Kootenai Medical Centers board of trustees has approved a five-year, $50 million expansion plan that will get under way this fall at the Coeur dAlene hospital.


The plan involves nine construction projects ranging from simple remodeling jobs to adding a fourth floor onto whats now the hospitals tallest structure. Projects also include the construction of a two-story cardiac-care department, a new central plant, and a four-story, attached parking garage.


At about $50 million, the expansion will cost nearly twice what had been estimated by KMC a year ago when it first announced tentative growth plans. The figures released last year, however, were based on a consultants report estimating the hospitals future space needs, and included neither the addition of new cardiac-care facilities nor the cost of furnishing and equipping all of the new space, says Joe Morris, the hospitals CEO.


KMC is the last big regional hospital in the Spokane-Coeur dAlene area to begin a recent capital-construction program. Sacred Heart Medical Center is working on a $131 million project to enlarge its facility and build a childrens hospital; Deaconess Medical Center just finished a $20 million expansion and is creating a $9 million heart hospital; Holy Family Hospital is undertaking a $29 million expansion and remodeling project; and Valley Hospital & Medical Center has a $17 million expansion under way.


KMCs board adopted the least expensive plan of several drafted by the hospitals architect, Northwest Architectural Co., of Spokane, Morris says. The most expensive plan would have cost about $88 million and would have included replacing the oldest section of the hospital with a three-story tower, he says.


Of the options we looked at, weve chosen the most conservative option just because there is a lot more uncertainty in health care today than existed in the past, he says. Two sources of that uncertainty are a plan announced by a group of North Idaho doctors to open a competing surgical hospital in Post Falls, and low provider reimbursement rates for state- and federally funded health care, he says.


Nevertheless, the plan adopted by the hospital board will provide for our needs between now and 2010, Morris says.


The hospital will pay for the projects through a combination of revenue bonds and its own reserves, he says. KMC is a nonprofit institution thats owned and operated by a public hospital district.


The hospital likely will hire a construction manager who will put individual projects out for competitive bid, he says.


The individual projects included in the growth plan are:


Cardiovascular surgery suites: Work will start this fall on two operating rooms for cardiac procedures, part of a previously announced introduction of open-heart surgery and full-service cardiac care to KMC. Space for the surgical suites already is roughed in next to the hospitals inpatient-surgery area as a result of a previous remodeling project. The hospital estimates that it will cost $1.2 million to finish and equip those suites, and that the work will be done by next April.


Cardiac-care and magnetic-resonance imaging addition: Work will start on this two-story structure next spring, and is expected to be completed by next November. About 6,000 square feet of floor space in KMCs original hospital building, built in 1966, will be demolished to make room for the facility. The 8,400-square-foot ground floor of the addition will house two MRI units. The 12,000-to-14,000-square-foot second floor will be a centralized heart center within KMC, featuring two cardiac-catheterization labs, plus equipment for echocardiogram and electrocardiogram testing, Morris says. The cost to build and equip the addition is estimated to be $10.4 million.


Central plant addition and upgrade: KMC will spend about $6.2 million to build a 10,000-square-foot addition to its central plant, which houses the hospitals heating and cooling equipment, and to replace that equipment. Currently, KMC is serviced by the same two boilers that were installed in the original hospital in 66, Morris says. Work is expected to start next spring and to be finished next November.


Fourth floor addition: Work could start next fall on construction of a $12.7 million fourth floor atop KMCs current three-story tower on the east end of the hospital complex. The work would add about 65 new beds to KMC, giving it 290 beds in all, Morris says. Some of the new beds would address KMCs future growth, while others would accommodate an increase in patients expected when the hospital adds comprehensive cardiac care, he says. The 70,000-square-foot addition is expected to be finished by August 2004.


Lab and radiology addition: About 3,900 square feet of space would be built between KMCs emergency radiology department and its laboratory, Morris says. The project, which would cost $1.7 million, would fill in a gap that currently exists between those two areas, and would be shared by them. That work is expected to be finished by October 2004.


Emergency-department expansion: KMC will add about 7,000 square feet of floor space to its emergency department. Like the cardiac-care area, the ER will expand by gobbling up a portion of KMCs original hospital building; the services that currently are housed in that part of the building are expected to move elsewhere within the hospital this fall, he says. Once the $4.9 million expansion is completed, by April 2005, the ER will have about 18,000 square feet of space.


Second- and third-floor remodeling project: Once the addition of a fourth floor on KMCs east tower is done, the hospital will begin remodeling the second and third stories of that 18-year-old tower in a project thats expected to cost $6.9 million. Morris estimates the start date for that work to be sometime in 2005. The third-floor remodeling will be cosmetic work, but most of the towers second floor will be remade into a specialty-care area for cardiac patients, he says.


Medical records, administration remodeling: KMC doesnt have a timeline for remodeling its administration and medical-records offices because, as with the tower remodeling, the work depends on when other projects within the hospital are finished. The remodeling is expected to cost about $747,000.


Parking garage: KMC plans to build a four-story, 225-stall parking garage to the north of the hospital that would be attached to the hospital in some way, Morris says. The parking structure, the first at KMC, is expected to cost $5.2 million.


To go with the parking garage, KMC is hoping to acquire five acres of land north of the hospital campus thats now owned by Panhandle Health District. The health district has expressed interest in selling the property and moving to a cheaper location, and Morris says the hospital either could trade other property it owns for that land, or could buy it outright.


If that happens, KMC would like to create a new north entrance to the hospital campus, Morris says.