Planning for replacing the Victoria General hospital stumbles along

They’re known as “The Floods.”

In September and December of 2015, water from leaks in the aged plumbing of the Victoria General site of the QE2 Health Sciences Centre poured into the floors below. The floods disrupted hundreds of surgeries, closed an ICU, and forced 50 patients out of their rooms.

Today, the pipes remain a ticking time bomb. Breaks are so routine they no longer merit a news release unless patient care is affected. On August 4 of this year, a burst pipe on the second floor of the VG’s Centennial Building  flooded the boardroom on the main floor and a training room in the basement. The Nova Scotia Health Authority confirms the incident and says patients were not affected, that the water stopped after half an hour, that the simulation training room used by anesthesia, critical care and nursing is still out -of-commission.

The events are not what one expects in a Canadian hospital in the 21^st century. But neither were they surprising to anyone familiar with the state of the VG Hospital. Besides The Floods, well-documented problems include elevator failures, lack of air conditioning, contaminated drinking water, a bedbug outbreak, and an ongoing struggle with infection control. While praising the care they received there, some former patients have described conditions at the VG as “Third World,” and called for outright demolition.

After the significant flooding in December, 2015, the Health minister told CBC News a plan to tackle the problem would come early in 2016, despite a number of challenges confronting the rebuild project.

“It’s taken a lot of meetings and a lot of work to get this plan ready to go, but in early January we will make known to Nova Scotians exactly what that plan will look like,” said Health Minister Leo Glavine.

But Nova Scotians are still waiting and will continue to do so.  This time next year — nearly two years after The Floods — Nova Scotians should finally see a “To Do” list of renovations and expansions required before authorities can transfer patients and close the decrepit Victoria General in 2022 — another six years from now.

Last month the Department of Infrastructure and Renewal issued a Request For Proposals to hire an outside consulting firm that specializes in construction management. The successful bidder will be charged with delivering a master plan, a preliminary cost estimate, and a schedule that will “sequence” the work to be done at the Halifax Infirmary to replace services delivered out of the VG. The report is due in August, 2017.

A similar tender was let in July and three firms have been shortlisted to manage construction planning at the Dartmouth General, where four operating rooms and about 50 new beds will help replace a fraction of those that will be closed at the VG.

“We knew services had to be decanted or stripped from the hospital site, and we think we know how much space is needed, but we don’t know exactly where they are moving,” says Terry Smith-Lamothe, a senior architect and the building design team leader with the Department of Infrastructure and Renewal. Smith-Lamothe oversaw the building and construction of C.P. Allen High in Bedford.

“Where it gets difficult,” he says, “is coordinating who moves where to allow construction or renovations to take place — with the least disruption to patients. For example, if you relocate everyone from one floor of the Halifax Infirmary to permit the construction of a new Intensive Care Unit, where do those patients and staff move? And, how do you continue to provide the service? The re-development of the QE2 is a multi-year project and it’s complex. We don’t have the experts in house to do that kind of master planning, and we need it.”

In April, Premier Stephen McNeil effectively acknowledged the wishes of frustrated staff and former patients. He announced that instead of renovating the 50-year-old Centennial wing at the VG, the entire brick hospital would be demolished and services relocated. Everyone applauded. Now it appears that despite several years of ongoing discussion within the Department of Health about siting and finding a replacement, no one knows quite how to get there.

The RFP for planning and construction management was issued after several studies for the Department of Health carried out by Nycum Associates from 2013-2015, at a cost of $1.5 million. Nycum looked at adding six or seven storeys above the ER at the Halifax Infirmary at a cost of $400 million in 2013 dollars and a fifth floor expansion at the Dartmouth General estimated at $132 million in 2016. Together these two expansions will replace most of the 15 operating rooms and 215 in-patient beds at the VG site.

The Department of Infrastructure and the Health Authority say Nycum’s work provides a valuable foundation for the work which will take place over the next year to get to a level of detail where another tender can be put out for architectural design drawings.

“There are some good ideas that can carry forward, although the whole scope of the project has changed since the flooding at the VG last September,” says Smith-Lamothe. The reason it took four months between the April announcement and the Department of Infrastructure issuing the RFP, says Smith-Lamothe, is that the province needed to hire another firm, A49 (formerly WHW Architects), to draw up accurate floor plans of the Centennial, VG, and Dickson Cancer Care Centre for the prospective bidders.

According to the timeline provided in the QE2 Redevelopment Plan of April, 2016, for the next six years, immuno-compromised patients being treated for cancer and people undergoing specialized organ transplants will continue to be cared for at the VG site until new beds, operating rooms, and outpatient clinics can be established elsewhere. The only exception involves beds for five palliative care patients, which will be transferred within the next two years to a new hospice being funded and built by the non-profit Halifax Hospice Society.

The QE2 Redevelopment timeline shows a proposed renovation of the fifth floor of the Halifax Infirmary site to add an Intensive Care Unit, Intermediate Care Unit and operating rooms by 2019. This would allow for the transfer of the most complex transplant surgeries.

But neither a final design nor the funding for that work is in place, making senior project officials skittish about whether that  target is realistic. The timeline will be revised once the consultant’s advice is received next August.

“The timeline as shown on the QE2redevelopment.ca site is as accurate as we know, but is subject to change as the input from the construction planning team gets more precise in the details,” explains Smith-Lamothe. “It’s a living document that will be updated from time to time as the unknowns become knowns.”

Asked if there’s any sense of urgency to get the ball rolling on construction before the pipes burst again at the crumbling VG, both Smith-Lamothe and Karen Mumford, the QE2 Redevelopment’s senior director with the NS Health Authority, insist there is, but say it is “essential” to get the planning right.

“We need to make sure enough due diligence is done but that we don’t sit and idly think about this,” says Mumford. “It is important we engage and get input on the planning from staff and clinicians but also that we set clear and aggressive timelines to move the project forward as quickly as possible.”

It sure looks and sounds as if the biggest healthcare infrastructure project in the province is off to a slow and lethargic start, while acknowledging that Phase 2 of  the QE2 Redevelopment (as it is known in government circles) is a massive undertaking with hundreds of moving parts.

The VG site does about 16,000 surgeries a year. They include everything from the removal of cancer tumours, hip replacements, and lung transplants, to abortions, “scopes,” urology and more. The hospital also provides chemotherapy,  acute care kidney dialysis, and cataract surgery for thousands of people each year. Together, the VG and Dickson Centre currently treat 437,000 outpatients a year. The planning concept developed by the NS Health Authority envisions expanding the Dickson Centre for Cancer Care to provide chemotherapy and other services for cancer patients now delivered from the VG.

The RFP orders the Master Planner to review the plan developed by the Health Authority, to consult with the public during the next year, and to provide the province with “guidance” on where to locate two outpatient clinics to replace the myriad of services at the VG.

The plan developed by the NS Health Authority would see:

• a new clinic built near the Halifax Infirmary for outpatients who need such services as acute care dialysis, day surgery, and high level post-op care.
• a second “community” clinic (that could provide diagnostic tests and possibly Heart Health Education and cataract surgeries) at a location outside the city centre — perhaps in Burnside or Bayer’s Lake — to improve access for patients driving in from rural areas.

“No decisions have been made on which outpatient services will be moved to which clinic,” stresses Karen Mumford, the Health Authority’s director of QE2 Redevelopment. That statement reflects the high-level lobbying and jockeying among doctors to keep their patients and services as close to the Halifax Infirmary as possible.

So far, the only decision the NS Health Authority has made with respect to moving more day surgery out of the VG is to do more business with Scotia Surgery in Dartmouth. The private orthopedic clinic did more than 400 scopes on knees and shoulders (and bunion removals) three days a week last year, at a cost of $1.4 million. Once the province begins buying service five days a week, that number will grow to 750 procedures a year.

Mumford refuses to say when that will start or how much it could cost. She says those answers will depend on which procedures the Health Authority decides to contract out to Scotia Surgery. The contract was signed in July. The one thing Mumford does say is that they won’t include any operation that would require an overnight stay, such as a knee or hip replacement.

The successful winner of the QE2 redevelopment RFP will recommend:

• where each medical service will be offered;
• whether an addition, renovation, or new building is needed;
• how much it will cost;
• how many full-time staff and how much medical equipment will be needed to meet health needs based 20 years in the future.

That’s as far ahead as Smith-Lamothe says they can realistically plan because of rapidly changing medical technologies, although the physical “bricks and mortar” will be built to last 50 years.

Tomorrow: we look at financing options — including public-private partnerships — to replace the VG Hospital.