More than one year after its projected opening, the new Martha’s Vineyard Hospital walk-in clinic, which was expected to be operating this summer, is not welcoming patients. Now it appears that a new plan is in the works for the newly refurbished section of the old wooden hospital wing.
In September 2014, former hospital CEO Tim Walsh announced plans to convert the former emergency room (ER) in the old hospital into a walk-in clinic. If all went to plan, the clinic was expected to open by June 2015.
One year later than expected, in March 2016, during a walk-through of the gutted and rebuilt 4,800-square-foot hospital wing clinic space, Mr. Walsh told The Times the transformation was in its final stages. Once completed, the state-of-the-art facility was expected to provide Islanders and visitors with improved access to noncritical health care — and an alternative to walking into the emergency room, or seeking an appointment with a primary care doctor.
“This is a need in the community that we needed to service,” Mr. Walsh told The Times in March. “It closes a hole in our delivery system that was being filled by others.”
The clinic, which was expected to be completed in April, and be fully functional by summer, is still not open.
The delay can be traced to a building with more physical damage than was expected, primarily the result of a notoriously leaky roof, and to which building codes — hospital or healthcare facility — ought to apply to the space. Hospital construction officials and Oak Bluffs building inspector Mark Barbadoro have continually been at loggerheads over their respective interpretations of rules that come with significant costs.
As a result, new hospital CEO Joe Woodin, who took over in May, said the delay has given him time to assess the project and consider a different model to improve Island healthcare access.
Primary care, primary concern
Mr. Woodin said primary care is the entry point to the healthcare system. That is where he is focused.
“When I got here, it had been pushed back a number of times,” he told The Times on Tuesday. “We’re taking a closer look at the intent of the walk-in clinic, what patients we’re trying to serve, what volume we’re servicing. One of the fundamental reasons for the walk-in clinic was to provide Islanders with more access to primary care services. Half of that space was already designed to be used for primary care services, so we’ll continue with that aspect of it. The need is out there.”
Mr. Woodin said that another reason to add more primary care doctors is that in today’s healthcare models, referrals from them have become so integral to getting treatment from specialists.
In addition to hiring more primary care doctors, Mr. Woodin said that the hospital will hire more midlevel staff — physician’s assistants and nurse practitioners. He said the need for primary care physicians, who typically do not make as much money as specialists, is reaching crisis levels nationwide. “It’s been a national trend for years, and of course we have our own challenges recruiting to the Island,” he said.
Mr. Woodin said he has begun actively looking for primary care physicians to fill the new offices, but at present, there are no candidates being considered.
Present challenges aside, Mr. Woodin was upbeat about the future of the nearly completed facility.
“It’s an exciting prospect. It’s good news for Islanders,” he said. “I think we’re making a cautious, appropriate approach. This is the most reasonable best step forward. Our primary interest in taking care of the residents here is getting some medical professionals who are interested in living on the Island and staying here. Building that family practice team is important.”
One percent away
On Monday, Oak Bluffs building inspector Mark Barbadoro told The Times that the renovation is “99 percent there,” and in his view, the only remaining issue is what he described as a substandard firewall between the newly renovated space and the hospital. The new space is separated from the main hospital building by administrative offices, outpatient services that include physical therapy, and two corridors.
“A hospital needs a lot of time to evacuate patients,” he said. “They might have to be wheeled out, they might be hooked up to machines or IVs that are keeping them alive. All that equipment will take time to be moved. When it comes to fire mitigation in a hospital, you don’t mess around.”
Mr. Barbadoro said the wall between the clinic and the hospital has to be a three-hour firewall. Mr. Barbadoro said the cinderblock wall currently in place is a two-hour wall, by American Society for Testing Materials (ASTME) metrics.
The firewall has been a bone of contention between Mr. Barbadoro and architect Christopher Kicza of Boston-based Steffian Bradley Architects, going back to last year.
Mr. Barbadoro said that the difference in building codes for “hospital” and “other health care facility” has come into play.
“It’s a very complicated process, and it can be difficult to get it right,” he said. “For the walk-in clinic to be classified a hospital, it would have required the addition of backup generators, fire-grade wiring, and significant structural changes. Because the decision was to go the less expensive ‘other health care facility,’ the firewall between it and the hospital had to be upgraded to a three-hour wall.”
Mr. Barbadoro said he hopes what has been a rocky experience with this project will lead to a smoother relationship between MVH and the building inspector’s office. “The hospital has a history of making changes without going through the building inspector’s office,” he said. “There’s no way to research what’s been done, because there are no permits. But they’re getting better about it. I look forward to the day when I can issue the CO (certificate of occupancy). And I’m looking forward to better working relationships with the hospital.”