In this video and podcast, newly elected Las Vegas City Councilman, Brian Knudsen and I discuss the past, current and future of the Las Vegas Medical District and the relationship between the medical district and Opportunity Zones. We further discuss what it will take to take advantage of the fact that much of the medical district is in an Opportunity Zone.
TRANSCRIPT OF THE VIDEO
Howard Kline [00:00:00] You’re watching CRC radio and TV I’m your host Howard Kline. In today’s video and podcast, I get to interview Las Vegas City Councilman Brian Knudsen. Brian and I are going to be discussing the Las Vegas city medical district and the fact that it is predominantly located in an opportunity zone and what that means for investors and the community. We’ll be right back.
HISTORY AND DESCRIPTION OF MEDICAL DISTRICT
Brian Knudsen [00:00:45] So the Las Vegas medical district was established in the 90s. It got some revitalization and some more conversation about 10 years ago and since then the city has been investing a lot in branding the district which is essentially the nine or the 15 up to about Valley View. And Charleston over to about Alta. There’s some there’s some bits and ends that go into my colleagues. Councilman Curtis’ ward in Symphony Park. And then there’s the Northwest Medical district which is up off of Cheyenne. And today I campaigned on the opportunity for greater access to quality health care. We’ve spoken and I’ve spoken about this publicly as my son has had some pretty extensive medical experience at UMC. Some experience that was not pleasant as an adult as a parent because the quality of care while great. We recognize there was challenges in in the connectivity of our medical community. And so when I when I think about the medical district I think about it from the patients special perspective or a parent of a patient’s perspective and what I think about it is when you when you need access to health care you want to make sure that your pediatrician is connected to your surgeon is connected to your immunologists is connected to your infectious disease doctor. Currently that isn’t really happening in our community medical district being an opportunity for concentrating medical care and connecting it through infrastructure which the city can be responsible for but also through organizational connectedness like medical records electronic medical records make a huge difference if you’re a patient and then just ease in access to the medical district is the heart of our entire valley. So whether you’re coming in on a ninety five or the 15 this is the easiest access to medical care.
Howard Kline [00:02:33] So I’m not sure I understand how the development of the medical district will improve medical care in the valley and why that is a problem currently.
PURPOSE OF MEDICAL DISTRICT
Brian Knudsen [00:02:48] So I can give you a personal experience right. My pediatrician amazing pediatrician just decided to pack up his bags and his family and move to the East Coast because they wanted to live work and play near a medical district. If you if you drive around our area you know that it’s kind of in the older part of town the buildings are kind of rundown. There’s not a lot of restaurant choices or taverns or bars for people to enjoy. There’s some wonderful amazing neighborhoods around there but there’s not enough housing. And so if you want to live work and play in in a concentrated area that doesn’t exist right now I think we have a lot of work to do to develop that area to bring about the facilities that doctors want to work in that facilities where you can have a concentration of different specialties in healthcare right now that doesn’t exist in the way that I think our community deserves.
Howard Kline [00:03:40] Is the medical district modeled after any other medical district that you’re aware of.
Brian Knudsen [00:03:45] So Las Vegas is unique and we all talk about that. There are medical districts around the country. We’ve tried to model this medical district after the San Antonio medical district and that really is a concentration of for profit nonprofit public hospitals and corresponding doctor offices all in the same area so that if you have an issue you can you know where to go and everything and everyone is connected within that space.
OBSTACLES TO DEVELOPMENT OF MEDICAL DISTRICT
Howard Kline [00:04:12] What are the current obstacles that you see with regard to the further development of the medical district and perhaps I should really be talking about improving medical care in the Las Vegas valley and what what are the current obstacles that you see and and how do you anticipate or hope to solve those obstacles.
THERE IS A NEED TO INCREASE MEDICAL SCHOOL RESIDENCIES
Brian Knudsen [00:04:32] So first question there are two main obstacles that I see that that hinder imagination. Imagination is always the first step. The first two obstacles that I would like to talk about are graduate medical education which I think is probably the biggest obstacle we face as a community. Graduate Medical Education are slots essentially for residents. So when you graduate medical school you enter into a residency to get further training. Nevada is limited by the number of residency slots from a federal dollar from a federal government perspective. And so we need to work with our federal delegation to increase the number of residency spots that just limits the number of residents in Nevada and 70 percent of doctors who who will see me say that and we you to say that that’s 70 percent of residents wherever they do their residency that’s where they choose to live. We don’t have enough residency spots and so we may be developing a medical school and training amazing physicians if they can’t get a residency here they’re going to go out of state to complete their residency and they’re 70 percent more likely to stay out of state. My job is to make sure that those doctors when we’re graduating them from the UNLV School of Medicine or from Touro or from Roseman is that they get a residency spot here and they choose to live and stay here. I think that will have the greatest impact on health care. The second obstacle that is publicly talked about in a wide variety of audiences is our reimbursement rates from Medicaid. I think that requires an intense effort working with our governor and our legislature to increase specific Medicaid rates so that physicians that we need here in town are paid at a rate that is equitable with other states around around about what goes to the Medicaid.
Howard Kline [00:06:23] I understand that. So if they’re not getting paid what they need to get paid they’re going to go to where they need to get paid more.
Brian Knudsen [00:06:31] Correct.
Howard Kline [00:06:32] Which is pretty simple. I’m not sure I understand the relationship of the federal government to the residency slots. Can you explain that?
Brian Knudsen [00:06:41] There’s there’s probably more informed and educated people that can explain it in greater detail but essentially back in the decades ago there was a formula that was set up by the federal government that allocates residencies funding for residencies throughout the country. We have a lack of residency spots in Nevada because we’re newer and frankly we’ve only had a medical school now in Nevada and in Las Vegas for a couple of years on the East Coast. Pittsburgh for example they have an abundance of medical schools and they have an abundance of residencies. Right now there’s a there’s too many residency slots on the uncertain states or sitting in certain localities in the east coast and not enough in the West Coast. So it’s going to take our federal delegation working with representatives from across the country to reallocate those residency spots to Nevada. More residents mean longer term physicians here in Nevada that have close ties to our community.
MEDICAL DISTRICT IS, PREDOMINANTLY LOCATED IN AN OPPORTUNITY ZONE
Howard Kline [00:07:36] The medical district is located predominantly as it’s all located in the opportunity zone or is it predominantly located in an opportunity zone.
Brian Knudsen [00:07:50] Predominantly it would be a good adjective it’s a good chunk of it is an opportunity zone.
Howard Kline [00:07:55] How do you perceive opportunity zones and the opportunity zone programs and the benefits. How do you perceive it will benefit the further development of the medical district and then we’ll talk about your ward. Why don’t we start with how opportunity zones will benefit your ward and the city and then we’ll go into little more detail with regard to the medical district.
Brian Knudsen [00:08:26] So I think opportunity zones and there’s there’s a whole team at the at the City of Las Vegas that can help developers think through the benefits that it has to public and private development. From my perspective at a policy level it adds to the imagination. We talked about that before the imagination of what the district can be by providing additional incentives for developers they’re able to think about the land differently. So much of the medical district is in an opportunity zone and my job is to reach out to the development community to say there are multiple advantages to developing in the medical district whether you’re developing housing or you’re developing medical infrastructure medical office space or a hospital. There’s a variety of incentives that’ll make it profitable for you. At the end of the day we still live in an economy that values profit and developers want to come into an area where they’re going to make money. And so my job is to understand what’s in the best interests of the public what’s in the best interests of the surrounding neighborhoods and community but also understand what incentives will allow for a developer to be creative and think about how they can assemble land and develop something that’ll be in the best interests of the community and the developer.
Howard Kline [00:09:34] What are these some of the obstacles that you understand currently exist with regard to Opportunity Zones and the medical district.
OBSTACLES TO INVESTMENT IN MEDICAL DISTRICT OPPORTUNITY ZONES
Brian Knudsen [00:09:45] I would say the only real challenge that we face is because of the it’s infill development. It’s not it’s not a blank slate. It’s not wide-open land where somebody can come in and just develop anything they want. There’s a lot of aged infrastructure and the city is going to be investing quite a bit of money in updating the infrastructure but there’s also smaller parcels of land larger parcels of land that are owned by a variety of different interests. And so for a developer to come in with anything substantial they have to acquire land from private interests. That has nothing to do with the government so they have to go out and find the multiple landowners or building owners or leases and identify what it will take to assemble a parcel of land to develop something meaningful. Much of the medical district is owned by no less than 100 different individuals or organizations with a variety of different contractual obligations because of the land they own and the buildings they built on top of that. And so the medical district is infill development it’s not a blank slate. It’s it requires a whole lot of imagination and a lot of sweat equity to get in there and do something meaningful.
Howard Kline [00:10:52] And the opportunity zones, I wrote an article that in order for opportunity zones to be successful it requires creativity and imagination courage. It’s not easy necessarily. There may be instances where it is and that’s where you know in those instances that’s where a lot of the early developers are going. But it just you have to sit down and say OK there were four parcels here each of which has two four plex’s is how do we make this financially worthwhile and beneficial to the community. And that takes some homework. What about zoning and blocks. Zoning is zoning no longer an issue with regard to Opportunity Zones and further development in the medical district?
ZONING
Brian Knudsen [00:11:48] I did a roundtable of developers right after I was elected and zoning and land use law is the first thing that came to their mind in their request of making it easier to develop. And so Las Vegas has some antiquated zoning laws much like every other jurisdiction in our country. The developers the brokerage firms are looking for consistency in land use laws. So every project that comes forward is going to have a constituency that loves it and a constituency that hates it. Developers are people who are working to develop a property are looking for consistency so they don’t have to juggle between multiple interests. I think as a local government we have an obligation to create a level playing field an expectation of what they can develop so that they don’t invest a lot in doing something that will never come to fruition. Zoning and land use laws have a lot to do with that. Currently there is a portion of the medical district that is covered under farm based code that’s intended to make it easier for a developer to come in based on set expectations from surrounding constituents. I am going to be asking the city to evaluate expanding zone farm based code within the entire medical district to establish a level playing field for the developers and they know that where my heart is where my intentions are is to develop that medical district.
ADDED: FORM BASED ZONING IS AN APPROACH TO ZONING THAT EMPHASIZES THE PHYSICAL FORM OF AN AREA, RATHER THAN TYPICAL ZONING BY USE. THE FOCUS IS MORE ON WHAT THE LOOK OF THE COMMUNITY AND MAY FURTHER FOSTER A MORE URBAN MIXED USE SCENARIO. FOR MORE INFORMATION, CLICK HERE
INFRASTRUCTURE
Howard Kline [00:13:11] What kind of infrastructure is currently on the table and to the extent that there is other infrastructure that you would like to see coming into your ward and the medical district. So what’s the current infrastructure that’s that’s currently planned?
Brian Knudsen [00:13:30] So right now if you drive through the medical district it’s an aged infrastructure it’s obvious the city is going doing a significant renovation of the Charleston corridor between the 15 and Rancho widening it to make it easier to block. They’ll also make it available for high density transit light something like light rail in the future. There’s also a significant infrastructure improvement project along the Rancho corridor between the 95 and Sahara. There’ll be some widening of most of Rancho. There’ll be some expanded sidewalks for walking and during that phase there’ll be some undergrounding of overhead light poles are not light poles but telephone poles undergrounding of some utilities that should increase the access to Wi-Fi and cable and telephone for some of those older neighborhoods and then there’ll be some increased lighting in the medical district that’ll hopefully make it safer as well. All that’s planned over the next three years.
Howard Kline [00:14:29] Oh good. So it’s the window here is only three years so someone were to start planning now and the hold period which is the pot at the end of the gold pot of gold at the end of the rainbow. It’s a ten year period. So with the improved infrastructure There’s actually reason to believe that the infrastructure will be adequate within the 10 year hold period correct.
Perhaps I wasn’t particularly clear, but as an investor and you are planning to hold for, at least, 10 years in order to get the greatest tax advantage offered by the Opportunity Zone legislation, you would be interested in the municipality already in the process of infrastructure improvements, rather than just the planning stage, which could take up much of the 10-year holding period.
Brian Knudsen [00:14:58] And if you’re a developer watching this you would you should start thinking about if you’re if you’re going to buy a parcel of land or you’re going to develop. If the cities are already dug a trench because they’re going to be underground now is a good time to develop. And so this this is a signal to the development community that the city is investing now is a good time to invest as well.
THE ISSUE OF GENTRIFICATION
Howard Kline [00:15:17] Do you have any issues or concerns with gentrification?
Brian Knudsen [00:15:21] Yes gentrification is tough. I’ve had some experience with that in neighborhoods that I focused on as a city employee I used I used to work here. I focused a lot on education. I definitely saw significant improvement in some of the schools that I focused in on and the neighbors around those schools changed and it pushed out people who couldn’t afford to live in their homes anymore. Raised the cost of homes. I struggle without it. It’s a moral dilemma that I face because we don’t have a lot of space or services for people in poverty in our community and I think about 70 percent of our community is struggling with poverty at any given time. So gentrification is definitely something I am very concerned about. I don’t have an answer for you. I do think that development is important. I think that increased access to health care is important that will have residual impacts on the surrounding neighborhoods that will rise. Raise the cost of their homes which will potentially push people out. I welcome ideas or opportunities to think about that differently. Right now I’ve struggled with it.
Howard Kline [00:16:26] I just did an interview with a gentleman by the name Daryl Carter who has been doing workforce and affordable housing for over 20 years, before opportunity zones exist the now he’s also added to the mix of opportunity zones because a number of his properties and projects are already in opportunity zones because that’s what he was focusing on before and I’d suggest I’ll send you a copy of that video. I did two days ago hopefully they’ll be out this weekend. You should take a look at that because a lot of his focus is on retaining the existing residents you know kicking out those who are bad residents but retaining as many as possible so so that his places you know may not have marble and may not have granite counter tops and whatever but he’s got a secret sauce that works is able to keep the prices reasonable and retain 85 percent of the existing residents and that’s his goal. So when you have an opportunity and you may want to actually I’ll introduce you to Daryl because he’s got about a two billion dollar fund that and lots of experience and very knowledgeable. What can citizens do to help you?
Brian Knudsen [00:18:08] So I think the imagination that’s that the the biggest struggle I always encounter is people are constituents residents in our community are set in the ways that say Charleston used to have horses up and down Charleston because this used to be an old Western town and there are still people who think that that’s where Las Vegas is. I think we need to examine what Las Vegas is and what it’s going to be in the next 10 to 15 years. I mentioned we have about 70 percent of our population that’s on Medicaid.
Brian Knudsen [00:18:39] Most of our our workforce is service based is people serving food as people cleaning hotel rooms. That is our community. I think as as residents we need to understand what our community is and expect that we will build a community around that. So that means that. Imagination is a big part of it. We can’t think about Las Vegas from 1950. It’s not that anymore. Las Vegas is dynamic it’s changing it’s evolving but we have a constituency we have a population that needs services. That means we need greater access to transportation greater access to housing and greater access to education and all of those things require imagination to think about it differently because it is not Vegas in 1950. That being said our population will grow by another five hundred thousand people in the next 10 years. And if we don’t adapt and change very quickly to meet the needs of our growing population we will forever be at the bottom of every list. And I know there’s nobody in Nevada that wants to be at the bottom of every list. So we need to rethink how we provide services and what Las Vegas is so that we meet the needs of our current population and anticipate the needs of our growing population in the future.
Howard Kline [00:19:49] Thank you very much. I appreciate it.
Brian Knudsen [00:19:51] Thank you so much.
ABOUT BRIAN KNUDSEN
photo by s.savanapridi
Brian Knudsen was elected to represent Ward 1 in June 2019, enabling him to continue to pursue his passion of public service. Since moving to Las Vegas in 2005, Councilman Knudsen has built programs and services for people and populations in Las Vegas and continues to serve the community as a member of the City Council.
For nearly a decade, he worked in the city of Las Vegas on initiatives that shaped the downtown core, redefined the educational landscape and rethought how city services are provided to Las Vegas residents.
Councilman Knudsen has worked alongside nonprofit partners, community leaders and elected officials to expand after-school meal programs for children, and helped launch a city- and community-led initiative to improve education in our downtown core.
Councilman Knudsen has more than 15 years of experience in city and state governments as well as time spent as the chief executive officer of a large nonprofit organization and as the owner of a small business. His experience covers multiple functions of government and nonprofit organizations and has focused on creating efficiencies, strategic planning and policy development.
He is a founding member of Downtown Achieves, which became the city of Las Vegas’ inspiration for creating the Department of Youth Development and Social Innovation. In addition, he is a founding member of Nevada’s Big Give, a one-day, online giving event that has raised nearly three million dollars for Nevada charities. He also has served as vice chair of the Downtown Las Vegas Alliance, vice president of the McNeil Neighborhood Association and as a member of the Adoption Exchange Board.
Councilman Knudsen has a Bachelor’s of Science degree from the University of Utah in health education and mass communications. He also has a Masters of Public Administration degree from the University of Southern California.
Brian is happily married and he and his husband have adopted two children. Councilman Knudsen believes that his children, and all Las Vegans, deserve leadership committed to making Las Vegas an even better place to live, work and play. He plans to continue to build a community that ensures equal opportunity, has great schools, provides strong public safety, preserves our neighborhoods and strives to be world class in all we do.
ABOUT HOWARD F. KLINE, ESQ.
Over the last 43 years, Howard’s job has been to increase or preserve his client’s wealth. He has successfully fulfilled his responsibilities in several different capacities, including as an attorney, real estate broker and business advisor. As such, he has served as General Counsel for Big Bear Markets, Security First Corp. and Legacy Electronics as well as General Counsel and Director of Real Estate for Allied Education Corporation.
Howard imparts as much knowledge & information to his clients so that they can make the most informed decision, possible.
Carrying on the tradition of educating the public and his clients, Howard founded CRE Radio & TV in 2010. In this capacity, Howard has interviewed and associated with some of the most knowledgeable and influential commercial real estate experts in the United States.
Howard is currently a real estate advisor with KW Commercial, a division of KW Southwest of Las Vegas Nevada.
Nevada RE License #0185884
Ca. Bar No. 071516