[This transcript was generated automatically from audio using AI and hasn't been reviewed by a person -- it can contain mistakes, including plausible-sounding sentences that were never actually said. Treat it as a starting point, not a verbatim record.]

[0:04] Good morning, everybody. I'd like to call to order the March 24th, 2026 committee of the whole meeting. I am the chair of the committee, Jorge Baron.
[0:12] Today's agenda, we have two briefings related to Harborview Medical Center.
[0:16] And we may take them out of order, but I'll note it as if I have them on the agenda. For the first briefing, we'll be hearing from the representatives of Harborview.
[0:22] And the second briefing will be focused on a new King County Otter's letter report regarding in Harborview, Wont Project, and the executive response and update on the project.
[0:33] Before we get started, I do want to note to my colleagues that we have a hard stop at
[0:38] 11 and hopefully actually able to finish a little bit before that to allow KCTV and all
[0:44] of us.
[0:45] I hope to get to the Women's History Day event in the Chinook Building, and I want to remind
[0:51] folks that if they are folks who are thinking about public comment, there's the for that
[0:56] reason we do not have action items on today's agenda, so we're not opening up for public
[1:00] for this meeting, let's note it in the agenda, but I want to remind community members that
[1:04] you can provide public comment via email or at today's Council meeting at 1 30 PM.
[1:09] With that introduction, we'll please call the roll.
[1:12] Clerk will switch to police call the roll.
[1:14] Thank you, Chair. Council member Balducci.
[1:16] Council member Dimbaoski.
[1:18] Here. Council member Dunn.
[1:21] Council member Fain.
[1:22] Here.
[1:23] Council member Lewis.
[1:25] Here.
[1:25] Council member Mosqueta.
[1:26] Here.
[1:27] Council member Perry.
[1:29] Chair, Council Member von Reikbauer, and Chair Barron.
[1:34] We do have a quorum.
[1:36] Next, we'll move to the minutes.
[1:38] Vice Chair Bauduccino.
[1:39] Have a motion for approval of the minutes of the meeting from February.
[1:43] Thank you.
[1:43] Chair, I move approval of the minutes.
[1:45] Thank you.
[1:46] The minutes are before us.
[1:47] Any questions or comments regarding the minutes?
[1:50] Seeing none.
[1:50] All those in favor of approving the minutes.
[1:52] Please say aye.
[1:52] Aye.
[1:53] Any opposed say nay?
[1:55] The meeting minutes are approved.
[1:57] I see our folks from Harvard we are right, so we are going to stick to the original plan of the agenda.
[2:03] Thank you.
[2:04] That first item on our agenda is a Harvard Medical Center update for any members of the public who might be listening in.
[2:09] I want to provide a bit of background on Harvard's relationship with King County.
[2:13] Harvard is owned by King County and operated in partnership with UW Medicine.
[2:17] Harvard considers a critical role as King County's primary safety net hospital,
[2:21] emphasizing care for the admission population, which is actually defined in a hospital services agreement
[2:27] that we have with Harbourview. That includes non-English speakers, uninsured and under-insured
[2:32] patients, survivors of domestic violence and sexual assault, people with severe mental illness
[2:37] and substance use disorder, people in incarcerated and county jails, and others.
[2:42] This committee, of course, the lead committee of jurisdiction regarding Harbourview,
[2:45] and one of my goals this year is to ensure that we stay informed on both operational and capital
[2:49] needs of the campus, notably being aware of changes to federal Medicaid programs that impact
[2:54] many of hardware research patients, which is our first panel was speak to and saying update
[2:59] on hardware use capital needs being addressed by the hardware review bond program, which is the
[3:04] second panel with discuss and more detail. And I will note that we are going to be having another
[3:10] touch, probably likely in the main meeting as a follow up to some of the things that we're going
[3:14] discussed today. I'd like to welcome our first panelist to the table. We are joined by
[3:20] Dorothy Teeter, who's serving as the President of the Harborview Board of Trustees. Go ahead
[3:26] and join us here at the table as I call you. Ian Goodhew, who is the Associate Vice President
[3:31] for External Affairs of Youth of Medicine and Summer at Kavino Wally, who is the CEO of Harborview
[3:37] Medical Center. Thank you all for joining us today and board President Teeter. I believe you will
[3:42] starting us off today. Please proceed and thank you and I'm sorry I'm calling you and you
[3:45] just as you arrive but you know we have a tight agenda today so go ahead.
[3:51] Is it a seat?
[3:52] Just a slight delay so just.
[3:54] Okay, you can hear me now.
[3:56] Yeah, perfect.
[3:57] I will not bore everybody with traffic problems because everybody has those very, okay well thank
[4:03] you very much for inviting us to come today. I'm going to leave you off with a whole um
[4:09] Yeah, maybe just pull your microphone, just a little closer there you go. Thank you.
[4:14] With the status of fundraising and philanthropy strategies for Harborview,
[4:22] we're going to just go through a series of findings that we had a consultant
[4:27] work with us on and then talk about some next steps that we as a board are going to recommend
[4:32] for following up with some with philanthropy fundraising. So if you go to the next slide, please.
[4:40] The reason that the board is interested in fundraising and philanthropy is because even with all of the
[4:49] fabulous support we get for a couple of fundraising from King County and the work that we do with
[4:54] UW Advancement. We had a burning question which we spent last year looking at in terms of,
[5:01] are we leaving any opportunities for fundraising on the table that we could use even more to support
[5:08] of our review. So in 2025,
[5:13] we contracted with a consulting firm, the CCS fundraising is the name of their firm.
[5:20] To determine whether, number one, the partnership we have with UW Advancement, is as effective as it can be,
[5:28] and should we continue that way or should we go with a different way to fund race.
[5:32] And secondly, what is the potential for philanthropy and fundraising for Harborview going forward?
[5:41] So the consulting firm was working for the board conducted an evaluation of the fundraising infrastructure that we currently use.
[5:50] They interviewed stakeholders across many different entities and experts to find out what their perceptions or about the fundraising and the opportunities.
[6:01] They then compare it to Harborview's fundraising potential and actual experience with other benchmark institutions.
[6:09] Similar to Harborview across the country, and then using that data did some analysis from their own level of expertise about fundraising with the potential might be.
[6:20] Next chair, I'm sorry to interrupt.
[6:22] Can I please ask the gentleman to lower that sign? Just a few inches. Just a few inches so that I can see the screen.
[6:27] Thank you. That's all. I appreciate you. Thank you.
[6:30] Thank you, Mr. Chair.
[6:33] So the findings from the fund raising consultants were these are very high level, but just
[6:40] they'll give you a really good sense.
[6:43] We raised, however, be raises more than experience institutions on an annual basis, and it also
[6:48] spends considerably less unfund raising expenses.
[6:52] Remember, we work in partnership with UW Advancement, so we were very happy to see that we
[6:58] were doing well relative to the amount of money that we're investing.
[7:02] However, they also, in this as a good news, I think, they identified nearly 20 million
[7:08] a year of potential additional funds that we could potentially be raising just with our existing
[7:14] donor base.
[7:16] So, that's just keep that in mind.
[7:18] And then they said, you know, there are some other pipelines or ideas that we have about
[7:22] where else you could look in addition to principal donors for additional funds, one of
[7:28] They call it a grateful pipeline.
[7:30] I like to think of it as making it easy if patients do want to donate to Harborview, make
[7:35] it easy for them to do that.
[7:38] And then, as we all know, we live in a fairly wealthy part of the country and wealthy
[7:43] part of the state and that they believe that there were some other opportunities that we could
[7:48] focus to get additional philanthropic support from other principal donors.
[7:53] And then lastly, and this is something that I didn't know.
[7:56] And we have over $6,700 foundations worth about $353 billion in assets in the state of Washington
[8:05] of that about 770, 787 of them give grants to health associations and health care institutions.
[8:14] So that's another opportunity they were suggesting that we could explore for funds.
[8:22] Next slide please.
[8:23] So when they put all of that together, again, it was the better retention of existing donors
[8:30] expanding the patient programs so that people that want to donate have an easier time
[8:35] doing that than targeting additional major donors and then additional foundation support.
[8:42] Their record, their conservative scenario for the potential would be that we could, instead
[8:47] of the 21 million annually that we currently raise from philanthropy, it could probably
[8:52] to move up to 30 million annually within five years.
[8:56] And the projected in, you know,
[8:58] put doing a little bit different math,
[9:00] that's a 40% increase in philanthropic revenue
[9:03] over the next five years.
[9:05] They're recommending this more balanced funding model
[9:07] that is identified above with the different pipelines.
[9:11] And most importantly, that kind of revenue
[9:14] would really help with expanded capacity
[9:16] for the critical programs that I know we all
[9:19] want to support for our review.
[9:21] And next slide, please.
[9:25] So the recommendations, and this is my last slide here.
[9:30] One of the questions we had, and UW advancement, I have to say,
[9:35] was extremely helpful during this process,
[9:37] helped share with information, recommendations,
[9:40] reviewed things.
[9:41] And the fundraising consulting from CCS recommended that we,
[9:45] indeed, continue to work with UW advancement.
[9:48] they've got a huge infrastructure, we have good working relationships with them, and they
[9:53] have been reviewed this information as well.
[9:58] So because every dollar that we raise philanthropically can really supplement the public
[10:04] funding and the needs that we have as an organization, you're going to hear more about that,
[10:09] I know from Ian and from Summer, this is really important, especially now, given the Medicaid
[10:14] potential cuts that are at the federal level in terms of policy.
[10:19] The other thing, so for her reviews board, this is a number one priority.
[10:25] To really work with UW advancement with our partners with all of you,
[10:29] to say how can we ensure that that potential is there at a conservative level.
[10:34] We can reach that potential over the next five years.
[10:37] So to those ends of the board request and we have formed a small subcommittee of board members to work with summer and her team and with UW advancement to say what are the next best steps we can take to ensure that we are meeting that potential and equally importantly how do we create reports and charts to show that we're all the different strategies we want to try our working that we can then share with all of you as well.
[11:06] So with that, I think we can take any questions or comments.
[11:11] Thank you so much, Dorothy, I appreciate it.
[11:13] I want to remind folks, I'm fine with the sciences,
[11:16] I'm also not blocking the screens or other people, okay?
[11:19] So I just please hold them so that they unlock the screens.
[11:21] Any questions, colleagues, for President Teeter?
[11:27] Councillor Morphine.
[11:29] Good morning.
[11:31] Thank you so much for the presentation, and thank you for your service
[11:34] on the volunteer board of trustees,
[11:39] questions about this, it's exciting to see the potential
[11:44] for $20 million one thing that I would think would be helpful to clarify for my colleagues
[11:51] here is maybe for some or to answer, this would not be operational dollars rate, a lot
[11:59] of fundraising that in philanthropy dollars that are raised are programatics, so they go to
[12:06] specific programs. So, summer what is the current proportion, or how much of the philanthropy
[12:15] dollars that come in are really available for operational spending other than programmatic?
[12:22] It does make sense, I don't have an exact amount, but you are correct that by and large.
[12:29] And I'm learning a lot about philanthropic work.
[12:34] You know, our partners, our philanthropic partners are interested in giving to technology, equipment, innovation, less to operations.
[12:46] The one exception that I've done a lot of work with is within our pediatric clinic with
[12:55] individuals with a few donors who have been very helpful in working with me on our outreach
[13:03] for homeless teens.
[13:05] So that has been an area and then we have a general fund for patients for greatest need.
[13:10] Those are smaller donations.
[13:11] The bigger donations that Dorothy is talking about really are directed and get specific, so I'm not able to move them around, but they're very specific for things like I want to fund a mammogram machine.
[13:24] I want to fund an MRI. I want to fund renovation of this X, right? So it's tied to something.
[13:34] There is also a lot that's tied to physicians and research.
[13:42] Thank you.
[13:43] Do you have a follow-up?
[13:45] Thank you.
[13:46] One other thing that I just want to commend summer on is we didn't previously have at the board.
[13:56] Sorry, at Harvard View, a commitment or a requirement for the CEO to really invest in play at the
[14:03] time and I know that you've done a lot of that and that explains a lot of the growth that
[14:08] there's been at her review around philanthropic dollars. One of the other potential areas of
[14:20] philanthropy that I know that was discussed last year was naming rights. Is that an issue or is
[14:31] identified by CCS include the potential for naming rates?
[14:38] I think my experience with this is that,
[14:42] depending on the donor, some are interested in that,
[14:45] and some aren't, and at this point,
[14:46] I think it's a very important question that will,
[14:50] in a way, have to be done in a case-by-case basis
[14:53] to see what the situation is,
[14:55] but certainly many donors, as we know,
[14:57] like to.
[14:59] Awesome.
[14:59] Many don't.
[15:00] Also, like to see their name attached to something. So, it's just part of the process that we'll have to go through when we see what some of the potentials are and engage with the county, obviously, in any situations like that.
[15:15] Thank you, Councillor Moreberry.
[15:18] Thank you. So, I know that some from a philanthropic standpoint, I know that there are restricted funds. Unfortunately, I know a lot about this.
[15:26] So there are restricted funds.
[15:28] It's a legally defined term.
[15:30] It can only be used for that thing.
[15:32] And there are quasi-endowments and full-endowments.
[15:35] So the quasi-endowments, the board can mess around with it
[15:38] and bring the endowment down itself,
[15:40] take the principle, but also take the interest,
[15:43] but also work are able to take principle out over time.
[15:46] A true endowment, the legal term,
[15:50] you can never touch the principle,
[15:52] and you get the interest as it goes.
[15:53] And there are usually levels for quasi-entrue
[15:57] for any kind of support for patients and for any kind of program that you would have that would be named.
[16:04] There would typically be a level associated with that.
[16:08] But when you're doing this and you're seeking it, are you creating a restricted fund
[16:13] or are the dollars going to the general fund when philanthropists are asked to give?
[16:18] I think it's a brilliant idea. I love the public private. I love all that.
[16:21] But the restricted fund piece of it is really important.
[16:24] And so I'm wondering if you are looking at a restricted fund for that amount with, you know,
[16:30] silent donors and then a campaign for that so forth.
[16:33] Yeah, so it's the answers, yes, to all of it, to you are absolutely right.
[16:37] We are really working on a cadre of options and provide them all to the potential donors and the philanthropic partners.
[16:47] But have a mixture of restricted funds,
[16:52] a mixture of funds that can be used for greatest needs.
[16:55] So the definition is much broader.
[16:58] So I can use it for supplies and the ED,
[17:00] for individuals who are on house, things like that, right?
[17:03] And then we also have restricted funds,
[17:05] where people come in and say,
[17:07] I want to give to X.
[17:09] I have a new endowed fund that is in through the CEO office
[17:13] That will allow me to continue to grow and then provide funding for things that are of the CEO's interest, right?
[17:24] So that's where a lot of the dollars have gone for the homeless teens and the shelters that we staff there has been my priority in that area.
[17:32] But it's a mixture.
[17:35] Thank you very much.
[17:36] I'm going to go to Councilmember Lewis and then I'm going to move us along because we got a tight agenda to keep.
[17:41] Thank you.
[17:42] Thank you. I'm going to ask this question and I can, I'm happy to take the answer offline,
[17:47] but back to the naming rights issue. I'm wondering what the county's policy is about naming
[17:53] rights for county facilities and then whether or not the harbor view operating a hospital
[17:59] operating agreement addresses naming rights. So we can, we can do that offline.
[18:04] Thank you. Okay. Yep. Sounds like we, that's what we're going to do. Wonderful. Thank you so
[18:08] much for the questions, and now I'm going to turn it over to, are you the medicine colleagues?
[18:17] Thank you, Chair Barone. And thank you, Council members, for inviting me back today. I will try
[18:22] to move quickly through this in the essence of time. So, some are Claven O'Walley, Chief Executive
[18:29] Officer, Harborview Medical Center.
[18:34] Always start off every presentation I do here with the
[18:38] But I know that you already went through it chair-barone, so it's just here for all of us to center ourselves for so next slide.
[18:47] Today, I'm going to try to give you a brief update on the status of healthcare.
[18:52] I'm going to then talk about some of the incredible work we are doing with the tax dollars that you have so kindly
[18:59] worked with us on ensuring that Harborview has access to for our patients in our community.
[19:05] And then I'm going to talk about a few priorities for additional tax dollar allocation that
[19:10] we'd like to propose or that we're proposing to the council for the next round of
[19:14] appropriations.
[19:16] First of all, thank you for this slide.
[19:19] If we think about what's happening in health care, so I think that a lot of people have talked
[19:24] about federal and state funding cuts, if we think about where we are at Harborview, we're
[19:29] about, said we're at an expectation of about 700 million in reduced reimbursement, okay, reimbursement
[19:37] reductions over the next five years. And that's with a combination of the federal cuts that
[19:43] are part of HR1 that everyone is very familiar with, along with state cuts that have happened
[19:48] because of severe budget issues at the state level also. As you can see, that leaves enormous
[19:56] holds for us from our long-range financial plan and how we will continue to ensure we have operational
[20:02] funding for the future coverage and service if we think about what that means or what we've
[20:09] started to see. So this has been a question several of you have asked me. Am I seeing changes in the
[20:14] environment already even though only you know one or two things have gone forward or have been
[20:24] that I'm looking at right now between fiscal year 25 and 26 has changed about has increased
[20:31] about 3%. And if you think about what that means to harbor view every 1% of increase and
[20:38] uninsured is about 8 million. So less revenue when you have uninsured. So we are seeing patterns
[20:46] of changes particularly through our transfer center. We are also in combination with a change
[20:54] in that pattern of more uninsured coming into Harborview, we are also seeing a decrease in transfers
[21:03] from other hospitals and other systems that typically would have helped us subsidize services
[21:08] that have lower reimbursement. And we know historically at Harborview that's been very important.
[21:13] For example, the trauma transfers that come in. We have seen a significant decrease in the ones
[21:19] that have more of a higher reimbursement that has always helped us subsidize the other care we do at Harborview.
[21:27] Thirdly, we continue to experience space capacity constraints that is not new to all of you.
[21:35] But just, you know, is incredibly important for us to continue to think about particularly as we move forward with the bond
[21:41] and any campus construction we can do to open up access and open up space for better experiences
[21:49] for our patients and better access for our patients that we serve.
[21:53] Okay, next slide.
[21:56] So I want again, thank you guys, in 2025, we were able to have through the County Hospital
[22:02] Levy 46 million in crucial operating support, and that is incredible.
[22:07] Today, I want to talk to you about kind of overall where what we've done with that 46 million,
[22:14] and then highlight a few of the programs specifically that that 46 million is helping us fund.
[22:21] The dollars are currently supporting about 265 FTEs in the following subset.
[22:28] So primary care clinics at Harborview, including things like our International Medicine,
[22:32] Pediatric, Family Medicine, etc., are off-campus clinics. You often hear that.
[22:38] We talk about those as in our Pioneer Square clinic, our hubs in place clinic, our downtown programs.
[22:45] I'll describe that a little bit more in depth, and then in our behavioral health and psychiatry.
[22:50] So all of that, 46 million is going into FTEs that are supporting that incredibly key work.
[22:57] I want to highlight a few of these clinics, because I'd like to make sure I'm starting to bring you more information about how the impact
[23:05] we're having on the population, we're here to serve.
[23:08] So next slide, please.
[23:11] First of all, I want to spotlight our international medicine clinic.
[23:13] And those of you that have two, Harborview have probably been able, and they have had the
[23:18] privilege to tour this clinic, which is staffed by amazing staff, amazing physicians, and does
[23:23] incredible work.
[23:25] It is a comprehensive clinic that serves both, or that provides both primary and mental health
[23:31] care for refugees and immigrants over the age of 16.
[23:34] Under the age of 16, we have RP after clinic that serves those individuals.
[23:40] We have a very robust community house call program that goes into in-home and providing
[23:46] follow-up care.
[23:47] We have on-site pharmacy, we have robust patient care coordination, navigators, cultural
[23:53] mediators, interpreters, nutrition, social work, everything embedded within one clinic.
[24:00] really focused on that refugee and immigrant population that we're here to serve.
[24:04] In the last fiscal year, we were able to provide 12,000 visits in that clinical loan.
[24:10] And the tax pay are the tax dollars you helped provide us was able to support that work.
[24:17] Next slide.
[24:18] Another program I want to highlight is what you hear us call our downtown programs.
[24:23] And this is just a piece of our downtown programs, but they're vast and they're robust.
[24:27] So I wanted to highlight three areas for you as the Council to know about.
[24:33] In 2025, we were able to provide almost 4,000 visits to with nurses, providers, and mental
[24:40] health staff that go into housing units with our partners in DEC and Plymouth.
[24:46] So go into different housing environments to provide care within somebody's actual home
[24:52] environment.
[24:53] So we don't have to rely on them coming into the hospital in order to get care.
[24:57] really trying to decrease our loss to follow up in the health disparity, you see in that area.
[25:03] Healthcare for the homeless, we were able to provide about 2,500 in that cadre of services,
[25:09] where again, we have nurses, providers, mental health providers embedded in shelters throughout the city.
[25:16] So again, providing, trying to reduce health disparity and providing care and meeting our individuals,
[25:21] where they are. And then a very special service I wanted you guys to know about.
[25:25] That has been highlighted numerous times, particularly in the news and things like that,
[25:33] palliative care for the homeless.
[25:35] So about 314 individuals were seen over the last year where we are providing palliative
[25:40] care that you would typically get in a hospital setting or in a home setting to individuals
[25:45] that are living on the streets or in unstable housing, where we're providing that same level
[25:51] of intense wraparound treatment at end of life
[25:54] for a severe illness levels.
[25:57] Next slide.
[25:59] Lastly, I wanted to highlight some of our behavioral health programs.
[26:03] So in patients like Hydritory,
[26:04] you've heard me talk about.
[26:05] We have three units to acute care, one ICU,
[26:10] and then we also have our ED psychiatric emergency services.
[26:14] Our ED psychiatric emergency services are the only,
[26:17] that is the only ED in the state
[26:19] that provides psychiatric care, including psychiatrists, staff, 24-7 for those that are in the most severe mental health crises.
[26:28] We are also the largest ICU for intense psychiatric acute illnesses.
[26:35] Can I ask you to pause for a second?
[26:37] Yes.
[26:38] Folks, we need to have signs that are not blocking other people.
[26:41] So just please make sure you block the screens or other people who are here to watch the hearing.
[26:46] Thank you.
[26:47] All right, I talked about our psychiatric emergency services really there for those in a acute crisis and then our downtown programs field base.
[26:56] So similar to our primary care that we're providing in the field meeting people where they need to be met in their living environments.
[27:03] I'm not relying on individuals coming in to receive care.
[27:08] Okay, next slide.
[27:12] All right.
[27:14] Really grateful to all of you for the work you did last fall,
[27:18] appropriating Harborview-based provisions for the county tax levy,
[27:22] increasing it to 15 cents, funding new building,
[27:25] the new building for Pioneer Square,
[27:27] Duncan, the Duncan building, very excited about that.
[27:30] Providing additional support for the bond,
[27:34] funding operational and emergency support for the
[27:43] as HR1 is implemented, supporting critical infrastructure that we have that needs fixing at Harbor
[27:49] View.
[27:50] And then funding the design phases and permitting phases of a parking garage that is going
[27:56] to be so desperately needed as a bond construction commences on campus.
[28:01] And we lose a great deal of parking, which is patient-facing.
[28:06] Next slide.
[28:08] Additional capital priorities for 2026, 2027 that I'd like to give you guys a heads up
[28:13] for us asking for a consideration are that new parking facility, so actually funding the parking
[28:21] facility, which is going to be incredibly key to have in place before construction starts on
[28:26] the tower. We cannot lose more parking on campus and continue to function as a health care environment.
[28:33] And then lastly, that neurosciences in Fusion Center, that helps us provide care to individuals with
[28:40] Alzheimer's and dementia drugs for that, along with the other infusions that we provide
[28:45] at Harborview for individuals who are more vulnerable in at risk and don't go to other
[28:51] infusions centers at U.S. medicine or other areas to get care.
[28:55] So, really, a lot of wrap-around care we provide currently.
[28:59] I will pause there and see if there's any questions.
[29:02] Thank you very much, Summer.
[29:04] Any questions from colleagues?
[29:07] Councillor Morphin.
[29:08] Oh, I didn't do too much.
[29:09] Just a quick clarification when you're talking about the parking facility or you're talking about the 9th and Alder.
[29:16] Yeah, do you want to go to slide Sam?
[29:19] I was going really fast and I missed a slide.
[29:23] Yes.
[29:25] You want me to cover, did you have a question?
[29:27] No, I just wanted to make sure.
[29:29] I'm sorry, yes.
[29:30] Parking on 9th and Alder, Tony will also be talking about that.
[29:33] But it's the 9th and Alder site that was purchased by the county.
[29:37] and that was appropriated money for the planning and permitting of a site there.
[29:44] Thank you.
[29:46] Sumer, I did have a question for you on the uninsured rate.
[29:50] You mentioned the increase of 3%.
[29:53] I imagine there might have been some variability over time,
[29:57] but is there a 3% kind of like a significant...
[30:00] If it can increase from where you've seen the past or have you, I'm curious what the history has been.
[30:05] It's a good question. So prior to the ACA being enacted, we had around 13 percent. As we all know, the state of Washington, incredible job.
[30:15] And frankly, we at Harvard, we didn't incredible job expanding and ensuring people got on Medicaid programs.
[30:21] and so we were running around two to three percent for a very long time.
[30:26] Pretty stable.
[30:28] We didn't really see a lot of fluctuations in that.
[30:30] Took a lot of support.
[30:31] A lot of financial counseling.
[30:32] A lot of insurance of ensuring we had the wrap-around support.
[30:36] But yeah, so a 3% increase over the last few months is...
[30:41] I'm sorry.
[30:42] In rough for a second.
[30:44] Folks, we can't have the front row.
[30:48] Because we have rules that we said, we, I'm telling you what the rules are.
[30:55] There are seats available in the rows behind you, and we need folks to be there.
[31:00] No, that has nothing to do.
[31:02] Everybody, everybody, if you're a presenter, you have the seats in the front.
[31:11] I need folks to please be quiet, so that we can continue the meeting.
[31:15] Summer, go ahead.
[31:16] Go ahead and finish.
[31:17] Oh, you're not okay.
[31:18] All right, thank you.
[31:19] Thank you.
[31:23] So with a 3% increase over just a few months, and I think we're seeing that frankly because of an increase in the number of other hospital systems, finding ways not to intake patients who are uninsured, so they're finding their way to harbor view.
[31:44] So, over just a two to three month period, that has a potential impact right if each percent increase is 8 million of approximately 24 million dollars.
[31:53] So, you can actually see there how impactful the operating dollars that the county,
[31:58] both the council and the executive provided is to our review. It's real-time budgeting.
[32:03] We're losing potentially 24 million on what we planned a budget for the fiscal year, yet we have that funding there from the tax to fill that gap.
[32:12] that that's how critical that is. And that is a that is a big percent increase. So now around 6% and our concern is that when HR1 actually starts to hit in January with job or court work requirements other eligibility criteria that are really designed just to kick people off of the program.
[32:29] That that percentage will continue to grow.
[32:33] Thank you very much.
[32:35] Thank you chair. Thank you for the presentation and thank you chair for scheduling these
[32:41] more regularly. I think it's going to be really good to keep in closer touch with what's
[32:45] going on at our county hospital. Two things. One first I just wanted to convey a long term
[32:53] and very well loved member of our county family has been going through a very serious health
[32:59] challenges lately and has been being treated at Harborview, and was sharing with us earlier this week
[33:04] how very much she values and appreciates the life-sustaining care that she has been receiving.
[33:12] I just wanted to pass that along. I mean it touches all of us and it touches the King County family
[33:16] certainly as well. So thank you to you and your whole team for the care you give to everyone and to our colleague.
[33:23] The second thing is a question. So in the last two years, when we've had these conversations,
[33:27] We have occasionally seen Harborview having challenges with patients that have very high levels
[33:34] of need beyond medical care, and so it's difficult to discharge them to an appropriate place
[33:40] where they can get the supportive services they need that are not Harborviews to provide,
[33:44] but you don't want to just push these people out the door because they need other services,
[33:49] and that at times caused us to close the doors. How is that going these days?
[33:54] So we made a lot of progress with partnering at the state level with, you know, the managed Medicaid plans and with individuals over the departments at the state level, including health care authority and DSHS, etc.
[34:13] However, we still have a cadre of individuals that are the most significantly complex, that
[34:21] are very difficult to discharge.
[34:24] My worry is though that as everything starts to shift with Medicaid changes, people not
[34:29] having funding, we've already seen people falling off from the subsidies being reduced,
[34:34] We're going to, that's going to rear its head again because we have it fundamentally fix the problem around matching the post-to-cute care entities having the reimbursement they need to supply the types of care they need to have available at those facilities to match the level of complexity of individuals.
[34:54] So.
[34:55] But we've been able to maintain.
[34:57] We've done much.
[34:59] Yes, we have not closed doors at all since that time period.
[35:04] Really, really good to hear.
[35:05] And just for those following along,
[35:06] this is the healthcare social safety net we're talking about here.
[35:09] This is where people without insurance,
[35:11] without documentation,
[35:13] without resources can get the healthcare that they need,
[35:17] and it is under strain.
[35:19] And so that's what we're talking about.
[35:20] How do we support and continue to provide this healthcare to people who badly need it?
[35:24] When other parts of our healthcare system and our government are pulling back,
[35:28] And that's putting even more pressure on this organization.
[35:31] So thank you for your report.
[35:33] I appreciate the time.
[35:33] Thanks, Councilmember.
[35:35] Thank you so much.
[35:35] I'm going to move this long.
[35:36] Thank you, Dorothy.
[35:37] Summer, Ian, appreciate it.
[35:39] Of course, welcome state for the next presentation.
[35:41] I'm going to invite our colleagues from the Elders team and from the executive, from the
[35:46] Harborview project.
[35:48] Because the second briefing is an update on the King County Harborview audit letter that we
[35:54] received a Senate Brigadier copy and that has been released today.
[35:59] For background in 2020, King County voters approved a bond measure to address the extensive
[36:03] capital needs on Harbor East Campus.
[36:05] Within King County, the Harbor View bond program has been managed by the Harbor View
[36:08] Construction and Infrastructure Division, who will hear from today after report from the
[36:13] auditor on the program's progress towards its goals.
[36:16] We'll start by hearing from Ben Thompson with the King County Honors Office, and then we'll
[36:19] follow that with the presentation from Tony and Patrick with King County's Harbor View
[36:23] instruction and infrastructure division, and I do want to note again that this is a kind
[36:28] of a first touch on this. We're probably going to bring Tony back, especially in May, with
[36:33] some more information, but we wanted to highlight this letter that we are received from the
[36:39] auditor formally today, and hopefully you all will have questions that we can then send to Tony
[36:46] to report back on at the May meeting. It's my hope with this presentation today. So Ben,
[36:52] Thank you per being here and for your work on this and please take it away.
[36:57] Thank you, Mr. Chair, for the record, Ben Thompson, King County Autors Office.
[37:01] The King County Autors Office under our Capital Projects Oversight Program started oversight
[37:07] of the 2020 part of your bond delivery program in 2021.
[37:13] We are planning to continue our oversight for the length of the program and today I'm going
[37:18] talked to you about a divided summary of a letter that we will
[37:23] publicize and post on our website at the conclusion of this briefing.
[37:29] First, a little context.
[37:31] Voters approved a $1.7 billion bond in November 2020.
[37:37] And there are several components of that bond.
[37:39] One of the primary ones was a new inpatient tower on the
[37:47] With three, it was recognized that the cost of delivering the full scope of the bond was not
[37:54] going to be achievable given a variety of cost increases largely due to the pandemic,
[38:00] from things like inflation, from materials cost increases, from labor cost increases.
[38:05] Therefore, the Council put together the ordinance working group, or OWG.
[38:09] The OWG then did their work in 2023 and eventually the Council approved the updated OWG scope in October 2023.
[38:22] And now we'll talk a little bit about some of the teams working together to deliver this program.
[38:27] At the center you have the Harborview Bond program team and this is composed of staff at both King County as well as supported by the Harborview Medical Center staff and they are in charge of program delivery.
[38:39] The next component is an owner advisor.
[38:43] This group provides technical support and organizational support for the Harborview
[38:48] Bond program team.
[38:51] Lastly, you have a design builder.
[38:54] The design builder is Mortensen and Perkins and Will.
[38:57] The design builder was brought on last year.
[39:00] And the design builders role in this project is to provide both design
[39:03] and construction of the capital program at the Harborview Medical Center.
[39:10] Now I'll provide some key takeaways from our letter.
[39:14] First, the full OWG scope approved in October 2023 may not be delivered without additional funding.
[39:22] This is, we put May here, this is not a certainty.
[39:27] There's a number of analytic steps that have to move forward to determine this, but this
[39:32] is our concern at this point.
[39:35] Additionally, the new impatient towers estimated to open in early 2032, which is three years later than the OWG estimate that was provided to you several years ago.
[39:48] And lastly, the program faces several significant risks that I'm going to talk about now.
[39:55] First, though, some program status, the parking solution was identified with a plan garage at
[40:03] 9th and Alder that would help mitigate the loss of the view park 1 garage, which is going
[40:09] to be demolished in order to make space for the new impatient tower.
[40:14] Secondly, as of last month when we wrote our letter, there was a lack of agreement on target
[40:20] value of for design.
[40:22] This is an agreement around both the scope and some of the component costs between the program
[40:26] team and the design builder.
[40:29] And this is essential to determine before what's called schematic design can begin.
[40:36] And schematic design is an incredibly important component or milestone in this project,
[40:42] where we'll be actually figuring out what is going to be built the full scope, the size
[40:48] of spaces and so on. And once schematic design is achieved or agreed upon, we'll have much greater
[40:56] clarity around both the cost and the schedule of the program because we have them the units
[41:01] that we need to do that analysis.
[41:06] What we're seeing so far is cost estimates are rising. This is due to a variety of factors.
[41:10] We're seeing inflation just like in our daily lives. There's a great deal of inflation
[41:14] of capital projects around the county and this program is also subject to that. We're seeing
[41:21] some updated building codes, particularly on seismic standards that's driving increased
[41:25] costs. There's the potential for some new geotechnical information and that's basically
[41:30] the soil around where the new inpatient tower is going to be. As Tony can talk about, there's
[41:38] additional boring as being done to understand whether the current plan foundation will be sufficient
[41:43] for the soil or whether additional and potentially costly steps will have to take in order
[41:50] to guarantee the stability of that tower.
[41:53] And as I talked about, when we wrote the letter, there were significant differences between
[41:58] the owner and visor and the design builder estimates for target value.
[42:04] This slide shows some of the milestone and schedule estimates that were provided by the
[42:15] You can see along the y-axis, a number of milestones, and then you can see the estimates of the dates at that time.
[42:24] These are the items that were completed since the OWG of estimates were provided, so you can see these three items have now been done.
[42:36] These are the current estimates of when a variety of these milestones are going to occur, and I'd just like to highlight too.
[42:44] The first is the amendment to the major institutions master plan, or MIMP that's going to be required in order to get many of the permits needed to deliver this program.
[42:57] The second is the, or on the bottom that I already spoke about is the occupation of the new tower.
[43:02] So these are two components that have both shifted since the OWG estimate.
[43:07] In talking to the executive and their staff around these to try to understand some of these
[43:14] scheduled shifts, they raised the issue that many of the estimates included the OWG report
[43:19] were very preliminary and not as rigorous as the ones that are being completed now.
[43:25] So we hope that as both target value for design and schematic design is completed that we
[43:31] can get a much more rigorous schedule that then we can hold the program accountable for.
[43:40] Some of the sources of delay in opening the new tower is around more time than originally
[43:46] estimated for both permitting and construction and I'll talk about both of those.
[43:51] And some risks exist that could delay opening even further, which again I will talk about when
[43:56] we get to the risk section.
[43:58] So, the first major risk we see is around the amendment to the major institution's master plan.
[44:04] This is required to get many of the permits that will be needed to deliver this program.
[44:10] Currently, the amendment is with the City of Seattle's Department of Construction and Infrastructure and Inspections.
[44:18] And it will need to get a recommendation from the Director of STCI in order to move to the Seattle Hearing Examiner.
[44:25] the hearing examiner than considers the amendment and if they approve of it it goes on to the Seattle City Council.
[44:34] So this is a multi-step process and through none of these steps do we have control.
[44:39] So this is all an external taking county process that will require coordination with the city.
[44:46] And the limited work can be permitted prior to this amendment being approved, which is the challenge.
[44:51] This is why, from early on in the project, achieving this amendment to the Major Institutions
[44:57] Master Plan has been one of the primary...
[45:00] Elements from the critical path for this project. And the concern is both the lack of control, but
[45:06] also that the city council could add additional conditions that could increase costs for the program.
[45:13] The next risk that we point out are incomplete management documents. As of the rating of this letter,
[45:20] neither a program charter nor a program management plan had yet to be finalized.
[45:26] Additionally, individual project manager plans have not been completed.
[45:32] These plans kind of set the rules of the road or the rules of the game for a program.
[45:37] They set how issues will be escalated, how decisions will be made, the thresholds of decision-making,
[45:43] and the really essential for a project that's as complicated and large as this capital program.
[45:52] The next risk that we talk about in our letter is parking.
[45:55] With the demolition of you park one garage, there was a substantial loss of parking on
[46:02] the campus, and there's an potential increase for demand.
[46:06] There's temporary demand for the needs of almost a thousand construction workers at the peak
[46:11] of the program, and under the Project Labor Agreement, we're required to provide parking
[46:16] for those construction workers that is the responsibility of the design builder.
[46:20] but it's potential to add congestion on the site.
[46:24] The new tower drives significant future needs,
[46:27] both from patients, staff, as well as guests.
[46:31] And UW Medicine has identified some longer term unmet needs
[46:36] at the campus.
[46:37] And all of the decision making around how much parking
[46:40] what the bond is going to pay for is all a risk
[46:43] that exists that we're concerned about
[46:45] because, as you well know, providing parking
[46:47] is incredibly expensive.
[46:48] this is a constraint site and there are a number of challenges.
[46:54] The last two risks I'll talk about are around roads.
[46:57] The first is for what's called the permanent loop road.
[47:01] As you can see from this picture and it's kind of small,
[47:04] so I apologize.
[47:06] There's a road there between the new impatient tower and i5.
[47:10] That's a permanent loop road that would provide circulation around the campus.
[47:16] And so it would alleviate sort of the congestion that the campus sees.
[47:20] The challenge is that this property is owned by Washington, and they must either grant
[47:26] a lease or transfer ownership in order for us to build this permanent loop road.
[47:32] There's the risk that we see here is whether Washington insists on a NEPA process, which
[47:38] is a federal environmental review process that could add years to the timeline if it's required,
[47:43] or could require redesigning the tower if it's chosen
[47:48] that the need for process isn't feasible.
[47:52] The second road is called a temporary hall road.
[47:55] This is, as it says, a temporary road
[47:58] that would provide access for materials equipment
[48:01] and workers to the site.
[48:05] And it also requires a temporary lease of land from washed out
[48:11] And a lack of achieving this lease could increase construction time, as well as increase traffic impacts around the campus.
[48:19] However, the whole road is less risky than the loop road because of its temporary nature.
[48:26] And the fact that there could be mitigating steps that the program team could take if it proves necessary.
[48:34] So again, I want to summarize some of the key takeaways we are concerned that the full
[48:39] OWG scope may not be delivered without additional funding.
[48:43] There are some scheduled shifts across the program and there are several significant
[48:49] risks that we've highlighted to the program.
[48:52] I'd like to thank Tony Wright, Patrick Hamaker and the Harvard Review Construction Infrastructure
[48:58] Division for their cooperation and our work.
[49:00] we plan to continue our oversight of this project and provide periodic updates to the council
[49:06] and our four port will be available online at the conclusion of this committee briefing.
[49:13] Thank you so much, Ben. I'm going to call on Tony to go next because you might start addressing
[49:19] some of the questions that we might have, but Tony once you go ahead.
[49:30] Thank you, Mr. Chair,
[49:31] for the record, Tony Wright, Director of Harbourview Construction, and I'm going to have to
[49:34] have to shut your division.
[49:36] I'm going to start off by thanking the Council for creating the Division Minament.
[49:42] But the first thing that I want to address is a couple of the specific questions that came
[49:50] out that were asked to address with this particular meeting.
[49:54] And then I can respond to questions and a couple of my thoughts.
[49:58] I also want to thank the Auditor's Office for an excellent report, although sometimes we disagree
[50:06] on the magnitude or where the concern is that it's a very factual and balanced report on
[50:11] what is happening with the project.
[50:14] So first off, and Bena really talked about this, but the Washington right away, that is
[50:20] a risk.
[50:21] It was an extraordinary risk, a while back, because although we had been talking to Washington
[50:28] for a couple of years, the individual that was handling our responses and telling us it
[50:34] was not going to be a problem retired without telling anybody what he had done.
[50:40] That was the start of our challenges.
[50:43] We initially escalated that with the support of the hospital, the executive, and the
[50:49] GAR teams and they came back to the table and we had very productive discussions about the soil conditions that are in the
[51:00] The green shaded area next I5.
[51:04] Most of us are very concerned about it because there is a historical challenge with this when I5 was built.
[51:11] There were agresized movements of land north of there based on some challenging soil conditions.
[51:17] And there's an extraordinary complex structure built into that slope below the hospital.
[51:24] They were concerned about our impact on that.
[51:29] We all agreed that having the hospital slide down on the I-5 was not going to be a good
[51:35] thing.
[51:36] So we spent a bunch of time with some geotechnical engineers and various other pieces identifying
[51:41] what the risks was, them better understanding what we were going to do.
[51:45] And we've, with some additional boardings that we're conducting on the slope, you may have seen those drove rigs running along the top of that retaining wall.
[51:57] I think we're in very good condition.
[51:58] I speak regularly with the Regional Administrator for Washington that we covered this particular area.
[52:04] And we are moving into the leasing negotiations for the hall road.
[52:10] I did have the whole road, got it as an amber risk.
[52:15] I no longer have the whole road as an amber risk.
[52:18] I'm confident that we will get that.
[52:20] There is still the potential of the NEPA consideration
[52:22] that Ben brought up for the permanent road,
[52:25] as whether or not that falls into a categorical exclusion or not.
[52:29] We have several steps that we can take with that.
[52:32] As some of you know, I'm a recovering fed.
[52:34] So I spent a lot of time in the NEPA arena.
[52:36] And there are several steps that we can take.
[52:41] I still consider the permanent loop road to be in what I would call it amber risk.
[52:48] There's some work that we need to do, we're addressing it.
[52:51] But the conversation with Washington is quite productive.
[52:55] If you look at the slide above, you can see what our current conceptual design is for the loop road.
[53:02] There's a street that's called 8th Avenue.
[53:05] It's not actually a street.
[53:08] It's county property.
[53:10] It's been vacated long ago.
[53:13] The way this is, we will no longer have traffic running
[53:15] between the new tower along what you would normally see as 8th Avenue.
[53:20] And the regular entrance to the hospital.
[53:22] If you see the little circular turnaround area there,
[53:26] that's where that's going to happen.
[53:28] but the ambulances in such will be coming down, Jefferson, as they do now, and come in to the ambulance entry issue in the screen.
[53:38] That's a much more efficient design, and by entering into what we currently believe is a long-term lease for the loop road condition.
[53:48] we will be and we can create a more effective traffic flow and maximize the capabilities of
[53:56] that site. Next slide.
[54:02] The next question that was asked was the use of the Broadway clinic
[54:07] that still under way, obviously the Broadway clinic is being used by the Department of Community
[54:13] and Human Services for the Crisis Care Center. There is additional space of remaining in that,
[54:19] which we have all discussed at different times.
[54:23] And the library is looking at it,
[54:25] both for potential, for temporary uses,
[54:28] and for longer term uses.
[54:30] I'm going to work through those occupancy pieces
[54:34] as they work through the programming
[54:36] with getting to a decision by this summer.
[54:42] Next slide.
[54:45] That's it.
[54:46] So I did want to just take,
[54:48] I talked a little bit about the soil conditions.
[54:51] I talked a little bit about the loop road, parking, parking is, I can't go into a meeting
[55:01] talking about how are you construction for more than five minutes without parking coming
[55:05] up as a key issue.
[55:06] It seems odd, but when you look at the campus and its constraints and the way people come
[55:13] to this hospital, it is something that we constantly need to worry about.
[55:20] Our solutions for that, as Ben said, none of them are inexpensive.
[55:27] I'm less concerned though about the workforce parking.
[55:30] We have identified particular locations for them to park that we can lease some of which
[55:35] are within a short enough distance that we don't have to pay additional labor fees for that
[55:40] transport time.
[55:41] This actually can be a productivity impact.
[55:45] We will not be allowing, although it will still happen.
[55:49] because this is all of us sometimes park over and not supposed to.
[55:54] We're not going to be allowing any construction parking on campus.
[55:57] It's all going to have to be offset.
[56:00] In terms of the governance structures,
[56:02] they talked about the program management plan.
[56:06] But that has been problematic.
[56:07] We have what I would consider the critical elements of the PGMP established and operating.
[56:16] But if we do not have a plan that has been finalized appropriately, I anticipate that the
[56:24] new owner's advisor, which we are moving to different firms and manner, we have solicited
[56:32] for them, and we will soon have them under contract when they are, I can tell you they
[56:40] But we will have a new owner's advisor and they're anticipate that we will get the program management plan finalized to a better degree of structure.
[56:55] In the interim, as I said, we have worked through governance and decision making and escalating tools closely with the hospital because, of course, everything that we do in this project is to get to that mission population.
[57:08] And so there's a very close relationship and I meet all the time with the hospital and we sit next to each other and the integration of this clinical requirements with the real budget constraints that we have in other pieces, that's the last item that I wanted to address is the cost increases.
[57:36] One of the largest drivers on the cost increase, and what we're seeing right now, is the Seattle and state energy codes.
[57:47] It seismic is also increasing it, and this hospital obviously has to survive through a maximum design earthquake,
[57:56] and be running at when it's a building stop shaking or well-shaking, I suppose.
[58:03] But the energy code requirements have created at least a $200 million in cost growth.
[58:17] Just from energy code changes.
[58:19] So when you combine that with some of the other aspects that are with there, there are lots
[58:24] different cost pressures that are occurring, we're looking through those closely.
[58:30] The task that we are in right now is to finish the target value design, and that is
[58:38] having a general agreement on scope and what the cost of that particular scope is.
[58:43] In this case, how many operating rooms, how bigger they're going to be, how many patient
[58:49] floors, what size are they going to be, and what the general idea of the cost per square
[58:53] foot?
[58:54] We then will enter into essentially an agreement with the design builder that, okay, this
[59:01] is how much each of these buckets has for money, and they will enter into schematic design
[59:06] with that parameter and budget, so to speak.
[59:10] That in a progressive design build, the livery model is a much better way to avoid various components
[59:18] getting out of control and driving the cost or curtailing scope, critical scope and other
[59:23] pieces.
[59:25] As Ben said, we were not in agreement on prices for square foot.
[59:30] We've spent a much of time working through that.
[59:33] I delays schematic design for a month because it is critically important for this project.
[59:40] I'm going to deliver this project within budget to enter schematic design with good target
[59:45] values.
[59:45] I feel like we're pretty close right now and that we should be able to proceed without another delay of this schematic design.
[59:56] And I think I covered.
[1:00:00] Most of the points there, but I want to finish by saying this is a complicated project and it does have risks. And we have lots of folks working to address them each day.
[1:00:14] And I appreciate the auditors comments in here and I don't have any other than clarifying some of the risks associated with that. I have no problem to the report. I think it's very fair.
[1:00:25] balance. Thank you, Mr. Chair. Thank you, Tony, I appreciate it.
[1:00:29] Colleagues, we have a little time for questions here. Vice Chair Balducci.
[1:00:32] Thank you.
[1:00:35] As a member, one of two members of the ordinance working group here, I have to say we are debating
[1:00:41] whether this is a trip down memory lane or PTSD or both.
[1:00:45] But I have to say, I am surprised at how we keep not talking about the reasons for all the delay.
[1:00:50] The costs essentially are linked to delay.
[1:00:53] The more we delay, the more it costs,
[1:00:55] then details are round what's driving the cost differ over time,
[1:00:59] but it's all about because we're not moving.
[1:01:02] We're subject to costs increases in many, many ways.
[1:01:06] And I still haven't heard a rationale for all the delays,
[1:01:09] like just headlines, permitting and construction delays.
[1:01:13] That doesn't tell me why we're not moving.
[1:01:16] And we're not moving, we're three years behind where we were when we were at the operational
[1:01:22] ordinance working group.
[1:01:24] And that was a delay.
[1:01:25] So I don't know how many years behind we are compared to what we promised the voters
[1:01:29] in the bond measure, but it's several years now, and I do not understand why, so can somebody
[1:01:35] please help me understand why and how we get out of this doom loop and move this project
[1:01:40] forward?
[1:01:44] Tony, Tony, it's not on, you have to hit it in just wait a second.
[1:01:49] Very good.
[1:01:52] I'll try to address that question.
[1:01:54] And there are a number of delays.
[1:01:57] The in the OWG that I was also part of and it was a accelerated and painful process.
[1:02:06] We made a series of assumptions on what the construction time would be.
[1:02:12] Those were, in terms of tower construction, by a couple of years, those assumptions that we
[1:02:19] made.
[1:02:20] As we got a design builder on board, and as we gathered more research with time, and you'll
[1:02:24] see that in the monthly reports that we've sent in, that's when the shift occurred.
[1:02:30] One of the other elements of the delay is an OWG we were talking about, beneficial occupancy
[1:02:37] dates, meaning that the hospital could move in, and the dates we're talking now, which are
[1:02:44] more relevant, are when the hospital concerned patients.
[1:02:48] There's a large amount of time, and I'll let the hospital address that more, but we've
[1:02:55] just finished a large project up in the mailing building, and also in the Ninth of Jefferson
[1:03:03] building, bringing up, bringing rooms online, and the activation time, we're looking at
[1:03:08] activation time of almost a year between beneficial occupants in there.
[1:03:12] That counts for part of the delay.
[1:03:14] The part of the delay before that is a number of things that the MIMP should have moved
[1:03:23] faster than it did.
[1:03:25] It did not get completed on the times that it should, and that was, and went, what is happening
[1:03:33] with it, the parts that were within our control were not completed on time.
[1:03:39] The quality of the document that was within our control was not completed on time.
[1:03:45] I can't go back and fix that, but that is one of the reasons that we're very real reason
[1:03:50] for delay that you can point at and say that was a problem.
[1:03:55] We are taking some risks.
[1:03:56] One of the risks that Ben did not address is the fact that we've entered into a contract,
[1:04:03] a progressive design build contract, so we have some off-ramps, but we've entered into a contract
[1:04:08] trying to gain time because we actually don't have the entitlements to build what we've
[1:04:16] hired a contract to for, and that's a significant risk.
[1:04:19] It's underwritten and we believe that's an appropriate risk, but we can't get too
[1:04:24] ahead of the permitting time one. But as you remember, we were behind, and as you accurately
[1:04:32] stated, Gems member, we were, we were, we were behind then, and we are further behind now.
[1:04:40] We think that we have a much more informed schedule based on the design partners that we have.
[1:04:47] And I plan on coming in with a detailed schedule of delivery in May, based on what I'm
[1:04:54] And what's the target value design?
[1:04:57] Just quick follow up.
[1:04:59] Thank you.
[1:05:01] What internal or project functions have we set up
[1:05:09] to ensure transparency and urgency
[1:05:12] around moving the project forward?
[1:05:14] How do we govern this thing?
[1:05:17] We have a series of governance elements that
[1:05:21] are combined teams of what we call the honors group,
[1:05:25] which is the county, the UW Medicine, and our owner advisor, combined with our design
[1:05:32] build team, and we have a governance structure that covers those particular issues.
[1:05:38] We have a schedule that identifies the various necessary components to get ready to do the work.
[1:05:46] We call it some of those critical make ready work.
[1:05:50] Things like moving the entrance to the hospital, as you saw where the new building is going
[1:05:54] have to move the entrance hospitals, we have these various lines of operations, amongst the
[1:06:00] three groups, the three buckets that came out of the OWG, as you recall, it was the tower
[1:06:05] and the revisions associated with tower, general revisions of space on the campus and
[1:06:10] then infrastructure repairs. Those are identified in a particular lines of operation that are
[1:06:16] governed at a leadership team level, a working team level, these meet regularly to cover
[1:06:22] these identify scope, develop A3s for getting decisions, work through those pieces, and then
[1:06:32] we're working closely with clinical staff.
[1:06:34] So there's both the structural energy that's getting this on schedule and recruiting
[1:06:41] the priority.
[1:06:42] But there's also the emotional energy as when some are facing.
[1:06:46] Can I pause you there?
[1:06:47] Sure.
[1:06:47] I really just want to know the formal structure.
[1:06:49] The organization, the owners working group, that's the formal structure where the urgency
[1:06:53] comes from?
[1:06:55] Yes.
[1:06:57] I'll send you a chart on how we're structured after this council member, I don't have one to show
[1:07:02] you on this, but I can show you how that works.
[1:07:05] I appreciate that.
[1:07:06] And then just to hand over the microphones, I know others have questions and comments.
[1:07:11] This project is on fire, and it has been for a long time, and we need to elevate and make
[1:07:17] it transparent so that we can address the problems collectively and move it forward.
[1:07:21] It's just we owe it to the voters and to the people who need these services to move it faster, to move it better.
[1:07:29] And I've said in too many rooms for too many hours to feel like we've really got this and I want to feel like we got this.
[1:07:37] So maybe we can go back to regular reporting, we used to ask for a regular report in writing, just to keep eyes here on what's happening.
[1:07:44] that might be a thing, we should revisit, but I'm very, very interested to re-engage as a council
[1:07:52] with this project to make sure that it's moving as it should.
[1:07:55] Thank you, Tony.
[1:07:56] I know you're doing everything you can.
[1:07:58] It's very challenging.
[1:07:59] It's very challenging to watch.
[1:08:02] There's, I do the only thing I would like to say is we are providing a monthly report council
[1:08:07] on this.
[1:08:07] It is voluminous.
[1:08:10] And perhaps we need to have something that's more digestible that we can come in.
[1:08:15] Thank you, Richard.
[1:08:16] Thank you, Tony.
[1:08:17] Yes, we have seen those reports, but I think I agree with the vice chair that we need to
[1:08:22] kind of dig in more into some of the information.
[1:08:24] And that is why we're going to have another follow-up expected in May to come.
[1:08:28] Councillor Mirdonbowski online.
[1:08:30] Thank you very much, Mr. Chair, and I have joined in the concerns expressed by Chair
[1:08:35] Well, douchey, it's a very high level numbers.
[1:08:39] There we have about a $1.74 billion bond.
[1:08:42] We purchased a building from the Pioneer Square clinic.
[1:08:46] We're doing investments at the campus.
[1:08:47] We bought property for parking garage of the capacity that's left.
[1:08:53] Can you give me that number?
[1:08:54] And then, can you tell me what the design
[1:08:57] build firm thinks it's going to cost to build a tower
[1:08:59] and what our owner's rep side thinks it's going to cost?
[1:09:03] How much is left?
[1:09:03] and what's the disparity between the two estimates to build the tower? Brown numbers.
[1:09:10] So I think about 1.6 is left, 1.64 or something like that.
[1:09:21] The design builder wants to build
[1:09:25] a bigger tower than when we have scope for that's why we've been negotiating with it.
[1:09:28] So I could tell you their number, but the number,
[1:09:31] council member wouldn't, wouldn't mean much
[1:09:33] because it's more than we want them to build.
[1:09:37] So we, the part of the challenges with target value
[1:09:39] is they've come in with some,
[1:09:42] they think that certain spaces need to be a certain size.
[1:09:45] We have different fiscal limitations
[1:09:48] and such in the work with that.
[1:09:50] But if we build the tower that design builder
[1:09:54] wanted us to build, then it's, we need about, you know, $2.6 billion dollars. That's about
[1:10:02] a billion dollars sure of what we have. We're not obviously going to do that. I can't
[1:10:07] answer your question until I finish this target value and then I can say, okay, this is what
[1:10:12] we're going to build. And this is, and we are agreeing that this is the limitations, but we know
[1:10:17] what money we have.
[1:10:20] I think we're going to get very close to the OWD scope.
[1:10:24] I'm concerned about whether we can get to that full scope.
[1:10:29] But if I was going to pick a difference in price,
[1:10:33] I think we're probably about 200 million short.
[1:10:37] $2,200 million?
[1:10:39] Yes, sir.
[1:10:41] But if this is a very preliminary, of course,
[1:10:43] But before you give a notice to proceed on the project to really get going,
[1:10:49] does that count or require, what kind of counsel and involvement?
[1:10:51] Because here's my concern.
[1:10:53] I just remember what happened on the youth jail,
[1:10:57] where we ended up with one contractor, similar type of structure.
[1:11:01] And you talked about off-ramps, but they end row and he don't exist.
[1:11:05] Because once you've got, once you're into it, you can't really stop.
[1:11:09] And I see what, I see a path ahead where Council is, we come back to us, say we need more money.
[1:11:17] And we're required to take our race taxes to do it.
[1:11:21] So, I'm interested, we don't have to answer it here, but I think we ought to talk about the governance issue.
[1:11:28] And we did a little bit in the budget when we set up this office, but there's probably more work to do.
[1:11:32] Really quickly, one of the things that the auditor identified as a risk was the operating process over at the city of Seattle for the major institutions plan update.
[1:11:44] We put a few hundred thousand dollars of money in the budget for you to hire a lobbyist specifically with city of Seattle skills.
[1:11:50] My understanding is that maybe this is wrong, but there hasn't been movement to go out and get that group or persons.
[1:11:56] I would encourage you given the auditors finding here, and that that's a risk and the delay that you've talked about over there.
[1:12:05] To engage some professional help to move that process along.
[1:12:08] We put it in the budget, and I hope you'll take advantage of it.
[1:12:12] Thank you very much.
[1:12:14] It counts a number.
[1:12:15] I would say that in terms of the off ramp, we're using a different delivery model.
[1:12:21] Then we use with the use shell.
[1:12:22] That was a traditional design build we're using, a progressive design build, and their needs
[1:12:30] to come to a point where we get a guaranteed maximum price that we agree with various
[1:12:36] parameters.
[1:12:38] That gate will be before we win, and notice proceed.
[1:12:42] We will probably have some enabeling projects that will occur in advance of that, but just
[1:12:47] to be clear.
[1:12:49] That's that off ramp, all those expensive off ramp to take, given design investment.
[1:12:56] We, in a progressive design, build all of the design documents when we get to that face.
[1:13:02] So we can, it's not completely sung, but yes, it's not an off ramp you want to take,
[1:13:08] but it's a stronger off ramp than we had at the CCFJC.
[1:13:12] Okay, thank you so much.
[1:13:14] Thank you.
[1:13:15] Councilor Biscuit.
[1:13:16] Thank you very much. First, I want to say because I miss the chance to say it to the previous panel, but it's on topic, Mr. Chair. Thanks to the team at Harperview as well for your support.
[1:13:26] In Olympia this year, lobbying for the Representative Bergville, which allows for us to have additional support for public health services overall. I know that the more that we can add to public health system. The fewer people end up going to Harborview for meeting their needs. I just want to say thank you for that. It was a really rough session.
[1:13:40] I also want to say thanks for your presentation here today at the table.
[1:13:47] One piece I want to lift up is that the report and your presentation have emphasized what
[1:13:52] we are dealing with is a delay in spending the dollars.
[1:13:56] What we are not dealing with is any sort of fraud or mismanagement and given the coverage
[1:14:00] that King County has experienced in recent months.
[1:14:04] I just want to make sure to lift that up.
[1:14:05] You mentioned it, the report mentioned it and it's important thing for a voter sender
[1:14:09] And while we're not talking about financial mismanagement or fraud happening at our
[1:14:14] video, what we're trying to solve for here is that we are nearly half a decade in from
[1:14:18] the passage of the levy and we really have not seen tangible progress on some really critical
[1:14:23] infrastructure that we know the community, the providers and you all at the county are desperate
[1:14:29] to see an action.
[1:14:31] So I'm optimistic, right?
[1:14:32] I can only be optimistic that you're continuing to make progress, but we have to get on the
[1:14:36] page on how we're going to remedy this issue. It's critical that we have the ability to show
[1:14:42] voters that what they pass is being put into action. I urge you to just say that we're not
[1:14:47] going to be able to get to full scope and you mentioned an initial dollar figure that you think
[1:14:51] we're short of. In other words, what are we going to do? How is what's the process along the lines
[1:14:59] of what comes.
[1:15:00] Members, the Valsky noted, what is the process for making sure that we are all on the same page
[1:15:06] about what this may be scope reduction means? And if we are not going to see certain projects
[1:15:15] completed, does that mean that second-tier projects from the OWG process are even more unlikely
[1:15:21] did it get completed?
[1:15:25] In answering the, there are several, the Council's established, the County Hospital
[1:15:31] Levy, which a component of that was to go for elements of the bond.
[1:15:35] When I talk about the shortfall, I'm talking about a shortfall of the existing bond
[1:15:41] measure, not using any of these additional sources which were designed to, I believe,
[1:15:52] to help
[1:15:52] full scope, but I just declare a fine council member. I don't think I can get to that full scope for
[1:16:01] that original number. It's, but I think we can get close and I think the other funding sources
[1:16:06] that are available to us might be entertained, but I would want to work with our budget director
[1:16:16] I'm a bit over the ski, my skis, and I'm talking about how we would pay for it.
[1:16:23] Thank you, Tony, and Councillor Roscai. Just on that point, I just want to add this because I think this is highlighting kind of one of the issues that I'm concerned about is.
[1:16:33] We're seeing increased costs.
[1:16:37] We know already that with the bond project, the original bond, we can't do what voters voted for in 2020, right?
[1:16:46] That was the OWG process, 2023, where we scaled down this body, scaled down the scope.
[1:16:54] Now we're in a situation where even that scale scope may not be accomplished with what
[1:16:59] the voters provided.
[1:17:01] So I think we have supported in the last two years some additional support from the County
[1:17:07] Hospital tax towards this project, they overall scope, but there are other demands on those
[1:17:15] resources, and of course, we heard from you the medicine of the swine.
[1:17:18] I thought putting this panel together with these issues is to highlight that there are
[1:17:21] very serious strains because of the changes in federal policy,
[1:17:28] that the operating part
[1:17:30] of Harborview is dealing with, and yet we have these shortfalls in the bond project.
[1:17:39] And we're trying, you know, we're trying to navigate, obviously we're kind of in a two-year
[1:17:43] budget right now where we made some decisions, but as we consider kind of where the county
[1:17:47] hospital tax is going to be used, we need to understand what the costs are going to be.
[1:17:52] How far are we going to get and what additional resources we're going to need?
[1:17:56] And so that's the question that I hope in our main meeting that we actually get a little bit
[1:18:00] that you'll have more estimates to what Councilmember DeBouski was asking, some more specifics.
[1:18:06] I realize that people who have been through the OWG process might hear hate us saying this,
[1:18:11] but we may have to have a revised version of that
[1:18:14] to figure out what we can do at this point.
[1:18:18] And I'm just throwing that out there
[1:18:20] just because I'm seeing where we're headed.
[1:18:22] The question I have for you Tony is,
[1:18:24] and this may be something we may need to fall off line two
[1:18:27] is one of the things that the otters I'll let her point it out
[1:18:31] is this issue of the program management plan.
[1:18:33] And I have to say that I don't really understand
[1:18:35] what that entails.
[1:18:37] You mentioned it that it's in work and progress.
[1:18:39] I mean, somebody asked me, you know, it's been over five years since the voters voted
[1:18:47] for this, how do we not five years into this, have a plan?
[1:18:53] What would be your, what kind of tell constituent who would ask me that question?
[1:18:58] The first thing I was saying is, we do have a plan, and even on events like this, so that
[1:19:02] it's not finalized.
[1:19:03] And it's also a living document, so it evolves as we bring different players on and different
[1:19:10] other pieces.
[1:19:11] It has some components in terms of some project delivery, escalation elements, stuff for
[1:19:21] lower-level projects that is not complete and I'm not happy with.
[1:19:27] I'm hopeful that our new contractor can be more responsive.
[1:19:31] But we have a plan, it's just not finalized as such, it's missing some components that I agree with the auditors should be there.
[1:19:44] Some of those components, though, in my opinion, are not affecting our progress.
[1:19:50] Some of those components, there's a escalation and decision making pieces which were affecting our progress.
[1:19:56] We think we have a good governance structure with that with various tensions, but that's what
[1:20:01] I would say.
[1:20:03] I mean, I've never actually seen a program management plan and kind of you get it to a
[1:20:10] point.
[1:20:11] Say, this looks good.
[1:20:12] We're walking with it, and then it continues to evolve.
[1:20:15] Great.
[1:20:15] I'm going to let Councilman Fein have the last word here.
[1:20:18] We wrap up.
[1:20:19] Thank you.
[1:20:19] And I don't need an answer today, but I would ask that the next time we have this discussion,
[1:20:23] And we look at the OWG report, which summarizes our nine months putting this work together,
[1:20:33] talking about the recommendation for a new tower, seven, seven built out, three-sheld,
[1:20:39] floors, and other components, certainly, and the county expansion pieces that were there.
[1:20:50] So those were what we recommended.
[1:20:51] I think there are opportunities and I'd be interested to hear more about this with the crisis
[1:20:58] care center moving in, you know, relatively close by, what we can do to address some
[1:21:06] of the recommended changes to our expanded behavioral health services at Harborview with the
[1:21:12] PEDs unit and the crisis stabilization.
[1:21:14] How does that factor in with the crisis care center moving in nearby?
[1:21:19] But I would like to see a breakdown of where the increased costs are and what it is that the design
[1:21:28] build contractors trying to do more of or less of and how those all pencil out because I think
[1:21:35] conceptually 200 million doesn't make sense for me in terms of how does that plug in?
[1:21:42] What have we changed? What are we not addressing?
[1:21:45] compared to what we have the council outlined from the OWG group and in the ordinance.
[1:21:54] So I would like to see that at the next presentation and I would welcome further discussion
[1:22:01] on how we can become more engaged again and ensure that we are doing our due diligence
[1:22:07] to make sure that the bond dollars are going to the projects that have been outlined through
[1:22:12] the OWG group.
[1:22:15] Thank you, Councillor Morbiffane. Well, colleagues, I really appreciate an engagement. I think it sort of reinforces my sense that this is a topic that we do want to spend more time on this year.
[1:22:27] So we are planning on having this topic back on our agenda in May when we expect that we will have some updated cost estimates that will help us have a further conversation.
[1:22:36] And I think, Tony, you heard some of the questions that we want more detail on.
[1:22:41] So I look forward to that discussion.
[1:22:43] I also want to acknowledge that we're going to have our labor partners also join that
[1:22:46] conversation, because we were able to include them in this conversation, but I also want
[1:22:49] to hear from them then.
[1:22:51] And then we will have that back on our agenda again.
[1:22:56] Thank you to everybody who participate in today's meeting.
[1:22:59] If there's no further business to come before the committee, we're adjourned, and we look forward
[1:23:02] to seeing many of you at the Women's History Panel event.