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Hospital looking up to meet patient demand

A proposed five-story 'tower' undergoes regulatory review.


STAFF WRITER | July 12, 2004

HYANNIS - When it's done, it will be the tallest building in Hyannis.


A computer-generated illustration shows the proposed expansion to Cape Cod Hospital as seen from Bayview Street in Hyannis.

But Cape Cod Hospital officials say there is nowhere to go but up to meet the health needs of a growing community.

The hospital's plan for a five-story patient tower is wending its way through the regulatory process. If all goes according to plan, the necessary permits will be in hand this fall and the hospital will break ground on the $38 million addition in January.

"The need for additional beds is one of the more pressing needs we've had, and we've had it for quite a few years," said hospital CEO Stephen Abbott.

When complete, the tower will provide the hospital with 120 new beds. It will be the first time since 1976 that new beds have been added, and it will begin a domino effect of modernization for the entire hospital, he said.

Two floors of the tower should be ready for occupancy when the first phase of the project is done in 2007, he said. The final three floors will be framed off for completion as money allows.

The brick, sandstone and glass tower will cover 10,254 square feet on Bayview Street and transform the back side of the hospital into a main new entrance. The Barton and Payson Houses on Bayview will be taken down to accommodate the structure.

Hospital officials met with the Cape Cod Commission late last month to begin deliberations on the development of regional impact application the hospital has made, due to the size of the new addition. A subcommittee is reviewing the application and has until September to make a recommendation to the full commission, said commission planner Sarah Korjeff.

The demand for expansion and modernization is reflected in the patient numbers coming out of Cape Cod Hospital. Modest growth until 1998 has since been followed by an explosion of patient visits, particularly in the emergency room.

In 1998, the emergency department saw 57,000 patients. Last year, more than 80,000 people came through, said Abbott. With a shortage of beds on some occasions, patients were forced to wait in the emergency room or in hallways until beds opened up, he said.

The hospital had 17,080 admissions last year with an average length of stay of 4.1 days.

Questions on design

Some minor differences remain between the Cape Cod Commission staff and the hospital over the plan, Korjeff said. Most surround the design of the tower.

"I wouldn't say we're far apart, but as it is, the building does not quite meet our standard for breaking down a large mass into components," she said, referring to the building's appearance.

Architect Mario Vieira of PRO Architects of Boston has designed the structure to have different appearances on different facades, said Korjeff. The south-facing facade, for instance, is a "curtain wall" with a metal framework and a combination of metal panels, glass and colored glass, she said.

"It's unusual for the Cape, but this is an unusual building," she said.

Vieira has convinced commission staff that it is not reasonable to break down the appearance of the building's mass into different components, but they are pressing him to make some design changes so the effect is softened, she said.

The staff is concerned about the building's appearance from two perspectives: up close by pedestrians and from the water.

Hyannis Fire Department Deputy Chief Dean Melanson said the building should be one of the safest around, despite the fact that the upper-level floors will be higher than the department's ladder trucks can reach. Building requirements for hospitals are some of the strictest for any structures, he said. Fire-retardant materials must be used and emergency equipment installed.

The Cape Cod Hospital facility has become so dense with additions, it would already be difficult to access parts of the building with ladder trucks, he said.

Town boards to weigh in

If the commission denies the DRI application, the hospital would then apply for approval under a new hardship exemption the commission added last year, said hospital attorney Patrick Butler. The permit, known as "project of community benefit," allows the commission to approve projects that benefit the community in some way.

One the commission hurdles are passed, the patient tower proposal will still need to pass muster at Barnstable and Yarmouth town boards. Two-thirds of the new tower is in Barnstable and one-third is in Yarmouth.

To review the hospital project, Yarmouth and Barnstable building commissioners last year suggested a joint site-plan review. The two town agencies have had two meetings so far, said Butler.

In addition to site plan approval, the Yarmouth Conservation Commission will be asked to approve an order of conditions for a small part of the property that is within 100 feet of a wetland. In addition, the canopy on the front entrance of the new wing on Bayview Street violates the setback requirement by a hair, he said. A special permit will be needed.

Hospital financial managers estimate they will need about $15 million in donations to complete the tower. Cotuit philanthropist David Mugar donated $5 million as a matching grant for the tower two years ago. The grant has since been matched by other donors, said Abbott. He expects to make announcements of gifts in the next week or so, he said.

If the tower project can be steered through the approval process, it will open a wide range of possibilities for the hospital, Butler said. Once new patient floors are open in the new addition, the hospital can decommission beds in the oldest portion of the facility in the Ayling 3 section. With that area opened up, the hospital pharmacy, emergency department and kitchen can be expanded down the road, he said. Meeting space will also be accommodated.

But patients will see the biggest benefit from the project, said Abbott.

While Ayling 3 still has rooms with two to four patients in them, all of the rooms in the new tower will be private. The entire structure has been designed with patient privacy and comfort in mind, he said.

Other patient amenities include room service-style meals, spaces for families to visit at all hours, and private meeting rooms for families and doctors.

"We're trying to give patients more choices and more controls," he said.

From The Cape Cod Times

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Hospital expansion gets warm reception

By Bill Barnes | Thursday, July 1, 2004


Cape Cod Healthcare CEO Stephen Abbott and Cape Cod Hospital COO Pat Nadle were all smiles after a Cape Cod Commission subcommittee hearing last week. - Staff photo by Bill Barnes

Plans to build a five-story in-patient building on the Yarmouth side of the Cape Cod Hospital's campus received a warm reception at a public hearing in Yarmouth last week as the Cape Cod Commission's review process got under way.

The project's immediate neighbors in the Hyannis Park area of West Yarmouth and Yarmouth selectmen both voiced support for the plan, as did a number of other officials in Yarmouth and Barnstable.

"We would suggest that we create as few barriers as possible to this project," said Bob DuBois, executive director of the Yarmouth Chamber of Commerce. The Hyannis chamber also expressed unanimous support from its directors.

The only cautionary comments came from Cape Cod Commission staff, which expressed mild concerns about the architecture and the impact on traffic on Bayview Avenue in West Yarmouth.

Cape Cod Healthcare CEO Stephen Abbott said the hospital has the funds to start construction as soon as the necessary approvals are received, which he expects to be in late summer or early September. In addition to the approval of the Cape Cod Commission for the overall project, the plan will need approval from the Yarmouth Board of Appeals for a canopy from the entrance of the new building to the road.

The plan is for two new buildings, a 10,254 square foot, one-story warehouse to receive, store and distribute hospital supplies, and a 111,529 square foot high rise that eventually would provide 120 new patient rooms. The estimated cost is $39 million.

The new rooms would all be private with their own bathrooms and sleep sofas to accommodate overnight care-givers. Some would be suites with seating areas for visitors. The 120 new rooms would add only 60 beds to the hospital's overall capacity of 218 because some would replace small older rooms housing up to four patients each.

"The rooms will be twice the size of any existing rooms," said Architect Mario Vieira. "This is not luxurious. This is a necessity to deliver health care today."

Attorney Pat Butler took the 40 or so people present at the hearing through a slide show of the existing facilities, demonstrating the level of crowding in the old rooms and in the adjacent corridors where various service carts are lined helter-skelter along the walls and staff pulls chairs into the corridors for consultations and preparing patient reports.

The addition also will allow the hospital to double the size of its kitchen, as the lobby of the new bed tower would be the new cafeteria. Rooms abandoned within the existing hospital buildings would be converted to other functions for which there is not enough space at present.

The new warehouse addresses the fact that at present the hospital is able to stock only one day's worth of many supplies and much of that in spaces not designed to receive or dispatch supplies.

Although the bed tower structure would all be built at once, the interior of the upper floors would be completed over time as funds are raised and the need for patient rooms increases. Patients presently are often kept in the emergency room overnight for lack of open in-patient beds, according to Butler, but patient volume is not yet sufficient to fill all the floors.

Economically, the project is expected to add $13 million a year to the hospital's $100 million annual payroll and provide the equivalent of 78 new full-time jobs, mostly for surgical nurses.

As to traffic, the addition on the Yarmouth side of the hospital is expected to add approximately 1,346 trips a day along Bayview Avenue, for which the hospital has agreed to make a mitigation payment of $36,975.10, which could be used to extend sidewalks.

That idea appeals to the Hyannis Park Association. "Anyone who drives through there knows you are dodging pedestrians constantly," said association President Chris Greeley. She said hospital planners also are working with the association to find ways to stop drivers from cutting though hospital driveways to Bayview Avenue in order to avoid busy streets on the Hyannis side.

The road would be widened at the entrance for patient dropoff and pickup and valet parking would be provided. Commission staffer Glenn Cannon was optimistic that remaining traffic concerns, especially in the area of encouraging hospital workers to use alternative forms of transportation are near resolution.

The architecture of both buildings came under some criticism from Sarah Korjeff, who deals with community character issues for the commission. They are unapologetically modern.

Korjeff acknowledged that the use of brick and glass for the bed tower was appropriate for the hospital complex and consistent with other large buildings in Barnstable. Her main concern was the mass of the structure, which she hopes to get broken up by more angles and changes of colors and materials.

In addition to its high visibility along Bayview Avenue, the new high-rise will become a major feature of the Hyannis skyline, clearly visible from across Lewis Bay.

"There are few precedents for a building of this scale on the Cape," acknowledged Vieira. "Cape Cod architecture is typically on a small scale. It is crowded onto the lot, right up to the 20 foot setback," he said. Internally it is also jammed up against the hospital's power plant and its south building.

Vieira argued that the design was in large measure dictated by the function of the building, and described the elements that have been introduced into the design to break up the mass.

Greeley, who represents a neighborhood of mostly modest old-time homes and cottages, said, "I think it looks fine. The contemporary design is driven by the contemporary needs you have in delivering modern hospital services."

Korjeff also raised concerns about the all-metal construction of the materials warehouse, but that will be largely screened by plantings.

Over the past year and a half the hospital and its neighbors in Hyannis Park have been in intensive discussion over hospital plans to direct its current phase of expansion toward Yarmouth. Not without difficulty, the hospital last year won the neighbors' support to change Yarmouth's zoning to add "medical uses" to what is allowed in the residential neighborhood.

That took compromise, and the size of the area rezoned was greatly reduced to meet neighbors' objections. In designing the new buildings, the hospital also took the neighbors' concerns to heart by doing things like fully enclosing the huge cooling and air exchange apparatus which will top the five story building to cut down noise and improve the look.

Yarmouth selectmen had made their endorsement of the project contingent on the hospital working with Hyannis Park on the plans. Greeley agreed that has happened. "The neighborhood of Hyannis Park and the commitments the hospital has made has been a good partnership," she said.

From The Register

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