Stim­u­lus money at work

ARRA-funded projects start to open for busi­ness

Modern Healthcare - - CONSTRUCTION - An­dis Robeznieks

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.”

Arctic chal­lenges

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.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.