Upgrades, New Construction to Improve Alaska's Healthcare Access
Upgrades, New Construction to Improve Alaska’s Healthcare Access
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www.akbizmag.com By Vanessa Orr H ealthcare construction in Alaska is influenced by many different factors, including an aging
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While it’s important to invest in expanding, renovating, or even building brand new facilities, healthcare systems must at the same time keep a very tight grip on expenses, especially in this time of economic uncertainty.
population; the need for specialized services such as mental health and addiction treatment; technological advancements; and requirements to update or replace facilities and equipment in order to meet state and federal regulations. Yet while it’s important to invest in expanding, renovating, or even building brand new facilities, healthcare systems must at the same time keep a very tight grip on expenses, especially in this time of economic uncertainty.
equipment. “We are also replacing an MRI with newer technology, which will
At Alaska Regional, for example, construction is underway on replacement equipment projects and on renovations required to meet regulatory requirements. Work is also taking place to repair damage caused by the earthquake in November 2018. Other projects, such as the addition of twenty-four new psychiatric inpatient beds, are on hold.
“Right now, we’re working on two replacement equipment projects, including a CT scanner that moved about twelve inches during the earthquake,” says COO Jennifer Opsut of the $900,000 investment, which includes construction and cost approximately $2.9 million, and replacing our Cath Lab with newer technology, at a total of $1.4 million.” Both the MRI and Cath Lab projects are expected to be completed next month. The hospital is also building a new Emergency Preparedness Conference Center to deal with future natural disasters, which is budgeted at $600,000 and is expected to be The 7.0 earthquake in November 2018 did not injure Alaska Regional Hospital patients or staff, but broken water pipes and fallen ceiling tiles caused a several day cleanup effort, as well as the need to replace some equipment. © Alaska Regional Hospital
www.akbizmag.com completed in December. A pharmacy remodel, the result of regulatory
requirements, recently went out to bid with a December completion date. “In the case of the preparedness center, it’s not a matter of ‘if’ but ‘when’,” says Opsut of the need to have a central planning space to deal with the next earthquake or emergency situation. In the past five years, HCA, the parent company of Alaska Regional, has invested approximately $100 million in renovations and is expected to continue its support of local facilities. While this year’s budget is similar to last year’s, according to Opsut, the instability caused by the state’s budget issues could influence future planning.
“Current and future projects absolutely could be affected by what happens with the governor’s budget,” she says. “Alaska Regional received a Certificate of Need for an upcoming behavioral health project, but that project is now on hold due to the uncertainty of the budget process. “We are also continuing to closely monitor expenses, as we are incurring the extra cost of managing more behavioral health patients due to Alaska Psychiatric Institute [API] not having all of its beds open,” she adds. “For at least
a year, we’ve been dealing with the fact that API is struggling, and that is only going to get worse with the governor’s proposed cuts.”
Opsut gives the example of patients currently on Medicaid who may soon see cuts in services. “This is going to lead to even more problems down the road, which is making us take a hard look at future projects at Alaska Regional,” she explains.
Still, the health system is continuing to evaluate projects and look at strategies, not only in the Anchorage community but throughout the state of Alaska. “We have a couple of projects in mind, but they are not to the point of public discussion because we haven’t made final decisions,” she says. “But we are always looking at projects for the future in order to treat the healthcare demands of our community.”
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www.akbizmag.com Providence Health & Services Alaska also has several projects in the works, including two pharmacy compliance projects, a laundry compliance project, and construction of a Cath Lab on Providence’s main campus in Anchorage.
“We just received funding for the $1.9 million Cath Lab 5 project, which is a construction build-out that is expected to take between six and eight weeks,” says John Bush, lead construction project manager for Alaska. “Right now, we’re ordering equipment, and we’ll wait to begin construction until it is on its way; we want to minimize downtime and not take the Cath Lab out of service any sooner than we have to.”
The Cath Lab build-out includes an equipment upgrade that requires tearing down the room. “Because the shielding requirements of the new equipment are beyond what the current equipment requires, we need to replace the lead lining in the walls, floor, and ceiling, so we have to tear down the entire lab and put it back together,” says Bush.
Providence also has a number of pharmacy compliance projects underway, including a $2.2 million project in Kodiak and a $1.6 million project in Anchorage. The projects are designed to meet new federal regulations that expand controls for the
“Current and future projects absolutely could be affected by what happens with the governor’s budget… Alaska Regional received a Certificate of Need for an upcoming behavioral health project, but that project is now on hold due to the uncertainty of the budget process.”
Jennifer Opsut, COO, Alaska Regional
protection of workers when processing hazardous drugs.
“This is a fairly new federal requirement that requires new ISO7 clean rooms, ante rooms, sterile compounding rooms, and hazardous drug rooms,” explains Bush. “As of December, all of the pharmacies in the United States must be in compliance with these federal requirements. Each of our fifty-two ministries has multiple pharmacies, so we will be making these changes throughout the system.” “Because these must remain active, live pharmacies, each of these will be multiphase projects,” adds
Dale Rahn, regional director for real estate, construction, facilities, and environmental services. “There is a lot of complexity, including numerous air differentials that have to be maintained to keep them at their current levels.” Providence will also be replacing outdated washers and dryers to meet compliance requirements in Kodiak, a project budgeted at $1.6 million. “The hospital facility is owned by the borough, but because we operate the hospital, we are responsible for the operations that provide laundry service in-house,” says Bush.
Because the hospital will need to
continue to operate the laundry while undergoing renovations, the project will take place in multiple phases. “We will replace the dryers in the first phase and the washers in the second phase,” says Bush, adding that the last phase will include removing the existing washers. “We’ve also made infrastructure changes, including adding a 1,000-gallon propane tank because propane-fired dryers are more effective and cost-efficient.” The project should be completed this month. The contractor for all of these Providence projects is Davis Constructors & Engineers.
Norton Sound Health Corporation is in the process of building a Wellness and Training Center in Nome, which is expected to be completed at the end of February 2021.
While there are renovations underway, Rahn says that the volume of healthcare construction is lower than in the past. “We are limited by the amount of money we can request and the fact that we are competing for it with many other departments,” he says, adding that in the past year, capital improvements have been minimal.
“We are hopeful that this will change; we are looking at receiving more money from an outside funding source for infrastructure improvements, though I can’t comment on what that source is at this time,” he adds. “We are hoping that soon we will be able to pump some additional money into aging infrastructure throughout the whole region.”
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www.akbizmag.com Norton Sound Health Corporation (NSHC) has quite a few projects underway, according to Mike Kruse, director of engineering, in addition to those it recently completed. In March, NSHC completed an MRI addition to the hospital, which was a significant milestone as it is the first MRI off the road system and the first MRI to be owned by a tribal health organization. Small adjustments are still being made to the $6.2 million project, though the MRI is already patient-ready. In August, NSHC also opened a new $5 million, 3,500-square-foot replacement clinic in Shaktoolik.
Three contracts were awarded in fall 2018, which include a $16 million, 25,000-square-foot Wellness and Training Center in Nome. The first floor will house the entire Behavioral Health Services program in a primary care setting, which will offer alternative health therapies to facilitate pain management, psychiatric services, and a social detox space with clinical decision-making to support the region. The second floor will contain classrooms and conference rooms for medical training.
“The majority of the training center is dedicated to supporting health aides as they get their certifications,” says Kruse of the center that will include a mock pharmacy, exam room, and lab, as well as functioning equipment. Construction is expected to be completed at the end
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The site of Norton Sound Health Corporation’s Little Diomede Clinic is approximately 1,000 feet from where landing craft can dock, meaning that all supplies and equipment must be handcarried to the site.
www.akbizmag.com of February 2021, with plans to open that July.
Approximately 200 feet down the road, construction is beginning on the $11 million, 18,000-square-foot NSHC Operations Building, which will house the village facilities maintenance crews as well as the Office of Environmental Health and other support services not directly related to patient care. One of the more demanding projects facing NSHC this year is the construction of a clinic on Little Diomede, which has no fixed wing service and no barge landing. Located on an island in the middle of the Bering Strait, the clinic is being built approximately 1,000 feet from where the landing craft will dock, meaning that all supplies and equipment must be hand-carried to the site.
“It is logistically challenging,” says Kruse, who at the time this article was being written had been trying for the previous five days to get a helicopter out to the site that was grounded because of weather. “I just got a picture of the construction site, and it’s pretty wild.”
“As of December, all of the pharmacies in the United States must be in compliance with federal requirements [for the protection of workers when processing hazardous drugs]. Each of our fifty-two ministries has multiple pharmacies, so we will be making these changes throughout the system.”
John Bush, Lead Construction Project Manager Providence
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www.akbizmag.com While the estimated finish date is July 2020, that plan is subject to change. “Last year, Little Diomede had one of the worst winters they’d had in eighttwo years,” says Kruse, “so I’ve got a lot of contingencies built into the project. But we’re looking forward to meeting the building challenges that the island presents and completing the project.” The clinic will replace the existing clinic, which is located on top of the washeteria. It will consist of 1,100 square feet of clinic space and 70 and 704 square feet of mechanical space, totaling 1,800 square feet, doubling the size of the existing clinic. It is budgeted at $6 million.
Two other replacement clinics are also underway; one in Shishmaref and one in St. Michael. Foundation and site
Norton Sound Health Corporation’s $16 million, 25,000-square-foot Wellness and Training Center is expected to be completed at the end of February 2021 and will open to patients in July.
work is budgeted at $1 million for each clinic; the total price is $8.5 million per clinic upon completion.
“We’ll be using a clinic design template piloted by NSHC,” says Kruse, adding that after site work is completed in fall, bids for vertical work will be awarded in October. A feasibility study to replace a third clinic in Wales, which will include permitting, leasing, and land acquisition, is on the books to start in 2021.
www.akbizmag.com Other healthcare construction projects throughout the state include the $2.5 million Rainforest Recovery Center at Bartlett Regional Hospital in Juneau. The facility, which will create a single point of entry for patients seeking addiction treatment, will be financed from the city’s 1 percent sales tax. Work continues on the Yukon Kuskokwim Health Corporation’s $300 million Paul John Calricaraq project in Bethel, which includes a new clinic and the renovation of the Yukon Kuskokwim
Site work on Norton Sound Health Corporation’s Operations Building is currently underway. The $11 million, 18,000-squarefoot facility will house the village facilities maintenance crews as well as the Office of Environmental Health and other support services.
Health Corporation’s hospital. Outpatient facilities began seeing patients on July 15. Central Peninsula Hospital is also continuing its $40 million Phase VI construction project that includes the construction of a new catheterization lab and obstetrics wing. Projects on hold include a $60 million expansion of facilities at the Mat-Su Regional Medical Center. That project, which was slated to take place in 2020 and 2021, includes a $14.5 million expansion of emergency treatment facilities and $4.5 million for new inpatient psychiatric beds.