Stimulus money at work
ARRA-funded projects start to open for business
The new Eagle Butte Health Center in South Dakota is set to open for business this week. The 10-bed, 138,000-square-foot Indian Health Service facility was paid for with $84.5 million from the American Recovery and Reinvestment Act of 2009, and it replaces a facility about one-third the size that opened in 1960, says Capt. Randall Gardner of the Public Health Service, who also is IHS acting deputy director of environmental health and engineering as well as the agency’s stimulus law coordinator.
The building, which combines a comprehensive ambulatory-care center and a small hospital, is one of four major healthcare construction projects paid for with stimulus-law money, and it’s the first to be completed.
Also on the list of stimulus law-funded replacement projects is another IHS facility, the $142.5 million Norton Sound Regional Hospital in Nome, Alaska, set to open in November; plus two Defense Department facilities: the $563.1 million Naval Hospital Camp Pendleton in California, set to open in March or April 2014; and the $621 million Carl R. Darnall Army Medical Center at Fort Hood, Texas, set to be completed around May 2014. (Figures represent money allocated in the legislation, not construction contracts.)
When it was signed by President Barack Obama in February 2009, the legislation drew criticism—and continues to do so—with many disparaging the program as a $787 billion boondoggle (costs are now estimated to total $840 billion) that deepened the deficit without aiding the economic recovery. Others have noted how it sped up construction of needed projects that had already been in the pipeline.
On the fast track
“The recovery act moved our construction forward five years for what we’re trying to do,” Gardner says, adding that it also helped speed up construction of another Alaska project, the $100 million Barrow Hospital, funded with traditional, non-stimulus budget sources and expected to open next year. It will replace Samuel Simmonds Memorial Hospital, built in 1964.
Similar comments are offered by Rick Bond, former commander of the U.S. Army Health Facility Planning Agency and now senior vice president and federal healthcare strategy leader for Dallas-based HKS Architects, which is working on the Fort Hood and Camp Pendleton projects. According to Bond, the recovery act sped up the military healthcare construction program by two to three years.
“This was a very important investment,” Bond says. “It really enhanced and accelerated the military health system’s ability to take care of the wounded warriors as they return from doing the nation’s work.”
U.S. Rep. Michael Burgess (R-texas), a physician representing a district just north of Dallas and Fort Worth, was a critic of the stimulus package in 2009, and says he’s still a critic— though he notes that he opposed the legislation and not necessarily the healthcare facilities it is helping to build.
“It’s not even the question of ‘Are these projects worthwhile?’ It’s ‘Was the stimulus bill the best way to approach these projects?’” Burgess says. “I’m not prepared to say none of these were good projects. But there’s an appropriate process where Congress has oversight. … The stimulus bill was a very poor way of doing things and reflected the inexperience of the incoming administration.”
The haste to create and pass the stimulus law, Burgess says, led to situations that were “not well thought out and not well vetted,” citing the $535 million loan to now-bankrupt California-based solar panel manufacturer Solyndra, which he calls a taxpayer loss that’s unlikely to be recovered.
Once the stimulus money is fully spent, Burgess predicts things will progress differently.
“I don’t know if a ‘slowdown’ is the appropriate word to use, but there will probably be a different model going forward,” Burgess says, citing the example of the privately built $55 million outpatient clinic just outside his district in Fort Worth that the Veterans Affairs Department is leasing. “It went from nowhere to finish in a five-year period.”
When the stimulus law was passed, the IHS projects also were criticized for focusing so much of the available resources in Alaska and South Dakota (June 1, 2009, p. 6). But that criticism was lessened by the inclusion of another $100 million for healthcare facility maintenance and repairs.
Gardner says that money paid for 304 projects
across the nation, including replacing roofs, remodeling facilities for better uses of space, repairing heating and ventilation units and “repairing by replacing” small clinics where the “value of repair exceeded the cost of replacing.”
The Eagle Butte (S.D.) Health Center, which will deliver healthcare to 9,300 Native Americans in the IHS Cheyenne River Service Unit that covers the Cheyenne River Sioux Reservation in north central South Dakota, was scheduled to open Jan. 16 (weather permitting). Gardner says construction was managed by the Cheyenne River Sioux tribe, which handed the building over to the IHS this past fall. The IHS inspected the building and came up with a punch list of items that still needed work. Once those were finished, moving furniture and equipment from the old building to the new began, he says.
Work, however, continues on staff quarters, which Gardner describes as 133 two- to threebedroom units similar to what is found in a military housing complex and he expects they will be finished by late summer or early fall.
“It’s a pretty remote area,” Garner says. “When we program a healthcare facility, we have to look at the availability of places for the staff to live.”
The facility also features a geothermal energy heat source with a network of pipes and heat pumps buried below a parking lot. “We’re anxious to see how much energy we’ll save,” he says.
Although the term became much maligned, Gardner says Eagle Butte and Norton Sound Regional were “shovel-ready” projects, as both had gotten started though neither had been fully funded in the federal budget.
“Both of them were partially funded and under way when the recovery act passed,” Gardner recalls. “For both of the projects, the first phase had been started. For Eagle Butte, we had finished design and much of the site work and developed its phased approach for construction.”
Because of the difficulty in delivering construction materials above the Arctic Circle, Gardner says steel needed for Norton Sound Regional had already been purchased and delivered when the opportunity arose to do so, and the beams had already been put in place when the stimulus law funding came through.
“Our shovels were already moving when the funds became available,” says Erik Goodfriend, director of the healthcare studio at Mahlum Architects in Portland, Ore., one of the contractors working on the project. He describes the Nome construction period as short and “very seasonable,” adding that it relies entirely on the delivery of materials.
Duncan Davidson in Mahlum’s Seattle office served as his firm’s project director, and he describes how the “engineering is based on the barge schedule,” with the last ship leaving Seattle on Aug. 2 and arriving in Nome on Sept. 28.
“Nome is off the road system,” Davidson says. “Everything goes up to Nome either by barge or by air.” He says that creates a huge incentive not to make mistakes. Also, the remote location needs to be factored into the design: Fuel tanks have to be bigger, and boilers and other machinery need to “have a different level of robustness” because replacement parts are not easy to get.
Davidson says other design considerations that had to be taken into account include that the hospital will often be a place where community elders spend their last days and that people may stop in for a doctor visit and then not be able to leave because of weather conditions. Also, the building is raised nine feet off the ground to allow for snow to blow through and to prevent melting of the permafrost soil. Goodfriend says buildings constructed on melted permafrost can settle unevenly and sink drastically—by as much as four to five feet.
Davidson says the construction crew, which has put in about 250,000 hours to date, averages about 90 to 95 people and between 25% and 33% of the workforce has been Native American. But he adds that construction labor wasn’t the project’s only job-creating component.
“A lot of this project was about ‘Buy American,’” he says. “It was not just dumping $90 million back in the tundra.”
The new 144,000-square-foot, 14-bed facility will replace one built in 1948 and it will be the regional destination hospital for everyone in a 300-mile radius. However, Goodfriend says calling it a “hospital” may be misleading because only about 40,000 square feet will be dedicated to inpatient services.
“It’s really an ambulatory-care facility,” he says, adding that there are also spaces for dental, mental health and nutrition services as well.
Much less remote are the two military facilities, with the Army’s Fort Hood located outside Killeen, Texas, roughly halfway between Waco and Austin. Camp Pendleton is on the Pacific Coast, 40 miles north of downtown San Diego.
At Fort Hood, the new 944,000-square-foot facility replaces the current 45-year-old Carl R. Darnall facility. The general contractor is a Balfour Beatty and Mccarthy Building Cos. joint venture, with architectural duties handled by HKS with Wingler & Sharp as design partners. Ambulatory services will occupy 334,000 square feet and a 122-bed hospital will fill the rest— which includes space for 28 mother/baby patient beds and 12 neonatal intensive-careunit beds reflecting how the facility will also serve military families.
Bond says there is a $534 million construction contract and the original plan was to build in two phases, but the stimulus money “jumpstarted” the project and allowed it to be built all at once with a mix of stimulus funds and traditional budget sources.
For the 67-bed Naval Hospital Camp Pendleton, there was an original contract for $394 million that can be increased to $451 million, according to materials supplied by HKS. A Clark Construction Group and Mccarthy joint venture is serving as general contractor with a design team that includes HKS and Wingler & Sharp working on an initial concept design created by the architecture firm HDR.
The Camp Pendleton and Fort Hood projects are being constructed using the designbuild method, Bond says, so their shovel-readiness “is in the eye of the beholder,” but he adds that they were “significantly developed in scope and concept and were ready to go” when the recovery act was passed by Congress and signed by President Obama.
Eagle Butte (S.D.) Health Center, which includes 10 inpatient beds, received $84.5 million in federal stimulus funding.
Norton Sound Regional Hospital in Nome, Alaska, which designers say is really more of an ambulatory-care facility, also is a recipient of funding from the stimulus law.