Oregon State Hospital Replacement Project Linda Hammond, Project Administrator March 2009

1. Oregon State Hospital Replacement ProjectLinda Hammond, Project AdministratorMarch 2009

2. Overview • Oregon is in critical need of a new hospital for its citizens with mental illness. The Oregon State Hospital (OSH) is one of the oldest continuously used mental health hospitals on the West Coast • OSH also has the distinction of being one of the most decrepit mental health facilities in the nation • For at least 20 years state lawmakers have heard from patients, advocates, citizens and staff about the inadequacy of the state hospital • The state has faced several challenges, including legal actions over a variety of hospital deficiencies • There currently is no electronic hospital management system in place that can produce timely and meaningful data

3. History • In 2003 the Governor established by executive order a 21-member Mental Health Task Force to identify key problems in the state’s mental health system and recommend improvements • Ongoing concern about the hospital prompted the November 2004 Legislative Emergency Board to allocate funds to DHS for an independent examination of the mental health system, with a specific focus on OSH • With those funds, the Governor and Legislature commissioned KMD Architects, a firm with more than 40 years of experience, to prepare a master plan for replacing OSH • The Oregon State Hospital Master Plan Phase I report documented the inadequacy of the existing buildings, identifying life-threatening conditions in patient care and treatment areas

4. History (cont.) • The Oregon State Hospital Master Plan Phase II report recommended to the Governor and Legislature that OSH be replaced with two new facilities • The siting of both proposed new facilities has been an open and public process • More than a dozen public hearings were held for legislators to receive input and feedback about the replacement project, including three public hearings regarding site selection criteria • The Governor and legislative leaders named a 10-member committee to identify and draft hospital site-selection criteria, which would be used by the Oregon Department of Administrative Services (DAS) and DHS staff to review and evaluate proposed sites

5. History (cont.) • Using the legislatively mandated selection criteria, developed with public input, Salem and Junction City sites scored highest among those considered • The OSH Phase II Master Plan, using a 25-year planning period, acknowledged that Oregon would need more than 1,000 hospital beds for its mental health system • The recommendation in the OSH Phase II Master Plan to build a second hospital was based on the projected growth in need for hospital-level care for adults who are civilly committed to OSH, those adults requiring medical and psychiatric treatment due to age-related dementias or younger adults with brain injuries, and those adults criminally committed to OSH

6. Key issues • In 2006 the U.S. Department of Justice (USDOJ) investigated conditions and care practices at OSH and provided a report to the Governor with the necessary remedial steps the state must take to correct the reported deficiencies • If the state fails to take the necessary remedial steps in a timely fashion, the state will be at risk of being sued by USDOJ • If the state were sued and lost, the federal court would appoint a court monitor to control the administration of the state hospital • In other states where the federal government and a monitor have intervened, the costs to those states and their local governments have been astronomical • Caseload projections support the need to develop 1,104 beds as outlined in the OSH Phase II Master Plan

7. Why replace the existing facility?

8. Decrepit facility • More than 40 percent of the building space is unusable – water leaks from roofs, walls are crumbling, and asbestos and lead present a toxic hazard • Expensive to operate • No insulation • Single-pane windows • Inefficient heating, electrical and lighting systems • Compromises safety • Exposed piping • Seismic issues • Lead and asbestos contamination

9. Unoccupied portions of the campus

10. Building for the future

11. Respecting the past

12. Salem site map DHS • Mental Health Facility • Approximately 620 Beds • Current Completion Schedule - 2011 • Square Ft Planned • Approximately 870,000 • Operational Staffing Approximately 2,400

13. Junction City site plan DHS DOC • Mental Health Facility • Approximately 360 Beds • Current Completion Schedule - 2013 • Square Ft Planned • Approximately 479,000 • Operational Staffing Approximately 1,000 • Minimum • Approximately 532 Beds • Current Completion Schedule - 10/12 • Medium • Approximately 1,263 Beds • Current Completion Schedule - 3/14 • Square Ft Planned • Approximately 700,000 • Operational Staffing • Approximately 500

14. Principles guiding construction of the new facility • Treatment design • The overarching goal of treatment is return to a meaningful life in the community, with appropriate and necessary supports • The goal is for people to return to their own communities, if possible and appropriate • Treatment is actively directed toward wellness, recovery and safety of the community • Providing a minimum of 20 hours of active psychiatric treatment for each patient each week greatly ensures long-term, successful recovery

15. Principles guiding construction of the new facility Physical design • The replacement facility is recognized as a collection of services in a continuum of care • The replacement facility is designed and constructed to ensure the safety of consumers, staff, visitors and the community • The Salem campus is designed and constructed in a manner that recognizes the history of OSH, its park-like grounds, and surrounding neighbors and neighborhoods

16. What does a modern facility incorporate? • A city-within-a-city model with modern physical space that can adapt to future treatment needs • Treatment space away from patients’ immediate living area • Patients able to function and participate in treatment during the day in a manner similar to typical daily living • Clinicians with a manageable number of patients at any one time in smaller treatment areas

17. What does a modern facility incorporate? (cont.) • Cost-saving energy management • Modern heating and air conditioning • Design promoting safety and security • Well-lit and open areas • New technology for treatment • Access to fresh air

18. Program design • Siting the new treatment facilities in Salem and Junction City addresses the goal to have hospitals close to patients’ homes • Approximately 93 percent of those requiring hospitalization come from the north Willamette Valley and central/western counties • The design for the facilities supports a centralized treatment model within a secure perimeter as the means of providing comprehensive and consistent therapeutic opportunities to all OSH patients • In keeping with the Recovery Model for mental health, the design for the new facility and its campus was driven by programming needs to ensure a patient-first, patient-driven and patient-focused mental health system • Both sites will be modern psychiatric treatment and recovery facilities

19. Behavioral Health Integration Project (BHIP) • OSH currently operates exclusively with a paper-based system • BHIP will implement an electronic health record that will comply with HIPAA and other confidentiality requirements • The project includes the design of a new OSH computer system, which will achieve data management, risk management, quality management, and treatment plans and medication management

20. Junction City the Road to Recovery

21. Major accomplishments: Junction City • The state already has contracted for $5 million worth of planning, design and land acquisition; approximately 30 – 40 percent already has been spent or otherwise committed • Junction City is the preferred location for a proposed bio-energy park, which would locate proximate to the reconstructed wastewater treatment plant where the biomass – especially the prison’s – can be diverted as an energy source for the new facility • The city is under order by DEQ to improve the quality of its effluent through the construction of a wastewater treatment plan • The Junction City projects are at a critical juncture for wetland mitigation, drainage work, highway and street work, and urban growth boundary expansion studies • The proposed prison and hospital will generate 1,500 – 2,000 jobs

22. Major accomplishments: Salem • September 3, 2008, groundbreaking ceremony was held • Remodeling has begun on six cottages located on the campus • Buildings 76 (Quonset Hut), 67 (cow barn), 71 (shed) and 74 (root cellar) have been demolished • September 13, 2008, 180 members of the general public toured the historic J Building and service tunnel system • Hazardous material abatement and demolition of the approved portions of the J Building has begun • February 12, 2009, OSH hosted a cottage open house and tours for 300 visitors

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24. Project Phase 1: Transitional patient housing • Six cottages on the OSH Salem campus will be used for transitional patient housing • These homes were constructed between 1909 and 1915 • They have been remodeled, are ADA accessible, and can accommodate either 5 or 8 patients

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26. Continuum of care • Transitional housing is critical to an individual’s successful return to the community • The cottages provide a step-down or an interim placement between the institutional and community settings • The cottages restore transitional capacity lost during the economic crisis in 2002-2003 • Since 2003 OSH patients have been discharged from the hospital directly to the community; while many made a successful transition, there were those who could have benefited from this type of pre-community placement

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28. Historic preservation • The first hospital building, with its farm and landscaped park, was built in 1883 • The National Register of Historic Places designated the entire OSH Salem campus as a historic district in February 2008 • As a result of that designation, all proposed exterior restoration, remodeling, re-location, mothballing or demolition on the entire site must be reviewed by the City of Salem’s Historic Landmarks and Design Review Commission

29. Historic preservation (cont.) • To minimize the impact on the Historic District and to balance the need to accommodate the new hospital’s program and funding limitations, DHS has worked diligently with designers, numerous stakeholders, historic preservationists, the State Historic Preservation Office, health care providers, OSH staff, patients and their families, citizen advocates, neighborhood associations, and consultants in the planning of the new hospital • DHS also contracted with a qualified architectural historian to review and inventory all the buildings on the Salem campus and identify their historic significance

30. Budget challenges Cost drivers that may affect the bottom line of this project • Escalation of construction costs that have continued to rise much faster than the CPI or PPI for finished goods • Inflation for construction from 1995 to the end of 2003 averaged 2.34 percent per year; from 2004 to the end of 2005 construction costs increased by 6.43 percent • Price increases for diesel fuel, steel, pre-cast concrete and other building materials will continue to be a major challenge • An additional cost driver is energy costs – the Junction City site must meet ORS 279C.527 – 279C.528 requirements for solar energy, which added costs not included in the original budget approved by the Legislature

31. Budget challenges (cont.) • Another cost driver is the direction from the Legislature to absorb the cost of furniture, fixtures and equipment (FF&E) into the budget • The estimate in 2007 for FF&E was $10.5 million ($7.5 for Salem and $3 million for Junction City); this estimate will be adjusted after completion of the design development phase • The original budget, which was set during the master plan phase of the project, assumed: • Treatment hours would be consistent with 2005 levels – 5 hours of active treatment per patient per week; the requirement was raised in 2007 to a minimum of 20 hours of active treatment per patient per week, which translates into additional square footage • Staffing levels would be consistent with 2005; new treatment and safety requirements have raised staffing levels by one-third on the Salem campus, again requiring additional square footage

32. Budget challenges (cont.) • All the factors listed in previous slides produce significant costs not known when the budget originally was set • Added to these are items such as: • City of Salem road improvements, including a connector road from Center to State streets – estimated at $2 million • Separation of utilities to the ongoing functions of facilities on the north side of Center Street in Salem – estimated at $5 million • The recognition of additional wetlands needing mitigation in Junction City

33. Oversight • Project team members and consultants have worked with OSH administrators, staff, patients, health care providers, a 40-member stakeholders group and numerous other interested parties to guide the development of the new facility • The team worked diligently to analyze the site’s existing buildings, topography, environmental qualities, archaeological importance, and parking and traffic conditions • DHS has enlisted expertise from renowned architectural, construction and engineering firms including numerous subcontractors to ensure delivery of the best mental health facility for Oregon • DHS contracted with the Hammes Company to conduct an in-depth review of the Salem site to ensure the site was appropriate for the planned facility

34. Oversight (cont.) • The OSH programming team visited psychiatric hospitals in Virginia, North Carolina, New York and Ontario, Canada, and imported the concept of centralized treatment, specialty malls and mixing patient populations • Feedback from staff, unit staff, department staff, consumers and families related to treatment and space needs were addressed with architects and incorporated into a programming design document • In late 2008 the Secretary of State began a construction contracting audit of the OSH replacement project • The audit is going well, with no material findings to date • Audit results will be released in the next few months • The OSH replacement project has undertaken comprehensive evaluations of other state projects and like development projects across the United States to ensure the size and cost of the facilities are consistent

35. Consultants • CH2M Hill – the project management consultant firm assisting the state with oversight of the design and construction of both facilities • HOK/SRG – vested with the responsibility to design and engineer both the 620-bed facility in Salem and the 360-bed facility in Junction City • Hoffman Construction Company of Oregon – the construction manager/general contractor for the 620-bed facility; the 360-bed facility will be put out for bid closer to the start of construction in 2011

36. Oregon State Hospital Replacement Project