Tehachapi News

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Last week, Alan Burgess, Tehachapi Valley Healthcare District’s CEO presented the board and the public with a list of six options for moving forward with building a new hospital. Burgess answered the Tehachapi News’ questions with his own candid take on each of those options.

Q: The first option you listed, is to proceed with the current OSHPD-approved design, including modular construction, citing the only “pro” as the “quickest means” to getting a new hospital built. You also followed this with a question mark. Why?

A: In theory, it is the quickest means because it's been through the OSHPD process and in theory, we know the costs involved. But we're still have to raise a means of funding, which of course means a delay. There are also a lot of assumptions, [i.e. deferred costs and designs issues] made by Aspen Street Architects, Inc. [ASAI], such as the installation of the sprinkler system. Each alteration to the plans would require a review by OSHPD. It's hard to predict how long that would take.

Q: That was the “pro” side of the first option, but you listed numerous “cons,” including the independent consultant's negative report deeming the plans too costly and impractical for either “buildability” or basic operation, also “known, inherent design flaws” and higher operational costs for heating and cooling. Can you explain in layman's terms how the OSHPD approved plans could contain so many flaws and apparent deterrents to building the current design “as is.”

A: OSHPD's job is to make sure the plans submitted meet the minimum standard of compliance in terms of structure, etc. For example, if the minimum standard for load bearing floors is only 40 pounds per square inch, and we have a portable X-ray machine exceeds that weight, the minimum standard isn't going to work for us. That's just one example.

Another concern is that the California Department of Health will inspect us after it's built and the issue of cross contamination posed by the design's long, snake of a hallway connecting lab, patient treatment and kitchen and refuse areas raises significant concerns that we will be cited by the state for related infection control issues.

Q: Shouldn't ASAI address and correct these design flaws? Isn't that what they were paid to do?

A: If they could mitigate these issues, then provide us with a cost estimate, then we could make some costs comparisons with our other options. Costs have to be taken into consideration. We need to know if it's worth the extra time and money.

Q: How confident are you that ASAI will respond in a positive manner?

A: I don't know what to expect. I'd like for them to respond [to the written request to correct the design flaws]. I'd rather work with them at this point if they can fix it. I'd hate to see $1 million already invested in the design be wasted. I'd like to say we're both learning from our mistakes and let's move forward. Let's build this hospital for this community.

Q: Your second option is to proceed with the current OSHPD-approved design, but modify it for conventional construction methods. You listed the necessary OSHPD review as a “pro.” Why?

A: Re-review and approval by OSHPD may resolve some design problems and eliminate all the cost overruns historically attributed to modular construction. Since they're familiar with the plans, it might be a quick review.

Q: And the “cons?”

A: The design change is recommended by the consultant for many reasons, but the re-design would also be subject to new/current construction requirements that say, for example, the kitchen has to face an outside wall. That also means ASAI would have to address the potential cross-contamination problem with the hallway. They knew these design change requirements were coming. That's why we worked together in December to expedite the OSHPD process. This aesthetically pleasing design comes with higher than average operational costs for heating and cooling, etc. due to a lack of sub-floor insulation, significantly more outside wall square footage (than a similarly-sized rectangular building, and other design issues.

Q: The third options is to start over with an “off-the-shelf” or “cookie cutter” design of a more conventional Critical Access Hospital. Wouldn't the added delay for this process result in even more difficulty estimating costs?

A: Not necessarily. Construction costs are coming way down from the 17-18 percent increase we saw in the past few years. Also, a “basic box” design would minimize heat and cooling losses and offer a more “Green” design. This “model home of hospitals” approach is a tried and tested design used elsewhere with lessons learned already applied. It should go through OSHPD more quickly than an original design, and it could still meet the timeline for construction completion before Dec. 31, 2012.

Q: And the downside?

A: It could require up to two years or more for design, OSHPD review, etc. And of course, we still haven't solved the funding issue.

Q: The fourth option of partnering with other organizations who can finance either the current design - or a new one - is multi-faceted. Can you expound just a bit?

A: There are a number of people out there that would work with us, organization to organization. Just one example is Kaiser's regional administrator has expressed an interest in building a new hospital somewhere in California, possibly Tehachapi. They know they have a lot of clients who now have to drive an hour to get to services either in Lancaster or Bakersfield. They could help or partially fund the building of our hospital, build their own adjacent facility for Kaiser patients, and connect the two. We could also gain a source of income by providing them with lab, radiology or other services. It's the so-called, win-win situation. The main reason we don't have a contract with Kaiser now is that we don't meet the accreditation criteria due to the outdated seismic standards of our hospital.

Q: Would this limit Tehachapi Hospital to Kaiser patients only?

A: Not in the least. We'd have our own buildings, they'd just be connected in a way that we could share the use of certain facilities and/or staffing, or we could provide them with services, ultimately saving them significant operational costs.

Q: You also listed the prison as a potential partner, but noted the public's past objection to sharing their hospital with prisoners. How would you address those concerns?

A: The truth is we already treat a lot of inmates every day at Tehachapi Hospital. Right now it takes two or three guards to bring each prisoner in for medical treatment. A secure wing would not only reduce the prison's personnel costs significantly, it would increase security drastically.

For example, Mercy Hospital in Bakersfield currently contracts with the prison. When you enter that floor, you go through a locked gate, just like you're going into the prison. The guard staff belongs to the prison, and the medical staff belongs to the hospital. The inmates are secured to the beds. It is not an unrestricted ward. Plus many of these prisoners are far too sick to pose any risk. This type of an arrangement would significantly reduce any cross-trafficking of prisoners with the general population of the hospital. 

Q: Starting over at square one, and going out to bid for a new design is the fifth option you listed. How realistic is this?

A: The pro is a new design, specific to our current and projected needs. On the CON side, it could require up to four to six years or more for design/ OSHPD review. Our seismic requirements waiver expires on Dec. 31, 2012. This would also leave the funding question unanswered.

Q: You list a sixth scenario that sounds a lot like the types of partnerships you described with Kaiser or CCI. How is this one different?

A: This option would require us to lease the land to a for-profit group to build their own hospital, with the potential for them to lease it back to us after it's paid for itself. This could relieve pressure on the district from building a hospital and change our focus to meeting other local health care needs, such as a larger and permanent Skilled Nursing Facility in a remodeling of the old hospital building. This is something the community really needs right now. We currently have a list of approximately 30 females and 20 males waiting for long-term care beds in our hospital right now.

Another benefit is that a much larger facility would be likely.

Q: Your final option is a consideration that could be utilized with any or all of the above options. Can you tell us more?

A: The present site for the new hospital is on a 15 percent South-facing slope. That location would probably lend itself to solar electric photovoltaic cells on the Northwest sector of the property and wind turbine electric generation on the Northeast sector of the property. If these were designed into the hospital planning and built before construction on the hospital, the energy generated could be sold back to the power company and the funds used to raise the amount saved towards the new hospital. The construction of the “green energy” could be partially and maybe fully offset by grants and energy credits. The energy generated could also be used after construction of the hospital to offset the costs of heating and air conditioning, etc. We could become an environmentally-friendly, “green” rural hospital — perhaps the first in the nation.