Opportunity for a Second Site.

A large parcel of land at the nexus of Bellevue and Redmond just went on sale. Consider:

• Overlake: 28 acres, 78$ million, zoned for up to 125 foot buildings and currently contains a former Group Health hospital (Seattle Times).
  
• 136 Laurelon Condos: 6 acres, 93$ million, zoned residential (Seattle Times).

Yet CHRMC has told neighbors that the Overlake site is "too small."

The Hospital needs to consider a second in-patient site as part of its EIS. The impacts of a massive expansion at the Hospital's current site may very well be unmitigatable. This makes it ever-more essential for the Hospital to explicitly, publicly justify the trade-offs of accumulating 600 beds in NE Seattle vs. establishing a second site for in-patient care.

We ask: Why not put the beds where the kids are?

Consider where the kids are.

• Seattle? Only 17% of the Hospital's patients came from Seattle in 2006, according to the Hospital’s own report. Furthermore, “Seattle [is] second only to San Francisco as the big city with the lowest percentage of households with children — only 20 percent have children under 18” (Seattle Times).
• The Eastside (for example). Issaquah's population (for example) just grew 26% in one year alone (Seattle Times). Yet remember, Children’s has filed suit to halt Swedish’s construction of 175 new beds (including pediatric beds) in Issaquah (Seattle Times).

Consider real transportation hurdles for patients and families. If you are an Issaquah parent and your child is hospitalized, the last thing you want to do is to fight the 520 bridge to see her before/after/during work. In a hectic hospital, kids need their parents as both advocates and sustainers. If you're a kid, you don't want to have to spend your school days trucking to endless follow-up appointments (or a long series of tests) across the lake. Long distance travel discourages consistency in follow-up and ongoing care. Just a fact of our transportations mess. The out-patient clinics the Hospital plans to add are helpful, but they do not fix the problem of accessibility of in-patient care & follow-up.

Define "critical mass." The hospital claims that it won''t have "critical mass" for a second in-patient site. At the same time, it proposes adding 350 beds to the 250 it already has at one site, for a total of 600. Why wouldn't 350 beds be sufficient to establish a second site? The current site had 200 beds until only recently.

Publicly evaluate trade-offs of a second site. Yes, initial startup size at the second site might be a challenge and a trade-off, but it would be temporary. As for proximity to the UW, it's time to talk about technologies that let doctors participate in research seminars on campus via teleconferencing. Yes, doctors would sacrifice convenience with two campuses, but patients would gain better access to care. And a 350 bed hospital would certainly be self-sustaining, so cross-lake trips for doctors should not be a daily activity.

Publicly evaluate potential partnerships with other hospitals. To improve the accessibility of beds while making the most of scarce resources, could Children's add a pediatric wing to an existing--or new-- adult hospital? Yes, highly specialized care might remain located in Laurelhurst, but less-specialized care could be offered closer to kids' homes. Thinking out-of-the-box, could Children's partner with another hospital to co-locate adult and pediatric beds during the start-up phase for a new site, converting all beds to pediatric use in the long-term?

We ask: Is it possible to put the beds where the kids are?

[Update: Please note:

• The Overlake site is most certainly not in Issaquah. We've heard of a letter from a hospital-paid legal team that claims that it is. Overlake is on the border of Bellevue & Redmond & right next to 520, as shown in the map above.
• This post mentions Issaquah because of the Hospital's efforts to kill the addition of a hospital there, including pediatric beds accessible to that area. It is included as an example of how the Hospital needs to think more carefully about accessibility of care to patients.]

Letters to the Editor

From neighbors:
Letter To The Editor of the Seattle PI-- Unpublished
Subject: Reply to P-I editorial 01/15/08

Your 01/14/08 editorial "Finding consensus" states that "Children's Hospital certainly needs to expand". The key questions are, by how much and where? Consider the facts:

CHRMC justifies the scope of its expansion by forecasting a need for a total of 548 pediatric beds by 2020. But the Washington State Department of Health (DOH) estimated this need at only 317 beds while a recent estimate by Field Associates put the number at 271, a substantial disparity.

You "liked what Children's Ruth Benfield said at a [Citizen's Advisory Committee] meeting last week: '...we will ultimately be able to come together with something that is workable ' ". However, when asked at an earlier CAC meeting why Children's OPPOSED Swedish Hospital's recent proposal to the DOH for new pediatric beds on the East Side, Ms. Benfield said "Swedish is a fine hospital, but they can't provide the same level of care that we can." Apparently it is ok for Children's to expand but not its competitors.

Finally, it is not only "some neighbors" who want the hospital to expand elsewhere. Many of the hospital's own physicians, nurses, and staff dread the impact of an entire generation (25 years, not 15) of very costly construction overlaying their existing buildings, where they treat the most vulnerable of patients.

Letter to the Editor of the Seattle PI, 1/10/2008-- Published
Building a second campus would cost less money

Seattle's Children's Hospital and Regional Medical Center proposes a 1.5 million sq. ft. on-site expansion overlaying their current 900,000 sq. ft. campus. CHRMC says "it would be too impractical and expensive" to expand to a second campus (Wednesday P-I), but has not released the cost of its own expansion plan. In fact, building a second campus would cost substantially less than on-site expansion. New construction on an unoccupied site is far less expensive than upgrading old buildings, especially for high-tech uses.

The cost-effective alternative: Maintain the current campus for non-critical patients and build a second campus at South Lake Union. That would save hundreds of millions of dollars to spend on world-class faculty and state-of-the-art equipment.

This alternative would avoid the severe impact of 15-20 years of on-site construction on the patients, families and medical staff of a working hospital. It would offer the advantage of contiguity to the Fred Hutchinson Cancer Center and CHRMC's own new South Lake Union research center. CHRMC's vital mission would be better served by this cost-effective alternative.

Recent articles in the PI and Times:

• Bigger Children's Hospital means more time in traffic
• Children's Hospital: Finding consensus
• Still too tall, say Children's Hospital neighbors
• Swedish Plans to Build in Highlands
  

A Neighbor Takes a Long-Term Look at Construction Costs

This interesting analysis of alternative plans and their costs was contributed by a neighbor:

CHRMC Expansion: Two Cost-effective Alternatives

Chicago's Children's Memorial Hospital (CCMH) is building an entirely new 1.25 million sq. ft. hospital on a new site to replace their current facility (see here and here). Their latest cost estimate is $1 billion, taking 4 years to complete. Compare this to the cost of Seattle's Children’s Hospital and Regional Medical Center (CHRMC) expansion proposal:

Plan A: CHRMC proposes a 1.5 million sq. ft. on-site expansion overlaying their current buildings, taking 15-20 years. They have not released the cost - our Citizens Advisory Committee (CAC) should ask for this estimate - but common sense and a professional construction cost estimator tell us that the cost will be at least double that of construction on a clean site. Based on the Chicago cost, this leads to an estimate of (1.5/1.25) x $1 billion x 2 = $2.4 billion.

Furthermore, CHRMC tells us that 20 years from now, the current buildings that remain will have to be replaced, having outlived their useful lives. How much more will it cost to replace these 900,000 sq. ft. on-site? Perhaps $1 billion, probably more, requiring another 10 years of on-site construction. Thus we estimate the total cost of 2.4 million sq. ft. of new/renovated space for CHRMC to be $2.4 + $1 billion = $3.4 billion, accompanied by up to 30 years of on-site construction impact and disruption on the patients, their families, the medical staff, and the community. (Cost estimate based on Chicago numbers; no estimate released by CHRMC.)

Plan B (buiid on a new site): By contrast, CHRMC does say that the cost to move from their present 900,000 sq. ft. site and build a brand new 2.4 million sq. ft. hospital (including the additional 1.5 million sq. ft. they ask for) would be $2-2.5 billion, taking only 5 years. And this cost would be reduced further by the proceeds of the sale of the existing campus. So for a savings of $1 billion or more, CHRMC could build a brand-new 2.4 million sq. ft. facility instead of the proposed 1.5 million sq. ft. on-site addition followed by renovation of their current buildings. This would avoid up to 30 years of disruption to CHRMC itself and the community.

Clearly Plan B would be win-win for everyone.

Another low-impact, low-cost alternative:

Plan C: leave the current 900,000 sq. ft campus untouched and build a second 1.5 million sq. ft campus on a new site, with the advantage of geographical diversity and/or locating next to a partner hospital or CHRMC's own new research facility. Based on the Chicago numbers, this would cost only $1.2 billion, again with no disruption to anyone. CHRMC objects, citing the inefficiency of operating a "smaller satellite hospital", but surely 1.5 million sq. ft. does not qualify as a small satellite. Chicago's CCMH is happy to be getting a brand new 1.25 million sq. ft. hospital in total.

Letters to the Editor from Neighbors

We're behind in sharing letters from neighbors to the Editor of the Seattle Times. Here are two that made it to us but didn't make it into print:

To the Editor:
The Times overlooked an important story with its recent article (“Laurelhurst, Children's Hospital at it again over planned expansion,” 9/27/07).

Children’s Hospital appears to be seeking to limit the location and thus the accessibility of in-patient pediatric care in our region. The Hospital plans to concentrate in-patient pediatric services in a heavily congested area that is already well-served by hospital facilities. Parents on the Eastside and elsewhere need to hear this news.

The Hospital is actively working against a planned expansion of hospital beds by Swedish on the growing Eastside. The Times reported that the Hospital has formally complained to the Department of Health that expansion in Issaquah “concentrates too many hospital beds” in one place (“Hospitals challenge state's OK for Swedish in Issaquah,” 6/23/07). Yet Children’s has proposed twice as many new beds (350 vs. 175) for its facility in Northeast Seattle, hardly the center of population growth in our region.

Swedish appears to be quite a progressive institution. Its website celebrates its collaborative, regional heart-surgery program (“Mary Bridge, Swedish Establish Joint Pediatric Heart-Surgery Program,” 2/10/04). Physicians care for young patients close to homes and families. What a forward-thinking idea. Let’s get more of those on the table.

To the Editor:
"Children's unveils revised plan" [10/31/07] discusses tower heights, but omits more important questions:

Is such a large expansion warranted? The hospital plans to build 300+ beds, but the Department of Health projects it needs only 65.

CHRMC actually opposes Swedish Hospital's plan to build 175 beds (including pediatric beds) in the growing area of Issaquah ["Hospitals challenge state's OK for Swedish in issaquah", 6/23/07]. Why does CHRMC oppose a geographic expansion of in-patient health care?

If expansion is justified, where should it occur? CHMRC's mission would be better served by a second campus rather than by 15-20 years of major construction on their current working campus. A few reasons:

• A second campus would offer geographic diversity to serve a growing population.
• Contrary to your article, the cost of a second campus would be only 1/3 to 1/2 the cost of on-site expansion. This would free up at least $500 million for land acquisition, additional medical personnel, and state-of-the-art equipment.
• 15-20 years of construction dust, noise and obstruction would threaten patient health, staff morale, and staff attrition. In fact, CHMRC administrators say [CHMRC, 10/30/07] they would much prefer to build on a clean site if feasible.

Patient Geography

A 2006 report by Children's Hospital, shows that only 17% of its inpatients come from Seattle.

Insight. Take a closer at the King County figures. Does the distribution of patients (Seattle vs. the rest of King County) match the actual distribution of kids in the county? If you run the numbers, Seattle kids appear as Children's inpatients 50% more often than they should based on population distribution alone. A host of things might contribute to this pattern, but having a single, Seattle location for inpatient care must surely play a role. The numbers suggest that having a single inpatient site reduces the accessibility of care in King County.

Analysis Explained. According to this chart, 45% of all inpatients come from King County. According to a report by New Futures, 23.9% of King County’s kids live in Seattle. Thus, you would expect that 11% of all of Children’s inpatients would be Seattleites (11 is 23.9 percent of 45). Yet 17% of all patients come from Seattle. This suggests that Seattle kids are much more likely to get care at Children’s than other King County kids. In fact, Seattle kids are represented among Children’s inpatient population at a rate more than 50% greater than you would expect if all kids in King County had equal access to care at Children’s Hospital.