option 2 consensus to move forward Sent from my Wad 2 jJr,- y. City Of �COMAAMIUNiTy Wheat�iclge DEVELOPMENT Memorandum TO: Mayor and City Council FROM: Kenneth Johnstone, Community Development Director THROUGH: Patrick Goff, City Manager„` DATE: December 8, 2017 (for December 18th study session) SUBJECT: Freestanding Emergency Rooms BACKGROUND: On April 11, 2016, City Council adopted Ordinance 1595 placing a 365 -day temporary moratorium on the submission, acceptance, processing and approval of applications for "freestanding emergency rooms." As defined in Section 3 of the ordinance, such facilities were defined as follows: "a medical facility that is not physically attached to a hospital facility that has the capacity of providing medical care and services to patients with emergency medical conditions in a manner similar to emergency rooms located within hospitals. Features of a freestanding emergency room facility may include, but are not limited to: expanded hours of operation, drive -lanes or vehicle bays to accommodate ambulance arrivals and departures, board certified emergency physicians, board-certified emergency nurses, on-site lab and imaging capabilities and similar equipment, services and treatments not commonly available in urgent care facilities." The ordinance was effective on April 28, 2016 and was set to expire on April 27, 2017. Prior to the moratorium's expiration, at a March 6, 2017 study session, staff updated City Council on the status of state level discussion of possible regulation of this industry. Subsequently, Council adopted Ordinance 1616 extending the temporary moratorium for an additional year through April 27, 2018. To date, the state has not adopted any regulations, but those discussions continue. There was in fact legislation drafted and introduced in 2017, but it did not advance out of committee. Staff has heard from industry insiders that state level legislation may be gaining some headway for the 2018 legislative session. As has been discussed with City Council in the past, state level regulation may preempt the need for local regulations or may alter the manner in which local regulations would be crafted. If the City Council wishes to consider adopting local regulations for freestanding emergency departments prior to the April 27, 2018 expiration of the current moratorium that process would need to start very soon. Staff anticipates a need for one or more study sessions with City Council and the Planning Commission to get preliminary direction on regulations. We would also need to Freestanding Emergency Rooms December 8, 2017 Page 2 consider whether additional outreach to the community and the industry would be desired. If those initial meetings were held in January/February, that would allow just enough time to conduct a first reading and Planning Commission and City Council public hearings on an ordinance in March and the first half of April. With that in mind, staff is requesting direction from City Council whether they would like to consider a short extension of the moratorium (possibly 90 days) to be able to be aligned with whatever action the state may take during the 2018 legislative session, which begins in January and ends in early May. The following text is repeated from previous memorandums and is included as additional background for reference and context on this topic. Existing Regulations The concept of freestanding emergency rooms is relatively new and has only emerged in the state of Colorado in the past few years. The business model has existed in some other states for somewhat longer. Because it is a new land use concept, the municipal code is silent to this specific use. The City's zoning code defines hospitals and allows them in certain zoning districts. The City's zoning code also defines medical offices and allows those in certain zone districts. These freestanding emergency rooms have characteristics of both of these uses and likely fall somewhere between the two in terms of the intensity of the use and associated impacts. With the code being silent to this specific use, the Community Development Director has determined that the use is most similar to a hospital emergency room and therefore allowed to be located in the same manner. Hospitals are not permitted in any of the City's "straight" zoning districts, based on those use charts being silent to hospitals as a use group. However, hospitals are allowed in the City's Planned Hospital Districts (PHD) upon approval of a rezoning of a property to that district. Currently only the Exempla Lutheran hospital campus is zoned PHD. In the City's Mixed Use Districts, hospitals are included in those use charts and are allowed in all of the Mixed Use Commercial (MU -C) Districts and not allowed in the Mixed Use Neighborhood District. Potential Code Amendments Local regulations could include: Modifications to Chapter 26 (Zoning and Development Code) defining freestanding emergency rooms and allowing them to be located in specific zoning districts. Some of the zoning approaches that might be considered would include: o Limiting the number of zoning districts within which they would be allowed o Requiring a special use permit or conditional use permit to authorize these uses o Limiting the total number of such facilities within the City o Establishing certain spacing requirements between such uses and/or between such uses and other existing emergency room facilities o Establishing other operational requirements such as hours of operation Freestanding Emergency Rooms December 8, 2017 Page 3 • Modifications to Chapter 11 (Licensing) creating unique licensing and permitting requirements for freestanding emergency rooms. Certain operational requirements could also be located in this chapter, including the possibility of allowing such licenses only upon a demonstration of "need," relative to the location and spacing of other similar medical facilities. NEXT STEPS: Staff seeks direction from City Council on how to proceed regarding freestanding emergency departments. Option 1: Do nothing. The moratorium would expire on April 27, 2018 and these businesses would be regulated under existing codes, as discussed above. Option 2: Begin the process of adopting regulations for freestanding emergency rooms, beginning with a study session with City Council in early 2018, where direction would be sought on some of the policy options discussed above. It would be important to receive input from Council on how much, if any, additional public input you would desire beyond the standard public hearing processes for adopting an ordinance. Option 3: Consider adoption of an ordinance extending the existing moratorium, possibly for an additional 90 days. Kenneth Johnstone From: Patrick Goff Sent: Monday, December 18, 2017 3:36 PM To: Kenneth Johnstone; Jerry Dahl (gdahl@mdkrlaw.com); cbeery@mdkrlaw.com Subject: FW: Sign code Timely.. Patrick Goff City Manager City of Wheat Ridge 7500 W. 29th Ave. Wheat Ridge, CO 80033 303-235-2805 (office) 303-995-6465 (mobile) www.ci.wheatridge.co.us City cif `Wheat Midge CCITY MANAGrRS Ofl ICE From: RD Sewald [mailto:rd@sewaldhanfling.com] Sent: Monday, December 18, 2017 3:33 PM To: Patrick Goff <pgoff@ci.wheatridge.co.us> Cc: Brittany Morris Saunders <brittany@sewaldhanfling.com>; Wes Friednash <wes@sewaldhanfling.com> Subject: Sign code Patrick, Please see the message below. Marcus/Outfront wanted to share some information prior to your study session. The Colorado Outdoor Advertising association would like to meet with you and your team. Please advise. Thank you Sir. Hi RD -- Happy holidays..... Per your phone call with Dan in regards to Wheat Ridge, below are some talking points to get to Patrick Goff for tonight. Let us know if you have any questions at all. Off -premise signage — planning commission and council is supportive of their approach that the property owner / lessee of the property be the same person applying for the sign. 5-7 years ago this same topic was looked at and thrown out for some very logical reasons 1.) Outdoor companies are the ones that take on all of the financial burden and risk with the construction and installation of the billboards, not the property owner. 2.) If the permit rides with the property you will create a windfall for the 16 lucky owners that currently have billboards on their land. By doing so, you preclude any other property owners that have viable billboard land and could qualify for one if a vacancy existed. This creates an exclusive group of 16 that will see large increases in property value, while diminishing the potential value for others. 3.) If this goes through it will be considered a regulatory taking. The current system works very well and is simple to follow. It offers the ability for a billboard company to approach any viable property, secure a lease, and apply for a permit. The opportunity is neutral and open to all. We just had a great example of that this year when a billboard vacancy opened up. Two companies applied (Mile High Outdoor being one) with valid leases in hand. A lottery was held at the end of the application period, and one winner was decided. No one complained. It was straight forward and simple. Reed V Town of Gilbert It is imperative to maintain a distinction between on -premise and off -premise signage. Without it there will be mass proliferation of on -premise signs selling and displaying advertising throughout Wheat Ridge Municipalities in Colorado that have done a deep dive into this case are maintaining the respective difference between on -premise and off -premise for the reason listed above. EMC, LED Signage • The industry would love to investigate this further with Wheat Ridge for the ability to potentially convert some existing signs from static to digital. Thanks Marcus R.D. SEWALD SEWALD HANFLING PUBLIC AFFAIRS Office +1.303.800.4500 Freestanding ER's • Freestanding Emergency Rooms or Emergency Departments is a business concept where emergency room types of services are provided, in a location not directly associated with a hospital • They have been common in certain parts of the country for many years, particularly in locations that might not be well served by convenient hospitals • They began to appear in Colorado several years ago • In Wheat Ridge, we have determined them to be most similar to a hospital and as such only allowed in locations where our zoning code allows hospitals — Planning Hospital and Mixed Use Commercial • Because of the uniqueness of this land use and business concept, there may be reasons to regulate them differently either through our zoning code or are licensing regulations • The state legislature has also discussed adopting statewide regulations • Because of that possibility, the City has in the past adopted moratorium on the approval of these facilities to see if the state would take action that might supersede local regulations or at least impact local regulations • Council first adopted a moratorium on April 11, 2016 for 365 days. That was extended an additional year in April of 2017. It is set to expire on April 27, 2018, which falls right in the middle of the legislative session. • Once again, we are hearing from industry insiders that the state legislature may take up this topic in the 2018 legislative session • Because of that, we are asking whether Council would want to consider another moratorium • That said, we've given you 3 options: 0 1) do nothing and the existing regulations remain in effect; 0 2) actually begin drafting regulations, which would need to be quick to stay in front of the April 27 expiration; or 0 3) consider extending the moratorium for an additional 90 days, to July 27, 2018 City of Wheat Pidge ID q V i I Z 1"d -�- ► � z alt' �- � 'Y '47 y, (�_O) ITEM NO: �t , 'z DATE: January 22, 2018 REQUEST FOR CITY COUNCIL ACTION TITLE: COUNCIL BILL NO. 02-2018 - AN ORDINANCE EXTENDING THE TEMPORARY MORATORIUM ON THE SUBMISSION, ACCEPTANCE, PROCESSING, AND APPROVAL OF APPLICATIONS AND REQUESTS FOR A PERMIT, LICENSE, LAND USE APPROVAL OR OTHER APPROVAL FOR A FREESTANDING EMERGENCY ROOM FACILITY ® PUBLIC HEARING ❑ ORDINANCES FOR 1sT READING (1/8/2018) ❑ BIDS/MOTIONS ® ORDINANCES FOR 2ND READING (1/22/2018) ❑ RESOLUTIONS QUASI-JUDICIAL: ❑ YES ® NO -7 *? - GWj& City Attorney City Manager ISSUE: In April of 2017, the Council adopted a one-year moratorium on the submission, acceptance, processing and approval of applications and requests related to freestanding emergency room facilities. This ordinance extends the moratorium period for an additional 120 days, to and including August 27, 2018. PRIOR ACTION: On April 11, 2016, City Council adopted Ordinance 1595 placing a 365 -day temporary moratorium on the submission, acceptance, processing and approval of applications and requests related to freestanding emergency room facilities and extended the moratorium by another 365 days through the adoption of Ordinance No. 1616. FINANCIAL IMPACT: The potential loss of license, permit, application and similar fees associated with applications for freestanding emergency room (ER) facilities for an additional 120 days is likely nominal. Council Action Form — Extend Moratorium of Freestanding ERs January 22, 2018 Page 2 BACKGROUND: Freestanding ERs continue to increase in number and popularity. In Colorado, the number of freestanding ERs rose from two in 2012 to at least 35 by mid -2016. These facilities provide emergency medical treatment and care similar to a hospital-based ER. Ambulances deliver to these freestanding facilities and many offer more sophisticated on-site services — such as radiology and lab services — than urgent care facilities. These types of facilities continue to be unregulated by the state. Freestanding ERs likely generate land use impacts that are more akin to hospitals than to other medical facilities, such as clinics, doctor's offices and urgent -care facilities. Unlike these other types of medical facilities, freestanding ERs accommodate ambulance and other emergency - vehicle traffic and they are often open 24/7. They produce light, noise, glare and traffic beyond that of a non -emergent medical care facility. It is therefore appropriate to study and evaluate whether the City's existing zoning regulations adequately address freestanding ER facilities. In the past, there have been media stories on freestanding ERs and patient confusion between freestanding ERs and urgent care facilities. Because freestanding ERs are not currently licensed or regulated by the state, patients may also be uninformed about the relative costs, benefits, advantages and disadvantages of visiting a freestanding ER versus a hospital-based ER. It is therefore appropriate for Council to study and evaluate whether the City should enter the licensing arena specific to these facilities and adopt some local licensing requirements for them. This Ordinance continues to maintain the status quo (no freestanding ERs within the City) while the Council studies these policy issues and adopts further legislation if it deems appropriate. RECOMMENDATIONS: Staff recommends approving the extension of the temporary moratorium. RECOMMENDED MOTIONS: "I move to approve Council Bill No. 02-2018 - an ordinance extending the temporary moratorium on the submission, acceptance, processing, and approval of applications and requests for a permit, license, land use approval or other approval for a freestanding emergency room facility, on second reading and that it take effect 15 days after final publication." Or, "I move to postpone indefinitely Council Bill No. 02-2018 - an ordinance extending the temporary moratorium on the submission, acceptance, processing, and approval of applications and requests for a permit, license, land use approval or other approval for a freestanding emergency room facility for the following reason(s) " REPORT PREPARED/REVIEWED BY: Carmen Beery, City Attorney's Office Patrick Goff, City Manager Council Action Form — Extend Moratorium of Freestanding ERs January 22, 2018 Page 3 ATTACHMENTS: 1. Council Bill No. 02-2018 CITY OF WHEAT RIDGE, COLORADO INTRODUCED BY COUNCIL MEMBER DAVIS Council Bill No. 02 Ordinance No. Series 2018 TITLE: AN ORDINANCE EXTENDING THE TEMPORARY MORATORIUM ON THE SUBMISSION, ACCEPTANCE, PROCESSING, AND APPROVAL OF APPLICATIONS AND REQUESTS FOR A PERMIT, LICENSE, LAND USE APPROVAL OR OTHER APPROVAL FOR A FREESTANDING EMERGENCY ROOM FACILITY WHEREAS, the City of Wheat Ridge ("City") is a home rule municipality operating under a charter adopted pursuant to Article XX of the Colorado Constitution and vested with the authority by that article and the Colorado Revised Statutes to enact laws to govern and regulate the use of land within its territory; and WHEREAS, pursuant to this authority, the Wheat Ridge City Council ("Council") previously adopted local land use regulations, codified as Chapter 26 of the Wheat Ridge Code of Laws ("Code"); and WHEREAS, City staff has interpreted the City's current zoning regulations as permitting freestanding emergency room facilities to locate within the Mixed Use - Commercial and Planned Hospital Development zone districts only; and WHEREAS, the Council finds that freestanding emergency room facilities may cause land use impacts that are different than those caused by other detached health care facilities due to the extended hours that emergency facilities may be open; and WHEREAS, in response to the increase in the number and popularity of freestanding emergency room facilities over the past several years, the Council determined that it was necessary and desirable to examine the City's zoning laws and business licensing regulations governing freestanding emergency room facilities to ensure that such facilities are appropriately located; and WHEREAS, additionally, the Council and City staff held a reasonable belief that the state legislature might adopt statewide legislation governing freestanding emergency room facilities that could potentially affect the desired parameters of local regulations on the topic; and WHEREAS, as a result, by and through the adoption of Ordinance No. 1595, the Council previously acted to impose a one-year moratorium through April 27, 2017 on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility; and WHEREAS, by and through the adoption of Ordinance No. 1616, the Council extended the one-year moratorium through April 27, 2018 on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility; and WHEREAS, the state legislature did not adopt such legislation during the 2017 session but Council and City staff have recently learned that the state legislature is considering legislation during the 2018 session; and WHEREAS, the Council therefore finds that it is prudent and desirable to extend the moratorium for an additional one hundred and twenty (120) days, to permit the careful study and evaluation of various local regulatory options with an expectation that such regulations would operate without an additional state regulatory gloss; and WHEREAS, the extension of the moratorium on the submission, acceptance, processing, and approval of all applications and requests for a City permit, license, land use approval or other approval is reasonable in time and scope and would not work an unnecessary hardship upon or unreasonably prejudice any party. NOW THEREFORE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF WHEAT RIDGE, COLORADO: Section 1. Findings. The above and foregoing findings are hereby incorporated by this reference as specific findings and determinations of the Council. Section 2. Temporary Moratorium Extended. The temporary moratorium imposed on the submission, acceptance, processing, and approval of all applications and requests for a City permit, license, land use approval or other approval for any freestanding emergency room facility originally adopted by Ordinance No. 1616 is hereby extended for an additional one hundred twenty (120) days, to and including August 27, 2018. The extension period adopted hereby shall commence and be measured from the date the original moratorium period expires. The City staff is directed to refuse to accept for filing, and not to further process or review any pending applications or requests for such facilities during this moratorium extension period. Section 3. Definition of freestanding emergency room facility. For purposes of this Ordinance, a "freestanding emergency room facility" is and means a medical facility that is not physically attached to a hospital facility that has the capability of providing medical care and services to patients with emergency medical conditions in a manner similar to emergency rooms located within hospitals. Features of a freestanding emergency room facility may include, but are not limited to, expanded hours of operation, drive -lanes or vehicle bays to accommodate ambulance arrivals and departures, board- certified emergency physicians, board-certified emergency nurses, on-site lab and imaging capabilities and similar equipment, services and treatments not commonly available in urgent -care facilities. 2 Section 4. Staff to Investigate and Prepare Proposed Regulations. Before the expiration of the moratorium period extended by this Ordinance, City staff shall review and analyze the City's existing regulations governing freestanding emergency room facilities, as directed by the Council, and present any proposed amendments thereto to the Council. The Council declares that it will give due and timely consideration to recommended changes to the Code. Section 5. Effective Date. This Ordinance shall take effect fifteen (15) days after final publication, as provided by Section 5.11 of the Charter. INTRODUCED, READ, AND ADOPTED on first reading by a vote of 8 to 0 on this 8th day of January, 2018, ordered published in full in a newspaper of general circulation in the City of Wheat Ridge and Public Hearing and consideration on final passage set for January 22, 2018 at 7:00 o'clock p.m., in the Council Chambers, 7500 West 29th Avenue, Wheat Ridge, Colorado. READ, ADOPTED AND ORDERED PUBLISHED on second and final reading by a vote of to , this day of , 2018. SIGNED by the Mayor on this day of , 2018. ATTEST: Janelle Shaver, City Clerk First Publication: January 11, 2018 Second Publication: Wheat Ridge Transcript Effective Date: 3 Bud Starker, Mayor Approved As To Form Gerald E. Dahl, City Attorney City of Wheat R�ijge D& V lij 1 A V- 1� Ln 7 -U ITEM NO: r7. JDATE: January 8, 2018 REQUEST FOR CITY COUNCIL ACTION TITLE: COUNCIL BILL NO. 02-2018 — AN ORDINANCE EXTENDING THE TEMPORARY MORATORIUM ON THE SUBMISSION, ACCEPTANCE, PROCESSING, AND APPROVAL OF APPLICATIONS AND REQUESTS FOR A PERMIT, LICENSE, LAND USE APPROVAL OR OTHER APPROVAL FOR A FREESTANDING EMERGENCY ROOM FACILITY ❑ PUBLIC HEARING ® ORDINANCES FOR 1sT READING (1/8/2018) ❑ BIDS/MOTIONS ❑ ORDINANCES FOR 2ND READING (1/22/2018) ❑ RESOLUTIONS QUASI-JUDICIAL: ❑ YES ® NO f--r� City Attorney City Manager ISSUE: In April of 2017, the Council adopted a one-year moratorium on the submission, acceptance, processing and approval of applications and requests related to freestanding emergency room facilities. This ordinance extends the moratorium period for an additional 120 days, to and including August 27, 2018. PRIOR ACTION: On April 11, 2016, City Council adopted Ordinance 1595 placing a 365 -day temporary moratorium on the submission, acceptance, processing and approval of applications and requests related to freestanding emergency room facilities and extended the moratorium by another 365 days through the adoption of Ordinance No. 1616. FINANCIAL IMPACT: The potential loss of license, permit, application and similar fees associated with applications for freestanding emergency room (ER) facilities for an additional 120 days is likely nominal. Council Action Form — Extend Moratorium of Freestanding ERs January 8, 2018 Page 2 BACKGROUND: Freestanding ERs continue to increase in number and popularity. In Colorado, the number of freestanding ERs rose from two in 2012 to at least 35 by mid -2016. These facilities provide emergency medical treatment and care similar to a hospital-based ER. Ambulances deliver to these freestanding facilities and many offer more sophisticated on-site services — such as radiology and lab services — than urgent care facilities. These types of facilities continue to be unregulated by the state. Freestanding ERs likely generate land use impacts that are more akin to hospitals than to other medical facilities, such as clinics, doctor's offices and urgent -care facilities. Unlike these other types of medical facilities, freestanding ERs accommodate ambulance and other emergency - vehicle traffic and they are often open 24/7. They produce light, noise, glare and traffic beyond that of a non -emergent medical care facility. It is therefore appropriate to study and evaluate whether the City's existing zoning regulations adequately address freestanding ER facilities. In the past, there have been media stories on freestanding ERs and patient confusion between freestanding ERs and urgent care facilities. Because freestanding ERs are not currently licensed or regulated by the state, patients may also be uninformed about the relative costs, benefits, advantages and disadvantages of visiting a freestanding ER versus a hospital-based ER. It is therefore appropriate for Council to study and evaluate whether the City should enter the licensing arena specific to these facilities and adopt some local licensing requirements for them. This Ordinance continues to maintain the status quo (no freestanding ERs within the City) while the Council studies these policy issues and adopts further legislation if it deems appropriate. RECOMMENDATIONS: Staff recommends approving the extension of the temporary moratorium. RECOMMENDED MOTIONS: "I move to approve Council Bill No. 02-2018 - an ordinance extending the temporary moratorium on the submission, acceptance, processing, and approval of applications and requests for a permit, license, land use approval or other approval for a freestanding emergency room facility, on first reading, order it published, public hearing set for Monday, January 22, 2018 at 7 p.m. in City Council Chambers, and that it take effect 15 days after final publication." Or, "I move to postpone indefinitely Council Bill No. 02-2018 - an ordinance extending the temporary moratorium on the submission, acceptance, processing, and approval of applications and requests for a permit, license, land use approval or other approval for a freestanding emergency room facility for the following reason(s) " Council Action Form — Extend Moratorium of Freestanding ERs January 8, 2018 Page 3 REPORT PREPARED/REVIEWED BY: Carmen Beery, City Attorney's Office Patrick Goff, City Manager ATTACHMENTS: 1. Council Bill No. 02-2018 CITY OF WHEAT RIDGE, COLORADO INTRODUCED BY COUNCIL MEMBER HOPPE Council Bill No. 02 Ordinance No. Series 2018 TITLE: AN ORDINANCE EXTENDING THE TEMPORARY MORATORIUM ON THE SUBMISSION, ACCEPTANCE, PROCESSING, AND APPROVAL OF APPLICATIONS AND REQUESTS FOR A PERMIT, LICENSE, LAND USE APPROVAL OR OTHER APPROVAL FOR A FREESTANDING EMERGENCY ROOM FACILITY WHEREAS, the City of Wheat Ridge ("City") is a home rule municipality operating under a charter adopted pursuant to Article XX of the Colorado Constitution and vested with the authority by that article and the Colorado Revised Statutes to enact laws to govern and regulate the use of land within its territory; and WHEREAS, pursuant to this authority, the Wheat Ridge City Council ("Council") previously adopted local land use regulations, codified as Chapter 26 of the Wheat Ridge Code of Laws ("Code"); and WHEREAS, City staff has interpreted the City's current zoning regulations as permitting freestanding emergency room facilities to locate within the Mixed Use - Commercial and Planned Hospital Development zone districts only; and WHEREAS, the Council finds that freestanding emergency room facilities may cause land use impacts that are different than those caused by other detached health care facilities due to the extended hours that emergency facilities may be open; and WHEREAS, in response to the increase in the number and popularity of freestanding emergency room facilities over the past several years, the Council determined that it was necessary and desirable to examine the City's zoning laws and business licensing regulations governing freestanding emergency room facilities to ensure that such facilities are appropriately located; and WHEREAS, additionally, the Council and City staff held a reasonable belief that the state legislature might adopt statewide legislation governing freestanding emergency room facilities that could potentially affect the desired parameters of local regulations on the topic; and WHEREAS, as a result, by and through the adoption of Ordinance No. 1595, the Council previously acted to impose a one-year moratorium through April 27, 2017 on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility; and Attachment 1 WHEREAS, by and through the adoption of Ordinance No. 1616, the Council extended the one-year moratorium through April 27, 2018 on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility; and WHEREAS, the state legislature did not adopt such legislation during the 2017 session but Council and City staff have recently learned that the state legislature is considering legislation during the 2018 session; and WHEREAS, the Council therefore finds that it is prudent and desirable to extend the moratorium for an additional one hundred and twenty (120) days, to permit the careful study and evaluation of various local regulatory options with an expectation that such regulations would operate without an additional state regulatory gloss; and WHEREAS, the extension of the moratorium on the submission, acceptance, processing, and approval of all applications and requests for a City permit, license, land use approval or other approval is reasonable in time and scope and would not work an unnecessary hardship upon or unreasonably prejudice any party. NOW THEREFORE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF WHEAT RIDGE, COLORADO: Section 1. Findings. The above and foregoing findings are hereby incorporated by this reference as specific findings and determinations of the Council. Section 2. Temporary Moratorium Extended. The temporary moratorium imposed on the submission, acceptance, processing, and approval of all applications and requests for a City permit, license, land use approval or other approval for any freestanding emergency room facility originally adopted by Ordinance No. 1616 is hereby extended for an additional one hundred twenty (120) days, to and including August 27, 2018. The extension period adopted hereby shall commence and be measured from the date the original moratorium period expires. The City staff is directed to refuse to accept for filing, and not to further process or review any pending applications or requests for such facilities during this moratorium extension period. Section 3. Definition of freestanding emergency room facility. For purposes of this Ordinance, a "freestanding emergency room facility" is and means a medical facility that is not physically attached to a hospital facility that has the capability of providing medical care and services to patients with emergency medical conditions in a manner similar to emergency rooms located within hospitals. Features of a freestanding emergency room facility may include, but are not limited to, expanded hours of operation, drive -lanes or vehicle bays to accommodate ambulance arrivals and departures, board- certified emergency physicians, board-certified emergency nurses, on-site lab and imaging capabilities and similar equipment, services and treatments not commonly available in urgent -care facilities. 2 Section 4. Staff to Investigate and Prepare Proposed Regulations. Before the expiration of the moratorium period extended by this Ordinance, City staff shall review and analyze the City's existing regulations governing freestanding emergency room facilities, as directed by the Council, and present any proposed amendments thereto to the Council. The Council declares that it will give due and timely consideration to recommended changes to the Code. Section 5. Effective Date. This Ordinance shall take effect fifteen (15) days after final publication, as provided by Section 5.11 of the Charter. INTRODUCED, READ, AND ADOPTED on first reading by a vote of to on this 8th day of January, 2018, ordered published in full in a newspaper of general circulation in the City of Wheat Ridge and Public Hearing and consideration on final passage set for January 22, 2018 at 7:00 o'clock p.m., in the Council Chambers, 7500 West 29th Avenue, Wheat Ridge, Colorado. READ, ADOPTED AND ORDERED PUBLISHED on second and final reading by a vote of to , this day of 2018. SIGNED by the Mayor on this day of 2018. ATTEST: Janelle Shaver, City Clerk First Publication: Second Publication: Wheat Ridge Transcript Effective Date: 3 Bud Starker, Mayor Approved As To Form Gerald E. Dahl, City Attorney City of Wheat RjL! jge ITEM NO: O - DATE: January 8, 2018 REQUEST FOR CITY COUNCIL ACTION TITLE: COUNCIL BILL NO. 03-2018 - AN ORDINANCE AMENDING CHAPTER 7 OF THE WHEAT RIDGE CODE OF LAWS REGARDING ELECTIONS TO ENSURE CONSISTENCY AND COMPATIBILITY WITH THE COLORADO MUNICIPAL ELECTION LAWS ❑ PUBLIC HEARING ® ORDINANCES FOR 1sT READING (01/08/2018) ❑ BIDS/MOTIONS ❑ ORDINANCES FOR 2ND READING (01/22/2018) ❑ RESOLUTIONS QUASI-JUDICIAL: ❑ YES City Attorney ►1 • City Manager ISSUE: Amending Chapter 7 of the Code, as it relates to Elections, by deleting those sections which are adequately covered and governed by state law. PRIOR ACTION: None FINANCIAL IMPACT: None BACKGROUND: Staff has determined that it would be prudent to delete those portions of Chapter 7 of the Code, regarding elections, which are sufficiently covered by state law (in C.R.S. 31-10-101 et seq., also known as the "Colorado Municipal Election Code," as well as related portions of title 1, C. R. S.) This ensures consistency and compatibility with state law, and also removes the need to amend the City Code every time there is a change in these sections of the state law. Council Action Form — Amendments to Chapter 7, Elections January 8, 2018 Page 2 RECOMMENDATIONS: Staff recommends approval of the ordinance. RECOMMENDED MOTION: "I move to approve Council Bill No. 03-2018, an ordinance amending Chapter 7 of the Wheat Ridge Code of Laws regarding elections to ensure consistency and compatibility with the Colorado Municipal Election Laws, on first reading, order it published, public hearing set for Monday, January 22, 2018 at 7:00 p.m. in City Council Chambers, and that it take effect upon adoption and signature of the Mayor and City Clerk." M "I move to postpone indefinitely Council Bill 03-2018, an ordinance amending Chapter 7 of the Wheat Ridge Code of Laws regarding elections to ensure consistency and compatibility with the Colorado Municipal Election Laws for the following reason(s) 97 REPORT PREPARED BY: Gerald Dahl, City Attorney Patrick Goff, City Manager ATTACHMENTS: 1. Council Bill No. 03-2018 CITY OF WHEAT RIDGE, COLORADO INTRODUCED BY COUNCIL MEMBER COUNCIL BILL NO.03 ORDINANCE NO. Series 2018 AN ORDINANCE AMENDING CHAPTER 7 OF THE WHEAT RIDGE CODE OF LAWS REGARDING ELECTIONS TO ENSURE CONSISTENCY AND COMPATIBILITY WITH THE COLORADO MUNICIPAL ELECTION LAWS WHEREAS, the City of Wheat Ridge, Colorado (the "City"), is a Colorado home rule municipality, duly organized and existing pursuant to Section 6 of Article XX of the Colorado Constitution; and WHEREAS, the City Council (the "Council") has authority pursuant to the Home Rule Charter and C.R.S. §31-16-101, et seg. to adopt and enforce all ordinances; and WHEREAS, pursuant to that authority, the City has previously enacted Chapter 7 of the Code of Laws of the Code of Wheat Ridge, Colorado (the "Code") to govern elections within the City; and WHEREAS, C.R.S. 31-10-101 et seq., also known as the "Colorado Municipal Election Code," as well as related portions of title 1, C. R. S., govern many aspects of the conduct of elections held within the City; and WHEREAS, the Council now finds it efficient and desirable to streamline its Code regarding elections by repealing certain sections of Chapter 7, which are adequately covered and governed by state election laws, specifically those portions concerning reporting requirements, filing and timeliness requirements, violations and penalties, and automatic recount. NOW THEREFORE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF WHEAT RIDGE, COLORADO: Section 1. The following sections of Chapter 7 are hereby repealed: Section 7-5 - Reporting requirements; candidates; Section 7-6 - Reporting requirements; persons; Section 7-7 - Filing; where to file; timeliness; Section 7-9 - Violations; penalties; and Section 7-11 — Automatic recount. Section 2. The remaining sections of Chapter 7 are renumbered accordingly. Section 3. Severability, Conflicting Ordinances Repealed. If any section, subsection or clause of this Ordinance shall be deemed to be unconstitutional or otherwise ATTACHMENT 1 invalid, the validity of the remaining sections, subsections and clauses shall not be affected thereby. All other ordinances or parts of ordinances in conflict with the provisions of this Ordinance are hereby repealed. Section 4. Effective Date. This Ordinance shall take effect upon adoption and signature by the Mayor and City Clerk, as permitted by Section 5.11 of the Charter. INTRODUCED, READ, AND ADOPTED on first reading by a vote of to on this 8a' day of January, 2018, ordered published in full in a newspaper of general circulation in the City of Wheat Ridge, and Public Hearing and consideration on final passage set for January 22, 2018 at 7:00 p.m. in the Council Chambers, 7500 West 29d' Avenue, Wheat Ridge, Colorado. READ, ADOPTED AND ORDERED PUBLISHED on second and final reading by a vote of to _, this day of 52018. SIGNED by the Mayor on this day of , 2018. Bud Starker, Mayor ATTEST: Janelle Shaver, City Clerk Approved as to Form Gerald E. Dahl, City Attorney First Publication: Second Publication: Wheat Ridge Transcript Effective Date: Published: Wheat Ridge Transcript and www.ci.wheatridg_e.co.us STUDY SESSION AGENDA CITY COUNCIL CITY OF WHEAT RIDGE, COLORADO 7500 W. 29th Ave. Wheat Ridge CO March 6, 2017 6:30 p.m. Individuals with disabilities are encouraged to participate in all public meetings sponsored by the City of Wheat Ridge. Call Sara Spaulding, Public Information Officer 303-235-2877 at least one week in advance of a meeting if you are interested in participating and need inclusion assistance. Citizen Comment on Agenda Items 1. Staff Report(s) 2. Localworks Update 3. 1-70/Kipling Environmental Assessment Update 4. Update on the expiration of the moratorium of freestanding emergency rooms 5. Elected Officials' Report(s) ADJOURNMENT City of Wheatdge COMMUNITY DEVELOPMENT Memorandum TO: Mayor and City Council FROM: Kenneth Johnstone, Communit Development Director THROUGH: Patrick Goff, City Manager DATE: February 24, 2017 (for March 6th study session) SUBJECT: Freestanding Emergency Rooms BACKGROUND: On April 11, 2016, City Council adopted Ordinance 1595 placing a 365 -day temporary moratorium on the submission, acceptance, processing and approval of applications for "freestanding emergency rooms." As defined in Section 3 of the ordinance, such facilities were defined as follows: "a medical facility that is not physically attached to a hospital facility that has the capacity of providing medical care and services to patients with emergency medical conditions in a manner similar to emergency rooms located within hospitals. Features of a freestanding emergency room facility may include, but are not limited to expanded hours of operation, drive -lanes or vehicle bays to accommodate ambulance arrivals and departures, board certified emergency physicians, board-certified emergency nurses, on-site lab and imaging capabilities and similar equipment, services and treatments not commonly available in urgent care facilities." The ordinance was effective on April 28, 2016 and expires on April 27, 2017. The ordinance also directed staff to investigate and prepare proposed regulations. In the intervening time, staff has been monitoring the topic at a policy level and has been aware of the potential for the state to address the topic through statutory amendments which may have pre-empted the need for additional local regulations or alter the manner in which local regulations would be crafted. Statutory language was drafted during the early part of 2017 and was introduced very recently during the legislative session; however, said legislation failed to advance out of committee and does not appear to be moving forward during the 2017 legislative session. Existing Regulations The concept of freestanding emergency rooms is relatively new and has only emerged in the state of Colorado in the past few years. It has existed in some other states for somewhat longer. Because it is a new land use concept, the municipal code is silent to this specific use. The City's zoning code defines hospitals and allows them in certain zoning districts. The City's zoning code also defines medical offices and allows those in certain zone districts. These freestanding emergency rooms have characteristics of both of these uses and likely fall somewhere between the two in terms of the intensity of the use and associated impacts. With the code being silent to this specific use, the Community Development Director has determined that the use is most similar to a hospital emergency room and therefore allowed to be located in the same manner. Hospitals are not permitted in any of the City's "straight" zoning districts, based on those use charts being silent to hospitals as a use group. However, hospitals are allowed in the City's Planned Hospital Districts (PHD) upon approval of a rezoning of a property to that district. Currently only the Exempla Lutheran hospital campus is zoned PHD. In the City's Mixed Use Districts, hospitals are included in those use charts and are allowed in all of the Mixed Use Commercial (MU -C) Districts and not allowed in the Mixed Use Neighborhood District. Potential Code Amendments Absent any adopted or pending state regulations, it is now appropriate to consider whether any additional local regulations should be considered for adoption. That said, there is not adequate time between now and the current expiration date of the temporary moratorium (April 27, 2017) to give proper consideration to new local regulations on these facilities. Local regulations could include: Modifications to Chapter 26 (Zoning and Development Code) defining freestanding emergency rooms and allowing them to be located in specific zoning districts. Some of the zoning approaches that might be considered would include: o Limiting the number of zoning districts within which they would be allowed o Requiring a special use permit or conditional use permit to authorize these uses o Limiting the total number of such facilities within the City o Establishing certain spacing requirements between such uses and/or between such uses and other existing emergency room facilities o Establishing other operational requirements such as hours of operation Modifications to Chapter 11 (Licensing) creating unique licensing and permitting requirements for freestanding emergency rooms. Certain operational requirements could also be located in this chapter, including the possibility of allowing such licenses only upon a demonstration of "need," relative to the location and spacing of other similar medical facilities. Next Steps As noted previously, new local regulations regarding freestanding emergency rooms have not yet been drafted and various options exist for City Council to consider. Absent any state regulations, local jurisdictions are now able to pursue their own course of action on this matter. With the pending expiration of the moratorium occurring in approximately 6 weeks, City Council has two principle options: Option 1: Allow the temporary moratorium to lapse and do nothing further. In this option, we would default to the existing regulatory environment as previously summarized, generally allowing freestanding emergency rooms in areas zoned PHD or MU -C. tion 2: Consider an ordinance extending the moratorium to allow time for additional regulations to be drafted and considered as an ordinance. It should be noted that amendments to Chapter 26 would also require review and recommendation by the Planning Commission. Staff would recommend a six-month moratorium. Staff would also request preliminary direction as to FA the manner in which additional regulations should be crafted. An additional substantive study session would then be scheduled to discuss draft regulations and the PC would be engaged in the drafting and review processes. 3 Freestanding Emergency Rooms — 3-7-17 • Not quite a year ago, on April 11, 2016, CC adopted ordinance 1595, placing a temporary moratorium on all applications for new freestanding emergency rooms • A definition of these facilities was included in the ordinance — generally they are facilities that provide many of the same services as in a hospital ER, but in a standalone facility • This is a fairly new concept in Colorado, though in some other states they have existed for several years • The moratorium was established for 12 months and expires on April 28, 2017 • There has been some discussion in the State legislature that a bill might have been introduced either late in the 2016 session or during the ongoing session • A bill was in fact introduced this year; however it died in committee a few weeks back • Staff had been waiting to draft any local regulations to see whether and how a statewide approach might impact any locally drafted regulations • Municipal Code is silent to these as a "use group" in our zoning regulations; though we define Hospital and medical offices and allow those in various districts • Staff has made the interpretation that these freestanding ERs are most similar to Hospitals and thus allowed in zoning districts where Hospitals are allowed • Generally, Hospitals are allowed either in a designated Planned Hospital District but not in other commercial districts. Hospitals are also allowed in all Mixed Use Commercial Districts, but not the lower intensity Mixed Use Neighborhood Districts. • Since we have not yet had substantive discussion regarding an approach to adopting any local regulations on these facilities, it is not possible to adopt any new regulations prior to the expiration of the moratorium on April 28 • If CC is inclined to adopt local regulations, staff would recommend consideration of an ordinance extending the moratorium an additional 6 months • Alternatively, CC could simply let the moratorium expire and we would continue to treat these as most similar to Hospitals and allowing them in PHDs and MUCs • If Council is inclined to adopt local regulations, staff would request preliminary input on your recommendations on a local regulatory approach and we schedule a subsequent study session Kenneth Johnstone From: Kenneth Johnstone Sent: Tuesday, March 7, 2017 8:16 AM To: Kenneth Johnstone Subject: City Council - 3-7-17 - all present City Council - 3-7-17 - all present Freestanding ERs - Kristy - cost is an issue - consumers don't understand the cost structure, leave them just in PHD and take out of MU -C, need to differentiate urgent care facilities - Gen - extend the moratorium - Monica - extend the moratorium, limit the total number of facilities in the City and limited range of districts - Tim - ERs must be associated with a hospital moving forward - Zach - traffic impacts, other concerns, free trade, but this is different from a consumer protection perspective, Sent from my Wad City of �Wh6atAjeMUNITY DEVELOPMENT Memorandum TO: Kenneth Johnstone, Director of Community Development FROM: Scott Cutler, Planning Technician DATE: March 23, 2017 SUBJECT: Freestanding Emergency Room Research Freestanding Emergency Rooms—referred to as Freestanding Emergency Departments (FSEDs) by health and government agencies—have become increasingly prevalent nationwide, and have concentrated in Texas, Arizona, and Colorado. Regulations of FSEDs are inconsistent and largely nonexistent. While states like Texas have regulated FSEDs, including creating a new development category to differentiate between medical offices and hospitals, Colorado has not, and recent legislative attempts to regulate FSEDs have failed. Regulations are also largely absent at the municipal level in Colorado. The City's current moratorium on FSEDs is notable in this regard. This document is a response to your request for research on if/how municipalities define FSEDs, medical offices, and hospitals in their zoning codes, and what steps have been taken to regulate/define FSEDs in the Front Range. Attached is: 1) research on local municipal codes and definitions of FSEDs, plus policy notes and sources, and, 2) a compilation spreadsheet with existing regulations/definitions written by local municipalities. The following is a list of trends, both local and national, regarding FSEDs. Local Trends • FSEDs are not specifically regulated in any Front Range municipality, and are not mentioned specifically in any zoning codes • FSEDs often are categorized as hospitals, not medical clinics or offices, because of the emergency services provided and 24/7 operating hours • FSEDs in the Front Range are concentrated in upper-income suburbs • FSEDs are generally located in new buildings or buildings that underwent major retrofits • No statement of need is currently required by the State of Colorado—hospitals need this to open a new location—allowing FSEDs to cluster (as was done in the southeastern suburbs of Aurora, Parker, and Centennial) • The majority of major municipalities have operating FSEDs or FSED projects • Emergency rooms, when mentioned, are considered essential facilities, and are subject to additional requirements (flood protection, ambulance access/circulation requirements) National Trends • FSEDs are expanding rapidly nationwide, beyond the "original" Texas market • Usually affiliated with an area hospital for branding purposes • Texas has the most comprehensive legislation, but they have had more time overall • Denials of FSEDs usually come when zoning boards deny special uses (e.g.: conversion from a standard urgent care to FSED use or SUP denied in application process) • General concerns: consumer confusion about services and prices, expense to the consumer, market saturation in some areas, location (favor high-income areas), too new to analyze overall quality of services • General positives: successful at relieving overcrowded hospitals or urgent care facilities, good at entering underserved markets Note: No APA recommendations currently exist for FSEDs. FSED Links & Notes Cities/Counties in the Front Range with Freestanding ERs Arvada Aurora Broomfield Centennial Colorado Springs Commerce City Denver Firestone Fort Collins Fountain Frederick Golden Greeley Highlands Ranch (Douglas County regs) Jefferson County (Littleton addresses) Lafayette (in process of being converted) Lakewood Longmont Loveland Parker Thornton Westminster Cities/Counties in the Front Range without Freestanding ERs Boulder Greenwood Village Louisville Superior Wheat Ridge Municipal Codes/Definitions WHEAT RIDGE Hospital. An institution providing health services for patients suffering from illness, disease, injury, deformation and other abnormal physical or mental conditions, including as an integral part of the institution such related facilities as inpatient and outpatient care, laboratories, training facilities, central service facilities and staff offices. (26-123) Hospitals and medical/dental clinics treated differently in terms of zoning allowances No specific regulation at this time for FSEDs; moratorium in place as of March 2017 GREENWOOD VILLAGE (no FSEDs) Medical or dental clinic means a group of medical or dental offices organized as a unified facility to provide medical or dental treatment, as contrasted with an unrelated group of such offices, but not including bed patient care. (16-1-100) Medical & dental clinics permitted use by right in some zones No specific regulation at this time for FSEDs; none exist in city limits 1 DENVER No specific regulation at this time for FSEDs Health care facility: Any licensed or certified medical or health care facility within the City and County of Denver or any office or clinic within the City and County of Denver regularly used by any licensed health care provider to provide medical, nursing or health care to patients. (38-114) Dental / Medical Office or Clinic An office use where the primary service is the treatment of patients or clients for physical or mental ailments and disorders, and which may also include passive (non -intrusive) research involving human subjects. Examples include doctor or dentist offices and clinics, and treatment of persons with eating disorders, sleep clinics, and other similar clinic uses. This use excludes hospital and animal hospital uses. (Zoning Code 11.12.4.6) Hospital An institution licensed by the state providing 24-hour health services, primarily for inpatients, and medical or surgical care of the sick or injured, including as an integral part of the institution, such related facilities as laboratories, outpatient departments, training facilities, central service facilities and staff offices. (11.12.3.2) AURORA Considered an "Essential Service Facility", along with public safety services, shelters, etc Essential services facilities. Essential services facilities include public safety, emergency response, emergency medical, designated emergency shelters, communications, public utility plant facilities, and transportation lifelines. These facilities consist of: ... Emergency medical (hospitals, ambulance service centers, urgent care centers having emergency treatment functions, and non-ambulatory surgical structures but excluding clinics, doctors' offices, and non -urgent care medical structures that do not provide these functions); (70-37) ... Elevation of the lowest floor, including basement or crawl space, or flood -proofing of the structure, together with attendant utility and sanitary facilities, to at least two feet above the base flood elevation. Medical clinic means an ambulatory health care facility where patients are admitted for examination and treatment on an outpatient basis by one or more physicians, dentists, other medical personnel, psychologists, or social workers, and where patients are not usually lodged overnight. (146-2001) Medical clinics permitted in more locations than hospitals/ERs; no specific definition of hospital/ER and no mention of FSEDs in medical clinic definition Aurora currently has several FSEDs, particularly in the SE near Centennial/Parker Some FSEDs have helipads; permitted through the Essential Service Facility code LAKEWOOD Same essential services definition as Aurora, in 14.25.160 of Municipal Code No mention of FSEDs or other medical clinics in definitions; No specific regulation at this time for FSEDs CENTENNIAL Signs for Full Service Hospitals. One monument sign located immediately adjacent to each public street frontage, but not to exceed four signs, is allowed. Each sign may be up to 16 feet in height, up to 150 square feet in sign area, and may contain up to 30 items of information. For the purposes of this regulation, a full service hospital (including a medical center) is a hospital that provides overnight and extended in-patient care and 24-hour emergency room services. Hospitals/Clinics/Medical Labs means hospitals, walk-in clinics, birthing centers, and medical laboratories, including general medical and surgical hospitals and specialty hospitals. The term "hospitals" does not mean alcoholism or drug rehabilitation facilities, nor does it mean medical offices where patients are generally seen by appointment. Office means uses in which professional, outpatient medical, or financial services are provided. The term includes: 16. Medical, dental, and chiropractic offices; FSEDs could possibly fall under the above definition of a full service hospital; not mentioned specifically Taken from Land Development Code: http://www.centennialco.gov/uploads/FileLinks/ef546fl52b9441c786b27ff6f84939b3/2011 LDC eff 0 9.14.15 5.pdf ARVADA Hospitals, ambulance service centers, and urgent care centers having emergency treatment functions are considered critical facilities Hospital. An institution that is licensed, certified, or approved as a "hospital" by the Colorado Department of Public Health and Environment, where sick or injured persons are given medical care and, in the course of same, are housed overnight, fed, and provided nursing and related services. The term "hospital" also includes related facilities such as laboratories, out-patient facilities, training facilities, central service facilities, and staff offices. Medical office/dental clinic. Office space used for the examination and/or treatment of patients on an outpatient basis (with no overnight stays by patients)... The phrase "Medical Office" includes medical laboratories to the extent necessary to carry out diagnostic services for the medical office's patients. The phrase "Medical Office" is subsumed by the term "Hospital." THORNTON Approved an Economic Development Incentive Agreement between the City and HCA-HealthONE for the development of a FSED No definitions of health-related terms; medical offices permitted in some commercial districts WESTMINSTER Hospital shall mean an institution, licensed by the state department of health, providing primary health services and medical or surgical care to persons, primarily inpatients, suffering from illness, disease, injury, deformity, and other abnormal physical or mental conditions and including, as an integral part of the institution, related facilities, such as laboratories, outpatient facilities, training facilities, or ambulance service. (11-2-1) No specific regulation at this time for FSEDs BROOMFIELD No specific regulation at this time for FSEDs PARKER No definitions of health-related terms; medical offices permitted in some commercial districts LONGMONT Hospital means a state -licensed facility providing accommodation and medical care of sick and injured persons, not including group care institutions or medical clinics. (15-10-20 Definitions) Clinic, medical/dental means an establishment operated by one or more duly licensed members of the human health care professions including, but not limited to, physicians, dentists, chiropractors, psychiatrists and osteopaths, where patients are not lodged overnight but are admitted for medical examination or treatment. Definition of medical clinic would likely exclude FSED because they are not 24 hr facilities (no one overnight) FORT COLLINS Medical offices and clinics considered a standard commercial use No specific regulation at this time for FSEDs GOLDEN Hospital. "Hospital" means any building or portion thereof used for the accommodation and medical care of sick, injured or infirm persons and including sanitariums, but not including clinics, rest homes and convalescent homes. (18.04 Definitions) Office definition includes medical/dental clinics but not in-patient or overnight treatment No specific regulation at this time for FSEDs LOUISVILLE (no FSEDs) Emergency rooms considered a "critical facility"; orspecific regulation at this time for FSED Hospital: Any building or portion thereof used for diagnosis, treatment and care of human ailments; but does not include medical clinics, rest homes, convalescent homes, nursing homes and retirement homes. Clinic means offices for one or more physicians, surgeons, dentists, or other practitioners of the healing arts, but does not include rooms for the abiding of patients. 4 COMMERCE CITY Hospital shall mean any building or portion thereof used for the accommodation and medical care of sick, injured or infirm persons including related facilities such as laboratories, out-patient facilities, training facilities, central service facilities and staff offices. Doctors, dentists, and medical labs defined as office use Other Entities: STATE OF COLORADO No statewide regulations; previous attempts have failed, but other bills are being debated/written STATE OF TEXAS Regulated statewide under HB 1357 (2009) and the Texas Freestanding Emergency Medical Care Facility (FEC) Licensing Act The Texas Freestanding Emergency Medical Care Facility (FEC) Licensing Act was first enacted in 2009 by the 81st Legislature. A freestanding emergency medical care facility is a facility that is structurally separate and distinct from a hospital and which receives an individual and provides emergency care. Emergency care is defined as health care services provided in a freestanding emergency medical care facility to evaluate and stabilize a medical condition of a recent onset and severity, including severe pain, psychiatric disturbances, or symptoms of substance abuse, that would lead a prudent layperson possessing an average knowledge of medicine and health to believe that the person's condition, sickness, or injury is of such a nature that failure to get immediate medical care could result in: • placing the person's health in serious jeopardy • serious impairment to bodily functions • serious dysfunction of a bodily organ or part • serious disfigurement • or in the case of a pregnant woman, serious jeopardy to the health of the woman or fetus The Department develops rules that establish minimum standards for licensing procedures; for granting, denying, suspending, and revoking a license; for licensing fees; for operation; and for requirements concerning design, construction. State law requirements/details (http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.254.htm): -Facilities open 24/7 -Differentiates between medical clinics, doctors' offices, and hospitals (creates a new category for freestanding ERs) -Requires facility to stabilize patient without regard to the individual's ability to pay -Requires facility to have a referral, transmission, or admission agreement with a full-service hospital -Requires information about rates, insurance networks, physician billing (posted in every room, payment counter, entrance, and website) 5 Policy Notes & Sources http://www.denverpost.com/2015/09/24/free-standing-ers-abound-in-affluent-colorado- neighborhoods/ (September 2015) -In Colorado, mostly constructed by hospital chains (Parker Adventist, UCHealth, SCL Health, HealthOne) -Concerns over being overbuilt, market saturation already happening in some areas -As of 2015, do not require a certificate of need to be built, unlike a real hospital -Ethical/class concerns: typically do not open in low-income areas (where need may already be higher) -Confusion over cost for consumer (much more expensive than urgent cares, even for minor issues) http://www.modernheaIthcare.com/article/20161004/NEWS/161009975 (October 2016) -FSEDs are not required to accept all patients under Federal Law; some may turn away uninsured patients -Have a policy to accept all patients, at least to stabilize, but can turn away for further care -Liability issues over whether/when independent FSEDs can turn away -More likely to locate in ZIP codes with existing FSEDs, and high rates of insured people; risk of market saturation ...Centers for Medicare & Medicaid Services (CMS) currently doesn't allow reimbursement for independent FSEDs that provide Medicare/Medicaid services; possible barrier to expanding to more underserved areas -Differing state and Federal legislation; grey areas make it difficult for consumers https://www.colorado.gov/pacif ic/sites/defa ult/f iles/Su m m a ry%20Overview%20-%20Aug%202016. pdf (August 2016) — Colorado Hospital Association Issue Brief -Majority are located in Texas, Colorado, and Arizona: 387 nationwide as of August 2016 -Colorado Department of Public Health and the Environment (CDPHE) lists 39 in Colorado -Hospital-owned and operated FSEDs are usually licensed in CO as a Community Emergency Center (CEC), though they can also be regulated as a hospital: can bill for Medicare/Medicaid and facility fees under the parent hospital's Federal ID number, subject to EMTALA (Emergency Medical Treatment and Labor Act) requirements -Independent FSEDs cannot bill Medicare/Medicaid; only subject to state standards (similar to EMTALA but not on a Federal level) N. -Hospital -affiliated FSEDs are like independent FSEDs but have an agreement with a hospital to use branding; they voluntarily comply with Federal standards like EMTALA (will accept Medicare/Medicaid patients but not bill for them) -EMTALA requires that a patient not be denied stabilizing care due to ability to pay; Colorado has adopted similar rules for facilities not under Federal jurisdiction (following initial screening, patients may inquire about estimated costs) -Colorado Hospital Association has requested that: ...identifying FSEDs with clear EMERGENCY signage ...hospital -affiliated FSEDs should continue to voluntarily comply with Federal standards ...hospitals develop models of care that ensure more accurate billing ...ensure proper communication with patients after they have been stabilized (or a lack of emergency is determined) about possible fees ...future FSED opportunities should consider the needs of underserved areas http://www.bizoournals.com/denver/news/2017/02/08/first-effort-to-regulate-free-standing- emergency.html (February 2017) -Republicans recently rejected (in State Senate committee) a bill to create new licensing for FSEDs and require operators to prove there was a shortage of health care in the areas they wanted to build ...would have also required a schedule of fees and froze new development until July 2019 C Wheat Ridge Denver Has No Yes Aurora Yes Lakewood Yes Centennial Yes Moratorium None Definition and/or An institution providing health services for patients suffering from illness, disease, injury, deformation and other abnormal physical or mental conditions, including as an integral part of the institution such related facilities as inpatient lation (code language in italics Medical Office/Clinic and outpatient care, laboratories, training Hospitals and medical/dental clinics treated facilities, central service facilities and staff offices. differently in terms of zoning allowances An office use where the primary service is the treatment of patients or clients for physical or An institution licensed by the state providing 24- mental ailments and disorders, and which may hour health services, primarily for inpatients, and medical or surgical care of the sick or injured, including as an integral part of the institution, such related facilities as laboratories, outpatient departments, training facilities, central service facilities and staff offices. None None None None None Hospitals, walk-in clinics, birthing centers, and medical laboratories, including general medical and surgical hospitals and specialty hospitals. The term "hospitals" does not mean alcoholism or drug rehabilitation facilities, nor does it mean medical offices where patients are generally seen by appointment. Signs for Full Service Hospital: One monument sign located immediately adjacent to each public street frontage, but not to exceed four signs, is allowed. Each sign may be up to 16 feet in height, up to 150 square feet in sign area, and may contain up to 30 items of information. For the purposes of this regulation a full service hospital (including a medical center) is a hospital that provides overnight and extended in-patient care and 24-hour room services. also include passive (non -intrusive) research involving human subjects. Examples include doctor or dentist offices and clinics, and treatment of persons with eating disorders, sleep clinics, and other similar clinic uses. This use excludes hospital and animal hospital uses. An ambulatory health care facility where patients are admitted for examination and treatment on an outpatient basis by one or more physicians, dentists, other medical personnel, psychologists, or social workers, and where patients are not usually lodged overnight. None Office means uses in which professional, outpatient medical, or financial services are provided. The term includes:... 16. Medical, dental, and chiropractic offices; Other Essential services facilities. Essential services facilities include public safety, emergency response, emergency medical, designated emergency shelters, communications, public utility plant facilities, and transportation lifelines. These facilities consist of- Emergency medical (hospitals, ambulance service centers, urgent care centers having emergency treatment functions, and non-ambulatory surgical structures but excluding clinics, doctors' offices, and non -urgent care medical structures that do not provide these functions); Same Essential Services Facilities definition as Aurora Notes Moratorium as of March 2017 FSEDs are considered "Essential Services Facilities." Aurora currently has several FSEDs (many clustered together in SE corner near Centennial and Parker); some FSEDs have helipads which are permitted through the Essential Service Facility code FSEDs considered full-service hospitals based on definition, but are not mentioned specifically Arvada Yes None Yes None Westminster Yes None Broomfield Yes None Parker Yes None Longmont Yes None Fort Collins Yes None (Golden Yes None IGreenwood Vil lag. No None Commerce City Yes None Louisville No I"'"SPA-�o , fccuu' Utr to rvet An institution that is licensed, certified, or approved as a "hospital" by the Colorado Department of Public Health and Environment, Office space used for the examination and/or where sick or injured persons are given medical treatment of patients on an outpatient basis (with care and, in the course of same, are housed no overnight stays by patients)... The phrase overnight, fed, and provided nursing and related "Medical Office" includes medical laboratories to services. The term 'hospital" also includes the extent necessary to carry out diagnostic Hospitals, ambulance service centers, and urgent related facilities such as laboratories, out-patient 'services for the medical office's patients. The care centers having emergency treatment facilities, training facilities, central service phrase "Medical Office" is subsumed by the term (functions are considered "critical" facilities (similar facilities, and staff offices. "Hospital." to Centennial/Aurora definition) Approved an Economic Development Incentive 'Agreement between the City and HCA- HealthONE for the development of a FSED None None An institution, licensed by the state department of health, providing primary health services and medical or surgical care to persons, primarily inpatients, suffering from illness, disease, injury, deformity, and other abnormal physical or mental conditions and including, as an integral part of the institution, related facilities, such as laboratories, outpatient facilities, training facilities, or ambulance service. None None - - one - -- - - None None An establishment operated by one or more duly licensed members of the human health care professions including, but not limited to, A state -licensed facility providing accommodation physicians, dentists, chiropractors, psychiatrists and medical care of sick and injured persons, not and osteopaths, where patients are not lodged including group care institutions or medical overnight but are admitted for medical clinics. - examination or treatment. None- - -- None Any building or portion thereof used for the accommodation and medical care of sick, injured or infirm persons and including sanitariums, but not including clinics, rest homes and Defined as an office (excludes in-patient or convalescent homes. overnight treatment) A group of medical or dental offices organized as a unified facility to provide medical or dental treatment, as contrasted with an unrelated group None of such offices, but not including bed patient care. Hospital shall mean any building or portion thereof used for the accommodation and medical care of sick, injured or infirm persons including i related facilities such as laboratories, out-patient facilities, training facilities, central service Doctors, dentists, and medical labs defined as facilities and staff offices. office use Any building or portion thereof used for diagnosis, treatment and care of human ailments; but does Clinic means offices for one or more physicians, not include medical clinics, rest homes, surgeons, dentists, or other practitioners of the convalescent homes, nursing homes and healing arts, but does not include rooms for the retirement homes. abiding of patients. i Eme rooms considered a "critical facil Definition of medical clinic likely excludes FSEDs because FSEDs are 24 hours facilities Hospitals restricted to Commercial or PUD zones city of nn Wheat i e I� ► �, � e c,�. U -4C ITEM NO: E DATE: March 27, 2017 REQUEST FO CITY COUNCIL ACTION TITLE: COUNCIL BILL NO. 04-2017 - AN ORDINANCE EXTENDING THE TEMPORARY MORATORIUM ON THE SUBMISSION, ACCEPTANCE, PROCESSING, AND APPROVAL OF APPLICATIONS AND REQUESTS FOR A PERMIT, LICENSE, LAND USE APPROVAL OR OTHER APPROVAL FOR A FREESTANDING EMERGENCY ROOM FACILITY ® PUBLIC HEARING ❑ ORDINANCES FOR 1sT READING (3/13/2017) ❑ BIDS/MOTIONS ® ORDINANCES FOR 2ND READING (3/27/2017) ❑ RESOLUTIONS QUASI-JUDICIAL: ❑ YES ® NO City Attorney City Manager ISSUE: In April of 2016, the Council adopted a one-year moratorium on the submission, acceptance, processing and approval of applications and requests related to freestanding emergency room facilities. This ordinance extends the moratorium period for an additional 180 days. PRIOR ACTION: The current moratorium was adopted and imposed by Ordinance No. 1595. On March 6, 2017, Council discussed this issue and directed that the current moratorium period be extended. FINANCIAL IMPACT: The potential loss of license, permit, application and similar fees associated with applications for freestanding emergency room (ER) facilities for an additional 180 days is likely nominal. BACKGROUND: Freestanding ERs continue to increase in number and popularity. In Colorado, the number of freestanding ERs rose from two in 2012 to at least 35 by mid -2016. These facilities provide Council Action Form — Extend Moratorium of Freestanding ERs March 13, 2017 Page 2 emergency medical treatment and care similar to a hospital-based ER. Ambulances deliver to these freestanding facilities and many offer more sophisticated on-site services — such as radiology and lab services — than urgent care facilities. These types of facilities continue to be unregulated by the state. Freestanding ERs likely generate land use impacts that are more akin to hospitals than to other medical facilities, such as clinics, doctor's offices and urgent -care facilities. Unlike these other types of medical facilities, freestanding ERs accommodate ambulance and other emergency - vehicle traffic and they are often open 24/7. They produce light, noise, glare and traffic beyond that of a non -emergent medical care facility. It is therefore appropriate to study and evaluate whether the City's existing zoning regulations adequately address freestanding ER facilities. In the past, there have been media stories on freestanding ERs and patient confusion between freestanding ERs and urgent care facilities. Because freestanding ERs are not currently licensed or regulated by the state, patients may also be uninformed about the relative costs, benefits, advantages and disadvantages of visiting a freestanding ER versus a hospital-based ER. It is therefore appropriate for Council to study and evaluate whether the City should enter the licensing arena specific to these facilities and adopt some local licensing requirements for them. This Ordinance continues to maintain the status quo (no freestanding ERs within the City) while the Council studies these policy issues and adopts further legislation if it deems appropriate. RECOMMENDATIONS: Staff recommends approving the extension of the temporary moratorium. RECOMMENDED MOTIONS: "I move to approve Council Bill No. 04-2017 - an ordinance extending the temporary moratorium on the submission, acceptance, processing, and approval of applications and requests for a permit, license, land use approval or other approval for a freestanding emergency room facility, on second reading, and that it take effect 15 days after final publication." am "I move to postpone indefinitely Council Bill No. 04-2017 - temporary moratorium on the submission, acceptance, processing, and requests for a permit, license, land use approval or other emergency room facility for the following reason(s) REPORT PREPAREWREVIEWED BY: Carmen Beery, City Attorney's Office Patrick Goff, City Manager ATTACHMENTS: 1. Council Bill No. 04-2017 an ordinance extending the and approval of applications approval for a freestanding CITY OF WHEAT RIDGE, COLORADO INTRODUCED BY COUNCIL MEMBER HOPPE Council Bill No. 04 Ordinance No. Series 2017 TITLE: AN ORDINANCE EXTENDING THE TEMPORARY MORATORIUM ON THE SUBMISSION, ACCEPTANCE, PROCESSING, AND APPROVAL OF APPLICATIONS AND REQUESTS FOR A PERMIT, LICENSE, LAND USE APPROVAL OR OTHER APPROVAL FOR A FREESTANDING EMERGENCY ROOM FACILITY WHEREAS, the City of Wheat Ridge ("City") is a home rule municipality operating under a charter adopted pursuant to Article XX of the Colorado Constitution and vested with the authority by that article and the Colorado Revised Statutes to enact laws to govern and regulate the use of land within its territory; and WHEREAS, pursuant to this authority, the Wheat Ridge City Council ("Council") previously adopted local land use regulations, codified as Chapter 26 of the Wheat Ridge Code of Laws ("Code"); and WHEREAS, City staff has interpreted the City's current zoning regulations as permitting freestanding emergency room facilities to locate within the Mixed Use - Commercial and Planned Hospital Development zone districts only; and WHEREAS, the Council finds that freestanding emergency room facilities may cause land use impacts that are different than those caused by other detached health care facilities due to the extended hours that emergency facilities may be open; and WHEREAS, approximately one year ago, in response to the increase in the number and popularity of freestanding emergency room facilities over the past several years, the Council determined that it was necessary and desirable to examine the City's zoning laws and business licensing regulations governing freestanding emergency room facilities to ensure that such facilities are appropriately located; and WHEREAS, additionally, the Council and City staff held a reasonable belief that the state legislature might adopt statewide legislation governing freestanding emergency room facilities that could potentially affect the desired parameters of local regulations on the topic, during either the last or the current legislative session; and WHEREAS, as a result, by and through the adoption of Ordinance No. 1595, the Council previously acted to impose a one-year moratorium on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility; and Attachment 1 WHEREAS, the moratorium is scheduled to expire on April 28, 2017; and WHEREAS, the Council and City staff have recently learned that it is now unlikely that the state legislature will adopt such legislation during the current session; and WHEREAS, the Council therefore finds that it is prudent and desirable to extend the moratorium for an additional one hundred and eighty (180) days, to permit the careful study and evaluation of various local regulatory options with an expectation that such regulations would operate without an additional state regulatory gloss; and WHEREAS, the extension of the moratorium on the submission, acceptance, processing, and approval of all applications and requests for a City permit, license, land use approval or other approval is reasonable in time and scope and would not work an unnecessary hardship upon or unreasonably prejudice any party. NOW THEREFORE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF WHEAT RIDGE, COLORADO: Section 1. Findings. The above and foregoing findings are hereby incorporated by this reference as specific findings and determinations of the Council. Section 2. Temporary Moratorium Extended. The temporary moratorium imposed on the submission, acceptance, processing, and approval of all applications and requests for a City permit, license, land use approval or other approval for any freestanding emergency room facility originally adopted by Ordinance No. 1595 is hereby extended for an additional one hundred eighty (180) days. The extension period adopted hereby shall commence and be measured from the date the original moratorium period expires. The City staff is directed to refuse to accept for filing, and not to further process or review any pending applications or requests for such facilities during this moratorium extension period. Section 3. Definition of freestanding emergency room facility. For purposes of this Ordinance, a "freestanding emergency room facility" is and means a medical facility that is not physically attached to a hospital facility that has the capability of providing medical care and services to patients with emergency medical conditions in a manner similar to emergency rooms located within hospitals. Features of a freestanding emergency room facility may include, but are not limited to, expanded hours of operation, drive -lanes or vehicle bays to accommodate ambulance arrivals and departures, board- certified emergency physicians, board-certified emergency nurses, on-site lab and imaging capabilities and similar equipment, services and treatments not commonly available in urgent -care facilities. Section 4. Staff to Investigate and Prepare Proposed Regulations. Before the expiration of the moratorium period extended by this Ordinance, City staff shall review and analyze the City's existing regulations governing freestanding emergency room facilities, as directed by the Council, and present any proposed amendments thereto to K, the Council. The Council declares that it will give due and timely consideration to recommended changes to the Code. Section 5. Effective Date. This Ordinance shall take effect fifteen (15) days after final publication, as provided by Section 5.11 of the Charter. INTRODUCED, READ, AND ADOPTED on first reading by a vote of 5 to 0 on this 13th day of March, 2017, ordered published in full in a newspaper of general circulation in the City of Wheat Ridge and Public Hearing and consideration on final passage set for March 27, 2017 at 7:00 o'clock p.m., in the Council Chambers, 7500 West 29th Avenue, Wheat Ridge, Colorado, READ, ADOPTED AND ORDERED PUBLISHED on second and final reading by a vote of to , this day of 2017. SIGNED by the Mayor on this day of 2017. ATTEST: Janelle Shaver, City Clerk First Publication: March 16, 2017 Second Publication: Wheat Ridge Transcript Effective Date: 3 Joyce Jay, Mayor Approved As To Form Gerald E. Dahl, City Attorney Kenneth Johnstone From: Salzmann, Carol <Carol.Salzmann@sclhs.net> Sent: Tuesday, December 5, 2017 5:40 PM To: Patrick Goff Cc: Wicklund, Grant; Kenneth Johnstone Subject: RE: [EXTERNAL EMAIL] Freestanding ERs Until a bill is introduced, language about "needs" test specific to FSEDs is unknown. In Colorado, and a limited number of states, there is no certificate of need required to build a hospital, urgent care, etc. Regardless of legislation, Lutheran has the capacity to meet and exceed the emergency needs of the citizens of City of Wheat Ridge and surrounding neighborhoods. We are committed to continuing to bring excellence in cardiovascular, stroke care and more. Regards, Carol Carol Salzmann VP of Community and Government Affairs Lutheran Medical Center P: 303-425-2414 M:303-204-8849 Carol.salzmann@sclhs.net From: Patrick Goff [mailto:pgoff@ci.wheatridge.co.us] Sent: Tuesday, December 05, 2017 4:30 PM To: Salzmann, Carol <Carol.Salzmann@sclhs.net> Cc: Wicklund, Grant <Grant.Wicklund@scihs.net>; Kenneth Johnstone <kjohnstone@ci.wheatridge.co.us> Subject: RE: [EXTERNAL EMAIL]Freestanding ERs Thank you Carol. No legislation to require a "needs" test for these types of facilities or other zoning restrictions? Would SCL's objection to freestanding ED's change if the legislation below is approved? Thanks Patrick Goff City Manager Cell Phone: 303-995-6465 t its• cel W h6 t id1g City -'-1ANUAR'S Of Wf From: Salzmann, Carol[mailto:Carol.Salzmann@sclhs.net] Sent: Tuesday, December 5, 2017 9:09 AM To: Patrick Goff <pgoff@ci.wheatridge.co.us> Cc: Wicklund, Grant <Grant.Wicklund@sclhs.net> Subject: RE: [EXTERNAL EMAIL] Freestanding ERs Hi Patrick, Here's what I've learned so far regarding Freestanding ED legislation in 2018: There is a bipartisan group of legislators planning to introduce FSED legislation in 2018 (Smallwood/Kefalas and Kennedy/tontine). SCL Health's lobbyist met with Rep. Kennedy in November and he indicated that they aim to include three provisions —1. Mandatory disclosure to patients in a way that doesn't violate EMTALA, 2. Location specific billing modifier so data researchers can tell which facility originated particular charges and 3. Split out FSEDs from community clinics in the licensure statute, so that these new requirements can be applied specifically to FSEDs and not other facilities. There is not a draft available for review at this time however, I will continue to monitor over the next two week prior to the 12/18 Council meeting. Best regards, Carol Carol Salzmann VP of Community and Government Affairs Lutheran Medical Center P:303-425-2414 M:303-204-8849 Carol.salzmann@sclhs.net SCL Health LUTHERAN From: Salzmann, Carol Sent: Tuesday, November 28, 2017 7:26 PM To: Patrick Goff <pgoff@ci.wheat ridge. co.us> Subject: Re: [EXTERNAL EMAIL] Freestanding ERs Thanks for the positive update. Last year we were told the legislature would address the issue in 2018. 1 have been following JBC - expect some bill drafts in December. I will research and let you know. On another note, Grant and I talked today. We are interested in meeting with you and Mayor Starker soon. I will have executive assistant work on finding a date. I hope you had a nice Thanksgiving. Carol From: Patrick Goff Sent: Tuesday, November 28, 2017 3:03 PM To: "Wicklund, Grant" ,"Salzmann, Carol" Subject: [EXTERNAL EMAIL] Freestanding ERs *** CAUTION! This email came from outside SCL Health. Do not open attachments or click links if you do not recognize the sender. *** Grant and Carol, As you both may remember, City Council established a 12 -month moratorium on the construction of freestanding emergency rooms in Wheat Ridge. That moratorium expires on April 13, 2018. We are considering asking City Council for a 3 -month extension at the December 18th study session to allow the Colorado Legislature to maybe address some of the issues associated with freestanding emergency rooms. Carol, you mentioned in the past certain groups may be lobbying for the legislature to do something. Do you know if that is still the case. Thanks Patrick Goff City Manager 7500 W. 29th Avenue Wheat Ridge, Colorado 80033 Office Phone: 303-235-2805 Cell Phone: 303-995-6465 Fax: 303-235-2805 www.ci.wheatridge.co.us t ilr of W heaticI;c 0111 �11ANA(;is.'�Orillr g. CONFIDENTIALITY NOTICE: This e-mail contains business -confidential information. It is intended only for the use of the individual or entity named above. If you are not the intended recipient, you are notified that any disclosure, copying, distribution, electronic storage or use of this communication is prohibited. If you received this communication in error, please notify us immediately by e- mail, attaching the original message, and delete the original message from your computer, and any network to which your computer is connected. Thank you. Kenneth Johnstone From: Kenneth Johnstone Sent: Tuesday, March 28, 2017 7:50 AM To: Kenneth Johnstone Subject: City Council - Gen, Kristi and George absent City Council - Gen, Kristi and George absent - Arbor Day - Dorothy Archer, 3640 Marshall, R-1 code and heights allowable - Colin, Perlmutter's office, making housing affordable conference ER Moratorium, - ordinance 1616 - Hoppe introduction - Carol Salzmann, raised consumer protection issues, proposed 12 month moratorium, status of house and senate bills, state moratorium to send department of health, 72000 patients a year, - Hoppe motion, Zach amendment to 12 months, Larry 2nd on amendment - 5-0 - Main motion - 5-0 Small scale alcohol production, Larry motion, Monica 2nd, 5-0 Design Standards, Monica motion, Hoppe 2nd, 4-1, Urban "no" Sent from my iPad r�3 G ^2 Pf ( (A ---,i 1(�✓1 city of ;�9' " W hea i e H _ D -v,,, (� Afpv,) JP n P 0 �-' � ITEM NO: VDATE: March 13, 2017 REQUEST FOR CITY COUNCIL ACTION TITLE: COUNCIL BILL NO. 04-2017 - AN ORDINANCE EXTENDING THE TEMPORARY MORATORIUM ON THE SUBMISSION, ACCEPTANCE, PROCESSING, AND APPROVAL OF APPLICATIONS AND REQUESTS FOR A PERMIT, LICENSE, LAND USE APPROVAL OR OTHER APPROVAL FOR A FREESTANDING EMERGENCY ROOM FACILITY ❑ PUBLIC HEARING ® ORDINANCES FOR IST READING (3/13/2017) ❑ BIDS/MOTIONS ❑ ORDINANCES FOR 2ND READING (3/27/2017) ❑ RESOLUTIONS QUASI-JUDICIAL: ❑ YES ® NO City Attorney City Manager ISSUE: In April of 2016, the Council adopted a one-year moratorium on the submission, acceptance, processing and approval of applications and requests related to freestanding emergency room facilities. This ordinance extends the moratorium period for an additional six months. PRIOR ACTION: The current moratorium was adopted and imposed by Ordinance No. 1595. On March 6, 2017, Council discussed this issue and directed that the current moratorium period be extended. FINANCIAL IMPACT: The potential loss of license, permit, application and similar fees associated with applications for freestanding emergency room (ER) facilities for an additional six months is likely nominal. BACKGROUND: Freestanding ERs continue to increase in number and popularity. In Colorado, the number of freestanding ERs rose from two in 2012 to at least 35 by mid -2016. These facilities provide Council Action Form — Extend Moratorium of Freestanding ERs March 13, 2017 Page 2 emergency medical treatment and care similar to a hospital-based ER. Ambulances deliver to these freestanding facilities and many offer more sophisticated on-site services — such as radiology and lab services — than urgent care facilities. These types of facilities continue to be unregulated by the state. Freestanding ERs likely generate land use impacts that are more akin to hospitals than to other medical facilities, such as clinics, doctor's offices and urgent -care facilities. Unlike these other types of medical facilities, freestanding ERs accommodate ambulance and other emergency - vehicle traffic and they are often open 24/7. They produce light, noise, glare and traffic beyond that of a non -emergent medical care facility. It is therefore appropriate to study and evaluate whether the City's existing zoning regulations adequately address freestanding ER facilities. In the past, there have been media stories on freestanding ERs and patient confusion between freestanding ERs and urgent care facilities. Because freestanding ERs are not currently licensed or regulated by the state, patients may also be uninformed about the relative costs, benefits, advantages and disadvantages of visiting a freestanding ER versus a hospital-based ER. It is therefore appropriate for Council to study and evaluate whether the City should enter the licensing arena specific to these facilities and adopt some local licensing requirements for them. This Ordinance continues to maintain the status quo (no freestanding ERs within the City) while the Council studies these policy issues and adopts further legislation if it deems appropriate. RECOMMENDATIONS: Council options include: 1. Approve the ordinance as presented on first reading 2. Approve the ordinance on first reading with amendment(s) 3. Postpone consideration of the ordinance indefinitely Staff recommends approving the extension of the temporary moratorium. RECOMMENDED MOTIONS: "I move to approve Council Bill No. 04-2017 - an ordinance extending the temporary moratorium on the submission, acceptance, processing, and approval of applications and requests for a permit, license, land use approval or other approval for a freestanding emergency room facility, on first reading, order it published, public hearing set for Monday, March 27, 2017, at 7:00 p.m. in City Council Chambers, and that it take effect 15 days after final publication." Or, "I move to postpone indefinitely Council Bill No. 04-2017 - an ordinance extending the temporary moratorium on the submission, acceptance, processing, and approval of applications and requests for a permit, license, land use approval or other approval for a freestanding emergency room facility for the following reason(s) " Council Action Form — Extend Moratorium of Freestanding ERs March 13, 2017 Page 3 REPORT PREPARED/REVIEWED BY: Carmen Beery, City Attorney's Office Patrick Goff, City Manager ATTACHMENTS: 1. Council Bill No. 04-2017 2. February 24, 2017 Staff Memorandum from Kenneth Johnstone (for the March 6 study session) CITY OF WHEAT RIDGE, COLORADO INTRODUCED BY COUNCIL MEMBER Council Bill No. 04 Ordinance No. Series 2017 TITLE: AN ORDINANCE EXTENDING THE TEMPORARY MORATORIUM ON THE SUBMISSION, ACCEPTANCE, PROCESSING, AND APPROVAL OF APPLICATIONS AND REQUESTS FOR A PERMIT, LICENSE, LAND USE APPROVAL OR OTHER APPROVAL FOR A FREESTANDING EMERGENCY ROOM FACILITY WHEREAS, the City of Wheat Ridge ("City") is a home rule municipality operating under a charter adopted pursuant to Article XX of the Colorado Constitution and vested with the authority by that article and the Colorado Revised Statutes to enact laws to govern and regulate the use of land within its territory; and WHEREAS, pursuant to this authority, the Wheat Ridge City Council ("Council") previously adopted local land use regulations, codified as Chapter 26 of the Wheat Ridge Code of Laws ("Code"); and WHEREAS, City staff has interpreted the City's current zoning regulations as permitting freestanding emergency room facilities to locate within the Mixed Use - Commercial and Planned Hospital Development zone districts only; and WHEREAS, the Council finds that freestanding emergency room facilities may cause land use impacts that are different than those caused by other detached health care facilities due to the extended hours that emergency facilities may be open; and WHEREAS, approximately one year ago, in response to the increase in the number and popularity of freestanding emergency room facilities over the past several years, the Council determined that it was necessary and desirable to examine the City's zoning laws and business licensing regulations governing freestanding emergency room facilities to ensure that such facilities are appropriately located; and WHEREAS, additionally, the Council and City staff held a reasonable belief that the state legislature might adopt statewide legislation governing freestanding emergency room facilities that could potentially affect the desired parameters of local regulations on the topic, during either the last or the current legislative session; and WHEREAS, as a result, by and through the adoption of Ordinance No. 1595, the Council previously acted to impose a one-year moratorium on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility; and Attachment 1 WHEREAS, the moratorium is scheduled to expire on April 28, 2017; and WHEREAS, the Council and City staff have recently learned that it is now unlikely that the state legislature will adopt such legislation during the current session; and WHEREAS, the Council therefore finds that it is prudent and desirable to extend the moratorium for an additional one hundred and eighty (180) days, to permit the careful study and evaluation of various local regulatory options with an expectation that such regulations would operate without an additional state regulatory gloss; and WHEREAS, the extension of the moratorium on the submission, acceptance, processing, and approval of all applications and requests for a City permit, license, land use approval or other approval is reasonable in time and scope and would not work an unnecessary hardship upon or unreasonably prejudice any party. NOW THEREFORE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF WHEAT RIDGE, COLORADO: Section 1. Findings. The above and foregoing findings are hereby incorporated by this reference as specific findings and determinations of the Council. Section 2. Temporary Moratorium Extended. The temporary moratorium imposed on the submission, acceptance, processing, and approval of all applications and requests for a City permit, license, land use approval or other approval for any freestanding emergency room facility originally adopted by Ordinance No. 1595 is hereby extended for an additional one hundred eighty (180) days. The extension period adopted hereby shall commence and be measured from the date the original moratorium period expires. The City staff is directed to refuse to accept for filing, and not to further process or review any pending applications or requests for such facilities during this moratorium extension period. Section 3. Definition of freestanding emergency room facility. For purposes of this Ordinance, a "freestanding emergency room facility" is and means a medical facility that is not physically attached to a hospital facility that has the capability of providing medical care and services to patients with emergency medical conditions in a manner similar to emergency rooms located within hospitals. Features of a freestanding emergency room facility may include, but are not limited to, expanded hours of operation, drive -lanes or vehicle bays to accommodate ambulance arrivals and departures, board- certified emergency physicians, board-certified emergency nurses, on-site lab and imaging capabilities and similar equipment, services and treatments not commonly available in urgent -care facilities. Section 4. Staff to Investigate and Prepare Proposed Regulations. Before the expiration of the moratorium period extended by this Ordinance, City staff shall review and analyze the City's existing regulations governing freestanding emergency room facilities, as directed by the Council, and present any proposed amendments thereto to 2 the Council. The Council declares that it will give due and timely consideration to recommended changes to the Code. Section 5. Effective Date. This Ordinance shall take effect fifteen (15) days after final publication, as provided by Section 5.11 of the Charter. INTRODUCED, READ, AND ADOPTED on first reading by a vote of to on this day of March, 2017, ordered published in full in a newspaper of general circulation in the City of Wheat Ridge and Public Hearing and consideration on final passage set for , 2017, at 7:00 o'clock p.m., in the Council Chambers, 7500 West 29th Avenue, Wheat Ridge, Colorado. READ, ADOPTED AND ORDERED PUBLISHED on second and final reading by a vote of to , this day of 2017. SIGNED by the Mayor on this day of 2017. ATTEST: Janelle Shaver, City Clerk First Publication: Second Publication: Wheat Ridge Transcript Effective Date: Q Joyce Jay, Mayor Approved As To Form Gerald E. Dahl, City Attorney City of Wheatjdge COMMUNITY DEVELOPMENT Memorandum TO: Mayor and City Council FROM: Kenneth Johnstone, Community Development Director THROUGH: Patrick Goff, City Manager DATE: February 24, 2017 (for March 6th study session) SUBJECT: Freestanding Emergency Rooms BACKGROUND: On April 11, 2016, City Council adopted Ordinance 1595 placing a 365 -day temporary moratorium on the submission, acceptance, processing and approval of applications for "freestanding emergency rooms." As defined in Section 3 of the ordinance, such facilities were defined as follows: "a medical facility that is not physically attached to a hospital facility that has the capacity of providing medical care and services to patients with emergency medical conditions in a manner similar to emergency rooms located within hospitals. Features of a freestanding emergency room facility may include, but are not limited to expanded hours of operation, drive -lanes or vehicle bays to accommodate ambulance arrivals and departures, board certified emergency physicians, board-certified emergency nurses, on-site lab and imaging capabilities and similar equipment, services and treatments not commonly available in urgent care facilities." The ordinance was effective on April 28, 2016 and expires on April 27, 2017. The ordinance also directed staff to investigate and prepare proposed regulations. In the intervening time, staff has been monitoring the topic at a policy level and has been aware of the potential for the state to address the topic through statutory amendments which may have pre-empted the need for additional local regulations or alter the manner in which local regulations would be crafted. Statutory language was drafted during the early part of 2017 and was introduced very recently during the legislative session; however, said legislation failed to advance out of committee and does not appear to be moving forward during the 2017 legislative session. Existin Relations The concept of freestanding emergency rooms is relatively new and has only emerged in the state of Colorado in the past few years. It has existed in some other states for somewhat longer. Because it is a new land use concept, the municipal code is silent to this specific use. The City's zoning code defines hospitals and allows them in certain zoning districts. The City's zoning code also defines medical offices and allows those in certain zone districts. These freestanding emergency rooms have characteristics of both of these uses and likely fall somewhere between the two in terms of the intensity of the use and associated impacts. Attachment 2 With the code being silent to this specific use, the Community Development Director has determined that the use is most similar to a hospital emergency room and therefore allowed to be located in the same manner. Hospitals are not permitted in any of the City's "straight" zoning districts, based on those use charts being silent to hospitals as a use group. However, hospitals are allowed in the City's Planned Hospital Districts (PHD) upon approval of a rezoning of a property to that district. Currently only the Exempla Lutheran hospital campus is zoned PHD. In the City's Mixed Use Districts, hospitals are included in those use charts and are allowed in all of the Mixed Use Commercial (MU -C) Districts and not allowed in the Mixed Use Neighborhood District. Potential Code Amendments Absent any adopted or pending state regulations, it is now appropriate to consider whether any additional local regulations should be considered for adoption. That said, there is not adequate time between now and the current expiration date of the temporary moratorium (April 27, 2017) to give proper consideration to new local regulations on these facilities. Local regulations could include: Modifications to Chapter 26 (Zoning and Development Code) defining freestanding emergency rooms and allowing them to be located in specific zoning districts. Some of the zoning approaches that might be considered would include: o Limiting the number of zoning districts within which they would be allowed o Requiring a special use permit or conditional use permit to authorize these uses o Limiting the total number of such facilities within the City o Establishing certain spacing requirements between such uses and/or between such uses and other existing emergency room facilities o Establishing other operational requirements such as hours of operation Modifications to Chapter 11 (Licensing) creating unique licensing and permitting requirements for freestanding emergency rooms. Certain operational requirements could also be located in this chapter, including the possibility of allowing such licenses only upon a demonstration of "need," relative to the location and spacing of other similar medical facilities. Next Steps As noted previously, new local regulations regarding freestanding emergency rooms have not yet been drafted and various options exist for City Council to consider. Absent any state regulations, local jurisdictions are now able to pursue their own course of action on this matter. With the pending expiration of the moratorium occurring in approximately 6 weeks, City Council has two principle options: tion 1: Allow the temporary moratorium to lapse and do nothing further. In this option, we would default to the existing regulatory environment as previously summarized, generally allowing freestanding emergency rooms in areas zoned PHD or MU -C. Option 2: Consider an ordinance extending the moratorium to allow time for additional regulations to be drafted and considered as an ordinance. It should be noted that amendments to Chapter 26 would also require review and recommendation by the Planning Commission. Staff would recommend a six-month moratorium. Staff would also request preliminary direction as to 2 the manner in which additional regulations should be crafted. An additional substantive study session would then be scheduled to discuss draft regulations and the PC would be engaged in the drafting and review processes. 3 City of Wheatj,!jg,e OFFICE OF THE CITY MANAGER Memorandum TO: Mayor and City Council FROM: Patrick Goff, City Manage Ken Johnstone, Community Development Director DATE: March 2, 2016 (for March 7th Council Meeting) SUBJECT: Freestanding Emergency Rooms Introduction Colorado has recently experienced a substantial growth in freestanding emergency rooms (ERs), increasing from 2 in 2012 to at least 35 by the summer of 2016. There has been one rezoning request to allow for this business model in Wheat Ridge. There has also been a tremendous amount of media coverage around freestanding ERs, primarily focused on patient confusion concerning the difference between freestanding ERs and urgent care centers (see attachments). On November 23, 2015, consensus was reached by City Council to include a discussion concerning freestanding ERs on a future study session agenda. Prior Actions In 2015, an application was received by the City to rezone the property located at the southeast corner of 38th Avenue and Wadsworth Boulevard from mixed-use neighborhood (MU -N) to mixed-use commercial (MU -C). If approved the MU -C zoning would have potentially allowed various commercial and mixed uses. However, the stated intent of the applicant requesting the rezoning was to allow for the construction of a freestanding emergency room on the site. Freestanding ERs are not a specified use in the City's zoning use charts. However, staff has determined the use is similar to both a hospital and medical office use. Based on hours of operation and heavy reliance on customers arriving by ambulance, staff determined these freestanding ERs are most similar to the emergency room activity associated with a hospital. A medical office is allowed in MU -N zone district and both medical offices and hospitals are allowed in MU -C zoning. Hospitals are allowed in a MU -C zone district (upon review and approval of an administrative conditional use permit); but not allowed in MU -N, which is the property's current zoning. Staff presented the rezoning application and a recommendation of approval to Planning Commission at a public hearing on October 1, 2015. By a vote of 4 to 1, the Planning Commission recommended denial of the request for the following reasons: 1. The proposed zone change is unnecessary because sufficient MU -C zoning exists in the immediately adjacent areas located next to the site. 2. The proposed zone change may negatively impact the public health, safety, or welfare of the community. 3. The proposed zone change is not compatible with the surrounding area; that being the church and the adjacent properties that will probably be subjected to zoning change requests in the future. 4. No certificate of need is needed for new hospitals in Colorado, which is an oversight. 5. There is no need for this use and no need for additional MU -C zoning. The rezoning was introduced to City Council on first reading on October 26, 2015. The first reading on the bill was approved 6 to 2. A public hearing was scheduled for November 23, 2015 but the applicant formally withdrew their rezoning application prior to the public hearing. Background As a policy matter, it is appropriate for City Council to consider whether there are operational or other aspects of these businesses that require them to be regulated in a different manner. There are many uses that are called out specifically in the City's municipal code for special regulation. Chapter 11 — Licenses and Permits. By way of example, pawn brokers, marijuana related businesses, amusement arcades, night clubs and social clubs all are subject to special licensing requirements contained in Chapter 11. It could be appropriate to consider requiring freestanding ERs go through a special licensing process to address specific issues of concern. Chapter 26 — Zoning. Various uses are required by Chapter 26 (Zoning and Development) to go through an additional review process. There are dozens of uses that require either special use review or conditional use review (mixed use districts only). Examples of special uses include day care, certain auto related uses, private schools, contractor's yards and certain fueling stations. Even government buildings with outside storage can trigger a special use review. The special use review process starts with a neighborhood meeting and can be reviewed and approved administratively. Under certain circumstances, special use review will come before City Council to approve or deny or approve with conditions. It could be appropriate to consider requiring freestanding ERs to be reviewed as either a special use or conditional use. There are likely various other zoning options that could be considered for application on these facilities, if it is determined that they generate unique impacts in the community or in a neighborhood. The City imposes minimum separation requirements on certain uses. The City has maximum "caps" on the number of billboards and marijuana establishments, which would be another option to consider. Conclusions Staff is requesting preliminary policy direction from City Council whether to conduct additional research regarding freestanding ERs. The intent would be to determine whether any local regulatory changes are needed to address unique impacts associated with this land use and business model. If so directed, staff would recommend additional research and likely conduct some type of convening of affected parties who operate in this or related industries. Attachments 1. Various media articles 2 Free -Standing Emergency Rooms Causing Controversy Critics say simple ERs create more demand and drive up costs Wed, Jul 31, 2013 COLORADO SPRINGS - Here at a tidy suburban shopping strip, in the parking lot near a tanning salon, a Starbucks and a cupcake shop, is a fierce new battleground for precious health care dollars. First Choice is a gleaming, stand-alone emergency room built like a drive-through dry cleaners, set in an affluent neighborhood to signal convenience to consumers - and to rake in profits for private investors. There's no towering hospital attached at the back, no helicopter pad, delivery rooms or surgery suites. But a doctor is always here, they handle hangnails to heart attacks, and regulators allow First Choice to charge high ER prices no matter how trivial the ailment. '"The hospital ER system right now is overburdened," said Andrew Jordan, chief marketing officer for First Choice. "We're the ultimate fix -it shop," senior vice president Heather Weimer said. "We want to fix you and send you up or down to the next level." But critics say free-standing ERs are creating and distorting demand, not just filling it. "What they're doing is driving up the cost of medical care," said Dr. Vince Markovchick, an emeritus professor of emergency medicine and author of the manual "Emergency Medicine Secrets." Free-standing ERs can charge four or five times what an urgent -care center or clinic charges for common problems such as stitches, abdominal pain or sprains. For-profit ERs are siphoning patients with insurance from urban hospitals that need the money to subsidize charity care, Markovchick and others said. Attachment 1 "They play the numbers of being in the right ZIP code," said Dr. Richard Zane, emergency department chair at University of Colorado Hospital. Zane said he expects First Choice to build up to five more ERs in Colorado, and other for- profit competitors will likely follow - none of them good for the system, he added. This First Choice ER on Powers Boulevard is the inaugural outpost for a company that has blanketed Texas with the controversial concept and now has sights on Colorado. With 15 other ERs around Houston and Dallas, First Choice is also renovating a site in Arvada to open early next year. Nonprofit hospital systems also have entered the "freestanding" game, with Banner Health and University of Colorado Health building stand-alone ERs near each other's territory in Greeley. Insurance companies - which spend time these days trying to keep people out of expensive ERs if they don't belong there - and other critics don't like the trend. When beds and exam rooms expand, customers tend to fill them whether they belong there or not. "There's some truth to it that if you build it, they will come," said Dr. Elizabeth Kraft, chief medical officer for Anthem's Blue Cross insurance in Colorado. "There's a learning curve on the patient's part, and they may get a bigger financial hit than they were expecting." Insurers encourage ailing consumers to think twice by boosting penalties for using the ER. Federal rules guarantee insurers will pay for medically necessary ER visits, but they have some freedom to share costs with the patient. Anthem, for example, has co -pays of $150 to $300 for ER visits, versus $10 to $75 for the same treatment at an "urgent care" or other primary doctor's office. Frustrating the health experts is what simple, nonemergency ailments ERs commonly attract: "allergic rhinitis," in other words a runny nose from pollen; headaches, and physicals for summer camps. "At least half of the patients seen in most busy ERs could be safely taken care of in a lower- cost, urgent -care setting," Markovchick said. First Choice executives say they have no more interest in keeping a patient who doesn't belong there than a hospital-based ER. They say First Choice refers non -emergency patients back to their family doctor, if they have one, and frequently writes off charity care. Under state law, and because it's the right thing to do, First Choice doctors say, every patient is given a medical screening by a physician before .any questions are asked about how they are paying. On a recent weekday in Colorado Springs, Olga Thein was brought in with chest pains and a history of heart illness. Dr. Ron Price spent 45 minutes with her, took labs that were done in minutes and determined she was not having a heart attack and offered a prescription. Price said he was calling her cardiologist to report the incident and the tests. The nurse on duty, Erica Miller, said she has worked at all the Colorado Springs ERs, and is doing far more patient care and less bureaucracy at First Choice than at the other locations. "I'm feeling like a nurse instead of a computer technician," she said. State law requires all licensed ERs to have a transfer agreement with a full hospital, and First Choice contracts with both Memorial and Penrose -St. Francis in Colorado Springs. Ambulances do not come to First Choice - all traffic is self-directed; a contracted ambulance is parked outside the front door for emergency transfers to hospitals. None of the ERs are official trauma centers, as only hospital ERs can receive that designation, a First Choice spokeswoman said. First Choice cannot bill Medicare or Medicaid because federal rules require an ER to be part of a full hospital system to get paid. That leads to the criticism from Markovchick and others that the for-profit ERs are only after high -paying private insurance. "The way you make a profit is you avoid anybody who can't pay," Markovchick said. First Choice employees reject that assumption, saying they always give the care needed to the patients who arrive. Thein, for example, was a Medicare and Medicaid patient, and when she walked out the door on the arm of a friend, her bill was written off. Researchers on costs in health care tend to hedge when addressing whether for-profit ERs are exploiting gaps or listening to consumer demand. "Free-standing emergency departments, like a lot of other players in the health care marketplace, tend to go where the well -insured patients are, not necessarily where the need is," said Emily Carrier with the Center for Studying Health System Change in Washington, D.C. "But that's not the same thing as saying that the need isn't there." Consumers are responding to something they want from the inviting new ERs, other analysts note. Other pieces of the health care system might do well to figure out what that is and try to deliver the same service in a less -costly way. Patients who don't have a regular doctor or who like knowing a clean, well -lighted place will take them in at 9 p.m. Friday, for example. Primary-care doctors can provide some of that with night and weekend office hours, access to e-mail or texted advice, and other techniques, Anthem's Kraft said. "Meeting patients where they're at, which is kind of a new concept," Kraft said. By Copyright Q 2016: PennWell Corporation, Tulsa, OK. All Rights Reserved. Serving Arkansas, Louisiana, Texas & Oklahoma A*MdjIIwTMw Home > texarkana > business > longview > doctors > tyler Freestanding Emergency Rooms Bring Competition, Confusion to East Texas Healthcare Questions mount as for-profit, stand-alone ERs arrive in the most affluent Northeast Texas neighborhoods vC SHARE: 72 1 Facebook Twitter More SHARES Q Twoky, ArAwy 12, 2016 Freestanding emergency rooms have been multiplying in Northeast, Texas. However, some patients are confused about the high cost of emergency care at some freestanding ERs they think are lower cost urgent care centers. he phrase "Real ER without the wait" has been heard constantly by people in TTexarkana and the surrounding area in the last few weeks as the city's first freestanding, ER opened with one of the grandest business launches of a new enterprise in recent memory for the Four States Area. Positive press flowed from virtually every local media outlet with widespread TV coverage, radio discussion, newspaper articles, magazine spreads and online media. Soon, Texarkana, Tyler and Longview will have several freestanding ERs in each city, and people in the Ark -La -Tex are beginning to have some questions about the concept of freestanding ERs: Are freestanding ERs "real" emergency rooms? How much should emergency care cost outside of a hospital? Should you go to an urgent care facility, freestanding emergency room or a hospital-based ER? These are just a few of the questions many Ark -La -Tex residents are asking themselves while waiting for doctor's appointments, at dinner and online following a deluge of publicity about Northeast Texas' new freestanding emergency rooms, which are not operated in conjunction with a local hospital. Multiplying like dandelions In the past few months, the Northeast Texas portion of the Ark -La -Tex has seen a land and building boom for new 24/7, freestanding ERs. The first freestanding emergency room just opened in Texarkana, Texas and at least two more are planned for the Texas -side of the city in 2016. Excel ER is scheduled to open in February 2o16 at 4102 Gibson Lane, and Pearland, Texas-based Neighbors Emergency Center will be opening its center in 2016 near Texarkana's famous Bryce's Cafeteria. Ark -La. Texx,m rk La- Texx,m has learned that other emergency centers are under consideration in the Texarkana area from other comers in the healthcare space. Residents of Tyler, Texas already have two freestanding ERs - Excel ER at 6718 S. Broadway and Neighbors Emergency Center at 2222 E. Southeast Loop 32. A new Patients ER has broken ground in the city, and the merger between Tyler Urgent Care and Complete Care will result in a fourth freestanding ER for Tyler in early 2o16. In Longview, Patients ER is being built next to Little Mexico restaurant on McCann Road and Excel ER will open in March 2016 at 120 Clay St. in the city. Recently, Neighbors Emergency Center announced plans to build a new emergency center at the west corner of the Gilmer Road intersection with Loop 281 in Longview. Excel ER has also announced a March 2016 opening for a freestanding ER in Nacogdoches at 1424 North Street, and Excel ER is planning for an expansion into Louisiana in the near future. A welt -respected doctor opens freestanding ER Texarkana Emergency Center is the first freestanding ER in Texarkana and officially opened on December 3. It is located across the street from Central Mall, adjacent to the Texarkana Convention Center and very near Christus St Michael Health System's Emergency Room. The building, which used to be a bank, was purchased during the first half of 2015, and it was listed for sale at $3.4 million by Reynolds Realty Management. The building was constructed in 2007, and it houses over 1o,000 sq.ft. of space. With 14 rooms for treatment (including two triage areas) the Texarkana Emergency Center promises a "Real ER without the wait." Five local emergency room doctors - Bo Kelly, Dallas Bailes, Erik Jacobsen, Kyle Groom and Matthew Young - are on-call at the facility. Local artists have adorned the walls with artistic works, and kids of all ages can enjoy the Netflix and Hulu enabled televisions in each room. In short, Texarkana Emergency Center has a purposefully "cozy" vibe. Possibly the greatest asset of the Texarkana Emergency Center is Matthew Young, medical director. Young, who prefers to go by the name "Matt," is the literal "face" of the new center and now a public figure. With mailers, videos, newspaper ads, online media and TV reports, Young's slight, confident smile is front and center. It is an excellent choice, because Young fits virtually everyone's description of the kind and caring doctor, and he could easily play one on TV if it was not his profession in real life. Young had an all-American childhood growing up with a large Catholic family in Texarkana's Highland Park area under the watchful eye of his beloved father, the late Dr. Mitchell Young and Donna, his mother. Young was an Eagle Scout and attended the University of Arkansas main campus for his undergraduate work and later attended medical school at UA Little Rock. Walk around the hallways of local medical offices in Texarkana where Young was well known as an emergency room physician at Christus St. Michael, and people will tell you that he is a "good doctor and fine person." High praise can also be heard for him around town, and people will often mention his well-respected father, Mitchell. Indeed, the medical tradition is so strong in his family that Young has seven brothers who are medical doctors and one who is a veterinarian. Young's mother, Donna, worked with his father in his medical office, and the tradition continues today. That's because Young's wife, Cindy, is an integral part of the mechanics of the new Texarkana Emergency Center and is its director of operations. Ark -La -Text, spoke briefly with Mrs. Young while she was at the center, but she preferred to let the center's marketing director and her husband do the talking about the business. Putting aside the fine people associated with the new freestanding ER in Texarkana is difficult when such an obviously exceptional person such as Matt Young is involved, but there is controversy about the concept of the freestanding emergency room industry in terms of the high costs involved and the fact that some patients cannot recognize the difference between some of these facilities and urgent care centers. Medicare -free zones Most freestanding emergency rooms that have become a trend in Texas and other states (like Arizona and Colorado) do not have federal recognition and are only recognized by the state. This means they do not accept Medicare or Medicaid. Even though many doctors, nurses and administrators at freestanding ERs will say that they would like to one day accept Medicare and Medicaid, it would probably vastly decrease profitability and it would definitely increase wait times. By accepting Medicare, freestanding ERs would be subject to the Emergency Medical Treatment and Active Labor Act (EMTALA) which would require the centers to provide care to patients who could not afford care, and that would be in addition to the relatively low reimbursements they would receive for patients on Medicare. Hospitals, of course, are bound by these regulations, and some critics argue that freestanding ERs take away patients with private insurance and leave hospitals to take care of society's indigent and elderly. Matt Young of Texarkana Emergency Center said that he would like to accept Medicare, and he has gone online to tell commenters this as well. The non-acceptance of Medicare at the center is mentioned often on the center's Facebook page. In response to one comment, Young replied: "It is unfortunate that we are not allowed to participate in Medicare or Medicaid. Maybe the laws will change." While some owners and employees of freestanding ERs might not be sincere in this statement, the high opinions of Young in the Texarkana community would lead almost anyone to believe that he really does want this change to happen. Nevertheless, centers like the one in Texarkana are required to provide medical screening examinations and stabilize any emergency patient - regardless of the ability to pay. However, some freestanding ERs might actively encourage indigent patients to go to nearby hospital emergency rooms instead of caring for them at their centers. Removing a splinter costs what?l Texas and Colorado have had the greatest growth in freestanding ERs - mainly due to favorable state laws. Ark-La-Texco► reached out to award winning TV reporter Chris Vanderveen of Denver, Colorado's NBC Affiliate, KUSA-TV. Vanderveen spent several months researching Colorado's freestanding ERs, which have expanded exponentially in a short time. Vanderveen, an investigative reporter who won a national Edward R. Murrow Award in 2011 and reported on the shootings at Columbine, said it is estimated that 50% of people entering a freestanding emergency room are not educated about the high costs. The KUSA reporter, who has a brother who is an emergency room physician, said his interest in freestanding emergency rooms stemmed from an email he received from a deck builder who received a $3,690 bill for the removal of a splinter from his thumb. After his private insurance paid the Chris Vanderveen, limit for his emergency care, the deck builder still owed reporter $2,301.6o for the removal of the splinter. xusA-W, Denver, co The reporter said some patients of freestanding ERs feel like they have been the victim of a scam. " I used the huge bill for the splinter as a jumping off point to tell a bigger story," Vanderveer said. "Everything freestanding ERs are doing is within the law, but people are not aware how much it costs." Vanderveer called on people across Denver and other areas of Colorado to send him their statements from freestanding ERs, and he said he was amazed. "We put out a request for people to send us bills from the freestanding ERs, and i was just shocked at how many were three, four and five thousand dollars for minor things," he added. One patient showed Vanderveen her bill for $6,237 when she went to a clinic complaining of shortness of breath. Some tests were run and they eventually told her to go home and "relax." Nevertheless, Vanderveer said that many people believe there is a place for the freestanding emergency rooms in both Texas and Colorado when someone has a legitimate emergency. He added that many of the freestanding ERs have good medical doctors and staff. However, the irony of a new, freestanding ER being housed in a former bank was not lost on the reporter. "The public has no idea what these places cost. A CT scan in one emergency room might cost $i,000 and $8,00o in another. It's a tremendous difference," he added. Indeed, the reporter said that, in his opinion, the future of freestanding emergency rooms is unclear. "People aren't versed on how expensive these things are," Vanderveer said. "The real question they have to face is that once the public is educated about the cost, how many customers will be left for them to stay in operation." Vanderveer said that in Colorado former customers of freestanding ERs have eventually let their friends and neighbors know the costs associated with them. "So it's a real question in my mind whether these places will be open in four years," he said. Why are there so many new freestanding ERs? The quick rise of freestanding ERs has more to do with high profits based on large bills for service. First Choice Emergency Room, which operates over 5o freestanding ERs, charged an average of $1,5oo per patient in 2013 according to a Securities and Exchange Commission prospectus it filed. The problem with this is that in many cases the medical issues are for relatively minor problems that could often be treated equally well in an urgent care or retail clinic setting for sometimes one-tenth of the cost. The main culprit for the high costs in most for-profit, freestanding ERs are the "facility fees" that are allowed to be charged. These fees, which are assessed on a per - patient basis, can routinely be $800 or more at many freestanding emergency rooms, and this drives up costs significantly for each patient. This fee is charged in addition to the bill for service at standard emergency room prices. In addition, many freestanding ERs also allow doctors to bill patients separately. So customers might face two large bills - often arriving in the mail on different days. And this has led to significant sticker shock for patients, according to Alan A. Ayers, associate editor of the Journal of urgent Care Medicine. Ayers said that many freestanding ERs believe they should be able to charge a facility fee because their capabilities are similar to a traditional hospital emergency room. Ayers wrote: "The facility fee [is] a fee historically charged by hospitals to cover the overhead of being prepared to handle any situation that presents - natural disaster, terrorist attack, ambulance diversion, etc., offset losses incurred in treating Medicaid populations and to subsidize charity care/sliding fee scales serving the poor and indigent," said Ayers in widely read paper titled "Dissecting the cost of a Freestanding Emergency Care Visit." However, Ayers argues that the cost structure of freestanding ERs is different than hospital emergency rooms because they are not subject to the aforementioned Emergency Medical Treatment and Active Labor Act (EMTALA), do not accept Medicare and have a lower cost structure than hospital-based emergency rooms. Patients without financial means Some freestanding emergency centers may not tell you this, but they are required by the state of Texas to medically evaluate and stabilize any patient that comes to them regardless of their ability to pay. The Texas Administrative Code that governs freestanding ERs specifically states this. fib A facility shall provide to each patient, without regard to the individual's ability to pay, an appropriate medical screening, examination, and stabilization within the facility's capability, including ancillary services routinely available to the facility, to determine whether an emergency medical condition exists and snail provide any necessary stabilizing treatment. Texas Administrative Code The problem with this is that some freestanding ERs do whatever they can to discourage people from coming to them without private insurance or the ability to self -pay. If that doesn't work, some freestanding ERs might try to have poor patients transported to a local hospital who must care for the patient due to EMTALA after the freestanding clinic has met the minimum state guidelines. In addition, many potential patients of freestanding ERs will be referred to a hospital-based emergency room before they even see a doctor or told incorrectly that payment must be made in full for any visit to the facility. We discovered some problems first-hand. An Ark-La-Texxom reporter called Texarkana Emergency Center on Friday December 4 at approximately 3:35 am. The reporter asked what the cost would be for him to be seen for his knee injury without insurance. In a somewhat discouraging tone, an employee told him the entire visit would have to be paid for in full at the time of service with no billing option. The reporter asked how much it would cost, and he was not given an answer. Finally, the reporter asked if the center was required to treat him by law, and the woman paused and then gave a somewhat terse "yes." The call ended. The shocked reporter then called back a few minutes later. He asked the same employee how he would know if he could "pay in full" without being given a price, and she offered a fee of $250.00 to be evaluated by the doctor. Then, she said, the reporter would be advised of the additional cost for treatment before care was given. Around noon the next day on Saturday, December 5, the same reporter called Texarkana Emergency Center again and asked a different employee about the cost to have his knee treated. During this call, he was offered a free medical evaluation by a doctor which would be followed by an estimate of the cost of treatment. It is unknown whether our multiple inquiries for this article about the center in the previous 24 hours had caused a change of policy or if the discouraging employee had mistakenly provided incorrect information because the freestanding ER and the employees are all new. For the record, the medical staff of Texas freestanding ERs are required to medically evaluate any patients who present themselves with an emergency and stabilize their condition if needed - regardless if they are rich, poor or somewhere in between. Wealthy zip -codes Texas was the first state to allow freestanding ERs not attached to hospitals in 2009, but the legislature really meant for these facilities to be placed in rural areas in need of emergency rooms. There were only about 20 Texas freestanding ERs in 2olo, and the number is closer to 200 in Texas today. However, it is not rural areas who are getting freestanding ERs, because affluent Texas suburban communities are where you will find the majority of these facilities. Because wealthier areas of larger cities were home to most of the original group of freestanding ERs, now the freestanding ERs are branching out to higher income neighborhoods in mid-size Texas cities, such as Tyler, Longview and Texarkana. A study by the Texas Tribune in 2015 showed that the income -level of the neighborhoods with freestanding ERs is 49% above the average state income. This is no surprise because freestanding ERs need patients with private insurance who are then able to afford the balance not covered by insurance Health economist Vivian Ho of the Baker institute for Public Policy at Rice University, said freestanding ERs will not be opening in lower income neighborhoods anytime soon. She said that patients in these communities would need to buy insurance and make sure it was in -network with the emergency center. Insurance confusion Because more and more freestanding ERs are being built in Texas, many of them are becoming more likely to be covered in -network by health insurance plans. However, most patients who arrive at freestanding ERs are out -of -network. Nevertheless, freestanding ERs have been helped by the "Prudent layperson standard," which was included in the "Patients Bill of Rights" of 199s. It allows a person to be medically evaluated if they believe they have an emergency medical condition, and this standard was adopted for Medicare patients in 1997. While health care companies and health insurance companies continue to debate the the "Prudent layperson standard," freestanding ERs are using this standard to force health insurance companies to pay for emergency care - even though some people use freestanding ERs for minor issues such as mild nasal congestion. Earlier this year, one woman complained to a Dallas Fort Worth TV news station about the cost for treatment of her runny nose. She just wanted some quick care for nasal drip so she could resume regular activities with her family over a holiday weekend, but her bill was $73 from the doctor plus a $98o facility fee from the freestanding ER. This will seem excessive to almost everyone, but some freestanding ER advocates argue that higher charges are justified because all patients are seen by an emergency room doctor and emergency staff - not a nurse practitioners, which is sometimes the case at urgent care centers. But freestanding ERs, which have been estimated to break even with an average of only 35-40 patients a day - compared to iso patients on average for most hospital- based ERs - are sometimes more than happy to treat a stuffy nose complaint. While some freestanding ERs will refer patients with this type of minor complaint to an urgent care, others will treat them with emergency care and charge the full rate of service. However, the cost differential can be startling to consumers, because care at freestanding ERs is covered under the emergency care provisions in private health insurance and not at the rates and co -pays assessed for doctor's visits or urgent care. To try and steer people away from seeking emergency care for inappropriate circumstances, many insurance companies make patients responsible for the first $500 - $1500 (or more) of emergency care. While someone might have a $40 co -pay at an urgent care clinic, a patient might be responsible for a cost up to ten times at a freestanding ER. After insurance has paid its part of a trip to a freestanding emergency center, some patients are shocked to get a bill for the remaining cost of care from both the freestanding ER and possibly a separate bill from the doctor as well. Deciding where to get treatment Knowing when to go to a freestanding ER is one of the hardest things for consumers to understand based upon online discussions. We wanted to ask an industry spokesman directly, and Ark -La -Tex cm briefly spoke with Brad Shields, executive director of the Texas Association of Freestanding Emergency Centers (TAFEC). Unfortunately, it was a Friday afternoon and Shields was not able to talk, but we were put in touch with TAFEC board member Marysol Imler. She directs both operations and planning at Five Star ER, which has several Texas locations. Imler said the best times to go to a freestanding ER are when a patient can't wait for a doctor's visit. "Freestanding emergency rooms are great options for severe stomach aches, chest pain, and orthopedic injuries, to name a few," she said. "Such facilities are typically capable of handling most any condition for which you might otherwise visit a hospital-based ER." Angela Evans, director of community education at Healthcare Express, said the new freestanding ERs are confusing to patients, and she has been trying to help educate consumers. "I do think it is confusing if you don't work in the industry," Evans said. "If you go to the Texarkana Emergency Center for a non -emergency, your co -pay will be much higher in most cases." Evans said insurance carriers prefer urgent care over freestanding ERs. "A lot of people don't know this, but your insurance carrier wants you to go to an urgent care, and patients will be seen in the order they arrived at urgent care," Evans said. "With emergency care, the patients with the most serious issues will be seen first." Healthcare Express is a growing, Texarkana -based company with several urgent care clinics in cities all around the Ark -La -Tex. They also own pain management, imaging and physical therapy clinics. Realizing the confusion, Angela Evans created an infographic for patients to use when deciding whether to utilize urgent care or emergency care. "If someone is suffering a major trauma, we will send them to local hospitals," she added. "But you will save time and money coming to us for most things. " Evans said Healthcare Express will be moving to a 24-hour service commitment at its Richmond Road clinic in Texarkana beginning January 2, 2016. "It was feedback from our patients that helped us decide to make this change," she said. "If your child is suffering a high fever in the middle of the night, there will now be a cost-effective place to go." Tonya Dubois, a physician's assistant and owner of Exceed Urgent Care at 3726 Mall Drive in Texarkana, also said the opening of the Texarkana Emergency Center had created some confusion, and she said patients need to look at the huge difference in insurance co -pays when utilizing urgent care versus freestanding ERs. "People I have talked to don't realize that you will be paying emergency room prices at freestanding ERs, and our co -pays are significantly less at an urgent care," Dubois said. "We have contracted with insurance so we have to charge you what we have already agreed, and we accept Medicare. Since we have already negotiated with insurance companies, it protects the consumer from surprise medical bills for emergency care that insurance won't pay for." With Excel ER moving into the Texarkana market soon, there is the possibility that some customers could confuse Excel ER with the urgent care center named "Exceed" that she owns. However, Dubois has a simple response for that. "If it's non -life- threatening, come to urgent care," she said Partnering with hospitals Freestanding emergency rooms present a difficult conundrum for hospitals. On the one hand, the new, freestanding ERs provide competition to their hospital emergency rooms. However, the new facilities can also feed more patients to hospitals. Nevertheless, all of the new, area freestanding ERs must work with local hospitals to treat patients which have problems outside of their capabilities or patients in need of care for more than 23 hours. Local freestanding ERs can stabilize and observe patients for up to 23 hours, but a hospital stay is required for any time longer than that because it is considered inpatient care. Ark-La-Texxo, spoke with representatives from both of the major hospitals in Texarkana about the confusion generated by the press coverage of the new Texarkana Emergency Center. Some citizens believed the new center was officially affiliated with at least one of the local hospitals, because some news reports discussed the cooperation between local hospitals and the new freestanding ER. Shelby Brown, director of marketing at Wadley Regional Medical Center, said her hospital wants to work with all emergency services in the area, including ambulance services and the new Texarkana Emergency Center. "We want great relations with everyone in the healthcare market," she said. "If a freestanding ER has a patient that needs to be hospitalized, we want to care for them." Brown also said that patients should remember that Wadley was the Four States Area's first certified stroke center. "We want everyone to know that we offer stroke victims timely care to make sure they are taken care of with the best emergency care that results in the least amount of debilitation possible," she added. Wadley Regional Medical Center recently purchased 55 acres near Gander Mountain and close to I-30, but the hospital is not commenting on plans for the acreage as it makes plans for future growth in Texarkana. Francine Francis, director of marketing and community relations at Christos St. Michael Health System, said her hospital has good relations with the new Texarkana Emergency Center. She said the hospital had already received a few patients from the center. "I can certainly confirm that they have admitted patients," Francis said. "Our relationship is that we are available for transfer for conditions that are more serious and when a patient needs to be admitted to the hospital." The community relations director admitted it was difficult for prospective patients to know where to go for emergency care with the new options. "It is very dependent on the level of care that you need," Francis said. "But if you have something that is fairly serious like a heart attack or stroke, this is where a hospital emergency room can help. We have significant in-house resources and specialists - including surgical specialists - that can be available immediately because they are on call 24/7." Hospitals are also moving into the freestanding ER space, and Francis said she "doesn't know if there is a possibility" that Christus St. Michael might one day open a freestanding ER. The University of Colorado Health System purchased a majority stake in more than a dozen Colorado freestanding ERs owned by Lewisville, Texas- based Adeptus Health. Adeptus operates Flower Mound, Texas-based First Choice Emergency Rooms with more than 50 freestanding ERs. Industry experts expect more health systems to branch out with freestanding emergency rooms if the trend proves financially lucrative and helpful to the community. Indeed, some of the new Ark -La - Tex -owned, for-profit ERs could be purchased by hospitals and health care centers in the coming years. We reached out to the freestanding ERs purchased by UC Health System and were surprised to learn that they still do not accept Medicare and are also stili under the auspices of a corporate office in Texas according to a person answering the phone at one of the freestanding ERs. Legislative action In early 2015, State Sen. Charles Schwertner (R -Georgetown), an orthopedic surgeon, said he had grown tired of hearing about "sticker shock" for relatively minor medical problems from freestanding ERs. Schwertner said he was "regularly" hearing from constituents who were confused about whether a facility was an urgent care or a freestanding emergency room. The senator said that "confusion quickly turns to frustration and anger" when a large unexpected bill arrives from a freestanding ER. To help alleviate at least some of the problems, Schwertner authored Texas Senate Bill 425 (SB425) in the 84th Legislature that required freestanding ERs to post important information about their services so Texas consumers would know that they would be paying for emergency services and not urgent care. The bill was passed by both the Texas Senate and Texas House and was signed by Governor Greg Abbott - effective September 1, Charles Schwertner, State Senator, R -Georgetown, Orthopedic Surgeon 2015. The law requires freestanding ERs to place vital information prominently in their office and on their website no later than January 2, 2016. Freestanding ERs must each post that: • The facility is an emergency room. • The facility charges rates comparable to a hospital emergency department, including a possible facility fee. • The physician may bill separately from the facility. • The facility and facility -based physicians may not be a participating provider in an individual's health plan network. Gary VanDeaver, who represents Texarkana in the Texas House of Representatives, voted for the provision, and he told Ark -La. Textw, that area families deserved the consumer protection. "To me, it is just wise from a truth in advertising perspective that people know up -front what kind of service they will be getting and what they will be paying," VanDeaver said. As previously mentioned, the state of Colorado has also seen Gary VanDeauer, massive growth in freestanding ERs, but legislation has been faster State in Texas. Chris Vanderveen, a Denver area TV news reporter from Representative, station KUSA, said a move from legislators in his state might come R -Aleut Boston about in the next year. Irene Aguilar, a Colorado state senator (D -Denver), said her state had traditionally embraced healthcare and freestanding emergency rooms without added regulations since some facilities would open during busy tourist times - for instance, during ski season. However, she told the reporter that the rules that were intended for rural areas needing emergency care may have "played into the business model" of freestanding ERs opening in the wealthiest suburban areas of Colorado. Experts predict the state will have 35-40 freestanding ERs by the summer of 2016. The benefits of freestanding emergency rooms For all the talk about the cost of freestanding ERs, it is clear that they have saved lives and will continue to do so. While some freestanding emergency rooms might be confused by consumers as an urgent care center, it appears that Texarkana Emergency Center has gone out of its way to look like an emergency room. Indeed, at night, the location could be easily confused as a hospital-based emergency room with its tall 40" illuminated letters that proclaim "ER" on three sides along with a large medical cross. Lit signs simply saying "Emergency" with arrows also direct potential patients into the parking lot, and the location has a large ambulance entrance on the side of the building nearest the Texarkana Convention Center. Besides being popular in the city of Texarkana, the medical director of the Texarkana Emergency Center, Matt Young, has an unmistakably friendly, Texarkana drawl, which is somewhat reminiscent of Ross Perot, who also grew up in the Highland Park area of the city and was a boyhood friend of Young's late father, Mitchell. By all accounts, virtually everyone spoken to by Ark -La -Tex.«„ seems to agree that going to see a well-respected and trusted doctor such as Young in an emergency situation is "worth every penny" - to quote one Texarkana citizen we spoke with at a local medical office. And even the most vocal critics of freestanding ERs usually will admit that there is a place in the healthcare marketplace for freestanding ERs. "We are more patient friendly, and you don't have to park in a remote parking lot" Young told us. "We can do as much as a hospital-based emergency room." Young also pointed to his freestanding ER's waiting times of ten minutes or less as a major point of difference in the local healthcare market. The biggest reason for the rise in freestanding ERs is patient waiting times, and with Texarkana Emergency Center you are getting the cream of the crop in people and facilities," he said. The slogan for the facility is "Real ER without the wait," and the medical director defended the use of the phrase. "We are a real ER without the wait up to the point of hospitalization," Young said. With a trusted local doctor and shimmering new facilities, this particular freestanding ER could and should be a shining star for the industry in the state of Texas. With millions spent on the new facility (Young would not give exact figures), many customers in the Texarkana area say they know it is emergency care, and they are %rilling to pay the price when it comes to an emergency with their friends or family. "We made a huge investment in the healthcare of our community, and we are now part of the community's healthcare." Young said. Marysol Imler, board member of the Texas Association of Freestanding Emergency Centers, also pointed out the benefits of the Texas facilities. "Freestanding ERs are equipped to provide quick, convenient emergency medical care in a comfortable environment," Imler said. "The combination of in-house x-ray, ultrasound, CT imaging, and onsite laboratory services (not typically available in an urgent care setting) gives physicians in freestanding ERs the information they need to rapidly diagnose and treat a medical emergency. Like traditional emergency rooms, freestanding ERs are open 24/7." s long as Ark -La -Tex consumers have the facts, freestanding ERs can make Aa positive impact in communities. However, the emergence of these facUities has led local healthcare industry officials to ask even more questions: Will there be enough emergency doctors? And, if so, where will they come from? Will more doctors leave hospital-based emergency rooms or will emergency doctors from outside Texas fill the void? If doctors leave hospitals, it is a serious public health matter, because Texas citizens in the most peril and in need of care usually end up in hospital-based emergency rooms. And the exit of some doctors in hospital emergency rooms has already happened in Houston, Dallas and Corpus Christi, where freestanding ERs have been present in the health marketplace for some time. Nevertheless, patients walking out of Texarkana Emergency Center seem to be pleased with a high level of care, and medial director Matt Young's rave reviews might easily have patients clamoring for his attention at virtually any price with his admirable aim of fast, comfortable, concierge care for every patient. Moreover, price is not an object to many people when it comes to the sickness of a child or a grandmother who has a bad case of flu and needs intravenous hydration at a freestanding ER - especially since many Ark -La -Tex residents die every year from flu. However, potential patients should educate themselves at the start of each year about their own insurance co -pay for emergency care versus doctor visits or urgent care. With this information, Texas healthcare consumers will have all the information they need to make informed decisions about care. For a topic that sparks so much confusion, one thing is clear: Freestanding ERs have already started to disrupt the healthcare market in Northeast Texas, and the long- term consequences of the presence of multiple facilities in Texarkana, Tyler and Longview could have a lasting impact on patient care, availability of doctors, insurance cost and patient pocketbooks for the foreseeable future. In the meantime, Matt Young and his staff are at their center across from Central Mall waiting for patients right now, and it is very likely that informed consumers who know the price of emergency care will continue to offer high praise for a well-run, customer -centric freestanding ER. But less informed consumers at any freestanding ER could be in for a real expensive surprise. ©Ark-La-Tex.com About the author: J. Jones is a graduate of the Walter J Lemke School of Journalism at the University of Arkansas - Fayetteville. His articles have appeared in over SOD newspapers in the United States, including some of the largest newspapers in America (USA Today and the Chicago Sun -Times) and smallest ones in Arkansas while covering Bill Clinton as governor. He has been a proud resident of the Ark -La -Tex since his childhood. 0 2016 Ark-La-Tex,com News All rights reserved. Buyer beware: Freestanding emergency rooms 9WANTS TO KNOW SPENT MONTHS LOOKING INTO THE BILLING PRACTICES Of SO- CALLED FREESTANDING EMERGENCY ROOMS, NAMED BECAUSE THEY ARE NOT ATTACHED TO HOSPITALS. SHARE THIS Stoat 2.420 KUSA - They are popping up in places once taken up by Blockbuster Video and Chgis: freestanding emergency rooms Supporters say the explosive growth of freestanding ERs is good for consumers. Critics point to people tike Jeff Nixon as proof of a costly downside Nixon, a deck builder, got a splinter in his thumb in April. Unable to pry H out himself, he went to a First Choice ER near South Kipling Parkway and West Bowies Avenue. In an how, the splinter was out. `Yeah. they were nice enough.* Nixon said A month later, he opened his WC and no longer considered the staff "sloe enough." 'Yeah. ended up being $3.690 to get a Over taken out of my thumb.' he said. Technically, atter his insurance kicked in. his till came out to $2.301.60. He cornpiained repeatedly but was told over and over again he would have to pay it "1 wish it was a joke." he said. ,iArlaaon 9Wants to Know spent months looking into the billing practices of so-called freestanding emergency rooms. named because they are not attached to hospitals What was found is a situation that should be considered a consurner alert. Now much was your free-standx►g emergency Mom bats Send us yow M by using this form httpJAvw►v 9news.aon✓storv/newsrhe8tt1120f5H7Jf6fiow mud► was-vaur-uroant- 4ere-bi11/7�5,70321fhXa:JAvww.9new3,00m/sl m"owarhemMh/201W11110ow�rrtuch-was• r-urognt-care-bitt1756570324 or email ahowusyourbills@9news. com. PIZ •.. 1 P R i WT -T F,.q I nro,• • VAI 4 �htln:;rw•u N.9nrws.crnnrstk+re tnrws�lranith2a i 5N I,IlbfiOw"-muCik-Nas-sp kir-, urernl-care-bit ;6170321} M 2015 KUW SNEM a 4 p nL 1IMML SHARE THIS STORY .nFua... ll 2015 9Nev+t 7V to other words, a patient with a low-level problem PRIM*: 041M should not be billed at an emergency -room rate. Injured in an Accident? x Need an Attorney? We H4Inlured Ptgle . 0 G Urgent care vs. emergency room care Dr. Vivian Ho works at Rice University's Baker Institute for Public Policy and has been a vocal critic of the freestanding emergency room model_ 'Under the current model, l think freestanding emergency rooms aro relying on an uninformed patient to make the profits they we earning right now.' she said. 'For most people. i don't think they re good Anthem Blue Goss/Blue Shield of C41 rado estimates 60 to 70 percent of their customers who go to freestanding emergency rooms have conditions that could be treated In urgent cares. The insurance company also says the average bill from a Colorado urgent care is dose to $200. The average bin at a freestanding emergency room is closer to S2.300. Dr. Ho seal, in the end. irs largely up to the patient to know more about Ns or her health insurance plan. 'The more information we can get to consumers and patients about prices of health-care services, the better Owy'8 be able to choose a doctor or other health care provider! Dr. Ho said. Dr. Zane said more transparency is coming. "1 think cost transparency is something (hat's talked about often in medicine, and I think the more transparent we are the better.* Dr. Zane said. Or Richard Zane heads UCHeallh ER and told Je"nilow Mme" ra+oa WWMs 9Wants to Know the bills are in kne with industry standards The cost of emergency care is relatively the same whether you go to a hmstar4ng emergency dopaMnont or a hospital-based emergency department." Dr. Zane said "And we clearly say we are an emergency department. We are unambiguous about being an emergency department. Each of the UCHeagh ERs has a CT scan. X-ray, and board eertibed emergency room physicians in the building at all hours of the day. There is a cost associated with that level of care." 9Wants To Know asked Dr. Zane if the bill for Nixon's splinter removal seemed a Wt excessive. •I cant tell you apeatecs about specific patients. but there is a cost associated with health care." he replied. Currently, the only Insurance that is in network with UCHealth ER is Anthem Blue CrossSue Shield Dr. Zane said theta are pians to add more insurance companies to "in - network' tare soon. M addition. UCHealth ER does not take Mede. Medicaid or ThCare. Dr. Zane said that should change sometkno in 2016. gums at • ".11MOMe. Injured in an Accident?)) Ib NeW an A='ft7? We H4 b*-d'P-pk E] dO Courteous yet confused staff Over the course of a month-and-a-half. Manns to Know visited nine freestanding emergency rooms along the Front Range with undercoyer cameras. Each lime Merits To Know walked in the door, workers greeted us with the same sentence: "Mtoome to our emergency room Signs noting the buildings were -emergency rooms" were in a number of visible locations. Merits To Know went in looking for specifics about bitting practices. Each f rne, it was told roughly the same story. "it depends on the level of caro." 'We wouldn't be able to give you a price H that's what you're asking' another said. Irs the quandary associated with health care in general Ws nearly impossible to know what the cost will be before treatment is received. The problem exists at a time when many people are signing on or being forced into high• deductible health -insurance plans that put them on the hook for thousands out of their own pockets at first Nixon assumed his splinter removal might run him a few hundred dollars. Doug Linder visited a UCHealth ER in August with a Wt finger. He never anticipated his bill for a few stiches wouid lead to a bill of more than S3.000. "We had no idea we were going to get slammed with this," his wife Teresa said. "Honestly. it just sucks.' A low employees at UCHealth ER did ten us they try to be honest with patients who might be better served at an urgent tare. `1 try to lel people know that. because 1 don't want you to get a $6,000 bill in the mail for you kid having a strep throat." one saki. Another told us of a few urgent -care clinics nearby. Others acknowledged patients remain confused. 'I actually had a patient tett me once. 'Oh. 1 thought you were just calling yourself an emergency room to be cute.' another admtlled. Dr. Zane said the UCHealth ERs oouldn t be more transparent however. As for ambiguity of lost. he said, it's an issue with health care in general. "It`s probably true tot mast of health care' Dr. Zane said. Centura Health, in an effort to bill "based on the levet of service." announced it pians on opening four hybrid urgent carettreestandmg emergency rooms. The model, conceivably, would allow patients with, (or example, splinters in their thumbs to go to the lower cost urgent care for service 'We are treating the patient at the level they need.' Jennifer Wills, spokesperson for Centura. said. `If they need urgent care. they will be seers at the urgent care level." or. Rkhwd Zrhe Uy — pvvaw upIn pt-- — tram up by VW wd.o aed ChW*: lie kN O q *RW2Wy rot 9armM9PAV 11116116. b. Colorado is promoting massive growth of freestanding ERs At the start of 2012, Colorado had two freestanding emergency rooms. As of November 20M there are 24 MAA: Where are the freestanding ERs and urgent cares in your neighborhood: http4jont3ne ars tWjNXW (Mlo&�.ty/f NX#w2F] lilt• 11. . J! �.{ •.l.!-�f,: i- !J71 ^:� Lit!A. 1 „e -.1_+I.' 1'.!1 •. t t. ::t7 I L_ 1. 1 A to records and company announcements reviewed by 9Wants to Know. there will be at least 55 by the summer of 2016. h tltitnlr our twat areas set us up to have rules that may have inadVeertenily played into the business model,* Colorado state Senator Irene Aguilar (D -Denver) said. Sen. Aguilar explained that. historicaby. Colorado has embraced and hesitated to regulate freestanding ERs because the slate didn't want to dissuade any from gang int, areas that might" have the kind of population to support a hospitalh was not uncommon. for example, for freestanding emergency rooms to open seasonally in ski areas. Also in Colorado, there is no requirement for operators to seek what's known as a Cerlificate of Needin slates where one is required, operators must prove to govemment regulators of the need for a medical facility in a particular area. The assumption Is overbuilding can Lead to an unnecessary Increase of health-care cost as operators raise prices to justify building and equipment purchases. Many heetnarket supporters feel the regulation is unnecessary as it tants compefibon Sen Agutler disagrees, and in 2014, she sponsored legislation to make h more difficult to run freestanding ERs. 'I personally thunk their billing practices are unethical. I think they're taking advantage of a loophole we have in our low,* she said. Settlor k w Agwlar 104)w wl (Prato wuewa� That 'loophole" allows freestanding ERs to charge what's known as a facility fee to every patient who receives care. Hospitals have "charged facility fees to justify the 24-hour nature of ERs as well as the fact that, under federal law, all ERs have to screen patients no matter of their ability to pay While that law applies to freestanding emergency rooms as well. critics suggest many freestanding ER owners cherry -pick areas of ft stale where people are more inclined to have Insurance In addition. the freestanding ERs typically send patients, sometarres via a costly ambulance ride. to hospitals when something like a surgery is required. Sen. Aguilar tried and failed to convince the legislature to forbid freestanding ERs to charge facility fees in 2014. gWants to Know has obtained bilis from patients which show the facility charge at the state's largest chain of freestanding ERs to be anywhere from $700 to $6,200. UCHeafth ER bought the majority stake In all of the Frost Choice ERs in Colorado earlier in 2015 it now operates 14 freestanding ERs with plans to build more. Jennifer Martin went to a Fwst Choice ER in ,Aute. Her bill shows a facility charge of $6,237. She came there with shortness of breath. "I thought it was an asthma attack or an allergic reaction she said. She said the staff was friendly and ran numerous tests to by to figure out what was going on, but -uli ately they sent me home and told me I needed to relax A few weeks later, she opened her bill and nearly fainted "I just feel like it was misleading.' she said Freestanding Emergency Rooms • Recently in Colorado and elsewhere across the country, there has been an increase in what are commonly referred to as Freestanding Emergency Rooms • These facilities provide emergency medical services similar to a hospital emergency room and beyond was is provided at a typical urgent care. They cannot accept patients requiring in-patient treatment and they cannot generally take Medicaid and Medicare patients • The topic has received a fair amount of media attention and has been discussed in the state legislature as well • Based on this new land use trend, at your November 23 CC meeting you directed staff to place the topic on a future CC agenda. We had scheduled this initially for a date back in January; however, the meeting ran late and we were not able to get to this agenda item • The conversation tonight is designed to be very preliminary to determine whether CC is interested in researching the topic further and consider whether any additional regulatory approaches would be appropriate • The City has received a couple of land use inquiries for these uses and Staff has made the determination that the use is most similar to a hospital in our zoning definitions and use charts • There is actually a zone district specifically tailored to hospitals — PHD, which makes allowances for taller building heights • Hospitals are not listed in our commercial use charts and therefor the default position is that they are not allowed • In our mixed use zone districts, which are very common along Wadsworth and 38th Avenue, the hospitals would be allowed in MU -C, with a conditional use permit, but not allowed in MU -N • In our staff memo, we provide a very general description of two primary regulatory options that might be appropriate to consider o Chapter 5 pertains to licensing and there are several specific uses in that chapter that are subject to a distinct review and approval process and regulated in specific ways o Chapter 26 pertains to zoning and similarly, there are various uses that trigger either a special use permit or a conditional use permit, which can be reviewed either administratively or in some cases through a City Council public hearing o There are various other zoning options that could be available, including prohibiting them in certain zone districts, limiting the total number allowed, instituting spacing requirements, etc. • If CC wishes to analyze this topic further, it might also be appropriate to engage the affected industry in some manner for a better understanding of impacts and issues City of W heat Ridge ITEM NO: -J DATE: March 28, 2016 REQUEST FOR CITY COUNCIL ACTION tmc�,s i� TITLE: COUNCIL BILL NO. 05-2016 - AN ORDINANCE IMPOSING A TEMPORARY MORATORIUM ON THE SUBMISSION, ACCEPTANCE, PROCESSING, AND APPROVAL OF APPLICATIONS AND REQUESTS FOR A PERMIT, LICENSE, LAND USE APPROVAL OR OTHER APPROVAL FOR A FREESTANDING EMERGENCY ROOM FACILITY ❑ PUBLIC HEARING ❑ BIDS/MOTIONS ❑ RESOLUTIONS QUASI-JUDICIAL: i City Attorney ® ORDINANCES FOR 1 ST READING (03/28/16) ❑ ORDINANCES FOR 2ND READING (04/11/16) ❑ YES /1 • . odt�_ e I City Manager ISSUE: This Ordinance imposes a 365 -day moratorium on the submission, acceptance, processing and approval of applications and requests related to freestanding emergency room facilities. The purpose of the moratorium is to allow the Council to evaluate - and amend, if appropriate - the City's existing regulations that address the zoning and licensing of these facilities. PRIOR ACTION: Council discussed this issue on March 7, 2016, and directed that a moratorium ordinance be prepared. FINANCIAL IMPACT: The potential loss of license, permit, application and similar fees associated with applications for freestanding emergency room (ER) facilities over the next year is likely nominal. BACKGROUND: Freestanding ERs are increasing in number and popularity. In Colorado, the number of freestanding ERs has risen from two in 2012 to at least 35 by this summer. These facilities provide emergency medical treatment and care similar to a hospital-based ER. Ambulances deliver to these Council Action Form — ER Moratorium March 28, 2016 Page 2 freestanding facilities and many offer more sophisticated on-site services — such as radiology and lab services — than urgent care facilities. These types of facilities are not currently licensed or regulated by the state. Freestanding ERs likely generate land use impacts that are more akin to hospitals than to other medical facilities, such as clinics, doctor's offices and urgent -care facilities. Unlike these other types of medical facilities, freestanding ERs accommodate ambulance and other emergency -vehicle traffic and they are often open 24/7. They produce light, noise, glare and traffic beyond that of a non -emergent medical care facility. It is therefore appropriate to study and evaluate whether the City's existing zoning regulations adequately address freestanding ER facilities. There have been a number of recent media stories on freestanding ERs and patient confusion between freestanding ERs and urgent care facilities. Because freestanding ERs are not currently licensed or regulated by the state, patients may also be uninformed about the relative costs, benefits, advantages and disadvantages of visiting a freestanding ER versus a hospital-based ER. It is therefore appropriate for Council to study and evaluate whether the City should enter the licensing fray and adopt some local licensing requirements for freestanding ERs. This Ordinance maintains the status quo of freestanding ERs within the City (none) while the Council studies the policy issues and adopts further legislation if it deems appropriate. OPTIONS FOR COUNCIL ACTION: 1. Approve the ordinance as presented on first reading; 2. Approve the ordinance on first reading with amendment(s); or 3. Postpone consideration of the ordinance indefinitely. RECOMMENDED MOTIONS: "I move to approve Council Bill No. 05-2016, an ordinance imposing a temporary moratorium on the submission, acceptance, processing and approval of applications and requests for a permit, license, land use approval or other approval for a freestanding emergency room facility, on first reading, order it published, public hearing set for Monday, April 11, 2016, at 7:00 p.m. in City Council Chambers, and that it take effect fifteen (15) days after final publication." Or, "I move to postpone indefinitely Council Bill No. 05-2016 an ordinance imposing a temporary moratorium on the submission, acceptance, processing and approval of applications and requests for a permit, license, land use approval or other approval for a freestanding emergency room facility, for the following reason(s) " REPORT PREPARED BY; Carmen Beery, City Attorney's Office Gerald Dahl, City Attorney Patrick Goff, City Manager ATTACHMENTS: Council Action Form — ER Moratorium March 28, 2016 Page 3 1. Council Bill No. 05-2016 2. March 2, 2016 Staff Memorandum CITY OF WHEAT RIDGE, COLORADO INTRODUCED BY COUNCIL MEMBER Council Bill No. 05 Ordinance No. Series 2016 TITLE: AN ORDINANCE IMPOSING A TEMPORARY MORATORIUM ON THE SUBMISSION, ACCEPTANCE, PROCESSING, AND APPROVAL OF APPLICATIONS AND REQUESTS FOR A PERMIT, LICENSE, LAND USE APPROVAL OR OTHER APPROVAL FOR A FREESTANDING EMERGENCY ROOM FACILITY WHEREAS, the City of Wheat Ridge ("City") is a home rule municipality operating under a charter adopted pursuant to Article XX of the Colorado Constitution and vested with the authority by that article and the Colorado Revised Statutes to enact laws to govern and regulate the use of land within its territory; and WHEREAS, pursuant to this authority, the Wheat Ridge City Council ("Council") previously adopted local land use regulations, codified as Chapter 26 of the Wheat Ridge Code of Laws ("Code"); and WHEREAS, the City's zoning regulations currently permit freestanding emergency room facilities to locate within the Mixed Use -Commercial and Planned Hospital Development zone districts; and WHEREAS, the Council finds that freestanding emergency room facilities may cause land use impacts that are different than those caused by other detached health care facilities due to the extended hours that emergency facilities may be open; and WHEREAS, in response to the increase in the number and popularity of freestanding emergency room facilities over the past several years, the Council finds and determines that it is necessary and desirable to examine the City's zoning laws and business licensing regulations governing freestanding emergency room facilities to ensure that they are appropriately located; and WHEREAS, to prevent the further location of freestanding emergency room facilities in potentially inappropriate locations while the Council studies the issue, the Council desires to impose a moratorium on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility, commencing upon the effective date of this Ordinance and expiring 365 days thereafter; and WHEREAS, the imposition of a moratorium on the submission, acceptance, processing, and approval of all applications and requests for a City permit, license, land use approval or other approval is reasonable in time and scope and would not cause an unnecessary hardship upon or unreasonably prejudice any party. Attachment 1 NOW THEREFORE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF WHEAT RIDGE, COLORADO: Section 1. Findings. The above and foregoing findings are hereby incorporated by this reference as specific findings and determinations of the Council. Section 2. Temporary Moratorium. A temporary moratorium is hereby imposed on the submission, acceptance, processing, and approval of ail applications and requests for a City permit, license, land use approval or other approval for any freestanding emergency room facility. The City staff is directed to refuse to accept for filing, and not to further process or review any pending applications or requests for such facilities during the moratorium period. Section 3. Definition of freestanding emergency room facility. For purposes of this Ordinance, a "freestanding emergency room facility" is and means a medical facility that is not physically attached to a hospital facility that has the capability of providing medical care and services to patients with emergency medical conditions in a manner similar to emergency rooms located within hospitals. Features of a freestanding emergency room facility may include, but are not limited to, expanded hours of operation, drive -lanes or vehicle bays to accommodate ambulance arrivals and departures, board-certified emergency physicians, board-certified emergency nurses, on-site lab and imaging capabilities and similar equipment, services and treatments not commonly available in urgent -care facilities. Section 4. Duration. The moratorium imposed by this Ordinance shall commence on the effective date of this Ordinance and shall expire on the 365th day thereafter. Section 5. Staff to Investigate and Prepare Proposed Regulations. Before the expiration of the moratorium imposed by this Ordinance, City staff shall review and analyze the City's existing regulations governing freestanding emergency room facilities, as directed by the Council, and present any proposed amendments thereto to the Council. The Council declares that it will give due and timely consideration to recommended changes to the Code. Section 6. Effective Date. This Ordinance shall take effect fifteen (15) days after final publication, as provided by Section 5.11 of the Charter. INTRODUCED, READ, AND ADOPTED on first reading by a vote of to on this day of , 2016, ordered published in full in a newspaper of general circulation in the City of Wheat Ridge and Public Hearing and consideration on final passage set for , 2016, at 7:00 o'clock p.m., in the Council Chambers, 7500 West 29th Avenue, Wheat Ridge, Colorado. READ, ADOPTED AND ORDERED PUBLISHED on second and final reading by a vote of to , this day of , 2016. PA SIGNED by the Mayor on this day of , 2016. ATTEST: Janelle Shaver, City Clerk First Publication: Second Publication: Wheat Ridge Transcript Effective Date: 3 Joyce Jay, Mayor Approved As To Form Gerald E. Dahl, City Attorney City of Wheat�idge " FFICE OF THE CITY MANAGER Memorandum TO: Mayor and City Council FROM: Patrick Goff, City Manager Ken Johnstone, Community Development Director DATE: March 2, 2016 (for March 7th Council Meeting) SUBJECT: Freestanding Emergency Rooms Introduction Colorado has recently experienced a substantial growth in freestanding emergency rooms (ERs), increasing from 2 in 2012 to at least 35 by the summer of 2016. There has been one rezoning request to allow for this business model in Wheat Ridge. There has also been a tremendous amount of media coverage around freestanding ERs, primarily focused on patient confusion concerning the difference between freestanding ERs and urgent care centers (see attachments). On November 23, 2015, consensus was reached by City Council to include a discussion concerning freestanding ERs on a future study session agenda. Prior Actions In 2015, an application was received by the City to rezone the property located at the southeast corner of 38th Avenue and Wadsworth Boulevard from mixed-use neighborhood (MU -N) to mixed-use commercial (MU -C). If approved the MU -C zoning would have potentially allowed various commercial and mixed uses. However, the stated intent of the applicant requesting the rezoning was to allow for the construction of a freestanding emergency room on the site. Freestanding ERs are not a specified use in the City's zoning use charts. However, staff has determined the use is similar to both a hospital and medical office use. Based on hours of operation and heavy reliance on customers arriving by ambulance, staff determined these freestanding ERs are most similar to the emergency room activity associated with a hospital. A medical office is allowed in MU -N zone district and both medical offices and hospitals are allowed in MU -C zoning. Hospitals are allowed in a MU -C zone district (upon review and approval of an administrative conditional use permit); but not allowed in MU -N, which is the property's current zoning. Staff presented the rezoning application and a recommendation of approval to Planning Commission at a public hearing on October 1, 2015. By a vote of 4 to 1, the Planning Commission recommended denial of the request for the following reasons: 1. The proposed zone change is unnecessary because sufficient MU -C zoning exists in the immediately adjacent areas located next to the site. 2. The proposed zone change may negatively impact the public health, safety, or welfare of Attachment 2 the community. 3. The proposed zone change is not compatible with the surrounding area; that being the church and the adjacent properties that will probably be subjected to zoning change requests in the future. 4. No certificate of need is needed for new hospitals in Colorado, which is an oversight. 5. There is no need for this use and no need for additional MU -C zoning. The rezoning was introduced to City Council on first reading on October 26, 2015. The first reading on the bill was approved 6 to 2. A public hearing was scheduled for November 23, 2015 but the applicant formally withdrew their rezoning application prior to the public hearing. Background As a policy matter, it is appropriate for City Council to consider whether there are operational or other aspects of these businesses that require them to be regulated in a different manner. There are many uses that are called out specifically in the City's municipal code for special regulation. Chapter 11 — Licenses and Permits. By way of example, pawn brokers, marijuana related businesses, amusement arcades, night clubs and social clubs all are subject to special licensing requirements contained in Chapter 11. It could be appropriate to consider requiring freestanding ERs go through a special licensing process to address specific issues of concern. Chapter 26 — Zoninp. Various uses are required by Chapter 26 (Zoning and Development) to go through an additional review process. There are dozens of uses that require either special use review or conditional use review (mixed use districts only). Examples of special uses include day care, certain auto related uses, private schools, contractor's yards and certain fueling stations. Even government buildings with outside storage can trigger a special use review. The special use review process starts with a neighborhood meeting and can be reviewed and approved administratively. Under certain circumstances, special use review will come before City Council to approve or deny or approve with conditions. It could be appropriate to consider requiring freestanding ERs to be reviewed as either a special use or conditional use. There are likely various other zoning options that could be considered for application on these facilities, if it is determined that they generate unique impacts in the community or in a neighborhood. The City imposes minimum separation requirements on certain uses. The City has maximum "caps" on the number of billboards and marijuana establishments, which would be another option to consider. Conclusions Staff is requesting preliminary policy direction from City Council whether to conduct additional research regarding freestanding ERs. The intent would be to determine whether any local regulatory changes are needed to address unique impacts associated with this land use and business model. If so directed, staff would recommend additional research and likely conduct some type of convening of affected parties who operate in this or related industries. Attachments 1. Various media articles 14 Kenneth Johnstone From: Kenneth Johnstone Sent: Tuesday, March 8, 2016 8:04 AM To: Patrick Goff, Kenneth Johnstone Subject: City Council Study Session - 3-7-16 (CORRECTED) City Council Study Session - 3-7-16 - Genevieve absent, all others present - CAPRA Parks Accreditation - Kristy question on benefits and costs - Tim - Larry question on long range park planning goals and compliment to Parks Department - George - Large Event Permit Policy - Tim, what is large - Kristy, is it manageable, why not charge some hosts for our costs - George, think about indirect benefits of external events and charge them for our costs - Zach, should we be able to host more than we already are? - Monica, different tier levels for charging costs - Janeece, for profit events should be treated differently than fundraisers, consider impacts on facilities that generate fee revenues - Larry, priority list, what are other city's fee policies - Zach, likes traffic associated with external events - Joyce committed to exploring a new policy with tiers and cost recovery - Larry, don't want to micro manage - Tim, good to bring activity to the City - Summary, cost recovery, tiers of events, policy to review, return on investment analysis and cost/benefit analysis, get the Beers and BBQ event - consensus Freestanding ERs - Zach, does the state regulate this - no, licensing impacts and costs - Larry, why not Medicaid, concierge medical centers, concerned with impacts on full service hospital ERs - Janeece, is Lutheran's ER over capacity, Kristy, certainly busy - Monica, concerned with cost, Medicaid, not full trauma care, so additional costs to transfer, does see a need for - Tim, personal experience, medical scam, doesn't like, sign code approach (not constitutional), need to regulate in a significant way - George, land use versus consumer issues, land use easier to regulate at our level, do something, consumer protection issues harder to address at a local level, we don't typically regulate markets, but do we have options - Kristy, some have not been very successful, moratorium or some other way to strictly control - Zack motion for a moratorium, 6 months or a year, probably not an emergency ord Elected officials Kristy - GAzette article by Wednesday - Urban Renewal - $50K a year from WR Cyclery can be used for community benefit, possibly business grants, infrastructure, art - Tim, Createyour38 final meeting, Business District grants, Rickoli sign, business beautification grants - Zach, CML, - Larry, District IV meeting, lightly attended, building enforcement not business friendly from one individual at the meeting Sent from my Wad City of W heat P4dge ITEM NO: / r DATE: April 11, 2016 REQUEST FOR CITY COUNCIL ACTION TITLE: COUNCIL BILL NO. 05-2016- AN ORDINANCE IMPOSING A TEMPORARY MORATORIUM ON THE SUBMISSION, ACCEPTANCE, PROCESSING, AND APPROVAL OF APPLICATIONS AND REQUESTS FOR A PERMIT, LICENSE, LAND USE APPROVAL OR OTHER APPROVAL FOR A FREESTANDING EMERGENCY ROOM FACILITY ❑ PUBLIC HEARING ❑ ORDINANCES FOR 1 ST READING (03/28/16) ❑ BIDS/MOTIONS ® ORDINANCES FOR 2ND READING (04/11/16) ❑ RESOLUTIONS QUASI-JUDICIAL: ❑ YES City Attorney ►1 � City Manager ISSUE: This Ordinance imposes a 365 -day moratorium on the submission, acceptance, processing and approval of applications and requests related to freestanding emergency room facilities. The purpose of the moratorium is to allow the Council to evaluate — and amend, if appropriate — the City's existing regulations that address the zoning and licensing of these facilities. PRIOR ACTION: Council discussed this issue on March 7, 2016, and directed that a moratorium ordinance be prepared. First reading was conducted on March 28, 2016. FINANCIAL IMPACT: The potential loss of license, permit, application and similar fees associated with applications for freestanding emergency room (ERs) facilities over the next year is likely nominal. BACKGROUND: Freestanding ERs are increasing in number and popularity. In Colorado, the number of freestanding ERs has risen from two in 2012 to at least 35 by this summer. These facilities provide emergency medical treatment and care similar to a hospital-based ER. Ambulances deliver to these freestanding Council Action Form — ER Moratorium April 11, 2016 Page 2 facilities and many offer more sophisticated on-site services — such as radiology and lab services — than urgent care facilities. These types of facilities are not currently licensed or regulated by the state. Freestanding ERs likely generate land use impacts that are more akin to hospitals than to other medical facilities, such as clinics, doctor's offices and urgent -care facilities. Unlike these other types of medical facilities, freestanding ERs accommodate ambulance and other emergency -vehicle traffic and they are often open 24/7. They produce light, noise, glare and traffic beyond that of a non -emergent medical care facility. It is therefore appropriate to study and evaluate whether the City's existing zoning regulations adequately address freestanding ER facilities. There have been a number of recent media stories on freestanding ERs and patient confusion between freestanding ERs and urgent care facilities. Because freestanding ERs are not currently licensed or regulated by the state, patients may also be uninformed about the relative costs, benefits, advantages and disadvantages of visiting a freestanding ER versus a hospital-based ER. It is therefore appropriate for Council to study and evaluate whether the City should enter the licensing fray and adopt some local licensing requirements for freestanding ERs. This Ordinance maintains the status quo of freestanding ERs within the City (none) while the Council studies the policy issues and adopts further legislation if it deems appropriate. OPTIONS FOR COUNCIL ACTION: 1. Approve the ordinance on second reading; 2. Approve the ordinance on second reading with amendment(s); or 3. Postpone consideration of the ordinance indefinitely. RECOMMENDED MOTIONS: "I move to approve Council Bill No. 05-2016, an ordinance imposing a temporary moratorium on the submission, acceptance, processing and approval of applications and requests for a permit, license, land use approval or other approval for a freestanding emergency room facility, on second reading, and that it take effect 15 days after final publication." Or, "I move to postpone indefinitely Council Bill No. 05-2016 an ordinance imposing a temporary moratorium on the submission, acceptance, processing and approval of applications and requests for a permit, license, land use approval or other approval for a freestanding emergency room facility, for the following reason(s) " REPORT PREPARED BY; Carmen Beery, City Attorney's Office Gerald Dahl, City Attorney Patrick Goff, City Manager ATTACHMENTS: 1. Council Bill No. 05-2016 2. March 2, 2016 Staff Memorandum CITY OF WHEAT RIDGE, COLORADO INTRODUCED BY COUNCIL MEMBER WOODEN Council Bill No. 05 Ordinance No. Series 2016 TITLE: AN ORDINANCE IMPOSING A TEMPORARY MORATORIUM ON THE SUBMISSION, ACCEPTANCE, PROCESSING, AND APPROVAL OF APPLICATIONS AND REQUESTS FOR A PERMIT, LICENSE, LAND USE APPROVAL OR OTHER APPROVAL FOR A FREESTANDING EMERGENCY ROOM FACILITY WHEREAS, the City of Wheat Ridge ("City") is a home rule municipality operating under a charter adopted pursuant to Article XX of the Colorado Constitution and vested with the authority by that article and the Colorado Revised Statutes to enact laws to govern and regulate the use of land within its territory; and WHEREAS, pursuant to this authority, the Wheat Ridge City Council ("Council") previously adopted local land use regulations, codified as Chapter 26 of the Wheat Ridge Code of Laws ("Code"); and WHEREAS, the City's zoning regulations currently permit freestanding emergency room facilities to locate within the Mixed Use -Commercial and Planned Hospital Development zone districts; and WHEREAS, the Council finds that freestanding emergency room facilities may cause land use impacts that are different than those caused by other detached health care facilities due to the extended hours that emergency facilities may be open; and WHEREAS, in response to the increase in the number and popularity of freestanding emergency room facilities over the past several years, the Council finds and determines that it is necessary and desirable to examine the City's zoning laws and business licensing regulations governing freestanding emergency room facilities to ensure that they are appropriately located; and WHEREAS, to prevent the further location of freestanding emergency room facilities in potentially inappropriate locations while the Council studies the issue, the Council desires to impose a moratorium on the submission, acceptance, processing, and approval of all applications and requests for a permit, license, land use approval or other approval for any freestanding emergency room facility, commencing upon the effective date of this Ordinance and expiring 365 days thereafter; and WHEREAS, the imposition of a moratorium on the submission, acceptance, processing, and approval of all applications and requests for a City permit, license, land use approval or other approval is reasonable in time and scope and would not cause an unnecessary hardship upon or unreasonably prejudice any party. Attachment 1 NOW THEREFORE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF WHEAT RIDGE, COLORADO: Section 1. Findings. The above and foregoing findings are hereby incorporated by this reference as specific findings and determinations of the Council. Section 2. Temporary Moratorium. A temporary moratorium is hereby imposed on the submission, acceptance, processing, and approval of all applications and requests for a City permit, license, land use approval or other approval for any freestanding emergency room facility. The City staff is directed to refuse to accept for filing, and not to further process or review any pending applications or requests for such facilities during the moratorium period. Section 3. Definition of freestanding emergency room facility. For purposes of this Ordinance, a "freestanding emergency room facility" is and means a medical facility that is not physically attached to a hospital facility that has the capability of providing medical care and services to patients with emergency medical conditions in a manner similar to emergency rooms located within hospitals. Features of a freestanding emergency room facility may include, but are not limited to, expanded hours of operation, drive -lanes or vehicle bays to accommodate ambulance arrivals and departures, board-certified emergency physicians, board-certified emergency nurses, on-site lab and imaging capabilities and similar equipment, services and treatments not commonly available in urgent -care facilities. Section 4. Duration. The moratorium imposed by this Ordinance shall commence on the effective date of this Ordinance and shall expire on the 365th day thereafter. Section 5. Staff to Investigate and Prepare Proposed Regulations. Before the expiration of the moratorium imposed by this Ordinance, City staff shall review and analyze the City's existing regulations governing freestanding emergency room facilities, as directed by the Council, and present any proposed amendments thereto to the Council. The Council declares that it will give due and timely consideration to recommended changes to the Code. Section 6. Effective Date. This Ordinance shall take effect fifteen (15) days after final publication, as provided by Section 5.11 of the Charter. INTRODUCED, READ, AND ADOPTED on first reading by a vote of 8 to 0 on this 28th day of March, 2016, ordered published in full in a newspaper of general circulation in the City of Wheat Ridge and Public Hearing and consideration on final passage set for April 11th, 2016, at 7:00 o'clock p.m., in the Council Chambers, 7500 West 29th Avenue, Wheat Ridge, Colorado. READ, ADOPTED AND ORDERED PUBLISHED on second and final reading by a vote of to , this day of , 2016. 2 SIGNED by the Mayor on this day of 2016. ATTEST: Janelle Shaver, City Clerk First Publication: March 31, 2016 Second Publication: Wheat Ridge Transcript Effective Date: 3 Joyce Jay, Mayor Approved As To Form Gerald E. Dahl, City Attorney V City of Midge OFFICE OF THE CITY MANAGER Memorandum TO: Mayor and City Council FROM: Patrick Goff, City Manager Ken Johnstone, Community Development Director DATE: March 2, 2016 (for March 7th Council Meeting) SUBJECT: Freestanding Emergency Rooms Introduction Colorado has recently experienced a substantial growth in freestanding emergency rooms (ERs), increasing from 2 in 2012 to at least 35 by the summer of 2016. There has been one rezoning request to allow for this business model in Wheat Ridge. There has also been a tremendous amount of media coverage around freestanding ERs, primarily focused on patient confusion concerning the difference between freestanding ERs and urgent care centers (see attachments). On November 23, 2015, consensus was reached by City Council to include a discussion concerning freestanding ERs on a future study session agenda. Prior Actions In 2015, an application was received by the City to rezone the property located at the southeast corner of 38th Avenue and Wadsworth Boulevard from mixed-use neighborhood (MU -N) to mixed-use commercial (MU -C). If approved the MU -C zoning would have potentially allowed various commercial and mixed uses. However, the stated intent of the applicant requesting the rezoning was to allow for the construction of a freestanding emergency room on the site. Freestanding ERs are not a specified use in the City's zoning use charts. However, staff has determined the use is similar to both a hospital and medical office use. Based on hours of operation and heavy reliance on customers arriving by ambulance, staff determined these freestanding ERs are most similar to the emergency room activity associated with a hospital. A medical office is allowed in MU -N zone district and both medical offices and hospitals are allowed in MU -C zoning. Hospitals are allowed in a MU -C zone district (upon review and approval of an administrative conditional use permit); but not allowed in MU -N, which is the property's current zoning. Staff presented the rezoning application and a recommendation of approval to Planning Commission at a public hearing on October 1, 2015. By a vote of 4 to 1, the Planning Commission recommended denial of the request for the following reasons: 1. The proposed zone change is unnecessary because sufficient MU -C zoning exists in the immediately adjacent areas located next to the site. 2. The proposed zone change may negatively impact the public health, safety, or welfare of Attachment 2 the community. 3. The proposed zone change is not compatible with the surrounding area; that being the church and the adjacent properties that will probably be subjected to zoning change requests in the future. 4. No certificate of need is needed for new hospitals in Colorado, which is an oversight. 5. There is no need for this use and no need for additional MU -C zoning. The rezoning was introduced to City Council on first reading on October 26, 2015. The first reading on the bill was approved 6 to 2. A public hearing was scheduled for November 23, 2015 but the applicant formally withdrew their rezoning application prior to the public hearing. Background As a policy matter, it is appropriate for City Council to consider whether there are operational or other aspects of these businesses that require them to be regulated in a different manner. There are many uses that are called out specifically in the City's municipal code for special regulation. Chapter 11 — Licenses and Permits. By way of example, pawn brokers, marijuana related businesses, amusement arcades, night clubs and social clubs all are subject to special licensing requirements contained in Chapter 11. It could be appropriate to consider requiring freestanding ERs go through a special licensing process to address specific issues of concern. Chapter 26 --Zoning. Various uses are required by Chapter 26 (Zoning and Development) to go through an additional review process. There are dozens of uses that require either special use review or conditional use review (mixed use districts only). Examples of special uses include day care, certain auto related uses, private schools, contractor's yards and certain fueling stations. Even government buildings with outside storage can trigger a special use review. The special use review process starts with a neighborhood meeting and can be reviewed and approved administratively. Under certain circumstances, special use review will come before City Council to approve or deny or approve with conditions. It could be appropriate to consider requiring freestanding ERs to be reviewed as either a special use or conditional use. There are likely various other zoning options that could be considered for application on these facilities, if it is determined that they generate unique impacts in the community or in a neighborhood. The City imposes minimum separation requirements on certain uses. The City has maximum "caps" on the number of billboards and marijuana establishments, which would be another option to consider. Conclusions Staff is requesting preliminary policy direction from City Council whether to conduct additional research regarding freestanding ERs. The intent would be to detennine whether any local regulatory changes are needed to address unique impacts associated with this land use and business model. If so directed, staff would recommend additional research and likely conduct some type of convening of affected parties who operate in this or related industries. Attachments 1. Various media articles 2