Summary
This ballot measure would provide up to $195 million of a $263 million project to carry out seismic improvements to the hospital structure, trauma center and other buildings, demolition and rebuilding of the Eastside clinic and Harborview hall, renovation of the emergency department and a new clinical services and medical examiner's building over a nine-year period. The balance of the $70 million in project costs would be funded through parking revenues, hospital operating revenue and bond interest income.

The levy rate will be $1.44/$100,000 of assessed valuation in the first year and increase to $6.68 in 2009.

The plan was developed in consultation with the surrounding community and with the Harborview Board of Trustees. As a condition of the project, low-cost housing (which is owned by Harborview for transitional housing for mentally ill persons), will be replaced.

Background
Harborview Medical Center is a 351-bed patient care, teaching and research facility located in Seattle. The hospital is a Level 1 trauma center, the only one of its kind in a four-state region covering Washington, Alaska, Idaho and Montana. There is a Level 2 trauma center located in Spokane. Seattle-area hospital The nearest Level 2 trauma center is in Spokane, while other Seattle-area hospitals offer limited trauma care. In the event of a major disaster involving high numbers of injured as in the 1999 Aurora Bridge bus accident, Harborview serves as a clearing house to direct the injured to area hospitals with available and appropriate care at that time.

The hospital buildings are owned by King County which provides no operating support for the hospital operations. Operational costs are covered primarily through reimbursement from health insurance and about $8 million annually from the State of Washington. As other hospitals, Harborview provides care to non-paying patients which are about seven percent of the patient population. The hospital operations are managed by the University of Washington through a management agreement established in 1967. All Harborview employees are employees of the University of Washington. A 13-member policy-setting board of trustees appointed by King County for 4-year terms oversee the medical center.

As a Level I trauma center, Harborview is the central facility in any regional disaster of major proportions. For this region, a severe earthquake causing serious property damage and injuries or death to the population is a constant risk. The 1994 Northridge quake in Southern California was a magnitude 6.8, killing 72 people and causing $25 billion in damage. In the Central Puget Sound region, we last experienced similar earthquakes in 1947 and 1965.

The proposed bond issue would fund the replacement of several buildings and upgrading others to meet current 1997 FEMA (Federal Emergency Management Administration) standards--specifically, the “immediate occupancy” for inpatient facilities. This level ensures that even if there is some building damage, the health care services could continue to be provided. The Harborview Medical Center facilities are actually a collection of buildings acquired over many years. Three of the buildings to be replaced by the bond issue were built in 1933, 1950 and 1970. They do not even meet FEMA’s “life safety” standards which means that while the building might be seriously damaged, occupants would still be able to safely get out. The oldest of the buildings would like fall in on itself in a magnitude 6 earthquake along the Seattle Fault or a magnitude 7.5 shallow earthquake.

The project would replace the oldest buildings in a new location with the demolished building area left as open space. The hospital's north wing would be seismically upgraded through structural renovation and by construction of a bridge building over Ninth Avenue. That building would buttress the wing by connecting it to a new building.

The hospital is licensed for 411 beds and currently operates 351 beds. The hospital operates at nearly 100 percent capacity now. Unlike most hospitals, Harborview has a high proportion of trauma care and burn cases. About 80 percent of Harborview’s total admissions come through emergency. About 70 percent of the nearly 15,000 patients hospitalized at Harborview in 1998 were emergency and trauma patients. Roughly 30 percent of the bond revenues would be used to add 60 new critical care beds. Harborview collaborates with other area hospitals for other care.

In 1987, voters approved a 20-year a $99.8 million Health Care Capital Improvement bond issue which expires in 2007. In 1997, Harborview completed this major construction and renovation project that nearly doubled its size and consolidated many of the medical center's critical services. This $176 million project expanded the emergency department, consolidated intensive care beds, expanded operating room capabilities and provided improved facilities for support and diagnostic services. The project also included the replacement of inpatient beds as well as new, modern clinic space. The average home in King County is currently paying $11.33 for the debt on 10 year old Harborview Bonds. If approved, it is estimated that the tax bill of $31.26 of an annual average home will be dedicated to paying for Harborview debt.

Analysis
Unlike many capital projects put before voters, this one has a degree of urgency. There is no question that the buildings to be replaced are not seismically sound. It is possible to argue that this is a lot of money to spend on an earthquake that might not ever happen, but can we afford to take that risk? It could be argued that this ballot measure should wait until the current levy is up in 2007. However, it will take about nine year to complete the improvements which would effectively be a delay of about 15 years. Fifteen years is a long time. Earthquake experts advise that the longer we go between major earthquakes such as the one that occurred in 1965 (35 years ago), the higher the odds are that a major earthquake will occur in this region.

There may be question as to whether the additional hospital beds are needed when other hospitals have empty beds. However, Harborview does have a certificate of need for 411 hospitals beds and the addition of 60 new beds would bring it up to that level. Given that Harborview is at nearly 100 percent capacity, it would be cost effective and timely to add them now. The question of additional beds beyond that for Harborview versus empty beds in other hospitals would be a matter for state hospital licensing authorities to address.

Capital improvements of this magnitude are very appropriately funded under voter approved property tax measures. This is the very kind of thing this authority was provided for. It might be argued that since people throughout the state use this facility that the State of Washington should provide some funding towards the capital improvements. However, it can be pointed out that King County citizens do not pay anything towards the substantial operating costs of Harborview. In return for a relatively small amount of property taxes, King County citizens can be assured of having quick access to outstanding trauma care.

Arguments For and Against

For:

• Harborview is a the only level 1 Trauma Center for our state where nurse and surgeons are available in 5 minutes of the arrival of severely injured patients, including burn victims.
• These key emergency facilities must be protected against damage from future earthquakes.
• The medical examiner's and emergency facilities are out-of-date and in need of being renovated or replaced.

Against:

• In 1987 voters passed a 20-year Harborview Bond measure that was supposed to do many of these improvements and seismic retrofits. They weren't done due to cost over-runs. What assurances do we have that they will be completed this time?
• County taxes have soared in the last ten years and this is another example of irresponsible county spending. Our earthquakes aren't severe enough to merit the need for reconstruction.
• There are empty beds in other hospitals in the area. We should not be funding more hospital beds at Harborview until those are filled.

Recommendation
The Municipal League of King County recommends a “yes” vote on King County Proposition No. 1 (Harborview Medical Center Improvements) to ensure that Harborview will be able to serve the community when most needed.