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.]

600 beds in once place is OK, but 175 is "Too Many"?

Children's Hospital has appealed to the Department of Health to block Swedish Hospital from building a new, 175 bed hospital on the growing Eastside. It claims that Swedish will put "too many beds" in one place. At the same time, Children's insists that it must build 350 additional beds at its own site, for a grand total of 600 beds in one place.

Somebody is not telling the truth here.

The following excerpts come from a recent Seattle Times article. The article summarizes the appeal filed against Swedish:

Swedish Plans to Build in Highlands (Seattle Times, 1/24/2008)

"Swedish Medical Center will build its future Eastside hospital in the Issaquah Highlands.... The first phase of the 175-bed facility is expected to open by 2012.

Four hospitals filed a joint appeal with the state Department of Health last June over its decision to allow Swedish to build a facility in Issaquah.

Overlake Hospital Medical Center in Bellevue, Evergreen Hospital Medical Center in Kirkland, Snoqualmie Valley Hospital in Snoqualmie and Children's Hospital & Regional Medical Center in Seattle argue that the state's approval concentrates too many hospital beds in one part of the Eastside.

The $207 million facility would include a pediatrics unit, 10 operating rooms and a neurology department."

A bit more food for thought:

• The planned Swedish Hospital location is "greenfield," so construction will be unhindered by existing structures. In contrast, Children's plans will entail decades of disruption to existing hospital facilities during construction. This will impact patient care and escalate costs.
• Children's seeks 600 of its own beds in one place. These beds would be very close to the UW Hospital, which has... you guessed it... even more beds.
• Which area is growing most quickly, so logically needs more beds-- the Eastside or NE Seattle? The Eastside wins hands-down. Issaquah's population just grew 26% in one year alone (see the Times).
  

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
  

How Many Beds?

An independent study on the Hospital's need for beds is now available for download as a 2MB PDF: Field Associates Bed Study. This professional study used the Washington State Department of Health's standard methodology for calculating the Hospital's bed needs. This is the methodology that the Hospital would be required to use to gain Dept. of Health approval for adding beds. The two most surprising findings (emphasis added):

"CHRMC proposes ten times more new capacity than this study finds is warranted through application of the Department [of Health]’s method."

"In Seattle, Swedish Hospital’s inpatient pediatric services now care for more King County children than does CHRMC."

Further excerpts from the study:

"Children’s Hospital and Regional Medical Center (CHRMC) is proposing ... approximately 350 new inpatient beds. ...

Based on the Department’s published method of distributing hospital beds across the state, this study finds no support for the addition of inpatient beds to CHRMC’s current capacity of 250 beds until after the the year 2015. A small increase in beds – up to 40 – may be warranted by the year 2026 (the very end of CHRMC’s 15- to 20-year master plan planning horizon. ...

CHRMC’s proposal of 350 new beds appears to be approximately ten times the actual number required at CHRMC twenty years from today. ...

In light of such an oversupply... the CHRMC Master Plan can be expected to have unwanted impacts on the financial and program viability of other hospitals and to unnecessarily increase the cost of health care both locally and in the state. Under-used hospital beds put extra costs into the health care system, thus driving up the taxes and health care premiums we all pay to support it. As the Washington legislature stated, when hospitals over-build, “that excess capacity of health services and facilities place considerable economic burden on the public.” [RCW 43.370.030(2)(a)]"

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.