ealthcare construction in Alaska is influenced by many different factors, including an aging population; the need for specialized services such as mental health and addiction treatment; technological advancements; and requirements to update or replace facilities and equipment in order to meet state and federal regulations. Yet while it’s important to invest in expanding, renovating, or even building brand new facilities, healthcare systems must at the same time keep a very tight grip on expenses, especially in this time of economic uncertainty.

At Alaska Regional, for example, construction is underway on replacement equipment projects and on renovations required to meet regulatory requirements. Work is also taking place to repair damage caused by the earthquake in November 2018. Other projects, such as the addition of twenty-four new psychiatric inpatient beds, are on hold.

In the past five years, HCA, the parent company of Alaska Regional, has invested approximately $100 million in renovations and is expected to continue its support of local facilities. While this year’s budget is similar to last year’s, according to Opsut, the instability caused by the state’s budget issues could influence future planning.

“Current and future projects absolutely could be affected by what happens with the governor’s budget,” she says. “Alaska Regional received a Certificate of Need for an upcoming behavioral health project, but that project is now on hold due to the uncertainty of the budget process.

“We are also continuing to closely monitor expenses, as we are incurring the extra cost of managing more behavioral health patients due to Alaska Psychiatric Institute [API] not having all of its beds open,” she adds. “For at least a year, we’ve been dealing with the fact that API is struggling, and that is only going to get worse with the governor’s proposed cuts.”

Opsut gives the example of patients currently on Medicaid who may soon see cuts in services. “This is going to lead to even more problems down the road, which is making us take a hard look at future projects at Alaska Regional,” she explains.

Still, the health system is continuing to evaluate projects and look at strategies, not only in the Anchorage community but throughout the state of Alaska. “We have a couple of projects in mind, but they are not to the point of public discussion because we haven’t made final decisions,” she says. “But we are always looking at projects for the future in order to treat the healthcare demands of our community.”

Providence Health & Services Alaska also has several projects in the works, including two pharmacy compliance projects, a laundry compliance project, and construction of a Cath Lab on Providence’s main campus in Anchorage.

“We just received funding for the $1.9 million Cath Lab 5 project, which is a construction build-out that is expected to take between six and eight weeks,” says John Bush, lead construction project manager for Alaska. “Right now, we’re ordering equipment, and we’ll wait to begin construction until it is on its way; we want to minimize downtime and not take the Cath Lab out of service any sooner than we have to.”

The Cath Lab build-out includes an equipment upgrade that requires tearing down the room. “Because the shielding requirements of the new equipment are beyond what the current equipment requires, we need to replace the lead lining in the walls, floor, and ceiling, so we have to tear down the entire lab and put it back together,” says Bush.

Providence also has a number of pharmacy compliance projects underway, including a $2.2 million project in Kodiak and a $1.6 million project in Anchorage. The projects are designed to meet new federal regulations that expand controls for the protection of workers when processing hazardous drugs.

“This is a fairly new federal requirement that requires new ISO7 clean rooms, ante rooms, sterile compounding rooms, and hazardous drug rooms,” explains Bush. “As of December, all of the pharmacies in the United States must be in compliance with these federal requirements. Each of our fifty-two ministries has multiple pharmacies, so we will be making these changes throughout the system.”

“Because these must remain active, live pharmacies, each of these will be multiphase projects,” adds Dale Rahn, regional director for real estate, construction, facilities, and environmental services. “There is a lot of complexity, including numerous air differentials that have to be maintained to keep them at their current levels.”

Providence will also be replacing outdated washers and dryers to meet compliance requirements in Kodiak, a project budgeted at $1.6 million. “The hospital facility is owned by the borough, but because we operate the hospital, we are responsible for the operations that provide laundry service in-house,” says Bush.

Because the hospital will need to continue to operate the laundry while undergoing renovations, the project will take place in multiple phases. “We will replace the dryers in the first phase and the washers in the second phase,” says Bush, adding that the last phase will include removing the existing washers. “We’ve also made infrastructure changes, including adding a 1,000-gallon propane tank because propane-fired dryers are more effective and cost-efficient.” The project should be completed this month.

The contractor for all of these Providence projects is Davis Constructors & Engineers.

While there are renovations underway, Rahn says that the volume of healthcare construction is lower than in the past. “We are limited by the amount of money we can request and the fact that we are competing for it with many other departments,” he says, adding that in the past year, capital improvements have been minimal.

“We are hopeful that this will change; we are looking at receiving more money from an outside funding source for infrastructure improvements, though I can’t comment on what that source is at this time,” he adds. “We are hoping that soon we will be able to pump some additional money into aging infrastructure throughout the whole region.”

Norton Sound Health Corporation (NSHC) has quite a few projects underway, according to Mike Kruse, director of engineering, in addition to those it recently completed. In March, NSHC completed an MRI addition to the hospital, which was a significant milestone as it is the first MRI off the road system and the first MRI to be owned by a tribal health organization. Small adjustments are still being made to the $6.2 million project, though the MRI is already patient-ready. In August, NSHC also opened a new $5 million, 3,500-square-foot replacement clinic in Shaktoolik.

Three contracts were awarded in fall 2018, which include a $16 million, 25,000-square-foot Wellness and Training Center in Nome. The first floor will house the entire Behavioral Health Services program in a primary care setting, which will offer alternative health therapies to facilitate pain management, psychiatric services, and a social detox space with clinical decision-making to support the region. The second floor will contain classrooms and conference rooms for medical training.

“The majority of the training center is dedicated to supporting health aides as they get their certifications,” says Kruse of the center that will include a mock pharmacy, exam room, and lab, as well as functioning equipment. Construction is expected to be completed at the end of February 2021, with plans to open that July.

“It is logistically challenging,” says Kruse, who at the time this article was being written had been trying for the previous five days to get a helicopter out to the site that was grounded because of weather. “I just got a picture of the construction site, and it’s pretty wild.”

While the estimated finish date is July 2020, that plan is subject to change. “Last year, Little Diomede had one of the worst winters they’d had in eight-two years,” says Kruse, “so I’ve got a lot of contingencies built into the project. But we’re looking forward to meeting the building challenges that the island presents and completing the project.”

The clinic will replace the existing clinic, which is located on top of the washeteria. It will consist of 1,100 square feet of clinic space and 70 and 704 square feet of mechanical space, totaling 1,800 square feet, doubling the size of the existing clinic. It is budgeted at $6 million.

Two other replacement clinics are also underway; one in Shishmaref and one in St. Michael. Foundation and site work is budgeted at $1 million for each clinic; the total price is $8.5 million per clinic upon completion.

Work continues on the Yukon Kuskokwim Health Corporation’s $300 million Paul John Calricaraq project in Bethel, which includes a new clinic and the renovation of the Yukon Kuskokwim Health Corporation’s hospital. Outpatient facilities began seeing patients on July 15. Central Peninsula Hospital is also continuing its $40 million Phase VI construction project that includes the construction of a new catheterization lab and obstetrics wing.

Projects on hold include a $60 million expansion of facilities at the Mat-Su Regional Medical Center. That project, which was slated to take place in 2020 and 2021, includes a $14.5 million expansion of emergency treatment facilities and $4.5 million for new inpatient psychiatric beds.