Martha's Vineyard Hospital : The road to building a new $42 million hospital
The new Martha’s Vineyard Community Hospital that Islanders tour this weekend will welcome its first patients later this spring. The contrast with the ramshackle wooden building it will replace, after serving visitors and residents for more than 36 years, could not be starker.
The new brick building may be a metaphor for a new, less fragile era in health care on Martha’s Vineyard. One that will electronically link the small, rural, nonprofit hospital and the patients it cares for to Massachusetts General Hospital (MGH), one of the nation’s most highly regarded nonprofit medical institutions and a member of Partners HealthCare group.
That the hospital, which cost $42 million, was built without a taxpayer contribution testifies to the generosity of the Island’s seasonal and year-round residents. That the project weathered the nation’s severest recession in generations reflects the financial and planning talents of hospital board members and community leaders.
Eight years ago, Island residents would have had good reason to doubt whether their well worn hospital — only recently emerged from bankruptcy, along with its nursing home and rehab unit, and beset with labor problems — would survive. When it rained, hospital staff in the 1974 building had to line corridors with buckets to catch the water dripping from the ceiling.
The most optimistic among Vineyarders would not have imagined that hospital leaders could replace it with a modern building. Or that Massachusetts General Hospital would come calling with a deal that would lead to the sale of the Vineyard hospital to Mass General and to a more financially secure future, plus new physicians, industry awards for quality care, and encouraging year-end financial reports for both the hospital and Windemere, the Island’s only nursing home. But, that is just what happened.
Upheaval led to a promise
In the winter of 2001/2002, the hospital and Windemere were awash in red ink, and contract talks between Kevin Burchill, hospital chief executive officer at the time, and union representatives for 35 permanent hospital staff nurses had become contentious.
Continuing friction between the tough talking Mr. Burchill, credited with leading the hospital out of bankruptcy and with reinforcing the focus on quality medical care, and Richard Koehler, the hospital’s self-assured staff surgeon, had reached a head. Dr. Koehler and his wife at the time, Kathleen Koehler, a highly respected gastroenterologist and member of the hospital board, resigned, setting off a storm of public protest from Koehler supporters.
At a public forum in March 2002, Mr. Burchill announced his departure, and the hospital trustees elected John Ferguson, chief executive officer of Hackensack University Medical Center in New Jersey and a seasonal West Tisbury resident, chairman. Tim Sweet, a year-round West Tisbury resident and manager of Farm Neck Golf Club in Oak Bluffs, was elected to the newly created position of vice chairman.
In an OpEd published on June 24, 2002, in The Times, Mr. Ferguson promised to chart a new course.
As an institution, he said, the hospital had been on the precipice of disaster for so long that the board had always managed an institution in crisis. “We have been so focused on our very survival that we have not had the luxury of being able to step back and make an honest appraisal of what we are doing well and where we need to change,” he wrote.
Mr. Ferguson said the process would begin with a fresh, comprehensive programmatic and facility master plan.
“This study will help decide the very form and function of Martha’s Vineyard Hospital’s future. What size should the hospital be? What health services should it provide? Which medical specialties are essential? What can we do well, and when is off-Island the better option? What does the community need versus what can it afford? The answer to these and many other questions will be the cornerstone for the hospital’s future.
“The most critical component to the study, however, is whether there is truly community support for our hospital. The simple truth is that in today’s health care environment, a small, rural community hospital cannot and will not succeed without substantial financial support from the community it serves.”
New CEO cheered
One month later, on July 24, before more than 30 employees gathered in the spare, institutional setting of the hospital cafeteria, Mr. Ferguson announced that Tim Walsh had been selected as the hospital’s new chief executive officer.
Employees cheered at the news. Their reaction echoed comments from board members, community health leaders, and members of the search committee, who praised Mr. Walsh as a man with the skills and integrity to do the job.
Mr. Ferguson, widely credited with building Hackensack University Medical Center into one of the country’s best hospitals, said at the time that with the resources on the Island there was no reason why Martha’s Vineyard Hospital could not be one of the best rural hospitals in the country.
Acknowledging the conditions under which the employees worked, Mr. Ferguson said, “We’re going to take care of that. You will see. Piece by piece, we are getting there and, guaranteed, there will be a new hospital.”
But repeating a familiar theme, Mr. Ferguson said success depended on cooperation. “If everybody works together, gets the community behind us, guaranteed, before you know it, you will have a new facility to work in and you will have wonderful careers here,” the chairman said.
That same day the hospital board voted to begin a fundraising feasibility study to gauge whether it would be possible to raise the $30 million then estimated to be necessary to build a new hospital.
In October 2002, the hospital issued a request for proposals (RFP) to prepare a facility master plan that would address the hospital’s program and facility needs.
In March 2003, the board selected Thomas Miller and Company, a Tennessee consulting and architectural firm, from among 10 firms that responded. The company would also be selected to design the new hospital.
New hospital takes shape
Initially, Thomas Miller said the cost to build and equip a new Martha’s Vineyard Hospital was expected to exceed $50.5 million, two thirds greater than first estimated. The expenses attached to constructing and furnishing a specialized medical building on the Island were the main drivers of the price escalation.
Also, the earlier estimate did not take into account the high costs of furnishing a new hospital — for example, the cost of the medical information infrastructure needed in a modern facility.
The so-called Island factor, the added cost of building on Martha’s Vineyard, and the specialized labor and materials that are required to build a hospital only added to the equation.
In June 2004, after more than a year and a half of planning and cost-cutting revisions, the hospital trustees presented their plans for a new hospital building to the public and described the reasoning behind the decision to build on the current site rather than an alternative location.
One of the largest cost savings in the new plan was the decision to drop plans to build a new medical building that would have included doctors’ offices and administrative space. Instead, the existing 1974 wooden hospital building was to be renovated.
Driving the choice to build on the current site, they said, was the cost of replicating all of the existing hospital services and facilities, including the Windemere Nursing and Rehabilitation Center, estimated to be in excess of $60 million.
The new hospital, designed by Thomas Miller and Company, was designed to increase staff efficiency, patient comfort and privacy, and to allow for new services and facilities based on a patient-centered health care system known as the Planetree Model.
The question Mr. Ferguson had asked in his OpEd about the depth of community support was answered a year later, in 2005, when, following a quiet, behind-the-scenes fundraising effort, the campaign emerged into the public spotlight.
On the eve of the Fourth of July 2005 weekend, Warren Spector of Chilmark and Frank Biondi of Edgartown, co-chairmen of the capital campaign committee, announced that $20 million had been pledged already and the campaign was about to move into the more public phase.
Tell a friend
In February 2006, having raised $30 million by appealing to seasonal and year-round residents with the means to make large donations, the leaders of the campaign to rebuild the Martha’s Vineyard Hospital turned to the wider Vineyard community to reach the $42 million goal.
Hospital officials said that raising the final $12 million could not be done without the financial support of those who most rely on the hospital, a target group they defined as the 6,500 households of registered Vineyard voters. The challenge, they said, was to gain their trust and confidence in the hospital’s plans for the future.
To accomplish that goal, hospital leaders relied on a core strategy that was personal, in a community where everything is local. That included ads, part of a campaign titled “A New Beginning, Building for the Next Generation,” in which well-known Islanders appealed for contributions
In one such ad, Chilmarker Bridget Tobin, the Vineyard Haven Steamship terminal manager, explained: “We need a new hospital. It’s my responsibility and the responsibility of every single member of this community to contribute what we can to make sure we get one.”
At the same time, a committee of Islanders led by Edward Miller of Chilmark, a hospital board member, took the capital campaign to living rooms around the Island.
Mr. Miller and Tuna Kiersted of Edgartown, a member of that committee, were described by Mr. Spector as “indefatigable, relentless.”
Over hors d’oeuvres or dinner and using a projector, Mr. Walsh and Mr. Sweet described the crumbling state of the existing facility and the reasons underpinning the board’s decision to build new on the current site, and what the community could expect for the $42 million price tag.
At one such event, Mr. Sweet said not raising $42 million was not an option. If the money were not raised, the hospital would continue to deteriorate, he said.
At the end of the presentation, John Anderson of West Tisbury, a house painting contractor and a member of the fundraising committee, added his own highly individualized pitch. “Tell a friend; tell two friends; tell three friends,” Mr. Anderson said. “That’s what we need to get people involved. We need people to understand.”
MVC benefits and detriments
Raising $42 million was not the only hurdle hospital officials faced. Construction could not begin until the Martha’s Vineyard Commission (MVC), the Island’s powerful regional permitting body, approved the design — every aspect of it — from the color of the bricks that would be used in the façade to the plants that would be part of the landscaping design.
The MVC’s review of the project as a development of regional impact (DRI) began with an informal presentation on October 21, 2005, by Mr. Sweet and Mr. Walsh.
The formal approval process would take more than one year and provide several anxious moments for hospital leaders.
The application was to build on the current Beach Road site in Eastville. Hospital officials insisted it was the only financially viable alternative.
However, even before the formal public hearing process began, in January 2006, an MVC subcommittee identified three properties, culled from a list of 30, as the top locations it wanted hospital officials to consider as alternative building sites.
In doing so, the MVC compiled its short list without speaking to the owners of the properties in question. The owner of one of the properties at the top of the list, Jeremiah Goodale, described that process as “bizarre.”
Hospital officials stood firm. A move to a new location was financially out of reach and would likely doom Windemere, the Island’s hospital-owned nursing home, which could not survive on its own, they said.
At the MVC’s first formal public hearing held on November 1, Tim Sweet quoted what he called the most alarming statement in a master plan study: “The building as it stands today is in its final stage of usefulness for the hospital.”
As 2006 came to a close, hospital officials pushed for a decision to avoid escalating building costs. In December, the MVC ended the review process and voted unanimously to approve the construction of a new Martha’s Vineyard Community Hospital building on the Eastville site.
MVC approval came with a list of conditions (68 total) attached to the project, and five pages listing what the commissioners deemed its benefits and detriments (31 benefits and 27 detriments).
In voting for the project, Dr. Martin Crane of Hingham, the governor’s appointee and a seasonal resident of the Vineyard, said that he had worn many hats in his public and professional life. While agreeing that “…in some sense the location is not ideal here,” the physician added, “The thing that I see, and I have to put on my healthcare hat now with this, is that the benefit to improved health care to people on the Island and the consequences of an improved quality of life here are indisputable, they’re very clear, and they’re compelling, and they far outweigh and override, as far as I’m concerned, any of the detriments I have seen in this project.”
MGH deal was a seismic shift
As the hospital moved forward in the MVC process, hospital leaders were equally busy behind the scenes. And on October 20, 2006, Martha’s Vineyard Hospital trustees agreed to the general terms under which the Island hospital would become an affiliate of Massachusetts General Hospital, one of the premier medical and teaching institutions in the world.
It was a seismic institutional shift. At the time, Mr. Walsh and Mr. Sweet said the arrangement would provide the Island hospital with access to state-of-the-art medical resources and provide patients with seamless medical care.
Mr. Walsh said that an affiliation with Partners, a $6 billion enterprise of which Mass General was an operating unit, would also provide a financial backstop that did not then exist for the two largest Vineyard health care providers.
On March 1, 2007, the Island’s not-for-profit privately owned hospital, founded in 1921, became one of a group of hospitals, health clinics, and physician organizations owned by Partners HealthCare System, a nonprofit organization founded in 1994 by MGH and Brigham and Women’s Hospital. Among the institutions of which Partners is the parent are Faulkner Hospital, McLean Hospital, Newton-Wellesley Hospital and Spaulding Rehabilitation Hospital.
The affiliation provided dividends throughout the construction process as the hospital was able to take advantage of MGH’s suppliers and specialists in the fields of hospital planning. MGH technology specialists provided the specifications for wiring the new building, which saved on design costs and ensured that the hospital would be smoothly linked electronically to Partners.
For patients and physicians, becoming part of the Partners HealthCare organization resulted in the adoption of a state of the art electronic medical records (EMR) system now in use in some units of the Partners network.
All Partners physicians are required to use the system.
Vineyard patients treated at hospitals within the Partners system will now benefit from instant record transferability.
In February this year, hospital officials announced that a private reception for donors and a public open house planned for the weekend of February 7 would have to be postponed to April, so that workers could complete interior finish work.
That decision was tied to a delay in laying floor tiles caused by the choice of an environmentally friendly adhesive product. Rather than invite the public to tour a building with some of the floors closed off, hospital officials decided to wait until the building was completed.
In a conversation with The Times, Mr. Sweet said of the delay that, taken as a whole, the hospital project had been very smooth, and to have this delay was not shattering. “Honestly, this has been a terrific construction project,” he said. “We have been on time and on budget for the entire process, and we are feeling very proud of ourselves for doing such.”