Hospital Wins Critical Approval from State in Push to Expand at Oak Bluffs Campus

By JAMES KINSELLA

Martha's Vineyard Hospital has won a crucial approval from the state for a planned $42 million expansion and renovation at its Linton Lane campus in Oak Bluffs.

The state Public Health Council unanimously voted last month to approve a determination of need application submitted in July 2004 by the hospital. Construction is slated to begin later this year.

"We're really excited," hospital chief executive officer Tim Walsh said. "It's a big hurdle to get by."

The determination of need is part of a state initiative to control health care costs, and all health care facilities in Massachusetts that are planning substantial capital expenditures must apply for it. Under state law, the expansion and renovation project could not have moved forward without council approval.

Mr. Walsh said the hospital plans to continue working with the Martha's Vineyard Commission and the town of Oak Bluffs to secure the rest of the local approvals needed for the project.

The hospital project would involve 91,478 square feet of new construction and 12,123 square feet of renovation. The project also would entail removing 28,848 square feet of existing space, leaving the hospital with a net increase of 62,630 square feet in its physical plant.

As part of the project, the hospital has proposed increasing its number of licensed beds from 19 to 25.

The application, as summarized in a council staff review, describes an aging facility seeking to cope with wide seasonal swings in patient demand.

Council members approved the application with a number of conditions, including requirements that the hospital provide $2 million over five years toward health initiatives on the Vineyard.

The application summary also highlights the increasing impact on the hospital by the Island's Brazilian community.

"The hospital has indicated that 30 per cent of annual births were to Brazilian women and that 95 per cent of requests for interpreters in the emergency department were for Portuguese interpreters," the summary states.

The council has given the hospital permission to use a $15 million bank loan to finance the construction. Mr. Walsh, however, said the hospital intends to use fund-raising rather than financing to pay for the project. More than $30 million so far has been pledged in the fund drive.

The state found the proposed maximum expenditure of the project at $44,248,575 to be reasonable, as well as the proposed annual operating costs of $2,817,236. Mr. Walsh said the $44.2 million figure would represent financing costs as well as the project itself.

The hospital serves a year-round population of 15,000, which swells by 90,000 residents and visitors during the season. The hospital also operates the Windemere Nursing and Rehabilitation Center, a 106-bed skilled nursing facility at the Linton Lane campus.

At present, the hospital is housed in sections dating from 1929 and 1972. According to the summary, the hospital has stated that "the structural, mechanical and electrical systems of both buildings are outdated and inefficient." Buckets are placed in the hallways of the 1972 section when it rains.

Martha's Vineyard Hospital is proposing a new two-story wing, partial replacement of the 1929 section and renovation of the 1972 section. The new wing would house all inpatient rooms, surgery, imaging, outpatient services and the emergency department. The 1972 wing would house physician and hospital administration offices.

As part of the project, the hospital would increase its medical/surgical beds by seven to 18, and decrease its obstetric beds by one to three.

At present, the hospital's relatively few beds can quickly result in an overflow of demand.

"When all of its beds are full, Martha's Vineyard must hold patients in its emergency department, a practice that limits the hospital's capacity to treat emergency patients," according to the staff summary. "During the summer, when the service area population is at its peak and when hospital emergency departments are busier than normal, a shortage of beds can create a crisis situation for the hospital."

In assessing the demand for its services, the hospital found that the year-round population in Dukes County, which includes the Vineyard and the Elizabeth Islands, grew by 31 per cent from 1990 to 2000, and is anticipated to grow 26 per cent from 2000 to 2010.

That rate of growth exceeds the state rate, estimated at 6 per cent, and the national rate, estimated at 9 per cent.

The council staff found that the proposed expansion and renovation and the cost of that work to be reasonable when compared with other hospital expansions approved by the state. The staff also judged the project "to be financially feasible and within the financial capacity of the applicant."

According to the summary, the hospital has said its proposal is the only viable way to meet its objectives. The hospital rejected only renovating its existing space, holding that the configuration of the space could not meet the project. The hospital also rejected doing nothing "because the issues affecting service quality, patient satisfaction and operational efficiency needed to be addressed in a timely manner."

Members of the Martha's Vineyard Commission, which regulates land use on the Island, have put forward another alternative: building a new hospital in a more central section of the Island. Hospital officials are not pursuing that option, given its substantially higher cost, which the officials place at about $71 million.

Mr. Walsh said the hospital did not include the relocation idea in its application because the proposal is not financially viable. He said that a relocation proposal would require the hospital to file for a new determination of need, which he said likely would take another 18 months.

Conditions placed on the approval by the Public Health Council include:

* That the hospital provide $2 million over a five-year period to help fund community health initiatives.

In particular, the state will require the hospital to provide $400,000 toward mental health and substance abuse services; $575,000 toward a Vineyard health promotion and disease prevention program; $925,000 toward recruiting and retaining primary care physicians; and $100,000 toward funding innovative approaches for Island health priorities.

* That the hospital fill the gaps in its medical interpreter service, given growing use of the hospital by the Island's Brazilian community.

The state specifically will require the hospital to provide interpretation beyond telephone interpretation, to have the capacity to track all interpreting sessions, to train all bilingual employees who may be in position to function as interpreters, and to put together an outreach plan to spread information about the hospital's programs and its interpretative services.