Zoning changes needed for Cincinnati Children’s Hospital Medical Center’s $550 million expansion into Avondale moved Monday to City Council, but with surprise requirements for the hospital to spend at least $27 million in the low-income neighborhood for housing and other improvements.

It’s unclear what impact the additional language, if approved, could have on the project, the region’s biggest construction project since Paul Brown Stadium in 2000. It's also uncertain if the language, inserted during a committee meeting Monday, will survive a full council vote on Wednesday.

Last week, six of the nine City Council members said they favored the zoning changes for Cincinnati Children’s new eight-story patient tower, emergency department with helipad and parking garage. Six votes would approve the zoning changes.

On Monday, though, City Council Member Yvette Simpson, who is running this year against incumbent John Cranley for mayor, unveiled the amendment to the zoning changes. She said that while she wants to support Cincinnati Children’s, she doesn’t believe the expansion invests enough in Avondale, one of the poorest neighborhoods in the city.

“I don’t want to continue to incentivize people coming in and out, coming from far out, and parking in garages to work all day, then coming out to drive away,” she said. “We have to find a way to allow economic development to be not just about dollars and cents but about people. Conversations about children in poverty should not be separate from conversations like this.”

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But Vice Mayor David Mann complained that Simpson had raised her objection “at the eleventh-and-a-half hour” over issues that Cincinnati Children’s is addressing through an $11.5 million five-year spending project in Avondale to promote economic growth, housing and health.

“That’s rather unfair to throw that out at this point,” Mann said. “It’s a zoning change, and to hold this thing up for dollars is unfair.”

Council member Wendell Young, who grew up in Avondale and walked a beat there as a Cincinnati police officer, objected to Mann’s characterization. The community, he said, has been locked out of the planning process.

“The reason we fight is not to fight against Children’s Hospital. We believe that Children’s Hospital wants to be a good partner, and wants to be intimately involved in the neighborhood. What they have done far is to make a lot of people feel left out. And those are real feelings.”

When Cincinnati Children’s unveiled its expansion in March, officials hoped ground would be broken later this year, and the project would be completed in 2021. The 150-bed, 600,000-square-foot expansion would go up on about four acres of now-residential land on Erkenbrecher, Hearne and Wilson avenues. The hospital is paying for the expansion without taking on debt.

Cincinnati Children's and Avondale activists opened talks two years ago about how to accommodate an expansion. The activists proposed that Cincinnati Children's spent $100 million in the neighborhood for housing, health care and other improvements, on top of the cost of expansion.

After Monday’s vote, Cincinnati Children’s officials lingered around City Hall debating next steps. The hospital’s chief operating officer, Dr. Steve Davis, said he had no idea that Simpson would put up an amendment with additional demands on the hospital. He declined to comment.

City Council was scheduled to consider the zoning changes last week. Council’s four-member neighborhoods’ committee was first to vote on the changes but could not act Tuesday because Simpson and Young were absent for personal reasons. The lack of a committee vote prevented City Council from acting the next day, so the issue was kicked over until this week.

Monday, the neighborhoods committee convened at full strength, with Cincinnati Children’s officials in the audience at City Hall. Simpson, with Young’s support, offered her amendment that would compel the hospital to invest 5 percent of the project’s development value into Avondale housing.

Based on the $550 million building estimate, that 5 percent would be $27.5 million. If the expansion costs $650 million, which is possible if the hospital can raise money for additional amenities, the 5 percent would be $32.5 million.

The amendment also would:

Require the hospital to promote home ownership in Avondale in its workforce and to do “significant hiring” out of Avondale.

Require the hospital to improve Avondale health outcomes by 10 percent over an unspecified period of time.

Require the city to spend $583,000 from the sale of land to the hospital for the project to go to the Avondale Community Development Corp.

The neighborhoods committee voted down the amendment and the four proposed zoning changes on 2-2 votes -- Simpson and Young on one side, Mann and council member Kevin Flynn on the other. Then Flynn and Simpson flipped their votes, not to signal a change of heart but to allow the matter to go to the full council Wednesday.