Hospital Construction

Region's Institutions Try to Keep Pace with Health Care Advancements

by Debra Wood

Around the New York region, aging hospitals aiming to stay competitive with the latest technologies are upgrading and expanding.

Projects are under way or getting set to begin in New York, New Jersey, and Connecticut at various types of institutions, including academic and research facilities, nonprofit community health care centers, and public hospitals.

Drivers for the current work include consolidation of services to core locations, patient-safety initiatives, conversions of multipatient rooms to private ones, expansion of emergency departments and surgical suites, and incorporation of new services that aging baby boomers are demanding.

But the region's activity is well short of the level of construction found in other parts of the country. The culprit is largely a lack of funds for such capital reinvestment, said Rick Abbott, health care principal and vice president overseeing East Coast projects for HDR, a design firm headquartered in Omaha, Neb.

"With the exception of major academic teaching hospitals or heavily endowed hospitals, it is sluggish in the Northeast and in particular in New York," he added. "The money is not available, and hospital profit margins are far less than in the rest of the country."

New York's hospitals indeed fare poorly in comparison to national trends, according to Kenneth Raske, president of the Greater New York Hospital Association. Raske testified before New York's State Senate in February and detailed how health care facility operating margins are well below national levels.

Raske also testified that nationally, hospitals fund capital projects through a 50-50 combination of savings and borrowing, with high-performing hospitals funding 60 percent of their projects through cash funds. By contrast, due to poor profitability, New York hospitals in 2003 could only pay up front for 18 percent of their projects, Raske added.

In addition, New York hospitals cumulatively logged a statewide operating loss of $127 million in 2004, the seventh straight year of red ink, said Daniel Sisto, president of the Healthcare Association of New York State, citing the last year for which full data is available.

The aging stock of the region's health care industry compounds the problem, Abbott said.

"Most hospitals are struggling with facilities that are at least 30 years old, and they don't have the funds to upgrade them and keep them up to the standards of the rest of the United States," he added. "Most of the hospitals [in the region], with the exception of major academic hospitals, are looking at construction projects in the $25 million to $50 million range. In other parts of the country, the average construction projects are in the $100 million to $200 million range."

Part of New York's problem lies in a stricter regulatory environment that limits state reimbursement of capital costs as well as other factors, said Robert Levine, senior vice president of Turner Healthcare of Brentwood, Tenn., a national unit of New York-based Turner Construction that oversees the company's work in the sector.

"New York State reimbursement is tougher, and there seems to be an inordinate amount of uncompensated health care given," he added. "It makes it more difficult to carry major capital programs."

Levine said those factors have contributed to a lack of new construction, and added that nearly 20 years have passed since a new replacement hospital for the public was built in the state.

Turner is overseeing early work on one new project that could result in a replacement hospital for Orange Regional Medical Center in Wallkill, N.Y. The new hospital would consolidate services now provided at two existing facilities, Arden Hill Hospital, built in 1915, and Horton Medical Center, built in 1929. But for now, Levine said the consolidation project has been placed on hold due to budgetary problems.

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Academic Units Mix Care, Research

Even in the New York region, academic centers remain a bright spot in the construction arena.

Both the University of Medicine and Dentistry of New Jersey in Newark, N.J., and the Joan and Sanford I. Weill Cornell Medical College in Manhattan are adding new facilities. Cornell is adding a new $230 million ambulatory care and medical education building and UMDNJ is building a new $75 million research-and-patient care cancer center.

Both projects are slated for completion later this year, and both will further a recent trend toward merging research and patient care into new facilities.

A similar effort is under way to construct the $47 million, 163,000-sq.-ft., four-level James P. Wilmot Cancer Center for the University of Rochester Medical Center in Rochester, N.Y. The Pike Co. of Rochester broke ground in March on the structure and expects to complete the post-tensioned, cast-in-place concrete building in April 2008.

"This will allow us to consolidate all cancer care into one location on the medical center campus and bring clinical and laboratory cancer research into the facility as well," said Leslie White, a spokeswoman for the medical center.

The hospital plans to recruit 25 more clinicians and scientists to expand its research program. It aims to become a National Cancer Institute-designated comprehensive cancer center.

Designed by Donald Blair & Partners Architects of New York with SWBR Architects & Engineers of Rochester, the building features a three-story atrium that will provide a bright, open environment. The structure is also designed to support additional floors in the future.

The new facility's first floor will contain treatment rooms while the second and third floors will have dry and wet research space. Merging research facilities with patient care "allows patients and researchers to understand each other's presence and, hopefully, energize both," said Patrick Rogers, a Pike vice president.

During preconstruction, Pike's cost modeling led to the selection of concrete over steel because it was cheaper, provided greater flexibility with the mechanical system, and allowed for shorter floor depths, which enables the new building to link to an adjacent existing structure on the campus.

In the construction effort, crews installed a retaining wall to hold up a street bordering the site while excavating the basement, which will house the radiation oncology unit. They also built a 3-ft.-thick, floating, concrete mat over driven piles to support a linear accelerator, which will be used for cancer treatment.

Another academic center project is set to start in September when Yale-New Haven Hospital in New Haven, Conn., breaks ground on a $430 million, 112-private room clinical cancer center.

The hospital currently provides cancer care services in six locations on its campus, but once the new 497,000-sq.-ft., center is complete, Yale-New Haven will bring all inpatient and outpatient care under one roof.

"Over the last five years, we've seen nearly a 25 percent increase in inpatient admissions, and the rate of growth is nearly double for cancer services," said Vin Petrini, senior vice president for public affairs at Yale-New Haven.

Shepley Bulfinch Richardson & Abbott of Boston designed the 14-story center, and Turner performed preconstruction services and will build it. Yale-New Haven will seek certified-level U.S. Green Building Council Leadership in Energy and Environmental Design status for the project.

Petrini said the center is scheduled to open in fall 2009 or early in 2010.

Another university hospital is focusing on a recent trend of building wellness centers that combine rehabilitation services with fitness facilities for the general public under one roof, said Brad Earl, vice president and managing principal of HLM Design-Heery International in Philadelphia.

He said his firm designed a $13 million, 87,000-sq.-ft. wellness facility for the Robert Wood Johnson University Hospital in Hamilton, N.J., which opened last year. He said the center has proven so successful that the hospital is looking for a site to build another.

Public, Community Hospital Projects

Activity in the public hospital sector in the region had been busy last year, when several projects started up and others neared completion. New York City's Health and Hospitals Corp. last year completed major modernization projects at Bellevue Hospital Center in Manhattan and Coney Island Hospital in Brooklyn and also moved ahead on expansions and modernizations at Jacobi Medical Center in the Bronx, Queens Hospital in Queens, and Kings County Hospital Center in Brooklyn.

Its most recent large project is a $243 million modernization of Harlem Hospital Center in Manhattan. The effort entails the renovation of the Martin Luther King Pavilion and construction of a new six-story facility that will have an updated emergency department, operating rooms, and diagnostic services; a parking garage; and an emergency medical services garage.

"This is bringing new technology to Harlem," said Vincent James, senior director of the hospital agency's Office of Facilities Development. "It's cheaper for us to do a new building and give the facility a new identity, so we can stay in the mold of the 21st Century."

Demolition of existing hospital structures on the campus and preparatory sitework was taking place in the spring. The project team, led by TDX Construction of New York as construction manager, is expected to break ground in late winter or early spring on the addition. A joint venture of Philadelphia-based McKissack & McKissack and HAKS Engineers of New York will build the parking facility and EMS garage.

As part of the project, the agency is taking Works Progress Administration murals painted by African-American artists out of structures that are slated for demolition. It plans to later restore them for installation in the lobby of the new pavilion.

In New Jersey, a major public project broke ground last year to replace of the state-operated Greystone Park Psychiatric Hospital, built in 1876. Torcon Inc. of Westfield, N.J., is building the new 460,000-sq.-ft. facility for the mental health services unit of the New Jersey Department of Human Services.

The new facility will have 450 patient rooms, treatment areas, and administrative offices. It is set to open in March 2008.

"We're looking to update the facility to accommodate a large number of people and to make it more modern," said Glenn Phillips, public affairs officer for the New Jersey Economic Development Authority, which is administering the project.

Some nonprofit community hospitals in the region are taking a longer-range approach to meet facility needs. Institutions such as Stony Brook University Hospital in Stony Brook, N.Y., Community Medical Center in Toms River, N.J., and St. Francis Hospital in North Hempstead, N.Y., have all begun multiyear capital programs that are upgrading and expanding their campuses. Hackensack University Medical Center in Hackensack, N.J., completed a similar upgrade last year with a new $110 million, 300,000-sq.-ft. Women's & Children's Pavilion.

At St. Francis on Long Island, Turner is construction manager on an effort to build a 154,000-sq.-ft. pavilion, extend an existing parking garage, and renovate 75,000 sq. ft. The team has already demolished existing buildings to prepare the site.

For the new building, Turner will use filigree wide-slab, precast, prestressed panels in the garage and tower to accelerate construction, said Christofer Deschler, the company's project manager. Once in place, the team installs rebar, plumbing drains, and electrical piping on each of the panels, then pours concrete over them to form the individual floor slabs.

The four-year job is part of a $190 million master plan to build new clinical, diagnostic, and treatment space and to upgrade patient care and physical plant facilities.