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Inflation Threatens Well-Being of $1B Health Facilities Expansion Plans

BY MARK LARSON

Just how on-budget the 10-year, $1 billion North County expansion of the Palomar Pomerado Health hospital district is , or not , will be revealed at a board of director’s meeting June 4.

“So far, so good,” said Mike Shanahan, director of facilities planning for PPH, in reference to budget tracking done so far. Preliminary discussions on the titanic project’s updated cost estimates will begin between the health care system’s staff and board this week.

In 2004, voters approved a $496 million bond issue to help fund the expansion that will be partially funded by the hospital district. But inflating prices of steel and land and labor, experienced in the second half of 2004 through the end of last year, have significantly boosted costs, said PPH’s Chief Planning Officer Marcia Jackson.

Seismic retrofits needed to earthquake-proof buildings have also contributed to higher-than-expected costs, she said.

But construction of the multipurpose expansion has continued as planned.

Still on the drawing board is a long list of projects, including:

– Construction of the new 450-plus bed Palomar Medical Center West in Escondido, which is scheduled to open in 2011.

– Redesign of the current downtown Escondido hospital campus from an acute-care facility to a specialty inpatient, outpatient and wellness services center with administrative offices and commercial space.

– Expansion of Pomerado Hospital in Poway.

– Development of four outpatient centers throughout the 800-square-mile district.

So far, said Jackson, site preparation for the new hospital in Escondido is planned for this summer, pending approval by the city of Escondido. Construction is planned to start late next year. The PPH board is set to discuss funding of the hospital on May 22.

At Pomerado Hospital in Poway, the first phase of expansion there , a five-story, 172,000-square-foot building , has just been finished along with a 1,200-space parking garage. The new medical building’s first two floors are dedicated to outpatient services and its top three floors will house medical offices. The new building opens this month.

A second-phase, five-story “nursing tower” is also planned at the site, which will double hospital beds to 200. It is expected to open by 2010.

And PPH is asking for a rezoning of 4.4 acres of property in Rancho Penasquitos to build an outpatient center. The plan is for two buildings: One existing 12,000-square-foot structure to be remodeled into a wellness center, with plans to open in two years; and the other would be a new 40,000-square-foot medical office building, expected to be open in three years.

In Ramona, PPH bought 2.4 acres of property in November for another outpatient center, which is expected to open in two to three years.


Pilot Projects

Part of the expansion of PPH involves participating in pilot projects designed to help bring innovation and efficiency to the design of its new facilities, and to streamline what historically has been a chronically slow permit approval process for large long-term, health care facility expansions.

One, called the “Pebble Project,” is a network of 41 member hospitals and medical research sources designed to help generate a ripple effect of innovation in the design of new medical facilities.

The Pebble Project, a program of the Concord-based Center for Health Design, is helping PPH come up with innovative designs for its new hospital.

“We’re designing the hospital for a future level of care that doesn’t exist today,” said PPH’s Shanahan.

For instance, he notes, today’s hospitals tend to shift patients from room to room depending on their health conditions.

The research-driven remedy for that is seen in the design of patient-care rooms with standard equipment used for various treatments in each room to help patients with different needs. The idea is to keep patients from being shuffled around, and to lessen distractions for doctors and nurses.

Another focus of the Pebble Project is conducting research to identify possible areas of improvements. Among them, safety standards aimed at the reduction of infections, the environmental benefits of a room , such as natural light and views of nature , which enhance the healing process, the benefits of adopting the latest health care technology, and nontraditional care strategies.


All-Inclusive Design

Anjali Joseph, a Pebble Project coordinator, said PPH President and Chief Executive Officer Michael Covert has looked to all levels of his staff to gather forward-looking research to plug into its new hospital, and Joseph said it has paid off with recommendations being incorporated into the new hospital’s design.

“It’s now at the end of the design process,” she said. “What they did is ground breaking.”

A report done by the Pebble Project documenting the research and design process was published recently in the industry trade publication Healthcare Design Magazine, said Joseph.

Having the staff participate is good for morale, adds Joseph, since they can get familiar with cutting-edge research and be better prepared to work in the new hospital.

Meanwhile, PPH is participating in a pilot program with the Office of Statewide Health Planning and Development to streamline its state approval processes.

John Gillengerten, the state health agency’s deputy director of facilities development, said approvals typically move at a glacial pace, slowed by months of waiting by both applicants and state permitting staffs to respond to each other’s actions.

“Because of the size of the project it can take up to 18 months to get a structural permit through this office,” he said.

The new approach is to begin permit reviews while the building is still in design.

“We look at different phases of the design so that code issues can get settled early before they affect everything else,” said Gillengerten. “It’s less time consuming and costly for the design team to make corrections seven or eight months before they normally submit. We hope to shave at least six months off the design permitting time, and maybe even do better than that.”


Mark Larson is a freelance writer for the San Diego Business Journal.

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