PPH Rejects City of Escondido's Spruce Street Site

The Palomar Pomerado Health (PPH) district has rejected the Spruce Street site proposed by the City of Escondido. No Surprise. They are again pushing the ERTC. See report in the North County Times:
http://www.nctimes.com/articles/2005/07/27/
news/inland/22_09_217_26_05.txt

The ERTC is too dangerous for a hospital because of the new electric power plant.



Inland North San Diego County needs at least three hospitals. A new hospital in San Marcos, an upgraded Palomar Medical Center in Escondido, and an upgraded Pomerado Hospital in Poway. See Union Tribune Editorial of May 26, 2005 (4th letter on the page)
http://www.signonsandiego.com/uniontrib/
20050526/news_lz1mc26letter.html

The Palomar Medical Center in Escondido is the Heart of Downtown Escondido. PPH should maintain PMC as an acute care hospital and Trauma Center, or PPH should sell the Heart of Downtown Escondido to those who care.

Dismantling PMC is Premature

The dismantling of the Palomar Medical Center (PMC) in Escondido as an acute care hospital and Trauma Center is much more important to The Palomar Pomerado Health (PPH) district than the site selection for the new hospital. PPH cannot find an acceptable location for its new hospital. But PPH is certain that it must dismantle PMC as an acute care hospital and a Trauma Center! Why?

Because with minor modifications, PMC can serve as an acute care hospital and Trauma Center for many decades. PPH must dismantle PMC before the community realizes that the buildings currently housing the most important areas of the hospital (Emergency Room, Labor and Delivery, Critical Care Unit) were constructed less than twenty years ago! In Proposition BB, PPH tricked the community into believing that the buildings at PMC were over 50 years old.

PPH will probably build its new hospital in San Marcos. PPH cannot build its new hospital in the ERTC because of environmental constraints imposed by the 500 MW power plant currently being built there. A remote possibility exists that PPH may build its new hospital on the Spruce site proposed by the City of Escondido. However, PPH has vigorously and forcefully expressed an extreme dislike for the Spruce site.

If PPH decides to build the new hospital in San Marcos, the residents Escondido and Valley Center will demand that PMC remain open rather than accept the fate of being without the services of a nearby acute care hospital for the first time in over 80 years. The residents of Escondido and Valley Center will demand that PMC remain open, which will impact the market for PPH's new "resort-like" hospital in San Marcos.

PPH is hoping for immediate approval of plans to dismantle PMC as an acute care hospital. As with Proposition BB, PPH must have their plans in place before the residents of Escondido and Valley Center understand its consequences. Thus, quick approval of the plan to dismantle PMC is much more important to PPH than the selection of an acceptable site for the new hospital.

PPH will host a public workshop on July 28 at the California Center for the Arts in Escondido for presenting its plan for dismantling PMC and preventing its use as an acute care hospital. Hospital officials said they could ask the City of Escondido for the necessary zoning changes to implement their plan to dismantle PMC as early as next month. See report in the North County Times:
http://www.nctimes.com/articles/2005/07/20/
news/inland/20_27_417_19_05.txt

The PPH workshop is a marketing trick. Until PPH commits itself to an acceptable site for the new hospital, any plans to dismantle PMC as an acute care hospital and Trauma Center are premature.

Escondido Funds Study of Spruce Site for New Hospital

The City Council of Escondido has approved expenditure of funds (up to $100,000) to study the Spruce Street site for PPH's new hospital. PPH has expressed an interest in jointly studying the property. The funds will come from a budgeted economic incentive fund. See report in the North County Times:
http://www.nctimes.com/articles/
2005/07/14/news/inland/22_22_467_13_05.txt

New High School May Spark Westside Improvement

The Westside Improvement Concept covers an area bounded by South City Center Parkway, South Tulip Street, Ninth Ave, and Second Avenue. The area has substantial area ready for revitalization. The initial economic engine to spark the Westside Improvement Concept may be a new 50-acre high school. The Westside Improvement Concept may be population neutral by replacing existing single family housing with higher density housing surrounding the new high school, in accordance with existing zoning designations. The Westside Improvement Concept may work around or move existing commercial, industrial, and railroad operations. It may be advantageous to move some of such operations to other parts of the city or area.


The blue and purple dotted lines show possible outlines for the new high school campus. The 50 acre campus would need about 11 blocks.

Your comments are encouraged.

Boiled Frogs In Inland North County

In researching the "healing environment" aspect of the new hospital design, I came across the following surprising information quoted below:

"The district also must determine how it will pay for the massive rebuilding project. Palomar Pomerado's new chief executive officer, Michael Covert, said recently that fund would probably be raised with philanthropic donations, hospital revenues and through the sale of bonds."

"The design process could take about two years, Palomar Pomerado officials said."

"Palomar Pomerado board members decided in 2001 to spend more to completely redesign their hospitals instead of spending $56 million to simply install braces and supports to meet the 2008 standards.
The $329 million project is essentially two jobs: In November, board members approved spending a maximum of $266 million to build a new patient-treatment tower ---- to replace the current tower that will be demolished ---- at the 319-bed Palomar Medical Center; and up to an additional $63 million to build a new patient tower, medical office building and increase the number of beds at the 119-bed Pomerado Hospital." See report in the North County Times at:
http://www.nctimes.com/articles/
2003/03/20/export6141.txt

For $56 million, PMC could have remained as it is until 2030.

The PPH Board recently approved a resolution that directs the county to start collecting the taxes needed to pay off $80 million worth of general obligation bonds that the district sold earlier this month, under Proposition BB. See report in the North County Times at: http://www.nctimes.com/articles/
2005/07/12/news/inland/71105193319.txt
Come each April 10 and December 10, property taxpayers within the Palomar Pomerado Health district may feel like boiled frogs.

A "Healing Environment" -- The Keystone of PPH's Philosophy and Action

The Palomar Pomerado Health (PPH) district has a nearly fanatical desire to create a "healing environment" in its "hospital of the future". The "healing environment" will be created by "resort-like hospital rooms" having "nice views with a connection to nature and landscape". This "healing environment" philosophy has been the keystone of PPH's actions for the last two years.

The "healing environment" philosophy was pitched by the architecture firm of Anshen Allen in 2003 when PPH was looking for architects to oversee seismic upgrades to the Palomar Medical Center. Anshen Allen's winning proposal was capitalizing on a fundamental belief revolutionizing the field of hospital design: that the environment in which the care is delivered directly affects the quality of the care.

The initial proposal was for a "healing garden" built into the center of the hospital. See report by the North County Times at:
http://www.nctimes.com/articles/
2003/03/07/export5123.txt

"Palomar Pomerado board Chairman Dr. Alan Larson said Tuesday that his vote was swayed by Anshen Allen's vision of rebuilding the closed-in, isolated Palomar Medical Center as a community 'jewel,' complete with a central 'healing garden.' 'The idea of setting the (new) buildings aside and creating a parklike scene that they called a healing garden or a meditation-prayer garden large enough that it can be used for outdoor gatherings or meetings, I like that plan,' Larson said." See report by the North County Times at:
http://www.nctimes.com/articles/
2003/03/20/export6141.txt

The "healing environment" philosophy appears to have taken over the hospital site selection process. A "resort-like hospital room" must be about 50% larger than a standard room. Thus, PMC is obsolete. In order to have garden views, the buildings must be no more than a few floors tall. Further, the hospital must "de-institutionalize the image of a 'hospital' ". Further marks against PMC. And a "healing environment" hospital is expensive and requires lots of acreage to accommodate the "healing gardens" for the patients to view. PPH appears to evaluate each site with the following thought in mind: will the "resort-like hospital rooms" of our modern "hospital of the future" have "nice views with connection to nature and landscape". (Will the City of Escondido's Spruce site pass this test?)

But did voters approve Proposition BB so that PPH could build facilities with "resort-like hospital rooms".

No.

Instead, voters were bombarded with the message that our Trauma Center may not be available in the event of an earthquake. Messages of alarm alerted us to the dire situation. "Are we ready for the next major earthquake? . . . Hospitals built over 50 years ago don't meet today's earthquake standards. Is your Trauma Center ready for you?" See, http://www.pph.org/mpeg/spokesperson.wmv.
More dire messages can be found at: http://www.pph.org/body.cfm?id=237

(Note: PPH has no "hospitals built over 50 years ago".)

The "healing environment" was discussed in PPH's Facilities Master Plan (FMP) at pages 1-4, 1-5, 1-11, 1-17, 1-21, 1-27 and 2-4. Unfortunately, Pomerado Hospital, since its rooms are already built, will only receive "healing gardens" as discussed at pages 4-9 and 4-10. See:
http://members.cox.net/4robroy/escondido/
PPHMasterFacilityPlan07-2004p150PDF.pdf

The "resort-like hospital rooms" appear to be part of the PPH's newest marketing campaign to attract patients from all over San Diego to its new hospital. See 10News report at: http://www.10news.com/health/4720388/detail.html.
(This piece ran on TV at about 5:40 pm on San Diego Channel 10 News, July 13, 2005.)

Both Escondido & PPH Agree to Analyze Spruce Site

In March, the City of Escondido proposed using a city-owned maintenace yard on Spruce Street as the basis for a site for the new hospital. Escondido and PPH have agreed to formally analyze the site. See report in the North County Times:
http://www.nctimes.com/articles/
2005/07/06/news/inland/21_07_157_5_05.txt

The Hospital Site Issues is agenda item number 27 for the Escondido City Council Meeting of July 13 at 4 pm. A copy of the agenda is available at:
http://www.ci.escondido.ca.us/government/docs/index.html

The design of the Hospital is under review. See North County Times article below:
http://www.nctimes.com/articles/
2005/07/09/news/inland/23_07_027_8_05.txt

PPH -- Unwilling to Explain Missing Hospital Space at PMC

A significant error has been found in the Facilities Master Plan for the Palomar Pomerado Health (PPH) district. See link to page 1-9 below:
http://members.cox.net/4robroy/
escondido/PPH-FMPp1-9f.PDF

The entire plan is at the link below:
http://members.cox.net/4robroy/escondido/
PPHMasterFacilityPlan07-2004p150PDF.pdf

The Plan erroneously states that the total building area of the Palomar Medical Center (PMC) is 282,000 square feet with the McLeod Tower and the Adams Wing having 190,000 square feet of the total.

The McLeod Tower and the Adams Wing are not compliant with the seismic structural regulations and must be upgraded or removed from service for acute patient care. That would leave only 92,000 square feet at PMC that is compliant with the seismic structural regulations. Right?

Wrong!

PMC has at least 180,000 square feet of hospital space, built since 1987, that is in full compliance with the seismic structural requirements of SB 1953. Housed in this compliance space is the heart of an acute care hospital and trauma center. Specifically, the compliant space currently houses the Emergency Room, the open-heart surgery unit, the heart examination lab, the operating rooms, the critical care and intensive care units, the labor and delivery rooms, the nursery, the radiation and chemotherapy department, the cardiac rehabilitation department, and over 100 patient care beds. See link below:
http://members.cox.net/4robroy/
escondido/PMC-BlogD.pdf

The Facilities Master Plan appears to be missing nearly 100,000 square feet of compliant hospital space. That is 50% of the compliant hospital space. And this is not an isolated error in the Plan. The error permeates the entire Plan. See pages 1-9, 1-26, 1-27, and 3-4.

Clues to the correct amount of hospital building space at PMC can be found on pages 1-11 and 3-8. On page 1-11, the Building Gross Square Footage (GSF) per bed for PMC is given as 1,270 square feet. Given that PMC has 324 beds (page 1-9), then the calculated total building space is 411,480 square feet (324 times 1,270). On page 3-8, the Department Gross Square Footage (DGSF) for PMC is 279,267 square feet. Using a Building Grossing Factor of 1.38 (based on the PMC building grossing factor used on page 1-11), then the calculated total building space is 385,388 square fee (279,267 times 1.38). These clues provide further indication that PMC has at least 370,000 square feet of building space.

Thus, the PPH Facilities Master Plan has a significant error.

Was the error intentional? The part of the Plan having the error states:

". . . the McLeod Tower (1967) and the Adams Wing (1957), which together account for 190,000 square feet (nearly 50%) of the total building area of the 282,000 square foot PMC hospital facility."

The parenthetical "nearly 50%" provides a clue. 190,000 square feet is not "nearly 50%" of 282,000 square feet. This was an easy error to find. Regarding intent, at one time, the 282,000 must have read something more than 380,000 square feet (like 382,000) for the nearly 50% number to be correct. Not susprisingly, more than 380,000 square feet is in line with the clues found on pages 1-11 and 3-8. It is reasonable to conclude that the change was made after the 50% calculation was made. Because the change was then carried over into conclusions made on pages 1-26 and 1-27, then it is reasonable to conclude that the change was intentional.

The error was pointed out to PPH on June 20 and PPH promised to look into the question about the "missing" 100,000 square feet of hospital space. See link below:
http://members.cox.net/4robroy/
escondido/PPHerrorEmail.PDF

It have been nearly three weeks! Maybe someone can loan them a tape measure. A reasonable conclusion is that PPH is unwilling to explain the discrepancy on page 1-9 of the Facilities Master Plan.

Why?

Perhaps it is another Covert Operation in the Sunshine state.

Legislation Not Yet Passed to Extend Hospital Seismic Deadline

A downtown hospital advocate has jumped the gun on the legislation to extend the hosptial seismic retrofit deadline. See North County Times Editorial:
http://www.nctimes.com/articles/2005/07/02/
opinion/commentary/20_25_047_1_05.txt

SB167, the hospital seismic safety bill, has been amended and is currently in the Assembly's Health Committee. The amended bill, before it becomes law, needs to go back for passage in the Senate, and then be signed by the Governor. The progress of SB167 can be tracked at:
http://www.leginfo.ca.gov/cgi-bin/postquery?
bill_number=sb_167&sess=CUR&house=S

All indications point to passage of SB167. Why? Because the California's hospital construction sector is in a mess. There are too many hospitals trying to meet the deadline, and not enough contractors willing to bid the work. Conversations with a construction supervisor that is working on a new hospital site reveals that plumbing contractors are either not willing to bid hospital jobs, or they are submitting extremely high bids. A principle reason is that the seismic regulations for hospitals are in a state of flux. Local (and familiar) building codes are preempted by statewide regulation. Allegedly, inspectors have required that entire walls be torn down and rebuilt merely because holes were drilled in the studs for wires and pipes, a standard building practice.

PPH - Start Construction - First Quarter 2007

Advocates for the Palomar Pomerado Health district claim that any site other than the ERTC site will cause too much delay. A major complaint against the City of Escondido's proposed Spruce site is that it will take 1 to 2 years to assemble the site and have it ready for construction. The PPH advocates claim this is too much delay.

Oh really?


The PPH Master Facilities plan has a construction schedule for the new hospital on page 1-23. The plan's project schedule for the new hospital has the start of construction set for the first quarter of 2007.

What has changed since the plan was developed to necessitate acceleration of the construction schedule?

Nothing -- except the political agenda of the PPH advocates.

PPH has already wasted "precious" time. The City of Escondido proposed the Spruce site in March. Now it is July, and PPH has finally become available to discuss the Spruce site. PPH owns this delay, not the City of Escondido.

PPH Site Selection Criteria for New Hospital

In its Master Facilities Plan, PPH listed the major criteria for selecting a site for its new hospital. The criteria fail to mention "40-60 acres" - "No use of eminent domain" - "No concrete drainage culverts" - "No delays" - "Pad Ready" -- and other argumentative phrases that seen to dominate the district's complaints about of all sites in Escondido other than the ERTC. Will PPH use these criteria in the site selection process?

Section 2 - Palomar Medical Center Second Site
2.1 Site Analysis
The Facility Master Plan development process determined that the development of a new tertiary care medical center on a second campus in the vicinity of Palomar Medical Center was the most economically, operationally and constructably viable solution to the healthcare needs of the community. The location for the second campus remains under review but the major criteria for a potential location are:
1) The site should have sufficient area to support the initial hospital development and also be able to accommodate subsequent growth for the hospital's services over time, as well as being able to support the potential development of adjunct medical services (medical office buildings, ambulatory care facilities, and related parking structures). The size of the site should range between 30 to 50 acres depending on the parcel's configuration and amount of actual buildable area.
2) The site should be located strategically to support the existing patient catchment area but also recognize future population growth potentials.
3) The site should be physically accessible - close proximity to freeways and close proximity to public transportation routes. The site should be easy and straightforward to find from city streets.
4) The site ideally should be visually accessible - a prominent location that would provide the community with a clear awareness of the medical center's presence.
5) The site should be supported by city street infrastructure to allow for clear and distinct onsite circulation patterns for the patients, staff, emergency and service vehicles.

Copy of page 2-1 of the Facilities Master Plan is at the link below:
http://members.cox.net/4robroy/escondido/PPH-MFPp2-1l.PDF

For a copy of the entire plan, see blog entry for June 13, 2005, or click link below:
http://members.cox.net/4robroy/escondido/
PPHMasterFacilityPlan07-2004p150PDF.pdf