Whether Guam Memorial Hospital is built on 10 acres opposite Micronesia Mall or whether the prescription is to extend the facility into the hospital’s present parking lot will depend on a survey by a structural engineer.

William I. McMillan chief executive officer and administrator of the hospital told the Journal he is seeking a second opinion from a professional to determine whether treatment is possible for the aging medical plant given its site in an earthquake zone or whether the building is beyond saving.

As exclusively reported in “Hospital straddles dangerous ground ” in the “Sept. 8 2003 edition of the Journal the hospital sits on a dangerous fault line.

The request for proposal for the engineer’s survey is due to be issued after July 19. The survey will be funded by a U.S. Department of the Interior grant of about $60 000.

“We are investing in an architectural engineering study ” McMillan said. “There are a couple of things we need to find out.” Referring to the mapped fault line in the geological survey in the Journal’s story he said “According to that map the fault line runs somewhere round here. We really need a qualified person to dig into that data and gauge the danger that it poses to the hospital. As I understand it the further you are from the cliff line the safer it becomes. Do we do massive renovations of this facility or do we do construction somewhere else? There may be a seismic hazard but the building is stable enough to withstand shaking.”

The original plans for the hospital allowed for a fifth floor. “If there is no seismic danger we could build up but we also need to construct substantial renovations — such as relocate the pharmacy closer to patient care.”

Urgent correction to the building could not wait for the decision to extend or completely rebuild McMillan said. “We are replacing all the seismic joints. Those are being replaced even as we speak. We can’t stop maintenance just because we hope to move in two years time.”

McMillan said damage to the hospital was a recurring problem when Guam was struck by typhoons. “We are starting to mitigate with FEMA money. Over the next 12 months all the sliding glass doors in patient rooms will be replaced with typhoon-proof windows.” At a cost of about $1 million exterior walls in those rooms would also be replaced.

Chamorro Land Trust land between Marine Corps Drive and Two Lovers Point is the potential site for the new hospital. “It’s a big tract of land. We don’t need all of it. It’s central and available.” He said the site was identified as convenient for the north and central parts of the island and offered routes from the South which had more access problems. “Once you get on Marine Corps Drive or Route 8 access is easy. The majority of the population lives in Tamuning and Dededo.”

McMillan said seven to 10 acres would be appropriate. “I would like to see a medical campus — a hospital with a parking facility and a medical office building.”

Sen. Lourdes A. “Lou” Leon Guerrero chairman of the Committee on Rules and Health of the 27th Guam Legislature said “I’d love to see it happen. The hospital does need to expand but I’d like to see more services provided to our people. We have a cardiac catheter lab that this administration has closed; we need to expand our diagnostic imaging capabilities. We are losing revenue from the catheter lab that’s been closed.

“These are not new ideas this administration has come up with. The Gutierrez administration was very aggressive in that regard.”

Re-siting the hospital Leon Guerrero said “Should be investigated and researched. To say we need a better health-care facility does not just mean a new building. The medical summit in March was basically a presentation on the financial status of the hospital. What about total health-care accessibility and prevention?”

Leon Guerrero said the specialties the island lacked should be given attention. “I will never be convinced we can’t bring those specialties in.” She said there was no reason why the hospital could not develop special relationships for instance with hospitals in the Philippines to send patients there and experts to Guam and questioned whether McMillan had researched all options. “My role is to make appropriations and policies.” She said while she did not wish to closely oversee the administrator “I’d like to see some aggressive planning to beef up our services so our people don’t have to go off-island.”

The difference between extending the present building and giving the region a new hospital is about $30 million. Renovation might not necessarily be cheaper McMillan said although it was preferable. “Building a new hospital and transferring everything three to four miles away is hellaciously complicated.”

The timetable aims to have construction completed by the “latter part of 2006 or early 2007. It takes about 2-and-1/2 years to do de novo construction. Any way you cut it you are looking at the latter part of 2006 or the early part of 2007.”

Either way McMillan said the facility should incorporate:

• additional beds to bring GMH up to the national ratio;

• additional beds for post-intensive care patients;

• oncology cardiac and cardiac surgery facilities;

• a new pharmacy closer to patient care;

• a primary care military veterans’ outpatient clinic.

If the hospital remained on its present site McMillan said the emergency room surgery and intensive care could be rebuilt in the parking lot with existing facilities renovated. “The only wrinkle with that is the power plant is to the south of the facility and it’s then getting far away for convenient supply.”

He said a number of factors had converged to necessitate the upgrade of Guam’s hospital.

“We have a population of about 155 000. We are able to field about one bed per thousand population. In the West Coast states and Hawaii it is about two beds per thousand population.” He said there was a national trend for lengths of hospital stay to become shorter but Guam’s population was projected to rise. “But still one bed per thousand population is inadequate. You see that translated here — especially around the weekends. People who need to be admitted to ER end up waiting 24 to 36 hours.”

Not only the overall number of beds but the mix of beds needs to be improved at GMH McMillan said as had been evidenced by the recent crisis with neonatal intensive-care beds and equipment. “We have a really high birth rate here; we need step-down beds for adult care [when patients leave intensive care but are not ready for discharge]; we need more capacity.”

Specialist services were lacking he said and the space to provide them. “The array of services that patients need when they are in those beds have been lost.” Guam’s most prevalent causes of death were cancer diabetes and end-stage renal disease he said.

“We are almost without assets to treat those patients. We have lost our cancer facility there is no oncology facility and we never had a cardiac surgery facility on-island ” he said.

The inclusion of a primary-care outpatient facility to cater to Guam’s military veterans would give Guam’s hospital an arrangement that is common in the U.S. mainland and would mean an additional source of income for GMH McMillan said. He said the two hospitals had good relations and categorized the Navy facility as a good citizen in the community. “Naval Hospital does accept trauma cases on a humanitarian basis and they provide a lot of help in terms of equipment and supplies. A number of their physicians work in the community when they are not on duty.” Navy Hospital Guam is a 23-bed facility.

A regional referral hospital to also be sited at GMH was agreed at the island chief executives conference in Guam on July 13 and 14. Radio Australia mistakenly referred to that as a new hospital in radio reports on July 20 citing Peter Callaghan spokesman for Gov. Juan N. Babauta as the source.

McMillan decried plans for a private hospital.

Peter P. “Sonny” Ada president of Ada’s Trust & Investment Inc. said plans for a hospital had been discussed but were not moving forward.

“Pedro P. Ada Jr. [chairman of the board and Sonny’s father] seeing the need for a better hospital facility and we being landowners solicited possible interest to develop a private hospital on Guam. There has been no interest to date.”

Funding for the hospital was available. “HUD through the Federal Housing Authority has bond or mortgage guarantee programs available to the hospital if we have an operating margin of zero or better for three years in a row.” McMillan said that margin was likely in 2004. The hospital’s debt service ability was also a factor. “The big hit on that is the retirement fund debt we carry of $15 million.” McMillan said the hospital was showing that sum as an operating deficit and was current on its obligations to the retirement fund.

Accreditation which McMillan expected by the end of 2005 was also a factor he said. “People who are likely to loan us money will feel better about it if we are accredited.”

He said the hospital could sell its skilled nursing facility in Barrigada a 60-bed facility presently using only 30 beds and repay the retirement fund from the sale or the fund could take over the facility. “It could be privatized or transferred to the retirement fund. It’s on our books at under $10 million. Replacement cost is a lot more than that.”

McMillan said eight administrators in five years had “contributed to the hospital’s problems ” and political considerations could affect how a new hospital was built and whether municipal leasing was also an option. “It really depends on what the 28th Guam Legislature looks like. I don’t see the Democrats ceding management of the hospital to a private firm.”

Nevertheless the hospital had made recent progress McMillan said. The Department of Homeland Security made recommendations based on population levels to prepare hospitals for disaster situations. From fiscal 2002 through fiscal 2004 this had brought GMH $2.5 million to purchase personal protective equipment and decontamination systems and for the hospital’s heating ventilation and air conditioning system. The hospital had decreased operating expenses by $2 million compared to the same period of 2003. “As we close out 2004 compared to fiscal 2003 we have nearly $7 million more revenue. MBJ