EGERMAN LAW GROUP, LLP
MARK EGERMAN TELEPHONE
[email protected] 280 South Beverly Drive (310) 248-6299 LEE EGERMAN Suite 304 FACSIMILE
[email protected]
Beverly Hills, California 90212 (310) 248-6288
September 9, 2022
Via Email
Mayor Lili Bosse
Vice Mayor Julian A. Gold, M.D.
Council Member Les Friedman
Council Member Sharona Nazarian
Council Member John Mirisch
Re: Ordinance of the City of Beverly Hills to Amend Beverly Hills Municipal Code Sections Related to Medical Use Regulations Applicable to Certain Commercial Zones in the City
Hearing Date September 12, 2022
Dear Mayor Bosse, Vice Mayor Gold and Council Members Friedman, Nazarian and Mirisch:
I am writing you on behalf of my client Medical Buildings of America, LLC which owns the two medical buildings located at 9735 Wilshire Boulevard and 462 North Linden Drive, Beverly Hills, California. The principal of my client is a resident of the City of Beverly Hills as well as Manager of the limited liability company that owns both buildings. He has asked that I relate to the Council concerns regarding the proposed ordinance of the City of Beverly Hills to amend the Beverly Hills Municipal Code related to medical use applicable to commercial zones in the City, item E 1 on the Council agenda for September 12, 2022.
On November 19, 2009, the City Staff issued a report (the "2009 Report" regarding how medical office use impacts the long-term goals and policies for land use in the City. A copy of the Report is attached to this letter as Exhibit A for your reference.
As stated in the 2009 Report, "only 8.9% of Beverly Hills land area (248 acres) is comprised of commercial uses. Since the commercial area of Beverly Hills is so limited, the City historically has been more vigilant in regulating commercial land uses." 2009 Report, page 4. The 2009 Report further stated that medical office use was the third largest commercial use in the City occupying 1,270,000 square feet. Medical office use occupied 21% or more than one-fifth of all of the office space in Beverly Hills." 2009 Report, pages 4-5.
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September 9, 2022
The 2009 Report pointed out that the conversion of office space into medical offices presented two distinct problems with regard to fostering a successful mix of uses. Such conversion is contrary to maintaining the City's vision for a pedestrian friendly commercial area with an "area with a mix of shops, restaurants, and offices; and providing opportunities for economic development including attracting priority businesses such as entertainment and high-end retail businesses." 2009 Report, page
5. The 2009 Report goes on to state: "the proliferation of medical offices reduces the office space available to 'priority business' discussed in the 2008 economic sustainability report and identified in General Plan Update Policy LU 15.2 as 'entertainment related Class A offices, high-end retail and fashion, restaurant, hotel, technology and supporting uses." 2009 Report, page 6. The 2009 Report also found that medical office use displaced general office and retail uses causing parking demands and vehicle trips to increase. 2009 Report, page 8.
The 2009 Report also clearly set forth that medical office use does not promote economic sustainability or viability for our City. One of the significant differences between the tax revenue generated by most business and the tax revenue generated by medical offices is the fact that the business license fee for medical offices is based on the number of employees, while most other business are taxed on their gross revenues and generate substantially higher revenues for the City. 2009 Report, pages 8 and 9.
The 2009 Report also establishes that "Beverly Hills appears to have more than enough physicians to care for the needs of the City and these physicians are also providing for the needs of people in the wider Los Angeles County area." 2009 Report, pages 11-12.
In response to the findings set forth in the 2009 Report and various economic studies, the City passed various ordinances limiting the unchecked expansion of medical offices and requiring increased parking for medical uses to mitigate the detrimental economic, traffic, and parking impacts of medical office use.
As a direct result of the Covid-19 pandemic, the City Council passed (and extended multiple times) Urgency Ordinance No. 20-0-2826 (a copy of which is attached to the Agenda Report). This Ordinance allowed a modest expansion of medical uses in buildings that already had medical offices of up to 6,000 square feet and medical use in new buildings if the applicant can show that the space was leased to a medical tenant at the time of application for a building permit. page 3
September 9, 2022
The current proposed ordinance reduces the parking requirements for medical offices to the general commercial standard of one space for each 350 square feet, rather than the existing medical office space standard of one space for each 200 square feet. Of greater concern, however, is that the proposed Ordinance would permit unlimited conversion of general office space (except ground floor space) into medical space (Section 5F of the Ordinance). Literally, the proposed Ordinance would allow the cannibalization of the commercially zoned areas of our City replacing general office use with medical offices.
The proposed Ordinance is directly contrary to the City's multiple studies on economic sustainability, traffic, and parking showing that medical use undercuts the economic sustainability of the City, causes substantial increases in traffic, and disproportionately uses the City's public parking facilities.
The proposed Ordinance is also in direct conflict with the City's General Plan, including but not limited to the Economic Sustainability and Land Use sections. ES 1 states in part:
"ES 1 Sustainable Economic Base. A fiscally sustainable base to maintain the level of service currently provided to residents, recognizing the City is highly dependent upon the symbiosis between a vibrant business community and the residential quality of life, which is the one of the City's defining characteristics, and which this General Plan aims to protect and enhance. It is the intent of these goals and policies to insure the City's continued financial health in a manner that is consistent with the goals and policies set forth in the Land use Element (LU), including but not limited to Community Character and Quality (LU 2).
ES 1.1 Fiscal Prudence. The first key to economic sustainability is the efficient use of resources by an effective and streamlined local government with the ongoing mission of providing the residents and community with superb value for money.
ES 1.2 Economic Sustainability Plan. Develop a plan to nurture a resilient business community and stable economic base to ensure that the City is able to maintain a high level of service for its residents. (Imp. 5.2) ES 1.3 Tax Base. Consistent with future economic sustainability plans, identify opportunities to enable the expansion of the City's tax base. (Imp. 5.2) page 4
September 9, 2022
ES 1.4 Retain Existing Industries. Consistent with future economic sustainability plans, encourage existing industries such as luxury retail, tourism, hoteling, finance, entertainment and media businesses and services to remain and expand within the City. (Imp. 5.2)" (Emphasis added).
The City's General Plan LU 15 states in part:
"LU 15 Economic Sustainability. Vital and successful businesses that contribute to the City's identity and culture, provide high-paying jobs, and contribute revenue that sustains the level and quality of services in the City.
LU 15.1 Economic Vitality and Business Revenue. Sustain a vigorous economy by supporting businesses that contribute revenue, quality services and high-paying jobs. (Imp. 5.2)
LU 15.2 Priority Businesses. Retain and build upon the key business sectors contributing to the City's identity, economy, and revenue for resident services, such as entertainment-related Class-A offices, high end retail and fashion, restaurant, hotel, technology, and supporting uses. (Imp. 52)" (Emphasis added).
"The proliferation of medical offices reduces the office space available to 'priority businesses, discussed in the 2008 Economic Sustainability Report and identified in General Plan Update policy LU 15.2 as 'entertainment-related Class A offices, high-end retail and fashion, restaurant, hotel, technology and supporting uses." 2009 Report, page 6.
The proposed Ordinance reverses nearly two decades of City planning that limits the growth of medical office use. It should either be (1) rejected outright or (2) delayed for further study to include, at the least, appropriate mitigation measures to address its highly negative impacts on the City's economic sustainability, traffic, and parking for the following reasons:
Under CEQA an environmental impact report is required because the proposed Ordinance reverses nearly two decades of City policy, will have a substantial impact on the economic sustainability of the City, will have adverse traffic impacts, will have adverse parking impacts, and requires an amendment to the General Plan, including but not limited to ES 1 and LU 15.
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September 9, 2022
2. Before considering the proposed Ordinance the City needs economic studies to determine the level of negative economic impacts which will occur to the City's economic sustainability efforts.
Before considering the proposed Ordinance the City needs traffic studies to determine the level of negative traffic impacts which will occur.
Before considering the proposed Ordinance the City needs parking studies to determine the level of negative parking impacts which will occur.
Before considering the proposed Ordinance the City needs to determine whether it is wise or appropriate to promote mixed use buildings containing general office and medical office use. See 2009 Report, page
6. Before considering the proposed Ordinance the City needs to determine the synergy, or lack thereof, between medical office use and the other businesses in our City such as hotels, stores, and restaurants.
Before considering the proposed Ordinance the City needs to determine if the proposed Ordinance will cause an increased burden on our fire department.
Before considering the proposed Ordinance the City needs to determine the potential negative impacts if the proposed Ordinance is applied to the Golden Business Triangle, potentially converting it into one massive conglomerate of medical offices.
For the foregoing reasons, it is respectfully requested that the Council not adopt the proposed Ordinance and, at the least, that the matter be continued to allow time for the Council to obtain adequate studies to determine the true negative impacts of the proposed Ordinance and any potential mitigation measures.
Very truly yours,
Tack Egerpa
MARK EGERMAN
ME/jI
enclosure
Exhibit "A"
(BEVERLY)
HILLS
STAFF REPORT
CITY OF BEVERLY HILLS
For the Planning Commission
Meeting of November 19, 2009
TO: The Planning Commission
FROM: Michele McGrath, Senior Planner
SUBJECT: Consideration of Changes to Medical Land Use Policy that Limits or Prohibits New or Expanded Medical Uses in the City.
EXECUTIVE SUMMARY
On July 21, 2009, the City Council directed staff to prepare an ordinance that limits medical land uses in the City. In the course of its review, the Planning Commission was directed to study ditterent approaches to achieve this goal. This report provides background intorma- fion on the subject, describes alternative approaches to regulate medical uses and seeks Planning Commission direction.
BACKGROUND
Concern about the impacts of medical uses in the City dates back to the late 1980s when Beverly Hills, like a number of other cities, recognized medical uses generate greater traffic and parking demand than other office uses. In 1989, the City increased the parking requirement tor medical office use from one parking space for each 350 square feet (the requirement for office spaces), to one parking space for each 200 square feet for medical office space. Existing medical office buildings were "grandfathered in" at the 1:350 parking rate and became legally nonconforming buildings with regard to parking. Shortly after the adoption of the ordinance, it was modified to exempt a few projects that had been in the pipeline.
The economic downturn in the early 1990s resulted in a high level of office vacancies and ordinance. In July 1993, the City Council adopted an ordinance allowing existing property Staff Report
Regulation of Medical Uses
For the Planning Commission Meeting of November 19, 2009 owners to meet the 1:200 parking requirement for medical offices by restriping parking areas and providing free, validated parking. No discretionary approvals were required.
Medical uses continued to increase and concerns were raised by the City Council and the Planning Commission that medical uses require more parking, create more traffic, and generate less revenue than retail and other types of commercial businesses. In July, 2005, the Planning Commission began to review medical office uses in the City in two study phases. Phase I included recommendation of the following two ordinance amendments that became effective December 2003:
a) Transitional Use Ordinance: limit hours of operation for medical uses in commercial areas that abut residential zones;
b) Eliminate the provision that allows the restriping of parking areas and the use of tandem and compact parking spaces for medical uses that could not other- wise meet the 1:200 parking requirement.
In Fall of 2005, the Planning Commission initiated discussion of Phase I to review how medical office uses impact long-term goals and policies for land use in the City.
In January 2006, the Planning Commission proposed the following range of recommenda- tions to address the proliferation of medical offices in the City:
• To address potential loss of revenue to the City, consider a review of business license taxes and fees for medical uses to determine whether or not these rates should be consistent with other professional office categories and/or rates for surrounding (or other comparable) cities.
• To address longer term impacts including parking, traffic, and a healthy mix of uses, one (or a combination of more than one of the following options are proposed:
a) Limit new medical office uses in the City to specific geographic areas.
Place a cap on the total number or square footage of medical uses permitted in the City.
Require a conditional use permit for all new medical uses.
Subsequent to the January 2006, Planning Commission meeting, the City Council and Planning Commission priorities shifted and the medical office use discussion was deterred.
In response to concern about a perceived increase in applications for medical offices, a General Plan Ad Hoc Committee meeting consisting of Mayor Nancy Krasne, Council Member John Mirisch, Planning Commission Chair Nanette Cole and Vice Chair Lili Bosse - 2-
Staff Report
Regulation of Medical Uses
For the Planning Commission Meeting of November 19, 2009 met on June 24, 2009 to discuss medical office policies in the City. As a result of the Committee's recommendation, the City Council reviewed the issue in July 2009. An urgency ordinance prohibiting medical uses was presented to the City Council but did not receive the 4/5 vote needed to pass the ordinance. Instead, the City Council directed the preparation of an ordinance that would prohibit medical uses with consideration of exemptions for existing buildings that provide adequate on-site parking. The City Council discussed other related matters explored further in this report, including:
• Whether to prohibit ground floor medical office space on Wilshire Boulevard • Evaluate the appropriate mix of medical office, general office and retail uses in the city
• Understand the appropriate number of medical offices/doctors to meet the City's needs
• Possible fiscal ramifications of medical use regulations • Limiting medical land uses on geographic basis
• Impacts of medical uses on other land uses, including ability to foster more nightlife opportunities.
DISCUSSION
Concerns have been raised by the City Council and the Planning Commission about the conversion of office and commercial space in the City to medical offices. Medical office uses may have impacts that generally fall into the following categories: land use impacts, traffic and parking impacts, and economic sustainability impacts. In addition, staff reviewed mpacts of medical uses on the City's emergency response services, Code entorcemen formation related to medical office uses, and standards for resident access to physicians t determine if the City is well-served by medical offices.
Land Use Impacts
The term "medical office" has come to encompass a variety of uses from traditional doctor's offices to surgery centers as health care has evolved. Despite these changes in health care, definitions of medical use appear to be consistent among most cities with three categories generally used: medical office, hospitals/long-term stay facilities and medical laboratories.
In an attempt to make distinctions among different medical office uses, it has been pointed out in past discussions of medical uses in the City that surgery centers may have lower - 3-
Staff Report
Regulation of Medical Uses
For the Planning Commission Meeting of November 19, 2009 parking requirements and higher revenues than traditional medical offices. It can be difficult to distinguish among different types of medical uses and the similarities among medical office uses such as operation on a tight appointment schedule, demonstrated traffic and parking impacts, and the need for special tenant improvements may speak to why cities have not further defined medical uses. Staff would recommend reviewing medical office uses as a class and not attempting to further define this use in regulations.
Most cities allow medical office uses in the same locations and under the same development standards as other office uses except for the parking requirements which are usually more stringent for medical uses. The City of Beverly Hills Zoning Code already prohibits hospitals and staff has found no examples of other cities prohibiting hospitals or of cities prohibiting medical office uses. While staff has not found examples of prohibitions on medical uses, there are many examples of cities prohibiting or limiting uses. Cities prohibit and restrict different uses in different areas depending on a city's goals. The City of Beverly Hills prohibits hospitals and stables, requires a Conditional Use Permit tor amusements parks, breweries, drive-in facilities, hotels and museums, and restricts financial establishments and medical uses in identified pedestrian areas.
Mix of Land Uses
There are no specific guidelines that define a "healthy" mix of uses in a city or in commercial General Plan Update Technical Background Report (October, 2005), only 8.9 percent of Beverly Hills' land area (248.8 acres) is comprised of commercial uses. Since the commer- cial area in Beverly Hills is so limited, the City historically has been more vigilant in regulating commercial land uses. The following chart gives a general estimate of major commercial uses in the City.
LUSE SQUARE FOOTAGE
Auto Dealer/Supplies 257,000
Eating & Drinking Establishments 495,000
Financial/Real Estate Institutions 600,000
Retail (Apparel, merchandise and other) 1,140,000
Medical Office 1,270,000
Hotel/Motel 1,862,000
- 4-
Staff Report
For lai land Mediml Wision Meling of November 19,2009
General Office 6,147,000
was used. For General orice, data was obained from he 0s Angles Busines Journal" dated April 25, 2005 per a survey performed by Grubb & Ellis.
Medical use comprises 21%, or more than one filth of the office space in Beverly Hills.
According to the 2008 Economic Sustainability Background Report prepared for the City, the health care sector is the City's second largest industry.
The conversion of office space to medical uses presents two concerns with regard to fostering a successful mix of uses: maintaining the City's vision for a pedestrian-triendly, commercia area with a mix of shops, restaurants and offices; and, providing opportunities for economic development including attracting priority businesses such as entertainment and high-end retail businesses
Pedestrian-Friendly Mix
While there is some anecdotal evidence regarding the relative contributions of various types of uses to creating a successful urban experience, staff has found little independent empirical information examining the relationship between medical uses and other uses in an urban environment. The City has commissioned studies of the local economy in the past and these studies do not capture the activities of medical visitors nor the more intangible benefits from the interaction of various uses, often referred to as "synergies." Synergy might refer to hotel patrons frequenting local restaurants or office workers shopping in local stores. Such information is usually only available through studies tailored to specific markets. The City commissioned a limited study in 2007 of Beverly Hills parking structure users. The draft report shows that a majority of medical office patrons who use the City parking structures do not live in Beverly Hills, usually arrive alone, and patronize retail or tood establishments on a limited basis as part of their medical office visit. Patronage of retail stores by medical office users appears to be at about the same level as other professional (legal/financial) office clients and as employees in the area. Employees patronize food establishments at a higher rate than medical or professional office clients. Public parking garage users who identified the following as the main purpose of their visit to Beverly Hills: eat or have a drink out, shop or browse, personal business errand, visit with friends, or sightseeing, had a much higher rate of combining other activities such as shopping with the original purpose of their trip.
The City has, in the past, approved restriction of medical office uses, along with financial, real estate and other professional uses (lawyers, accountants) on the ground floor in the - 5-
Staff Report
Regulation of Medical Uses
For the Planning Commission Meeting of November 19, 2009 City's designated pedestrian-oriented areas. As stated in the City/s Zoning Code, these uses were restricted because:
"it is necessary to restrict the uses within these areas in order to preserve the urban village atmosphere and promote pedestrian friendly development. The City Council further finds that it is necessary and desirable to protect the public health, safety and general welfare to prevent the commercial spaces in these areas from being dominated by nonretail uses in order to preserve the city's retail tax base and ensure the city's continued ability to provide essential ser- vices to its residents." (ВНМС 10-3-1651, 2002).
Economic Development
The proliferation of medical offices reduces the office space available to "priority business" es," discussed in the 2008 Economic Sustainability Report and identified in General Plan Update policy LU 15.2 as "entertainment-related Class A offices, high-end retail and investment than other types of commercial uses, resulting in medical offices remaining medical offices for decades. This stability is often cited as a benefit but could be an issue if residents, attract customers from the region and provide a quality experience for national and international tourists" (LU 9.1). A preponderance of medical office could diminish the attractive diversity that has drawn key businesses and visitors to the City, maintaining the City's strong economic base.
Traffic and Parking
With the exception of restaurants, the parking requirement for commercial uses pursuant to the Beverly Hills Municipal Code (BHMC) is higher for medical uses (5 spaces per 1,000 s.f. or 1:200) than for other commercial uses such as office and retail (2.85 spaces per 1,000 s.f. or 1:350). While the Code requirements attempt to address the parking demand for various uses, it cannot be exact because the actual parking demand and trip generation figures are variable based upon times of day and demand for the specific use.
Most cities require parking at a rate of 1:350 or 1:200 or a combination of the two. Below is a sample of the medical parking requirements for the cities adjacent to Beverly Hills. - 6-
Staff Report
Regulation of Medical Uses
For the Planning Commission Meeting of November 19, 2009 Beverly Hills Medical Offices - Ispace per 200
square feet
West Hollywood Medical services: Clinics, offices, labs, and other outpatient facilities of 1,200
1. ft. or less, tenant space existing pri
• May 2, 2001 - 3.5 spaces per 1,00
sq. Ht.
All Others: 5 spaces per 1,000
Culver City Vedical/dental offices, clinics and labs
space per 350 square fee
Los Angeles
The following chart provides a comparison of the trip generation and parking factors tor a sample of general commercial uses as compiled in the Institute of Transportation Engineers (ITE) Manual, considered the most authoritative general resource on the subject.
Use Trip Generation Parking Demand BHMC
(per 1,000 sq.ft.) (per 1,000 sq.ft.) Require-
ment (per
AM Peak PM Peak Daily Average Peak Demand 1,000 s.f.)
Medical-Dental 2.48 3.72 36.13 3.53 5
Office
General Office 1.55 1.49 11.01 2.40 2.85
Shopping 1.03 3.75 42.94 3.02
Center Retail (4.74 at Peak: Saturdays. in- 2.85
December)
Specialty Retail not open 2.71 44.32 | not available 2.85 Source: ITE Trip Generation Manual (7th Edition) and ITE Parking Generation Manual (3rd Edition) - 7.
Staff Report
Regulation of Medical Uses
For the Planning Commission Meeting of November 19, 2009 The chart above demonstrates that the parking demand for medical uses is greater than the demand for general office and retail uses. Trip generation during morning peak hours is also much higher for medical offices than for general office or retail uses. The afternoon peak for medical is more than double that of general office, and virtually the same as retail.
A 2007 study of Beverly Hills public parking structure users found that medical patrons park for a shorter period of time (1.8 hours) than a majority of users (2-4 hours) which is consistent with greater traffic generation from medical use. As medical offices displace general office and retail uses, parking demands and vehicle trips increase and the impacts from the proliferation of medical uses become more widespread.
Economic Sustainability Major Tax Revenue per Building Square Foot, 2006 Revenue received by cities is now based
more on how land is used and developed Offices $ $2.22
rather than on property taxes. According to Medical Offices 1 $2.09 the 2008 Economic Sustainability Report
Service $4.22
prepared for the City of Beverly Hills,
Car dealerships $38.20
Commercial land generated more than five
times the revenue of an average acre of Retail $11.36
land in the City. General offices and $46.73
Hotels
medical offices yielded the lowest revenue
per square foot of all commercial uses. $0 $20 $40 $60
Revenue from medical offices ranked Source: Beverly Hills Economic Sustainability Background Report second behind commercial leasing as a top generator of business taxes for the City but this is due to the total size of the health care sector (905 establishments). The retail sector has fewer establishments (393 establishments) but yielded higher revenues. For another comparison, health care's 926 businesses contributed over $342 million (2006 payroll) but the City's 587 entertainment enterprises contributed over $836 million (2006, payroll). The graph above reflects revenues generated through property, sales, business, and transient occupancy (hotel) taxes.
Business Taxes: Medical Office vs. General Office
There is a significant difference between tax revenue generated for most businesses in the City and the business tax revenue generated for professional offices such as medical offices because most businesses are taxed on gross receipts while the medical and other protes- Beverly Hills Economic Sustainability Background Report, Muni Services/Burr Consulting, January 2008. - 8-
Staff Report
Regulation of Medical Uses
For the Planning Commission Meeting of November 19, 2009 sional offices are taxed on the number of employees. Medical office uses typically command higher rents than general office uses and therefore contribute more to property and lease taxes (business taxes) collected by the City. General office uses typically have a higher number of employees relative to floor area than medical office uses so general professional office uses generate more revenue to the City in the form of slightly higher business taxes per building square foot. In addition to fewer employees, the 2008 Economic Sustainability Background Report shows that pay in the health care sector is well under the City average due largely to low-skilled workers who pertorm basic service jobs. Since pay correlates to the level of employee expenditure in the City, health care sector employees contribute tewer dollars to the local economy.
According to economic studies, entertainment enterprises possess synergies with retail and hotel uses, which also contribute significant revenues to the City. Medical office appear to have limited synergy with the other commercial usest and may contribute less to pedestrian activity and character.
Parking Revenue
Over 25 years ago, the City implemented a "two hour free" parking program in City parking structures as an incentive to attract shoppers and diners to commercial districts. The goal was to increase sales tax revenue from restaurants and retail businesses. The City has experimented in the past with reducing the free public parking to one-hour. Today, a large number of the parking garage spaces on the west end of the Business Triangle in the North Bedford and North Camden public parking structures, as well as parking spaces on the east end of the Triangle in the two North Crescent Drive garages, are taken up by medical office users and commercial district employees rather than shoppers and restaurant clientele (11/7/2005 staff report to the City Council regarding public parking facility fees and 2007 parking structure users report). In response to this situation, the time limit for free parking in some of the public structures was reduced from two hours to one hour. Reducing the time limit for free parking in garages used mainly by medical office patrons and employees is one way to capture some of the revenue that would otherwise be generated by retail sales or office uses.
T Plastic surgery has some synergy with hotels, spa services, and beauty supplies, but other medical office uses interact more with drug stores, medical labs, and medical supplies. Source: Beverly Hills Economic Sustainability Background Report, Muni Services/Burr Consulting, January 2008. - 9 -
Staff Report
Regulation of Medical Uses
For the Planning Commission Meeting of November 19, 2009 Other Medical Office Use Issues
Emergency Response - Fire Department Services
As part of past review of ordinances related to medical offices including the ordinance allowing overnight stay at surgery centers, as well as review of medical office projects, staft has worked with the Fire Department to determine whether such uses result in additional services provided by the City's emergency response system. Past studies have found no significant impact on the City's emergency services from medical office uses.
Access to Medical Care
There does not appear to be a generally accepted standard for the number of physicians that is optimum for a community. The U.S. Department of Health and Human Services does designate Health Professional Shortage Areas (HPSAs) which are determined using the ratio of primary care doctors and dentists to population. A ratio of population to primary care physician of 3000 - 3,500 population to one doctor is considered low enough for possible designation as an HPSA. The medical literature emphasizes primary care as the backbone of the nation's health care system since primary care includes first contact care, continuity of care, comprehensive care and coordinated care. These activities are often associated with internal medicine (internists) or family practice doctors and can also be associated with general practice and pediatrics. The number of primary care physicians in a community is a better indicator of whether a community is well-served by medical services than the overall number of doctors. Reports in the medical literature show that an increase in primary care physician supply results in improved health care outcomes in the United Statest Organization for Economic Cooperation and Development (OECD) provides figures for the number of doctors per 1000 resident population in OECD countries including the United States (2.4 physicians per 1,000 or 1 physician for 416 people) but this includes all physicians and does not distinguish between physicians delivering primary care medicine and other specialists. Similarly, the U.S. Census publishes an abstract of the number of doctors per resident population by state (1 doctor for 382 people in California) but that list includes all doctors except doctors of osteopathy, federally employed doctors and doctors with unknown addresses.
To gain a better understanding as to whether Beverly Hills is well-served by medical offices, staff reviewed the number of internists and family practice doctors in the cities of Beverly Hills, West Hollywood and Culver City. The cities are all located in proximity to each other, have similar population totals and are in proximity to hospitals. Brotman Hospital (420 # Macinko J, Starfield B, ShiL. Quantifying the health benefits of primary care physician supply in the United states. Int J Health Serv. 2007; 37(1):111-26
- 10 -
Staff Report
Regulation of Medical Uses
For the Planning Commission Meeting of November 19, 2009 beds) is in Culver City and Beverly Hills and West Hollywood are both located near the Cedars-Sinai Medical Center (958 beds) which is in the City of Los Angeles. The table below shows the number of residents in each City per primary care doctor. # Internists # Family Total Primary Residents Per
City Total
Population Practice Doctors Care Doctors Primary Care
Doctor
35,983 144 241 185 195
Beverly Hills
21 181 197
West 35,716 160
Hollywood
40,500 23 115 38 1,065
Culver City
Information about the number of doctors was obtained from HealthGrades, considered a a it nice finend la, he cradion specive as
included in the 132 specialties tracked by HealthGrades are listed below.
Specialty Number of Doctors in
Beverly Hills
Cardiologist 38
Dermatologist 47
Orthopedic Surgeon 56
Plastic Surgeon 89
Psychiatrist
Using the number of doctors in Beverly Hills from the two primary physician categories and the five specialties above, yields a doctor to poulation ratio of one doctor for 75 residents.
This ratio does not capture all of the physicians in Beverly Hills and far surpasses any ratio of doctors to population that staff has found.
It is clear from these numbers and from information provided by real estate professionals and local doctors that the proximity of the cities of Beverly Hills and West Hollywood to the Cedars Sinai Medical Center is a major reason these cities have more doctors per capita than other cities. Beverly Hills appears to have more than enough physicians to care for the - 11-
Staff Report
Regulation of Medical Uses
For the Planning Commission Meeting of November 19, 2009 needs of the City and these physicians are also providing for needs of people in the wider Los Angeles County area.
medi Hice
In crafting an ordinance regulating new medical offices, the Planning Commission may consider a prohibition of new medical office uses and may also consider allowing medical offices with restrictions :
A. Limit new medical office uses in the City to specific geographic areas; B. Require discretionary review of new medical uses.
C. Place a cap on the total number or square footage of medical uses permitted in the City;
A. Limit new medical office uses in the City to specific geographic areas.
Medical uses are spread throughout the City's commercial areas with a concentration at the western end of the business triangle. The Planning Commission could determine that the City already has the maximum square footage of medical office use that is desirable and prohibit new medical office use in the City; alternatively, the Planning Commission could determine that new medical offices are appropriate in certain areas and not in others. The main areas that have been discussed by the City Council and Planning Commission as potentially inappropriate for additional medical use are the Business Triangle and Wilshire Boulevard.
These areas have been identified in economic studies as important locations for the "vital and successful businesses that contribute to the City's identity and culture, provide high- paying jobs and contribute revenue that sustains the level and quality of services in the City" (General Plan Update goal LU 15). General Plan Update policy LU 15.2 identifies such "Priority Businesses" as entertainment-related Class A offices, high-end retail and fashion, restaurant, hotel technology and supporting uses.
Additional commercial areas that could be considered for medical office restrictions include South Beverly Drive, the portion of Little Santa Monica Boulevard west of Wilshire, part of Olympic Boulevard, part of San Vicente Boulevard and La Cienega Boulevard. These commercial streets are located adjacent to residential zones. If medical office uses are prohibited in the Business Triangle and/or on Wilshire Boulevard, it would create pressure to locate medical offices in these other commercial areas, possibly creating a conflict with General Plan Update goals LU 10, "Economically Vital Districts" and LU 12, "Business Districts Adjoining Residential Neighborhoods." Goal LU 10 is focused on retaining existing businesses and attracting new ones as well as sustaining employment, well-paying jobs and - 12-
Staff Report
Regulation of Medical Uses
For the Planning Commission Meeting of November 19, 2009 extraordinary economic activity. A policy that promotes this goal is to promote the development of businesses that serve, are located in proximity to, and are accessible to adjoining residential neighborhoods such as grocery stores, dry cleaners and personal care businesses. Goal LU 12 is a "compatible relationship between commercial districts and corridors and adjoining residential neighborhoods assuring that the integrity, character, and quality of both commercial and residential areas are protected and public safety and quality of life are maintained." Additional medical offices along the City's residential-adjacent streets could have increased traffic and parking impacts and would not appear to be consistent with the General Plan Update goals and policies.
For an additional frame of reference to discuss limiting medical use by geographic area, the City, in 2003, adopted an overnight stay ordinance for surgical centers to allow patients to remain overnight (but not more than 24 hours). Commercial areas within 170 feet of single- tamily residential zones were excluded from applying for overnight stay permits. This was due to concerns about potential impacts of additional evening medical office activities on the nearby single family areas. The following are the blocks zoned for commercial uses that are within 170 feet of single-family areas:
• West side of Beverly Drive between Charleville and Olympic; • North side of Wilshire east of Crescent and west of Almont; • North and south sides of Wilshire east of Arnaz and west of La Cienega; and, • South side of Wilshire west of Robertson and east of Doheny.
It is noted that staff has found no negative impacts resulting from the overnight stay ordinance.
B. Require discretionary review of new medical uses.
Should the Planning Commission wish to allow medical offices with restrictions, the most appropriate discretionary process would be a Conditional Use Permit (CUP) for future medical uses. Although this process would allow the Commission to review each new incoming medical use and craft appropriate conditions, there would be time and costs considerations for applicants and staff. The Commission's decisions could be appealed to the City Council.
Currently, applications for medical office use must meet all of the development standards for a commercial use as well as the additional parking requirements for a medical use. New construction that requires the issuance of a building permit is currently subject to Develop- ment Plan Review unless it is construction of less than 2,500 square feet, in which case it is - 13-
Staff Report
Regulation of Medical Uses
For the Planning Commission Meeting of November 19, 2009 exempt from Development Plan Review. New medical offices may also be subject to the following regulations:
Commercial/Residential Transition Ordinance (BHMC 19.5). Medical uses located near residential uses are currently subject to this ordinance that imposes additional development and operational standards for medical uses; Pedestrian Area Ordinance (BHMC 16.5) Medical uses are not allowed on the ground floor of buildings in the pedestrian-oriented area (retail area of the Business Triangle) unless less than 25 feet wide and authorized by the Director of Community Development or approved by the Planning Commission through a CUP.
In addition, the City's existing ordinance restricting uses in pedestrian-oriented areas includes findings that could be helpful to the Commission in discussing findings for a CUP for medical uses (pertinent Code sections are attached).
C. Place a cap on the total number or square footage of medical uses permitted in the With the City's limited commercial area it could be argued that the City does not need any additional medical office use and new medical office users would have to find an existing medical office space in the City. Staff has concerns about instituting a threshold number as it is difficult to determine an exact baseline figure for medical offices, as well as how much new medical office space should be allowed in the City. Creating a separate registration program would require a substantial amount of resources and delay other policy projects.
Previous caps the City has adopted, one on the annual number of new hotel rooms and the other an annual limitation on residential conversions to common interest developments, have not proved necessary or successful.
Other Considerations
Exemption for Existing Buildings
The City Council specifically directed the Planning Commission to consider a provision tha would allow medical office con versions if the spaces mels current Zoning and Buildins - 14-
Staff Report
Regulation of Medical Uses
For the Planning Commission Meeting of November 19, 2009 Pipeline Projects
There are concerns regarding the perceived proliferation of medical-related land uses in the City. Three projects involving medical office use are currently being processed. Previously he City Council discussed exempting from new regulations projects at a certain point in th process. Should the Planning Commission consider restricting, limiting or prohibiting new medical uses, the Commission may wish to consider whether projects in the pipeline should be exempted.
ENVIRONMENTAL ANALYSIS
A draft ordinance would be reviewed for compliance with the California Environmental Quality Act (CEQA) for consideration by the Planning Commission.
GENERAL PLAN ANALYSIS
Neither the current Land Use Element of the General Plan, nor the draft General Plan Update, nor the recommendations of the General Plan Topic Committees appear to specifically address medical office use. The current General Plan and proposed General Plan Update both have as a goal the long-term stability of the City and this goal supports restriction of medical office uses to maintain the competitive ability of the city's commercial areas.
ities of the community, andwith it, the factors which enhance the uniqueness as well as the factors which jeopardize them. Beverly Hills is fortunate in that it is able to serve a variety of residential and commercial demands in a manner and combination which is difficult to duplicate elsewhere in the Los Angeles area. Consequently, as long as Beverly Hills is able to provide an alternative not available elsewhere, it will endure....Aside from the issues of change which face the community as new devel soment occurs and new demands are placed upon the City, it is equally important to recognize that the process of maintaining the quality of life is a dynamic one.
The City's programs must be able to recognize and respond to the problems which typically affect Cities, such as deterioration of its older housing stock, obso- lescence or loss of competitive ability of commercial areas, rising costs and over- burdened
In addition, as previously discussed, General Plan Update goals LU 12 and LU 15 encourage economic sustainability and compatibility between commercial and - 15 -
Staff Report
Regulation of Medical Uses
For the Planning Commission Meeting of November 19, 2009 residential areas and prohibition or restriction of medical office uses would support these goals.
ZONING ANALYSIS
Should the Planning Commission wish to amend the Zoning Code with regard to medical uses, it is proposed that Section 16-3-1601 of the Zoning Code, "Commercial Zone - Uses Permitted," be amended to define "office" to exclude medical offices which would then be listed in the commercial zone under "businesses excluded," or to allow medical office use as a "conditionally permitted use" in the commercial zone.
PUBLIC NOTICE AND COMMENTS
This item was on the July 7 City Council Study Session agenda and the July 21, 2009 formal City Council agenda as an interim urgency ordinance that was not adopted. This is a study session item before the Planning Commission on November 19, 2009 and interested persons including the Beverly Hills Chamber of Commerce were notified about the meeting.
RECOMMENDATION
It is recommended the Planning Commission direct staff to prepare an ordinance amending the Beverly Hills Municipal Code to prohibit or limit new medical office uses in the City.
MICHELE MCGRATH
Attachments:
1. July 7, 2009 staff report to the City Council and minutes of the meeting
2. July 21, 2009 staff report to the City Council, draft ordinance and minutes of the meeting
3. Public Parking Facility Staff Report
4. Pertinent Zoning Code Sections.
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