BY MAUREEN N. MARATITA
Will the Guam Memorial Hospital get major capital improvement funds, will it make do with funding approved by the Guam Legislature or will there be a new hospital in Guam’s future, given the problems with the present campus?
A lot hinges on a U.S. Army Corps of Engineers report that the U.S. Department of the Interior will fund, according to a July 30 release from the Office of the Governor, but the hospital has already been deemed unsafe.
William I. McMillan, chief executive officer and administrator of the hospital, told the Journal in 2004 that a request for proposal for an engineer’s survey was to be issued in July of that year. The survey was to be funded by a U.S. Department of the Interior grant of about $60,000.
This followed a story the Journal ran in the Sept. 8, 2003 issue, “Hospital straddles dangerous ground,” based on a Seismic Hazard Vulnerability report prepared by the Water and Environmental Research Institute in 1994.
If rebuilt, GMH was looking at Chamorro Land Trust land and between Marine Corps Drive and Two Lovers Point as a seven- to 10-acre site for the new hospital, but McMillan pointed out the original plans allowed for vertical expansion — a fifth floor to be added to the building. McMillan said, “If there is no seismic danger, we could build up.”
In 2004 the hospital went ahead and replaced the seismic joints. McMillan told the paper at the time, “We can’t stop maintenance just because we hope to move in two years’ time.”
Lillian P. Posadas, administrator at GMH, said, “I don’t have the report that Bill McMillan initiated in terms of the seismic study in reference to the earthquake fault. There have been other reports and studies that have been done — not just general structure, also capital improvement, financial management.” She said Sen. William Castro had a hospital management assessment study done before he became a senator. “It incorporated a revenue-generating piece, plus the structure — the Z-wing that is now condemned and needs to be demolished and options to enhance that area with other services that can then help the hospital generate revenues.”
Thomas P. Camacho is principal of Duenas, Camacho & Associates and is the principal structural engineer at the company. He was at GK2 Inc. when that company and associates from other companies surveyed the hospital in the late 1990s. “The report was focused on the feasibility of vertical expansion,” he said.
Either way, he said, “The building … won’t meet current code for the type of structural system that it has,” he said of GMH. Camacho said, to build up, “There’s a huge amount of retrofit that needs to happen. It would be very physically challenging and fiscally challenging also. I don’t think it’s financially feasible — to get it there, we’d have to go in and wrap the columns and do all sorts of things, basically clad the thing and scale it.” The GK2 survey worked from “as-built” plans and a structural model, analyzed the existing structure and examined the plans for modern code compliance, he said. “That code has since been updated. In addition to that we have seismic upgrades; we’ve got detailing upgrades.”
The main building was built to allow for damage, he said, but is now inadequate.
“I believe it was designed as a movement-resisting frame,” which allows for movement, he said. “Then it’s clad with pre-cast panels. That’s more susceptible to damage than other systems. It doesn’t meet current code refinement requirements. For example, we used to hoop everything spaced out. Now we have all these hoops that are very tight to keep the columns nice and tight so they can get damaged but still maintain vertical capacity. You always expect damages, but over the years of continual movement — if you don’t see it, you don’t repair it — it could get worse and worse and worse.”
The GK2 survey was given to GMH, he said. “If you want to retrofit it to meet current code, I believe there’s a tremendous amount of work that needs to be done. My involvement was over 20 years ago, but I don’t believe anything’s been done since then and the codes have been upgraded many, many times.” However, he said, “If the building was modified, then that report’s out the window.” Camacho said new softwares could be used to evaluate the building for performance-based design.
As to a new hospital or any new-build, he said, “A lot of times there are guidelines out there. We do a risk analysis and if your building cost to renovate and replace exceeds 50% of the cost of the existing facility, it’s probably better that you consider alternatives, as opposed to investing back into it.” Financial risk analyses have formulas for that the hospital could consider, Camacho said.
Given Guam’s current public land inventory, finding land for a new hospital on Guam should not be a problem, he said.
“Reinforced concrete can last for a long time; it just needs to be maintained and fixed. We’re just in a very active seismic zone and typhoon alley. Buildings like this that are covered up — there are so many corners and so many finishes on it — you can see what you can see and repair what you can repair, but the true test is when you get these big earthquakes and how the building performs. We don’t want to get to that point — you never can tell.”
From functional, operational and efficiency standpoints, it would be better to build new, beneficially site the hospital and master plan it, Camacho said.
On-island, he said, “We have the ability to design, plan and build these facilities. GMH has done a good job of trying to keep what we have and service the people,” he said. “We just have to be careful about who is planning and who is doing the design for the hospital because there are firms out there that will give you ‘pie in the sky’ plans, and really what it amounts to is designing a proper facility.” A practical sense of island conditions is important, he said. “Anything built along the shoreline is going to be more susceptible to environmental — the challenges of corrosion.”
Pending the study by the Army Corps of Engineers, William N. Kando, associate administrator for operations at GMH, said the hospital has no firm idea of the safety of the building. “We still don’t know. Every study we’ve done in the past structurally — we’ve never done any destructive testing of our columns, etc. That’s why we need something in-depth.”
The scope of work is still being developed, according to Posadas.
She said, “That’s what we’re communicating with the Army Corps of Engineers in Honolulu; that we would really like an in-depth assessment of the integrity of this building. That will help us determine if we can enhance it — expand it, modernize it — or it’s just not strong and stable enough, so we just need a new facility.”
Kando said the hospital would also ask for an objective opinion on its systems, such as its electrical distribution panel.
Posadas said a new hospital would be ideal. “This facility is over 40 years old. … We also have some regulations with CMS [Centers for Medicare & Medicaid Services] and accrediting organizations that dictate what codes and compliance for facilities.”
The hospital is also grappling with increased demands such as on its intensive care unit. “We’ve expanded to accommodate 14 patients who need critical care, but with staffing we can only accommodate six. There are rooms that can accommodate more patients, but unfortunately we’ve been struggling with a staffing shortage.”
GMH does have beds, but Posadas said Guam’s population continues to grow. “Not only the size of the population, but also the acuity of their health conditions.”
Whatever the determination is, Posadas said, “We’ll move forward. If the Army Corps of Engineers finds that this hospital is not stable and strong for expansion and modernization … and we need to build a new hospital, then yes, we need to proceed with it.”
In the meantime the hospital will still need to operate, she said. “We still need to fix whatever the issues are, such as the electrical panel, the electronic health records, the roofing that’s leaking.”
Those three issues were the top three included in GMH’s draft 2020 budget, Posadas said, but none of it was included in its allocation from the Guam Legislature. “None of our CIP requests were included; all they allotted for us was the $28 million for operations.”
Kando said as systems age, they become inoperable. He said monies are allocated on an emergency basis. The hospital’s fire alarm system was replaced in 2009. “It was well past 50% inoperable before we were given the money that we needed to replace it.” Kando complimented facilities and maintenance staff for their abilities to keep equipment operating. “It’s not the best way to go since we’re focused on quality patient care in a safe environment,” he said.
A public-private partnership for the hospital could obviate the need for bond funding; Posadas is open to that too. “There’s been many talks about public-private partnerships for the hospital, for health care; it just hasn’t gone forward beyond talks.”
There would be benefits to a public-private partnership, she said.
As for another task force, which Sen. Tello Taitague suggested, Posadas said it is not practical now. The hospital’s preference is to wait for the Army Corps of Engineers report and then move forward.
And as to where a new hospital might be located, it should be located centrally “so the people of Guam won’t have to travel so far,” she said. “Some of us envision a medical center.” That could include the hospital, the Guam Behavioral Health and Wellness Center and the Department of Public Health and Social Services. All three facilities have their structural issues as well. Mangilao would be central and close to the University of Guam, she said. mbj
From reports on plans for the hospital
GMH Strategic Plan Fiscal 1995 to 1997
“The hospital’s Capital Improvement Projects Committee will assess and revise the parking plan to ensure that GMHA a) provides adequate parking for patients and the public; and b) designs adequate parking areas for the medical staff, hospital employees and volunteers.”
The hospital intended in this plan to provide valet parking for patients and visitors, and van pools for employees by fiscal 1997.
GMH Strategic Plan 2004 to 2006 – capacity expansion
“GMH has begun a feasibility study to determine renovate or rebuild alternatives to bring the bed capacity to 250 beds with future additional capacity. It is anticipated that the additional capacity will be on line in 2 to 3 years.
”The hospital has 158 licensed acute care beds, plus 40 beds at its off-site, long-term care Skilled Nursing Facility.
2014 GMH Evaluation
Office of the Inspector General, U.S. Department of the Interior
Capital Improvement Projects“GMHA has a plan that includes a series of capital improvement projects. OIG was informed, however, that because of the lack of funding, many of the projects in the plan continuously get postponed. The 2014 CIP contains 14 projects totaling $5.7 million that have yet to be approved for funding.”
“The GMHA infrastructure is deteriorating and not adequate to meet the needs of the population of Guam, presenting concerns about the health and safety of patients, staff and visitors. GMHA has identified $9.9 million in needed capital improvement updates, but has only 9% of the funding necessary to make those updates.”
2016 Guam Memorial Hospital Task Force Report
Issued by the Office of Sen. Dennis G. Rodriguez Jr.
Task Guidance: “Develop a comprehensive plan of action for the construction of a new state-of-the-art Guam Memorial Hospital facility at a location within the government of Guam’s footprint.”
“The consensus of the members is to pursue a public-private partnership as a model to ensure a sustainable and quality facility for the people of Guam.”
2017 GMH Business Sustainability Plan
“The Z-Wing Replacement Project seeks to rebuild a facility that is over 50 years old and currently represents a life safety risk for all who work at or visit the hospital. The Z-wing … represents the single oldest component of the hospital …”