On Saturday, April 19, 2008, a month before she was to graduate from the School of Medicine, Mila Rainof, M.D. ’08, left Harkness Dormitory’s exercise room and began walking north on York Street. At South Frontage Road, Rainof began to cross against the light. It probably seemed safe: as often happens at that corner, a large truck was blocking cars on the other side as it crossed South Frontage Road on York Street. As the truck cleared the road, though, cars bound for the expressway burst from behind the truck. Rainof dodged cars in two of the three lanes, but the driver of a sports car in the third lane did not see her in time, and Rainof was struck just a few feet from the curb.

Rainof died of her injuries the next day. She was 27.

The intersection at York and South Frontage is one of several around the medical center notorious for close calls. Located beside the busy Air Rights Garage, its signals are some 40 years old, installed at a time when a very different vision of the medical center’s neighborhood prevailed. The intersection serves as a transition point between three lanes of city traffic and an on-ramp to the Oak Street Connector, an expressway leading to Interstates 91 and 95. And its traffic flow is frequently impeded by trucks backing in and out of the hospital’s loading dock.

A half-century ago, the intersection would have been almost unrecognizable. In the mid-1950s, South Frontage Road was called Oak Street and marked the boundary between the medical campus and the crowded Oak Street neighborhood—home to poor Jews and Italian-Americans as well as newly arrived immigrants of every nationality. As part of the ambitious urban-renewal agenda pursued by Mayor Richard C. Lee and funded by government grants, the neighborhood was razed in 1957 to make way for an expressway and two frontage roads. The new roads brought more traffic into the city but isolated the medical campus and separated downtown New Haven from the Hill neighborhood.

But times have changed. City planners now prefer houses and shops to medians and on-ramps. New Haven has enjoyed an urban renaissance since the mid-1990s, and a series of overhauls proposed by Mayor John DeStefano Jr.—new buildings and roads behind the medical school; garages, restaurants and shopping at Union Station; a redesign of the vast and underutilized Long Wharf area; and a relocation of Gateway Community College from Long Wharf to downtown—will transform the face of the city as completely as Lee’s projects did a half-century ago. Bruce D. Alexander, Yale’s vice president for New Haven and state affairs and campus development, said of Lee’s urban projects, “Unfortunately, as well-intended as those dollars were, they got spent in ways that [mean] we’re now undoing virtually all of them. The Coliseum, Chapel Square Mall, the Oak Street Connector—they’re all being undone.”

A cancer hospital brings change

When Rainof died, plans were already in the works to fix what ails York and South Frontage and 11 other nearby intersections. The catalyst was the Smilow Cancer Hospital. Groundbreaking for the 14-story, $467 million building on Park Street and South Frontage Road took place in September 2006 after a protracted fight between the city and local unions on one side and Yale-New Haven Hospital on the other. Expected to create 500 jobs and inject $1 billion into the local economy, it will be the largest health care development in state history, according to Steve Merz, the hospital’s vice president for administration. (Previously, the Children’s Hospital held that record.)

“The hospital had to expand,” said Merz. In the past 10 years, he said, the medical center has seen an increase of approximately 20 percent in the number of patients discharged from the hospital as well as those seen in outpatient clinics. “The demand is unbelievable.” In addition to having a higher patient census, the hospital’s cancer facilities are spread out over several buildings. Administrators feared that the logistical complexity that presented for patients might be among the problems threatening the hospital’s National Cancer Center designation. The result was Smilow, along with two ancillary buildings. At 55 Park Street, a six-story building will house pharmacy and laboratory facilities. And a city-block-sized parking garage called Lot E will be built at 2 Howe Street. Some employees who park at the Air Rights Garage will be asked to park in the new building instead to create space for cancer patients.

Because of the anticipated extra traffic, the streets around the medical center received a significant upgrade. Now a traffic circle, or roundabout, at the end of the Oak Street Connector diverts cars into and out of the Air Rights Garage, keeping traffic off side streets. A loading dock underneath the garage will also direct construction vehicles and delivery trucks directly from the highway into the garage. Twelve pedestrian-friendly traffic lights along the Frontage Road corridors are being installed at intersections, including the one where Rainof died. And an extra lane has been added to the expressway’s on-ramp to discourage drivers from jockeying for position while they merge. The changes will also include such measures as improved pavement markings and signage. “We are doing everything we can to make it as safe as possible for pedestrians at the medical center,” Merz said at a review of the plans in August; they are expected to be complete in late spring 2010.

The hospital is no stranger to injury prevention strategies. It co-sponsored the New Haven Safe Streets educational campaign, and its trauma center has been named a member site of the Injury Free Coalition for Kids, a National Program of the Robert Wood Johnson Foundation developed to prevent traffic injuries in the hardest-hit areas of the city.

With a higher percentage of residents who walk to work than any other city in New England, New Haven has much at stake, so many residents will be watching the changes closely. They include Rachel Wattier, a medical student in her fifth year and one of Rainof’s classmates. Shortly after Rainof’s death, Wattier and other grief-stricken medical students formed the Yale Medical Campus Traffic Safety Group. The group brings together university personnel, aldermen, police, bicyclists, students and other citizens to seek ways to address such neighborhood traffic problems as speeding cars, drivers who run red lights and intersections that are inhospitable to pedestrians.

“A lot of people’s behavior, both as drivers and as pedestrians, is due to frustration and urgency,” Wattier said. “[Traffic] fatalities are preventable if you reduce speed particularly, and educate people, and improve the infrastructure so that it doesn’t allow people to speed comfortably.”

If the city has its way, the now-forbidding stretch of parking lots, housing projects and such massive institutional buildings as the School of Nursing, the Tower One/Tower East senior housing and the Doctors’ Building between the medical school and the train station will soon be unrecognizable too. Offices, residences, retail shops, and parking structures are planned, as well as a network of new and more pedestrian-friendly streets. Dean Robert J. Alpern, M.D., Ensign Professor of Medicine, says he’s pleased by the timing, as the medical school is considering building in that area in a few years. With the street restructuring, he said, the streets will “make more sense.”

Perhaps the most drastic change to New Haven’s inner city will be the proposed removal of the Oak Street Connector, also known as the Richard C. Lee or the Route 34 Connector. As part of a project called Future Forward, Mayor DeStefano hopes to tear out the expressway—which carries tens of thousands of cars each day into the downtown area and the medical campus—and replace it with an urban boulevard and 10 acres of mixed-use development. Similar changes have taken place in Milwaukee, Portland, Ore., and San Francisco. “We’re starting to see market demand to push the highway back to I-95 and bring a street grid back into service,” said Michael Piscitelli, director of the city’s Department of Transportation, Traffic and Parking. (Alpern applauds the idea, saying that the school looks forward to “being part of a continuous downtown.”) The city received a $5 million federal grant in September to research and implement the change, and studies will begin early this year.

West of the Air Rights Garage, along a corridor where Pfizer built a vast research facility for clinical trials in 2004 and where the Lot E garage will be built, New Haven once again owns what was until recently state land. The city has begun to hold workshops for local would-be retailers as part of its plans to develop what is now mostly a wasteland of grass and parking lots between the two frontage roads.

It wasn’t always a wasteland. The Oak Street Connector, the Air Rights Garage and Crown Towers, an apartment building popular with medical students and residents, sit squarely atop what used to be the Oak Street neighborhood. Spreading over 11 square blocks with 326 buildings, it was either a rank slum or a vibrant inner-city quarter, depending on one’s point of view. But by the late 1950s it was marked for destruction.

The city was remaking itself because of the rise of the automobile. A post-World War II jump in car ownership meant that people could live far from work; this change, along with a trucking boom that eclipsed rail freight, meant that cities faced vastly increased motor vehicle traffic even as their downtowns lost residents to the suburbs. New Haven was no exception.

When Lee took office in 1954, he and his city planners thought big. Funded by grants—during the mayor’s 16-year administration, New Haven received more federal and state monies per capita for its urban renewal than any other city in America—the city poured hundreds of millions of dollars into huge projects like the Connector, the Chapel Square Mall and the Coliseum. The dense but threadbare and crime-ridden Oak Street neighborhood and its poor and immigrant residents did not fit the city’s new image. Moreover, it seemed to city leaders that bringing in cars would bring life to downtown New Haven. Named for what it replaced, the Oak Street Connector is a 1.1-mile spike of concrete that protrudes into the city from the two nearby interstates; it was intended to be part of a larger freeway that would have extended down Route 34 all the way to the town of Derby. The first portion (and, as it would turn out, the last) was completed in 1959. In addition to the loss of the Oak Street neighborhood, Orange and Temple Streets were severed, the Hill neighborhood was isolated, and Yale’s medical campus was separated from the main campus. Crossing weedy, glass-strewn sidewalks high above a river of rushing cars has for decades been a fact of life for many people at the medical center.

A new approach to urban planning

The ideas that drove New Haven’s city fathers to replace a neighborhood with a freeway were challenged only a few years after it was built. In 1961, Jane Jacobs, an urban activist who would become perhaps the most influential thinker about city planning in North America, published her landmark book, The Death and Life of Great American Cities. In stark contrast to prevailing opinions of the time, Jacobs argued that neighborhoods should be mixed-use; that buildings should vary in age and purpose; that population should be dense; that people walking down sidewalks, sitting on porches and looking out windows are all-important for safety and a sense of community; and that well-intended gargantuan projects actually worsen urban quality of life. Jacobs helped prevent the building of a freeway across lower Manhattan and, later, a similar project in Toronto. Her ideas are at the root of the urban-planning movement known as New Urbanism, whose practitioners include two Yale graduates, Andrés Duany, M.Arch. ’74, and Elizabeth Plater-Zyberk, M.Arch. ’74, co-founders of the Congress for the New Urbanism. The movement began in the early 1980s and gave rise to such model towns as Seaside, Fla. Jacobs’ thinking also helps to explain why Chicago’s Cabrini-Green and similar low-income high-rise housing built in that era later failed so spectacularly.

Inspired by Jacobs’ ideas, many area residents have criticized the medical center’s infrastructure. Anstress Farwell, M.A. ’79, president of the New Haven Urban Design League and a 30-year resident of the city, is one of the most vocal critics. She laments the uninviting nature of the medical campus, with its blank walls, fences along the sidewalk and parking structures. There is little housing and there are almost no inviting street-level retail stores—Cappuccino’s, a sandwich café on Congress and Cedar and the Yale Medical Bookstore, are recent exceptions—and no reason for pedestrians to take a stroll. There is little neighborhood feel. As with many features of the city, this situation can be explained in part by the dominance of the automobile.

In recent decades, Farwell said the hospital has reinforced the lack of a street connection “and an over-reliance on single-occupancy vehicles. All those driveways and aprons define the street as related to cars, with pedestrians as a marginalized presence.”

As an example, Farwell points to the Air Rights Garage, a joint project of the hospital and the city that bookends the terminus of the Oak Street Connector and arches over York Street. The walk beneath the garage overpass is a bleak and noisy stretch of sidewalk lined by fast-food stores, convenience stores, a pharmacy and parked ambulances. Built in 1982, the garage was intended to be a partial solution to congestion in the surrounding neighborhood and was considered a model for mixed-use development in its time. The Temple Street Parking Garage, built on similar principles, soon followed.

“The Air Rights Garage was really the only thing that made sense,” said Philetus Holt, a lawyer who shepherded the Air Rights Garage to completion. A vanpooling initiative by the hospital had had few takers, he said. And the region and city lacked a strong public transportation system. “People did not want to give up their cars.”

Merz maintains that the hospital is committed to mixed-use development, pointing out that more pedestrian-friendly features are planned for its newer buildings. “These LEED-certified, brownfield-redevelopment, mixed-use projects are bringing tremendous economic benefit to the city and medical center,” he said.

In recent years, New Haven builders and residents alike have learned from the past. The simultaneous accessions to power in 1993 of both Yale’s President Richard C. Levin and New Haven’s Mayor DeStefano marked the beginning of a warmer town-gown relationship that would transform the city yet again. In an era of reduced city prosperity and slipping prestige on the part of the university—it was losing money and faculty, its physical plant was in disrepair, and undergraduate Christian Prince had recently been murdered during a robbery—Yale began to act as a community developer, initiating a homebuyer’s assistance program for its employees and buying up distressed retail properties on Chapel Street and Broadway. This change touched off what the media has called the New Haven renaissance. Alexander joined Yale in 1998 after having worked at the Rouse Corp. on such revitalizing projects as Faneuil Hall in Boston and Harborplace in Baltimore. Asked to locate the epicenter of the renaissance, he points to 15 Broadway, where the New York-style 24-hour delicatessen Gourmet Heaven set up shop in 2000 at his invitation. Barnes & Noble and the clothing stores J. Crew and Urban Outfitters soon followed. To encourage lively sidewalk traffic, Yale stipulated that retail tenants remain open until 9 p.m. “We now have life and activity and a very comfortable environment for shopping,” Alexander said. “Whenever we have the chance to put shops or restaurants on the ground plane of buildings that are on city streets where the campus interfaces with the community, we try to build in that retail space.”

The high-end tenants stayed, and developers elsewhere took notice. According to Alexander, Yale’s aggressive retail-development policies have had the unintended consequence of demonstrating to developers that upscale retail and housing could succeed in New Haven. Firms are now bidding on the chance to develop, for example, the Shartenberg site, a planned mixed-use luxury housing development at the corner of State and Chapel streets downtown—a dramatic contrast with the beginning of the Levin/DeStefano era, when the city had to entice developers with perks.

“We have a really good partnership with the mayor, the city administrators and the Board of Aldermen. There’s so much power in Yale and the city working together on projects—virtually everyone’s come to that recognition,” said Alexander.

New Haven has also benefited from the biotech boom. Investment in Science Park, a former industrial site, and the refitting of the former telephone company building at 300 George Street with wet labs has ensured that many fledgling biotech companies born of Yale research have stayed in the city.

The replacement of the Oak Street Connector with boulevards is expected to bring more life to an already revitalized downtown. Such a change would reconnect Yale’s medical and main campuses for the first time in a half-century. More people may be walking or biking to work, and efforts to reduce motor traffic are under way. Under a process called transportation demand management, the hospital offers incentives to employees not to drive to work, including vanpools and subsidies for public transport. Some 3 percent of employees participate, removing hundreds of cars from the road. The hospital aims to bring the total to 10 percent. The hospital’s new buildings will contain street-level retail stores to encourage pedestrian life on the sidewalks. Even the planned Lot E garage, whose primary purpose is to house 845 cars, will contain not only retail and commercial space but also housing. “These are all part of our commitment to responsible, smart development,” Merz said. “We’re trying to interact with the fabric of the city a little bit better.”

The city and the medical center will continue their dialogue, it seems certain, for decades to come. The hospital’s satellite Long Wharf Medical Center opened in 2000, in a part of town that will change drastically if DeStefano’s plans go into effect. Some employees commute by public transportation, and many more might do so if the commute is simplified. Most of all, the city’s plans for Route 34, known as Legion Avenue west of the Air Rights Garage, will directly affect the medical center, and the gradual change of philosophy in urban planning has begun to affect the medical center’s vision of itself.

“Does this vision of us just [building new facilities] down Route 34 make sense—having a long corridor of institutional medical services? That was kind of the old vision,” said Merz. But the mayor’s dream of a dense mixed-use inner city has advantages for the medical center, he said. The reasons for that are straight out of Jane Jacobs: fewer cars; more retail enterprises; a livelier human presence on the sidewalk; and better relations with out-of-town visitors and community dwellers alike, who will see a pleasant downtown rather than a grim expressway as their welcome to the medical center. YM