‘We Aren’t Quite Sure Where the Dust Is Going to Settle’: Munson Healthcare capital improvements on hold

Several major capital improvement are moving forward for Munson Healthcare in spite of COVID-19-related impact and delays.

“COVID has impacted our hospitals tremendously,” said Debra Henderson, interim president for Munson Healthcare Foundations, which works with donors throughout the region to raise funds for projects at Munson hospitals. “(The pandemic) has put a halt to a lot of capital improvements, because we aren’t quite sure where the dust is going to settle on the financial impact.”

Fundraising projects that are currently in a holding pattern include new MRI equipment for Otsego Memorial Hospital in Gaylord, as well as money for Munson’s new Family Birth and Children’s Center.

Munson Healthcare Foundations is still continuing to raise money for two high-urgency projects: an upgrade to the MMC stroke care program and Manistee Hospital’s emergency department renovation.

Rajah

The new stroke care program was launched in June, when Munson hired Dr. Gary Rajah, an endovascular neurosurgeon who specializes in cerebrovascular neurosurgery, particularly for the treatment of stroke, intra-cranial hemorrhage, and cerebral aneurysms.

Rajah’s arrival dovetailed with new capital improvement plans at MMC intended to make the hospital a statewide leader in the prevention and treatment of stroke. Central to it will be a pair of biplane imaging labs – advanced 3D medical imaging systems that assist with locating blood vessel blockages in the brain that may lead to stroke, or with helping doctors navigate the brain when placing stents or inserting catheters in the wake of a stroke.

Henderson calls the biplane “the gold standard in interventional medical imaging technology.”

So far, MMC has purchased one of the two biplane systems needed for its new Comprehensive Stroke Center. Henderson says that Munson is one of the few facilities in the country to have this state-of-the-art equipment and the only hospital in the state of Michigan.

Munson Healthcare Foundations needs to raise just over $5 million to purchase the second biplane system, as well as to pay for the facility upgrades, supporting equipment and staff training necessary to make the system a viable part of MMC’s operations.

In seeking out donors to support the project, Henderson and her colleagues are using appeals grounded in stroke statistics. Stroke is currently the leading cause of long-term disability and the fifth most common cause of death in the United States. Risk of having a stroke doubles every 10 years after the age of 65 – notable for the region, given northern Michigan’s aging population.

Last year alone, Munson Healthcare recorded just under 1,000 stroke patients across its system hospitals; more than half of them had to be transferred to larger hospital systems in other parts of the state because Munson didn’t have the equipment to provide adequate treatment.

“Five hundred twenty-two patients last year would have benefited from having a state-of-the-art comprehensive stroke center here in Traverse City, or close to home,” Henderson said. “That’s what we’re focusing on: bringing life-saving equipment and techniques closer to home.”

With stroke, time is “brain cells,” she said.

“A one-hour delay in treatment is the equivalent of the brain aging by four years, so if you’re going from here to U of M, that’s four hours – or 16 years of brain aging – to get you to treatment,” she said. “(The biplane technology) will make a huge difference in our ability to treat stroke patients and to treat them in the crucial, timely manner that is so important for stroke.”

Beyond the stroke program, Henderson says the other fundraising priority right now is for an emergency department renovation at Manistee Hospital. Manistee’s emergency room hasn’t gotten a facelift since 1991 and is in need of an enhanced trauma room, private waiting areas and other improvements to enhance privacy and quality of care for patients.

Munson Healthcare Foundations has so far raised about $700,000 out of a roughly $2.5 million goal.

Prioritizing those two projects leaves two major capital improvements on relative pause. Henderson notes that she and her team have so far raised more than $10 million for MMC’s surgical expansion project and its new Family Birth and Children’s Center. Those fundraising projects are on hold until some of the uncertainty around COVID-19 dissipates, though neither development has halted entirely.

Both projects are part of a larger, record-breaking $80 million expansion at MMC, which started in the fall of 2018 with a new parking deck and continued last fall when Munson broke ground on the new surgery addition. Construction on the surgery add-on shut down in March, as the COVID-19 pandemic impacted Michigan, but it resumed in July and is currently moving forward once more.

According to Jim Fegan, MMC’s systems director for design and construction, the surgery addition – which was initially intended to be completed sometime next year – is moving forward on a more piece-by-piece basis than what was originally intended. If all goes as planned, the project will bring four new operating rooms to MMC, upgrade a pair of existing operating rooms, and construct a central processing unit and waiting rooms for the new surgery addition.

Also on the wish list is a new da Vinci robotic surgical system that assists surgeons in performing laparoscopic or minimally invasive surgeries; Munson already has two da Vinci units and would like to add a third for the new surgery center.

Right now, Fegan says the priority for the surgery addition is getting the exterior shell of the structure completed before the weather turns. After pausing the project in March, Munson released $3.2 million in funding in July to allow construction crews to get the brick and the stone on the façade, install the windows and set up key equipment on the mechanical floor.

Going forward, the Munson board will be reviewing the project every quarter to decide how to move forward – and whether to release funds that have technically already been committed to the project. If design changes or downscaling of the vision for the surgery add-on are needed, the Munson administration will make those calls during these quarterly reassessments.

“What you’re seeing going on at the surgery center right now is that we’re getting the building enclosed before winter,” Fegan explained. “We’ve got all the big systems here on the site – the electrical switchgear, the air handlers, the underground piping – they’re all here and they’re in place. We’ll be reviewing this project again with our administration and our board in the very near future to release some additional funds so that we can keep on working.”

One challenge, beyond the initial economic blow of COVID-19, is that the surgery addition will likely cost more than was originally anticipated due to current conditions in the construction industry. Those conditions are raising questions about how much the project will actually cost, versus what was projected pre-2020.

“Because of the fires out west, and COVID, and the hurricane down south, the (construction) materials that haven’t been committed to a job already are ranging between 30-40% higher than they were back in March,” Fegan said.

2020 has also brought a few unexpected capital investments, which have made it even more difficult for Munson to plan ahead for larger projects like the surgery addition or the Family Birth and Children’s Center. For one thing, 26 areas throughout MMC were damaged by heavy rains and flooding that occurred in Traverse City in late May and early June. Since May 28, Fegan says Munson has spent close to $2 million on flood mitigation and repair.

Rob Richardson, vice president of facilities for MMC, also points to on-the-fly COVID-19 modifications as a major focus for the hospital’s facilities and construction crews this year. While those projects didn’t have a huge cumulative dollar value, Richardson says they did require a significant time commitment. Specifically, the facilities crew had to be ready to change the air pressure for a room if/when a COVID patient arrived at the hospital.

Positive air pressure rooms keep higher pressure in the patient room, allowing airborne particles to be filtered out. Negative pressure rooms keep lower pressure in the patient room to keep contaminants from escaping the room. For infectious viruses like COVID-19, negative pressure rooms are essential to a hospital’s ability to maintain a safe environment.

Munson’s facilities and construction teams worked together to make quick switch-ups possible.

“All along, we had to negatively pressurize rooms at the drop of a hat (when we had COVID patients),” Richardson said. “We’d get a call to essentially remodel the room and reconfigure it so that we could have a highly infectious COVID patient in there.”

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