MVC hears testimony on need for new hospital building

By Janet Hefler - November 9, 2006

After almost four years of planning, the Martha's Vineyard Hospital's $42 million renovation and expansion proposal came before the Martha's Vineyard Commission (MVC) on Nov. 1 in the first edition of a multi-chapter formal public hearing process.

In his opening remarks to the commission members, Tim Sweet, vice chairman of the hospital's trustees, quoted what he called the most alarming statement in a master plan study conducted for the hospital by the architecture and design firm Thomas, Miller and Partners: "The building as it stands today is in its final stage of usefulness for the hospital."

Tim Walsh, the hospital's chief executive officer, outlined the need for a new facility, noting that the present building's space is inadequate, aging and deteriorating. Currently there are eight rooms in the emergency department, whereas projected needs based on demographics indicate 16 will be necessary. The present building does not meet hospital code, Mr. Walsh said, and cannot be brought up to code because of its wood framing.

"The biggest complaint we have isn't about the care patients receive, it's the environment they're in," Mr. Walsh said.

Looking at the hospital's financial picture, Mr. Walsh said that hospitals make money on in-patient services and lose money on out-patient services. Although Martha's Vineyard Hospital lost volume in in-patient admissions from 1998 to 2002, after 15 new doctors were added to the staff since 2002, inpatient admissions started going up. By the fiscal year ending March 31, 2006, inpatient numbers had doubled. The operating surplus for FY06 was $1,570,177.

In looking at demographics, about 13 percent of the population in Massachusetts is over age 65, compared to 14 percent on Martha's Vineyard. Over the next 10 years, the over 65 population is expected to increase by 17 percent, and in the following 10 years by 30 percent, Mr. Walsh said. As the population on the Island ages and people retire, it is expected there will be more year-round residents in need of medical services.

As part of the hospital's planning process, public forums were held Island-wide, asking for suggestions on how to proceed. The Martha's Vineyard community said no to an initial pricetag of $55- to $60-million for a new facility.

Mr. Walsh explained that rather than replacing the entire hospital, constructing a new building and also renovating the old sections of the existing hospital for use as offices and support services cut the cost to $42 million. He also explained that building at an alternative site would require an additional $19 million for a support services building and for replacement of Windemere an additional $11.5 million, which would bring the cost up to $72 million.

Time is of the essence, Mr. Walsh emphasized, as delays in building the new facility could drive the costs up by 12 percent a year.

A team from Thomas, Miller and Partners presented a thorough explanation of the hospital's building plan, site plan, traffic and parking requirements, landscaping, lighting, and construction sequences. Architect Marc Rowland said that the firm would revise its plans in response to the recommendations included in a risk and vulnerability assessment released last week by the Woods Hole Group.

These changes include raising the building's emergency generator and fuel tank above the Category Three storm maximum surge level; regrading the perimeter access road to provide access during a Category three storm on the north and west sides of the facility; and upgrading the design of the building to withstand winds of 120 mph, using brick throughout the building and eliminating wood siding.

MVC Land Use Planning Committee (LUPC) chairman Christina Brown, chairman of the MVC Land chaired the five-hour long hearing at Martha's Vineyard Regional High School, attended by about 25 members of town boards, organizations, and the public.

At her invitation to members of town boards and community organizations to speak, three of the five Oak Bluffs selectmen made individual statements not representative of their board. Oak Bluffs selectman Ron DiOrio read a statement from selectman chairman Duncan Ross in support of keeping the hospital where it is.

Selectman Roger Wey agreed, adding that, "We can't afford to wait any longer. The Island needs and deserves a new hospital now."

Despite the arguments against building the hospital at another site, Oak Bluffs selectman Kerry Scott raised the issue again. She also relayed concerns she said she received from nearby residents worried about the construction impacts.

Oak Bluffs planning board chairman John Bradford relayed the consensus of his board, which wholeheartedly supports the project and is comfortable with its location, he said. The building plan will go to the zoning board of appeals for a special permit and will require a site plan review by the planning board.

Oak Bluffs emergency management director Peter Martell also spoke in favor of the hospital remaining at its present site. "We don't really consider the location dangerous as far as a storm surge," Mr. Martell said.

Joan Hughes, chairman of the Oak Bluffs Conservation Commission, said an expert consultant will be hired to refine plans for storm water management, and that the concept is workable in terms of the Wetlands Protection Act.

Giving the commissioners an opportunity to ask questions and request further information for the next hearing session, Ms. Brown suggested they categorize their questions under site design, building design, town services, traffic, and risk analysis.

Despite the recommendation in the risk assessment study for using brick on the hospital's exterior, the commissioners discussed the subject at length. Megan Ottens-Sargent, Aquinnah commissioner, asked about alternatives. Mr. Rowland explained that pre-cast concrete or metal panels were the two other possibilities, which he had ruled out because he thought they would be out of character with Martha's Vineyard.

Andrew Woodruff, West Tisbury commissioner, asked whether plywood covered by some kind of facing could be used instead of brick, which he considers out of character for the Vineyard. Project manager Dan Cress explained that building codes require non-combustible materials.

Mark Morris, an MVC commissioner newly appointed by the Edgartown selectmen, questioned why there was such a bias in the MVC against brick, considering a successful brickyard once operated on the Island.

"I think the biggest concern is everybody doesn't want this big red building," Mr. Morris said. "I think if you dyed the bricks gray or something, I don't see a problem, you know what I'm saying?"

Switching the topic to building design, Tisbury commissioner John Best criticized it as looking like suburban Boston condos. "I assure you I have no intentions of offering design suggestions, but it just don't look like home," commented Mr. Best, whose wife Margaret is an architect.

Ned Orleans, Tisbury MVC commissioner, asked Mr. Walsh and Mr. Sweet whether they would consider asking the Oak Bluffs Historic Commission to review the proposed design. As Mr. Sweet pointed out, the historic commission usually only looks at buildings within the historic district.

"Windemere was a disaster," Mr. Sweet added. "The building design blends with Oak Bluffs, but it is a maintenance nightmare. Making a large building look homey is nearly impossible."

In discussing risk assessment, Dr. Martin Crane, the governor's MVC appointee, asked whether the study took into account the fact that because Martha's Vineyard is an Island, in emergency situations, patients may have to be evacuated by air to another facility. Ms. Field said no, that the study assumed in the event of a hurricane if any evacuation had to be done, Martha's Vineyard Hospital patients would be moved to Island shelters, which Mr. Martell confirmed.

The commissioners compiled a lengthy list of questions for the Martha's Vineyard Hospital officials and design and engineering team to answer at the second public hearing session on Wednesday night at the Katharine Cornell Theatre in Tisbury.

Session three takes place tonight at 7 pm, at the Old Whaling Church in Edgartown.