Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part Two: Creating a graduate health education and biotechnology research initiative on the St. Elizabeths campus

Combined with creating an expanded community health and economic development program as outlined in the previous entry:

-- "Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part One: Rearticulating the system of health and wellness care East of the River"

and the follow up entries:

-- (this one) Part Two: Creating a graduate health and biotechnology research initiative on the St. Elizabeths campus
-- Part three: the potential for donations around an expanded program

the construction of a new United Medical Center hospital should be paired with the creation of a biotechnology, health, and science education and research development program on the adjacent St. Elizabeths East Campus

The city has been trying to develop that campus for the past decade, mostly unsuccessfully.

Speculative proposal for a biotechnology, science and medical education and research program at Walter Reed.  A few years ago I fell in with some people who tried to get the city to reconsider its pretty simplistic approach to the redevelopment program for the old Walter Reed medical campus in Northwest DC.

Instead of tearing down the hospital--at 2.1 million square feet it epitomizes Jane Jacobs' recommendation that city's retain a large stock of old buildings to seed innovation--we called for keeping it and using it as the foundation of creating new medical and health education programs like new medical, pharmacy, and dental schools, among others, and biotechnology and science development programs.

The aim was leverage proximity to the biotechnology sector in Montgomery County, including the National Institutes of Health, hundreds of private sector businesses, the FDA, United Therapeutics which is based in Silver Spring, and health and biotechnology education programs at DC's various universities.

In doing the research for the proposal, I was surprised to find a report out of the University of Baltimore which stated that 40% of the jobs in biotech were held by people with high school, associates, and bachelor degrees.  So there was a great opportunity for workforce development as part of the proposed program.

The proposal also included a multifaceted arts center of a couple hundred thousand square feet (modeled after GoggleWorks in Reading, PA; Cablefactory in Helsinki, La Friche in Marseilles, etc.) a big maker space with analogue and digital equipment, a nonprofit organization incubator and other initiatives.

But for various reasons, this proposal did not move forward.

The city had already committed to the retail and residential program it has, and the people leading the effort for changing the approach didn't have a lot of credibility, although I wrote a killer proposal, which included a justification for how the city could justify shifting to a different path and "changing its mind."

If we had been able to obtain the Letter of Intent that we needed from a particular medical school to commit to moving the proposal forward we probably could have shifted the discussion, especially because that LOI would have meant that the local university we were working with would have gone forward on the project as a partner. Instead they moved on to other projects, including building a new science building on their campus.

The proposal died.

Still, it's a great model of a program that could be implemented for the St. E campus in combination with the creation of a new UMC, which already has a variety of allied health professions teaching at the hospital currently, in association with UDC.

Note that as one example, the University of Texas Southwestern Medical Center, today comprised of a medical school, school of biosciences, and school of allied health professions, grew out of old military barracks buildings adjacent to Parkland Hospital in Dallas. Today the center boasts Nobel Prize winners, over 3,600 faculty and 7,000+ other workers, educating more than 3,000 students, residents, and postgraduate fellows, on an annual budget of more than $1 billion.

Urban research parks and cross-university collaborations. Some universities work to strengthen the commercialization of their scientific research through the creation of allied and adjacent science parks, where units of the institution commingle with firms and nonprofit institutes. Examples include the University Park science-research park at MIT in Cambridge, Massachusetts and the biotechnology park in East Baltimore, spearheaded by Johns Hopkins University and Hospital System.

In Greensboro, North Carolina, North Carolina A&T and the local campus of the University of North Carolina have jointly developed the Joint School of Nanoscience and Nanoengineering, which anchors an affiliated science park.

Large scale urban research districts with multiple anchors. Complementing the existence of university and medical campuses, some communities have developed large scale collaborative research and practice districts with multiple anchors, such as the University Circle District in Cleveland, anchored by the Cleveland Clinic and Case Western Reserve University and the Texas Medical Center in Houston. TMC, branding itself as a “leader in collaborative medicine,” is home to 54 health-related institutions including hospitals, multiple medical and nursing schools, research institutes, and other academic programs.

Other cities are working to create their own knowledge districts by developing new collaborative efforts with the participation of multiple academic partners at the outset.

Examples include the University District in Spokane, Washington, where five universities and the community college system are developing a 50-acre higher education and medical district adjacent to the city’s Downtown on the waterfront ("Campus evolution: WSU kicks Spokane development into high gear," Spokane Spokesman-Review), and the aforementioned Cornell University and Technion Institute project in NYC

In Cambridge, Massachusetts, a similar district has developed around Kendall Square ("Alexandria Real Estate’s empire grows in Kendall Square: The area’s life sciences boom puts the developer on top," Boston Globe) involving private entities, MIT, and Harvard.

Other examples include the Phoenix Biomedical Campus and the Mars Discovery District in Toronto.

Health-centered redevelopment programs at Brooks City Base and March Air Force Base.  DC has had a hard time making much headway on redeveloping the St. Elizabeths Campus. 

As mentioned, unlike other communities aiming to redevelop old military facilities around business, technology, and science uses to stoke economic and jobs development, the Walter Reed development will focus on residential and retail with far fewer jobs than the 8,000 that were there when the campus was a medical facility. 

(Although separately Children's Hospital was able to carve out a portion of the campus, which they will use for medical research--that space would have been ideal for the development of a medical education campus.)

While researching, I learned about a couple of other initiatives that were similar to what we proposed but weren't referenced during the planning phase for WR.

At the redeveloping Brooks Air Force Base in San Antonio, the University of the Incarnate Word has created a medical school using the old base hospital as a foundation, and the new school complements the university's programs in pharmacy, optometry, nursing and allied health professions, and physical therapy.

In Riverside County, California, the redevelopment of the March Air Force Base includes the creation of the March Life Care Campus on 236 acres of the base.

When completed and anchored by a 150-bed hospital focused on mental health care, the redevelopment will include emergency care, continuing care, assisted living residences and skilled nursing facilities, research and medical office buildings, retail and restaurants, child care and fitness facilities, a performance space and a hotel. The campus will support 7,200 full-time health care related jobs.

Personalized medicine research initiative in Northern Virginia. The INOVA Hospital System, the dominant hospital group in Northern Virginia, is building a wide-ranging research, education, and clinical treatment program focused on personalized medicine based on genomic analysis and related breakthroughs, on a 117-acre campus in Fairfax County (which formerly housed Exxon-Mobil operations) with 1.2 million s.f. which they purchased for $180 million. The first new project will be the construction of the INOVA Cancer Center, which will cost $200 million for an 180,000 s.f. facility.

The initiative includes an agreement with the University of Virginia to create a new medical school as part of the program.

-- "Behind Inova's $100 million venture fund plan to invest in the region," Washington Business Journal
-- "Personalized medicine could mean big business to DC area companies," Washington Post
-- "Inova lures U-Va. to Northern Virginia with $112 research center," Washington Post

The creation of new medical schools.  While it seems like there are already too many doctors the reality is that there aren't enough primary care physicians.  As a result, new medical schools continue to be created.  Over the past few years,  new medical schools have opened in New Jersey, New York, Florida, California, Missouri, and elsewhere, including the Texas example of UIW.

An advantage of being new is the ability to introduce new curricula and methods.  For example at some of the new medical schools, students immediately go through EMT training ("Trial-by-Fire: Training New Medical School Students as EMTs," Time Magazine) as a way to bring them into contact with patients at the outset of their education and training.

Of course, existing medical schools tend to expand and their impact grows over time ("UB Medical School opens with aim to be 'catalyst for change'," Buffalo News).

Other higher education health programs.  Pharmacy, bioscience and biotechnology, allied health professions, nursing, and other programs could be developed as part of the program. This could involve relocating and/or expanding existing programs and creating new programs and facilities.

Union Square Campus, Greensboro.

In Greensboro, building from the collaboration between NC A&T and UNC, the Union Square initiative downtown is leveraging the city's many institutions of higher education and has developed a new center for local nursing workforce training and academic programs, including the launch of a new doctoral degree granting program, with the major hospital system as the primary healthcare industry partner, in a consolidated facility that opened in 2016 ("A center for nursing: Union Square Campus opens," Winston-Salem Journal).

The next phase of the Union Square Campus development is moving into cyber-security and product design ("Next phase for Union Square Campus: cybersecurity; product design," Greensboro News & Record)

Workforce development.  The University of the District of Columbia has a nursing school and already offers health professions workforce development curricula in classroom facilities at the existing United Medical Center.

Bioscience high school. The bio/technology program could also be extended to the DC Public School system through the repositioning of at least one of the high schools located East of the River as a bio/technology oriented magnet high school, through the development of joint educational programs, comparable to programs developed at the Research Triangle High School in North Carolina, the Biotechnology High School in New Jersey, and the Phoenix Union Bioscience High School, etc.

Other programs.  The Citizen Science Lab in Pittsburgh, a lab facility open to "unaffiliated" citizen scientists would be an interesting component to add ("The Promise of Community Citizen Science," Rand Institute).  The library and information sciences program for the schools and hospital could be developed in a manner also open to the general public (e.g., the San Jose State University Library is combined with the City of San Jose's Central Library).

Shared BioLab Space/Urban Bioscience initiative. In New York City various life sciences and biotechnology development initiatives include a 50,000-square-foot biotech co-working center, created by the NYU Langone Medical Center in conjunction with national shared lab-space provider BioLabs on the space. According to a press release, at the facility:

BioLabs has hosted a seminar series for the startup community, leveraging the vast knowledge of its sponsor and partner network. Topics to date have included CRISPR technology, clinical trials, IPO, licensing, biologics, and VC funding. Pharmaceutical sponsors offer regularly scheduled office hours on site with employees from various department functions to provide in-person access to BioLabs residents and other invited guests.

The City of New York's LifeSci NYC initiative will contribute $5 million to the center.  Separately, the city's Economic Development Corporation has released an RFP to create a life-sciences hub and is offering up to $100 million in land, funding, and other incentives.

Recommendations

In addition to the broader community health and community economic development program suggested for the hospital project, as outlined in the previous entry, "Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part One: Rearticulating the system of health and wellness care East of the River," this entry calls for the development of a biotechnology and health science education, research and business development initiative, adjacent to and part of the planning process for the development of a new United Medical Center hospital on the St. Elizabeths campus in Congress Heights.

1. Create a companion biotechnology and science development initiative.  Create a coordinating organization.  (One model is the Center for Innovative Technology in Northern Virginia.  Biotechnology programs in Phoenix and Greater Kansas City are others.  Consider building a wet lab building as a way to seed the program, to serve as an incubator for developing businesses.

2. Develop a graduate health education campus adjacent to the new United Medical Center, with medical, pharmacy, and allied health professional programs.  Get a letter of intent to create a medical school with a successful existing organization, such as the Royal College of Surgeons, Dublin, which has opened medical schools outside of Ireland.  Leverage this anchor to seed the development, expansion, and relocation of other health-related academic programs on site.

Another model is the RFP issued by New York City which resulted in the creation of the science and technology program on Roosevelt Island as a collaboration of Cornell University and the Technion Institute of Israel ("High tech and high design, Cornell's Roosevelt Island campus opens," New York Times).

3. Land anchor companies.  Area firms like Sucampo Pharmaceuticals and United Therapeutics ("United Therapeutics Corp. buys two D.C. buildings," Washington Business Journal) should be brought on board as early entry anchors.  UT, based in Silver Spring, has bought some buildings located in DC, and may have some interest in locating some operations in the city.

4. Create a bioscience high school program and companion workforce development programs.

Benefits

Creating an economic development position for the St. Elizabeths campus.  The value of creating a viable economic development program for the St. Elizabeths program is significant, and will contribute both to the economic improvement of the East of the River section of the city as well as the city more generally, in terms of broadening the local economy beyond its dependence on federal government related activity.

Lowering community health and human services costs.  DC spends a few billion dollars each year on health and human services functions.  Creating and delivering a broader community health program and generating more positive health outcomes will have economic benefits to the city in terms of long term reduction in health care costs, while citizens will personally benefit from improved health outcomes. 

Increasing the likelihood of success for the United Medical Center by developing a broad range, innovative, transformational program.  Like Prince George's Hospital, United Medical Center has had negative economic ("DC CFO says United Medical Center is 'functionally bankrupt': 6 things to know," Becker Hospital Review) and health care outcome issues for a number of years. 

Sometimes this has been a function of management, but often it is a result of providing care to an impoverished population that tends to be sicker than average as a result of poverty, often without health insurance.

By adding a broader community health and biomedical research and education program to the new hospital, it becomes more likely that the hospital will be successful and a positive choice for potential patients rather than a choice of last resort.  This makes it more likely it could support the reinstitution of obstetrics programs ("Dangerous mistakes led to shutdown of United Medical Center obstetrics ward," Washington Post) and other higher volume, higher revenue services.

Positive economic impacts. 

Hospital.  For the purposes of this proposal, it is not unreasonable to extrapolate figures based on other economic impact studies and data produced for similar projects.  A hospital of the size proposed (104 in-patient beds) has on average 622 full-time employees and 263 part-time employees. 

According to the American Hospital Association:

each hospital job supports about two more jobs and every dollar spent by a hospital supports roughly $2.30 of additional business activity.

Although this would be a replacement hospital and without the creation of a broader program such as suggested in these blog entries, outside of construction, additional economic impact wouldn't be expected to occur.

Retail program.  The retail program outlined in the previous entry would also have positive economic impact.  A community pharmacy could be included as part of the retail offer, and could be part of the teaching program for the proposed pharmacy school.  Etc.

Biotechnology and science sector.  The science-education program is a different story.  For example, the study commissioned for the New York City Cornell-Technion project projects that 600 companies and 30,000 jobs will be created, with a $23 billion economic impact over 30 years, generating $1.4 billion in tax revenues over that time frame.

While it is hard to track down exact numbers for the economic impact of Montgomery County’s biotech industry beyond the economic impact of federal research facilities, there are 10,000 scientists working at over 300 firms. The NYC study looked at all jobs, while the data reported in Montgomery are only for workers with advanced degrees, understating actual employment.

Another way is to consider the economic experience of particular companies as a way to consider the possibilities that arise from the addition of new firms active in the local economy. For example, United Therapeutics in Silver Spring is a growing company, adding buildings and employees, with $1.33 billion in annual revenue and a market capitalization of more than $8 billion. They pay about $140 million in federal and state income taxes, as well as property taxes to local jurisdictions.

The founders of Sucampo Pharmaceuticals chose to locate in the DC area because of proximity to NIH, FDA, and the US Patent and Trademark Office (in Alexandria). The company, now located in Rockville, has 80 employees, 650 patents, about $120 million in annual revenue, and was recently acquired for more than $1 billion ("Sucampo Pharmacueuticals has officially sold for $1.2 billion to U.K. company," Washington Business Journal).  Although it is not clear if the firm will be absorbed into acquiring firm, in facilities outside of the DC area.

Economic impact of medical and health graduate schools.  Another datum is the economic impact of new medical schools. The economic impact of the new medical school at University of California-Riverside is projected to be $150 million per year when the program is fully operational in 2021. A study for the new medical school at Florida State University in Tallahassee states that $2.50 is generated for each dollar invested, while a similar study for the University of Central Florida in Orlando found that $13 was generated for each dollar of investment.

However, the average economic impact of a mature medical school affiliated with a university is $1.7 billion, based on an annual research program conducted for the American Association of Medical Colleges. But the economic impact for a new medical school when there are existing schools is estimated to be less, $882 million.

Other economic impact data can be calculated for the development of related programs in pharmacy, allied health professions, nursing, etc.  For example a study on the University of Tennessee College of Pharmacy found an annual economic impact of more than $50 million, with the support of over 600 jobs, and an ROI of almost $30 per state dollar invested in the school.