The Tribune

• Planned facility to care for 400 patients daily
• But prominent doctor backs PMH expansion
• Asserts lack of consultation 'really pathetic'

Report highlights flooding fears at planned location

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Flooding risks are "a great concern" for New Providence's new $290m hospital which will need a 650-strong medical staff to care for the anticipated 400 patients it is set to house daily.

The newly-released Environmental Impact Assessment (EIA) for the proposed specialist maternal and childcare facility disclosed that "historic wellfields" are located at the Perpall Tract site, which presently "act as a natural drainage from surrounding communities".

With only one existing water run-off, the study by JSS Consulting revealed that "drainage swales and flood control ditches" will be required to prevent flooding in nearby residential communities. It added that "the development of an adequate drainage system that can handle flood water" will be critical to minimising the proposed 50-acre hospital's impact.

The EIA, meanwhile, estimated that 80 percent of the hospital's construction workforce will be Bahamian, but hitting that could be a challenge given that Chinese labour and contractors will be a condition sought in return for the hospital's concessional financing from the China Export-Import Bank, one of Beijing's state-owned institutions.

Bahamians will likely play a greater role once the hospital is open. "During the operational phase, the project is expected to house 400 patients per day and 650 staff members," the EIA said. "The complete development of the project will require significant capital investment.

"It is estimated that approximately $289.399m will be invested into the project. Of the total estimated, $238.776m will be allocated for building construction and site development, including the parking area. The balance will be required to purchase medical equipment and furniture." Parking will be provided for 510 vehicles.

Some $50.623m has been budgeted for purchasing the necessary medical equipment. When combined with the $238.776m construction costs estimate and VAT at 10 percent, the final near-$290m price tag is achieved.

The EIA's release came after a prominent Bahamian physician backed "optimising and improving" the existing Princess Margaret Hospital (PMH) rather than constructing a brand new hospital facility, while blasting the lack of consultation with medical professionals over the project as "really pathetic".

Dr Conville Brown, principal of The Bahamas Heart Centre, Cancer Centre Bahamas and The Medical Pavilion Bahamas, told Tribune Business that the phased expansion and redevelopment of PMH "makes a lot more sense" because all the necessary utilities and other infrastructure required to support it is already in place.

Both the former Christie and Minnis administrations were working on a PMH expansion, rather than constructing a new out-of-town hospital, and Dr Brown said the existing site has the advantage of being centrally located in the heart of downtown Nassau.

He added that Bahamian taxpayers, via the Government, have already sunk "several hundred million dollars" into PMH and its staged upgrades, including the $100m-plus Critical Care Block. Asserting that "we don't even operate that properly", Dr Brown said management of existing facilities remains among the biggest healthcare challenges, which is a further argument against the proposed new hospital.

"My vote in a nutshell is that we optimise and improve PMH," he told this newspaper. "That $300m they're talking about, my crystal ball tells me we will see cost overruns, under-estimates and a challenging cost structure." The EIA, too, concedes that the $290m figure is an estimate that "represents the best judgment at this preliminary stage" and "is only intended to assist in decision-making to move the project forward".

Dr Brown, though, added: "I'm strongly of the view that we have already dropped several hundred million into the Public Hospitals Authority (PHA) and PMH. At least it's central. It's central to downtown, at the centre of the city, and sits in the centre of the island between east and west." He also pointed out that PMH sits on a major road artery, Shirley Street, and is close to others such as Bay Street and Collins Avenue.

The proposed new hospital will be located off the road that connects Saunders Beach with the six-legged roundabout at JFK Drive, but Dr Brown argued this will effectively leave the new facility boxed in from a traffic flow perspective because "you have only got one road in and one road out, left and right". The EIA confirmed no traffic impact study has yet been conducted, although one is planned.

"The FNM administration had already planned it," Dr Brown said of PMH's planned phased expansion. "They decided to do a big tower in the front. If parking was an issue, build a big parking deck. It solves most of your problems right there and then.

"That, to me, makes a lot more sense because you can take advantage of all the infrastructure you have in the ground. We've spent $100m on the Critical Care Block and don't even operate that properly. We don't have the infrastructure and resources-wise. The biggest issue is the management of these things."

Rather than spend $290m to build a new hospital, the former Minnis administration planned to invest some $55m to construct a six-storey tower at PMH’s downtown campus that would house several medical units including a new children’s ward, surgical ward, maternal care and gynaecology ward.

Both the Christie and Minnis administrations had hired the Beck Group, a US architectural and engineering firm headed by Bahamian, Fred Perpall, to plan the redevelopment of the PMH campus. Its 141-page report, which has been seen by Tribune Business, called for the demolition of existing buildings, including the PMH warehouse and oncology units, to make wake for the new six-storey tower and a helipad.

Further phased redevelopment called for the demolition of existing clinics and storage and their replacement by a medical/surgical tower; expansion of surgical services; and other facilities. Beck Group had proposed a five-phase approach that also involved the creation of additional parking and a clinical housing complex according to the plans seen by this newspaper.

However, the EIA defends the Perpall Tract move by asserting that space for expansion and redevelopment at PMH is "limited". Following through with the earlier plans would "would decrease the functionality of the entire hospital", it added, which was why a new "greenfield" site is now essential to meet the Bahamian public's healthcare needs.

"More than 20 years ago the Ministry of Health and Wellness created the Dorsett Report, which reviewed the suitability of PMH as the premier public tertiary-level healthcare provider to meet the existing and projected demands of the Bahamian population," the EIA said. 

"The report concluded that, in 1999, the hospital's ability to provide services could not meet the demand of the population at a level that would keep pace and maintain international standards. Due to the old equipment and facilities, renovations of PMH were required. It was recommended that renovation occur in three phases.

"It was stated that the existing PMH site is limited and, to construct a new building on the existing site, would decrease the functionality of the entire hospital in terms of traffic flow, parking, internal circulation and other factors. The relationships between departments in the hospital would also be compromised. This still holds true today."

As a result, the EIA asserted that while the "first phase of renovation was determined to occur at the existing PMH site" it was "during this time that it was determined a greenfield site was needed for further expansion". It added that The Bahamas is not receiving value for money on mother/child care as the maternal and infant mortality rates are still viewed as too high compared to monies spent.

"The maternal mortality rates and child mortality rates are less than optimal in PMH, and do not reflect the funds invested in assuring optimal healthcare," the EIA said. "Therefore, the Government of The Bahamas has determined that not only the quality of healthcare should be addressed but the facility in which the care is provided." And hence the focus on specialist mother and infant healthcare.

Justifying the new hospital's development, the report said: "The location and development of the project will position a tertiary hospital closer to larger population centres of New Providence, minimise disruption of existing hospital services at PMH, introduce designs that will promote a healing environment, enhance the quality of service and efficiency of operations, offer ample parking, remove the challenges associated with navigating the traffic congestion of downtown and increase the ability to introduce in-patient room designs that can improve patient safety, experience and privacy....

"PMH has a capacity of 402 beds and, although recent renovations have helped to meet the local medical needs of the population, the expansion of clinical spaces has been outpaced by the need for tertiary health services in the country. The current footprint of PMH and available surrounding properties cannot support expansion required to meet demands."

As a result, the new hospital drive is based on the "current limitations to the expansion of the infrastructure of PMH as the premier public tertiary hospital centre" and "the challenge for physical space at PMH to appropriately allocate hospital resources that support specific women and child health conditions". The Perpall Tract move was also billed as improving PMH's capacity to manage adult and geriatric services.

Dr Brown, meanwhile, echoed concerns voiced by Dr Gemma Rolle, the Medical Association of The Bahamas (MAB) president, over the Government's failure to widely consult doctors and other medical professionals over its plans in advance.

"It's amazing how this was done without any consultation with the people working in the hospital and clinical medicine in this country," he told Tribune Business. "You say you're building a specialist hospital and don't consult with your specialists. You bring people into this country to tell us what we need.

"Why do we get an education, work here for 30-40 years and we're not in a position to say what the shortcomings are? Suggestions need be relevant to the country. Our solutions are not the same as developed countries who have already gone through their developing stage. That's a standard modus operandi that we have got and it's really, really bad.

"I think the MAB president brought it out when she went to the Town Meeting. How could MAB members and the medical community be in the dark on a hospital that you have decided without input from the medical community on how you do that.... I don't agree with the process. It's really pathetic, but they have done that with other things.