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11-17-2005 Workshop A~ .8 ~.. ~ 19200 West Counlrv r1uh Drive Aventllrfl. FT. City Commission Workshop Meeting November 17, 2005 Immediately Following 2:30 p.m. Commission Meeting Executive Conference Room ,;1'd,-,;-,:,,'i~~~K~i!);li,,<:':r:."'-'7'.:"', - AGENDA 1. Mount Sinai Medical Center Certificate of Need* 2. Recommended Land Development Regulation Amendments (City Manager) * 3. Legislation to Require Gas Stations to have Generators (Commissioner Auerbach) 4. Adjournment * Back-up Information Exists This meeting is open to the public. In accordance with the Americans with Disabilities Act of 1990, all persons who are disabled and who need special accommodations to participate in this meeting because of that disability should contact the Office of the City Clerk, 305-466-8901, not later than two days prior to such proceeding. -.-----.---..---.-.~.--..--".-.-----.-----..--,..--.---..-------r---.-~-._--.----'-.-.-..,- ..----...------ '! Aventura Hospital ... and Medical Center 20900 Biscayne Boulevard Aventura. Florida 33180 305.682.7000 www.aventurahospital.com October 10, 2005 The Honorable Susan Gottlieb, and City of Aventura Commission Members Aventura Government Center 19200 West Country Club Drive Aventura, Florida 33180 Re: Mount Sinai Medical Center Proposal for New Acute Care Hospital Dear Madam Mayor and Commission Members: I had hoped that we would have had the opportunity to meet informally, and under different circumstances, but am compelled to write you today to seek your support in a matter of paramount importance to the patients and staff of Aventura Hospital and Medical Center. I am asking that you formally express opposition to Mt. Sinai Medical Center's (Mt. Sinai) request to the Agency for Healthcare Administration (AHCA) for a Certificate of Need (CON) to construct a new 280-bed hospital in North Miami Beach. Aventura Hospital and Medical Center has been providing healthcare services to the Northeast Dade County community for over 40 years. During the development and founding of the City over 10 years ago, we were proud to offer our support by hosting sponsored monthly commission meetings in our Biscayne Boulevard Medical Office Building. In fact, our institution was renamed Aventura Hospital and Medical Center to reflect the integral relationship with our community. Over the years, our mutual planning in the areas of wellness, community health initiatives and health program development have culminated in the newly renovated, expanded, and well-regarded tertiary health facility we all now enjoy. On behalf of our team of 1,300 employees and 800 physician staff members, it has been a pleasure to serve the greater A ventura community for the past 40 years. We are asking for your support in providing AHCA with your input and opposition to this proposal based upon the following facts: . Northeast Miami-Dade is already served by two acute care hospitals, Aventura Hospital and Medical Center ("Aventura") and Parkway Regional Medical Center ("Parkway"). Aventura Hospital has 407 licensed beds. Parkway has 382 licensed beds, including a 23-bed obstetrical unit. Each of these hospitals provides comprehensive, general acute care services. Additionally, Aventura Hospital provides specialty services (inpatient psychiatric care) and tertiary services (adult interventional cardiology services). The Honorable Susan Gottlieb, and City of A ventura Commission Members Page 2 October 10, 2005 Presently, there is no difficulty in accessing acute care hospital services in northeast Miami-Dade. In fact, the licensed acute care beds at Aventura and Parkway are underutilized. According to utilization data reported to the Agency for Health Care Administration, in calendar year 2004 average occupancy was 52.46% in Aventura's 407 licensed acute care beds and average occupancy was 48.79% in Parkway's 325 licensed acute care beds. . A new acute care hospital in northeast Miami-Dade would mean one more emergency department for physicians to cover, without any corresponding benefit to the service area. There is no documented difficulty in accessing emergency services in northeast Miami- Dade. In addition, a nationwide shortage of both emergency physicians as well as emergency nurses would mean placing an undue burden on the operation of both the Aventura and Parkway Emergency Departments. . A new acute care hospital in northeast Miami-Dade would potentially dilute the quality of nursing care. There already exist a limited number of experienced and qualified nurses. The staffing required for an entirely new hospital would necessarily stretch what is already a very tight labor market for nurses. . An article in the Miami Herald recently indicated that Mount Sinai believes it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating with managed care health insurance plans (Ref. "Mount Sinai plans new facility", Miami Herald, September 23, 2005). Mount Sinai's proposal appears driven more by self- interest rather than the interest of the northeast Miami-Dade community. . Aventura has already provided the community with a "new" hospital. We recently completed a $160 million facility expansion project. This project is part of the hospital's overall Master Plan that provides for the expansion, renovation and eventual replacement of most of the hospital in order to better serve the medical needs of the community. In addition, A ventura is currently in the process of constructing a 100,000 square foot Medical Office Building to support the continued recruitment of high quality physicians to relocate their practices into our community. . Aventura is a tax-paying facility with 2004-tax revenue generated to the City of close to $4,000,000.00. This makes Aventura the second largest taxpayer in the City. A non- profit facility that generates no tax revenue would increase competitive market pressures at the same time hindering Aventura's ability to generate greater tax revenue. Thank you for the opportunity to allow Aventura Hospital and Medical Center to express our position in this issue. I trust that the City will take a position on this matter that is favorable to our city, our hospital and our community. I am at your disposal should you require any Ihe Honorable Susan Gottlieb, and City of A ventura Commission Members Page 3 October 10, 2005 additional information or if you would like a presentation at your next commission meeting detailing further salient points of this request. In closing, I am honored to have recently been appointed as the Chief Executive Officer for Aventura Hospital and Medical Center. I have been closely associated with this community since my tenure at the hospital from 1997-2000 as its Chief Operating Officer. In fact, one of my primary roles while working for Aventura Hospital at that time was the development of the master facility plan which resulted in the fabulous patient care facility we have just completed constructing. This $160 million project has resulted in the addition of 243 private patient rooms, 10 state of the art operating rooms (two of which are dedicated to our newest advancement, open heart surgery) and the expansion of our emergency department to accommodate 28 beds with a dedicated cat scanner. I look forward to working together with you over the coming months and years to continue the tradition that Aventura Hospital and Medical Center has established in providing quality healthcare to the community as part of what makes Aventura the "City of Excellence". I would be happy to discuss this matter with you further. Please don't hesitate to contact me at (305) 682-7101. / Best regards, ~ HeatheKhan Chief Executive Officer HJR/tlc cc; Eric M. Soroka, City Manager -~---"----'---~-----"~'-'---~--'-r----~---"-"-'~---'-.-".---.-- Mount SinaL,) M E D C L C 'J' . ,_lx.'..'. ." I A E N" EH<Lii'{ C_Eim , ' ,_ 0' . September 27, 2005 ZOG5 OCT -3 Pr\ 2: 54 CITY OF AVENTURA ~ Suaan GolIIIeb CommlNlonel1l" .:z6 Auerbach . -~:~ond -1'f8rry Halzberg .' Michael Stem luz Urbaez Weinberg Mayor Susan Gottlieb 19200 West Country Club Drive Aventura, FL 33180 Dear Susan: 1 am writing to request your support for Mount Sinai Medical Center's effort to establish a new hospital in northeast Miami-Dade County. Mount Sinai's hospital will be a positive addition to the local community and will result in enhancements to the health care services currently available to the local population. To ensure our success, I am requesting that you prepare a letter in support of this project. The Certificate of Need (CON) application process for the new hospital requires that we complete the application by October 19th This application is filed with the State's Agency for Health Care Administration with a decision expected by mid-December. As part of the information we will be providing to the State, it is important that we include a strong show of local support for the proposed new hospital. The key points that we will be including in our CON application are: . No new inpatient beds will be added to the local healthcare system. Instead, existing licensed beds will be transferred to the new proposed site. . Weare bringing our services and facilities closer to our patients who live in this area. . We will be able to bring a new level of quality and cost effective care to northeast Miami-Dade County, providing Mount Sinai's proven approach to medical care services in an accessible manner. . As a not-for-profit organization and one of only six statutory teaching hospitals designated by the State of Florida, the proposed new hospital will support teaching, research and community service. . We will be bringing a full range of women's services, including obstetrical service, to the local community. For your consideration, I have attached a draft letter of support to provide some guidance. It is important, however, that you include your personal experiences and feelings in creating your letter. Form letters and numerous letters presenting the same information are much less persuasive than original letters. I would greatly appreciate receiving your letter by Monday, October 10. A self-addressed, stamped envelope is included for your convenience. We will be including your letter in our application. Thank you for your continued support of Mount Sinai Medical Center and for your willingness to help in this important new hospital endeavor. Sincerely, teven D. Sonenreich resident and Chief Executive Officer Enclosure Mount Sinai Campus 4300 Alton Road Miami Beach, FL 33140 Phnnp7 10~-('74<n 21 Mi<Jmi Heart Campus 4701 N. 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". all J ... ... ... ... ... ... ... .. ... .. ... .. ... .. .. ... ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... .... -- Aventura Hospital T. and Medical Center Table of Contents Letters from our Community I Letters from our Board of Trustees 2 Letters from our Physicians 3 Letters from our Employees 4 -- Aventura Hospital ......... and Medical Center MISSION STATEMENT The Mission of Aventura Hospital and Medical Center is to provide healthcare services responsive to the needs of our patients, in partnership with our physicians, employees, volunteers and community, which promote continuous quality improvement and excellence in volunteers and community, which promote continuous quality improvement and excellence in performance. VISION STATEMENT A ventura Hospital and Medical Center is committed to becoming the healthcare facility of choice by patients and the providers and purchasers of healthcare services. We will strive to surpass customer expectations, exceed performance standards of our competitors and commit to continually improve the quality and efficiency of our processes, services, and clinical outcomes. VALVES AND BEHAVIORS RESPECT ALL, SERVE OUR CUSTOMERS, AND DELIVER EXCELLENCE IN EVERYTHING WE DO. RESPECT SERVICE EXCELLENCE . Civility . Trust . Listening . Sensitivity . Courageous Conversation . Caring . Anticipation . Reliability . Responsiveness . Exceeding Expectations . Consistency . Challenging Results . Professionalism RCA CORPORATE VALUES Above all else, we are committed to the care and improvement of human life. In recognition of this commitment, we strive to deliver high quality, cost effective healthcare in the community we serve. . We recognize and affirm the unique and intrinsic worth of each individual . We treat all those we care for with compassion and kindness. . We act with absolute honesty, integrity and fairness in the way we conduct our business and the way we live our lives . We trust our colleagues as valuable members of our healthcare team and pledge to treat one another with loyalty, respect and dignity. Florette S. Semigran 20379 W. Country Club Drive #2640 Aventura, FI. 33180 The Agency for Healthcare Administration October 3, 2005 Please be advised that I have been a resident of Aventura for more than thirty-one years. I remember when my husband was treated at what then was named Biscayne Hospital, and have watched their growth through the years.. I have been informed that a new hospital is being contemplated for the North Miami area. We now have in addition to Aventura, Parkway, North Shore and Memorial hospitals in the area. They serve all of us very well. In addition please take into account the shortage of nurses, doctors. and hospital staff. I sincerely urge this proposition to be reconsidered. Thank you for your consideration. Yours truly " Florette S Semigran I / / 10/17 / U.S / , I Iv /Ii c/ It ( lJi/.:;' k'T[.'j\)/l BUI/L t..;Uv;1i'-! 1) ) "-11 ttri FE i1IV() / dRE RE5/ (JE/VL,!; {)1 ItALLrtiVCYH-G r!-I.)(~/Pf1 FOR IitG Pf(S( /4!cilf5 ri/v'!7 or O(/I~ (1(;13 !/& !J/E&()&P HOf,PlifiL (J)f?G j"/ttrlY TI HE!> OVR/4;{; 1HOSe YElles. 'bepOR.E 1HE AVEIYll/RA HCSPltAL u/f/5 Rf81/ILr fiN'v [/Pf,f?ri/lG"[) fYE v'SE/J IO 60 10 HG,i10R/I{'- PCF1&c/IOR H1tlNi /teART HD5P/1fTL. BtAL/f[f'LY ouR f)1~IS wHO Cv1r<CY FOE? tJ5 ftRE fTLSO [fERE //11 Pr/l&lv'ri/RA I ftND WE 'F/N'p ritE CrlRE rt/Vr} 5ERVI C6S AR~ !:?YiiLbvT ~pe(ltil y LvHe/11H~ l1EltRT' Ii. ik'VOl-VCj) I wE c.flrf N'Dr tJ Iv'OERSTfWD tv/fY /lye 'vE&?y ';/V TIfIS; f7{~EA , _ A N(}lHcR HOS Prli'1L WHE/V rtlcf?E ftf?E EI{PIY o~I)'5 HcRI3 Rrlp SHDf?/Nes,s OFF ,VtJRS!3S;. WL2 'FeEL ITS tl /lIjSTE of HONeys ~ ~/'6 :RE: veRY HftPPy wlrH w-fffT ~tlE HAVt3 , ~n/'~)' ./,..-.-7/1 At< - ,5/NCERLk IIIV iJ{-'(/::'J{vt:/"I/T LIl KtR !tNv ~ I-IT/(J.{Eo !.fOO ll/e /4./-t. the /14/1 " rff1 L. L rhV"J}AL.t:: FL 33 DC' 'I >",,4,;.1,,, >C' j~~: - . VfRIt L ItKkt:.i~ f/;) //7, (; :<1" . 1/ YII",(.f-tJ/t'u ".( '/ 809 Richmond Road East Meadow, NY 11554 October 2, 2005 The Agency for Health Care Adninistration Gentlemen: Several years ago my husband was an extremely ill patient a Aventura Hospital. The fact that we are four-to-five month. a year "snowbirds" made no difference to the staff. As far as they were concerned, he was a desperately ill patient wh, needed them. The attention and treatment he recieved was, . believe, as fine as any hospital in the country could give. Both he and I feel that in addition to the physicians, it w. the nurses who pulled him through and because of their attention and care he survived. We believe that the addition of another hospital, perhaps unnecessary, in the area would certainly drain the existant body of nurses as well as medical staff. And we wonder if such a drain would have an adverse effect on the excellence of Adventura Hospital. Sincerely, ,~~ 4etu~r~~ f Mrs. Herbert Schwart ./ ~'? /. j' ' ~~ ol:. ~ ,'_t :1"/-/." .....-.' ,/.;. I , ~ ". . ( '. I -',.;-,' /~i, .' "-,, ,.( / J: . ,,:'~ )(...' 0....( i.;:'~<.._<.;-.... C:,.t:../ '/dL ~)> / .:'/o!" , / /'.//" ({ .1(,1./> / ~--~- " 1'//, . _' ,,' , .. ..,( ;J. '~l; ,/ ,:/-',:/') )", / ':r:" ,.;~~/t';~ .,'~ L ..' )' ./-1. .~-->~~..: .<."' "- ? I, .:' /';{( .., ;.. '~',~' t1 i.. -..iL ;: ;":(....: I I . i /~, .'. .t"..... .",,'" L.. _ -.:>: ;i-I:... c:.t. C.i_ ~ i' (....-'...f' ..C .(, , /' -' "t _ ~, . ., I '~'-Y-" - '- ~ /;i.t, )})d,()C -:l-jLC'-a:. '/eL- :l ,.~~.,.~-(: -~<-..2: _~(/:- t-.':."?./(_.>>- f _ _ _L}.( 1... 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SiM. 2('8('1 :m"cmpu; 9J"ufutwuJ. Suitt 4('3 CLmrlwta, fJt.vud4 331S(1 fJekpfwnc: (3('5) 937-(1(117 fJ"""imik (305)937-2%8 Agency for Healthcare Administration 2727 Mahan Dr. Tallahassee, FL 32308 October 5, 2005 Dear Sir or Madam: I was somewhat dismayed to read in the Miami Herald last week that your agency is considering the approval of a proposal by Mount Sinai Medical Center to construct a new hospital facility in northeast Miami-Dade County. As a local attorney, I do a fair amount of work for several hospitals in the tri-county area, and can tell you that a new facility here would spell financial ruin for many of them. More to the point, there is absolutely no need for another hospital. If you look at the census of most of the hospitals in this county, including those in Northeast Miami-Dade and those on Miami Beach, you will see that virtually all of them are operating at no more than 60% of their capacity. This holds true for Mount Sinai's facility on Miami Beach, as well. Aventura Hospital and Medical Center has recently opened its new tower, and is licensed for 407 beds. Its current census is only 240. Moreover, if you review the procedures that the existing facilities are licensed to provide, it is clear that there are no new services that might be offered by a new facility that are not already being provided. What justification can there be for licensing an additional facility in the area when it will offer nothing new, and when none of the existing facilities is operating at anywhere approaching capacity? At best, the census numbers for several facilities in the area, likely including this new one, will plummet to a point below that which is required for financial viability. What do you imagine will happen to the quality of patient care when hospitals are struggling to avoid bankruptcy? High quality patient care is the most important issue that you must consider. At a time when there is a critical and chronic shortage of professional nurses and licensed therapists, the opening of an unneeded hospital will merely make those shortages worse, as an increasing number of facilities compete for a declining number of staff professionals. An appropriate nurse to patient ratio is the single most critical element in positive patient outcomes, and it is a folly to force hospitals to bolster that ratio through extended shifts and overtime. Yet a new facility will need to hire nurses and other professionals, and it is unrealistic to imagine that it will not do so by cannibalizing the employment rolls of existing facilities. If I believed that a new hospital would benefit this community, I would actively campaign in favor of its construction. But in this case, just the opposite is the case. A new hospital in Northeast Miami-Dade County, an area currently served by 4 separate facilities, will do nothing to improve the delivery of healthcare services to those of us who live here and work here. It will ultimately diminish the quality of those services. 1 therefore respectfully request that you consider all of this before you make your decision. Thank you for your consideration of this matter. Sincerely, (~lL~(X\L~ li/"" David A. Silk, Esq. DAS;mco 1/, ?, , " v:/[~t<:~ /,:'-tc",'~C /'1 'I }, / ,':'! :i">._L>.r /'/~""_( ,.-, /.-" 1I '{N' (' // L-,' "tl-,(LY'r(__?-,1 ,:. C / " / ')-~;~1 '(!', . '1/'" ' ~ .__ _..~._Jl('_.0 //,. ]'t'( /~. ,1" /..,' , ..l j l /1./ f (/;/ 'c';vc Ltf<:'1XY /,./(j.v /L.JCIi4' "elM, ' cU:r:,'it,,:.YZ.i.,L,U,Yz-'" t:ii~t<.l(..tul. IJtI y~z J't<{ I~ '{ '. / .7 ,"/IY. / }, (,/.(o'-~/''51Xr,:t,?::'" 0:;c':t,~/.--ii.~\,/; r'{ ~7^/' ,,' -)~j' , ;t.' {{<(V(;:"". .c,; J'~tu7 (,t'?UL'L<' ; ../1,141c t:: .. ki'::'/l,t...? ~t. (J / ~LL-tt: }lC&2-CZ lp.;t-- Y,[\' /">t.u' j-; .J' .//' . (/ /, , , / 1'/ j?~/'!"'_ F~t4JU,~/ t;~La:, ?,[.<N.-f .,i-tc-CL.- kt Ie ,,?/[./J l't';Ul..7;?t .(? l~tt'tl ~.(t?d Y~r Cct'7/?NU.L<c.,~'7' :iC.t.CC<O.C.l" /4'!.(,?~~ ~~r~ItLkq ULrhu,dy /kc[ ?~1 q.~Jlt-L2 '7~0 7~~i, 0a~~7 ~ ~'~ ~ ~'U-t~~< 'i1(~~~ ~ /Ar:. Ic;.ct,tAdH't.t~.[ "",/C-c7' , {U flu ,/l ~L.,?0y ~ 'U-f ,;t'::{e <...L-- /i ;J' ~ ~rU'-'H h de ~~/~~?~ .eO >;:?-4fJ<, Ylc~-c<~ /~.bt.J ~;:::'(,.'~-o'k/ ay~ ~4.d.acvr7 ~ f y~"c/C /~/ (:44,4(~~1"..,(' ~Nv;1!. ~A~~ {;?/"I (L-<., C ,"e ?U: ~!~-,:L"?J/,(';;/( {. /i' ." '/"', ,." /' \' / ' ,/ " /;( ( ....- "-"~'-._~~'-:""'-:'" j~' ,r_~ '(I'C, L-f t,.-.(.-........ /'-'/; ',<: . // ./ l' // l....'. 'l:''''' '/~ -' ..' -.'.. . /.- -' ,/' . L---"\ "r' .. '...:c.-::--'..:,./v---.:... "'-'- .- .- - __ /.' '-'-"~,-__ '1, ,'/ /" " /.' ,/,;':{t/~'C_~_J'_./~. -;:..> ,,"-4"-;;~::.__/ :~~!(_<'("..'~;":- a. ,(_~_ ( , , I / ,/, -,:-.{ /> / - ?..- _,:'- c .::... / " / ' " ...l~_ ,,-. L L; t.t ,~~:.../ "C~, / , /'--!/_/'~/c,' CL V i, t ~~...... / /. -/:..-;,1.. , . , / /: (. ',/ , , , .. ~ "I ~".' " '. ,/ J ! / , . ,. / /.- " .. '. - t /.. _ f !"_f I, , " / ,:c,,,C ./--....-- /_'-1 '- j / , , \ (t./ ( '--- i__ 4.t:/ 'f- .;:.-;' RACHEL S. RIVERS 1300 N. Miami Gardens Drive N:lRTH MIAMI, FlA. 33179 October 15, 2005 OFFICE OF AIMINlSTRATION AVENIURA HOSPI'.LAL 20900 Biscayne Boulevard AVENI'URA, MIAMI, FlA. 33180 I am writing in regard to the proposal for an additional hospital to be located in North Miami. It is of great interest to me to have sufficient hospitals to care for the entire population of this area and there is a question as to whether or not AVENl'URA HOSPITAL meets this need and future needs. I have lived in this ccmnunity for in excess of four years and have been an out-patient of AVENl'URA HOSPITAL on numerous occasions. I have also mown many people who have been patients af this hospital and all of whan have received excellent medical care. I am aware of the fact that there is an urgent need of nurses but this would not necessitate a need for a new hospital. The need for I1Dre medical staff simply does not require AVENl'URA HOSPITAL to build additional hospital roans. Although I am not a candidate for open heart surgery at this time, I am aware that with the expanded services of this hospital fulfills a sufficient need to serve the camnmity,and to build an extra hospital would not be to meet the needs medically of the present ccmnunity. The recent growth and improvements at this hospital are adequate to meet the needs of this ccmnunity and should be seriously studied at a time when these needs are not met. This, in my estimation is not the time. I trust the proposal for that additional hospital will be 1.IDsuccessful if not based on the true need of that additional space. Sincerely yours, RACHEL S. RIVERS VlLo.i<C{! Sfr:-ll.f:* x'l J..O';; ~') JJ ~ ~ r ~ .p, IteM.!;;;....l ~ '2.?J I e, 0 Oct I( oS "I\\~ .A~~o..; f"c.e.. -I-\El>J.:.. 1\+ CtLiU:. ~"'\.I tJl S-rr.Ll"ITtO~ \)t-tO.~ ~;~ ~ r \.HwC.. <a~ A ~~"" L.GfL ~ 'Il\~ f-\ ve /J- \ qe."'\' A rJ!) ScC.n", h..-Oi2,t>A Tue4 Com C'Y'$')~ ,: '.7 ~ I t-Cc= .si~ \QS3, .L Ofti-:;. l\~ E::>GfbU A\.leW1Uf.J4. W~t>. IUI:\S ~u \ LT dud ~ ce>t(~ TlH:;, 1Jee>6l> ~,\ I ty. l.u in-l } . . (:' ()rU1\E;fL ?~ f' ~tJ-;, 101$ \~c..\()j:)lf,.)c. c,pE:-U ~'E:AaJ ~ Aop OVj.\€:C ~J<:PANI)Eb 5E'lC'hCe<s "f'"1~ ~'T~ ~ fV\oY".!:.. i"l'AfJ k~::> "'il\E ~E€o . c>P Tl\~ C <:> ""~Ot-.l rTV. , / UAV"Je:. L....\lcst:::> \~ "1l(C t-{IAM- ~CM - AUoU..lTUI2.A Ai'2€A, F=-orU..IOTl:\L cC 5 2- yu.~ .:c I-l- A.\lE 5eEt-J S Ot..l E .. <<C6p If A-L<;" Th A'T we IZ.c p':>UIW A-rGt2eAT c;c.,r<=osc ,6.J4b C4McTo Au 1<Ot00Mi~ I U6 P-~ILUc.k, o!-)~ ~u,,--'l;>iuc. L e,E=tl'e~~ . o~c..-e...I\-\~ VIS A CccK" lUGe ~\. Lu li-~ ST . PQ.~ t-J ds ~ l-\tf'\j2.~ :u--:,'\iTU\E.. ) AUD 'SouTl\ E:A-:>\~ Cr.JI\.(~ A~ WHI.. As "=>o4.lU ~~ I~o$p'\\'<\-,- C!<:>SC::D ~oMe~or:>y \-\~ ,GOTlb?U\OLlI\\~J'L C\ U '::>>':) EO"::> t- ILE:A 0 1\\ (:; l-\t\ Ol~ l.u I2-l \II) G 0 A.) l\.\ E. to l\U. . ~IVK~1 ''1 O-uJ ~ru Suzanne A. Trudel 2334 S. Cypress Bend Dr. Apt. 409 Pompano Beach, FL 33069 October 12, 2005 The Agency for Healthcare Administration Dear Sirs: Regarding the proposal for an additional hospital to be located in North Miami, I regret to say that there does not seem to be a need at the present time. A ventura Hospital has lots of empty beds as well as all other hospitals in the area. The expanded services, including open heart provide more than the community's needs. [ do not reside in this area but have friends who live here and use the wonderful facilities at A ventura and feel that it is more than adequate. There is no need to duplicate services in the same general area. These are my thoughts in this matter and hope that the situation will be well analyzed before further action is taken. Most sincerely, I <......-1 . .I" ..... /~.. {L./ - ' /'~ -. -~J' C..il. f,.' - " '_~../ c:..... , ,. ."..... .....L- , \~ Suzanne Trudel ~.. l i ! -'_ ( .... '_4~ r- (" >. ?\,-~ ( . . r J(f1- / ~, Ms Sylvia Tucker .( .;~. " {J ,/,',.(1/ c'::t l } ~i L.. '~r t, . 'Ii , . il (..4- i.-. t. l ( <' ;' l.. Pi,,_, . ; l,,{_;. it / :/ (J; t: (~ (/r',. '''''', '" .If- .:1.//. ;{",... i ! (~ ; ,f,' '{J ( .:< '\./ ",.,' / /. \. 'j. { ( JL' uf 1/' i. tj / (.1';., (~ /. 'II ;. , . '. ../ , . , {. l/'i>" it F'.' . .-..1 t /"/ C' le..' <1,- . . ,ryt)'....L l.-I-V......r -( rC1.....- ..1\.....Ll (!~ . {L' 'i-'L l .{ tu' Jc. Ll( lot. t',. L ;: ~ / /~. V{, i... t. ../.../p,A:',\'. L~~. .1 j ...(" " ~ t'.I J/\.- ,{, ~,- "t..~ (11("""0" ,./. ^' / , .',' ".J I .' I .. 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" .~ .-;-:) ~ ) ~ .. \ , -..... :, '. ~ , .~ '-..1 '", .,) ,..l .. :- ,1 i ! ~\ " .~ ~ .- ~ .. ....,.'..~ ..) , ... -~.~.. "........ . \.'.j \,..;- t ..~ J ....~ ~ .. ..<d~ .( . 1 ~ "~j "...J "J ~ ,J ') ..\ , .~~ .. \ ~ ,1 ,j ~'J "J h.,/\ ~';:';" ;". ("' 'i -.) " . ~"" ' j'0 ..oj 'jl \. i '.\ .~ '1 .~ [1--. i i ,:.'. .,,{ 1 .;\ \.~ ~ \ ~". X --'" 1 . I \ . 1 '~J ,,'" r~, \ .i' ~ '1,~ '.~ ';'il .\ i{ '1 ~ ,~j1~ ,I..t~ ~ F~, l ~ \~, .~:~ ~. .~ ], Ii i,~ i · T tt ~ t ,N ,. ~ ." ~ ~ .~} ,~,., :.~ ':~ ...f:J;~~' ~,.,:~ .....~ '<> '~ -! .)., . " . . " -. t. '1 'j 'f~ ,~~ t, ~ 1'1,\.,) ~' 0}~,'~ ~ :;.'J, I, " <~ A:... ~ ......."'-.. '-l \ , " i ,~ ; .~ '\ > . ~'''' '-',~ '" , ). f' . ) .. ,.J ) <~ ~'" ~ .J .,.,.~ '). '), /- I.' ,,,,..,. -,..~. ,,,W, ','",," , ,v-"" ;c, ,.",,;. 'J' . .ill",~~-.1i~"-,.,..~l,.,.~'~"''''''.,.fi,.-,....,,. H Lore Hcppenheimer , 220 I S OceWl Dr Apt 24 HolI)wood. FL 33019 . q/~/ ;~~;7"" ~~ /rv ~IML~JM~~ u~fw U J (li)1l CI '11\Q.,t41 ~ Ctml~ ~ hMtk( a f~t ~\ tio ~(;~ h~citJ ~1,~{ ~ -~ ' ~ L-iu ~ O/)/M ~ , . ~ ~ Jmth4-tRctM ~ ~Yr1~ d)~ t& n6.;W ~ . ~-t6 ~ tlv o-L d;v~tM-a h . U 1Oti..v ..,t",.( "1 wk ~ ~ ' f """'1 (r""'~ g~~ -"'I' , /, /, /./")<.A //-"1 ,,/~; ( I. ""'./ ,.' 'j " ,4-.-"I'-i/' ,1'..___/' ,- / r "_ .-.../ L. ('..<-/ I _/1 / .1. . ., r;() / j '~>.f' ( -" ..~. . , ' f/{(f,} / v" '" t/l(, (. l" / ,/ -;:'r t>. [>'?I: {.'-- --(~.1' -;.-c: / / I'-J (. It,; , {(- ~;'/"L / L/ . 'f~u - ... .,....l... ~ ..'~ -"~) .' .~2? c;;'// (~'- -', I.)r; )":>.... c. . I (~ ' A:'. /i '{.J /.1,__. ./' It /{~> (; (:;,..f~' ' ,'J / i\ .; L/, '~'9<(_./- /.,,,- ..) ,.." ..,..,";r t(,' i.~t'> __.J f::-:/j/':' / /~t;: /::,.,'1: i / f. :/". It)...I.. (/,' ,( /, '-.;/ 1;;L,j ({...,' _, I ",-, ....-; / /' V cj.:...ct 1:.1" t,' / ;- . (J,~.{ // /1:.,;; rl ..-;;I/~ c....f / <).? (J-Zt&'k-C ju;~ft / ;:_.+ t"-,,/ C{: l '~,~' ;' J k4'j:!./.{.-Ci22/ f t/ ~J .. ,V-V .......(.,.~. _" , ..F '".~. ,;.:' . ,,- "- //'J />/ .., I . ,;' 'J' }-' )."--'-i r / ,j t. (...-'.-." \.- $->'(/ 'f L-v ../f.,' .' ._/ J:)& lee/- / . I Cj;.. ;;3 t;j ;>'- /i/t',...~ . ""CAw' ...,~./ / ) I ,.. j , . /1_- .,. ( ~;i Mrs, Charlotte Shelnitz I .' JJ W COlllltry Club Dr. Apt. Aventufa. FL 33180 Ih(-,< "~. .-- :3;c' '." ,,- ""/ <) / .< /?c /. ,"~"'tl_.,~ .-" (/ ,', l>'( ;t~ J' -... ..L~.' / j/ '../ j.~, ~. p.(7 //F-e. --'i:'t'.~., .r;.~,tLA'_,<.~,l1~! :,~.//~ //''1,..e~,:{ 1::"',/'# Z;::l . ~Cfl"'Ct" f~..- -t:"" ~..\) ~/tC/; - ~ //',,,, ~ ./ ( " 'j' <~-:.l, .~ " ;!' .,' '-l'.Y . r_ ~ -.c:...__ / .. / ,")/c..f ,: 1-;,,/<' /' <:: ( .-..- '///i' /. - ~ ' /".J "'[.) I {/~. IY..tL 1..;: '1<, t. ,J I",. l'i- . f ~.lZ:;-- "7 I. /j. -;. <' 1)1 (<j~. " /) . '-. ~ i . f i, /'" .' ", r "I t ,/" " ,J.. ,1. . i l/O ( ..' ." ,;/ Ii:'" ( I ,.... 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E ~ v....!-k.>'-if.P....c{/....'..i--" /<:'/'.__. /j.", C-/... c:t.- #'r:'-?f'~:~ j" ~"'::-f /,"-'L<~'<~?' ~ , c { ,'.-,,,,'z., v;z:/.~ L~'~ '2..~:'r--,""2Z? )>U'-L.t' ~-'- ":;u,,,,J, \ "'il /~( C:f-:f V / ./ .' r;(.-. ./' ! /' /' /- / K Mr. /rviJg KaiJste 3030 Marcos Or Apt T607 Aventura, Fl 33160-2572 '.:. "- / '~.,Ii , . '~ " ""_/ "l.-c (. .-") ,;:( I~". ':''Z.... c( i-/< " ,," CCf.C'C l. .. {. , .' ,.., 7/ i,.' r \.., __" _ ...... "",., ~. '''',y v ': ... . (' '. j C' j:/ -2-:;; t ) " .1 -\....:'.. "'/j' ./, l;/" /' /'7' .-t-~C~_(~L-.tf..,"C'" L. (,J / ., c .~.,<{. , , ' , ',.( (,../ ; .I, I (, "" '- YI " ,,~ .. I 1.J / , " 1 /1 (. ,J C, ~v --1::-;:,<.. (.2,(:'(. . Lr -. ,"(~:~ (YZ" "[/1_/ i/ ,f , - ''7(1 .. II -( //,' ,:,./".. '" /1 . ,j j"--C"CL L, \J-/ /1 ',/ , .~'\ >,1., 2 ,~.. , , "'<".l \...... I-ke -'../1: (. ,;((, / t /': :.;'" ~ ~~(. . /, 7',~/l r:'(. ,/. ,If _'\ '<'''-''ro.,-. 'I' , ! C' ,;-'. ':;:. 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" /' ~ (,.', I. I, ,': 1)_ ) OetobeJt 10, 2005 Ageney ~OIL lieaUheMe Adm.i.~u.,tlta..ti.on Attention: Judy NeweU., V.i.Jtec;tolt H2U a..t AventuJul H06pda..i Aventulta, Fta. 33180 Gen.tiemen: At, a ,~e6,tdent 06 Ha..f.landa..e.e Beaeh60lt 28 piM yeaJt6, I would Uf<e to C'.onvey my fupleMU!t.e abou.:t the plLopo6a..f. 60IL an adc:uA;wna..f. h06pda..i to be loea..ted .tn Noltth IAUuni. I ex.peJL.i.enC'.ed one 6U!t.g.tC'.a..f. pltOC'.edU!t.e tlvU pa..6t yeall and C'.an only f.>ay ".uC'.e tlU.ng6" about the qua..i.i.ty 06 cane~endeJted by both the opelta..t.i.ng 6ll!tgeon and the hof.>pital 6.ta66. In my op.ton, thefte M, tllll.ly IW need 60ft alWtheJt 6ac)..U;ty to C'.oMume OWL tax. doUaJt6. I hope my meMage to you ha..6 J.,Ome me.a.ung. YouM ;t,~uly, \, /?.,; .j J ,G-.f1/ V"/ , S.tmon s.tantOYl, 6;;;;5 -"'l.~ J~:t~l R. PH. r2b'r'tl'~ /~:u!f $~~ f /:'~-<.- .;? '''C . / -<-f.(. u' /- .)" 8962 S.Hollybrook Blvd.,'34-103 pembroke Pines, FL 33025-1315 October 8, 2005 'ventura Hospital & Medical Center .0. Box 2910 nallandale, FL 33008-9987 Gentlemen: I am a member of your H2U Chapter and it was called Senior Friends. I also have several friends in the 11iami-Dade area, two of which were in Aventura Hospital long before they had a Heart Care Center and they had to be transported to the Miami Heart Institute to have their heart problems corrected. So it was a blessing to learn that Aventura was keeping up with the needs of a Heart Care Center and they expanded accordingly. Attn: The Agency for Healthcare Administration have been for several years when I do not see any need for another hospital in the area to be located in North Miami when there are several hospitals already in existence to take care of the needs within the North Miami area. As it is with the shortage of nurses, I do not know why there is any need to have an additional hospital in North Miami. Aventura's expanded services, including open heart, more than meet the community's needs. Sincerely, 7.)~-:,.. ,} /-- l2-:...--..v,......~ '- -'!.. (. (~L.. ~;--/L-'2- "- '__' .....<. /' (lis.) Consuelo Rinaldi 1.\//,'0; FROM: INGE SCHWARTZ /, ,/ t c l-"' / / /' ) '(I ,r-- - _ L( /,' ,L .//, (,i TO: (,...~_v.~~..c":.\ ,,-,.' !'T" r,: k.--e".. _l~ " ,\ / r.. I ': ,', '.), (~,;L )~.. -,), '- <vT,-~t l. ,~~ l (, __'./,..;.:1".:.. t:'''l.:..t'~,_);--_:' __Q r..'" -t ..... .L.,~--._---- ~ -,,-' L>..l (:" ,:t' (''"' .': Ii ~', C'-- I{ ?:?I;:< ~L_,_. _~.....",.<\'__j". a_~=----L2~~-I.I"..LL'-'--T-- "r ("--t(: ,,','r .1'.. -I( L:~';" tC'c_"';->-~~~--~-f'Ct"'''T':~#-~':;;'-;-L //\ . ..' ~u,~':!2 .C-, ,,'C_____, 'h,y, (L~__ '~-f.,,""'L.~~:TJ("'..J tL C_,., 'l(;:-C " . ~,. 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(' ',' ~.f-~,4 {/!-;{,W /,1-""'1> :.-~n (. !.~t .::c/ '-' f;J-d<:~t" -4C~~./-"-t.:<---<-'~' ,1 .~.A""--C'--(~,-" A-"(~i!.iZ~ .A-.,-..G-:'-c.v .:j(,~ .,,<,,'<!- At> "'-d--L::::::-'::.,~ T"'~' '/C,j /, . .~'-t"i{~~' ............--- ,,/ . --r ,;' -",._"..-/..~-O/':~ L -:7 . / :-'~~~,:~~t.~ , .I\.:"~ ~/i!._ (~CZC ~_' ~(.kr:../,~~, ~----~;-- )~./ ~..., Y' ...._../,/~..,>, / '- .:./ /; ~,~( 1-- _ -,:'., -~'<,>'~"l, i. ...r: ~.: '~,.-.!:.{..:. 1.....11(_ // _",-I / -- . ;-~_.,-::.,::..,,,,,t-.-' ( J/ ~'~'--' " / Cctobe~ 10, 2005 Agerley tM Heafti!ecne AdrrUrlt6 ttati.of! Atteft'ti.orl: Judy fill! at AveYJ.:tuM Aventult<1, FLa. ,"Jewett, V~ec.tolt. fiO.6pUa-e 33180 Gel1.:tlemen: I WM appated a,;t teaJtrUng about the Jteque.~t 60Jt anothe.t ho 6p-i.tat. I have ~pent 28 yecvu, On my Une ,{,n heaLth eaJte; both phaJunaey and phy~,{,ciaY!6 ' C'nMc.u. S-i.x and ha-tn yea.J!~ WelLe ~pel'!.t a,;t a majoJt heaLth mcUl'!.teMn('e 6acALdYln New YOJtk. Wyand we/.>tc.he/.>telL Co ul'!.ty , ,"Jew !lJJtk. and 6ee-t lean objewve-ty M~U.6 the rleed6 00 heaLth eaJte ,{,rI the ;t;;Jerlty fl,{,Jt6t eel'!.tUf!Y. In June on 2204, I WM .tJr.ea,;ted M an emMgeney pa.tiel'!.t ,{,n Avel'LtuJul fio~pUat wi.th a bout On cU.veM:-i.euU;(;{;... The ('Me JtendelLed by bot hmy a,;tterlcU.ng phy~,{,cian, the ~Uf!georl who WM ea..U.ed UpO/1. ,{,neoY!6u.Ua.tio/1. and the AventuJul Mppoftt Maon WM exeeitel'!.t. 0/1. the ~.tJr.ength 06 thio expeJtienee, I ~ee no need nOJt anothelL 6aeiLLty ,{,n the Mea. I ~.tJr.o/1.gly objec;t to the buil.cU.ng On arlotheJt Itc6P,{,tal whelLe my tax doUcvu, woui.d be ~pel'!.t ,i./1. a ~upelLnlotL6 mamlelL. PleMe Jtead thio arid eOY!6,i.deJL aUf! ~eMoJt rleed6 ,{,rI thio M VelLY expeY!6,("ve Me-td 06 heaLth c.cvr.e. AtM, pleMe c.a.U. UpOrl me ~houi.d the rleed nOJt volun.tee.Jt6 ,{,n thio Jte/.>pec;t beeome rleee/.>~MY. Tlumk.~ 60Jt tv..terUrlg. You.Jt6tJlui.y, 1Z ~---(' " //~j --r{.. -c.i2. //~. J-tPy______ (~--u~'-_.. V/ ". ~dLth H Sobel (/(J:? ?l, ~ .:U It a.u-. tfcJ.{~~/ .~. 33t)Of t - ;) , , ('Ii {" ,V',C' - I ' :/ /. , ':" ';,.{:-k /'". ,/. J', 1/_,." ...-L ",' '''-.'';-1.--'1 r,(.<'I-, ,/ i--"'_ _ / I' '-"' / .... / . ./, .{ J //." <.:t.:-c ,~- L.>' ..- (i~.I'-/;'_"'L:' :., ~ ..n pi t.<.- .:!~__. c:c. 'I> ;i ,~ _~"7[.",--v -/ )-C___" ;'/L...8( !---' --~"" ,...! Y j<_c" <-I- "C /" "..'-- . ' " cz.. ) < '-, L.~ ,::~- ',,-... ;r,-, -1..7:"" I ~I c7c'~';r:: 'I.....<.-(.:...,:..,.-._,~ t, _..._,~ Jit.. '., '"'--- .c.-I.!J4.. <:'-4___~_<;-.-- -~ ."- /"' -'-<--- .,7:._~. <. "1:...-:..,_ c./,t..>c:..-- ,.1....:..:;. <-"1. . " ..,/~w-,. , --' ~ --"-_.- .('~I. ~.- ...) / - - / 1'-" '''/-.; -, ,,' 'f . - -- -............_L,,<--. .--.l 4;-w...L_'<<".>... I ?t. :'-t: c.."':"'-0) OJ">L ~t':1t'_1':"-- )-JLc '(,'-__, 'f"Ls_...-_ 7-rl...;'.<~i-- ti~ C,-:. , :-;-- , -e nt.._....,-:-1_"--I.-;_'-.~/~J J-L.,;.'_-L :t,.-Jc '7,-c<~ -h...?-___~:_ ~:. '-',- .:"'i_....,. A_~_,_,'_., j" I . ( .. />t.~<:::.'_'- ~j, ') , 1....... 1...,." /1 "'j -;fj'7// I/tJtPt:? "/~ ~. ~ .~ -1.4, ::3:3/3 .f ( t7AIL M. r=~~1\ Consultant 7135 Collins Avenue, #1624 Miami Beach, Florida 33141 Ph/fax: (305)864-2831 gfrank@the-beach.net October 8, 2005 TO: The Agency for Healthcare Administration RE: A ventura Healthcare Needs I am a member of H2U at A ventura Hospital and have been involved for five years now, That's when I moved to North Miami Beach to help my elderly in-laws, who have both been in and out of A ventura Hospital, as well as Miami Heart and Mt. Sinai, on many occasions, I now live on the beach, but I wish to let you know that I am opposed to any proposal for another hospital being build in North Miami. A ventura Hospital has come a long way in recent years, pouring funds into expansion of facilities and services to the community, Patients and visitors alike can see the vast improvement in the quality of care and improved attitude of their employees; something like that can only come from the top, and it is all pervasive in the Aventura Hospital of today, I look at a proposal for a new hospital as a blatant bid to grab a spot in the higher income area that is A ventura, which is where everyone wants to be, all hoping for huge profits. That is where the money is, But beds are going vacant here already, and additional medical facilities would be better placed in areas that are underserved right now, rather than crowd another one in Aventura. Not to mention ...where in Aventura? There1s no room left and we cannot bear the increased traffic. Please use the funds and influence you have to improve the existing medical facilities in the area rather than build another hospital. Cordiall}, Gail M, Frank ROSL YN S. DAWSON 3530 MYSTIC POINTE DR. APT. 511 A VENTURA, FL. 33180-4525 October 8, 2005 Thc Agcncy for Hcalthcarc Administration A ventura Hospital and Medical Center POBox 2910 Hallandale, Fl. 33008-9987 Gentlemen: I have been a resident of A ventura since January 1998, I am glad that A ventura Hospital now affords expanded services including cardiac care, as I have had a myocardial infarction and it means a lot to know that should 1 need emergency care and hospitalization I can get it close by. We the residents of Aventura, which is a prosperous growing community, are fortunate to have a beautiful new facility in our area. However, I do know that A ventura Hospital as ,ell as Parkway Hospital are not filled to their capacity. With this is mind, and knowing that there is a shortage of nurses, I do not believe that North Miami should allow another hospital to come into our arca. Sincerely, /. . ~_.1 " /;. ,..--1.__/'.... .. ROSL YN S. DAWSON 222 N.W, 121 Street Miami, FL 33168 October 7,2005 The Agency for Healthcare Administration TO WHOM IT MAY CONCERN I want to express my appreciation for the outstanding services which my sister received at the A ventura Hospital while a patient there for a short period of time. I have never been a patient there myself, but I have heard from friends who have been there, about the good quality of care they received from the hospital. They even mentioned that the best hospital meals they ever received, were while at A ventura Hospital. Although I have never been a patient at Aventura, as a member ofH2U for the past two years, I have the privilege of enjoying the programs that the organization offers, including the provisions of resources regarding our heal the are needs. Over the two years, I have seen great growth in the A ventura Hospital, and find that the expanded services, including the open heart surgeries, are all adequate services for the community. ) f}vG~ /. D. 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I!.:-~r uf '>\ ,:?~tid)', '(" '7f#~ _/f~pJC/ jj/$-.tU- ,/ ,~ rflLMd vd~;dz ~/ /{jPY~dJ ~~/zd~ 7Jd ~.?( 71/ /fu~JI. /'> ~ ~" 'I , ,t', ' . - I ;' - ?/ .-", ' t~j;/.#'~, /~$;. / _/.,:~ -/??:I~~/} ;i~dJ ~rr~ ~bd(!h'/?Jj/t~4 /"','f )' J "U' ~". /:./ ,// ' - / /..--"-;.,.'-v .-- ~~c:e::u0-.:-Y' ,___ /1 ;/ . t. t/,/--) ~ / .. /' ~ . / :,. /; .,~;- ;~? ,//_'~/ _y_ ;t;",~-~>. _~ /.?/ <1< - l:;/f:l// /;/ /('?,IVc,~:e- .e:t/ v; "'t". ~;) :.' / / ~',/ ,,/-~; i I l/ ... '(. , "1 October 11, 2005 The Agency for Healthcare Administration c/o Aventura Hospital & Medical Center Dear Sir/Madam: I became a full time resident of Sunny Isles Beach last year, after 7 years of part time residency. During the past 6 years I have had occasion to utilize the services of Aventura Hospital. I found these services to be highly satisfactory in all respects. Further, I am aware of the full plate of medical services which Aventura Hospital is able to provide the Northern Dade County Area on a "world class" basis. In addition, I have been advised that the utilization rate for these services is substantially below capacity. The considerations cited above lead me to believe that Aventura Hospital will be able to meet the current and future medical needs ()f this community on a high quaLit.l basis for years to come. Further, I believe that the proposed construction of an additional hospital in North Miami will be unnecessarily duplicative of existing facilities in the North Dade County area resulting in an inefficient use of healthcare dollars and possibly in a diminution in the quality of healthcare provided to area residents. In view of the foregoing I implore you to completely reject any application for an additional hospital in North ~ami. Sincerely, /0t t:t /'--~_J2-" ~t..c:C:2-<.'J--J' \.-' / MARIE MASON 230 - 174 Street Apt. 2202 Sunny Isles Beach, Fl 33160 November 13, 2005 Jeffrey N, Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg, 1 Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital This letter is written not only as an employee of Aventura Hospital, my husband and I are both residents of North Miami-Dade area, Think well what Mount Sinai Medical Center is planning, it is not to serve better the North Miami-Dade area, it is only self interest. We actually have enough medical services provided by Aventura Hospital and Medical Center, and by Parkway Regional Medical Center, they both provide excellent services to our community, and it is done not using our beds at full capacity, Do you realize how difficu/r is to recruit nurses? I can see the tremendous work our Administration Team at Aventura does day after day recruiting nurses, Any idea of an unnecessary new hospital will only strain the shortage of nurses, This will cause a lack of efficiency that we as residents of this area will never see it as no more than an adventure of Mount Sinai, they lack of purpose but they have plenty self-interest. I am very proud to work at Aventura Hospital and Medical Center and will never think a smart person like you would approve some, thing as unnecessary as a New Hospital in our area which is so masterfully covered by our two Hospitals, Thank you for allowing me ~/ express Z irplly believe, /1/ v; ;, i~1/ , Zaball;~Delv; . e BS~RPFT---------- Jeffrey N, Gregg, Chief Certificate of need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg 1 Tallahassee,Fl. 32308 Re; Mount Sinai Medical Center Proposal for a new Acute Care Hospital Dear Mr. Gregg, This letter is to express my opposition to Mount Sinai's Certificate of need for a new Acute Care Hospital. Currently there two acute care hospitals one being our own Aventura Medical Center, and Parkway Regional. Both hospitals provide comprehensive general acute care. In addition A ventura Hospital provides specialty services such as our Adult interventional services. Aventura and Parkway combined have a total of789 beds, And in fact the licensed acute care beds are underutilizied , A new acute care hospital in Northeast Miami-Dade would exacerbate an already diluted market of quality care nurses. Thus, Mount Sinai's proposals appears to be driven only by its own self-interest of the community of Northeast Miami-Dade, Thank you for the opportunity to comment on this issue. ~I lsmael Sosa,Crtt b~(; () r{ E ,q~; ') f Af) (- ~'"2 I ) .- N~"Nrfl 1- ,/~t1J <,)(1(<11 Fe} j] /11 .~~ 0 (-' c,l~ (i (/, (';~j OJ - 1 i /- I .' Ac;erlJcy FO.I./. 1 L/ (- ({ /f~ (/1 rC /1 c/7711 7/.J I~') ;~ () AJ E.... l: r i ..\..//1-. Do';' C-' .. .. ...) f:' iV 0 /2 E <: /-/ e p E 102 ;\-f';' t eN (///fRk i .II- //.1 l'rv,.c: 0 r A..-14 {/ 0 ';u t C:( / b;' (/1- j:: Ui;L U /Vt) G 1./ u 1-10 .r/J//~ / A tit: A/f".uPA Es;d A/O //1 ",() c-l3 / ,) ,.:' Elf) .~? t:'.. ~ (' / c :.u A (/-,1 f: I ,;(j /2 ;: I't D c'- Fit) Eitoj -13, t"A-( If Y ~ t..C .4 t)f;;;f...iTt.;PA ;>oz ('CIlI..r/(rt,J/cEA/FtE pv',~~l>Q e/l-r/TIIL / U;' (";(1 /rG-<!. / Q (fd eel .1-/0 j r'/,4 / ,})E /fl.) G"4) ro.e,f }) l.r I.) c' Nt!? .0 fi"'. ?"",c; 0 // ;A ('4/, // 0 /).4.J /l ~ R./ ,sf /f..o.:-.v ~ elL 11/J AJt:=c Gf/t1A4E-j' COtfl..['d c~t'/E~.JCJ "(-1'Z;/co y tJrc-V/C/Z//i!!"'" n ~ ~ / ' .- I! . iJl..J fT-1 A- / ,0(' C U,i/G-/ /''! EdE"V A'!/ rcN~eA eM F'J /J41l) 0 ( Jl--ft-'Y !2tJeu,lf (!i)N,f)tJF,,(J4(";la~ J PeU/I! jll.""'cP FkP;1,..,./rr Fie 1/')-1,4.iJe- (/ /~ 0 {) E e..<..-'C' r ~. c.;?(.,ll r "?~' . 4 If (.) /<.4 C (/ N b' / /O,R. 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Ll.f.' /7 /"i,7d/~,;E;(./."C; ,-(....{).......)r/,l<..> <ill V'l) /1= /,./.-'f-I,'/f .<.J ; (',Iy 7" U-' J j 1'- ,1'/ t= I!/ ,."" l'A 4 (' ~...t't- /Ail) ,"" '.', 'I,. ,). ,t'! /~'\.' ;'l,~'4Y,. 1/['/1(/ } ";/ I ...< I/'.'..~/, 4[/.... >....,/:/,4 /,<,"~}}/A./ },<1JI/,:j,'-.1P/,4 /,1 ,'... _.. ... /j , .1_.. /d .'L/""' .1_/ .<- .,,:':' t j '/;~f _,:-". or ',-.'..:-:'-- > . . / ' n ,-r. J ; -~. .J -,. G.. fL- C:.J' ':'.j f /~*"'-. /' , 1_.' oJ ~ /' ;...i wi ""' / ) 1~/ft>l( A 1) v) FA/ p. / -1.K? E I't" () f: /v'CR rfl 11)/11-11- //[ -5' / j) (.) /J/!t./EiYTC ciV 1::-- / /,,/0 J;tJ /' /".4,-- / {./" . / .-//' r / . i ../.' 4' ""i Ii,' 10/5/2005 Jeffrey N Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg 1 Tallahassee. Florida 32308 Re: Mount Sinal Medical Center Proposal for a new acute care hospital Dear Mr. Gregg, I am writing you this to inform you about my opposition of Mount Sinai's certificate of need proposal for a new, 260-bed acute care hospital in northeast Miami-Dade County. As an individual who knows a little on what is going on in the medical field, it is safe for me to say that if I am needing a medical attention, I will be looking for a facility whose quality of care and reputation in the community is of great importance. If Mount Sinai is driven by the fact that what they are thinking is to put up a third hospital within the area because of their third party contract i.e. managed care which is one of their business strategy to increase their revenue, then patient/client care is not their number one priority and definitely, the clientele does not want that We already have two acute care facility within the vicinity (Miami-Dade) namely Aventura Hospital and Medical Center with 407 license beds and Parkway Medical Center with 382 license beds including Obstetric both providing comprehensive services to include specialty of psychiatry and tertiary services, adult interventional cardiology services. Another issue that I am concern about is the personnel who will provide the services and care for the patients. As we all know, every single entity that our education system department is being creative to be able to get through the shortage of our medical personnel not only nursing but rehabilitation, pharmacy and so forth. With Mount Sinai proposal, labor will create more openings creating more shortage on those said department And let us not forget the emergency services that it will be needing emergency physician to cover the needs, Presently, I have not heard of any difficulty providing everyone who needs this kind of service. Right now as reported by Agency for Health Care Administration, both acute care facilities have been underutilizing their cute care license beds. As times goes on, I assume that whatever new services that the community needs, both facility will be able to find ways and means to provide it if it needed. Putting up a new facility will not solve the problems we have but will creale more friction and animosity due to the competition known to everyone. Thank you for your time to read and giving me the opportunity to express my thoughts Sincerely, Nenita P. Mercado 2801 NE 183cd St #1201 Aventura Florida 33160 C.M. Cearon 1350 N.E. 171 Street, N. Miami Beach, FL 33162 The Agency for Healthcare Administration Aventura Hospital 20900 Biscayne Blvd. Aventura, FL 33180 To Whom It May Concern: I recently read that Mr. Sinai is planning to build a hospital in the North Miami Beach area. What we do not need is another hospital. We already have four hospitals in the area, none of which is filled to capacity and all of which need competent staff. I have lived in the area for 22 years and am very grateful that we have the Aventura Hospital to serve our community. I hope we can use our health dollars in a more beneficial way. Sincerely, / J /J / \ ' /~-,/)/~ ,.....-.'-"'~ 1 ") ~ ~~<>?"-- Florence Adelman 18031 Biscayne Blvd. Aventura, Fl. 33160 TO: THE AGENCY FOR HEALTH CARE ADMINISTRATION To Whom It May Concern: I have lived in Aventura for the past 11 years and watched the growth in our community. I have been a patient in Aventura Hospital as was my husband, prior to their expansion. I sincerely feel that the excellent services provided to the medically needy at Aventura Hospital is superior. Statistics show that the four area hospitals serving No. Miami, Aventura, Hallandale, Hollywood and other surrounding communities are not at capacity. I feel that another Hospital in this area would be detrimental to residents, health care providers, hospital staff, and costs to all of the above. Aventura Hospital has grown to provide many health care needs in the recent opening of their new tower. State of the Art heart services being a major addition, The staff is caring and professional. Let us not spread these wonderful clinicans too thin. Sincerely, , // I/L. ;i'\.. , r , t:1~ t' j)' ,T ;,........ _..,-,~ ! r ./ ""~ .,:'-- J~. / t J~, "'_J (_C '.'} ~~:.: )_ l !':' Y~_:~--"'!-'- (~~' ,-' -' / , / 7 ~'-~n--...-~ ,,-_C~...-' ,/, -./ /" C I, ,: iL -----;.~! v ,--"C-;-...~_. ,_/~~ j .~. .....-') -- -Lv. .- . , .......-.. ~.-...... } -I '~-,~- ;..::'-~~.,L-L.- - L, '~J ,-, '/"'\.." -""-"--' I .? /'....-.... I! "') . ij j:)-' {,', ""'".:- .. C ( \..1 -.L"-"'_~, \J-.,_,.._" ~" /. 4- ~. 'uL ./ <- ~: t.. .I~ L--"'-l ./ -'L.,(:,,_~ '1_' -!:.~_ ~;' '-.-' ~- -'.J"L _.;.. (. ,; /C.:- < :,-", .L-<::-z.,,--{ ,,_ i ,-- .-' ~"I'-";-:"- ,.." .,1 ' ,4.,.",( .' ,-. ~..~ -/ ...., " 'L-' '-..... /! ./ / -"...-....... ... ( - C.Z ;'-'Z-C : ILL '_ '-..... ,. i'.1.- "1;' > I ". ~Z 'V"C-C'-V.-t>v'-C,-- "'; . ~ -~. , / ..' I Lt.) "~~"JJ 7.( _) C.' 1'---(. n, ...- / -/ / L / l ( I ,_( . L (" (, { ( '-. -1-( '-1' ~)(.(~ ..~. T "~ IL l" ;-- I c: )( t~'.1 . )!( t. )'- ~l '- " ,J .' ....: (t,., , I '.-, 1_, '':;' ! , , / .'- J;. I .. i //.- I , , ',' ,- ~i ( .Ji,/-/ i f I ". ( l) - .I '...... ;,'-, "', " " ~ ;. \J. ) j / I ; '. I I (, " / : (/ ) ( I I -' j ( ./ I ~'('... <,', /1 U\( October 3,2005 The Agency for Healthcare Administration Gentlemen: I have just heard that another hospital is planning on building another hospital in our area, As of this time I think that we have enough hospital beds to serve the needs of Aventura and the surrounding communities, Acccording to the census of patients to hospital beds for this area we have more than enough to cover us, I have lived in the Aventura area for three years and have seen the Aventura Hospital grow to its present size and feel that it is enough along with the three other hospitals to serve this community, The Aventura Hospital has also added an Open Heart Surgery floor to the hospital and I understand that the performance ofthis service is excellent, I do not feel that as of this time another hospital would be advantageous to the A ventura area. Sincerely, )J~~ ~, ~ Hilary G, Hesse 3000 Marcos Dr., Apt. P310 A ventura, Fl. 33160 1005 SW 7 Terrace Hallandalc Beach FL 33009 Tel; 9544579643 October 3, 2005 To Whom It May Concern, 1 have lived in Hallandale for the past five years, During that time I have watched the growth of Aventura Hospital and feel very lucky to live so close to such an excellent facility which meets the needs of our ever changing community so well. I was extremely surprised therefor to hear the proposal for an additional hospital to be located in North Miami. This would, in my opinion, be a disaster for both facilities and the communities they would be serving. All of the hospitals serving the south Miami area are very rarely full to capacity so why is it necessary to spend more money on another hospital. Wouldn't our healthcare dollars be better spent improving the facilities we already have? The national shortage of healthcare professionals such as nurs~s is well documented and another hospital would surely put a more of a strain on our existing facilities staffing and locally could cause a shortage of both clinical and support staff. 1 hope that you will take these views into consideration. _:0) // . . < ,"'." /-, '. :', I. i ) 0 . \ f/\J lit;':::: \.j \,..../ (l \ ! I I i>( { Ii / l / ~.' j\jl \ i ., f'J .~ 1__ C-' \....../ Yours sincerely Sherree Valliere 1225 NE l25ST North Miami FL33161 October 3, 2005 To Whom It May Concern, I have lived in North Miami for the past ten years, During that time I have watched the growth of A ventura Hospital and feel very lucky to live so close to such an excellent facility which meets the needs of our ever changing community so well, [ was extremely surprised therefor to hear the proposal for an additional hospital to be located in North Miami, This would, in my opinion, be a disaster for both facilities and the communities they would be serving. All of the hospitals serving the south Miami area are very rarely full to capacity so why is it necessary to spend more money on another hospital. Wouldn't our healthcare dollars be better spent improving the facilities we already have? The national shortage of healthcare professionals such as nurses is well documented and another hospital would surely put a more of a strain on our existing facilities staffing and locally could cause a shortage of both clinical and support staff. I hope that you will take these views into consideration. Yours sincerely I ( ~ ( , " ( < ( {- Maria Castillo Eric F. Green 20281 East Country Club Drive, Apt 215 Aventura, Florida 33180-3024 Tel 305-937-0942 Fax 305-692-9376 e-mail October 2. 2005 The Agency for Healthcare Administration A ventura Hospital and Medical Center Aventura, FL 33008-9987 This letter is in response to July Newell's request for help in a recent letter. I have lived in Aventura since 1990 and seen the Hurnana Hospital become the greatly enlarged Aventura Hospital. It is quite reassuring to learn that there are many more hospital beds in the area than are justifiably needed. Everyday news reports lead many ofus to suppose that there are never enough hospital beds in the world to meet the needs. In 2002 I went to the emergency room at Aventura hospital for what turned out to be congestive heart failure due to aortic stenosis. I was admitted without delay but the following day I was transferred to Memorial Hospital in Hollywood where after two days of testing I had open-heart surgery that was most successful and treatment that was exceptionally good. In 2003, after a fall that fractured a hip, I was admitted to A ventura Hospital through the emergency room and operated on on Thanksgiving Day. Again the delay was brief and the treatment excellent. In both experiences, it was of course the skills and care of the surgeons and medical staff that produced the fine results. Weare fortunate in this area to have so many professionals to take care of us. It does seem obvious that the shortage is not of beds but of personnel, and that adding beds is not the best way to use the skills available, Sincerely yours, /" ^ , \ I \ c,c Judy Newell ,I October 3, 2005 The Agency for Healthcare Administration I am writing to you with my concerns. I have lived in this community for 50 years. And in that time have seen the growth of the area and the Aventura Hospital. Aventure HOspital is a fine hospital with its expanded services and does meet the cJmmunity's needs. We want to keep the quality of this hospital which certainly fills the need of the area. Thank you for attention in this matter. Cordially, . .~~.~---'J_4"~-'-' .': " .,:........- '--'" Helen B. Mosher 1145 N.E. 182 Street N. Miami Beach, FL 33162-1329 -.",.... '... '-, ... ", ,.1""""". !:""i 1;...,;," .,'\,. .~ ; rl ~,~.. /'If, . ":J. ' ..... ..... _ ....'. '\ ';,. '('. . r tj'.'''"'. ., . '-". ":. ..'.. Ii.. ,. -i., *' ";~'; ';,- '~'. ~. .,..,- "',' ./" , l~ /~> '. 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C~ /~ v( a",-<->~ii.~ ~~. ?'-__#' I..:..d't.-LI:: .LL. ;,~<., x.l.? ,ot<_ ,'b;,fl-.L J-<-'V ,F d, )1;,,,, ".'"'~ VA~~'-'''.<J./ f "~~~~ /':';1 .c..( Utb (VQ..1-C ~ L/ 1./.3 '1'tP l'1,s" ;xl#' ! (:) ) J( )JZ-<.,4'''', dL~<..1..., It 5:1JICt David Gcrstein 20281 E Country Club Dr. Apt. 608 A vcntura Fl 33180 Tcl: 305-937-2200 Fax: 305-937-7455 DavidGerstein@bellsouth.nct 1011/05 The Agency for Healthcare Administration-re h2u at Aventura Hospital I am a member of the above community for the past 10 years and 1 have seen the growth in Aventura Hospital and I fmd that the expanded services including open heart, more than meets the community needs and meets the standards of this community== I remaip, /-~ y o~ivery trul( . i';:::;"> / ~ \. / / (.... L.-.." L.\. David M Gerstein Dmg:er= i / ~- . ;'7; c. (. A /If; /)/):::(,,;( 1-- /0/[ v / ./ Oftob~J' 1, 200:- To: 'nll' Agfncy {ill Htclllthcan~ Admini,hlltioD I rec('ntl~' read about the l)rOposal to build another hospital in North Miami. I cannot nnderstand wby tbis would be necessary, since thne are four large bospitll already in the North Dade/South Broward area, and I have read where they are also not anywhere NEAR their full capacity. So, where is the reasoning behind building yet another hospital in the same area?? I have lived in this area for the past 30 years. My husband has been a patient at Aventura Hospital and we were very pleased with their service. We have watched that hospital grow to what it is today and are very pleased with all their new services they now offer, especially the added open heart surgery which they lacked before and which is badly needed in our area. We feel that building another hospital so close to the other four is a waste of money which could be used elsewhere. And another problem: just where are all the nurses coming from to work in a new hospital, when everyone knows there is a very huge shortage of nurses everywhere. Please do re-think of your proposal. Respectfully yours, _ "~~l)><-":"<-"'<"-' (Mrs.) May Miller 2101 Atlantic Shores Blvd. #218 Hallandale Beach, FL 33009 /' , ~ fi , ~~ .~ y,- 'l J.'.I'/ "'.'" ...{,/ / -, ' I /' ?J<Z;Y X/f/, ./'.."'/. .,..... > "... L "./ ,,~ >!~. .,' ) "'-::. ' '1/' , ,.Z ..~. ~., ; , ~r. ;4ndgnrs. J{erman 1. Levinson 3161 S Ocean C})r ;4pt 1602 J{a{fandafe (Beacli) PL 33009-7282 //', .~ \'::,,_/ C~ . ,-, ~#~' '.~'._ . .(C'. --" } / ;/ ',. ".<, .,,) 'it, , / I " /~ (./ .( -<:'" (/;t>). j <:........ ..' ;/-/'J,_..<:.':'c'l~';"!.'- /;t:--;;:~ -,", ,:,',--".' (!.../?'-) i"l..-/t~.f ..., ~-- ',,-'''j ~'7"'J L " I /~/) ; {J .'::<:'-;/"'1 / c./' L' ,. /1 , , . ,;<~ c'\" J .,1 / ,l . / .-- ... u ,.:_L. ~. ',- .... //~-::=. . /, . ,; ",- (' /'h/ r ".t'. " ~._.... ~- ," ...~.- - ',-, . '.. ;', -.. .. <'t. ,. \, ,.,.....( .A'..__ ',,_~ ,"i. 7~' " '.. I I < I .p,. I ,-'.1/....,....<-..1'-'.. . 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(/' .I'll i I Y .5 AiE E () S, r;;; E r1- f{ E;;z- ~.;' E,j IV.:" r, IV i..;:::i='-l> /7/1/ ~. 77-1 IS' /'C 7' s '7 - ,(.~.:. I~./ {/tLt i2 c.)q"- lIlt' *t Co Itt.f';{ ,A/ (..: Il' ,f~ ~ S /[ /v.f) I ~( ,11- 11'1 it h-;::- r- 4-/ trY ,c/~/j(j /{ /!, /f('~ S /'J/ f'/l'-:::' .It d /> / ),./ P- /'1 ., , '- / /11,'; .;:::;-;....,/) -If/Ai ju 0 i? E CUI'V' S ,:J..) C /i) ~(; (...; '5 /?IS /'/ f) C' i i .I::> '-' I ~ ( J-J - . '.) - r n ~ )'I-Lk ell-A' C -') " ,a. ,'J 0;: i-/ t L L II /<; v /.v I :j c- L. 'I . '.../ / i,,' (:: L:'/, 'J )IE' .6-.: y .____-... ._,.L.~~,~- . -:....?. ' ' / ,,/<.., c'.:. , ,!~. J' . ". (( { ~~';LL e:-,~' A' , -j ,~ ~.. -" -.' I. t..............' - Ie") ;:':, . .A..,. ..~ .(. ,. r. .j GUNTER SCHWARZBART, M,D. F,A,C,S" F.I.C.S., F.RS.M. Hidden Bay. 3370 N,E. Hidden Bay Drive. Apt. 2911. Aventura. Florida 33180-2465 Tel: (305) 466-4161 . Fax: (305) 692-3737 Monday, Octobcr 03. 2005 Thc Agcncy tor Hcalthcarc Administration To whom it may conccrn: Dcar fricnds, 1 urgc you to think through with the requisite objectivity and in dcpth whether or not to approve a proposal for an additional hospital located in North Miami, My wife and 1 have resided in North Miami BcachlAvcntura since 1971. Wc havc watched with approval and admiration as Aventura Hospital grew, developed and improved its services, which now include open heart surgery, In this as in other domains, practice and dense usage make perfect. As a retired professor of surgery, I have long had occasion to observe and deplore the adverse effects of underutilization of specialized scrvices, the wasteful duplication of expensive equipment, and the destructive competition for scarce highly trained personnel. Unless the new hospital does indeed offer new, strikingly beneficial and otherwise locally unavailable diagnostic and therapeutic modalities, perhaps it would serve the community best to support hospitals already in existence which suffer from a relative scarcity of patients in relation to beds. With cordial and collegial regards, r-- -~1~.K4<- ~~1~~ GUnter Schwarzbart, M,D, rO~A- 3!J! ~oos- , 7/f I ft"- ~. I -; 8' S'I. IV. J'/I.IT "', F-t." "HI Ill. IJtr .ffl.GM, ~: ~ ~.i:t:/~:. .9~~ (J..- ~j ~ ~~';r~r~. GroJ 4x.~ .J'..~ #, . / r7 ~ ~~~~~~ a~~~ ~ 0 ~~7 r~ .0 4;<. ~~ ~ (/J..... ~ ~ LO'A.!._ _ __ ~ ~. (/' .---..-.:...e...... f ~ .~ .:.a.7~~~'J'~ I / 4 ~I CAtRj) -r~C5 o[9~ .-t.., -~- ~\ 'W. G . 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'__' t.. i,-L':" <.. ,/,..,.. -;""r' ~ j. .' /. .~:- <j~ .I~.. )(~. ., /' <--' d...n, :,..c_ r-t?.. , r..,,, , ;;.; ~-~... J ;;:/ '') .. ?,." " /.1 I~'Y''' t' ....-.. "".t. .' ~. l.k." ( J" ' 'r; (L'r ._<".._,,-i-:..,,_..~ < . ,~/I~ ". '--" .--' /~ "'-::>/I'i.' ~-" <.:::....e'.,...., 1 .1 . " I ~, -,.'7__..-.. / )' q , .~. 0'''' ,....';/6 .. ;' / .^ ...<jILl: (',L"...-:,-/.-,t."".),,q..' I' / , .. "- -:.~> -s'') /,' .f,'!...,....~. .f....; _'~ ..~ ... (' r(~/ '- , ' II '~ ,;I }.i::... ~-,/ / 'f--k.- :1..._41,.. [.,I." -x.......... / '; ./ l ....- (-<.F-., _ ' ,--1_ <__!="'_';; ). C,'." r-~ __ .~ -r"- .}I~,;L:" ....~_. -{ L{~><~~" ,1 .._..~-~,~/ "0;, 30) c~.('} ~:- "J,f-:jf/' -'7 I" , 1 v> (}if'f-d:k!.~- ... '--''' l , .. ,. ----.,-- <_J... /lC-;....-r.'.....:',c;;J., .i.c --,.;'/ .J. ./' ./. .J.. .tIJ, .. . ,,-__' /,:cii. '//.'j,/' ii.' P1...t...,_.~.,.. ::: ~ ,,(--' /,f; ',;, ~.f~ ~. '" ,; 4_ .4I0 ,;c;!-iJ-&-i?r /-"flLC"-""'" _/,'..e )l- iht ~: ~:j,;.r.'l/ t:0{ t:L..~t~r'~~C-- ./'" _ jJ,. ~ /) /J I /J p v- 1---" a,-<::-.t;: C'-)'-<.-/ ..Y"/I....--z-rl-.C:.~.,' -"."...-..'-.....-..- -t~o;~~~- <- 0~~ ~ ;,..-.ct. ,f?t.z'cJ~ .-'-L_ .~r'.Y-t:'<-< >,-,",'7 "/,,, (' /r{< .c.:'1J; .....;?//.d._<,:fl--..-;-:.-J), ~i./(i_AJ. ,,'-,.L"-;'-t:'_~._G-:'P~U~ ~- (J(j/l{}-'7'''cI! ,11~t'1iL, .--?,.'-.3V,' "'"-'r" t.' ..1 / i {J /". j? '''';'T'':'' /)/:; II J ,~...//," J L- ,:/f2.,~~~, t_j;J,,~LJL,- ,J-,-'",,--, /",,,_._~,_j2t2,(.....-- /"-" /-YV /"~L. ~ ~Fi'-C l'-<y ;( < -<-- / ': t' ~ ' ., " --C. Ii ,. "" L.' . , ;; ./,'-' "" -Y7A< ;.c.j;<.,. ..~ .< L, ! "," ""v. ."",,,,o..'.L) l) J" '(C A-{"r.' ' 'fi;.-Lt.rl~.,-""'L-;- p~J.e6.v"". . ? ~ ,-, " ,"~7:" " " I --l-r .., .J ,). ., .'. ,J . . , ~ , . . J ,:,",/_ ,/ J~O:' ,f~~i~e-- ~~'-7'7r., /-Z-:"~r"i-"''''7 -,' /_......~-J!.-'<J / ,', ./ ,\ , J ._Jt'.~.o.'\_ ~t(./ /' . i :c;~( /) (.i/l- i7_',.':P::;:"<'_<- ~ / ,"'}--J .'':> -p , " / 1'-C..-"'7tL.-tI 1~-'l.---" ,:c-<-e- ''-f Vr I I L.' /. {.....'7-, .L. Cc___, !;~ ~ ' l.. ',,? /' -f':... J/ . ,{ ,.._.:'_, i?.~ ..!../ :1:. ,';~jJ. -c....._) ,,- .."'..... / ~. ..1'_,,-; :,. <.. ...:_..:_.~.,o f'-~-:_t:__~ ~ L (\... .II, ),.f JO r': ,.1'/""", , .' "'''Y','; -,.",-' .".;' ,'~'.:, "~O'~-l. / .k ~ . i. (, ''It' ! .J/ .f... , /' ,v-- '.. -'-~~, "., / / . . f' \ I " , ':.,~ -/::.'.-~..,_..'---~ .~ "/'- -:; ,,-.. I - --;-- .~ ..... .'.-' , /. Helen Gonzalez 1553 N,E. 105 Street Miami Shores. FL 33138 October 4, 2005 Agency for Healthcare Administration To Whom It May Concern: 1 have lived in the North Dade area for 42 years and have watched the growth of the much needed A ventura Hospital. It has met the needs of our surrounding communities. To build another hospital in North Miami at this time, I feel is not needed or necessary. SinCerel[ l.~_C_. c.. "c. Hekm Gonzalez ,---- , '.... ) - -'\Z-"-1\ 0, I \" .J . (-.... r / ..... c'__ ~__5"'--f ~ ) I, ,/ / " . .---.--.... ( , IJ L ' '" l. l "-) ,.f r' J 1,( l~v f__',' "f j ._:.~~~.... 'JA- '/ /'11 "/"'.--:... ::-(.. ....." -J -.-;-- :1-.. ,.{ ;' ,_, ;. I '/ .' r' '\ /' l, 1/', "-'~/ (.. "{.~ .~-r ~)~J .,/~ ,- I '. / /{ .';, /,,.,., -:;'/ ," "J /' /.4-...y /- !.-, 'lL /Yd/ 1.....(/ ./ ../ / /I/[' /?~" :~ L- .... ;/ + .-(.. /. // / /' /. ~/ ~ / /--;~ r/J ,; /'---'~! .-y"'- <- L..... /.... _....'L-- ~ ~ ,. , , >,./// i~ " / V \.- " I.., /"../.;" // "j-~>t / 'I." ./ U-/}//,;>~ ,_-1'~./ . I ........., // ./("I/:i .' '-'G. l. " / ,) .-/<~ / / "">" /:' c }{ vi.' ...~'-~ /- "_l{ /7 ..;,?~ J::/ ')/:' " /~ / " '. . /-;/": ,/<</ / . \-- { i I. ? 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'.; ~ "V c:::V J , ~ f ~ ,~\' 'Y ), C~i. .~.~'~ <,1 ll- \> l' "!. .~ -<2 \- ,~ '-<.::' ) (~ J~:" ';:-'~ \''':' l"j ";''' "') "" r:y" ~ ''i~I~~j ~ ~. ~ t, .~~~> .-::\\:~; r~ .",-\~~ ~~ <r _ \,' "',---:--~ 'J ',-.) _J '__".. .. " J '\ "-.' '"", '''':j ~ ~' ~'-- y -..> ) .,' 1i,1 / ~ J . t1 " - ,",\-/ " 1;0.' <, - " '~ .,' '0. ~l '-..y 'J! ~ "j ~ ,,( ".. ,.-:1 ......'/ ~('~ ') ."-. \\ ~ .~::., I ~ I~ ((c / /~jL'C'/ / /' (//.. i, -I -, ) -/ (> l.( /1-) "o'h/ j . II/tel ' (iL '- " "} ,C I Y la: :'" / C{ 'c ((2et, ,Z;:," ./c>' {Z'.-C)L (, ,,'- j/:'-a)-~q:/~~/ 16=cjCCrLfl-/ - C~:;c,"jJ:<,w &ru~ c;/~/h, '(~ //t<;)2<.,e'r;-t.:, -A'~ "Z.~~<"L.R'-~'-' Cd ':'([73 .') S"J:' '(L , r.. > ~~", -6 z"'- </7 <:<;?, L -- z,- c-cu Ct,' 'i.) . {'(jut . /~'d1 . /Ju, ~ < ): C '/2, .f( 7{-" c. /,', c,~, . !,S<,L(,'- ...._ V /. /, c/ _~)1/ . Zl!t<2/ a'L' 0-1/ _ -y-' ec,c k,f ,<0'<- &";3 / LC,O ctd)e I~--.v _~( ~d";J/{X, ,1J2.I'71-':'; :~/a fL,f:c:.~~..:'t(:( ,~,c).rl' -/.<.,,- :;;/5;-'/tiL-'~G;/:[L/h "D-{ ,.' j,J? ,j;J(~2 {~-...z.);1;2Y )JCiZ-~/'C, -C"; -?/CM-,:r y. ,[h,;t:;;.~: --.}/ ,-=./ ~~/ h<?LA '';~'j-~r'~;j,.JK.;.L:~.<<.;;'ty . _?;rv:c. /i:"u~~,~ Cl!ui"k.c, ct'lC'f~(t~';' . ("t[4' ,(,L/ r<'7,n/ ':;')zL _~/-I;O ,/~nt'-ujD- ~ --[t:~ o Lc2cv _-L,' -t>l( . . .--- .' ~lI;;;;t~~ _=;J;7hd,i .t{1~<' (!: PflU'JC L~- /r/'{. )7lG),-::"..c..(~7 .1/ //-.7 #!'jP;'Z'-~ 7.4. .3.3L2,C) THE AGENCY FOR HEAL THCARE ADMINISTRATION H2U at A ventura Hospital 20900 Biscayne Blvd. A ventura, FL. 33180 Gentlemcn: As rctirees and tax payers in A vcntura for thc past 17 years or so, we believe there is really no necessity to build another hospital in North Miami when there is a shortage of nurses and patients to fill the beds that are already available. In our opinion, this would constitute a waste of our tax dollars, which are sorely needed elsewhere;, such as improving the traffic snarls the residents of A ventura are experiencing as a result of overbuilding by housing contractors. The City of Aventira should demand contractors to provide sufficient parking for their residents. To conclude, Aventura Hospital has been expanded with extra needed services, such as open heart surgery and other innovations, sufficient for this area. We hope this matter will be carefully considered and acted upon. Sincerely yours, .') '1 ,,'l./' c.~'.S:_-:.,~_-/i_-,<,__(__ - I ' ':1/"..::"'''2..- Rachel Torres G._.~. 7"/~~ ., , ~, ~:( ~'_'_ .. .CY' / . /coe::,/\ , . Torres ., , ,./ ; / " ,'" ,( , l ,/ // .--. C"h \../~ -.- .7 :1/ Crl,',/ ) ~ y:f'/ l,,::~?()<M'''~ 12/U(/' /-;'/ ,...-'\ lj'~" ~ /9. ,7 /, } ,~/J /" 7,/ //Zv-l (.( .~0'--' ,.!-;/>/ ',r-7, "_/ /, !~, L,l~!./.. /~/ :?"t~_j-,~'-cy'.ZJ! ( I; , _ '] /< . ,'17 ' .,,' , -r- /C:r" ///.(L,/,/-!~ /;.____!!:t{//~C'd,O- ,_..2 E" 'V t' {, .'>; ./' , _ (---;. / -, 71 " ..-/ ""' '-+./ /., ; ''', / / ..,. " .,' / V, .-- 1/, '.;" ,~.'" ',,'.I.1"''7.':A ~ ..." (. './ j- [... 1.- _ .'" ' r -:15' ~ // - _V" _""- --, /J /!,J ,I- v':.2"~I/ ,r- //, ,/e'? ' 77'~ (,O',-, /'-'~7;/~;. ,;-4;., ";":;~/"" ;~""{I/'if" I, ~,/"" ,/ J ~? ~.:" --~ 1.-----....7 j/ /' - -?A-r-A '.._ - /" ,'/ ,<-/.....(,~:~ /1; /r i_ ,...' /J f./ ./ ' . / / .-- " ;),< /,?~~, //1 I,' ,,/ /.. '- -", '~; / C_ fA... ~~~<.-,~,d:~.i~' ,6J).: (7"7 (/('--',.,."" ~~ ,.j '" ,---- J L ~:/b ,/5//1"'-" ;/,,"7fl//1k <1 SU IE.. I ;7;;4.)'1-. jJ .''3 C,/ /( tJzLtt 7)iL-~~i- .y~/~ - ,~3 ,)/ /)' ) I'r. / Jerome Benner 1423 N.E. 177 St. North Miami Beach Florida 33162-1335 Phone (305) 945-2525 .( 1 %' .; ./ ;1 'J 0' ~ .f; {'. -) /'.--. i.' 1..-.:.,:; ,~......-, .. .,}f<-e (1';<::<- '<'J ,;:6'--- . , II Y i );7 /_- .~ Ai(~ct~7(/h CO~j(( v C!CcI!/r,r-i//"v-v,'yt'v2J/()/'Tv 9-t1 'b>1';-v ;)/.~ <- / /} L-:r.;t-.:--<:tb>, _:i/f!;~tJ'-{)J2o 1..3:-.,:Uv:..z.,L,.. /) ,/ t,.^ -e, \..J /,/'.. V- 'i-'-(J - '&LA..' i "./'vC(..C_) Ck;f(7 j <t.. / cj \ ..:...;,-"-~. /i_Jl..~~ / .~ /i ~ r ~ .J__ .' .,<~~i~p~_{( vc~~.:jh~~~I~c!E::;;:/Z~(~~0t/~iL/ ~ il; 1) /) . /1 . t ' . ,/~ LJ S . /).' --4-. 'J' 0 ~~. ~J2/v~l''!&-'Jl-d /C-L)I'~ ',. /. C' ~..c.CiJL ~\A/:C,<:v .//u.;Ji!./~ h:C{,~yl'U/ 6Uvld . /~Vzl /rL{~/ ~~r.:).- I '79 r!lj U...f/O" JA{)""J-1!/,Ai!.i!",^-- _dc.iz... a./I"€.<Lf!l.&-t..v....., " J" -; '," , " ..rr ' . /' '/ /.' _//~j 7' ?j.c(f..-v;j ,<2A-/1u2~ ~ ;:.// {.d:V~"'1 A~.-L' ~/' .';1';; y Lu.{.(.j;(, 'YIA.j/J.'~ --WU /LCL...y<J:l //L(/A!.f!..lfh.C/ ~/V.L.~ Ie; 6 Z;.~5'.' . ~ .tv J..e-uHJ0A1.fi-~/~,~ 4&vv~ ot;(~~-t~~.) ~~hL~f'Iz~~ ~(AC~,-,Aj.x....C . /'~.\..~\.- /C1/ '.c'-fZ/ 'Z- J;Jf'dJli/~'/ C2-<..tZ.~Zr /? . ,d0 ~Juz..u.. . . " .' rTJV a;t;~X ) . CZ-1<tA. tt:~~{. ~~~/Li:. 1')< ;[ /) ./';1/1 /.1'*-___ / ~ ~1 {; /( ;/~ )'rU2n~lc2_'L/ (~1-;_'i-c,-~/ ':'}/'/i.. ;.Y~,-c-/, .{3Z:;'7 (; . . .v'.,,,...' ~'..I.. ,-c v ,./ '_.. -.~ './ 1; ( ."" 'l!)~/.(r./",~tL,.}Ai _So /7nn/("t)1.f!.I/(L;r;-cc< /( /....() i ('J~~~ (c(j'J:li .{:,' J ") ) ./' . , (../ 'I... -1 \. ". .', _/". .~/I ~~ -!~ 1/ < ,",,-, /~.~J"-~;' ~!)~ /i/\_cJ (_.~" /(.._<.(~ ~:.~,-,( /C-i, ~..~::..~-'.'J.~ _ ~I T ... ....-.: .-' .... .I ., " . ,>:'!'I.)/'V'l../ j .. " I I ,.' I;' ./', <~. <.....-:..... (/ ').--1',.t.." ;';'(.. -'-'-, , ,.,.; "I "\ I J , - - n L ,C /'. _ 1 " _<_ " i." _ , ./ " i/ I f -,.., ,>' ~ . / 'Ji.. / -, - . I", i . r._' . -,' 1 -,' . "'~. .. i 1 " J ',. '....-' "/.' ~,," I ;/. ~.:.,../ t...- _'_<,,~ - ).- .,..{(. .- ./.,. ;;' t ~. _ ~ " ~ /.' .' ( { 1/ .I.' ~'-? 1.... -' 'I ./ j '/ " '-J j. r }"\ ./ , / JI ..-",z>:. , ( J \ ,. -~ )--..-c ~ f. I , J I ,- / ) I'~ ". f \ / '. < { "--' l ,1/ '-/ '-- : ( ....,,/../..:,6 '.t:, :.'r' -,. -),. :. ) ALAN d. FOX 1985 So. OGEAN DRIVE-11H HAbbANDAhE.Fb33009 October 3, 2005 The Agency for Healthcare Administration c/o Aventura Hospital A ventura, Florida Gentlemen: I have lived in the Miami Beach-Hallandale-Hollywood area for most of the past 77 years, 1 have heard that a new hospital is being planned for North Miami in the near future and 1 am dismayed to learn of this, There are presently five hospitals in the North Miami-Hollywood area and all are only at about half their patient capacity. Another hospital in this same area would cause an additional nurse shortage as well as a shortage of clinical and other hospital support staff. The North Miami Hospital closed a few years ago because of a lack of patients, so why is another one needed in the same area? We have sufficient services available to our communities, To create more hospital beds in a community where they are not needed would add an extra burden onto those living nearby, and I ask that you re-think your present plan, Thank you for considering our community's requirements. ~ /A,S' ,e~~Yj,:,:' ,,/ ,. ~'/ ,;:/""j. ( 'V:bo/' ... " , j!jJ< 'I-.~~/ ',"" ;j:J;>/ (/ l.' ' ;! ':,-} ...",/ ,....""~ i ,'\';: - '! \../ J~A.~N~rr~ JACO~SON 4200 I'Ilffcrellt 0rlve-W0S l'Ion~wooJ, F'L 33021 October 3, 2005 The Agency for Healthcare Administration c/o A ventura Hospital A ventura, Florida Gentlemen: I have been a resident of the North Miami-Hollywood area for 25 years. It has come to my attention that a hospital is being planned to be erected in North Miami sometime in the near future, and I am very distressed to hear this news, There are five hospitals in the area of North Miami-Hollywood and all are at about half their patient capacity. To open another hospital in this same area would create an additional shortage of nurses and other clinical and hospital support staff. 1 also remind you that there was a hospital in North Miami (where I was once a patient), and it was forced to close its doors because of a lack of sufficient inpatients to support it. That being said, it would seem to me that we have adequate services available to our community. More hospital beds are being created in an area that clearly does not need them, and I ask that you reconsider your current proposal. Thank you for your consideration of our community's needs. Sincerely, '~\ ! I 'i" ;.l. -~'. ' I ._ ~ ) \,'0 !, ,I, i I \.....1 ',,' ~/___ i,'!/ v '--./ ) t <". ",}.. I, 11,>>// , f .f ., Cf',rL1Lr"., 't ;f ; ," " L C_.(_......-' (~C.': '_' ] ,/.J ','71e <-" ;l, /,',t I.> .' ~ - - ,J / ) {, " ,;: l_,L-- , f' I,'" ' \./ "JJ' ,I c ,') ./ )..,/ "I'lL;!''l,,- l /,<,>., -> ;,) }--.- _. -.'-.-) / - / ' 'i" . ' "f-,-CL,t.-- '""c' '::> '~c.t'l >t.L /~l, i< "/ ,I,t '(}uL-- 1:Z1j2/! I ~:iLv,---IrltJ) rA-/..lLl./ /'!ifcCu / ~.,,;'L "'1'}' J ;Lt'l cL. Its:, J I' ~- ii,'!<< , '/'. -.--( > 'e' {:'.../'.-.... -..."t. FLi /2C Y/ I'l..-_ :I~i) l,I'/' <1,1" ;Co ,) ,~ ill t~/-t c ~.{,::: .I", /- ~, , " / . ~~...{, -, -,' -r-" 'I I( " l/ ~."... ,.-' _ '," __",'/ -' ,- __",__- .J "'\"-'.--0 ) ,')('. ,)(" J/{,~1 , ' " ('~' j / ' "- / '-f" / -' /_ tc,L-c.Uj //t/^.kZ 17L.7,L<'- C, ':,Iec(o.it:" IrJiLcC /&J-'''-<1c'~/.- ec', t//c..c..(/"<;U: L ) )._/,~, ;' I" I,' _e. , '" I -+ ; r.t. ~J'.''' (;:{ &f..L ,,1/0') ,h,-h:{ h /(.OL/C(/,.<.,/ I I ;t,~v,~ .) / k /1 ", /\,@,71'/(jV''t![ 1 ,~ t~. }7tt ,.I Z-<, I ' :!Ua I , / tt.{ f L~ .:( cil--r-/ ! d -- /r :lC, r {-it. ,~ c .~/I t. (LLi :L[ 7<;' c..-4Lf/ ~ 'Z<<"\.1 {IF /I.' '; ,J- ,/;'-~~'L4'-zL :; }/FJ 2~} 7;1 iU i 0:t--~ ~ d;ooS- :3~7S ~, !,P.. -t ~S-lj.3 /5L 3 I~ .J , , ~ ",,,~.P~ t?~4,.... ~.:;;J ~~ ...~" ~~~~--lo - ~~ .,..' ~~~~~) '0. tl'1 I' OL-'~~~4- {.... p-,LfZ-..--... 3440 NE 192"d Street, #3E Aventura, Fl. 33180 October 6, 2005 The Agency for Healthcare Administration Recently my husband and I read in the Miami Herald about the plans Mt. Sinai Hospital has to build another hospital in North Miami. We find this to be an extravagant waste of money. At present there are enough hospitals to serve this area properly. It is our understanding that this would also affect the problem of the nursing shortage. We have owned property in Aventura since 1987 and have watched with interest the improvements in the Aventura Hospital and Medical Center. We feel this hospital more than meets the needs of Aventura and the surrounding communities. Yours truly, ca[/~""-<t<R. ~ 3::6,,<~_~ Catherine B. Hanson October 4 2005 The Agency For Healthcare Administration Concerning the proposed Mt. Sinai application to open another hospital in the Aventura area, this would be overkill, We have been residents of Miami since 1949 and have lived in the greater Aventura area since 1962, Our first question would be, why didn't the proposed hospital company come to the area when we needed them? We have seen Aventura hospital grow from virtually nothing to a first class facility, offering a complete menu of services, The newly expanded facility is magnificent. We would think that when they have standing room only, maybe some new beds would be necessary, Why dilute the talent that exists, Actually, many of the Doctors who practice at Mt. Sinai also have offices here and some have made Aventura their only office, Consider that Aventura is virtually built out and therefore should not be experiencing much more growth. It therefore appears that the only reason for the proposal would be to get a piece of the very pie that they never helped bake. Please do not approve this,.,. Th~nt you.,., / l '.'-- l j':' . I ./, t/ i //' L-~ i (/ /I Burris Millstone Marilyn Millstone 3600 Yacht Club Drive Apt 1401 Aventura FI 33180 ----~-- ""'')8: 1 10105/05 The Agency for Healthcare Administration: During the 10 years that I have known both Aventura Hospital and the doctors working there I came to trust and respect their commitment, professional care as well as the programs they provide. To my surprise, I found out there is a proposal for a hew hospital in the area. To the best of my knowledge there are to day more licensed beds at Aventura Hospital than patients. That is why I'm writing, to put things into perspective and to help a reliable institution to keep up their good work. I've witnessed the growth of Aventura Hospital and admire the way it has progressed. Sincerely, ~K-.. ~ Ruthy Rozental 5825 Collins Avenue #9A Miami Beach, FL 33154 Eric F. Green 20281 E. Country Club Drive #215 October 2, 2005 The Agency for Healthcare Administration: I have lived in Aventura since 1990 and seen the former Humana Hospital become the greatly enlarged Aventura Hospital. It is quite reassuring to learn that there are many more hospital beds in the area than are justifiably needed. Everyday news reports lead many of us to suppose that there are never enough hospital beds in the world to meet the needs. In 2002 I went to the emergency room at Aventura Hospital for what turned out to be congestive heart failure due to aortic stenosis. I was admitted without delay, but the following day I was transferred to Memorial Hospital in where after two days of testing I had open-heart surgery that was most successful. In 2003, after a fall that fractured a hip, I was admitted to Aventura Hospital through the emergency room and operated on Thanksgiving Day. Again the delay was brief and the treatment was excellent. In both experiences, it was of course the skills and care of the surgeous and medical staff that produced the fine results. We are fortunate in this area to have so many professionals to take care of us. It does seem obvious that the shortage is not of beds but of personnel, and that adding beds is not the best way to use the skills available. Sincerely yours, (J1;~ .2, I;' Eric F. GreeiI 7)/:/ 'I j.;1l'......, --I. f, -. .... "~~_~ ..21st CenturyOilcology \'. ,', '- >/ "'r:AAIi!,".';',\-.,:, "-:'_<-=t~-,';f,-1t,~t1~Il1f,ffu"P:t''''' ~,;' ',I'i_;~,,;j.,,><,.:;, "f,d- -""~"', r, "~ / ",' 'c, Isaac Vaisman, M.D. Medical Degree: CemraIUn,versll\'cfVe,~eZUfia, Sacci cf Medicine, CJrJCiiS, Vl'~e~'Jfi" ResIdency: Radi3/ion Oncclog~ Ti:omdsJeffersan Univff5ilyHospilJI, Phi,ladelphiiJ, PA MJssachust'ltsGeneralh'osp,'tal, 80slon MA Ed d F d M 0 Ph 0 FACRO I am writing this letter of opposition regarding the CON for Mt. Sinai to add an uar 0 ernan ez, .., ... h . I h N h M' . D d k d' . Medical De ree: acute care osplta to t e ort east laml- a e mar et area. I am a ra ratIon un"er"~OiMo'aQa. Spain oncologist that has privileges in this area. I would like to identify a couple of ~::~~nlon reasons why I do not think this community would be served by adding a third RadlalronOncology. hospital to the Northeast Miami-Dade Area: The Cleveland Clinic Founaatior:, Cleveland,OH Fellow: American CoJ/pge of Radiation Oncclogv i Debra Linzer, M.D. Medical Degree: Albert Emstem Cellege of Mediclhe, Bronx, NY Residency: Radia/ion Oncology Mount Smai Hospital, NewYork,NY Christopher T. Chen, M.D. Medical Degree: Jefferson Medical College, Philadelphia, PA Residency: RadidtlonOncclogy, Thomas Jefferson University Nospital, Philadelphia. PA Patrick M. Francke, M.D., FACRO MedIcal Degree: University 01 LCUi~V1/,'e Scrool ,jf Medlcm€ L,)lJ!svll.le, KY Residency: ,lj,~I\ifn:ily-: r,lr:I,'.cily,V"jlu)C( .'1,1(:: l.cy,"l(iIOr. i'n' .. ~:; L' J I, f' ,", I ., 'l ',l ::: c,,:' . '. {- C,I ",! :'.:' " :1, .,', ;.',::4 October 12, 2005 Board Certified In the Practice of Radidtfon Oncology .. Intensity Modulated Rddidtion Therapy (IMRT) .. HDR Brachythempy . Prostate Brachytherapy . Stereotactic Radiosurgery . 3-D Conform.:J1 Rildioth,H.:JPY . RddiOisotope' Therapy Agency for Healthcare Administration (ARCA) Re: Mt Sinai CON proposal for hospital in Northeast Miami-Dade area To Whom It May Concern: . Currently, Northeast Miami-Dade is already served by two acute care hospitals, Aventura Hospital and Medical Center and Parkway Regional Medical Center. A ventura has 407 licensed beds and Parkway has 382 licensed beds including a 23-bed obstetrical unit. Both of these hospitals provide comprehensive, general acute care services. Additionally, Aventura Hospital and Medical Center provides specialty services such as inpatient psychiatric care, radiation oncology and tertiary services such as adult interventional cardiology servIces. . There is no difficulty in accessing acute care hospital services in northeast Miami-Dade. According to the utilization data report that is submitted to ARCA, for calendar year 2004, Aventura's average occupancy rate was 52.46% and Parkway's average occupancy rate was 48.79% As a physician that is committed to providing patient services to the Northeast Miami-Dade community. I am also very concerned that bringing a new acute care hospital to this area will decrease the supply and quality of nursing care in the area. With a major nursing shortage this addition would stretch the already very limited nursing shortages to a critical stage. 1 want to thank you for taking the time to read my letter. Thank you. Sincerely, /:~ { , . "'j>a ick Franckc, MD " . '\,,1,' /1r;daricn nler:jPyrJncolo9yr;,-ru,oO"" J:: .,.he ,~/(eric,'"m College cl Parliatil)n Gncc/ogy -. '-,'I I,; ,.,_i,~ C'. (, 1,.' [' I .l( Ii" 'i,' ,1:' 1,(,,( ,:(.u, 'i,'~ ; " ~ rti~ :. I~ '",. " I. I. I i'~, .,1;, I,'. . '- '-;;';;'""'" ,'-J' ,,_,- ~ . '; '. ..Co \-"j !', '-I<~(_, Iii' ':;,',:, --"-'. V',';.. l",;j';"'::t . .._ uu _____m \ ~.~~i ~ ;213t C>)I ittHY Or',cclogy '.,-<C'C/ ;:/it"l,:oe:t'iilf ,.'i:','.' ,,' ',::'~.i~~~~''''I';;' 'J:j,*. ';)'.,~.Zt.i:i;~.:, Isaac Vaisman, M.D. Medical Degree: CGmraJ UnM,'.'siryc! ',ionS::Ufia, Schcoi of Medlcme, CJ'3CaS, 'vkfiUE,] Residency: Radiation Oncclcg~ Thomas Jefferson UntlHSlly h'C:pi:.il, PhiJJdelphi3, P4 Massachusetts GEneral Hospital, Be5lOn, MA Re: Mt Sinai CON proposal for hospital in Northeast Miami-Dade area Eduardo Fernandez, M.D.. Ph.D., FACRO Vv'h [M C Medical Degree: To om t l ay OIlCern: University of Malaga, Spain European Union Residency: RadialionOncology, The Cleveland Clinic Foundation, Cieveland,OH Fellow: American College of Radiation Oncology Debra Linzer, M.D. Medical Degree: Albert Einstein CollegE 01 ,Medicine, Bronx, NY Residency: Radiation Oncology, Mount Sinai Hospital, New York, NY Christopher 1. Chen, M.D. Medical Degree: Jefferson MedlcalCoiJege, PhiladelphlJ, P4 Residency: RadiarionOr;colcgy, Thomas Jefferson UmvHSlty Hc~pllal. Philadelphia, PA Patrick M. Francke, M.D., FACRO Medical Degree: UniversltycILoub...IleSchcdotA-~edlclne Lwsvit.1e, KY Residency: U.'~i',ltr:-jly c/ r,lrr"JLI.} ,~lt,jw,;/ Cd:t"I; L:_-in~ion, Kl' . l - ,I: ,. i.,_'. S','I;'_ -c. ,:i.ri -4 " ' ',l"," ',.I..,f" n. Board Certified In the Practice of Radiation Oncology . Intensity Modulated Radiation TherilPY (IMHT) .. HDR Bmchytherapy . Prostate Bfilchythempy .. Stereotactic Radiosurgery . 3-D Conformal Radiotherapy . Radioisotope Th€"'lpy Octobcr \2. 2005 Agency for Healthcare Administration (AHCA) I am writing this letter of opposition regarding the CON for Mt. Sinai to add an additional acute care hospital to the Northeast Miami-Dade area. I am a radiation oncologist that has privileges at A ventura Hospital and Medical Center. I would like to identify a couple of reasons why I do not think this community would be served by adding a third hospital to the Northcast Miami- Dade Area: . With two hospitals in the immediate Northeast Miami-Dade area, there is not difficulty in accessing acute care hospital services in our area. It is my understanding that according to utilization data reported to AHCA that in 2004 the average occupancy rate was 52.46% for Aventura Hospital and Medical Center and 48.79% for Parkway Regional Medical Center. . A new acute care hospital in n0l1heast Miami-Dade would mean onc more emergency depal1ment for physicians to cover, without any corrcsponding benefit to the service area. To my knowledge, there is no difficulty in accessing emergency services in the northeast Miami- Dade As a physician that is committed to the Northeast Miami-Dade community, [ am also very concerned that bringing a new acute care hospital to tillS area will decrease the quality of nursing care as well as the supply of nurscs. With a major nursing shortage this addition would stretch the already very limitcd nursing supply to a critical stage. I want to thank you for taking the time 10 read my lettcr. Thank you. Sincerely, Christ"phcr Chen, rvID "III" , ,; ,,:,r ;~aJiaticn Therapy Oncology Group. 'C, ; i.',' ;"t:e I~me/'iran COllege of R.'diation Ofil:vlo';7Y , i~"'." ("/..;,-; :~'" ," "'1_' . ',( :1 r:tli; L,~ Ec:,l:'I,l,..r, ',II ~ ; l ; L ,/<',: r,'1 :: -::, ,,=,"j,' L ~',j . ,"J'''P..'(.. ,Lf ,. 'I r~, '", I ..,,'~" - ,:'" ;;, ',:".} ~ }',,' I ~:~', !,: .;. r -L,;" : ;f,-- '.I ~ , ,.:,.1: ; I ';, ~ - ,,'. ;!~,'t,\r;i"I' :1 c "j~~' ,;,'1': Aventura Comprehensive (:ancer Center A Department of Aventura Hospital and Medical Center Eduardo Fernandez, M.D., PH.D Chief of Radiation One%MY 20950 NE 27th Court Av(~ntura, Florida 331 no Phone (305) 792-.'i850 . FdX .30::;) ~~'q::-.')L;i e-rnail: vf('rn;lnd(>zr;~rtsx.com October 12, 2005 Agency for Healthcare Administration (ARCA) Re: Mt Sinai CON proposal for hospital in Northeast Miami-Dade area To Whom It May Concern: I am writing this letter of opposition regarding the CON for Mt. Sinai to add an acute care hospital in the Northeast Miami-Dade area. I am a radiation oncologist that has privileges at the two existing hospitals in this area. I would like to identify a couple of reasons why I do not think this community would be served by adding a third hospital to the Northeast Miami-Dade Area: . Currently, Northeast Miami-Dade is already served by two acute care hospitals, A ventura Hospital and Medical Center and Parkway Regional Medical Center. A ventura has 407 licensed beds and Parkway has 382 licensed beds including a 23-bed obstetrical unit. Both of these hospitals provide comprehensive, general acute care services. Additionally, Aventura Hospital and Medical Center provides specialty services such as inpatient psychiatric care and tertiary services such as adult interventional cardiology services. . Aventura has committed to providing the community with a "new" hospital. It recently completed Phase I of its $130 million facility North Patient Tower expansion project. This project is part of the overall Master Plan to provide for the expansion, renovation, and eventual replacement of most of the hospital. As a physician that is committed to the Northeast Miami-Dade community, I am also concerned that by bringing a new acute care hospital to this area will decrease the quality of nursing care in the area. With a major nursing shortage this addition would stretch the already very limited nursing shortages to a critical stage. r want to thank you for taking the time to read my letlcr, Thank YOll. Sincerelv .' Eduardo Fernandez-Vieioso. MD, PhD Chief, Radiation Oncology Center, Aventura Hospital and Medical Ccnter Floyd A. Osterman, Jr., M.D., PA. l,aSCl:!ar and /fUl 'J'l', ';Ii.m:m r:.",'di()/C'f!,}" 21150 Bi,;cayne Blvd, . Sui[c 30J . :\Ji:U111, FL .33180 Tel: (305) 932-"7800 . F~x C()'j) 932-9166 Agency for Healthcarc Administration Tallahassee, FL September 28, 200S To Whom It May Concern: I wish to express my objcction to the Certificate of Need requested by Mt. Sinai Hospital to build a facility adjacent to the Aventura Hospital and Medical Center campus. The following outlines my justification for the objection. A ventura Hospital and Medical Center (AHMC) presently has the unique opportunity to develop a Cardiovascular Center of Excellence, which is vital to the growing needs of the Aventura and South Florida community. The goal of the Cardiovascular Center of Excellence is to improve the understanding and management of peripheral and cardiovascular diseases through an integrated multi-disciplinary effort. Such a program will provide patients with quality medical care at a university academic level, which is unprecedented in South Florida. Recently AHMC Administration has embraced the importance of a university level academic program and is providing the funding and appropriate administrative and medical staff personnel to oversee the project. Advanced technological capabilities, the collective expertise of our physicians, administrative and allied health personnel, and the coordinated approach to patient care will bring world-class vascular and cardiac care to the A ventura and South Florida community. HCA has demonstrated its support of the Cardiovascular Center of Excellence through its $ I 30 million expansion project to include state-of-the-art interventional radiology and cardiac catheterization suites and cardiac and vascular surgical suites. The administrative and medical staff leadership team includes Heather Rohan, CEO, Rick Kennedy, COO, Alfredo Rego, MD, PhD and myself. Ms. Rohan and Mr. Kennedy both understand the community benefits of the program and more importantly, have the university level experience to ensure the program is brought to its fruition. Dr. Rego. Medical Director of Cardiovascular Services at AHMC. also has extensive experience in the university setting. I was the Chief of the Cardiovascular Diagnostic Laboratory at The Johns Hopkins Hospital for 10 tears. During my tenure, I developed and directed a 2-year Intcrventional Radiology Fellowship program and managed a multimillion dollar expansion project to include 12 interventional radiology, cardiology, and e1cctrophysiology suitcs with prc-opcrativc and post-opcrativc rccovcry units. WW'IV ,angioplasty -"ir.com ASSOCIA TES IN INTERNAL MEDICINE 2500 EAST HALLANDALE BEACH BOULEVARD THIRD fLOOR HALLANDALE BEACH, FLORIDA 33009 Tdephont: (q54)4:q~.T'66 Fax (9S4J457-S624 September 27. 2005 ACHA Tallahassee. Fiorida Dear Sirs: I am writing this letter on behaif of A ventura Hospital and Medical Center in A ventura. Florida where I have been a member of the medical staff for more than thirty years. I have also served this facility in such leadership positions as Director of Medical Education, Chairman of Quality Assurance, Chairman of Credentialing, Chairman of Patient Care, Chief of Staff, and for the past several years as Member of the Board of Trustees. This work has given me a unique perspective and insight into the needs of the A ventura medical community. Over the past several years. and as recognized by ACHA, JCAHO and others. I have observed A ventura Hospital and Medical Center develop and provide outstanding medical care to this community. In addition, there has been major renovation and improvement to all the hospital's facilities which also include the latest technology and services. This hospital's experienced medical staff provides services for all specialties with the exception of transplant surgery. I read in newspapers recently that Mount Sinai Hospital plans to build another medical facility close to A ventura Hospital. I see no advantage for a new facility in this area in view of the current medical services Aventura Hospital and other hospitals. including Parkway Regional Hospital, North Shore Hospital, Memorial Regional Hospital and Hollywood Medical Center now provide; there already is a large glut of hospital beds in this area, I recognize that Mount Sinai Hospital is a teaching facility. However, A ventura Hospital is in the process of exploring ways to work with medical students and residents to better serve this community. While health care dollars are scarce, excellent medical care is provided at several community hospitals in Aventura and the neighboring communities. This proposal by Mount Sinai to build an additional hospital would only be needless. superfluous and extravagant. Very truly yours. Stewwd 1>. Sfudf, Stewart D, Shull. MD,. FAC.P., FAC.G. Member. Board of Trustees SDS.'pm LEE B. PRAVDER, M.D. -(/u't( ._":I;/" (Jet?ll a)t<I.~~l;td( ~J-..l~rc;;,.a6,.lf Diplomate of the AmeriC,ln Board of Psychiatry and Nl:llrology 21] I (I Biscayue Boulevard Suite 304 J\orth MiamI Beach. Florida 3318(1 Subspecialty Board Certification in Child and Adolescent Psychiatry (305) 932-5500 September 29, 2005 To: Agency for Healthcare Administration Re: Expansion of Mt. Sinai Hospital to the Aventura area To Whom It May Concem: I believe the efficient delivery of healthcare resources is essential to maintaining quality care and keeping astronomical costs down. This area has more than enough beds. with capabilities of expanding, to meet the needs of this community. I believe that adding another hospital in this area would have a negative impact on the citizens of this community by adding to overall cost and potentially diminishing the quality of care by having units that open and close due to oversupply. Thank you for your attention. ~CtfUIIY ;( L,/ I ee Pravder, MD LPllj 'lip ....EL-Jl.:r~~cr:c). -.----- Pl,'...j".;;,r! \.~,;\()Cj,lh:.~ p.o. Box 801931 Avcntura. Florida 33280 Ph: 305.682.7290 Fax: 305.682.7036 Thursday, September 29,2005 To Whom It May Concern: I have recently become aware of the plans for Mount Sinai Hospital to attempt to open an inpatient facility in the A ventura area. As a physician that practices in the A ventura community, I wish to express my concerns regarding this expansion. A ventura Hospital and Medical Center has service lines and total hospital beds that is more than capable to meet the needs of the community; any dilution by adding un-needed hospital beds will weaken the inpatient volume for the facility and jeopardize the services that are already in place. Based on the growth and the service lines of Aventura Hospital and Medical Center, I see no need to have an additional hospital in our community. Sincerely, ~~b~ Ahmed Shehata, MD -----nElnc:rgcnC) --.-, j' h " :'; i ,:' i .111 . \,';S()~~i J rL '; P.O. Box 801931 Aventura. Florida 33280 Ph: 305.682.7290 Fax: 305.682.7036 Thursday, September 29, 2005 To Whom It May Concern: Mount Sinai Hospital has for many years served the medical needs of Miami Beach, North Miami Beach and, as a secondary market, Aventura. Over the last several years, A ventura Hospital and Medical Center has expanded inpatient beds and service areas to provide a first class facility for our primary service area, the community of A ventura. I have now become aware of a plan for Mount Sinai to open a hospital in the Aventura community. It is my opinion that this is unnecessary. Aventura Hospital and Medical Center has more than enough capacity and service lines to care for our patients. Please vote no on any Certificate of Need requests from Mount Sinai Hospital regarding expanding to A ventura. J~ John Abt, DO, FACEP --'--Emugcncy ---- Ph\~;ici,t:~ ,\~SO,,__i:ltL.., p.o. Box 801931 Avenrura. Florida 33280 Ph: 305.682.7290 Fax: 305.682.7036 Thursday, September 29, 2005 To Whom It May Concern: I have recently become aware of the plans for Mount Sinai Hospital to attempt to open an inpatient facility in the A ventura area. As a physician that practices and lives in the community, I wish to express my objections to those plans. Mount Sinai has for many years serviced the medical needs of Miami Beach, North Miami Beach and, as a secondary market, A ventura. A ventura Hospital and Medical Center has recently expanded to provide a first class facility capable of treating patients in our community as well as, or better than. Mount Sinai, for our primary service area. Aventura Hospital and Medical Center has service lines and total hospital beds in accordance with community growth. Their business plan more than meets the needs of my community; any dilution by adding an additional hospital will decrease the inpatient volume for the facility and jeopardize the services that they have strived to put in place. Please let Mount Sinai continue to serve its primary service area, Miami Beach and let Aventura Hospital and Medical Center serve the community of Aventura. Sincerely, .lames E. Pro o. MD, MHCM, FACEP AmeriPath -".-..'..'---------'.,,-" --.. .~~,;., ,~,.,..." ,; i'~ ,...~,;,,;.l<"'-t. \It'III/J/':III'','ltilnl ( 11,.111,.,,1 Ct'"I,'/' I i;J,,'1!1 ii', -Ii! (.I' f,;llJi.),<.; September 29.2005 The Agency for Healthcare Administration 2727 Mahan Drive Mail Stop #28 Tallahassee, FL 32308 To Whom It May Concern: I am writing this letter in opposition to the petition by Mount Sinai Medical Center to build an acute care hospital in the North Miami Beach area. I feel there is already substantial hospital capacity in this area of the County and another facility is not needed. In the area of North Miami Beach there are several acute care facilities including North Shore Hospital, Parkway Hospital, Aventura Hospital and Medical Center, and in the South Broward area Hollywood Medical Center and the Memorial Healthcare system. In fact, several years ago a hospital in the North Miami area (North Miami General Hospital) closed in large part because of the excess bed capacity in the Northern area of the County, A ventura Hospital and Medical Center recently completed a new patient care tower allowing for some 200 additional patients, an open heart surgery program, and expanded emergency room services. An additional medical facility in this area would lead to additional unused, expensive bed capacity. Sincerely, 1// .. ~f/ Kip +azon. ~ .D. KA:ydf "-ip \lJJ:l:',()ll. \'1.1), JI\1 t;h'Hli'!'ill;lll. \1.1), Scotl \1aisdl. \'1.1). 20900 BIS('<I.\lil' Hou[I:\:'lI'(l . \\\'IIIUl'n. FJ. :::~lgo .. :~():).GH~."dj-)O .. F\\ ::O:;.G82.:U140 HOW ARD ESTRIN, M.D., F.R.C.P. (C) DlPLOMAn: AMERICAN BOARD OF INTERNAL MEDICINE SUBSPECIALTY BOARD OF GASTROENTEROLOGY DISEASES OF THE DIGESTIVE TRACT AND LIVER 21110 BISCAYNE BOULEVARD SUITE 200 A VENTURA, FLORIDA 33180 TELEPHONE (305) 937 -2307 FAX (305) 937-2218 September 27, 2005 Agency For Health Care AdmInistration Tallahassee, Florida Dear Sir/Madam: I am writing this letter regarding the recent announcement of the possible establishment of a new hospital in North Miami Dade, Florida. According to the information announced In the newspaper, it was suggested that there was Inadequate capacity for hospital beds In our area. It is my considered opinion that there is more than adequate availability of hospital beds. Actually, the hospitals, which are In the region, are under utilized at this time. Based on the information available in the press, I cannot foresee improved delivery of health care In our area with the addition of another hospital. Thank you for your consideration in this matter. Yours sincerely, ~,.- \ CJ.-- Howard M. Estrin, M.D., F.R.C.P. (C) Chief Of Gastroenterology Aventura Hospital And Medical Center HME: vgr/jam 3512568_00_13_.Hcwar<CEstrin_Lettel'_5_ Page 1 of 1 Vi.i, , \1, J I: ~. .,1 \ September 30, 2005 Agency for Healthcare Administration To Whom It May Concern: I am writing to state my opposition to the application for a Certificate of Need (CON) for an acute care hospital in the Aventura area by Mt. Sinai Medical Center. My opposition is based on the following: I) Two acute care hospitals A ventura Hospital and Medical Center, a full service facility and Parkway Regional Medical Center are in the same area and are not running at full capacity. 2) Based on lack of "saturation" an additional hospital would only be serving as dividing a market that is already adequately provided for. 3) An additional hospital would drain resources in an already "straining" health care environment - the nursing shortage is acute and serious. An additional acute care facility would serve as a drain on the already "too small" pool of nurses as well as other ancillary staff - this would further impact the shortage and jeopardize patient safety. With the inordinately high cost of hi-tech medical equipment, supplies, phannaceuticals, implantables, an additional hospital would be duplicating services for a community that has no shortage of acute care access. 4) As a primary care physician [ can see no benefit to my patients or to the community of spending multimillions of dollars to build a facility without need, only to become a white elephant. 5) As a Physician Advisor in Utilization and Quality management, waste of resources is frivolous and irresponsible. It goes against the principles of appropriate resource management and does not enhance quality of care. We iearned a hard lesson in the late 1980s when, after the hospital "building boom" of the 1970s and early 1980s, one hospital per week was closed down due to an oversupply. Let's not let history repeat itself. Sincerely, ~~ t\- ~2....~~,-~:l-.jl H --1) Desiree A. Rosenthal, M.D. Diplomate ABQAL'RP Physician Advisor '/ SHERIDAN HL\IT]:C d{!~ ,613 N. Harrison Parkway Suite 200 Sunrise, Fl 33323 800.437.2672 Fax 954.851.1700 September 29, 2005 The Agency for Healthcare Administration Dear Sirs: As the Chairman of the Department of Anesthesia at Aventura Hospital and Medical Center and the Dade County Regional Director of Anesthesia Services for Sheridan Healthcorp, I am vehemently opposed to the construction of a Mt. Sinai Hospital campus in North Miami Beach. The healthcare needs of this area are already adequately served by North Shore Hospital, Parkway Regional Medical Center, Aventura Hospital and Medical Center and several free standing ambulatory surgical facilities. The brand new $130 million state of the art expansion at A ventura Hospital and Medical Center which opened in 2004 was designed to serve this community and is doing so in exemplary fashion. In addition to opening more beds, more operating rooms, and an expanded emergency room, AHMC recently started an open heart surgery program to further meet the needs of this community. Furthermore, there already exists a significant shortage of nursing personnel as well as anesthesia providers which would be exacerbated by the addition of another hospital in this area. One of my responsibilities for Sheridan Healthcorp is the recruitment of Anesthesiologists and Certified Registered Nurse Anesthetists. The demand for these providers far exceeds the current supply which has already driven up the costs for anesthesia services at the existing North Dade hospitals. Adding to the existing excess capacity of operating rooms in this community will surely drive up the cost of providing anesthesia services. For all of the above reasons, and more, I urge you to oppose the proposed Mt. Sinai expansion in North Miami Beach. lIiL-b"~ Steven Sheinman, MD Dade County Regional Director Tckpbone:305-931'8844 Art/lUrJ. Sclratz, M.D., F.A.CO.G., f~A,CS. Diplomate - American Board of Obstetrics and Gynecology Diplomate - American Board of Foreosic EnmiDe... A.A.M.R.O. Certified Medical Review Officer 2627 N.E. 203'. Street, Suite 115 Aventura, Florida 33180 Facsimile: 305-935-4113 October 4, 2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I Tallahassee, Florida 32303 Re: MOWlt Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg: This correspondence is to e"press our opposilion to Mount Sinai Mount Sinai's certificate of need proposal for a new, 260-bed acute care hospital in northeast Miami-Dade County. Our opposition to Mount Sinai's proposal is based upon the following: · Northeast Miami-Dade is already served by two acute care hospitals, A ventura Hospital and Medical Center ("Aventura'') and Parkway Regional Medical Center ("Parkway"). Aventura has 407 licensed beds, and Parkway has 382 licensed beds including a 23-bed obstetrical unit. Each of these hospitals provide comprehensive, general acute care services; in addition, Aventura provides specialty services (inpatient psychiatric care) and tertiary services (adult interventional cardiology services). . There is no difficulty in accessing acule care hospital services in northeast Miami-Dade. In fact, the licensed acule care beds at A ventura and Parkway are underutilized. According to utilization data reported to the Agency fot Health Care Administration, in calendar year 2004 average occupancy was 52.46% in Aventura's 351 licensed acute care beds, and average occupancy was 48.79% in Parkway's 325 licensed acute care beds. . A ncw acute care hospital in northeast Miami-Dade would, in aU likelihood, dilute the quality of nursing care. There is a limited number of experienced and qualified nurses already, and the staffing required for an entirely new hospital would necessarily stretch what is already a very light labor market for nurses. · A new acute care hospital in northeast Miami-Dade would mean one more emergency department for physicians to cover, without any corresponding benefit to the service area. There is no documented difficulty in accessing emergency services in northeast Miami- Dade. · Aventura has already essentially committed to providing the community with a "new" hospital. It recently compleled Phase J of its $130 million facility North Patient Tower I -d Elli>SESSOE a w Z~~40S L ~n4~~~ ~Oi>:ll SO so ~OO 2'01 expansion project. This project is part of the hospital's overall Master Plan that provides for the expansion, renovation and eventual replacement of most of the hospital. . An article in the Miami Herald recently indicated that Mount Sinai believes it needs a second hospital in Miami.Dade in order to have increased leverage in negotiating with managed care plans (see "Mount Sinai pl8l1li new facility", Miami Herald, September 23, 2005). Thus, Mount Sinai's proposal appears to be driven more by its own self-interest than the interest of the northeast Miami-Dade community. Thank you for this opportunity to Comment. Sincerely, -' ~{Je J. Schatz, M.D. E l1VSESSOE a w z,e40s r ~n4,~8 eOv'11 SO 90 ,00 ("'\(/hto. , CardioCare of South Florida. ,,^ ... . ,,/1 CARDIOLOGY AND INTERNAL MEDICINE ERIC M. SPIVACK, ~I.D. October 14,2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg: As a resident of Miami-Dade County and a physician currently working at Aventura Hospital and Medical Center, this correspondence is to express my opposition to Mount Sinai's certificate of need proposal for a new, 260-bed acute care hospital in northeast Miami-Dade County. My opposition to Mount Sinai's proposal is based upon the following: . Northeast Miami-Dade is already served by two acute care hospitals, A ventura Hospital and Medical Center ("Aventura") and Parkway Regional Medical Center ("Parkway"). Aventura has 407 licensed beds, and Parkway has 382 licensed beds including a 23-bed obstetrical unit. Each of these hospitals provide comprehensive, general acute care services; in addition, A ventura provides specialty services (inpatient psychiatric care) and tertiary services (adult interventional cardiology services). . There is no difficulty in accessing acute care hospital services in northeast Miami-Dade. In fact, the licensed acute care beds at A ventura and Parkway are underutilizcd. According to utilization data reported to the Agency for Health Care Administration. in calendar ycar 2004 average occupancy was 52.46% in Aventura's 351 licensed acute care beds, and average occupancy was 48.79% in Parkway's 325 licensed acute care beds. . A ne", acute care hospital in northeast Miami-Dade would, in all likelihood, dilute the quality of nursing care. There is a limited number of experienced and qualified nurses already, and the staffing required for an entirely new hospital would necessarily stretch what is already a very tight labor market for nurses. '~ll' n ,f)ISC,~_';'l\ E BL D. . SLITE 208 " ,~\ E~j'n_:K,\, fL 331l~O " (:o,~) G~1~JY~99. FA.X: 12(3) 692-Stll1b . A new acute care hospital in northeast Miami-Dade would mean one more emergency department for physicians to cover, without any corresponding benefit to the service area. There is no documented difficulty in accessing emergency services in northeast Miami- Dade. . An article in the Miami Herald recently indicated that Mount Sinai believes it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating with managed care plans (see "Mount Sinai plans new facility", Miami Herald, September 23, 2005). Thus, Mount Sinai's proposal appears to be driven more by its own self-interest than the interest of the northeast Miami-Dade community. Thank you for this opportunity to comment. I { October 16,2005 Jeffrey N Gregg Chief, Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Building I Tallahassee, FL 32308 RE: new hospital in northern Miami-Dade County Dear Mr. Gregg: I was surprised to hear of consideration for construction of a new hospital in northern Miami-Dade County. Such consideration seems frivolous at best and harmful at worst given the current over supply of hospital resources in this region. I am writing as a resident of North Miami who has been on the medical staffs ofMt. Sinai Medical Center on Miami Beach, North Shore Medical Center in North Miami, and A ventura Medical Center in A ventura. The three hospitals cited are within 20 minutes from each other. Located among them is Parkwav Medical Center and located but five minutes north of this group is Hollvwood Medical Center. The group of five acute care hospitals is bounded by the very large government supported hospitals of Memorial Regional Hospital in Hollywood and Jackson Memorial Hospital in Miami. Our region is rich in hospital resources. My working experience shows excess hospital capacity. All hospitals boast generous physician staffs, emergency departments, and operating rooms. In A ventura, where I am Chief of the Section of Urology, for instance, the operating cystoscopy suite is seriously underutilized. I offer this as but one illustration of what is the generalized state: more beds, services, and doctors than we can fully occupy. As a potential serious downside, a new hospital could intensify pressure on nursing personnel, which complicates medical administration, compromises the quality of care, and delivering no benefit to our patients. I do not know the motivation behind consideration for yet another hospital in our region. Let me take the chance in any event to share that I see no need for and can imagine no good from yet another hospital. Sincerely yours, Arnon Krongrad, MD OCTo! 8-2005 03: 3ZPM FROM- Aventura Neurologic Associates Julie B. Schwartzbard M.D., P.A. Sheryl Strasser, M.D. Jennifer Montanti, M.D. Board Certified in Neurology T-618 P 00Z/003 F-Z34 .........o.....o.. I I........................... 21000 NE 28'" Avenue, Suite 205 Aventura, Florida 33160 Tel: 305.933.5993 Fax: 305.933.9415 Oc~ober 17, 2005 To Whom It May Concern: It has been brought to my attention that Mount Sinai is proposing a second hospital in Miami-Dade according to a recent article in the Miami Herald, dated September 23, 2005. I wish to bring to your attention that northeast Miami-Dade is already served by two acute care hospitals, Aventura Hospital and Medical Center and Parkway Regional Medical Center. These two hospitals have a capacity of nearly 800 beds, including a 23-bed obstetric unit and all the important facilities that an acute care facility provides. Certainly, Aventura Hospital has intensive care and acute adult interventional cardiology services. AS far as I am aware, there is no difficulty accessing these facilities either by ambulance or by private vehicle. In fact, the acute care beds at both these facilities are underutilized, which makes the addition of another hospital that much more superfluous. In the 2004 calendar year, the average occupancy in Aventura Hospital was about 52% and that in Parkway Hospital about 48%. It certainly is well known to all those who work in the area that there is an acute nursing shortage and it is very difficult to keep nursing staff as it is. An additional facility would further dilute this scarce resource and make it very difficult to find adequate nursing care in existing hospitals. It also appears superfluous to have a new facility since Aventura Hospital has just committed $130 million to expanding and renovating its facility. OCT-18-Z005 03:3ZPM FROM- PAGE 2 OCTOBER 17, 2005 T-6l8 P 003/003 F-Z34 = hope that the Mo~nt Sinai proposal is driven more by a community interec than self-interest and feel, again, that this is very superfl 0 s and is not need in the area. LEONARD V. CO EN, .. Board Certified in Neurology Chief of Internal Medicine at Aventura Hospital Lve: sw D: 10/17/05 T: 10/18/05 14-0CT-2005 04:59PM FROM-S BROWARD CAROIOlOGY CONSULTANTS +9549Sl15TI T-197 P 001/002 F-162 1150N 3S'.hAvonl,lll, S\IIII 60016CS 'rol;lS;0-4)i!le~"3331 Fax:' 'JS41~B1.0465B ~lcwafd F. Berlin, MO, F \.ce Ka8nmlrs P. Bhil~h", M,' FAce Michael J. Elri1un, MO, " .~cC ""leel en1.mt:lllrg. MO FACe yl GrI:tDr'I~erg,AR"'" ,A. Guzman, MO, F"CC oll!TY D. Hlilrr;s, MD Relph M. levy, MO, FA-I C Dllnl91 NQrt)org, MO, FJ.,:;:C Frank J, Pt:lI!lr:, MD. FAI I:}, FCCP, FACP lawfence M. RIII$$, Mt:, ~ACC Bemare, e SMlr, MD, , ...ce, FeOp E.lrllll'l Sll!Iv, MD, FACe South Broward Cardiology Com.ultimls 3700 W811hlnglon $trl:lol, Swlle500 T&':{QS.4)961-01 90 fl!lle(954}96.Il- '024 W:;;lillTl d. NllZberg, MO, FAce D~vld C. Tepj)4Ir, MD. FAce InNrwntlDnal CJII'dlolOlY a.tc:lvuO\ll.,MIlLilclrM Bl1Ifl"J R. Aller, MD, FACe, FAC!"' Mo;:h,,~ $. Marek, MO. FACe lul:i F. T"M:, MD, FAce, FSCAI www.seClllrdlolOll'y_com OIP:Clm'lllI5 American Board or Intom'll Mlldlel~e Si,lb$padelly iiGllrd of Cs'tlIOYIIKUlaf OIli>lileae DIHll&1I 8. Crlth:.Iil1 MaclcJr.s Offit:C!~ in HOllywood, Pembl'QIUJ F'lnQ~, Alllil!'llure aM WIi~lor. C..rcU~C EleCUl;lptlys!oIogy RSIJ: D. MI\r.lni, MO, FACC Pemhfok&\Pln'3~ Tel: {'lI~"} <137.9116 Fllx:(954) 43'3-'<1734 Avnnlt.tra Till: (305) 933-2t21 Fsx:{30S} ~:,J-37a4 ~ Tel: {~54J 9B,.3331 FilL (954) 96',~15" A~mlnI5tr'l1IC1rlC.E.O. Jl.l(lon "rl~cmll!'l. MED, MBA October 12, 2005 To Whom It May Concem: I am a practicing cardiologist in the North Dade area, inciuding Aventura, Florida. I was very disheartened to hear that Mt Sinai Medical Center, which is a not for profit hospital, is planning to open a facility in proximity to Aventura I;ospital and Medical Center. For well over 10 years, Mt. Sinai has fought regarding Aventura Hospital getting a Certificate of Need for performing open heart procedures and cardiac interventional procedures. Their arguments asking the State to deny Aventura Hospital the Certificate of Need was based , the fact tl1at there were already facilities in Dade County when in reality, Aventura is in a very unique .Jcation in North Dade county where there were no facilities that were within the general proximity so that primary interventions for acute heart attacks could not be done. I think it height of hypocrisy for Mt. Sinai now to claim that they need to provide this type of care when in reality, in my opinion, their need is more financial than concerned with the quality care that is already available in this are. Aventura Hospital and Medical Center has committed a large sum of money, in the range of 150 million dollars. to build a tertiary center in the heart of the North Dade area. There is now high quality tertiary care in a community which did not have this care prior, and for another hospital to be built in proximity would simply be done out of profit motive on Mt. Sinai's part. I know, having spoken face to face with the CEO of Mt. Sinai Hospital approximately 6-6 months ago, that he was very concerned that were, as he puts it, losing market share to Avp.ntura Hospital, and this is most likely the true reason that Mt. Sinai is looking to open up a facility in the North Dade area. If Mt. Sinai were to open up another facility it would simply, in my opinion. be allowing a not for profit hospital to blatantly venture into the for profit area. There are already two acute care hospitals, once being Aventura Hospital and Medical Center and the other one being Parkway Regional Medical Center, which is located just south of Aventura Hospital I have reviewed some utilization data reported to the Agency for Healthcare Administration, and the average occupancy of Aventura Hospital was 52% and Parkway was 48%. Ther~fore. there are several hundred beds that are not filled even prior to there being a third facility in the area. It would be my pleasure to discuss this with anyone who would like further information regarding my opinion as a practicing cardiologist in the area about the lack of need for another hospital, especially when Aventura Hospital has already committed so much money to providing this specialized care to the community. Thank you for taking the time to consider my opinion and. as stated above. I would be more than happy to 'leak with rlnyone if further information were needed. Sincerely yours, 14-0CT-2005 04:59PM FROM-S BROWARD CARDIOLOGY CONSULTANTS +9549831571 T-197 P 0021002 Ha2 Michael J. Braun, MD, F,A.C.C. MJB/bma/reh lU/11/~UU~ l~:~~ JU~~J1UbU~ ALI~CHUL~k ~ JUHk MV PAGE 02 MARK A. ALTSCHULER. M.D., F.A.C.S BERNARDO M. JOHR, M.D., F.A.C.S. Dlplomalcs of the American Board of Surll"IY GENERAL and V ASC1.JLAR SURGERY October 12, 2005 Jeffrey N. Gregg, Chief Certificate ofNced Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I Tallahassee, FL 32308 To Whom It May Concern: I am writing to you &bout the proposed :North East Miami Dade expansion ofMoUDt Sinai Hospital. All a praeticing physician at both A ventura Medical Center and Parkway Regional Medical Center, I am astounded that anybody would consider expanding beds in an area where both hospitals are fiux;tioning at SO% of capacity. There is certainly no need fur further explUI$ion of half filled filcilities. As you koow, there has been a tremendous problem with ll\IJ"Sing shortages. The number of qualified nurses available to the private hospitals has been severely limited. Obviously, any new hospital would further stretch these very limited resources. The level of services including both emergency rOOfllli, cardiology, invasive cardiology, cancer care, radiation oncology and aU medical subspecialties are well represented in the North East Dade area. There is certainly 110 reason to expand further. Finally, A ventura Hospital & Medical Center bas just completed, a $ 130 million facility expansion. This new hospital more than adequately meets the needs of the SUITOundlng community. All a matter of filet, many of tile physicians on staff at Mt. Sinai are also on staff at Aveutura Hospital. I feel very strongly that any further expansion would oot only waste funds but would endanger patient care as it would delete the pool of nll1'se5 and delete the overall quality of care. If you have any further questions, please do not hesitate to contact me. S' I~ ;r ~~- A~ Mark A. A uler, M.D., F.A.~.S. MAAlcze/srilsr-00686279.doc DD: J 0/12/05 DT: 10/13/05 21110 Bio<:oyne BouIe\'8l"d ALTSCHULER &: JOHR, M.D., P.A Suite 301 Avenlura, Florida 33180 (305) 931-7650 ~ .... 1 Jeffrey N. Gregg. Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive. Building I Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for New Acute Care Hospital Dear Mr. Gregg, I'm writing to express my concerns and opposition to the Certificate of Need Proposal for a new 260-bed acute care hospital in northeast Miami-Dade Hospital. As a Department Director at Aventura Hospital and Medical Center I am very aware of Aventura's conunitment to providing the community with the best possible care in our recently renovated hospital. In an area that is presently served by two acute care hospitals that provide comprehensive, general acute care services, as well as inpatient psychiatric care and tertiary services (adult interventional cardiology services) at A ventura, a third acute care facility is not necessary. Both A ventura Hospital and Medical Center and Parkway Regional Medical Center licensed acute care beds are underutilized, according to utilization data reported to the Agency for Health Care Administration for the calendar year 2004. What would the addition of another facility mean for the future? Hospitals are already competing to recruit and retain qualified nursing staff to provide optimal care for their patients. Another new acute care facility would drain the limited personnel resources available from the already existing facilities, thus creating an even tighter labor market for nurses and adversely affecting the quality of nursing care. As there is no documented difficulty in access to emergency services in northeast Miami-Dade County. adding another facility would only mean adding the additional burden of Emergency Room coverage for physicians. As stated in a recent article in the Miami Herald, Mount Sinai believes that it needs a second acute care facility in Miami-Dade to increase leverage for their negotiations with Managed Care Companies. This does not seem to be in the best interest of the northeast Miami-Dade conununity, but rather Mount Sinai. Hopefully all of these factors will be carefully considered during the review process. Sincerely, , " Susan Mab1eson, R.N. Director oflnfection Control \ ~ October 7, 2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I Tallahassee. Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg I recently read an article in the Miami Herald recently indicated that Mount Sinai believcs it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating with managed care plans (see "Mount Sinai plans new facility", Miami Herald, September 23. 2005). Thus. Mount Sinai's proposal appears to be driven more by its own self-interest than the interest of the northeast Miami-Dade community. I am strongly opposed to having another hospital in the area due to the faet that we have A ventura and Parkway. There is no difficulty in accessing acute care hospital services in northeast Miami-Dade. In fact, the licensed acute care beds at Aventura and Parkway are underutilized. According to utilization data reported to the Agency for Health Care Administration, in calendar year 2004 average occupancy was 52.46% in Aventura's 351 licensed acute care beds, and average occupancy was 48.79% in Parkway's 325 licensed acute care beds. A new acute care hospital in northeast Miami-Dade would, in alllikeiihood, dilute the quality of nursing care. There is already a limited number of experienced environmental services personnel. and the staffing required for an entirely new hospital would necessarily stretch what is already a very tight labor market for this field. A new acute care hospital in northeast Miami-Dadc would mean one more emergency department Il)r physicians to cover, without any corresponding benefit to the service area. There is no documented difficulty in accessing emergency services in northeast Miami-Dade. In closing I would like to say oncc again how strongly I oppose these plans to build another hospital in northeast Miami-Dade. Thank you for your attention to this matter. Sincerely_ Dale Jacks(Jh 17021 N Bay Rd, Apt 712 Sunny Isles Beach. FL JJ] 60 , , \ October 7, 2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I Tallahassee, FL 32308 Re: Mount Sinai proposal for Certificate of Need Dear Mr. Gregg: As an employee of Aventura Hospital and Medical Center, I am writing to urge you to reject Mount Sinai's application for a Certificate of Need. Aventura Hospital has recently completed a $130 million facility expansion project in order to meet the needs of our community. A new acute care hospital in northeast Miami-Dade would. in all likelihood, dilute the quality of nursing care. There is a limited number of experienced and qualified nurses already, and the staffing required for an entirely new hospital would necessarily stretch what is already a very tight labor market for nurses and ancillary staff. An article in the Miami Herald recently indicated that Mount Sinai believes it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating with managed care plans (see "Mount Sinai plans new facility", Miami Herald, September 23, 2005). Thus, Mount Sinai's proposal appears to be driven more by its own selt~interest than the interest of tht, northeast Miami-Dade community. Thank you for this opportunity to comment. Sincerely. I, , ~I"\, i jl" " Am) (. Moor1 Bobbie Ordet 20900 Biscayne Boulevard Aventura, Florida 33180 October 9, 2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive. Bldg. I Tallahassee, Florida 32308 Re: Mount Sinai Medical Center's proposal for a new acute care hospital Dear Mr. Gregg: My letter is to oppose Mount Sinai's Certificate of Need Proposal for a new, 260-bed acute care hospital in northeast Miami-Dade County. I oppose this because there are already two acute care hospitals, Aventura Hospital and Medical Center and Parkway Regional Medical Center serving this area. There is no difficulty in accessing acute care hospital services. Data states that the average occupancy rate for both hospitals is in the 50% range. Adding another hospital will make the already difficult task of hiring quality nurses to staff a facility even more difficult. I wouldn't want someone taking care of my family that was inexperienced and without the best qualifications. Our newspapers are always filled with ads trying to find nurses; there are even billboards along the highways advertising for nursing staff. A ventura Hospital completed a $ I 30 million North Tower renovation and has opened a state-of- the-art open heart program. and is working on upgrading the rest of the Hospital. The Miami Herald reported recently that Mount Sinai needs this second hospital to negotiate better contracts with the insurance companies. This is a business decision. not \\hat is best for the people in northeast Miami-Dade. rhank you for taking the time to wad my cone'erns 'lbout [his matter. Yours l:r1Jl~:~. /) / , ' ,j:r,t fl. ' . . I Bohbi,.; ()rdct ; ,~. < October 10, 2005 Brad Itzkowitz 9793 Lemonwood Court Boynton Beach, FL 33425 To Whom It May Concern: I am writing to state my opposition to building another Hospital in Northeast Miami- Dade County. Both Aventura Hospital and Parkway Regional are running under census and offer a wonderful variety of serviee. Based on the article I read in the Miami Herald, it appears that the motivation to build this facility is more self focused on profit the adding to the best interest of the community. In addition, the national shortage of qualified hcalthcare professional, especially Nurses would contribute to a level of care not meeting the expectations of the community. I urge you to not allow Mount Sinai to build this new facility. Very truly yours, '-~~,~ Brad Itzkow~ " Ricbat'd S. Kennedy 506 SE 7th StI'eet # :106 }'0l1 LntuIel'dale, FL 33301 October 7, 2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg: I am writing to you today to express strong opposition to the recent application by Mt. Sinai Hospital for a Certificate of Need to build a new acute care facility in North Miami Beach, Florida. In my role as Chief Operating Officer for the A ventura Hospital and Medical Center, I have had direct experience with the issues caused by an excess of hospital beds in northeast Dade and southeast Broward counties. These issues include competition for specialized staff (including physicians, nurses and technologists), wage rates that are increasing faster than the adjusted cost of living index, overall increased healthcare costs (as a direct result of the aforementioned) and competition for procedural volumes which could ultimately result in substandard quality of care. The approval of an additional facility in Northern Miami-Dade County will only exacerbate these issues and could lead to the demise of very important safety net hospitals that serve those who are economically disadvantaged. In closing. I urge you to consider all these factors when making your final decision at to the disposition for this application. The decision to approve Mt. Sinai's request could have long term and deleterious ramifications for healthcare delivery throughout South Florida. Very truly yours, , .'1.' \ . X~\j \,) L.I"'" \ ,t/,'",,"#" , \ Richard S. Kennedy '\ , \ 11_ tl r It), . ' . '. ':" I! ,;. ,\.',' ,;,j," I':)() ,,-;,', " lL: :-Ill October 10, 2005 Jeffery N. Gregg, Chief Certificate of Need Unit Agency of Health Care Administration 2727 Mahan Drive, Bldg. 1 Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for A New Acute Care Hospital Dear Mr. Gregg: Mount Sinai has requested a certificate of need for a new 260-Bed acute care hospital in Northeast Miami-Dade County. I am writing this letter to oppose their proposal. . There are a limited number of experienced and qualified nurses already and the staffing required for an entirely new hospital would severely stretch what is already a very tight labor market for nurses. . A new hospital would mean one more emergency department for physicians to cover, without any corresponding benefit to the service area. . Northeast Miami-Dade is already served by two acute care hospitals, Aventura Hospital and Medical Center and Parkway Regional Medical Center. . Currently, the licensed acute care beds at Aventura Hospital and Medical Center and Parkway Regional Medical Center are underutilized. According to utilization data reported to the Agency for Health Care Administration, in calendar year 2004, average occupancy was 52.46% in Aventura's 351 licensed acute care beds, and the average occupancy was 48.70% in Parkway's 325 licensed acute care beds. . A recent article in the Miami Herald indicated that Mount Sinai believes it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating with managed care plans. Mount Sinai's proposal appears to be driven more by its own self-interest that the interest of the northeast Miami-Dade community. Thank you for reviewing and considering my comments. Sinc;erely, ... \ ,) Kathleen S. Morris VP, Quality Management , M. Clemencia Silk, R.N, BSN, MSc 19731 NE 20.h Place North Miami Beach, FL 33179 Agency for Health Care Administration 2727 Mahan Dr. Tallahassee. FL 32308 Dear Sir or Madame: I am writing this letter as a concerned resident of northeast Miami-Dade County. The Miami Herald recently reported that your agency is considering an application by Mount Sinai Medical Center requesting pcrmission to build and operate a 260 bed hospital east of Biscayne Boulevard in A ventura. Please understand that our community is already served by at least four other hospitals in the area, and that an additional facility here would harm this community far more than it would help. As the newspaper reported, not one of the surrounding hospitals is operating at anything approaching its licensed capacity. I have resided in South Florida for over seventeen years, and have lived in this community for more than six. I can tell you that the low census rates in our area hospitals are not a recent anomaly. While I believe that population growth in this area in coming years will increase hospital usage, it certainly will not be enough to justity the addition of yet another facility. An additional facility can only be justified if it proposes to offer needed medical services that are currently not available at existing hospitals. But this is certainly not the case. With the addition of the cardiovascular and open-heart programs at Aventura Hospital. there is no current lack of necessary services for local patients. Indeed, the addition of a new facility is likely to have a highly detrimental effect upon the quality of medical services offered here, as a new hospital will wind up competing with the existing facilities for a shrinking pool of physicians, nurses. and staff members. At the same time, it will make today's low census numbers seem rosy by comparison. I don't know about you, but if I ever need hospital care I don't want to be forced to go to a hospital with insufficient staff to provide appropriate care for me and with financial constraints that limit the amount and quality of care that can be delivered to me. Ultimately, those of us who pay for medical care, whether through insurance, taxes, or out of our own pockets. will bear the costs of building, equipping, and staffing any new facility. I urge you to be wise with the expenditure of my money. It is foolish to commit to spcnding large sums of money on an unneeded facility that isn't wanted by those of us that it is intended to serve, Sincerdy, .. .I , ~,. / ',-- 'v ,.t,"." ,( IVI. C1cmcncia Silk . ,~il \- , IVICSdp October 4, 2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital L;l:o.<r Mr. Gregg: This correspondence is to express my opposition to Mount Sinai Mount Sinai's certificate of need proposal for a new, 260-bed acute care hospital in northeast Miami-Dade County. Reasons for my opposition to Mount Sinai's proposal: 1. Northeast Miami-Dade is already served by two acute care hospitals, Aventura Hospital and Medical Center ("A ventura") and Parkway Regional Medical Center ("Parkway"). Aventura has 407 licensed beds, and Parkway has 382 licensed beds including a 23-bed obstetrical unit. Each of these hospitals provide comprehensive, general acute care services; in addition, A ventura provides specialty services (inpatient psychiatric care) and tertiary services (adult interventional cardiology services). 2. There is no difficulty in accessing acute care hospital services in northeast Miami-Dade. In fact, the licensed acute care beds at Aventura and Parkway are underutilized. According to utilization data reported to the Agency for Health Care Administration, in calendar year 2004 average occupancy was 52.46% in A ventura's 35 I licensed acute care beds, and average occupancy was 48.79% in Parkway's 325 licensed acute care beds. 3. There is a limited number of experienced and qualified nurses already, and the staffing required for an entirely new hospital would necessarily stretch what is already a very tight labor market for nurses. 4. Aventura has already essentially committed to providing the community with a "new" hospital. It recently completed Phase I of its $130 million facility North Patient Tower expansion project. This project is part of the hospital's overall Master Plan that provides for the expansion, renovation and eventual replacement of most of the hospital. Thank you for this opportunity to comment. Sincerely. Laura Sira-Jimcnez 19355 Turnberry Way . \ ventura. Fl. 33180 ! 1 October II, 2005 Jeffrey N. Gregg, Chief Certiticate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I !'ullahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg: This letter is written to express my opposition to Mount Sinai Mount Sinai's certiticate of need proposal for a new, 260-bed acute care hospital in northeast Miami-Dade County. My opposition to Mount Sinai's proposal is based upon the following: . Northeast Miami-Dade has already two acute care hospitals, Aventura Hospital and Medical Center and Parkway Regional Medical Center. Aventura has 407 licensed beds, and Parkway has 382 licensed beds including a 23-bed obstetrical unit. Each of these hospitals provides comprehensive, general acute care services; in addition, Aventura provides inpatient psychiatric care and adult interventional cardiology services. . Since I have been at this hospital since 1974, we have never been at maximum capacity. Our current census averages 240, slightly above 50% capacity. . Adding another acute care hospital in northeast Miami-Dade would cause even more competition for nurses and other licensed healthcare workers that are already very difficult to recruit. . Aventura has already provided the community with a "new" hospital, with the recent addition of the North Tower and Open Heart Program. . In my opinion, creating another hospital in this community is a waste of hcalthcare dollars. Thank you for this opportunity to comment. Smccrely, Linda Brandstetter. M.T. ASCP Administrati, e Laboratory Director Avcntura Hospital and Medical Cenke 305-6R2-7351 October 12,2005 Jeffrey N. Gregg, Chief Ccrtificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. 1 Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg: This correspondence is to express my opposition to Mount Sinai's certificate of need proposal for a new, 260-bed acute care hospital in northeast Miami-Dade County. My opposition to Mount Sinai's proposal is based upon the following: . Northeast Miami-Dade is already served by two acute care hospitals, Aventura Hospital and Medical Center and Parkway Regional Medical Center. Both of these Hospital's are within 5 miles of one another and each provides excellent patient services to the residents in the community. Aventura has 407 licensed beds, and Parkway has 382 licensed beds including a 23-bed obstetrical unit. Each of these hospitals provide comprehensive, general acute care services; in addition, Aventura provides specialty services (inpatient psychiatric care) and tertiary services including adult interventional cardiology, open heart surgery and the Comprehensive Cancer Center to name a few. . There is no difficulty in accessing acute care hospital services in northeast Miami-Dade. In fact, the licensed acute care beds at Aventura and Parkway are underutilized. According to utilization data reported to the Agency for Health Care Administration, in calendar year 2004 average occupancy was 52.46% in Aventura's 35 I licensed acute care beds, and average occupancy was 48.79% in Parkway's 325 licensed acute care beds. . A new acute care hospital in northeast Miami-Dade would, in all likelihood, dilute the quality of nursing care. There is a limited number of experienced and qualified nurses already, and the staffing required for an cntirely new hospital would necessarily stretch what is already a very tight labor market for nurses. . A new acute carc hospital in northeast Miami-Dade would mean one morc emcrgency ,'partmcnt for physicians to covcr, without any corrcsponding benefit to the service area. There is no documentcd difficulty in accessing cmcrgcncy scrvices in northeast Miami- Dade. . Aventura has already essentially committed to providing the community with a "new" hospital. It recently completed Phase I of its $ 130 million facility North Patient Towcr expansion project. This project is part of the hospital's overall Master Plan that provides for the expansion, renovation and eventual replacement of most of the hospital. . An article in the Miami Herald recently indicated that Mount Sinai believes it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating with 1TIanagcd care plans (see "Mount Sinai plans new facility", Miami Herald, September 23, 2005). Thus, Mount Sinai's proposal appears to be driven more by its own self-interest than the interest of the northeast Miami-Dade community. Thank you for this opportunity to comment. Sincerely, ! ! ,'r, i" , \ ,: , (; / ~ '. ;. ' .~. /~. , Nancy McCarthy, RN, MHSA Director, Telemetry October 12,2005 Jeffrcy N. Grcgg, Chicf Cei\ificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. 1 Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg: Please allow me to express my opposition to Mount Sinai's certificate of need proposal for a new, 260-bed acute care hospital in northeast Miami-Dade County. . The Northeast quadrant of Miami-Dade is currently served by two acute care hospitals, Aventura Hospital and Medical Center and Parkway Regional Medical Center. Aventura has 407 licensed beds, and Parkway has 382 licensed beds including a 23-bed obstetrical unit. With a combined total of 789 licensed beds, these two hospitals provide comprehensive, general acute care services, additionally A ventura Hospital and Medical Center provides specialty services as inpatient psychiatric care and adult interventional cardiology services. . The labor market for qualified nurses and other ancillary disciplines is tight. The opening of an unneeded and undesired hospital will stretch the current limited work force to a new and dangerous low, affecting our community. . With the first phase completed at a cost of 130 million dollars, A ventura Hospital and Medical Center is already meeting the community's needs with innovative technology and experienced and qualified staff. . Acute care services in the Northeast Miami-Dade are available and underutilized as reported to the Agency for Health Care Administration, in calendar year 2004. The average occupancy was 52.46% in A ventura's 351 licensed acute care beds, and average occupancy was 48.79% in Parkway's 315 licensed acute care beds. Thank you for your time in rcading my opposition. Sincerely, Carlos Lopez Assistant Director Cardiopulmonary Services October 12, 2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. 1 Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg: I am writing this letter to express my feelings regarding Mount Sinai's certificate of need proposal for a new, 260-bed acute care hospital in northeast Miami-Dade County. Our opposition to Mount Sinai's proposal is based upon the following: There is no difficulty in accessing acute care hospital services in northeast Miami- Dade. In fact, the licensed acute care beds at Aventura and Parkway are underutilized. According to utilization data reported to the Agency for Health Care Administration, in calendar year 2004 average occupancy was 52.46% in Aventura's 351 licensed acute care beds, and average occupancy was 48.79% in Parkway's 325 licensed acute care beds. A new acute care hospital in northeast Miami-Dade would, in all likelihood, dilute the quality of nursing care. There are a limited number of experienced and qualified nurses already, and the staffing required for an entirely new hospital would necessarily stretch what is already a very tight labor market for nurses. Aventura has already essentially committed to providing the community with a "new" hospital. It recently completed Phase I of its $130 million facility North Patient Tower expansion project. This project is part of the hospital's overall Master Plan that provides for the expansion, renovation and eventual replacement of most of the hospital. Th~,~'jl,o,J, ' tJ>/~(/- ~'i""'-<' (/) ~;-tf'e.l ;~ist~nt Director of International Services Aventura Hospital & Medical Center 209QO Biscayne Boulevard Avehtura, FI33180 Telephone: (305) 682-7151 Facsimile: (305) 682-7043 E-Mail: DanieI.Perez@hcahealthcare.com October 12, 2005 Jeffrcy N. Gregg. Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I Tallahassee, Florida 32308 Re: Mount Sinai Medical Center - Proposal for a New Acute Care Hospital Dear Mr. Gregg: This correspondence is to express opposition to Mount Sinai Mount Sinai's certificate of need proposal for a new, 260-bed acute care hospital in northeast Miami-Dade County. Northeast Miami-Dade is already served by two acute care hospitals, A ventura Hospital and Medical Center ("A ventura") and Parkway Regional Medical Center ("Parkway"). Aventura has 407 licensed beds, and Parkway has 382 licensed beds including a 23-bed obstetrical unit. Each of these hospitals provides comprehensive, general acute care services; in addition, Aventura provides specialty services (inpatient psychiatric care) and tertiary services (adult interventional cardiology services). There is no difficulty in accessing acute care hospital services in northeast Miami-Dade. In fact, the licensed acute care beds at A ventura and Parkway are underutilized. According to utilization data reported to the Agency for Health Care Administration, in calendar year 2004 average occupancy was 52.46% in Aventura's 351 licensed acute care beds, and average occupancy was 48.79% in Parkway's 325 licensed acute care beds. A new acute care hospital in northeast Miami-Dade would, in all likelihood, dilute the quality of nursing care. There are a limited number of experienced and qualified nurses already, and the staffing required for an entirely new hospital would necessarily stretch what is already a very tight labor market for nurses. A new acute care hospital in northeast Miami-Dade would mean one more emergency department for physicians to cover, without any corresponding benefit to the service area. There is no documented difficulty in accessing emergency services in northeast Miami-Dade. An article in the Miami Herald recently indicated that Mount Sinai believes it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating with managed care plans (see "Mount Sinai plans new facility", Miami Herald, September 23, 2005). Thus, Mount Sinai's proposal appears to be driven more by its own self-interest than the interest of the northeast Miami-Dade community. Aventura has already essentially committed to providing the community with a "new" hospital. It reccntly completed Phase I of its $130 million facility North Patient Tower expansion project. This project is part of the hospital's overall J\'laster Plan that provides for the expansion. renovation and eventual replacement of most of the hospital. Thank you for this opportunity to comment. Sincerely, Sandra Hamlin October 5. 2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I Tallahassce, Florida 32308 Re: Mount Sinai Medical Center - Proposal for a New Acute Care Hospital Dear Mr. Gregg: I am writing to express my beliefs about the possible construction of a new hospital in Northeast Miami-Dade County. Mount Sinai has brought up several points that I'd like to discuss. Firstly, Northeast Miami-Dade is already served by two acute care hospitals, Aventura Hospital and Medical Center and Parkway Regional Medical Center. Aventura has 407 licensed beds, and Parkway has 382 licensed beds including a 23-bed obstetrical unit. Each of these hospitals provides comprehensive, general acute care services; in addition, A ventura provides specialty services and tertiary services. Another argument used by Mount Sinai Medical Center is their belief that access is a driving factor for their case to open a new hospital. There is no difficulty in accessing acute care hospital services in northeast Miami-Dade. In fact, the licensed acute care beds at A ventura and Parkway are underutiIized. According to utilization data reported to the Agency for Health Care Administration, in calendar year 2004 average occupancy was 52.46% in Aventura's 351 licensed acute care beds, and average occupancy was 48.79% in Parkway's 325 licensed acute care beds. A new acute care hospital in northeast Miami-Dade would, in all likelihood, dilute the quality of nursing care. There are a limited number of experienced and qualified nurses already, and the staffing required for an entirely new hospital would necessarily stretch what is already a very tight labor market for nurses. A new acute care hospital in northeast Miami-Dade would mean one more emergency department for physicians to cover, without any corresponding benefit to the service area. There is no documented difficulty in accessing emergency services in northeast Miami-Dade. At the end of the day, the application appears to be a financial decision and not the "patient centric" focus spelled out in the CON. An article in the Miami Herald recently indicated that Mount Sinai believes it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating with managed care plans. Thus, Mount Sinai's proposal appears to be driven more by its own self-interest than the interest of the northeast Miami-Dade community. Aventura has already :ntially committed to providing the community with a "new" hospital. It recently completed Phase I of its $130 million facility North Patient Tower expansion project. This project is part of the hospital's overall Master Plan that provides for the expansion, renovation and eventual replacement of most of the hospital. Thank you for this opportunity to comment. Sincerely, , j,,'I,. : /. !' i ;,,//1/1, r{J I<aphael Ruiz October 12, 2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. 1 Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg: This correspondence is to express my opposition to Mount Sinai Mount Sinai's certificate of need proposal for a new, acute care hospital in Miami-Dade County. Below is a list of reasons for my opposition to Mount Sinai's proposal: I. There are a limited number of experienced and qualified nurses already, and the staffing required for an entirely new hospital would necessarily stretch what is already a very tight labor market for nurses. 2. Northeast Miami-Dade is already served by two acute care hospitals, Aventura Hospital and Medical Center ("A ventura") and Parkway Regional Medical Center ("Parkway"). A ventura has 407 licensed beds, and Parkway has 382 licensed beds including a 23-bed obstetrical unit. Each of these hospitals provides comprehensive, general acute care services; in addition, Aventura provides specialty services (inpatient psychiatric care) and tertiary services (adult interventional cardiology services). 3. There is no difficulty in accessing acute care hospital services in northeast Miami-Dade. In fact, the licensed acute care beds at A ventura and Parkway are underutilized. According to utilization data reported to the Agency for Health Care Administration, in calendar year 2004 average occupancy was 52.46% in A ventura's 35 I licensed acute care beds, and average occupancy was 48.79% in Parkway's 325 licensed acute care beds. Sipcerely, ! ~ ,I \ ',' I I .~ f' , Vanessa Craig 2450 NW 108th Street :'v1i:lmi F1. 33] 67 \ \ \ . , j i! f; " . '. ~ i! \ 1':'11' ::i.; ''''~W'')''1'lltur';'' j I October 12, 2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg: I am writing to express my opposition to the proposal by Mount Sinai Medical Center to build a new acute care hospital in Northeast Miami-Dade. My concerns with this proposal stem from the difficulty in recruiting and retaining qualified personnel. I am the Human Resources Director at Aventura Hospital and Medical Center and struggle each day to find qualified candidates to meet the needs of our community. I have worked at various hospitals in this community and feel strongly that yet another hospital in this area would only increase the demands for registered nurses, technologist, therapist and other professionals. At present none of the four hospitals in the area are at capacity, Therefore, I have a hard time understanding the need to for yet another. Again, I remain strongly opposed to this proposal and ask that you take my comments into consideration when making your decision, Sincerely, \Iaria C. Naranjo Human Resources Director . \ \!~ntura Hospital and l\I~dical CCllt~1 October 10, 2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dcar Mr. Gregg: This correspondence is to express my opposition to Mount Sinai's certificate of need proposal for a new, 260-bed acute care hospital in northeast Miami-Dade County. My opposition to Mount Sinai's proposal is based upon the following: . An article in the Miami Herald recently indicated that Mount Sinai believes it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating with managed care plans (see "Mount Sinai plans new facility", Miami Herald, September 23, 2005). Thus, Mount Sinai's proposal appears to be driven more by its own self-interest than the interest of the northeast Miami-Dade community. . Northeast Miami-Dade is already served by two acute care hospitals, Aventura Hospital and Medical Center and Parkway Regional Medical Center. Aventura has 407 licensed beds, and Parkway has 382 licensed beds including a 23-bed obstetrical unit. Each of these hospitals provide comprehensive, general acute care services; in addition, A ventura provides specialty services (inpatient psychiatric care) and tertiary services (adult interventional cardiology services). . There is no difficulty in accessing acute care hospital services in northeast Miami-Dade. In fact, the licensed acute care beds at A ventura and Parkway are underutilized. According to utilization data reported to the Agency for Health Care Administration, in calendar year 2004 average occupancy was 52.46% in Aventura's 351 licensed acute care beds, and average occupancy was 48.79% in Parkway's 325 licensed acute care beds. . A new acute care hospital in northeast Miami-Dade would, in all likelihood, dilute the quality of nursing care. There is a limited number of experienced and qualified nurses already, and the staffing required for an entirely new hospital would necessarily stretch what is already a very tight labor market for nurses. Thank you for this opportunity to comment. Sincerely. , Kathi Serna RN CPUR October ih, 2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. 1 Tallahassee, Florida 32308 RE: Mount Sinai Medical Center - Proposal for New Acute Care Hospital Dear Mr. Gregg: This correspondence is to express my opposition to Mount Sinai Mount Sinai's certificate of need proposal for a new, 260-bed acute care hospital in northeast Miami-Dade County. I am employee of Aventura Hospital and Medical Center, a 407 bed facility that serves the area which Mt. Sinai is looking into building their second facility. According to the article in the Miami Herald, Mount Sinai believes it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating with managed care plans. By reading this article you can clearing see that Mount Sinai's proposal appears to be driven more by its own self-interest than the interest of the northeast Miami-Dade community. A new acute care hospital in northeast Miami-Dade would, decrease the quality of nursing care. As we all know. there is currently a shortage of experienced and qualified nurses, and the staffing required for an entirely new hospital would impact our tight labor market for nurses. Aventura Hospital and Medical Center just completed Phase I of its $130 million facility North Patient Tower expansion project. By doing this Aventura has already essentially committed to providing the community with a "new" hospital. Thanking you in advance for you time and consideration, / / Glad} s Santana 7441 Wayne Ave. Apt. IIH Miami Beach, FL 33141 october 12, 2005 Jeffrey N. Gregg. Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I Tallahassee, Florida 32308 Re: Mount Sinai Medical Ccntcr - Proposal for a New Acute Care Hospital Dear Mr. Gregg, This correspondence is to express opposition to Mount Sinai Mount Sinai's certificate of need proposal for a new, 260-bed acute care hospital in northeast Miami-Dade County. Northeast Miami-Dade is already served by two acute care hospitals, A ventura Hospital and Medical Center ("Aventura") and Parkway Regional Medical Center ("Parkway"). Aventura has 407 licensed beds, and Parkway has 382 licensed beds including a 23-bed obstetrical unit. Each of these hospitals provides comprehensive, general acute care services; in addition, A ventura provides specialty services (inpatient psychiatric care) and tertiary services (adult interventional cardiology services). There is no difficulty in accessing acute care hospital services in northeast Miami-Dade. In fact, the licensed acute care beds at A ventura and Parkway are underutilized, According to utilization ,lata reported to the Agency for Health Care Administration, in calendar year 2004 average occupancy was 52.46% in Aventura's 351 licensed acute care beds, and average occupancy was 48.79% in Parkway's 325 licensed acute care beds. A new acute care hospital in northeast Miami-Dade would, in all likelihood, dilute the quality of nursing care. There are a limited ,': :nber of experienced and qualified nurses already, and the staffing required for an entirely new hospital would necessarily stretch what is already a very tight labor market for nurses. A new acute care hospital in northeast Miami-Dade would mean one more emergency department for physicians to cover, without any corresponding benefit to the service area. There is no documented difficulty in accessing emergency services in northeast Miami-Dade. An article in the Miami Herald recently indicated that Mount Sinai believes it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating with managed care plans (see "Mount Sinai plans new facility", Miami Herald, September 23,2005). Thus, Mount "):li's proposal appears to be driven more by its own self-interest than the interest of the northeast Miami-Dade community. Aventura has already essentially committed to providing the community with a "new" hospital. It recently completed Phase I of its $130 million facility North Patient Tower expansion project. This project is part of the hospital's overall Master Plan that provides for the expansion, renovation and eventual replaccmcnt of most of the hospital. Thank you for the possibility to comment on this. Truly yours. LcllTY Wummer. 801 SE t6th Court Unit #9 Fort Lauderdale. FL 333 t6 Susie Glennon 13856 NW 21" Street Pembroke Pines. FL 33028 954-885-1716 October 13.2005 The Agency for Healthcare Administration To Whom It May Concern: I am writing you today to express my deep concern over the plan that Mount Sinai Hospital has to build another acute care facility in Northwest, Miami-Dade County. As a healthcare worker, I know that this would take away quality care nurses from the existing Aventura Medical Center and Parkway Regional Medical Ccnter. As a nursing manager, I already see that with the nursing shortage, it is difficult to staff an acute care hospital. The addition of another facility would only dilute the quality of patient care for the local Miami-Dade hospitals. Aventura has 407 licensed beds (including inpatient psychiatric care, and adult open heart) and Parkway has 382 licensed beds including a 23 bed obstetrical unit. Actually, these acute care beds at both facilities are under-utilized. The Agency for Health Care Administration in 2004, reported that Aventura was only at 52.46 % and for Parkway only at 48.79% occupied. How are physicians to physically cover patients at another cmergency department? Patients already have access to appropriate emergency care between Parkway and A ventura. From what the Miami Herald recently published in an article on September 23 of this year, Mount Sinai appears to be looking out for its own self interest and not that of the Miami Dade community. Please consider the negative effect the addition of another hospital will have on the community of Miami-Dade. Sincer<:ly. Susie Glennon. R\!. BSN October 11, 2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. 1 Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg: This correspondence is to express my opposition to the Mount Sinai certificate of need proposal for an acute care hospital in northeast Miami-Dade County. I am a resident of Miami- Dade County and the City of Aventura. My opposition to the Mount Sinai's proposal is based upon the following: . Northeast Miami-Dade is currently served by two acute care hospitals, Aventura Hospital and Medical Center (AHMC) and Parkway Regional Medical Center (PRMC). Aventura has 407 licensed beds, and Parkway has 382 licensed beds including a 23-bed obstetrical unit. Each of these hospitals provides comprehensive, general acute care services. Additionally, Aventura provides specialty services (inpatient psychiatric care) and tertiary services (adult interventional cardiology services). Our community is well served with comprehensive, state of the art health care services. . At this writing, the licensed acute care beds at Aventura Hospital and Medical Center and Parkway Regional Medical Center are underutilized. Utilization data available through the Agency for Health Care Administration, reports the following for 2004: . AHMC average occupancy was 52.46% of 351 licensed acute care beds. . PRMC average occupancy was 48.79% of 325 licensed acute care beds. Easy access to acute care hospital services for the northeast Miami-Dade community is efficient and available. . Nationally, we are challenged with a limited number of experienced and qualified registered nurses - especially among the specialty services. In South Florida the vacancy rate for registered nurses looms near the national average. My observation as a registered nurse, clinical director and community member, is that the addition of an acute care hospital in northeast Miami-Dade would exacerbate an already diluted concentration of quality healthcare providers and compromise the standard of care in the community. . Emergency Services are both accessible and streamlined to the needs of the northeast Miami-Dade community. Another facility would not provide corresponding benefit to the service area. . AHMC is committed to providing the community with a new facility and state of the art services. The completion of Phase I of its $130 million facility North Patient Tower expansion project is testimonial to that commitment. This includes a 28 bed emergency department. This project is part of the AHMC master plan that provides for the expansion, renovation and eventual replacement of most of the pre-existing facility. . Mount Sinai's proposal appears to be driven more by its self-interest and self- preservation than the interest of the northeast Miami-Dade community at large. As supported by a recent article in the Miami Herald stating that Mount Sinai believes it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating managed care plans (see "Mount Sinai plans new facility", Miami Herald, September 23,2005). Thank you for your time and consideration in this opportunity to comment. Sincerely, i-. n ,). ') (- :f.IUJ2ipriY:'rnJ/lU, l:fjJr'f~ }(YY I ' Denise M'.-uldau MSA fiN CNA 3000 NE 19O1h Street #110 Aventura, Florida 33180 \ . \ october 4, 2005 Geffrey N. Gregg Chief Certificate of Need Unit Agency for Heath Care Administration 2727 Mahan Drive, Bldg. 1 Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new Acute Care Hospilal Dear Mr. Gregg: This correspondence is to express my opposition to Mt. Sinai's certificate of need for a new, 260-bed acule care hospital in northeast Miami- Dade County. My opposition to Mt. Sinai's proposal is based upon the following: . There is no difficulty in accessing acute care hospitai services in northeast Miami-Dade. Both Aventura and Parkway hospitals are underutilized, according to utilization data reported the Agency for Healthcare Administration. The average occupancy of Aventura's 351 licensed acute care beds in 2004 was 48.79%, and average occupancy in Parkway's 325 licensed acute care beds was 48.79% . A new acute care hospital in northeast Miami-Dade would create more nursing vacancies that could necessitate fiiling of these positions with nurses who haven't received enough education to properly perform the many facets of the job affecting quality of care patient receive. . With the completion of $130 miilion new North Patient Tower: Aventura is committed to continue to meet the growing needs of lhe community through continuous enhancement and service excellence. . Aventura has already essentially committed to provide a much needed service to the community; the new cardiac surgery program that will allow the hospital to provide lifesaving cardiac inlerventional procedures, Thank you for this opportunily to comment. Sincerely, 7 ' " I Flor Santos, BSN, CCRN, MSN Director of Critical Care Services October 4. 2004 Jeffrey N.Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. 1 Tallahassee, FL 32308 RE: Mount Sinai Medical Center Proposal for New Acute Care Facility Dear Mr. Gregg, It is important you know that I am strongly opposed to Mt. Sinai's CON proposal for a new, 260 bed acute care hospital in NE Miami-Dade County. It seems obvious that acute care beds are already UNDER utilized in 2 other facilities within the NE Miami-Dade area - Parkway Regional and Aventura Hospital and Medical Center. Besides providing comprehensive acute care to the area, Aventura also provides specialty services such as inpatient psychiatric care and cardiology services. According to the Agency for Health Care Administration, in 2004, average occupancy at Aventura Hospital was 52.46% and at Parkway, the average occupancy was 48.79%. This certainly does not support the need for additional beds within the same area. Additionally, the nursing profession is experiencing severe shortages. It seems to me that another facility within the same area would only further dilute the already weak nursing pool. A recent article in the Miami Herald stated that Mount Sinai wants to build in Miami-Dade to increase their leverage with managed care plans. This sounds to me like Mount Sinai is more interested in this, than in doing what is best for the area. Thank you for considering my comments. Sincerefy, . /-f"'?: ') J. it Le_ I Suzanne Keehne 1900 Van Buren, #209 Hollywood, FL 33020 ') \_ f,e , \ . J October 7. 2005 Jeffrey N, Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg Mr. Gregg, the intent of this letter is to voice my opposition to Mount Sinai Mount Sinai's l:~rtificate of need proposal for a new, hospital in the North Miami area, Objections to this proposal are supported by the statements below: Aventura Hospital and Medical Center ("A ventura") and Parkway Regional Medical Center ("Parkway") provide adequate health care coverage for the North Miami area. Both facilities total have over 780 licensed beds to serve the North Miami community. The combination of facilities has specialties areas which is broad enough to cover all of the community's health care needs. The hospitals currently in the area are not being utilized to maximum capacity at the current time. Agency for health care statistics support the statement above based on percentages of occupancy documented at about 50%. The challenge of staffing a facility with quality well trained medical. nursing and auxiliary staff will he further diluted, not allowing one or two institutions the ability to have very well trained staff to care for our patients. Physician staff would be spread even thinner than it is already and this would cause a lot of physician's satisfaction a reason for them to change practice location. A ventura has already essentially committed to providing the community with a "new" hospital. It recently completed Phase I of its $130 million facility North Patient To\'~"er expansion project. This project is part of the hospital's overall Master Plan that provides for the expansion, renovation and eventual replacement of 1110St of the hospital. Processes in many facilities are a work in process. The two hospitals which support the North Miami area h~ve bcr.;n around with a vast history of process improvement to ensure that our community receives the hest care. [mplementing a nr.;w facility will only lead to mort' potential errors in an area when.: another facility is not net'llt:d. Thank )tau for your time. Sincerl'ly, Dove l.acknallth Director of Pharmacy St::rvices Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Admimstration 2727 Mahan Driw, Bldg. I Tallahassee, Florida 32308 October 5, 2005 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg: This letter is to express my opposition to the Mount Sinai Mount Sinai's certificate of need proposal for a new, 260-bed acute care hospital in Northeast Miami-Dade County. My opposition to Mount Sinai's proposal is based upon my professional experience as a healthcare administrator over the past thirty years. Northeast Miami-Dade County is currently being services by two very capable hospitals, which include A ventura Hospital and Medical Center and Parkway Regional Medial Center. The two institutions are licensed for a total of 789. The services offered to the community cover comprehensive, general acute care, inpatient psychiatric care and tertiary service. Aventura and Parkway Hospitals are accessible to the community. They offer extensive community outreach programs that provide information and awareness on prevention of various health issues including Cancer, Diabetes and Cardiovascular disease. A new acute care hospital in Northeast Miami-Dade would most likely create a strain on the already limited number of available healthcare professionals such as nurses. It would add to the traffic congestion in the area. A new acute care hospital in northeast Miami-Dade would mean one more emergency department for physicians to cover, without any corresponding benefit to the service area. There is no documented difficulty in accessing emergency services in northeast Miami-Dade. In addition I want to also point out that an article in the Miami Herald recently indicated that Mount Sinai believes it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating with managed care plans (see "Mount Sinai plans new facility", Miami Herald, September 23, 2005). Thus, Mount Sinai's proposal appears to be driven more by its own self-interest than the interest of the northeast Miami-Dade community. I thank you in advance for the opportunity to comment and express my opinion. /J/ ~ t.; ','//" C /. -'--/ Sincerely, / Gilbert Baerga 17077 NW 20th Street Pembroke Pines, FL 33028 Aleida Mejia Andrew 800 NE 195 ST apt#412 North Miami Beach FI. 33179 Octubre 30 de 2005 AGENCY FOR HEALTHCARE ADMINISTRATION: A qui en Ie pueda interezar: Me he tomado la molestia de formalizar esta nota, porque considero que el hospital de Aventura tiene toda la capacldad de atender mls necesldades con su cuerpo medico y de enfermeria, los cuales pueden atenderme en espaf\ol y con verdadera conslderacion. Con cuatro hospitales en nuestra area, no veo la necesldad de crear uno mas. Recldo en la area del Norte de Miami y he sldo paclente en el hospital de Aventura. Los servlcios fueron estupendos y las facllldades fueron super modernas y eficlentes. EI programa de "Corazon Ablerto" es algo espectacular, no me senti ria tan confiada de poner ml salud en las manos de otros medicos y mucho menos otro hospital. Aparte de eso soy mlembra del grupo H2U en este mlsmo hospital. H2U es un grupo de blenestar para no solo personas de la tercera edad, sino para cualquier adulto. Ofrecen actos sociales a preclos verdaderamente modicos. Este grupo ha hecho parte de ml vida en los momentos de mas dlficlles. No tengo suficientes palabras para expresar ml gratitud. Como parte de esta comunidad les agradeceria su atenclon al respecto. Atentamente, cdd--<.cl- /tj, ~c CL.c~_~,-./ Aleida Mejia Andrew Judy & J.P. Newell III 600 N.E. 36'h Street #1123 North Miami, Florida Jeffrey Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive Bldg. I Tallahassee, FL 32308 Re: Mt. Sinai Medical Center Proposed New Hospital Dear Mr. Gregg: As a long-time resident of Northeast Miami-Dade County, I have seen many changes in our population and health care services. I am distressed over the prospect of a new Hospital in our area. My understanding is that both Parkway and Aventura Hospitals have more than adequate capacity for growth. I have also read of the national shortage of nurses and other clinical personnel. It would seem that an additional facility would just add to this problem. I am certain that Mt. Sinai feels it would be in their best interest to have a hospital in the north part of the county, but in my opinion it would not be in the best interest of the community and would create an additional strain to provide quality nurses, ER physicians and other staff. Aventura Hospital has become a comprehensive Medical Center, providing a range of services from Wound Care to open heart surgery. Using the financial resources to provide beds and services that are not needed seems at the very least, poor judgment. Please do not allow this hospital to be approved. The quality and care given at our current local hospitals is more than serving our communities needs. Sincerely, Judy Newell Octobcr 5, 2005 Jcffrey)l. Grcgg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. 1 Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg: This correspondence is to express my opposition to Mount Sinai Mount Sinai's certificate of need proposal for a new, 260-bed acute care hospital in northeast Miami-Dade County. There is already an overabundance of hospitals in the South Florida area, especially in the Miami/Miami Beach area where I live. There are already quality and nursing issues with an overabundance of acute care facilities in our area and another facility would further dilute the available resources. It is already extremely difficult to recruit good healthcare service employees and allowing another facility would further dilute the pool. It is apparent that Mount Sinai is attempting to "chase" a specific patient population by building another facility where there are better payors. This strategy is in Mount Sinai's own best interest and not in the interest of the residents of Miami-Dade and Miami Beach. I believe Mount Sinai should focus on its own internal issues first and get to near capacity in their main facility before attempting to install satellite locations in the highly Medicare/ wealthy/elderly areas, i.e. North Miami Beach. Your attention to this matter is greatly appreciated. Sincerely, , I / Joshua DeTiIliC; , 1545 Euclitl Ave #2F Miami Beach, FL 33139 Eric Brauer 1029 NE II 4th St. Biscayne Park, FL 33161 October 4, 2005 Dear The Agt:ncy for Healthcare Administration: As a member of the community of North Miami, I am writing to express my concern for the proposal of adding an additional hospital to our thriving community. In the past 10 years this area has rapidly expanded into what little land is available, And along with that, the healthcare facilities of the area have responded to the communitics need, most notably A ventura Hospital & Medical Center with its growth in both square footage and services. In addition to A ventura Hospital; Parkway Hospital, North Shore Hospital, Memorial Regional Hospital, and Hollywood Medical Center are all located within 15 minutes of each other in the South BrowardINortheast Miami-Dade area. And from my understanding all of the above mentioned hospitals are running at levels far below patient capacity. And many of these hospitals provide complete lines of patient care services from cardiac & vascular surgery to orthopedic & spinal surgery to obstetrics to psychiatry, etc. I do not believe a line of health care services is not covered by this grouping of hospitals. It causes me to ask what is the motivation of adding another hospital into a mix where competition is already very cutthroat. The greater concern isn't just having the available beds for patient care, but it's having quality healthcare professionals to care for those patients, most importantly nurses. This is a nationwide problem. And in South Florida, it is only escalated due to the housing boom and being able to frod affordable housing. Not only is it hard to fmd nursing and other support staff locally, recruiting to the area also faces a tough challenge as nurses do not want to move to the area because they cannot afford to live in the area. And many are leaving the area due to the rapid cost of living increases. The addition of another hospital to the area would only increase the staffing challenge. In a time when healthcare costs are rising at an alarming rate as medical devices, supplies, and implants increase in costs, to add in the additional costs of salaries to the equation that will be needed to staff the existing hospitals excluding the addition of a new hospital, will only make matters worse. At this time I strongly believe our community is being well served by the existing hospitals of our area. I feel that by adding an additional hospital to the community will decrease the level of healthcare that is offered in the area as there will not be enough quality healthcare professionals to provide the service that is needed. I believe that our existing hospitals fully meet the needs of our community and there is no need to add an additional hospital to an already saturated market. Sincerely, 17L., ytiflCL L t{/ " l_ Eric Brauer The Agency for Healthcare Administration RE: New hospital in North Miami Area To Whom It May Concern: As an employee of Aventura Hospital and Medical Center, I find it difficult to believe that we are considering another hospital in our area. I have been working here for almost 9 years. The proposal for an additional hospital to be located in the North Miami area would be excessive. I have seen the community grow and change but there are four large facilities which service the North Miami area (Aventura, Parkway, North Shore and Memorial) and they all have beds available for the residents. In addition, another facility would place a burden on the community to secure well trained clinical staff to provide quality care. Weare already in the midst of a nationwide nursing shortage as well as other clinical staff such as respiratory therapist, physical therapist and radiology technicians. I think when you review the current services that are readily available to the residents of the North Miami area, you will find that the current hospital meet the communities needs for the present and future. Thank you for your time in reviewing this letter. S incerel y, I.,H7~ (~" '" 1/ 01(1,/'/ -r/ .. {(/ ) .~..~LY -~- . Holly Tirrell, MSPT 1'1, J; '(it. \ ' I.,;; i: i 1 f j' ':t.' " J \. Ii ; \ ~ -. ' \ ',v" I, . ~:.., ,'. Cd September 30, 2005 Agency for Healthcare Administration To Whom It May Concern: I am writing to you today to express my concerns about Mt. Sinai Hospital in Miami Beach, Florida applying to build a new hospital in Northeast Dade County. I am currently the Director of Physician Relations for Aventura Hospital and Medical Center and I have direct access to physicians on a daily basis, which is why I am writing to you today. A new hospital in an area where other area facilities are not at fully capacity will result in rising healthcare costs, which will ultimately result in lower reimbursement for our physicians and higher out of pocket expenses to our community and employees. As you are also aware, there is a national shortage of nurses and building a new hospital will cause even more of a shortage because we will be competiting with this institution to obtain high quality nurses and clinical staff as well as hospital support staff. I would appreciate your consideration of this letter before making any final decisions. Sincerely, ,---~~t)[)/5~ C}~uJ Stephanie B. Sttrr-YL..t1 Director Physician Relations ".:,' Odob"r 4, 2005 Jcffrey N. Grcgg, Chid Certificate of Nced Unit Agency for Health Care Administration 2727 Mahan Drive, Building I Tallahassee, Florida 32308 Re: Mount Sinai Medical Center Proposal for A New Acute Care Hospital Dear Mr. Gregg: I was recently made aware of the new proposal to build an acute care hospital by Mount Sinai Medical Center. Immediately two things came to my mind as I ponder on this proposal and I would like to share them with you. I am strongly opposed to this proposal as a healthcare worker who understands the growing shortage of health care workers. Besides the most prominent nursing shortage, there is a growing need, to name a few, for Radiologic Technologists, Pharmacists, and Physical Therapists. Another facility to staff would require the diluting ofthe qualified pool of health care workers thereby exacerbating the situation. It is within a decade and a half that I can recall the closing of several hospitals in the Miami Dade County. The existing hospitals in the Northeast Miami are not at full capacity that makes mc wonder why do we want to repeat those days. Thank for the opportunity to comment as you consider the matter at hand. Very Truly Yours, "'. ' " I ,. ./ /lJ, <<. j .......... l....'. . Annette Watt. MHSA. RT(N) Director of Medical Imaging 1 r /, "~'. '. l The Agency for Healthcarc Administration RE: New hospital in North Miami Area Dear Friend; I am writing you this letter as an employee of Aventura Hospital and Medical Center. I have currently been an employee of Aventura Hospital for the past seven years and have watched it grow into a beautiful and expansive facility. We now have more services to offer the community and I am proud to be a member of this hospital. There is a proposal for an additional hospital to be located in the North Miami area. I find it hard to believe that this community needs another hospital in this service area as the current hospitals nearby are not at their full capacity. This would also impact on having more staffing shortages than there is currently. At times, there are positions for clinical staffthat go unfilled for months at a time even up to years. This poses the question, why would the North Miami area be in need of another hospital in such close proximity to already established hospitals in the area. Please review the justification as to why another facility would be needed in the North Miami area. It is truly my thought that there are many hospital facilities that the residents of North Miami could pick from such as Aventura, Parkway, North Shore and Memorial. Hopefully, I have expressed my concerns on this issue to have some long, thought out decisions made. Should you have any questions in reference to this matter, please call 305-937-6948. Thank you for your time in reviewing this letter. Sincerely, L U~H/lLdffiJ QJ!W Vanessa J. Rodriguez, ~SN Program Director Pain Care Center October 5, 2005 The Agency for Healthcare Administration To Whom it May Concern: As a healthcare professionai in the Miami-Dade area. I am writing to urge you to reject Mount Sinai's application for a Certificate of Need, As an employee of Aventura Hospital and Medical Center I am proud of the quality of care we provide to our patients, We have expanded our services to meet the needs of the community, In October of 2004 we successfully started our open heart program as part of our expansion project At the completion of the expansion we are now licensed for 407 beds and our daily average census is typically about 240, In fact, the other facilities in our area (Parkway, Memorial and North Shore) are below capacity as well. In addition to the surplus of beds in our market, the national shortage of nurses impacts all of us in securing quality personnel to care for our patients, Building another facility would oniy further tax our ability to hire staff and serve to drive up salary, wage and benefits which would contribute to increasing healthcare costs. Thank you for your kind consideration of this matter. Sincerely, ~,~ Cynthia Fancher, RN, CNOR Director, Surgical Services Aventura Hospital and Medical Center October 3.2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. 1 Tallahassee, FI. 32308 Re: Mount Sinai Medical Center Dear Mr. Jeffrey N. Gregg: This Letter is to express my opinion and opposition to the proposed certificate of need for a new, 260-bed hospital in the Northeast Miami area. I am coming to you with a request for help. I am the Director of Cardiopulmonary Services at Aventura Hospital and Medical Center. Northeast Miami-Dade County already has two acute care hospitals that provide a wide variety of comprehensive services. A ventura Hospital with the new North Tower expansion, total of 407 licensed beds including services such as, adult interventional cardiology and impatient psychiatric care along with general acute care. Parkway Medical Center has a 382 licensed beds the also provides general acute care and a 23 bed obstetrical unit. A new and additional acute care hospital in Northeast Miami Dade County would, further dilute the quality of clinicians and nursing care. There are already a limited number of experienced clinicians and nurses. The staffing required for a new facility would stretch even further, what is already a very tight labor 'llarket for clinicians and nurses. There was a recent article in the Miami Herald, Sept. 23, 2005 indicating that Mount Sinai was submitting for the certificate of need for a second hospital in order to have more leverage in negotiating with managed care plans. These plans certainly appears to be driven more by its own self- interest rather than in the best interest ofthe Northeast Miami-Dade County Community. Let me thank you in advance for taking the time to read this very important opinion and concern, I most certainly appreciated. Sincerely, 0 /-~? ::::------ Frank Gomez Director of Cardiopulmonary Services A ventura Hospital and Medical Center . October 4, 2005 Jet1rey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive. Bldg. 1 Tallahassee. Florida 32308 Re: Mount Sinai Medical Center Proposal for a new acute care hospital Dear Mr. Gregg: This correspondence is to express my opposition to Mount Sinai Mount Sinai's certificate of need proposal for a new, 260-bed acute care hospital in northeast Miami- Dade County. Northeast Miami-Dade is already served by two acute care hospitals, Aventura Hospital and Medical Center ("Aventura") and Parkway Regional Medical Center ("Parkway"). A ventura has 407 licensed beds, and Parkway has 382 licensed beds including a 23-bed obstetrical unit. Each of these hospitals provides comprehensive, general acute care services; in addition, A ventura provides specialty services (inpatient psychiatric care) and tertiary services (adult interventional cardiology services). There is no difficulty in accessing acute care hospital services in northeast Miami- Dade. In fact, the licensed acute care beds at A ventura and Parkway are underutilized. According to utilization data reported to the Agency for Health Care Administration, in calendar year 2004 average occupancy was 52.46% in Aventura's 351 licensed acute care beds, and average occupancy was 48.79% in Parkway's 325 licensed acute care beds. A new acute care hospital in northeast Miami-Dade would, in all likelihood, dilute the quality of nursing care. There is a limited number of experienced and qualified nurses already, and the staffing required for an entirely new hospital would necessarily stretch what is already a very tight labor market for nurses. A new acute care hospital in northeast Miami-Dade would mean one more emergency department for physicians to cover, without any corresponding benefit to the service area. There is no documented difficulty in accessing emergency services in northeast Miami-Dade. The article in the Miami Herald recently indicated that Mount Sinai believes it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating ,vith managed care plans (see "Mount Sinai plans ne'" facility", Miami Herald, September 23, 2005). Thus, Mount Sinai's proposal appears to be driven more by its own self-interest than the interest of the northeast Miami-Dade community. A'.entura hospital has already essentially committed to providing the community ,vith a "ne"," hospital. it recently complded Phase I of its $130 million facility l\orth Patient TO\\er expansion project. This project is part of the hospital's overall Mu:,t<.:r Plan that provides for :he ~, , ,"'''''' to " d ' t I ., '1, ,,', . t I" "t 'I, I, " ""1 .." ,P,lfi.J.C, . l '_.Lu _-,-..l.~1(f_l ..:LJ ~"jll~'::l J,p ac,_~,l(!1. 0 mos '. 1t..,:,.lu.:-PJ".... . Thank you for this opportunity to comment. Sincerely, ~ ~ Carola Kurct 5420 Tyler St. Hollywood, Fl. 954-964-1230 Lester R. Eljaiek, CPA 15551 SW ISIs! Street Miami, FL 33196 October 11th. 2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Health Care Administration 2727 Mahan Drive, Bldg. I Tallahassee, Florida 32308 Re: Mount Sinai Medical Center - Proposal for a new acute care hospital Dear Mr. Gregg: This letter is to express strong opposition to the recent application by Mt. Sinai Hospital for a Certificate of Need in order to build a new 260-bed acute acre facility in Northeast Miami-Dade County. In my role as Chief Financial Officer for the Aventura Hospital and Medical Center, I have been involved with decisions relating to the labor market as well as the excess of hospital beds in our surrounding area. If this proposal is approved, we will see a bigger impact in the already tight labor market. There is currently a shortage of specialized staff, which includes physicians, nurses, and technologists. The opening of another acute care facility in this area would, in all likelihood, dilute the quality of nursing care. The article in the Miami Herald (please see "Mount Sinai plans new facility", Miami Herald, Sept. 23'd, 2005) clearly illustrates that Mount Sinai's proposal is being driven by its own self- interest, and not by the interest of the Northeast Miami-Dade Community. A ventura Hospital and Medical Center is committed to provide the community with a "new" Hospital. It recently completed Phase I of its projected $130 million facility expansion project. The hospital's Master plan includes expansions. renovations. and eventual replacement of most of the hospital. I am urging you to please look at all the factors that are affecting our industry when making your final decision. There is clearly not a necd for anothcr acutc carc facility if both facilities that serv ice the Northeast Miami-Dade arca are approximately 50', occupied. Thanking you in advance for timc and considcration. I ,estcr R. Eljaiek. CPA ,:. \ October 12,2005 Jeffrey N. Gregg, Chief Certificate of Need Unit Agency for Healthcare Administration 2727 Mahan Drive, Bldg. I Tallahassee, FL 32308 Re: Mount Sinai Medical Center Proposalfor New Acute Care Hospital Dear Mr. Gregg: I am writing you today to seek your consideration in a matter of paramount importance to the patients and staff of Aventura Hospital and Medical Center. I would like to formally express opposition to Mt. Sinai Medical Center's (Mt. Sinai) request to the Agency for Healthcare Administration (AHCA) for a Certificate of Need (CON) to construct a new 280-bed hospital in North Miami Beach. Please consider the following facts in your deliberation: . Northeast Miami-Dade is already served by two acute care hospitals, Aventura Hospital and Medical Center ("Aventura") and Parkway Regional Medical Center ("Parkway"). Aventura Hospital has 407 licensed beds. Parkway has 382 licensed beds, including a 23-bed obstetrical unit. Each of these hospitals provides comprehensive, general acute care services. Additionally, Aventura Hospital provides specialty services (inpatient psychiatric care) and tertiary services (adult interventional cardiology services). Presently, there is no difficulty in accessing acute care hospital services in northeast Miami-Dade. In fact, the licensed acute care beds at Aventura and Parkway are underutilized. According to utilization data reported to the Agency for Health Care Administration, in calendar year 2004 average occupancy was 52.46% in Aventura's 407 licensed acute care beds and average occupancy was 48.79% in Parkway's 325 licensed acute care beds. . A new acute care hospital in northeast Miami-Dade would mean one more emergenC) department for physicians to cover. without any corresponding benefit to the service area. There is no documented difficulty in accessing emergency services in northeast Miami- Dade. In addition, a nation\\ide shortage of both emergency physicians as \\Cll as emergency nurses would mean placing an lLlldue burden on the operation of both the .\ventura and Park\\ay Emergcncy Departments. The Honorahle Susan Gottlieb, and City of A ventura Commission Members Page 2 October 12,2005 . A new acute care hospital in northeast Miami-Dade would potentially dilute the quality of nursing care. There already exist a limited number of experienced and qualified nurses. The staffing required for an entirely new hospital would necessarily stretch what is already a very tight labor market for nurses. . An article in the Miami Herald recently indicated that Mount Sinai believes it needs a second hospital in Miami-Dade in order to have increased leverage in negotiating with managed care health insurance plans (Ref. "Mount Sinai plans new facility", Miami Herald, September 23, 2005). Mount Sinai's proposal appears driven more by self- interest rather than the interest of the northeast Miami-Dade community. . Aventura has already provided the community with a "new" hospital. We recently completed a $ I 60 million facility expansion project. This project is part of the hospital's overall Master Plan that provides for the expansion, renovation and eventual replacement of most of the hospital in order to better serve the medical needs of the community. In addition, A ventura is currently in the process of constructing a 100,000 square foot Medical Office Building to support the continued recruitment of high quality physicians to relocate their practices into our community. . Aventura is a tax-paying facility with 2004-tax revenue generated to the City of close to $4,000,000.00. This makes Aventura the second largest taxpayer in the City. A non- profit facility that generates no tax revenue would increase competitive market pressures at the same time hindering Aventura's ability to generate greater tax revenue. Thank you for the opportunity to allow Aventura Hospital and Medical Center to express our position in this issue, and I would be happy to discuss this matter with you further. Please don't hesitate to contact me:rat (305) 682-7101. /1 Best regards, \ (f f {I .- if ~P Heather J. Rohan ,; 'Executive Officer I-IJR/tlc CITY OF AVENTURA OFFICE OF THE CITY MANAGER MEMORANDUM FROM: TO: DATE: November 10, 2005 SUBJECT: Proposed Revisions to Land Development Regulations Based on a series of workshops over the past year relating to the preparation of the Evaluation and Appraisal Report, staff was provided general guidelines to address and revise several areas of the City's Land Development Regulations (LDR). The consideration and adoption of the proposed revisions to the LDR will be one of the most important tasks that the City Commission will undertake during their term of office. The revisions will set the tone and vision for all future development and redevelopment in the City. The major theme throughout the reVISions is that all new development (initial construction of undeveloped property) shall be subject to the development standards contained in the LDR. Redevelopment will be subject to the development standards as allowed with the exception that any property on which the density andlor intensity (floor area ratio) allowed by the LDR is exceeded by existing development, the new density or intensity shall not exceed that allowed by the LDR. Furthermore, if the initial development was constructed with density and/or intensity lower than allowed by the LDR, the redevelopment shall be limited to the lower density andlor intensity Simply stated, all new development on vacant land shall adhere to the revised LDR. Redevelopment projects shall be limited to the initial construction density andlor intensity of that particular property regardless if it was below the number of units or floor area allowed by the LDR. This concept will facilitate redevelopment of areas in the City without increasing impacts on infrastructure and traffic. Excepted from this provision is areas included in redevelopment plans outlined in the City's Comprehensive Plan. The following is a summary of the recommended revisions: 1. Language was added to Section 31-2 entitled "Authority and Purpose" to mirror and address the goals of the EAR as it relates to development and future redevelopment and minimizing its impact to the City's infrastructure, traffic congestion, hurricane evacuation clearance times and quality of life. 2. In section 31-21 entitled "Definitions" the following was addressed: . The definition of Development was revised to reflect the initial construction on vacant land. . The definition of redevelopment was added to provide a clear description. . The definition of developer was revised to add redevelopment. . The definition of development approval was revised to add redevelopment 3. In all residential and business zoning districts the following language was added to address the redevelopment issue: Development of a parcel shall be subiect to the Site Development Criteria set out in the zoninQ districts. Subsequent redevelopment shall be limited to existinq densitv andlor intensitv. More specificallv. for anv propertv on which the densitv andlor intensitv allowed bv the Site Development Standards is exceeded by existinQ development. the new density and/or intensity on redevelopment shall not exceed that allowed in the Site Development Standards and further provided that if the development has received site plan approval. is under construction or existed prior to the effective date of this provision with density and/or intensity lower than allowed by this Section, redevelopment shall be limited to that lower density andlor intensity. Excepted from this provision is redevelopment that is contained or envisioned in the Comprehensive Plan or such additional parcel(s) that will implement specific development or redevelopment Qoals that may be established for a particular area by the City Commission followinQ a public hearinQ. 4. The Multifamily High Density Residential Districts (RMF4) development standards were revised as follows: . Densities were reduced from 60 to 45 units per gross acre. . The maximum height of building was reduced from 40 to 25 stories. . Uses that exceed the height limitation up to 30 stories and the density limitation up to 60 units/acre were added as a Conditional Use. This allows the City Commission to consider granting the higher density and height after a public hearing. 5. The Community Business (B2) District development standards were revised as follows: . The maximum height of buildings was reduced from 20 to 12 stories. Buildings adjacent to Biscayne Boulevard would be restricted to 7 stories unless approved for additional height up to 12 stories by Conditional Use after a public hearing. . Structure parking shall no longer count as part of the floor area, but will be counted in computing height and number of stories. . Open space, lot coverage and setback requirements have been revised to reflect the original provisions of the 1999 LDR. The 2001 amendment was deleted due to the elimination of the provision to allow structured parking to be included in the building height. . Lot coverage requirements was revised to 40% and open space will now be regulated by the landscape requirements of the LDR. 2 6. The Heavy Business (B3) District development standards were revised as follows: . The maximum height of buildings was reduced from 20 to 12 stories. Buildings adjacent to Biscayne Boulevard would be restricted to 7 stories unless approved for additional height up to 12 stories by Conditional Use after a public hearing. . Structure parking shall no longer count as part of the floor area, but will be counted in computing height and number of stories. . Open space, lot coverage and setback requirements have been revised to reflect the original provisions of the 1999 LOR. The 2001 amendment was deleted due to the elimination of the provision to allow structured parking to be included in the building height. . Lot coverage requirements was revised to 40% and open space will now be regulated by the landscape requirements of the LOR. 7. The Office Park (OP) District development standards were revised as follows: . The maximum height of buildings was reduced from 176 to 100 feet. 8. The Medical Office (MO) District development standards were revised as follows: . The maximum height of buildings was reduced from 176 to 100 feet. . Residential uses as a conditional use are limited to 25 units per gross acre. 9. The Town Center (TC1) District development standards were revised as follows: . Allows uses permitted in the B1 District with increased floor area provided it is approved by the City Commission as a Conditional Use. This will allow larger stores such as restaurants and grocery markets in the Town Center zoning district. . A new section was added that all development shall conform to the guidelines provided by the City Manager. This document is attached. This was included to insure uniformity in the district and address concerns expressed by the Commission concerning the lack of clear guidelines for future development. 10. The Town Center (TC2) District development standards were revised as follows: . A new section was added that all development shall conform to the guidelines provided by the City Manager. This document is attached. This was included to insure uniformity in the district and address concerns expressed by the Commission concerning the lack of clear guidelines for future development. It is also recommend that the City Commission consider amending the zoning map for the property contained in Point East from RMF3 to RMF4. This would not increase future density but would provide an incentive for redevelopment to a height compatible to surrounding development. 3 I would like to take this opportunity to commend the Planning Director and her staff in the preparation of the attached documents. The City Attorney's Office has reviewed the LOR revisions. Based on the results of the Workshop Meeting, the revisions could be scheduled for first reading at the January Commission Meeting. If you have any questions please, feel free to contact me. EMS/act Attachments CC01438-05 4 EAR Based LOR Amendments Description/Background of Proposed Amendments: Underlined provisions constitute proposed additions to existing text; stricken thfo~!lR provisions indicate proposed deletions from existing text. Remaining provisions are now in effect and remain unchanged. Sec. 31-2. Authority and purpose. The LDRs shall provide a cohesive blueprint for development and redevelopment of the City by addressinq strateqies to accommodate qrowth while maintaininq neiqhborhood inteqritv; ensure appropriate heiqht and site development requirements and desiqn quidelines; ensure appropriate transitions and linkaqes between different neiqhborhoods and uses: encouraqe more walkable neiqhborhoods; buffer neiqhborhoods and existinq development from the encroachment of incompatible uses: limit the intensity of future development and redevelopment in a manner that is consistent with current development patterns and that minimizes further neqative impacts to the City's infrastructure, traffic conqestion, hurricane evacuation clearance times and quality of life and prevent redevelopment of a parcel in a manner that would increase its existinq intensity or density, unless redevelopment of said parcel will implement specific development or redevelopment qoals or plans that are or that miqht be established for particular areas by the City Commission. Sec. 31-21. Definitions. Developer shall mean any person, corporation, partnership, other legal entities or a governmental agency, undertaking any development and/or redevelopment as defined in these LDRs. Development shall mean the construction. alteration or material chanqe to vacant land and will be limited in its applicability to those properties shown on the City of Aventura Vacant Land Map included as Fiqure 1I.A.3 in the 2005 Evaluation and Appraisal Report of the City's Comprehensive Plan. Development on all other parcels not shown as vacant land on the City of Aventura Vacant Land Map will be considered Redevelopment. See Redevelopment.Carrying out of any building activity or mining operation, the making of any material change in the use or appearanoe of any structure or land, or the dividing of land into paroels. The following activities or uses more specifically, but without limitation, shall be taken for the purposes of these regulations to constitute "development": (1) 1'. reoonstruotion, alteration of or material ohange in the extent or appearanoe of a struoture on land. 1 (2) ^ ohange in the inteneity of uee of land, eueh ee an inorease in the number of d'A'elling units in a struGturo or on land, or an increase in the nllFRber of businesses, manufacturing establishment, or offices. (J 1) Alteration of shore or bank of a lake, pond, or canal, including any "coastal construction" as defined in F.S. 9 161.021. (42,) Commencement of drilling, mining, or excavation on a parcel of land, except to obtain soil samples. (5) Demolition of a structure. (e ID Clearing of land as an adjunct of construction. (71,) Deposit of refuse, solid or liquid waste, or fill on a parcel of land. The following operations or uses shall not be construed for the purpose of these regulations to involve "development": (1) Work by a highway or road agency or railroad company for the maintenance of a road or railroad track, if the work is carried out on land within the boundaries of the right-of-way. (2) Work by any utility and other persons engaged in the distribution or transmission of gas, water, sewerage, or electricity, for the purpose of inspecting, repairing, renewing, or constructing within any established rights-of-way any sewers, mains, pipes, cables utility tunnels, powerlines, towers, poles, tracks, or the like. (3) Work for the maintenance, renewal, or alteration of any structure, if the work affects only the interior or the color of the structure or the decoration of the exterior of the structure. (4) The use of any structure or land devoted to dwelling uses for any purposed customarily incidental to enjoyment of the dwelling. (5) A change in the ownership or form of ownership of any parcel or structure. (6) The creation or termination of rights of access, riparian rights, easements, covenants concerning development of land, or other rights in land. (7) The use of any land for the purpose of growing plants, crops, trees, and other agriculture or forestry products; raising livestock; or for other agricultural purposes. 2 (8) A change in use of a structure from a use within a zoning district to another use in the same zoning district. Development includes all other development customarily associated with it unless otherwise specified. When appropriate to the context, development refers to the act of development or to the result of development. Reference to any specific operation is not intended to mean that the operation or activity when part of other operations or activities, is not development. Reference to particular operations is not intended to limit the generality of this definition. Development Approval, development order or development permit shall mean any building permit, site plan approval, conditional use approval, temporary use permit, subdivision approval, change of land use district boundary, plan amendment or any other official action to grant, deny or grant with conditions, issued by any official, commission, or board of the City having the effect of permitting development andlor redevelopment. Redevelopment shall mean the demolition and reconstruction, renewal. alteration or material chanae in the extent or appearance of a structure or structures or sianificant part of a structure or structures and/or a chanae in the intensitv of use of land, such as an increase in the number of dwellina units in a structure or on land. or an increase in the floor area or an increase in the number of businesses, manufacturina establishment or offices. Redevelopment includes all other development customarilv associated with it unless otherwise specified. When appropriate to the context, redevelopment refers to the act of redevelopment or to the result of redevelopment. Reference to anv specific operation is not intended to mean that the operation or activitv when part of other operations or activities. is not redevelopment. Reference to particular operations is not intended to limit the aeneralitv of this definition. Sec. 31-143. Residential Zoning Districts. (a) Purpose. These residential districts are intended to provide for residential development in conformance with the parcel's Future Land Use Map designation. A residential parcel's zoning designation shall be equivalent to the designation of the Future Land Use Map. The number of dwelling units permitted per gross acre of a zoning parcel, as defined in the DLRs, shall not exceed the total number of dwelling units permitted by the City's Comprehensive Plan designation for the zoning parcel. The uses within this district shall be consistent with, but may be more restrictive than, the corresponding Residential land Use Plan category or Town Center Land Use Plan category permitted uses. These zoning districts shall be applied to land designated Residential on the City's Future Land 3 Use Map. A development parcel may have a maximum number of dwelling units based on an adopted development order or resolution. Development of a parcel shall be subiect to the Site Development Criteria set out in the zoninQ districts of this Section. Subseauent redevelopment shall be limited to existina densitv and/or intensity. More specifically, for any property on which the density andlor intensity allowed bv the Site Deyelopment Standards is exceeded by existinQ development. the new density andlor intensity on redevelopment shall not exceed that allowed in the Site Development Standards and further provided that if the development has received site plan approval. is under construction or existed prior to the effective date of this provision with density and/or intensity lower than allowed by this Section. redevelopment shall be limited to that lower density andlor intensity. Excepted from this provision is redevelopment that is contained or envisioned in the City's Comprehensive Plan or such additional parcells) that will implement specific development or redevelopment Qoals that may be established for particular areas by the City Commission followinQ a public hearina. (b) Residential Single-Family District (RS1). The following regulations shall apply to all RS 1 districts. (3) Site development standards. Q. Development shall be subiect to the criteria set out in this Section. Redevelopment shall follow the Site Development Standards with the exception that any property on which the density andlor intensity allowed by the Site Development Standards is exceeded by existinQ development. the new density and/or intensity on redevelopment shall not exceed that allowed in the Site Development Standards and further provided that if development has received site plan approval. is under construction or existed prior to the effective date of this provision with density andlor intensity lower than allowed by this Section, redevelopment shall be limited to that lower density andlor intensity. (c) Single-Family Residential Districts (RS2). The following regulations shall apply to all RS2 districts. (3) Site development standards. a. Development shall be subiect to the criteria set out in this Section. Redevelopment shall follow the Site Development Standards with the exception that any property on which the density and/or intensity allowed by the Site Development Standards is exceeded by existina development. the new density andlor intensity on redevelopment shall not exceed that allowed in the Site Development Standards and further provided that if the development has 4 received site plan approval. is under construction or existed prior to the effective date of this provision with densitv and/or intensitv lower than allowed bv this Section, redevelopment shall be limited to that lower density and/or intensity. (d) Multifamily Medium Density Residential Districts (RMF3). The following regulations shall apply to all RMF3 Districts. (3) Site development standards. k. Development shall be subiect to the criteria set out in this Section. Redevelopment shall follow the Site Development Standards with the exception that anv propertv on which the densitv and/or intensitv allowed bv the Site Development Standards is exceeded bv existino development. the new densitv and/or intensitv on redevelopment shall not exceed that allowed in the Site Development Standards and further provided that if the development has received site plan approval. is under construction or existed prior to the effective date of this provision with densitv and/or intensitv lower than allowed bv this Section, redevelopment shall be limited to that lower densitv andlor intensity. (e) Multifamily Medium Density Residential Districts (RMF3A). The following regulations shall apply to all RMF3A Districts. (3) Site development standards. k. Development shall be subiect to the criteria set out in this Section. Redevelopment shall follow the Site Development Standards with the exception that anv property on which the densitv andlor intensitv allowed bv the Site Development Standards is exceeded by existinq development. the new density andlor intensitv on redevelopment shall not exceed that allowed in the Site Development Standards and further provided that if the development has received site plan approval. is under construction or existed prior to the effective date of this provision with densitv andlor intensity lower than allowed by this Section. redevelopment shall be limited to that lower density and/or intensity. (f) Multifamily High Density Residential Districts (RMF4). The following regulations shall apply to all RMF4 Districts. (1) Purpose of districts. The purpose and intent of this district is to provide suitable sites for the development of well-planned, environmentally compatible medium-high density multifamily residential use in areas consistent with the City's Comprehensive Plan Future Land Use Element. Densities shall not exceed W 45 units per gross acre. 5 (2a) Conditional Use. The following uses may be established if first approved as a conditional use: a. All uses permitted in the CF zone. b. Uses that exceed the heiqht limitation. to a maximum heiqht of 30 stories or 300 feet. c. Uses that exceed the density limitation, to a maximum of 60 dwellinq units per qross acre. (3) Site development standards. b. Maximum height: 1. Duplexes: Two stories or 25 feet. 2. Townhouses: Three stories or 35 feet. 3. High-rise apartments: 4G 25 stories or 400 250 feet. i. Development shall be subiect to the criteria set out in this Section. Redevelopment shall follow the Site Development Standards with the exception that any property on which the density and/or intensity allowed by the Site Development Standards is exceeded by existinq development. the new density andlor intensity on redevelopment shall not exceed that allowed in the Site Development Standards and further provided that if the development has received site plan approval. is under construction or existed prior to the effective date of this provision with density andlor intensity lower than allowed by this Section, redevelopment shall be limited to that lower density and/or intensity. (g) Multifamily Medium Density Residential Districts (RMF3B). (4) i. Development shall be subiect to the criteria set out in this Section. Redevelopment shall follow the Site Development Standards with the exception that anv propertv on which the densitv andlor intensitv allowed by the Site Development Standards is exceeded by existinq development. the new density andlor intensity on redevelopment shall not exceed that allowed in the Site Development Standards and further provided that if the initial development was constructed with density and/or intensity lower than allowed by this Section, redevelopment shall be limited to that lower density andlor intensity. Sec. 31-144 Business Zoning Districts. (a) Purpose. These business districts are intended to provide for commercial development in conformance with the Comprehensive Plan and provide for a variety of zoning districts to accommodate the City's business and commerce needs. These zoning districts may be applied to land designated Business and Office and Industrial and Office on the City's Future Land Use Map, however, the 6 uses within this district shall be consistent with, but may be more restrictive than, the corresponding Business and Office and Industrial and Office category permitted uses. Development of a parcel shall be subiect to the Site Development Criteria set out in the zonino districts of this Section. Subseouent redevelopment shall be limited to existino density and/or intensity. More specifically, for any property on which the density andlor intensity allowed by the Site Development Standards is exceeded by existino development. the new densitv andlor intensity on redevelopment shall not exceed that allowed in the Site Development Standards and further provided that if the development has received site plan approval. is under construction or existino prior to the effective date of this provision with density and/or intensity lower than allowed by this Section, redevelopment shall be limited to that lower density and/or intensity. Excepted from this provision is redevelopment that is contained or envisioned in the Citv's Comprehensive Plan or such additional parcel(s) that will implement specific development or redevelopment ooals that may be established for particular areas by the City Commission followino a public hearino. The floor area ratio permitted in Business Zoninq Districts shall not exceed the maximum of 2.0 as set out in the Business and Office Future Land Use Cateoorv in the City's Comprehensive Plan. (b) Neighborhood Business (B1) District. This district is intended to provide primarily for retail sales to a surrounding neighborhood. Retail stores permitted therein are intended to include primarily convenience goods which are usually a daily necessity for a residential neighborhood. The district is appropriate for location on a collector or an arterial roadway. (1) Uses permitted. No building or structure, or part thereof, shall be erected, altered or used, or land used in whole or part for other than one or more of the following specific uses provided the requirements set forth elsewhere in this section are satisfied: (g) Institutions suoh as plasm; of 'Norship, libraries, museums anEl similar faoilities. (J:l 9l Antique shops. (i- h) Restaurants and coffee houses or dining room where kitchen is screened or located altogether within an enclosed building or room and with ample provisions for carrying away or dissipating fumes, odors, smoke or noise and where premises are so arranged and the business is so conducted as not to be offensive or create a nuisance to occupants of adjoining premises or to passersby. 7 G D Restaurants and cafes may serve alcoholic beverages where such service is strictly incidental to the service of food and from a service bar only provided no entertainment of any kind is furnished. (k il No sign or any type of character shall be exhibited or displayed to the outside denoting that alcoholic beverages are obtainable within. ill Uses accessory to any of the above uses when located on the same plot. (5) Site development standards. f. Development shall be subiect to the criteria set out in this Section. Redevelopment shall follow the Site Development Standards with the exception that any property on which the density andlor intensity allowed bv the Site Development Standards is exceeded by existina development. the new density andlor intensity on redevelopment shall not exceed that allowed in the Site Development Standards and further provided that if the development has received site plan approval. is under construction or existed prior to the effective date of this provision with density andlor intensity lower than allowed by this Section, redevelopment shall be limited to that lower density andlor intensity. (c) Community Business (B2) District. This district is intended primarily to provide for general commercial activity for a wide range of goods and services to the entire community and sub region. Such businesses generally require locations convenient for both vehicular and pedestrian traffic and would be expected to have orientation toward and direct access to arterial roadways. (2) Conditional use. The following uses if first approved as a conditional use: I. Uses that exceed the heiaht limitation for properties frontina on Biscavne Bouelvard in this district. UP to a maximum heiaht of 12 stories or 120 feet. (5) Site development standards. a. Floor area ratio and lot coverage uR6I minimum .'aR6!&supod opOR spilSO requirements: For purposes af this paragrafli:1 a., structure flarking shall not count as part of ti:1e floor area, But may be counted toward calculation of the floor area ratio. 1. For all buildings: Any structure parking serving the primary use on the site shall be incorporated into the building envelope and shall be compatibly designed. Such parking structure shall comply with all minimum setback and buffer yard requirements. 2. For those buildings 'Nith zero JJ percent of the required parking located within a parking structure: The flaor area ratio si:1all be 0.10 at ane story and shall be inercased by 0.11 for each 3eeitional story. The total lot eo'/erage 8 permitted for all b\lildings on the site shall not eX€leed 10 percent of the total lot area. The total minimum lan<lmJaped open spa"e required shall 80 :n percent of the total lot area. Howe'Ie1', if structure flarking level(s) isfare oounted towarels oaloulation of the floor area ratio then the total lot ooveraSle permitted for all buildings an the site shall not exoeed 38 peroent of the total lot area. ^dditionally, the total minimum lands€laped open spaoe required shall be 35 peroent of the total lot area. 3. For those buildings with 33 percent 66 percent of the required parking looated within a parking strU€lture: The floor area ratio shall be 0.10 at one story and shall be inoreaseel by 0.11 for ea€lh additional story. The total lot ooverage permitteel for all buildinSls on the site shall not exoeed 10 percent of the total lot area. The total miniml,JF1'1 land soaped oflen spaoe requireEl shall be 36 percent of the total lot mea. However, if structure parking level(s) isfare oounted to'Narss oaloulatioR of the floor area ratio then the total lot ooverage J3ermitted for all bl,Jilelings on the site shall not exoeed 35 fler€lent of the total lot area. /\elelitionally, the total minimum land soaped open sJ3aoe required shall be 37 peroent of the total lot area. 1. For those buildings with 66 percent 100 J3eroent of the required parking looated with a parking structure: The floor mea ratio shall be 0.10 at one story anEl shall be inoreased by 0.11 fer eaoh additional story. The total lot ooverage permitted fer all buildings on the site shall not eX€lees15 percent of the total lot area. The total minimum landsoaJ3es open spaoe reEl\lired shall be 3Q percent of the total lot area. Howe'ler, if structure parking level(s) isfare oounteel towards oaloulation of the floor area ratio then the total lot €loverage permitted fer all buildinSls on the site shall not exoeed 35 J3ercent of the total lot area. ^sditionally the total minimum lanssoaped open spaee requires shall be 10 peroent of the total lot area. 2. The floor area ratio shall be 0.40 at one stOry and shall be increased bv 0.11 for each additional stOry. Structure parkina shall not count as part of the floor area, but shall be counted in computina buildina heiaht and number of stories. The total lot coveraae permitted for all buildinas on the site shall not exceed 40 percent of the total lot area. The floor area ratio shall not exceed 2.0 for all buildinas in this district in conformance with the Comprehensive Plan. b. Maximum height: For those properties frontina on Biscavne Boulevard, 7 stories or 70 feet overall maximum heiaht. includina structured parkina. For those properties not fronting on Biscayne Boulevard, 2Q j,Lstories or J4+ 120 feet overall maximum height, including structure parking. For J3l,Jrposes of this paragraph b., struotur.e parking shall not be oountes in computing number of stories but shall be oounted in oomputing overall maximum height. That portion of the building or structure within 200 feet of any residential zone shall be subject to a height limitation of one foot for every two feet in distance from the residential 9 zoned plot unless the application of this requirement would limit the building height to a minimum of 25 feet. c. Minimum lot area and width: There shall be no minimum required width or area of plot except as otherwise provided. d. Setbacks: For purpsses sf tRis paragraph d., structure parking incorporated within the building envelope shall count towar.a the number of stories. Front yard: not less than 25 feet in depth Street side yard: not less than 20 feet in depth Side and Rear yard: There is no side or rear yard setback required for a plot which is not adiacent to a street or alley. A side and rear yard setback of 20 feet in depth is required for a plot adiacent to a residentiallv zoned district. street or alley. 1. Those buildin!js whoso total number of stories is betweon zoro and ton ~ floors, includin!l any strl:lcture parking incorporated within the building envelefile, shall have a front yard not less than 25 foet in dopth. E'/ery plot shall have a street sido yard of not loss than 20 foet depth. Thero is no sido or roar yarE! setsack roquirod for a plot which is not adjacent to a street or alley. ^ side anE! rear yard setback of 20 foet is required when adjacent to a residentially zoned district, street or alley. 2. Those buildings whose total nUn:lser of stories is setween 11 seven and 20 12 floors, including any structure parking incorporated .....ithin the building envelsfile, shall have a front yard not less than 35 foet in depth. Every plot shall have a street side yard of not less than 35 feet in depth. Thero is no side or roar yard setback required fer a fillet which is not adjacent te a street er alley. /\ side and rear yard setback of 35 foet is required when adjacent to a residentially zoned district, street or alley. 3. Those builE!ings whese total number of steries exceeE!s 20 floors includin!j any structure parking incorporated within the building envelope, shall ha'/e a front yard not less than 15 foet in depth. Every plot shall have a street side yard of not less than 15 foet in depth. There is no side or rear yard setback required for a plot which is not adjacent to a street or alley. 1\ side and rear yard setback of 15 foet is required when adjacent to a residentially zoned district, street or alley. e. Structure parking: All structure parking shall be compatibly designed to complement the primary use structure for which it serves. Parking structure ceiling heights shall be seven feet six inches except where greater heights may be required by other regulatory agencies. Pipes, ducts and mechanical equipment installed below the ceiling shall not be lower than seven feet zero inches above finish floor. 10 f. Development shall be subiect to the criteria set out in this Section. Redevelopment shall follow the Site Development Standards with the exception that anv propertv on which the densitv and/or intensitv allowed bv the Site Development Standards is exceeded bv existina development. the new densitv andlor intensitv on redevelopment shall not exceed that allowed in the Site Development Standards and further provided that if the development has received site plan approval. is under construction or existed prior to the effective date of this provision with densitv and/or intensity lower than allowed by this Section, redevelopment shall be limited to that lower density and/or intensity. (d) Heavy Business (B3) District. This district is intended to provide locations for planned commercial centers, sharing a common identity, parking and other support facilities developed according to an overall development plan; and for a wide range of goods and services to serve a market beyond the community itself. Such commercial concentrations are expected to draw substantial patronage from outside areas and are not expected to serve the convenience needs of local residents. As such, these centers should be oriented towards and have direct access to arterial roadways, particularly major arterials. (2) Conditional use. The following uses if first approved as a conditional use: a. Uses that exceed the heiaht limitation for properties frontina on Biscayne Bouelvard in this district. UP to a maximum heiaht of 12 stories or 120 feet. (6) Site development standards. a. Floor area ratio and lot coverage 3mi minimum k;mcJseaped open spaeo requirements: For purposes of this paragraph a., structure parking shall not count as part of tAo floor ar.ea, but may be counted to.....ard calculation of the floor area ratio. 1. For all buildings: Any structure parking serving the primary use on the site shall be incorporated into the building envelope and shall be compatibly designed. Such parking structure shall comply with all minimum setback and buffer yard requirements. 2. For those buildings with zero aa percent of the requires l3arking located within a parking strueture: The floor area ratio shall be 0.10 at one story and shall be increased by 0.11 for each asditional story. The total lot CO'Jerage permitted for all Bl,Iilsings on the site shall not exceed 10 l30rsent of the total lot area. The total minimuFl'l landscaped open space required shall BO aa percent of the total lot mea. HO'.ve'Jer, if structure parking level(s) ie/are counted to'....arde calculation of the floor area ratio then the total lot coverage permitted for all buildin€ls on the site shall not exceed as percent of the total lot area. II ^dditionally, the total minimum landcoaped open spaoe required chall be 35 poroont of tho total lot ama. 3. For those builsin!')s with 33 percent 66 percent ef the required parkin!') located within a parking structure: The floor area ratio shall be 0.10 at one story and shall be increased BY 0.11 for each additional story. The total lot Gcwerage permitted for all Bl,lilsings on the site shall not eXGees 10 percent of the tetallot area. The total minimum landscaped open space requires shall be 36 percent of the total lot area. Hewever, if structure parking level(s) is/are counted towards calculation ef tt-le floor area ratio then the tetal lot coverage permittes for all buildingE on the site shall not exceed 35 percent of the total lot area. Additionally, the total minirnum landscaped open sl3aee required shall be 37 percent of the total lot area. 1. For those buildings with ee percent 100 percent of the required parking located with a parkiA!') structure: The floor area ratio shall be 0.10 at OAe story and shall be increased by 0.11 for each additional EtOry. Tt-le total lot coverage permitted for all buildings on the site shall not exceed 15 percent of the total lot area. The total minirnl,lrn landscaped open Epace FOEluired shall be 39 perGent of the total lot ar.oa. However, if structure parkiA!') level(s) is/are countes to'....ards calculation of the floor area ratio then the tetal lot coverage perrnittes for all buildingE on the site shall not exceed 35 pereent of the total lot area. ^dditionally the total minirnl,lm landscaped open space required shall be 10 l3ercent of the total lot area. 2. The floor area ratio shall be 0.40 at one stOry and shall be increased bv 0.11 for each additional stOry. Structure parkino shall not count as part of the floor area, but shall be counted in computino buildinQ heiQht and number of stories. The total lot coveraQe permitted for all buildinQs on the site shall not exceed 40 percent of the total lot area. The floor area ratio shall not exceed 2.0 for all buildinQs in this district in conformance with the Comprehensive Plan. b. Maximum height: For those properties frontino on Biscavne Boulevard, 7 stories or 70 feet overall maximum heioht. includinQ structured parkinQ. For those properties not fronting on Biscayne Boulevard, ;W 12 stories or d4+ 120 feet overall maximum height, including structure parking. For purpoces of this paragraph b., structure parking shall not be countes in computing numBer of stories but shall be counted in computin!') overall maximum hei!')ht. That portion of the building or structure within 200 feet of any residential zone shall be subject to a height limitation of one foot for every two feet in distance from the residential zoned plot unless the application of this requirement would limit the building height to a minimum of 25 feet. c. Minimum lot area and width: There shall be no minimum required width or area of plot except as otherwise provided. 12 d. Setbacks: For purposes of this paragraph d., structure parking inoorporated within tho building onvolol3o shall count toward tho numbor of storios. Front yard: not less than 25 feet in depth Street side yard: not less than 20 feet in depth Side and Rear yard: There is no side or rear vard setback required for a plot which is not adiacent to a street or allev. A side and rear vard setback of 20 feet in depth is required for a plot adiacent to a residentiallv zoned district. street or allev. 1. Those Buildings whoso total nUFABer of stories is bet\\looA zero and ten ~ floors, inoluding any struot\,lre parking inoorporated within the building envelopo, st-lall ha'Ie a front yard not less than 25 foet in deptt-l. Every plot shall have a stroet side yarEl of not less than 20 foot Elepth. There is no sido or rear yard setbask required for a plot whioh is not adjaoent to a stroet or alley. 1\ side and roar yarEl setbaok of 20 foet is roEj\,lired '",hen adjaoont to a residentially zonod distrist, street or alley. 2. Tt-lose buildings whoso total fmmber of stories is Between 11 sovon and 20 12 floors, inoluding any struoture parking inoorporated within the building envelopo, shall havo a front yard not less than d5 feet in depth. Evor! J3lot shall have a street side yard of not loss than 35 foot in doptt-l. There is no sido or rear yard setbaok required for a J3lat '",hioh is not adjaccnt te a street or alley. .^. side and rear yard sotbaok of 35 feet is requirod whOA adjaoent to a rosiElentially zoned distriot, streot or alley. 3. Those B\,Iildings whose total n\,lFAber of stories oxseeEls 20 floors insl\,lEling any struoture parking inoorporated within tho builEling envelopo, shall have a front yard not less than 15 feet in depth. Evor)' J3lot shall have a stroot sido yard of Aot less than 15 foot iA Elepth. There is no side or rear yard sotbaok rOEj\,lireEl for a plot whioh is not a€ljaoent to a street or alley. ^ side and rear yard setbaok of 15 feot is reEjuired when adjaoent to a residentially zonod €listriot, street or alley. f. Development shall be subiect to the oriteria set out in this Section. Redevelopment shall follow the Site Development Standards with the exception that anv property on which the density and/or intensitv allowed bv the Site Development Standards is exceeded bv existinq development. the new densitv and/or intensitv on redevelopment shall not exceed that allowed in the Site Development Standards and further provided that if the development has received site plan approval. is under construction or existed prior to the effective date of this provision with densitv and/or intensity lower than allowed bv this Section, redevelopment shall be limited to that lower density andlor intensitv. 13 (e) Office Park (OP) District. This district is intended to provide for high quality, semi-professional and professional offices in a campus setting reflecting creative design and environmentally compatible use of space and perimeter buffer areas. This zoning district may be applied to land designated Business and Office and Industrial and Office on the City's Future Land Use Map, however, the uses within this district shall be consistent with, but may be more restrictive than, the corresponding Business and Office and Industrial and Office category permitted uses. (4) Site development standards. b. Maximum height: No building or structure, or part thereof shall be erected to a height exceeding ten stories or 4+e 100 feet overall maximum height, including structure parking. For purposes of this paragraph b., strbleture parking shall not be counted in cOR'lputing number of stories but shall be counted in cOR'lputing overall maximum height. c. Floor area ratio and lot coverage: For l3b1rposes of this paragraph c., structure parkiAfij sholl not count as l3art of the floor area, bblt may be counted toward calculation of the floor area ratio. 1. For all buildings: Any structure parking serving the primary use on the site shall be incorporated into the building envelope and shall be compatibly designed. Such parking structure shall comply with all minimum setback and buffer yard requirements. 2. For those Buildings 'Nith zero 33 percent of the required parking located within a parking strbletblre: The floor area ratio shall be 0.10 at one story and shall be ineroased by 0.11 for each additional story. The tetal lot cO'lerage permitted for all Bblildings on the site shall net exceed 10 percent of the total lot arco. However, if structblre parking le'lel(s) is/are ceblnted to'....ards calculation of the floor area ratio then the total lot coverage permitted for all Bblildings on the site shall net exceed 38 percent of the total lot area. 3. For those Bblildings with 33 percent ss percent of the required parking located within a parking structure: The floor area ratio shall be 0.10 at one story and shall be increased by 0.11 for each additional story. The total lot coverage permitted for all buildings on the site shall not exceed 10 percent of the total lot area. However, if structure parking level(s) is/ore counted to'.vards calculation of the floor area ratio then the tot31 lot coverage permitted for 311 buildings on the site shall not exceed 35 percent of the total lot area. 1. For those buildings '""ith 66 percent 1 00 !'Jercent of the required parking located with 3 parking structure: The floor area ratio shall be 0.10 at one story and sholl be increased by 0.11 for each additional story. The total lot coverage permitted for all buildings on the site shall not exceed 15 percent of the total lot 14 area. HO'Naver, if structurc parking le'/el(s) is/am counted towards calculation of tho floor aroa ratio then the total lot coverage permittod for all buildings on tho site shall not exceeel 35 percent of the total lot area. 2. The floor area ratio shall be 0.40 at one stOry and shall be increased by 0.11 for each additional stOry. Structure parkinq shall not count as part of the floor area, but shall be counted in computinq buildinq heiqht and number of stories. The total lot coveraqe permitted for all buildinqs on the site shall not exceed 40 percent of the total lot area. The floor area ratio shall not exceed 2.0 for all buildinqs in this district in conformance with the Comprehensive Plan. d. Setbacks: No parking areas shall be located within 30 feet of any residentially zoned property or within ten feet of any street line. For purposes of this par.a!ilr.aJ3h d., structurc parking incorporated within the building envelope shall count toward the number of stories. Front Yard: not less than 50 feet in depth. Street Side Yard: not less than 15 feet in depth Rear Yard: not less than 25 feet in depth. Adiacent to any RS districts, the rear yard setback shall be 30 feet in depth. 1. Those bl:JileliA!ilS whose total number of stories is between zero and ten floors, including aAY strUGtur.e parking inoorporated within the building envelope, shall have a front yard not less than 50 feet in depth. E'/ery plot shall ha'/e a street side yard of not less than 15 feet depth. E'/ery plot upon whioh a struoture is hercatier ercoted shall have a minimum rear yard of 25 feet. Adjaoent to any RS distriots the setbaok shall be 30 feet. 2. Those buildings '....hose total number of stories exoeeels ten floors, iAGluding any structure parking inoorporated within the building envelope, shall have a front yard not less than 50 feet in depth. Every J319t s"'all have a street side yard of not less than 25 feet in depth. E'/ery plot upon whioh a struoture is hereafter erected shall have a minimum r.ear yar.e of 25 feet. /\djaoent to any RS distriots the setback shall be 35 feet. 3. Those buildings whose total number of stories exoeeds 20 floors inoluding any struoture parking inoorporated within the building en'/elope, shall have a front yard not less than 15 feet in depth. E'/ery plot shall have a strcet side yard of not less than 15 feet in depth. Thare is no sido or roar y;:ud sotbaok required for a plot whioh is not adjaoont to a streot or alley. ^ sido and roar yard setbaok of 15 feet is rcquircd when adjaoent to a residentially zoned district, stroet or alloy. e. Minimum open space: Minimum open space shall be 22 percent of the net lot area. Landscaped open space may include entrance features, passive recreational uses and/or pedestrian walkways. This minimum requirement may 15 also include 50 percent of roof decks and other above grade surfaces which are provided and maintained for the common benefit of all occupants of the building. Water bodies may be used as part of the required landscaped open space but such water areas shall not be credited for more than 20 percent of the required open space. 1. These l3l,JilElings whose total nl,JR'll3er of stories is between zero and ten floors, including Llny stmctured parking incorllorated within the building envelope, shLlII have a minimum allen space of 22 percent of the net lot urea. If structure parking le\'el(s) is/are cel,Jnted towards calculatieR of the floor area ratio, then the total minimuR'l landssaped open space requireEl shall be 25 percent of the total lot Llrea. 2. Those bl,JilEliR9s whose total nUR'll3er of stories exceeds ten floors, incll,JEling any structured parkin!! incorporated within tl:le building envelope, shall have a minimum open space ef 25 percent of the Ret lot area. If struGture parking le'.'el(s) is.lare counteEl towards calculation ef the floor area ratie, then the total R'linimuR'l landssaped open space re~uired shall be 28 !lercent of the total lot area. a. Development shall be subiect to the criteria set out in this Section. Redevelopment shall follow the Site Development Standards with the exception that any property on which the density and/or intensity allowed by the Site Development Standards is exceeded by existina development. the new density and/or intensity on redevelopment shall not exceed that allowed in the Site Development Standards and further provided that if the development has received site plan approval. is under construction or existed prior to the effective date of this provision with density andlor intensity lower than allowed by this Section, redevelopment shall be limited to that lower density and/or intensity. (f) Medical Office (MO) District. This district is intended to provide for medical offices and other uses supporting the medical profession associated with the hospital. This zoning district may be applied to land designated Business and Office on the City's Future Land Use Map, however the uses within this district shall be consistent with, but may be more restrictive than, the corresponding Business and Office category permitted uses. (2) Conditional Use. The following uses if first approved as a conditional use: b. Multi-family residential uses with a maximum density of 25 dwellina units per aross acre. (4) Site development standards. 16 b. Maximum height: No building or structure, or part thereof shall be erected to a height exceeding ten stories, or 4+e 100 feet overall maximum height, including structure parking, unless otherwise specified in this section. For f3urposes of this paragraph b., structure parkiAg shall not be counted in computing numBer of stories but shall be counted in computing o'/erall maximum height. c. Setbacks: No parking areas shall be located within 30 feet of any residentially zoned property or within ten feet of any street line. For purposes of this paragraph c., structure parking incorporated within the building envelope shall count toward the numBer of stories. Front yard: not less than 50 feet in depth. Street Side yard: not less than 20 feet in depth. Rear yard: not less than 25 feet in depth. 1. Those buildings whose total numBer of stories is between zero ans teA floors, incll:lsiAiil any structure parking incorporated within the Building en'/elope, shall hove 0 front yore! not less than 50 foet in depth. Every plot shall ha'/e a street side yard of not less than 20 foet in depth. Every plot l:I!'lon which a structure is hereafter erected shall have a minimum rear yare! of 25 foet. 2. Those builsings '",hose total number of stories is Between 11 and 20 floors, incll:lsiniil any structure parking incorporated 'NithiA the building envelope, shall !:lave a front yard not less than 50 foet in depth. Every plot shall have a street side yare! of not less than 30 foet in depth. !;;.very plot upon '....hich 0 structure is hereafter erected shall have a minimum rear yars Elf 30 foot. 3. Those buildings whose total number of stories exceeds 20 floors, including any structure !'larking incorporated within the building envelope, shall have a front yard not less than 65 foet in depth. E'iery plot s!:lall have a street side yard of not less than 15 feet in de!'lth. E'iery plot upon which a strl:lcture is hereafter erected shall ha'/e a miniml:lm rear yard of 15 foet. 4..1. For those properties lying between NE 206 Street to the south, NE 209 Street to the north, NE 28 Avenue to the east and East Dixie Highway to the west, the following standards shall apply: a. No parking areas shall be located within 30 feet of any residentially zoned property of within ten feet of any street line. b. Minimum front yard setback shall be ten feet in depth for the first two stories of the structure and 15 feet in depth for any additional stories. c. Minimum street side yard setback shall be ten feet in depth for the first two stories and 15 feet for additional stories. 17 d. Minimum rear yard setback shall be ten feet in depth, except that the minimum yard setback from Biscayne Boulevard in this district shall be 25 feet in depth. d. Floor area ratio and lot coverage and minimum landscaped open space requirements: For purposes of this paragraph d., structure parking at:Jall Rot COURt as I'lart of the floor area, but may be counted toward calculation of the floor area ratio. 1. For all buildings: Any structure parking serving the primary use on the site shall be incorporated into the building envelope and shall be compatibly designed. Such parking structure shall comply with all minimum setback and buffer yard requirements. 2. For those buildings with zero 33 percent of the required parkiRg located within a parking structure: The floor area ratio shall be 0.40 at one story and shall be incr.eased by 0.11 for each additional story. The total lot coverage permitted for all buildings on the site shall not exceed 40 percent of the total lot area. The total minimum landscaped open space required shall be 33 percent of the total lot area. However, if structure parking level(s) ie:far.e counted towards calcldlation of tt:Je fleer area Fatio then the total lot cO'/erage permitted for all buildings on the site shall not exceed 38 percent of the total lot area. Additionally, the total minimum landscaped open space required shall be 35 percent of the total lot area. 3. For those buildings with 33 perseRt 66 percent ef the required parking located 'Nithin a parking structure: The fleer area ratio shall be 0.40 at one story and shall be increased by 0.11 for each additional story. The total lot coverage permitted for all buildings on the site shall not exceed 40 percent of the total lot area. The total minimum landscaped open space reEll,Jiree shall be 36 percent of the total lot area. Howe'ler, if structure parking le'lel(s) is/are counted towards calculation of the floor area ratio then the total lot coverage permitted for all buildings on the site shall not exceed 35 percent of the total lot area. Additionally, the total miniml,Jm landscaped open space required shall be 37 percent of the total lot area. 4. For those buildings with 66 percent 100 percent of the Fequired parking located with a parking structure: The floor area ratio shall be 0.40 at one story and shall be increased by 0.11 for each additional story. The total lot coverage permitted for all buildings on the site shall not exceee 45 percent of the total lot area. The total minimum landscaped open space required shall be 39 percent of the total lot aFea. However, if structure parking le'lel(s) is/are counted towards calculation of the floor area ratio then the total lot coverage permitted for all buildings on the site shall not exceed 35 percent of the total lot area. Additionally the total minimum landscaped open space FOquired shall be 40 percent of the total lot area. 18 a 2. For those properties lying between NE 206 Street to the south, NE 209 Street to the north, NE 28 Avenue to the east and East Dixie Highway to the west, the following standards shall apply: The maximum floor area ratio shall be 0.40 at one story and shall be increased by 0.11 for each additional story. The total lot coverage permitted for all buildings on the site shall not exceed 40 percent of the total lot area. The minimum landscaped open space required shall be 33 percent of the total lot area. 3. Minimum landscaped open space reauired shall be 33 percent of the total lot area. The floor area ratio shall be 0.40 at one stOry and shall be increased by 0.11 for each additional stOry. Structure parkina shall not count as part of the floor area, but shall be counted in computina buildina heiaht and number of stories. The total lot coveraae permitted for all buildinas on the site shall not exceed 40 percent of the total lot area. The floor area ratio shall not exceed 2.0 for all buildinas in this district in conformance with the Comprehensive Plan. f. Development shall be subiect to the criteria set out in this Section. Redevelopment shall follow the Site Development Standards with the exception that any property on which the density andlor intensity allowed by the Site Development Standards is exceeded by existina development. the new density and/or intensity on redevelopment shall not exceed that allowed in the Site Development Standards and further provided that if the development has received site plan approval. is under construction or existed prior to the effective date of this provision with density andlor intensity lower than allowed bv this Section, redevelopment shall be limited to that lower density andlor intensity. Sec. 31-145. Town Center Zoning Districts. (a) Purpose. The purpose and intent of these districts is to provide suitable sites for the development of structures combining residential and commercial uses in a well planned and compatible manner. The uses within these districts shall be consistent with, but may be more restrictive than, the corresponding Town Center Land Use Category permitted uses. Residential densities shall not exceed 25 units per gross acre and nonresidential densities shall not exceed a floor area of 2.0. (b) Town Center District (TC1). The following regulations shall apply to all TC1 Districts: (3) Conditional uses permitted. The following uses may be established if first approved as a conditional use: a. Those uses permitted in the RMF3 District. b. Those uses permitted in the 81 District. 19 c. Those uses permitted in the B1 District with increased floor area. s., d. Sale of alcoholic beverages for on-premises consumption except with meals. &.- e. Uses that exceed the height limitations, including parking structures. &. L Aboveground storage tanks. Aboveground storage tanks (AST) only as an accessory use and only for the purpose of storing fuel for emergency generators. ASTs must conform to the following requirements: 1. Be of 550 gallons capacity or less. 2. Be installed and operated under a valid permit from the Miami-Dade County Department of Environmental Resources Management. 3. Be fully screened by a masonry or concrete wall with a self-closing and locking metal door or gate. Such wall shall be landscaped in accordance with the City's Landscape Code. 4. Be located in a manner consistent with the site development standards of the TC1 zoning district. 5. Installation of any AST shall require a building permit from the City. Application for building permit shall be accompanied by a site plan indicating the location of the AST relative to property lines, the primary structure served by the AST, any other structures within 300 feet as well as a landscape plan prepared by a Florida licensed architect or landscape architect and other supporting documentation as deemed necessary by the City Manager or designee. f, 9..,. Floor areas that are less than the minimum floor areas required by the provisions of 31-145(5)g hereof. !r h, Allocations of interior spaces other than as set forth in section 31- 145(b )(7) hereof. ~ L. Structured parking that is not incorporated into the building envelope of a primary use structure, as required by section 31-145(9) hereof. h 1. Structured parking that can be seen from a primary use building and that does not have the area of the top level landscaped and/or decoratively paved in order to provide amenity areas for building occupants, as required by section 31- 238 of the Code. }.. !s..:. Driveways for mixed-use projects exceeding 20 acres in size with a separation of less than 150 feet of landscaped frontage as long as it is determined, as part of site plan review that: 1. Landscaping for the total project site exceeds the minimum requirements of the Code, and; 2. Traffic studies indicate that a lesser distance between driveways does not constitute a safety hazard to either vehicular or pedestrian traffic. 20 k.L Off street parking that does not meet the requirements of section 31- 171 (b) or (d) of this Code. I.m. All uses permitted in the CF District. Fll. ,^.II UGCG llerA'littea as accessory uses in the CF, Community Facilities District (10) Desian Standards. All development in the TC1 zonina district shall conform to the "Town Center Desian Guidelines" as provided bv the Citv Manaaer. (e) Town Center Marine District (TC2). The following regulations shall apply to all TC2 Districts. (12) Desian Standards. All development in the TC2 zonina district shall conform to the "Town Center Desian Guidelines" as provided bv the Citv Manaaer. 21 City of Aventura Town Center Design Guidelines I. Site Concepts A. The Town Center Concept The objective is to create a Town Center feel which will primarily serve the City's existing and future residents and businesses. The Town Center shall be characterized by a mixture of different urban functions integrated horizontally and vertically, multi-modal transportation access and circulation and high quality urban design. Primary characteristics are consistent building streetwalls with minimal setbacks, pedestrian-scale, mixed uses, and livelworklplay activity. In order to achieve such attributes, special site planning and building orientation principles should be followed. . Create a continuous streetwall with buildings fronting on both sides of the street. . Building facades should generally maintain at least a 25' height to provide a sense of enclosure to the street. . Focus pedestrian traffic along the street in front of shops by locating entries on the street side of buildings. . Maintain a view corridor to the water through the adjacent Harbour Centre. . Access from parking areas to retail or residential uses should occur via major street sidewalks (Biscayne Boulevard, NE 187th Street and NE 29th Avenue and internal streets); office uses may provide direct pedestrian access from parking areas where necessary. . Corners of buildings can be eroded at key intersections to open up visibility and allow collection areas for pedestrians; cafes and other uses that promote street life are encourage at these corner locations. . Pedestrian oriented streets. Typical Roadway Sections from the City's Adopted Comprehensive Plan are attached. . Bike racks should be located in areas that are convenient and near building entrances or other highly visible areas which are self-policing. . Transit stops at appropriate locations with sheltered comfortable waiting areas and seating, designed to City standard bus shelters. . Shade trees should be planted to provide additional climate protection and contribute to an attractive pedestrian environment and should consist of a minimum 14 foot canopy trees spaced 6 feet apart, 12 foot flowering trees spaced 5 feet apart and palms as approved by the City's Landscape Architect. . Street furniture shall consist of approved 6 foot Scarborough Strap benches or similar, litter containers manufactured by Street Smart Designs with The City of Aventura logo or similar and street lights are to be Mogul Base Venture Lamp or other as approved by the City. B. "Outdoor Rooms" A plaza or "outdoor room" is to be created along the main easUwest street through the Town Center at the area where intersections with the north/south street occurs. This is the place where pedestrians will tend to collect and engage in the very human activities of standing, waiting, talking and eating. Architecturally, the comer elements of the buildings at this intersection need to be accentuated with towers and may include double height spaces to create dramatic entries into the retail spaces. The plaza will include a large central fountain and integrate amenities such as outdoor seating, shade trees and public art and will require adjacent storefronts that look and open into the plaza. Special attention will be given to the plaza to create a pleasant, humanly scaled environment that is appropriate to adjoining uses. C. Land Uses A clear vertical separation of land uses is essential with the Town Center, with retail and restaurant uses located along the sidewalk level along Biscayne Boulevard to create a datum that pulls pedestrians down the street. With the exception of The Venture, residential will primarily be located at upper levels of buildings with sidewalk entrances that support street life. Office uses will be allowed in a stand alone building or above retail. Facades should also be articulated and/or modulated to create visual interest. D. Transitions/Pedestrian Areas It is important to pay attention to transition areas that link the Town Center to the surrounding area by providing gateways or landmarks that help to draw the visitor into the Town Center. A minimum walkway width of 10' should be kept free and clear for pedestrian traffic, with the exception of restaurant uses, where minimum walkway areas can be reduced to accommodate outdoor dining areas. Walkways, crosswalks and plaza areas should be made of a decorative paving treatment that provides a comfortable walking surface that is vibration free. Pavers or stamped concrete will not be permitted. Acceptable decorative materials include DuraTherm or similar. E. Climate/Solar Orientation Due to the strong sun of Southern Florida, solar orientation should play an important role in determining the built form of shopfronts. All elevations should incorporate devices to aid in sun control and provide outdoor shaded areas (i.e. awnings, screening canopies, arcades or recesses). These elements should be carefully integrated into the overall design so as not to appear ''tacked on." Overhead landscape canopies can serve to filter sunlight and reduce glare, making pedestrian activity more pleasant, and are encouraged. II. Building Design Concepts A. Overall Design Intent and Themes Aventura is the City of Excellence. The architectural character should evoke the image of Florida. Designs that refer to "period architecture" should be interpreted in a contemporary way. Building groupings should be composed of a series of individual elements that stand on their own, but when combined contribute to a coherent overall sense of place. The buildings and shopfronts are to build on the basic design themes of the Town Center while striving for design creativity and individual expression. B. Character and Massing . Simple yet varied massing promotes a "Town Center" character. . Breaking down the massing and scale of larger buildings creates a pedestrian scaled collection of smaller individualized elements that is in keeping with the overall concept. . Especially at corners, create a varied skyline with strong forms (i.e., towers, domes and rotundas). . Accentuate important locations, especially entries. . Architecture of "mass" that provided deep openings and shadow lines as well as details enhanced by the strong Southern Florida sun are encouraged. . Architecture should enhance the pedestrian experience by providing human-scaled details and amenities. . Architectural massing that strongly defines a base, middle and cap is strongly encouraged. Roof forms should be expressed whenever possible along the pedestrian realm in a visually interesting fashion, avoiding flat, unarticulated expressions. . The massing of any fayade should generally not exceed 50' maximum (horizontal dimension). Shopfronts may be broken down even further. Consider massing variations every 3D' or less where appropriate. C. Ground Floor Uses . Design and leasing of ground floor areas should focus on uses that enhance and enliven the pedestrian experience along the main eastlwest street and Biscayne Boulevard. . Preferred uses include specialty, service, and convenience retail, and restaurants (with outdoor dining). . Main entries to offices, housing and other second level uses should front onto a street to promote active street life. Entries to residential uses shall be separate from entries to offices and retail uses. . Secondary entries oriented toward parking fields other than service entries are discouraged. D. Fenestration · recessed windows are appropriate. They should be inset from the face of the building to create deep shadow lines and visual relief. · Clear glass is required in all retail storefronts; smoked, reflective, or black glass is prohibited. · Use of reflective glazing shall be limited to second level uses and above and are subject to review. E. Exterior Colors, Materials and Details . Color palette should take cues from the surrounding buildings in Aventura, integrating the classic base colors including but not limited to warm earth tones such as tan, ochre, beige, and terra cotta. · Roses, pinks, plums, blues and violets should generally be avoided. · Vibrant accents may be used in limited quantities at appropriate locations. Accents are to be of high quality materials and are used to promote a vibrant street life in a manner compatible with the 'civic' nature of the street. . Large expanses of flat exterior cement plaster walls along the surrounding major streets (Biscayne Boulevard, NE 187th Street and NE 29 Avenue) are not desirable. Where large amounts of mass are required, the mass should be broken down by changes in plane, reveals or decorative details. · High quality materials such as terra cotta, natural stones, and clay fired CJinJ!1 are encouraged for architectural details and accents whenever appropriate. A more generous use of details and materials is suggested at entries and the ground floor along the major perimeter streets. · Where appropriate to an approved building design, a high quality durable base material, such as terra cotta, natural stone, or Clay fired tile, is suggested for building facades abutting the sidewalk. Stucco may also be used. The base should be a minimum of 18" in height and proportioned and detailed for the fa98de of the building. · Roof tiles should be of high quality. Different shapes and finishes of tiles that promote variety and individuality to buildings within an overall compatible palette of materials are encouraged. F. Integration of Signage/Lighting/Artwork · Signage and environmental graphics should be conceived as an integral part of the buildings architectural design, not applied as an afterthought. · Refer to Signage portion of the design guidelines for additional design guidelines. G. Screening of Mechanical Units and Service Areas · All mechanical units shall be screened from public view, preferably with cohesive design elements such as roof forms that contribute to the overall design intent. . When roof decks with mechanical units are visible from adjacent developments, they should be as unobtrusive as possible and painted to match finish roof material or screened from view. . Service areas shall be screened, gated and be as unobtrusive as possible. . Landscaping of screen walls is required. III. Storefront Criteria In keeping with the Town Center design concept, storefronts have been placed where high visibility and accessibility are desired. . Storefronts should be composed of a minimum 70% glazing and a maximum 30% solid wall. With restaurants, variation may be considered in order to accommodate individual restaurant concepts while keeping in mind the need for maximum transparency in keeping with other adjoining storefronts. . Maximum storefront transparency from the sidewalk to the lease space is required. All glazing should be completely transparent. . In general, all glazing must recess completely into sills, jambs, and headers and be composed of a minimum Yo" tempered glass. . Awnings, canopies, arcades or other shaded areas are recommended. . Storefronts are to be used for displays only. No backsides of shelves should be visible along storefronts. . Generally, no part of the storefront other than the path of a swinging door should project beyond the shops' lease Line into the Public Zone. Any projections over the Lease Line require City approval. . Recessed entries of the storefront are encouraged. . Solid wall portions of the storefront should continue the character of the design concept of the downtown. . Storefront tile work should be in keeping with the design concept of the downtown. . Service doors should be surrounded by at least 18" of solid wall and recessed l' behind the lease Line. IV Paseos Paseos are pedestrian passages that form a linkage between the inside of a block and the street sidewalk. These areas occur at two locations of the Town Center, between Buildings 0 and E and between the Existing Bank building and Building K on the Conceptual Master Site Plan. Paseos are characterized with details that enhance a pedestrian environment such as special materials, and intimate scale. Shops that are adjacent to paseos should provide special design elements that address this condition. . Blade signage is the preferred signage in these areas and should be reviewed on an individualized basis and should be consistent in design. . Shop owners should provide designs of the blade sign bracket for review before fabrication and installation. Other design elements that break down scale and provide a high quality pedestrian environment are encouraged, including canopies, building mounted lights, planters, trellises, special tilework, niches with small fountains. The goal is to create an interesting environment of light, shade, color and texture. V. Lighting Lighting sources and fixture types should be carefully selected in order to create a variety of ambient, decorative and accent illumination. A. Storefront Lighting . Direct visual exposure of incandescent and fluorescent lamps is prohibited. All visible lighting should be glare free. . Track fixtures are permitted if they are not visible from the sidewalk and are contained within a light pocket in the window display. . All storefront lighting must work during hours of operation and should be controlled by a time clock. . Decorative low-voltage spotlighting within the storefront display area is encouraged. B. Site Lighting . Site lighting shall conform to the requirements of Section 31-234 "Outdoor Lighting Standards" of the Land Development Regulations. . Lighting shall be located, screened or shielded so that adjacent structures and the right of way are not directly illuminated. . A site lighting plan shall be submitted as part of the Site Plan Approval application. . Street lights shall be to City standard. VI. Outdoor Seating Areas for Restaurants . Outdoor seating areas shall be designed in a manner to allow appropriate pedestrian circulation on adjacent public sidewalks, Minor pedestrian circulation "choke points' of clear sidewalk no less than 6' in dimension are generally acceptable (Le. between street tree grates and outdoor dining areas). In no instance shall the total clear sidewalk area, absent said choke points be less than 12'-16' in width as measured from face of curb to face of adjacent building. VII. Sign Criteria . Blade signs should have brackets made of metal; sign panels may be fabricated of wood or painted aluminum; graphics may be incised, applied, or painted directly to the sign panel surface. . All blade signs are subject to City approval and are limited to the paseo areas of the Town Center. . Wayfinding signs are allowed based on City review and consistency with an approved master sign concept plan. . All other signage shall conform to the requirements of Section 31-191 "Sign Regulations" of the Land Development Regulations. Figure 8: Typical Street Intersection Plan . 'f /1 l ~. ~l>l>r l1!W5 otJ.~~ t\.l>I'">\(l..I,o.N~ ,..... ,'-'II .1l~1 ~~",s"1t> I\ltIIRrna- c.f1..tsiF.>wl>J-.lL- ~ .' . WllA'L <7, """,,"111JreI2.~ 'fLI,N City of Aventura es"",eheNsive Pia" Adopted COllwrel1cIIsit'f;' P/lln TMNsmiftQI DMft Poge 17.>> of 33&i flproj1936.01 Iwplt/ernenll ,'riee.'iI", \ 0-981 urbon design Figure 7: Comfort Zones at Street Level S\VJl\lJGi lX;VIGII? -~<<lI-l NlG.w. .r -lJl~?(.lI.l k-ls.u:: ~wttS- ~WN/J"I,y" ~:lf-l\lIN1Cll.. WQ1lIJa6 ~- lU\I.w.;l'fo~ W<>fl'iAAl<.l-1el2- '$UIJ City of Aventura CB"'f1rrehe"siw Ph,. 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