When building the replacement for the William Beaumont Army Medical Center at Fort Bliss in El Paso, Texas, the local premium will be “blast protection” and other anti-terrorism measures, “which is something you don't see in civilian facilities that add to the cost,” says Jim Draheim, senior vice president with Omaha, Neb.-based HDR Architecture. Draheim recently held an intensive two-day design review with government officials where costs were very much front and center.
According to Draheim, the 131-bed, all-private-room hospital has been budgeted at $950 million, but plans call for another $160 million in infrastructure improvements and a joint Defense Department-VA ambulatory-care center, whose cost estimate is listed at $549.7 million in the VA's five-year capital plan (so far, however, no money has been assigned to that portion of the project).
Other elements on the table include a fire station and utility plant, Draheim says, casually describing the entire plan as “probably the largest construction project in the city of El Paso.”
Draheim says much effort has been put toward calculating dollar amounts to show the return on investment that can be expected from using solar and geothermal energy sources and implementing infection-control strategies that are part of the project. He says construction is expected to begin around the third quarter of 2012.
“People usually just throw out adjectives,” Draheim says. “We're actually going to show them what they're getting for their money.”
Some 640 miles east down Interstate 10 in Waco is Fort Hood's Carl R. Darnall Army Medical Center, built in 1964 to provide care for 17,000 troops stationed at the base. A 947,000-square-foot replacement is planned to serve 55,000 active soldiers and some 176,000 eligible beneficiaries under TriCare, the military's managed-care plan. The latest TriCare figure puts the project at $927 million, which includes $621 million in stimulus-law funding, though other estimates put the price as high as $983 million.
This Texas triangle is completed some 100 miles north in Dallas, where the Parkland Health & Hospital System is planning a $1.27 billion complex that will include an 862-bed, 1.7 million-square-foot hospital, 380,000-square-foot outpatient center, 275,000-square-foot office center and 6,000-vehicle parking facility.
In November 2008, Dallas County voters approved a plan for Parkland, also known as the Dallas County Hospital District, to borrow some $747 million through a bond issue. A high credit rating and the ability to tap into stimulus funds allowed Parkland to lock into low interest rates resulting in significant savings. According to Parkland President and CEO Ron Anderson, this led the system to lower its request for tax-supported funds by about $42 million.
Ultimately, Parkland issued about $680 million in federal stimulus Build America Bonds and $24.8 million in traditional tax-exempt bonds last August. Plans call for the rest of the project to be paid for with $250 million in cash from prior-year operations, $100 million from future operations and $150 million from a philanthropic campaign launched in September 2008.
“We just passed the $90 million threshold,” Anderson says, thanks largely in part to large gifts from two foundations. “Dallas pays attention to those gifts, because they're usually well-researched.”
Parkland also enjoys public support because of its role as a teaching hospital that trains about 55% of the region's physicians, Anderson says.
The big project resulted in big contracts. The $44 million architecture contract went to a joint venture between HDR and Dallas-based Corgan Associates. The $46 million construction-management contract went to a joint venture consisting of four local companies including two minority-led firms.
Anderson says a formal groundbreaking is scheduled for late October, and occupancy is expected to occur around mid-2014. He adds that the goal is to achieve a silver, if not gold, rating in the U.S. Green Building Council's Leadership in Energy and Environmental Design, or LEED, certification system. Anderson also says the new building will have the offstage-onstage “Disney concept pushed to the extreme,” with separate staff and public entrances and a separate emergency department entrance.
The layout was also planned so similar departments were next to each other to take advantage of potential shared spaces and minimize staff and patient travel. “Adjacencies are very important,” Anderson says. “Everywhere we could, we did that so we could have surge capacity.”
The move to all single rooms—equipped with family zones—will provide much greater infection control, privacy and security, Anderson says, and—perhaps most important—it will “give us a chance to compete post-reform” as newly insured patients will have other options besides the community safety net facility.