October 31, 2005
Building mode | A backlog of hospital expansion projects clears, and construction is underway across the state
By David Raths
June 8 was an exciting day for officials at Calais Regional Hospital and residents in the hospital's northern Washington County service area, as construction work began for a new hospital building.
Hospital officials are confident the 60,000-square-foot facility, funded in part by a rural development loan of almost $19 million from the U.S. Department of Agriculture, will mean a lot to both patients and employees of the hospital, which is the area's largest employer with 200 staff members. In the last five years, the number of visits to the rural hospital's emergency room has increased by 20%. The new $22 million facility, scheduled to open in fall 2006, will have larger operating rooms, private emergency triage and treatment rooms, and private registration stations, said DeeDee Travis, director of community relations for the hospital. "It's a much improved layout," she said. "Currently, patients who are registering have to walk through the ER."
Like Calais Regional, Maine hospitals both large and small have been in construction mode this year, and several significant projects are on the drawing board for 2006. Other hospitals are seeking state approval for significant building projects that will take several years to complete, including a $120 million facility at Inland Hospital in Waterville and a $66 million plan by MaineGeneral Medical Center to close its Seton Unit in Waterville and move its services and staff to an expanded Thayer Unit, also in Waterville. Other projects envisioned include a $26 million in-patient center at York Hospital, a $28 million cancer center at Eastern Maine Medical Center and a $9.5 million critical-care facility at Central Maine Medical Center.
Changing demographics and medical technology have put increased pressure in particular on emergency departments of hospitals in fast-growing regions of the state. For instance, in 2004 the emergency department at Southern Maine Medical Center in Biddeford saw 36,000 patients, an increase of 1,000 patients over 2003. In the first six months of this year, that number had already grown by 1,200.
Despite the increase in demand, hospital expansion has been caught up in the state's struggle to control spiraling health care costs.
Gov. John Baldacci's Dirigo Health Reform Act in 2003 placed a one-year moratorium on large capital projects. When the moratorium was lifted in 2004, a backlog of more than $200 million in projects seeking the "certificate of need" approval required by the state had built up. In response, Maine created a Capital Investment Fund, which is not really a fund, but a cap on the amount of money that can be spent on hospital expansions statewide each year. The CIF is based not on the cost of construction, but on a complicated formula involving ongoing operating expenses. For the 2004-2005 budget period, that cap was $6.6 million.
Hospitals now must compete with one another to prove to the state how urgent their construction need is. "It limits what we'll authorize," said Trish Riley, director of the Maine Governor's Office of Health Policy and Finance, "and it has slowed the rate of applications." But she said the state still has to study what kind of savings can be attributed to the creation of the fund. She also noted that the certificate of need process only applies to capital improvements costing more than $2.4 million, or about 20% of hospital expansions.
An emergency room expansion project slated for next year at Southern Maine Medical Center was among the first projects to go through the new CIF process, and Sue Hadiaras, director of community relations for the Biddeford hospital, said it went relatively smoothly. "The state did a very thorough study," she said. "They spoke to our planning manager constantly, and we provided mountains of paperwork. They really did their homework."
Following is a roundup of Maine's major hospital construction projects that got under way or were completed in 2005. (See "On the drawing board," p. 24, for some projects proposed for 2006.)
Maine Medical Center, Portland
Architect: The Ritchie Organization, Danvers, Mass.
General contractor: William A. Berry & Son Inc., Danvers, Mass.
In September, former first lady Barbara Bush officiated over the groundbreaking as Maine Medical Center began work on a three-year-long construction program. The approximately $120 million Charles Street Project will include a women and infants building, a parking garage, a helipad, improved access and wayfinding, and a central utility plant. MMC plans to upgrade facilities for intermediate care and routine and critical care patient services. It will also renovate and expand the emergency department.
Speaking at the groundbreaking, Vincent Conti, MMC's president and CEO, explained the need for the facilities upgrade: "Along with the finest professionals and the latest equipment, the medical center must offer facilities that truly reflect a contemporary view of the nature of healing. Patients and families expect comfort as well as competence, privacy as well as pills, tenderness as well as technology," he said.
Inland Hospital, Waterville
Architect: Lewis & Malm Architecture, Bucksport
General contractor: Nickerson & O'Day, Brewer
The Lakewood Continuing Care Center on the campus of Inland Hospital in Waterville is nearing completion of phase one of its four-phase plan to expand from 76 to 105 beds and create three distinct care areas ˆ one for long-term care, one for rehabilitation/skilled care and a new wing dedicated to Alzheimer's/dementia patients.
The $7 million project begun in the fall of 2004 should be finished in late 2006 or early 2007, said Dan Booth, a vice president at Inland. He said increasing demand in the Waterville region for long-term care and skilled nursing beds spurred the expansion. Booth also noted that Inland is working on a new helipad, as well as a remodel of its OB/GYN facilities and medical labs.
Goodall Hospital, Sanford
Architect: Medical Space Planners, Morro Bay, Calif.
General contractor: The Sheridan Corp., Fairfield
The first of several building projects in the works for Goodall Hospital in Sanford, a $5 million medical office building was begun last December and is expected to be finished in January 2006. The two-story pre-engineered building was designed by The Sheridan Corp., and Medical Space Planners was retained to work with the engineering staff at Sheridan to complete the design.
Physicians who currently reside in the Goodall Professional Office Building will lease space in the new 39,000-square-foot facility. There will also be a blood drawing station and several testing services for Goodall patients. When the old medical office building is vacated, the contractors will demolish it and turn the space into a parking lot for the new facility.
The hospital is "definitely in building mode," said John Martins, director of community relations. Other projects on the drawing board include a new medical office building in Waterboro and a major remodel of the hospital's emergency room, he added.
MaineGeneral Medical Center, Augusta & Waterville
Architect: SMRT Inc., Portland
General contractor: H.P. Cummings Construction, Ware, Mass.
MaineGeneral Medical Center began construction early this summer on a $10 million expansion of the emergency departments on its Augusta and Waterville campuses.
In Augusta, the number of exam rooms will increase from 15 to 22, and in Waterville the number jumps from 15 to 23 rooms. The rooms will be bigger ˆ from 90 sq. ft. currently to 150 sq. ft.
The Waterville project will be done in three phases over approximately 20 months. It will involve construction of an addition between the ambulance entrance and the kitchen area, and renovation of the former special procedures space and the library into a new entrance, waiting room and exam space.
In Augusta, the project is planned in four phases and should take about 19 months to complete. Changes include construction of a new ambulance entrance and EMS space, and a new entrance for patients. The project also will expand the waiting area to nearly double its current size and incorporate a separate treatment space for patients with behavioral health issues.
Mount Desert Island Hospital, Bar Harbor
Architect: SMRT Inc., Portland
General contractor: H.E. Callahan Construction, Auburn
Mount Desert Island Hospital opened a new obstetrics unit in May, which completes the Bar Harbor hospital's first phase of a plan to modernize all inpatient units. Funded by a $3.5 million capital campaign, the new obstetrics unit added 700 sq. ft. of space. The entire modernization project will involve moving all inpatient units, including medical/surgical, critical care, telemetry and obstetrics, to the second floor.
MDI this year also opened the 15,000-square-foot Cadillac Mountain Medical Building in Bar Harbor, which houses its behavioral health center, High Street Health Center and a dermatology practice. Jeff Nichols, public affairs coordinator for the hospital, said the added space was needed to accommodate the growth of expanding practices. The building, which at different times has been home to a dairy, nurses quarters and a car dealership, was completely renovated to accommodate the practices, including the addition of a third floor.
Southern Maine Medical Center, Biddeford
Architect: SMRT Inc., Portland
General contractor: J. Allie Construction Inc., Biddeford
Scheduled to open at the end of October is a 12,870-square-foot birthing unit at Southern Maine Medical Center. With input from nursing staffers, SMRT designed the unit to give new parents a feeling of a cozy Maine cottage, with all private rooms and baths, featuring beds and furniture by Maine Cottage Furniture, window treatments by Window Pretties, pull-out beds for dads, flat-screen TVs and mini-refrigerators in each room, private baths with pedestal sinks, soft lighting and wood-look flooring.
The $1.3 million project was funded in part by a donation from the late Elmina B. Sewall.
Eastern Maine Medical Center, Bangor
Architect: Vanderweil Engineers, Boston
General contractor: Cianbro Corp., Pittsfield
This summer, Eastern Maine Medical Center became the first hospital in Maine to embrace combined heating and power plant technology, which produces electricity and then uses the byproducts (steam or hot water) for other purposes. The natural-gas turbine produces power for heat, hot water and air conditioning.
The hospital was awarded $3 million of the $7.5 million project cost by the Department of Energy, said Jeff Mylen, director of facilities special projects at EMMC. The hospital had been considering such a project since the ice storm of 1998, which forced it to switch to its own generators. The company had paid for a feasibility study, but the possibility of Department of Energy funding "really got the ball rolling," Mylen recalled. The hospital began construction in July and expects to have the plant operating by the end of September 2006, he added.
Mylen projects the 4.6-megawatt plant, which will be located on the east end of the EMMC campus, could save the hospital as much as $1 million a year in energy costs. The cost of building and equipping the plant could be made up in less than four years, according to EMMC.
EMMC also recently opened a new walk-in care center and has received state approval to expand its intensive care unit by 12 beds. The ICU project, which will begin in late November or early December, will cost $4.5 million.
Hospital officials are confident the 60,000-square-foot facility, funded in part by a rural development loan of almost $19 million from the U.S. Department of Agriculture, will mean a lot to both patients and employees of the hospital, which is the area's largest employer with 200 staff members. In the last five years, the number of visits to the rural hospital's emergency room has increased by 20%. The new $22 million facility, scheduled to open in fall 2006, will have larger operating rooms, private emergency triage and treatment rooms, and private registration stations, said DeeDee Travis, director of community relations for the hospital. "It's a much improved layout," she said. "Currently, patients who are registering have to walk through the ER."
Like Calais Regional, Maine hospitals both large and small have been in construction mode this year, and several significant projects are on the drawing board for 2006. Other hospitals are seeking state approval for significant building projects that will take several years to complete, including a $120 million facility at Inland Hospital in Waterville and a $66 million plan by MaineGeneral Medical Center to close its Seton Unit in Waterville and move its services and staff to an expanded Thayer Unit, also in Waterville. Other projects envisioned include a $26 million in-patient center at York Hospital, a $28 million cancer center at Eastern Maine Medical Center and a $9.5 million critical-care facility at Central Maine Medical Center.
Changing demographics and medical technology have put increased pressure in particular on emergency departments of hospitals in fast-growing regions of the state. For instance, in 2004 the emergency department at Southern Maine Medical Center in Biddeford saw 36,000 patients, an increase of 1,000 patients over 2003. In the first six months of this year, that number had already grown by 1,200.
Despite the increase in demand, hospital expansion has been caught up in the state's struggle to control spiraling health care costs.
Gov. John Baldacci's Dirigo Health Reform Act in 2003 placed a one-year moratorium on large capital projects. When the moratorium was lifted in 2004, a backlog of more than $200 million in projects seeking the "certificate of need" approval required by the state had built up. In response, Maine created a Capital Investment Fund, which is not really a fund, but a cap on the amount of money that can be spent on hospital expansions statewide each year. The CIF is based not on the cost of construction, but on a complicated formula involving ongoing operating expenses. For the 2004-2005 budget period, that cap was $6.6 million.
Hospitals now must compete with one another to prove to the state how urgent their construction need is. "It limits what we'll authorize," said Trish Riley, director of the Maine Governor's Office of Health Policy and Finance, "and it has slowed the rate of applications." But she said the state still has to study what kind of savings can be attributed to the creation of the fund. She also noted that the certificate of need process only applies to capital improvements costing more than $2.4 million, or about 20% of hospital expansions.
An emergency room expansion project slated for next year at Southern Maine Medical Center was among the first projects to go through the new CIF process, and Sue Hadiaras, director of community relations for the Biddeford hospital, said it went relatively smoothly. "The state did a very thorough study," she said. "They spoke to our planning manager constantly, and we provided mountains of paperwork. They really did their homework."
Following is a roundup of Maine's major hospital construction projects that got under way or were completed in 2005. (See "On the drawing board," p. 24, for some projects proposed for 2006.)
Maine Medical Center, Portland
Architect: The Ritchie Organization, Danvers, Mass.
General contractor: William A. Berry & Son Inc., Danvers, Mass.
In September, former first lady Barbara Bush officiated over the groundbreaking as Maine Medical Center began work on a three-year-long construction program. The approximately $120 million Charles Street Project will include a women and infants building, a parking garage, a helipad, improved access and wayfinding, and a central utility plant. MMC plans to upgrade facilities for intermediate care and routine and critical care patient services. It will also renovate and expand the emergency department.
Speaking at the groundbreaking, Vincent Conti, MMC's president and CEO, explained the need for the facilities upgrade: "Along with the finest professionals and the latest equipment, the medical center must offer facilities that truly reflect a contemporary view of the nature of healing. Patients and families expect comfort as well as competence, privacy as well as pills, tenderness as well as technology," he said.
Inland Hospital, Waterville
Architect: Lewis & Malm Architecture, Bucksport
General contractor: Nickerson & O'Day, Brewer
The Lakewood Continuing Care Center on the campus of Inland Hospital in Waterville is nearing completion of phase one of its four-phase plan to expand from 76 to 105 beds and create three distinct care areas ˆ one for long-term care, one for rehabilitation/skilled care and a new wing dedicated to Alzheimer's/dementia patients.
The $7 million project begun in the fall of 2004 should be finished in late 2006 or early 2007, said Dan Booth, a vice president at Inland. He said increasing demand in the Waterville region for long-term care and skilled nursing beds spurred the expansion. Booth also noted that Inland is working on a new helipad, as well as a remodel of its OB/GYN facilities and medical labs.
Goodall Hospital, Sanford
Architect: Medical Space Planners, Morro Bay, Calif.
General contractor: The Sheridan Corp., Fairfield
The first of several building projects in the works for Goodall Hospital in Sanford, a $5 million medical office building was begun last December and is expected to be finished in January 2006. The two-story pre-engineered building was designed by The Sheridan Corp., and Medical Space Planners was retained to work with the engineering staff at Sheridan to complete the design.
Physicians who currently reside in the Goodall Professional Office Building will lease space in the new 39,000-square-foot facility. There will also be a blood drawing station and several testing services for Goodall patients. When the old medical office building is vacated, the contractors will demolish it and turn the space into a parking lot for the new facility.
The hospital is "definitely in building mode," said John Martins, director of community relations. Other projects on the drawing board include a new medical office building in Waterboro and a major remodel of the hospital's emergency room, he added.
MaineGeneral Medical Center, Augusta & Waterville
Architect: SMRT Inc., Portland
General contractor: H.P. Cummings Construction, Ware, Mass.
MaineGeneral Medical Center began construction early this summer on a $10 million expansion of the emergency departments on its Augusta and Waterville campuses.
In Augusta, the number of exam rooms will increase from 15 to 22, and in Waterville the number jumps from 15 to 23 rooms. The rooms will be bigger ˆ from 90 sq. ft. currently to 150 sq. ft.
The Waterville project will be done in three phases over approximately 20 months. It will involve construction of an addition between the ambulance entrance and the kitchen area, and renovation of the former special procedures space and the library into a new entrance, waiting room and exam space.
In Augusta, the project is planned in four phases and should take about 19 months to complete. Changes include construction of a new ambulance entrance and EMS space, and a new entrance for patients. The project also will expand the waiting area to nearly double its current size and incorporate a separate treatment space for patients with behavioral health issues.
Mount Desert Island Hospital, Bar Harbor
Architect: SMRT Inc., Portland
General contractor: H.E. Callahan Construction, Auburn
Mount Desert Island Hospital opened a new obstetrics unit in May, which completes the Bar Harbor hospital's first phase of a plan to modernize all inpatient units. Funded by a $3.5 million capital campaign, the new obstetrics unit added 700 sq. ft. of space. The entire modernization project will involve moving all inpatient units, including medical/surgical, critical care, telemetry and obstetrics, to the second floor.
MDI this year also opened the 15,000-square-foot Cadillac Mountain Medical Building in Bar Harbor, which houses its behavioral health center, High Street Health Center and a dermatology practice. Jeff Nichols, public affairs coordinator for the hospital, said the added space was needed to accommodate the growth of expanding practices. The building, which at different times has been home to a dairy, nurses quarters and a car dealership, was completely renovated to accommodate the practices, including the addition of a third floor.
Southern Maine Medical Center, Biddeford
Architect: SMRT Inc., Portland
General contractor: J. Allie Construction Inc., Biddeford
Scheduled to open at the end of October is a 12,870-square-foot birthing unit at Southern Maine Medical Center. With input from nursing staffers, SMRT designed the unit to give new parents a feeling of a cozy Maine cottage, with all private rooms and baths, featuring beds and furniture by Maine Cottage Furniture, window treatments by Window Pretties, pull-out beds for dads, flat-screen TVs and mini-refrigerators in each room, private baths with pedestal sinks, soft lighting and wood-look flooring.
The $1.3 million project was funded in part by a donation from the late Elmina B. Sewall.
Eastern Maine Medical Center, Bangor
Architect: Vanderweil Engineers, Boston
General contractor: Cianbro Corp., Pittsfield
This summer, Eastern Maine Medical Center became the first hospital in Maine to embrace combined heating and power plant technology, which produces electricity and then uses the byproducts (steam or hot water) for other purposes. The natural-gas turbine produces power for heat, hot water and air conditioning.
The hospital was awarded $3 million of the $7.5 million project cost by the Department of Energy, said Jeff Mylen, director of facilities special projects at EMMC. The hospital had been considering such a project since the ice storm of 1998, which forced it to switch to its own generators. The company had paid for a feasibility study, but the possibility of Department of Energy funding "really got the ball rolling," Mylen recalled. The hospital began construction in July and expects to have the plant operating by the end of September 2006, he added.
Mylen projects the 4.6-megawatt plant, which will be located on the east end of the EMMC campus, could save the hospital as much as $1 million a year in energy costs. The cost of building and equipping the plant could be made up in less than four years, according to EMMC.
EMMC also recently opened a new walk-in care center and has received state approval to expand its intensive care unit by 12 beds. The ICU project, which will begin in late November or early December, will cost $4.5 million.
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