HomeMy WebLinkAbout780542.tiff WELD COUNTY GENERAL HOSPITAL
Greeley, Colorado
LONG RANGE GOALS REPORT
October 1978
WELD COUNTY GENERAL HOSPITAL
Board of Trustees
Planning and Development Committee
780542
/1500 '77
GEAERAL HOSPITAL
sixteenth street and seventeenth avenue-greeley,colorado 80631 -phone 303-352-4121
October 20, 1978
• L. Cent Reitz, President
Board of Trustees
Weld County General Hospital
Greeley, Colorado 80631
Subject: Planning and Development Committee
Long Range Goals Report
Dear Mr. Reitz :
We are presenting this report for Board review and approval
in accordance with your instructions to the Planning and
Development Committee. The report has been prepared with
the guidance and assistance of three subcommittees, utilizing
non-trustee community residents.
Contained in the report are our conclusions and recommen-
dations on planning for the Weld County General Hospital.
We have outlined some specific items to be accomplished
as a "first-phase" program and have included a tentative
schedule of implementation. The Committee recommends to
the Board that the long range plan of the Hospital be
periodically reviewed and updated.
The interest and participation by the WCGH Administration
and Medical Staff and by other individuals in the community
has been very beneficial.
Sincerely,
WELD COUNTY GENERAL HOSPITAL
William F. Allnutt, Chairman
Charles W. Meyers
Planning and Development Committee
board of trustees
•
I. kent reitz, president william f. allnutt, vice-president charles w. meyers,secretary
hiroshi tateyama michael d. neighbors ida s. karowsky patricia thomas
TABLE OF CONTENTS
Page
LETTER OF TRANSMITTAL i
TABLE OF CONTENTS ii
I. COMMITTEE CHARGE 1
II . HOSPITAL MISSION 3
III. RECOMMENDATIONS AND FINDINGS 4
A. Specific Recommendations 4
B. Capital Financing
Advisory Subcommittee Report 6
C. Hospital Services
Advisory Subcommittee Report 9
D. Facility Development
Advisory Subcommittee Report 12
IV. RECOMMENDED ACTION TO BE TAKEN BY THE
BOARD OF TRUSTEES 18
A. Implementation of services to be
included at Weld County General
Hospital 18
B. Hospital additions and remodeling
with estimated costs 20
C. Method of financing 20
Capital Budget Guideline 21
D. The educational role of Weld County
General Hospital 22
E. Name change consideration 22
F. Selection of professional planners 23
G. Implementation schedules 23
H. Community and professional support 26
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I. COMMITTEE CHARGE
The Weld County General Hospital Board of Trustees has
_ instructed the Planning and Development Committee (Trustees
Bill Allnutt, Chairman, and Chuck Meyers) to recommend long
range goals for this health care institution in serving the
community, primary, secondary, and tertiary areas, to identify
and recommend facilities to achieve these goals, to recommend
development of resources to implement the long range plan,
and to establish implementation schedules.
To accomplish these recommendations three advisory sub-
committees were appointed. The instructions for the
advisory subcommittees and their members are as follows:
CAPITAL FINANCING ADVISORY SUBCOMMITTEE
The Financing Advisory Subcommittee will review all possible
sources of financing including debt financing to provide for
capital financing in the expansion and development of Weld
County General Hospital . It is necessary to identify the
maximum amount of resources available as well as the practical
amount to acquire and service by the Hospital. The report
should identify various debt instruments and their character-
_
istics and limitations.
Subcommittee members: Samuel Addoms, Chairman
Patrick Sullivan, M.D.
Thomas Dhority
Dale Weyerts
Wendell Fuller, Secretary
HOSPITAL SERVICES ADVISORY SUBCOMMITTEE
The Hospital Services Advisory Subcommittee will review all
hospital services and procedures currently being offered at
Weld County General Hospital and evaluate the quality and
limitation of these services. It will be important to
define those with need of increased capability and the
introduction of new services required to the extent that
Weld County General Hospital should consider need and support
as a regional Medical Center.
It will be necessary to include the estimated costs for
facility adaptation, equipment costs and staffing services
involved, including revenues and suggested date for service
implementation if the service is not presently being offered
or is substantially changed. The role of the Weld County
General Hospital in areas of preventive medicine, community
health, health clinics, educational services and mental
health services, should also be recommended.
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Subcommittee members: Jerry Ballard, M. D. , Chairman
Robert Drennan, Ph. D.
Richard Cripe, Ph. D.
Wayne Livermore, M. D.
Mrs. Roy Shaughnessy
Wendell Fuller, Secretary
FACILITY DEVELOPMENT ADVISORY SUBCOMMITTEE
The Facility Development Advisory Subcommittee will use the
Capital Financing Advisory Subcommittee report and the
Hospital Services Advisory Subcommittee report, together
with the Herman Smith Associates report. The Facility
Development Advisory Subcommittee will coordinate and develop
the long range needs for new or modified hospital services
and facilities at the Weld County General Hospital for
recommendation to the Board of Trustees. Special emphasis
will concern the needs for surgery, X-ray, ICU, CCU, obstet-
rics, nursery and pediatrics, and inpatient facilities
improvements. Current capacity and projected need of existing
facilities and bed care capabilities throughout the building
program must be recognized.
Subcommittee members: Bill Allnutt, Chairman
Charles Meyers
Sheldon Brooks
William Mangum, M.D.
Richard Stenner
Wendell Fuller, Secretary
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II . HOSPITAL MISSION
The Mission of the Weld County General Hospital shall be to
provide hospital and health care for the benefit of the in
habitants of Weld County and of any person falling sick or
being injured or maimed within its limits and for others re-
ferred to Weld County General Hospital for services and
care. The Weld County General Hospital will serve as a
regional health center serving the primary, secondary and
appropriate tertiary needs of northcentral and northeastern
Colorado and will develop both hospital and physician re-
sources to meet those needs.
The Weld County General Hospital will assist rural and
smaller hospitals in meeting their hospital service obli-
gations; and as their capabilities are developed, the Weld
County General Hospital will increasingly become a provider
of more specialized referral services required by residents
of the service area.
The Weld County General Hospital will provide and actively
encourage, guide and support medical and health education
for patients, professionals and the public and will cooper-
rate with colleges and universities in such programs.
The Weld County General Hospital will participate in selective
research programs.
The Weld County General Hospital will establish and maintain
reliable referral mechanisms to other health care institutions
to ensure prompt transfer of patients requiring services
beyond the capabilities of this hospital.
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III . RECOMMENDATIONS AND FINDINGS
The Capital Financing, Hospital Service, and Facility Develop-
ment Subcommittees have submitted written reports to the
Planning and Development Committee. A copy of each of the
three reports follow as a part of this section. The third
report, that of the Facility Development Advisory Subcommittee,
presents only the recommended new and remodeling of facilities.
It does not address itself to the other recommendations of
the Planning and Development Committee.
A. SPECIFIC RECOMMENDATIONS
It is recommended that the Weld County General Hospital
be continually engaged in a long range planning program,
with a major emphasis on attaining a regional health
care status.
1 . Specific items recommended which do not involve
facility construction are as follows:
a. Employ a fulltime planner to direct the
Weld County General Hospital service and
facility planning program.
b. Follow through with the approval and ac-
quisition of a CT Scanner to support the
present X-ray capabilities of the Hospital
and to complement and expand the present
Oncology Center services.
c. Develop a strong and continuing community
public relations program to educate the
public and to gain its support of the
overall Hospital efforts to meet the long
range goals.
d. Maintain a continuing program of health
care education within the Hospital and
with other hospitals in the Weld County
General Hospital service area through
the expertise of our very competent medical
staff and other nursing, technical, and
administrative staff members.
e. As a part of maintaining a strong financial
position, continue County mill levy funding
for capital growth assistance and obtain
County financial funding for indigent
health care.
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f. Obtain a full commitment by our Medical
Staff to support the Hospital ancillary
services in order that there be real justi-
fication for the long range financing of
equipment and services necessary to the
development as a regional health care
center.
g. Maintain the present Board policy that
all hospital cost centers shall be finan-
cially self-supporting and service charges
should reflect this policy.
2. Specific areas involving facility construction
which are recommended by the Facility Development
Advisory Subcommittee are enumerated below:
a. Develop a new intensive care and cardiac
care unit.
b. Provide for additional vertical transportation
(elevator) facilities.
c. Develop a new X-ray Department area.
d. Develop a new surgical and recovery
room area.
e. Redesign, with possible relocation, the
laboratory area.
f. Enlarge and modernize the Dietary Depart-
- ment area.
g. Possible relocation of the labor and
delivery area.
h. Possible relocation of the Family Practice
Medical Center facilities, with ownership
of real property.
i. Possible relocation and expansion of the
physical medicine and rehabilitation area .
j . Investigate methods to upgrade and moder-
nize existing patient rooms and provide
patient bed capacity as required.
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B. CAPITAL FINANCING ADVISORY SUBCOMMITTEE REPORT
May 9, 1978
Mr. William Allnutt
Chairman
Planning & Development Committee
Board of Trustees
Weld County General Hospital
— 16th Street & 17th Avenue
Greeley, Colorado 80631
— Dear Bill:
On behalf of the members of the hospital' s Capital
Financing Advisory Subcommittee, the following interim
report is respectfully submitted. In essence four distinct
potential sources of funding have been identified, none of
which are mutally exclusive.
1. ) Contributions from private donors could provide
funds that need not be repaid. One professional fund-
raising firm has estimated for us that $1, 000, 000 could
be collected in the Weld County area with fund raising
costs of roughly 5% . It was suggested that professional
fund-raising need not conflict with other financing
alternatives and in fact could assist in developing
public awareness of the needs for improving hospital
facilities.
2. ) The hospital could continue on a "pay as you go"
basis and make only those forward commitments easily
funded out of current operations supplemented by the
County mill levy. The hospital would avoid interest
costs associated with funded debt as well as the
constraints attendant to financing which mortgages
future revenue.
If the hospital priorities and building schedules
exceed the revenues evident in options 1 and/or 2, then long
term financing may be in order. The two alternatives for
this financing are as follows :
3 . ) A general obligation bond approved by the electorate
would probably be the least expensive method of debt
financing. The County has a limited potential for
general obligation bonds aggregating 1 1/2% of the
assessed valuation. This would presently limit the
general obligation debt of the County to $8. 7 million.
It is highly unlikely that the County would be willing
to extend this entire commitment to the hospital.
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General obligation bonds would typically be retired
from future property tax revenues, although hospital re-
venues might be used in lieu of taxes to the extent they are
achieved. In any case, G.O. bonds and the entire tax levy
for debt service must be approved by Weld County voters
through an election process.
4 . ) Revenue bonds appear to have the greatest potential
for raising capital. Tax exempt revenue bonds could be
issued either through the County' s building authority
or through the newly formed Colorado Health Facilities
Authority. In either case, the hospital would lease
new equipment and facilities from the issuing authority,
one year at a time, and would acquire title at the end
of the financing term. These bonds would be sold based
upon the revenue potential of the hospital, after a
thorough independent feasibility study of future rates
and revenue. The bond issue would be retired from
operating revenues of the hospital, rather than from
property . taxes. County Commissioner approval is
required but a public ballot is not.
For example, if the Health Facilities Authority
were to issue $10, 000, 000 in revenue bonds with a 20
year term, at 7% , the annual debt service would be
approximately $944, 000. The hospital would have an
annual expense of this amount. This equates to an
increase in hospital rates and charges of $12 to $13
per patient day. We believe that such an expense would
be recognized for reimbursement from third party payors.
(It is possible that only interest and depreciation
would be reimbursable, but the debt service would still
be feasible. ) Any property taxes allocated to us by
the County would supplement operating revenue in meeting
_ this expense.
Recommendation
It appears that the most feasible method of capital
financing will be a revenue bond issue through the Colorado
Health Facilities Authority. The prospectus for such an
issue must include an independent feasibility study of the
hospital ' s ability to retire the amount of the bond issue
from future revenues.
Inasmuch as we are faced with a chicken-egg dilemma, we
suggest you consider prioritizing your capital budget recom-
mendations together with their respective costs. At this
juncture, an independent feasibility study would be approp-
riate to determine the debt capacity of the expanded facility.
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The members of this committee will await your con-
sideration of capital improvement priorities and will be
available to you whenever we may be of further help.
Respectfully submitted,
WELD COUNTY GENERAL HOSPITAL
CAPITAL FINANCING ADVISORY SUBCOMMITTEE
Samuel D. Addoms, Chairman
SDA/jkm
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C. HOSPITAL SERVICES ADVISORY SUBCOMMITTEE REPORT
DATE: July 19 , 1978
TO: Mr. William F. Allnutt, Chairman
Planning and Development Committee
FROM: Hospital Services Advisory Committee
J.D. Ballard, M.D. , Chairman; Richard Cripe, Ph.D. ;
Mrs. Kathleen Shaughnessy; Wayne E. Livermore, M.D. ;
Robert H. Drennan, Ph.D.
RE: Committee Final Report
The Committee, in principle, wishes to endorse the
basic recommendations of the report from Herman Smith
Associates with the modifications and general priorities
recommended by the Medical Staff.
The Committee strongly endorses the goal of Weld
County General Hospital establishing a plan of action
to become a Regional Medical Center. This will require
a long range commitment to develop expanded facilities,
plus the addition of new equipment and technology to
_ offer medical service capabilities that are associated
with the role of a Regional Medical Center. There
must be decisions to add new technology in a leadership
role rather than deferring until there is an established
and totally validated economic demand.
It was the judgement of the Committee that there
is no conflict with Poudre Valley Memorial Hospital in
Ft. Collins in establishing W.C.G. H. as a Regional
Medical Center. For primary care, they have a medical
service area population that has little overlap with
our medical service area. There may be a need to
coordinate with them in the initial installation of
some new equipment, but would expect that each will
ultimately have its own population base for justifi-
cation. It will be important to have the initiative in
making technological additions . Having the second
unit in the area is not a leadership role.
Some attention needs to be given to dealing with
_ the implied geographic limitation of the name Weld
County General Hospital. As a regional hospital we
would need to serve secondary and some tertiary level
needs of patient populations of all Northeastern
Colorado and into Nebraska. This presents the need to
give consideration to developing a more regional
identity.
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_ Mr. William F. Allnutt, Chairman
July 19, 1978
Page 2
The committee toured the surgical suite, the
labor-delivery suite, pathology labs and radiology
department. These were viewed as basic medical services
that must be capable of regional medical center
service levels if the rest of the hospital services
are to develop regional stature.
The surgical suite was felt to be of highest
priority for new facilities. Areas of deficit are
significant in meeting appropriate and adequate
functional work area needs for the broad scope of
surgical procedures being done. Even as laypersons
touring the surgical area, it was clear that venti-
lation was inadequate despite it being 8 : 00 p.m. and
there not being the usual "load" of personnel present.
Employee areas were inadequate as was the supply
storage area. Comments on existing physical facilities
was not a specific input requested from this committee.
However, the level of surgical service possible is
less than believed to be proper for a regional medical
center due to these deficiencies.
The labor-delivery suite likewise appears to be
less than appropriate for a regional medical center
due to the deficiencies of the building. In several
_ instances, the room size and arrangement does not
allow a patient to be moved on a standard cart with-
out rearranging of equipment in the rooms. The
committee is not familiar with emerging new trends in
birthing alternatives, but feels that we must be
responsive; except that it appears we are limited to
"patch-up" solutions which are short term at best.
The pathology laboratories are a prime example
of having to use inadequate and obsolete space to
meet the immediate demands for basic medical services .
This would seem to be an area in which there is
opportunity to move forward in providing technologi-
cal leadership for the region. We were advised that
one alternative being considered is to expand the lab
into space now occupied by the radiology department.
This configuration may be difficult to utilize effec-
tively and would still need to include resolution of
the heating and ventilating inadequacies present in
both areas.
As in the case of the other basic service areas,
the Committee felt that the diagnostic radiology area
was a "make do" arrangement in terms of the appropri-
- ateness of its operating space. Based on information
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Mr. William F. Allnutt, Chairman
July 19 , 1978
Page 3
provided us, some of the equipment is technologi-
cally obsolete and should be updated to regional
medical center standards if we are to factually offer
diagnostic services that encourage regional referral .
Particular note was made of the inadequacy of patient
waiting areas, plus several limited access corridors
and procedure room space.
The new program considerations as reported by
the Medical Staff were judged by the committee to be
consistent with the goal of actively moving forward
_ to the status of a Regional Medical Center. The
committee did not have the technical competence to
judge the propriety of each item, but based on dis-
cussions and presentations made, are in agreement
with initiating the programs proposed.
A classic example of the need to take the risks
of being a leader in adding new technology and services
has been shown by the McKee Medical Center in Loveland.
The supporting Medical Staff and patient utilization
came as a result of the real existence of modern
patient facilities and expanded medical services, not
as a result of a paper need or demand.
There is need to give attention to administrative
support and outreach programs which facilitate out-
lying hospitals and medical staffs to relate nosi-
- tively with WCGH' s role as a regional medical center.
Also, it would be appropriate for the hospital to
provide the leadership in assuring that programs
integrate with the ambulatory health services provided
by agencies such as the Weld County Mental Health
Center, Weld County Health Department, Eastside
Clinic, etc . The continuity of care and preventive
aspects of such coordination would provide an important
element in cost containment as well as a method of
directing diagnostic services and acute care services
to WCGH on a regional basis.
The Committee had three scheduled meetings along
with receiving multiple reports regarding the Smith
report and the Medical Staff report. Tours of basic
services facilities add an important perspective in
our deliberations. We wish to thank the Planning and
Development Committee for the opportunity of partici-
pating in this phase of the planning process .
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D. FACILITY DEVELOPMENT ADVISORY SUBCOMMITTEE
REPORT
The Facility Development Advisory Subcommittee
considered the facility changes in Weld County
General Hospital that will provide medical
service capabilities to enable the Hospital to
achieve the role of a Regional Medical Center.
Hospital facility changes and additions of
— immediate priority, and those which by necessity
will proceed concurrently, are considered "Phase
One" . Phase Two development can be delayed until
the demand requires, and in some instances will
be implemented separately.
The following narrative is the recommendation of
the Facility Development Subcommittee with
comments as supporting data for each decision.
1. PHASE ONE
a. Construction of a new intensive care
and cardiac care unit.
Both the existing cardiac care unit
and the intensive care unit do not
meet current minimum standards. Each
unit is a linear design which prevents
the nursing personnel from maintaining
direct line of vision between the nursing
station and the patient. In the cardiac
care unit, cubicles were constructed
which provide privacy and to insulate
the patient from noise and disturbances
in other parts of the area. The cubicles,
of necessity, are small and do not accom-
- modate the personnel and equipment in
code situations. Replacement of both
of these units is one of the highest
priorities of the Hospital' s needs.
The units should either be combined
into a single intensive care unit or
placed side by side so that the staff
can be interchanged and, when appropriate,
patients consolidated to minimize staffing
requirements. Construction codes require
that each patient have an outside window.
The intensive care units should be located
with quick and easy access to surgery.
During evening and night hours, the in-
tensive care unit is used as a recovery
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room. The Davis plan proposed to locate
the units directly above surgery with
an interconnecting elevator. The Smith
plan calls for the intensive care units
to be located above surgery with the
_ utility floor interposed between. Both
plans shall be considered in the final
design.
b. Provide for additional vertical trans-
poration facilities.
The hospital presently lacks adequate
vertical transportation. Four elevators
are available for transportation between
the sub-basement and the fifth floor for
inpatients and outpatients. In addition,
clean and dirty laundry, trash, supplies,
meals three times a day, equipment, staff,
and visitors must utilize the elevators .
The Hospital has the original three ele-
vators plus a fourth elevator which was
added in 1962. They are not adequate for
the Hospital ' s regular needs, and should
an elevator be taken out of service for
_ repair or maintenance, the remaining
elevators are even more inadequate to
meet the demand placed on them.
c. X-Ray
A new X-ray Department area is needed because
of the failure of the area to meet present
building codes and regulations. The con-
figuration of the present location of the
X-ray Department does not permit correction
of the deficiencies that exist. The ceiling
height in the existing building is not ade-
quate to accommodate modern X-ray equip-
-- ment, and the necessary ventilation and
utility support that must be installed in
the ceiling area. The second floor location
of X-ray has 10 ' -6 1/2" clearance from floor
to ceiling and modern hospitals require 13
to 15 feet clearance. The department is re-
quired to have an 8-foot corridor; however,
the present location will not allow expansion
of the corridor to eight feet and still main-
tain rooms of adequate size.
Relocation of X-ray to the area immediately
west of the present emergency/ambulatory
care area was identified in the Davis plan
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with a linking corridor to go thru the
area presently occupied by the film
processor in the emergency room, with
the radiographic room to be accessible
from the west side where the new X-ray
unit was to be developed. In addition,
it is anticipated that the CT Scanner
would be located in the emergency room
area in close proximity to the new X-ray
Department. The Smith plan calls for
the X-ray Department to be located south
of the west end of the 1 West area. In
either case, floor to ceiling clearance
will have to be raised above the 10 ' -6 1/2"
height of the present first floor area.
d. Surgery and Recovery Room
The present surgery area is essentially
as it was when constructed in 1952 . The
electrical wiring has been updated. The
ventilation is inadequate and will not
meet present day standards. The con-
figuration of the unit is of a nature that
it is difficult, if not impossible, to
control traffic in the surgical area.
Supplies must be transported thru the
_ central surgery area when delivered. In
addition, patients going to and from the
recovery room must pass thru the middle
of the surgery suite. The layout does
not contribute to efficient use of per-
sonnel or their time. In surgery, as
in X-ray, the ceiling height of 10 ' -6 1/2"
is not adequate to accommodate the needs
of a modern day surgical area. Here again,
13 to 15 feet clearance is needed.
The original hospital was not built with
a recovery room. In 1958 a lean-to was
added to the building to provide a recovery
room. Its size and capacity are inadequate
to meet the demands placed on it, and at
times it may be necessary to move a patient
out earlier than desirable in order to make
room for a new patient. Ventilation in this
area is also below standards.
In the Davis plan, the surgery/recovery area
is proposed to be located west of the emer-
gency room and south of the proposed new X-ray
unit, with a private corridor connecting the
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surgery area to the emergency area.
Here, too, the ceiling clearance must
be elevated to 13 to 15 feet. In the
Smith plan, the new surgery/recovery
area is proposed to be north of the west
end of 1 West, with the option of expanding
to the east along the 1 West wing. Again,
Intensive Care must be readily accessible
to the surgical area without limiting
expansion options of either area, and these
factors will be considered in the final
design.
e. Laboratory
The Laboratory will need redesigning and
remodeling to make it more efficient. The
Davis plan calls for relocation of the
laboratory to the First floor level to
the west of the proposed X-ray unit and in
close proximity to surgery. The Smith plan
calls for the laboratory to expand into the
area vacated by the X-ray Department. As
the Hospital develops to the west, the Smith
plan would place the laboratory at a distance
from the patient care units.
f. Dietary
The Dietary Department should be enlarged
and modernized at the service floor level .
This development would be contingent upon
the design and expansion of the First floor
level for development of new services such
as surgery and X-ray, located directly above.
2. PHASE TWO
a. Labor and Delivery
The labor and delivery room area has recently
been renovated and presently is adequate in
size and design. When the hospital develops
to the west, labor and delivery may be too
distant from the acute care units. This area
will be restudied at that time.
b. Family Practice Medical Center
Consideration must be given to more permanent
quarters for the Family Practice Medical Center
presently housed in office space leased from
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the Greeley Clinic. Several alter-
natives may be considered:
(1) Acquisition of additional property
to accommodate the construction of
a new Family Practice Medical Clinic,
should construction funds become avail-
able from sources outside the hospital.
(2) Establish a long-term lease, or ne-
gotiate purchase, of the quarters
presently occupied by the Family
Practice Medical Center.
(3) Consideration could be given to re-
- locating the Family Practice Medical
Center into re-modeled available area
of the Hospital, should the patient
_ care activities move to the west. It
should be noted that the Family Practice
training standards prefer a facility
separate from the hospital to maintain
an identity of the Center separate from
the institution and to more typically
duplicate the situation residents will
find themselves in when they enter into
private practice.
c. Physical Medicine and Rehabilitation
Physical Therapy is located in its original
location on the service floor which consisted
of a hydro room, three treatment cubicles and
an exercise room. In recent years, the Depart-
ment has expanded into the S Ward and into the
old emergency room area. It has also expanded
in services to include speech therapy, occu-
pational therapy and rehabilitation services.
_ The increased number of burn patients has
placed a heavy demand on the Physical Therapy
section as patients are debrided in the hydro-
therapy room almost daily. With the present
load of three major burn patients, the
hydrotherapy room is in constant use with
burn patients. An additional load which is
developing is the cardiac rehabilitation pro-
gram. A new program to be considered is the
infant stimulation program, which is more of
a preventive medicine approach. In all like-
_
lihood a larger hydrotherapy room will be
needed and presently an additional body whirl-
pool could be well-utilized. Outpatients have
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increased in the past year and a half and
would increase rapidly with the develop-
_ ' ment of a cardiac rehabilitation program
and the infant stimulation program. In
such case, the P M & R Department should
be located with direct outside access for
easy accessability by outpatients and for
utilizing the outside area for training
handicapped people in walking, car trans-
- fers, and other such activities. In a
new department, a larger Occupational
Therapy area would be needed with a
_ kitchen and other daily living activities
simulated. A new location would be re-
quired to provide direct outside access.
It will be necessary to carefully monitor
the activities of this department and plan
for physical plant changes that growth might
require.
d. Patient Accommodations
The original patient wings of the Hospital
were constructed with two-inch walls between
rooms which is inadequate to get modern
equipment into the walls. In addition,
two semi-private rooms share one toilet
between the two rooms. The public is be-
coming less and less tolerant of this
situation, particularily as surrounding
hospitals have improved and modernized.
The Hospital also has a serious lack of
private rooms. More and more patients
are requesting private rooms, which the
Hospital is unable to accommodate. The
size of the present nursing stations is
not always sufficient for staffing pur-
poses. This is especially true on the
North wing where sections of rooms have
been removed for intensive care units and
burn care patients. Presently the favored
design is a double corridor with service
rooms in the middle and patient rooms on
the outside. Such a design can reduce
the travel distance for hospital personnel.
Although the hospital has an adequate num-
ber of beds, consideration should be given
to construction of a new building to correct
the deficiencies in the present building which
cannot be accomplished thru remodeling. This
would then require that the present patient
areas be converted to other useful purposes,
which fits in with the Phase One plans for
improving and enlarging ancillary services.
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IV. RECOMMENDED ACTION
TO BE TAKEN BY
THE BOARD OF TRUSTEES
_ A. IMPLEMENTATION OF SERVICES TO BE INCLUDED AT WELD
COUNTY GENERAL HOSPITAL
The Hospital Services Advisory Subcommittee endorsed
the basic recommendations of the Herman Smith report
and the goal to become a Regional Medical Center. The
Planning and Development Committee makes the following
recommendations.
1. Approval and installation of the CT Scanner, for
_ which the Certificate of Need application has now
been filed by the administration. The approval
of this diagnostic equipment is necessary for Weld
County General Hospital to maintain adequate radia-
logical diagnostic capability. In addition, recent
advances in oncology services indicate that the
scanner will be increasingly necessary to complement
existing radiation therapy services and to allow
for expansion of these services. It is estimated
that this service will be self-sustaining within
24 months. The cost for equipment and facility
remodeling is estimated at $900 , 000 . Leasing will
be arranged through the Colorado Health Facilities
Authority.
2. The establishment of an acute renal dialysis capa-
bility is suggested to support the chronic dialysis
unit approved for Poudre Valley Memorial Hospital.
This capability will be extremely beneficial to
Weld County General Hospital because it will provide
a needed service to the community, particularly in
emergency cases, while at the same time resulting
in more complete utilization of the Hospital. Cost
for equipment is approximately $3000 . Initially
this service will be staffed by Dr. Ethridge of
Fort Collins and Greeley. Weld County General
Hospital technicians should be trained to accomplish
this procedure.
3. The Weld County General Hospital Intensive Care
Nursery has been identified as a Level II Nursery,
with Level I being the basic level of nursery care
and Level III being the most advanced. This hospital
has a capacity of four bassinets and has been averaging
from three to four infants in the Level II Nursery.
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Patients are those that are born here who need
the services of the Level II Nursery, as well
as referrals from other areas. The nursery is
capable of caring for all complications of the
newborn except those who need to be referred
out who need a ventilator, who need surgery
and who have cardiac problems. In 1977 the
hospital cared for six infants in the Level II
Nursery; however, as of October 1978, 20 infants
have been cared for. Weld County General Hospital
is the only hospital outside metropolitan Denver
receiving referrals of such patients from other
areas. Patients have been referred to this hos-
pital from Colorado, Wyoming, Kansas and Montana.
At the present time, equipment is adequate. However,
the intensive care nursery is experiencing some
difficulty, because of lack of space and, in the
future, it may be necessary to add an additional
room to the intensive care nursery. Administrative
attention should maintain statistics and recognize
any need for expansion.
4 . The Weld County General Hospital has been identified
as a burn care facility by the Colorado Burn Injury
Council. As a burn care facility, beds are not
dedicated solely to the care of burns, but instead
burns are assigned to the 3 North nursing station
for specialized care. The Hospital has developed
a burn care team consisting of several disciplines,
trained in the care of severe as well as minor burn
injuries. The Hospital has experienced a definite
increase in the number of burn care cases treated
within the past year. Presently, there is only one
burn unit in the state, at Colorado General Hospital
in Denver. The burn care capability requires a
significant amount of continuing education because
of the rapidly changing techniques. The concentration
of burns on 3 North does present staffing problems
because of the high level of nursing care required
by burn patients. It is recommended that further
study be given before establishing a burn unit at
Weld County General Hospital.
5. The Hospital is considering the development of an
alcohol rehabilitation unit through arrangements
with CompCare Corporation of Newport Beach, Cali-
fornia. This unit is expected to occupy a nursing
unit of 18 to 33 beds. CompCare officials are con-
fident that an 80% occupancy can be maintained on
the unit. There is no anticipated major capital
investment associated with this program; however,
it does exclude those beds from us by other medical/
surgical patients. Patients using this type of
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facility usually require other health care
treatment, so it is expected that this service
will result in increased revenue for other
hospital areas.
6. Cardiac Catherterization was recommended in the
Herman Smith report, but is not recommended by
the Planning and Development Committee. Open
heart surgery at Weld County General Hospital
will not be performed within the term covered
by this report. Insufficient patient popu-
lation will not result in an adequate number
of procedures to maintain the high level of
skill, nor justify the investment in facilities
and equipment, and assemblage of a qualified
surgical team.
B. HOSPITAL FACILITY REMODELING AND ADDITIONS WITH ESTIMATED
COSTS
Weld County General Hospital was opened as a new health
care facility in 1952. At that time the Hospital was
considered well designed and equipped. The complexity
and intensity in which changes have occurred in health
care, facilities and equipment during the past three
decades is well known.
A review of the deficiencies by the Facility Development
Advisory Subcommittee indicate the areas that can only
be corrected by new construction. Other medical services
and patient care areas can be improved by remodeling.
Refer to Section III , A, 2, a through j , page 5 of this
report.
The attached Capital Budget Guideline describes the
initial phase, referred to as "Phase One" , and the
estimated costs of construction, remodeling and
equipment. Projected date of implementation is
January 1981.
C. METHOD OF FINANCING
The Capital Financing Advisory Subcommittee investigated
sources of potential funding including:
1. Contributions from private donors
2. Funding by current operations and supplemented by
the County mill levy.
3. General obligation bonds retired by future property
tax revenues.
4 . Revenue bonds issued through Weld County' s Building
Authority or through the Colorado Health Facilities
Authority.
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CAPITAL BUDGET GUIDELINE (1981 Construction)
PHASE ONE MASTER PLAN DEVELOPMENT
Est. Gross Unit Estimated
Level Department Sq. Ft.* Cost Cost**
Sub-Basement
New Connection to Future
Elevator Rbwer 1,800 $ 30.00 $ 54,000
Basement
New General Storeroom 10,000 40.00 400,000
New Central Supply (excl.equip. ) 3,500 80.00 280,000
— New Kitchen (excl.equip.) 7,000 80.00 560,000
New Physical Therapy 5,200 70.00 364,000
Mechanical 4,000 60.00 240,000
_ Remdeling 3,600 40.00 144,000
First Floor
New Surgery 15,000 100.00 1,500,000
New Radiology (excl.equip.) 13,100 90.00 1,200,000
New Medical Records 1,600 50.00 80,000
Remodeling - Med. Records 4,506 40.00 180,000
Surgery/Radiology Admn
Second Floor
New Duct Space 15,000 Incl.in other calculation
Remodel Vacated Radiology to
Laboratory 8,000 60.00 480,000
Remodeling - Miscellaneous 700 40.00 30,000
Remodeling - Vacated ICU to Pt.
Rms. 1,000 50.00 50,000
Third Floor
New ICU/CCU (16 rooms) 9,700 90.00 873,000
Remodel Vacated CCU to Pt. Rm. 1,000 50.00 50,000
Estimated Construction Cost = Phase One 6,485,000
Inflation 33% 2,140,000
8,625,000
Fees at 8% 690,000
Contingencies at 10% 863,000
Sub-TOtal $ 10,178,000
Equipment
Group II 450,000
Dietary 550,000
Radiology (To be Replaced, Exclusive
of Phase One) 1,000,000
2V1AL Estimated Capital Budget*** $ 11,178,000
Guideline - Phase One
*Including building circulation, stairwells, mechanical, etc.
**Rounded
***Exclusive of financing costs and radiology equipment replacement
(1978 construction costs inflated to 1981 estimate) .
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It is the recommendation of the Advisory Subcommittee,
and the Planning and Development Committee, that revenue
bonds should be issued through the Colorado Health
Facilities Authority. The prospectus for such an issue
must include an independent feasibility study of the
Hospital ' s ability to retire the amount of the bond
issue from future revenues. An investment banking
firm will market the bonds of the CHFA.
In addition, fund-raising activities by the Weld County
Hospital Foundation are encouraged to supplement ongoing
hospital growth.
It is noted that past Boards of County Commissioners have
financially assisted capital growth at Weld County General
Hospital by appropriations of mill levy funds. It is
recommended that continued communication remain between
the two Boards to foster the responsibility of Weld County
Citizens to assist in capital growth as well as in the
care of the indigent.
D. THE EDUCATIONAL ROLE OF WELD COUNTY GENERAL HOSPITAL
The educational role of Weld County General as a regional
hospital is paramount. The educational process improves
the capabilities of the faculty, as well as the student ' s
capabilities.
The Hospital should continue its commitment to financial
and educational support for the Family Practice Residency
Program.
There is need for administrative and Medical Staff support
for outreach programs which will assist hospitals and staffs
in the secondary service area of Weld County General Hospital.
Communication, education, and professional trust is necessary
in order that Weld County General Hospital achieves and
maintains a regional status. Special staff committees and
administrative assignments are recommended for this ongoing
program.
Similiar cooperation should be made with other health
organizations such as Weld Mental Health Center, Weld
County Health Department and Eastside Clinic.
E. NAME CHANGE CONSIDERATION
The title of the primary medical institution in the Weld
County area has ranged from "Island Grove Hospital" ,
"Greeley Hospital" , "Weld County Public Hospital" to
"Weld County General Hospital" . The name has been changed
periodically to accommodate to the times and mission of
the hospital.
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If Weld County General Hospital is to achieve and
maintain regional status, a change in the hospital
name may be in order to more nearly depict its
position in the service area.
F. SELECTION OF PROFESSIONAL PLANNERS
The establishment of the Planning and Development
Committee early in 1978 , and the request for this
report to. the Board of Trustees of Weld County
General Hospital, is indicative of the Board' s con-
cern for long range planning. The 1969 Davis report
and the 1977 Herman Smith report are evidence of
former Boards' desire to achieve such planning.
Professionally prepared reports for the Weld County
General Hospital will present the current status of
the institution' s programs for health care, the con-
dition of its facilities and projections for its
future needs. Little will be accomplished, however,
unless the Administration and Board are prepared to
implement a plan of action.
In the past, the Administration, Medical Staff and
Board have been concerned with Hospital operations
and completion of single projects that are intre-
grated into the long range goals. Such projects
may be defined as the Emergency Room in 1974, the
Oncology Center in 1977 and the Power Plant and
the the CT Scanner in 1978. While this process
has apparently been successful, there are time
constraints on all concerned, as well as qualifi-
cation limitations for the extensive planning that
has been recommended by this committee.
It has been previously recommended that a full-time
staff planner be engaged to direct the service and
facility planning. It is also recommended that an
external planning firm be engaged to coordinate the
planning with the Hospital Planner, the Planning and
Development Committee, an AE firm, and the Colorado
Health Facilities Authority.
Firms which are familiar with the Weld County General
Hospital and have been previously involved with Hospital
Planning should be considered.
G. IMPLEMENTATION SCHEDULES
Long range planning and implementation must be a
continous procedure for the Weld County General
Hospital. Recommendations and schedules of implemen-
tation will require revisions as time progresses due
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to changes that cannot always be forecast suf-
ficiently in advance. The recommendations con-
- tained herein are for a "first-phase" program
which is specific and short range enough to be
planned and scheduled in detail. There is much
_ to be planned and scheduled in detail. There is
much to do beyond this program, and Weld County
General Hospital must have an in-house planner,
with adequate clerical support, to keep up with
this important hospital function.
1. The overall plan for implementation of the
recommended Weld County General Hospital
first-phase plant modifications and additions
involve the following steps.
a. Submittal to the Weld County General
Hospital Board of Trustees for review
and approval.
b. Presentation to the Weld County Board of
Commissioners for information and coordi-
- nation.
c. Selection of professional planning help.
d. Develop financing plan.
e. Prepare certificate of need application.
f. Selection of AE consultants.
g. Preparation of detailed plans and con-
struction schedules.
h. Construction.
2. The schedules for implementing the above steps
are as follows.
a. This report will be presented to the Weld
County General Hospital Board of Trustees
on Friday, October 20, for consideration
and approval at the regular board meeting
on Monday, October 23.
b. Copies of the report, as approved by the
Board of Trustees, will be furnished to
the County Commissioners by Monday,
October 30 .
c. Contingent upon Board of Trustees' approval,
the Planning and Development Committee will
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begin the selection of a professional
planner after the October 23 board meeting.
d. Development of the financing plan should
_ start shortly after the Board of Trustees
has the organization meeting on January 9,
1979.
e. The preparation of the Certificate of Need
application can begin at the same time.
Both steps d and e should proceed until
health agency approval has been received.
It is estimated that such approval may be
obtained by about November, 1979.
f. Selection of the architectural-engineering
firm should start once the financing plan
has been fairly well defined. The AE firm
should be of assistance in finalizing the
Certificate of Need application and in pre-
sentinit to the health agency. Selection
of the AE firm should start May 1979 and a
firm should be selected by the August 1979
board meeting.
g. The preparation of the detailed plans and
construction schedule should not commence
until after approval of the Certificate
of Need.
h. The new construction and remodeling to
provide the top priority items outlined
in section III , D, 1, a through f, of this
report should be scheduled over a three-year
period. This period will start about
January 1981, shortly after the power
plant project has been completed and carry
through about December 1983 .
3. No specific schedule has been developed for the
recommended goals beyond the first phase outlined
above. The Committee has made certain long range
recommendations, as included in the Section III ,
D, 2, a through d. It is difficult to place any
_ specific time schedule beyond the first phase,
but it is anticipated that the Hospital will
endeavor to complete the overall long range recom-
mendations in an orderly manner. It is expected
that the overall program will be a continuing
one.
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H. COMMUNITY AND PROFESSIONAL SUPPORT
1. Throughout the years Weld County General Hospital
has enjoyed a position of esteem in the community.
It is now extremely important that the Hospital
develop a strong public relations program which
will educate the public and gain its support
of the long range goals and the efforts to reach
these goals. The present public image is good,
though somewhat ccnfined. An intensive program
should be started to make the public - private
citizens and public officials - aware of the im-
- portance of the institution to the overall live-
ability of the community and to the specific
health care requirements of the service area.
_ The public sector should be continually aware
of the total services available at Weld County
General Hospital, and that it is important all
services be utilized to further improve the
strength of the institution. In this respect,
the Weld County General Hospital Foundation is
a significant educational resource, in addition
to their function of fund raising.
Important physical plant additions and modi-
fications are required in the near future
if the Hospital is to keep up with medical
technology and health regulations. Health
care services must be expanded in order to
provide the scope of health services demanded.
Such programs are complex, as well as costly.
They can be properly culminated only if the
public supports the philosophy and the finan-
cing. To insure this support, the public must
be educated not only to understand the difference
between a community hospital and a regional health
care center, but also to know how our present Weld
County General Hospital will be adversely affected
if the Hospital is unable to proceed toward
achieving its long range goals. A competent medi-
cal staff, complete with the principal specialities,
will not be attracted to, nor will stay at, a com-
- munity hospital. They will, in fact, migrate to
other hospitals maintaining regional status. Such
a program requires administrative staff assign-
ment and probably outside help, at least initially.
2. The Weld County General Hospital has a medical
staff of proven competence and overall hospital
allegiance. The Medical Staff is dedicated to
developing quality health care for everyone in
the Hospital service area. In order to attract
and maintain a medical staff that will provide
26
the broad range and top quality medical services
to complement the institutional facilities and
equipment capabilities, the Hospital must pro-
vide an environment of educational and tech-
nological excellence. The Weld County General
Hospital has endeavored to do this. To justify
the financial commitment the Hospital has made
and is planning to make for patient care facilities
and for ancillary services, the medical profession
must support the Hospital by utilizing the an-
cillary facilities. In essence, while the an-
cillary services must be available to support
our Medical Staff, the services can not be
offered unless the Medical Staff supports ancillary
services. Beyond the pure and simple financial ram-
ifications, new and continuing government regulations
demanding proof of utilization further emphasizes
the absolute necessity of physician support. A
total commitment to utilization of the Hospital
ancillary services will certainly help the Hospital
become more cost competitive.
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