Rhode Island Hospital president and chief executive officer, Dr. Joseph F. Amaral takes a matriarchal view of his institution.
Over the years the hospital has doled out hundreds of millions of dollars in care for the state’s indigent, implemented innovative new procedures and technologies and nurtured several generations of new doctors through its strong ties with Brown University.
”Now it’s time to take care of Mom,” Amaral said. And Mom’s going to get a major facelift.
The hospital plans to pour about $70 million into capital-improvement projects over the next three years, including a new emergency department that will be more than twice the size of the existing emergency department.
Plans also call for a new $20 million cancer center in the hospital’s ambulatory patient care (APC) building and a $5 million renovation of the Coro Building on Point Street, which will add research and outpatient services there. The hospital’s Cooperative Care Center also will get $5 million in renovations.
”We’ve got the people and the programs, but we don’t have the facilities to match,” Amaral said. “The limitations of the physical plant itself inhibit our ability to conveniently and effectively take care of our patients.”
State health officials apparently agree: The Department of Health, which reviews the necessity of infrastructure projects proposed by the state’s health-care providers, recently approved Rhode Island Hospital’s expansion plans.
The hospital is plowing ahead with the ambitious expansion projects – the institution’s largest and most expensive since construction of Hasbro Children’s Hospital in 1994 – despite its continued operating losses. It has lost a combined $113 million since 1997, when the federal government implemented steep Medicare reimbursement cuts that have slashed hospital revenues nationwide. Rhode Island Hospital lost more than $29 million in its most recent fiscal year, which ended Sept. 30.
But Amaral, and the hospital’s board, remain undeterred. He says many of the improvements can’t wait, and all are interrelated, which requires them to be done concurrently.
”I think these things are all too important, and they can’t be done overnight,” Amaral said. “We have a huge number of people coming here for their health care, and that number will only get bigger. We have to provide them with what they need.”
Roughly 20 percent of the $70 million will come out of the hospital’s endowment, while the remainder will be financed through tax-exempt bonds, Amaral said.
Work on the $41 million, 51,000-square-foot emergency department will begin in August. The new building will bridge across Dudley Street, between the hospital’s Cooperative Care Center and the existing emergency department. The new facility, which will include a trauma and critical-care unit and a separate space and entrance for urgent care, should be complete by August 2004.
The plans still must be OK’d by the city, including negotiation for the right-of-way over Dudley Street.
Amaral said the new building is needed to handle the swelling demand in the hospital’s emergency room, which has seen patient volume grow five percent annually over the past several years. The existing, 21,700-square-foot emergency room opened in 1983 and was built for a capacity of 40,000 patients per year, Amaral said.
Rhode Island Hospital saw about 73,500 emergency-room patients during fiscal-year 2000 – roughly 60 percent of its overall admissions – and projections are for 100,000 patients by 2009.
”It’s a tight, cramped space, which leads to safety concerns and ultimately affects our patients’ satisfaction,” Amaral said. He said the new emergency room, which will have the capacity for 110,000 patients per year, will provide more patient privacy and better accommodate their family members.
The existing emergency room’s number of “visits per square foot,” which is a standard capacity measure, stands at 3.3. That number will drop to about 2.2 in the new facility, bringing it more in line with what Amaral calls “benchmark” emergency rooms like New York Presbyterian’s (2.13) and Barnes Jewish Hospital’s in St. Louis (1.8).
Once the project is finished, the hospital could add two additional floors to house a cardiac unit and operating rooms, Amaral said, although those plans have not been submitted to the state.
The hospital had included an additional 51,000 square feet for those floors in its original application. But the state was apprehensive about approving them because the intended uses weren’t clearly defined, according to John X. Donahue, who heads the state’s Health Services Council, a 22-member advisory group that reviews proposed health-care projects.
Donahue said he expects the hospital might submit plans for those additional floors next year. But any approval would hinge on successful negotiations between the hospital and the city on the emergency-department project, he said.
The second-largest portion of the capital-improvement plan is a $20 million cancer-care center, which requires an overhaul of the first two floors of the hospital’s APC building. Amaral said the new center would coalesce all the hospital’s cancer services into one location, bringing together oncology services, surgery and radiology.
”When you go to a place like Dana Farber (Cancer Institute in Boston), you go to one building, you see all the specialists in one trip, it’s comprehensive,” Amaral said. “Here, everything is spread out, and patients have to go from place to place.”
The Health Services Council, however, balked at the project’s label as a “comprehensive care center.” Donahue said that term carries specific criteria related to the National Cancer Institute’s cancer-center designation, which Rhode Island Hospital has been seeking for years.
Amaral’s vision for the cancer center is a model for creating “centers of excellence,” a plan outlined – along with the expansion projects – at the hospital’s annual meeting a year ago. He envisions patient services and personnel grouped in different “pods” spread across the hospital’s campus, based on niche clinical areas such as cancer, cardiovascular thoracic services, pediatrics, neuro-orthopedics and transplantation and diabetes.
By decentralizing services into nimble, multidisciplinary groups with tightly focused clinical objectives, Amaral says the hospital will be better able to deploy new technologies, handle increases in patient volume, lower costs and ultimately improve outcomes.
The third main component of the hospital’s expansion plans is an overhaul of the Coro Building, which the hospital purchased last March for $28.3 million. About half of the building already is occupied by Lifespan administration offices. For the other half, plans include an orthopedics research lab, a new diabetes clinic, a pediatric-care unit, a geriatrics unit and the hospital’s behavioral health center, which already has moved in.
But before any of the projects move forward, Amaral said both the city and state have required that the hospital come up with a plan for what he calls its biggest problem: parking. He said a consultant has been hired to conduct a traffic-and-parking analysis for the 69-acre campus.
Mike Colias can be reached via e-mail at colias@pbn.com
