HomeMy WebLinkAboutNantucket Cottage Hospital presentation to the TON Finance Committee 9.11.14_201409151634230827NANTUCKET COTTAGE HOSPITAL
FINANCE COMMITTEE -SEPTEMBER 11, 2014
Prospect Street*Nantucket, MA 1
Introduction
Margot Hartmann, MD, PhD
President and CEO, Nantucket Cottage
Hospital
Stephen R. Karp
Board of Trustees, Nantucket Cottage Hospital
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The Topics We Would Like to Discuss
The need for a new hospital
-site
Alternative development sites
The preferred development site
Preliminary financial considerations
Process/permitting path
Timeline/next steps
Frequently Asked Questions
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The Need for a New Hospital
Inefficient infrastructure requires NCH to spend more than $1 million-a-year in
repairs and maintenance and accounts for most of its operating deficit; these funds
should be going towards better patient care and services
NCH has only one operating room, which restricts scheduling of routine and
emergency surgeries as it must be reserved when women go into labor due to
potential for emergency C-sections
Public Health standards with the exception of one function, CT scans
Lack of space impacts patient privacy, restricts specialty care offerings
Any maintenance/improvement project is a complicated and expensive endeavor
Critical services are separated in different areas of the hospital, an inefficient layout
that results in the duplication of services and facilities, and prevents the efficient
use of staffing
The hospital building was constructed in 1957 with a medical inpatient model no
longer in use
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Why we can’t build a new hospital on
the existing site
Severe operational limitations impacting patients and staff associated with constructing a new hospital on the existing site while trying to operate the existing facility (construction noise, inadequate parking and inability to provide certain medical services)
Many hospital functions would need temporarily to be relocated off-site to accommodate construction activities
Existing medical office buildings would have to be demolished to accommodate construction
The construction phasing would be very difficult and result in a large expense for the hospital
New building would be constructed within 2 feet of existing facility, which jeopardizes existing hospital functions
Hospital design would be inefficient as a result of site constraints
Flat roof would be required to accommodate helicopter landing pad; building design would be out of character for the Island and require HDC approval
Certain key services could not be provided during the construction period, such as our walk-in care service
Construction would be highly disruptive to the outpatient services
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Site Plan for Existing Site
Hammond Pond
City of
Newton
Town of
Brookline
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Rendering for Existing Site
Hammond Pond
City of
Newton
Town of
Brookline
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Alternative Development Sites
Reviewed
After rejecting the existing hospital site, we identified certain key alternative sites
The following sites were initially reviewed in 2013 and then subsequently refined in response to input from the Planning Department:
Existing site combined with 47 Prospect Street
Existing site combined with Gouin Village/Sevrens property
Valero site (64 Old South Road)
Glowacki site (63 , 67 & 73 Old South Road and 4,6,8,10,12,14 Nancy Anne Lane)
0, 20 Davkim Lane, 24, 26, 28, 30 Evergreen Road
Airport Parcel site from 10 Sun Island Road
We also reviewed additional sites, including the Fairgrounds property next to the police station, the Town owned property next to Sherburne Commons and the Boy Scout Property on the corner of Fairgrounds and Surfside, which were rejected for a variety of reasons, including size, topography, cost, shape and location.8
Plan of Alternative Development Sites
Hammond Pond
City of
Newton
Town of
Brookline
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Preferred Alternative –Wyer’s Valley
-term potential for a medical campus to meet a full range of island needs
Located near the existing hospital site
Total site area accommodates the anticipated program as well as future expansion areas to adapt to changing technology
Topography allows the hospital to construct a new building that is consistent with the design of other island buildings and to utilize multiple levels (e.g., emergency services to enter on lower level)
Superior access from multiple locations on the island with proximity to five roadways while other sites have only one or two access points
Traffic report indicates the existing roadway network can support proposed project
Close to public transportation and retail/restaurants
Limits development to the edge of the Town Overlay Area without extending too far into the Country Overlay
Site supported by the Water Company 10
Preliminary Site Plan
for Preferred Alternative Site
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Site Access for Preferred Alternative
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Preliminary Financial
Considerations
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Water Company Requests
In partnering with NCH, the Water Company
has requested from the hospital:
Approximately $1.5 Million for the installation of 2 new wells to
replace the expensive to operate and outdated vacuum wells
Approximately $2.5 Million for the construction of new Water
Company offices and maintenance buildings on the North
Pasture parcel
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Tax Impacts
currently pay taxes because the land is owned by the Water Company
Impact of Tax Status on Existing Hospital Site:
will provide greater property tax revenue potential to the Town of Nantucket
If the existing hospital site is sold and redeveloped with housing, the site would be returned to the tax rolls generating, depending on the development program, in
excess of $30 million in real estate tax base
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Site Values
Valley Site?
Due to the current zoning (LUG3) and ownership, the
value is very limited
What is the current value of the Existing
Hospital Site?
Given the the current zoning, location and the
potential for residential and commercial uses, the
current value is approximately $10 Million
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Town’s Benefit from Sale of Existing
Site
Proceeds up to $10,000,000 from the sale of the existing site, will be placed in the NCH endowment, and 4-5% annually will
be dedicated to the use of a community board
A community board would be appointed by the Selectmen and Finance Committee with representatives from the Board of Selectmen, Finance Committee, Hospital, civic leaders -5% of the proceeds as an annual payment
After appointment, the Special Committee would allocate the annual proceeds to the year-round Town residents for
healthcare services, such as:
Support for behavioral/mental health issues
Support for co-pays
Support for specialists
Other healthcare related uses as identified
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Our Island Home
As discussed with the Selectmen, if Our Island Home and the Hospital are at the same location, they could potentially
share the following services:
Materials Management
Laundry
Food/Nutrition Services
Physical Therapy
Occupational Therapy
Speech Therapy
Laboratory Services
Medical Director
The shared services could result in a substantial potential savings to Our Island Home and, therefore, the Town of Nantucket. The Island Home existing site has the potential to add to Town revenue from its sale and, possibly, real
estate taxes.
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Net Financial Benefit to the Town
The Town could receive millions of dollars in value when you consider some combination of the following:
$1.5 Million to replace existing wells
$2.5 Million to replace Water Company office and maintenance building
$400,000 -$500,000-a-year in payments provided for healthcare services (net present value of $10,000,000)
Taxable land at the existing site
Only by way of example, 30 residential homes sold at the median sale price for one family homes on Nantucket ($1,115,000) would generate approximately $125,772 in real estate taxes ($3.76 of taxes per $1000 of value)
Plus, potential financial benefits if Our Island Home is located on the proposed hospital site
Plus, no loss of existing taxable land
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Anticipated process/permitting path
Local Approvals
Any use of the land by the hospital would have to be approved by the voters of Nantucket at Town Meeting
Rezoning to the Commercial Neighborhood zoning district, consistent with recent zoning efforts
Creation of a hospital sub-district that focuses on the unique needs of a hospital, including the potential for expansion and related health care services
Land restriction to ensure healthcare use as well as preservation of existing vegetation/buffers
State Approvals
Environmental Notification Form
Coordination with the state
Coordination with DEP on well relocation
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Anticipated timeline/ next steps
Coordinate with the Selectmen on the process and the collective goals of
the Hospital and the Town
Coordinate with the Water Company on well relocation and related issues
Coordinate with the Planning Department and Planning Board on potential
zoning issues
Coordinate with the Historic District Commission and Finance Committee
Continue public outreach and dialogue on the need for a new hospital and
site
Coordinate with the state on permits and due diligence
Identify timeline for Annual Town Meeting
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Preliminary Rendering for
Preferred Alternative Site
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Frequently Asked Questions
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Why do you need a larger building
on a larger site?
The main hospital building would be located on approximately 7 acres; the total amount of land remaining after the well relocation and the hospital development (approximately 13 acres) allows for adequate stormwater systems, treed buffer areas, access, landscaped areas and parking and the opportunity for expansion as part of a medical campus.
NCH currently has inadequate space for hospital departments and clinical areas. With the exception of one function, CT scans, these departments and clinical areas do not meet state Department of Public Health size standards
To meet these standards, the new facility would be slightly larger than the combined square footage of the existing hospital and auxiliary buildings (aggregate square footage of existing hospital buildings is approximately 76,000 sf; square footage of proposed hospital is approximately 100,000 sf)
The size of the new hospital is dictated by several factors, including Department of Public Health requirements, maintaining key services in the new building, and the topography of the site.
sustainably .
This properly sized building allows NCH to better serve the community, including providing:
Greater opportunity for specialists (e.g, dermatologists, neurologists and oncologists) to see patients;
Space for infusion services;
Adequate space for doctor exams and consults; and
offices.
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Why do you need a larger building
on a larger site? (cont’d)
The new facility must be designed to meet current standards, including a
second operating room and a fixed MRI unit and diagnostic center.
The building must be designed to provide adequate and appropriate space
that will enhance the patient experience and provide our clinicians with an
environment conducive to quality care.
Adequate parking spaces will be constructed to support the hospital along
with associated access and circulation drive aisles.
Sidewalks and bikeways will be constructed to enable pedestrians and
cyclists to access the hospital safely from bordering roads.
A new building would allow the hospital to continue to add physicians and
sub-specialists to its ranks, and provide a home for urgent care and
primary care services that would assist in recruiting and retaining new
doctors.
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Why doesn’t the existing site meet
future needs?
Construction of a new hospital on the 5.7-acre site would impose significant constraints on the design of the new facility, and would take 18 months to two years to complete.
This would cause an interruption in patient services, the temporary off-site relocation of medical offices and staff parking, and disruptive construction noise and dust (the new hospital building would come within two feet of the existing structure which would then be razed after new construction was complete). No space available on site for staging of construction equipment or materials.
new building at an estimated additional cost of $2-3 million: a fire suppression system and elevator shaft would be needed, as well as a flat roof to accommodate the helipad, requiring HDC approval for a building not in character for Nantucket.
If a new facility were built on site, the hospital would be at capacity from the day it opened, prohibiting any future expansion or the development of ancillary structures and/or housing for staff.
Current site is directly adjacent to one of the most congested intersections on Nantucket, and thus problematic for emergency ambulances and other emergency vehicle runs.
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What services will be offered in the
new hospital?
Cancer care
Obstetrics
Medical/surgical
Emergency medicine
Ambulatory care with inpatient capacity
Walk-in clinic/urgent care
Primary care
Additional sub-specialists
Dialysis
Imaging
Nutrition counseling
Speech therapy 27
What other sites did you look at?
The following sites were initially reviewed in 2013 and then subsequently refined in response to input from the Planning Department:
Existing site combined with 47 Prospect Street;
Existing site combined with Gouin Village/Sevrens property;
Valero site (64 Old South Road);
Glowacki site (63 , 67 & 73 Old South Road and 4,6,8,10,12,14 Nancy Anne Lane);
0, 20 Davkim Lane, 24, 26, 28, 30 Evergreen Road; and
Airport Parcel site from 10 Sun Island Road.
We also reviewed additional sites, including the Fairgrounds property next to the police station, the Town owned property next to Sherburne Commons and the Boy Scout Property on the corner of Fairgrounds and Surfside, which were rejected for a variety of reasons, including size, topography, cost, shape and location.
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Comparison of Alternative
Development Sites
Hammond Pond
City of
Newton
Town of
Brookline
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Comparison of Alternative
Development Sites
Hammond Pond
City of
Newton
Town of
Brookline
30
Comparison of Alternative
Development Sites
Hammond Pond
City of
Newton
Town of
Brookline
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What are transportation advantages of
the Wyer’s Valley site?
Located within 1 mile of the existing hospital site
Centrally located from island villages and major population centers
Safe and convenient emergency vehicle access from major roadways
Direct access from Old South Road and Milestone Road
Does not require primary travel through residential areas
Primary access routes provide adequate width and separate accompanying facilities for pedestrians and bicyclists for safety
Emergency response times are similar to or improved over current hospital site
Accessible from all 7 NRTA bus routes
None of the other sites provide this level of transportation benefits
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Will the new hospital impact the
aquifer?
between building the new hospital at the water company property or building it at the current NCH site.
The potential for any issue is highly unlikely, given the measures included in the design, but the benefits to the community from a centrally located hospital with excellent transportation links to most portions of the island are significant.
The Best Management Practices (BMPs) that will be part of the project design will provide better protection from and better response actions than is available
commission felt this was an opportunity for tomorrow, to make a partnership to protect public health, increase public health, and create the services we need on Nantucket. The commission is, bottom-line, committed to protecting the drinking
The proposed hospital will be farther away from the wells than existing commercial buildings. (See attached)33
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