1. Chatham-Kent Health Alliance Facility Renewal and Capital Infrastructure Needs Tri Board Meeting October 26, 2010

2. Facility Renewal and Capital Infrastructure Needs October 2010 Chatham-Kent Health Alliance is a partnership of 3 hospital corporations: Public General ( PGH), St. Josephs Hospital ( SJH) and Sydenham District Hospital (SDH). Request to review current state and capital needs for facility upgrades PGH – dates back to 1954 SDH – dates back to 1955 Both facilities have reached a critical point in their life expectancy and are in need of major investment to maintain patient and staff safety.

3. Facility Renewal and Capital Infrastructure Needs October 2010 !magine redevelopment project is 10 plus years away Inadequate resources available over the years to support infrastructure upgrades Sydenham and Public General buildings are outdated and do not meet code in many areas, (i.e. building, medical gas, fire codes, etc.)

4. Facility Renewal and Capital Infrastructure Needs October 2010 Costs are estimates Many upgrades cannot be done in isolation of one another Any changes to current systems will require all code upgrades Significant capital facility upgrades will require Ministry approval Cannot bring certain systems up to code given building structure limitations Does not include capital needs for the SJC or offsite properties, i.e. 47 Emma, MHA, adjacent houses. Multi-year coordinated plan and dedicated annual resources required to proceed with any upgrades

5. Facility Renewal and Capital Infrastructure Needs October 2010 References used: Cohos Evamy Facility Audit Report July 2009 Honeywell Energy and Facility Renewal Report 2009 Emergency Department Hay Study 2009 (LHIN study) Asbestos Audits – Advanced Environmental Corporation 2007 Stantec Facility Audit Report SDC 2005 Applied Building Sciences LTD Facility Audits – 2002 & 2004 PGC and SDC Additional Inspections, i.e. Medical Gas, Fire Marshall, HIROC, Roofing Inspections, etc. External Contractors and CKHA Engineering Staff

6. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus

7. Roofing Cost Estimate $1,000,000 Multi-Year project will be complete 2010-2011 $ not included in total request

8. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Roof Replacement Plan

9. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Windows Cost Estimate $ 1,500,000 Connected to envelope deterioration project Add: Building Envelope Asbestos Abatement

10. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Exterior Window

11. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Interior Window

12. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Building Envelope Cost Estimate $ 1,500,000 + Connected to Window deterioration project Add: Window Replacement Asbestos Abatement

13. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Heat Loss from Building Envelope

15. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Balconies Cost Estimate $330,000 Deterioration to the point of unsafe Do not meet code Currently locked for safety, no access Add: Building Envelope repair if balconies need to be removed

16. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Exterior Balcony

18. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Fire System Upgrade Cost estimate $ 1,000,000 Does not meet code Currently equipped with smoke and heat detectors Must bring up to code when doing any renovation (only 2 sprinklers at present time) Add: Structural changes (Ceiling heights) Asbestos abatement Electrical upgrade

19. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Elevators Upgrade Cost Estimate $ 250,000 Interior Upgrades 2010 – floors, walls, lighting Control Systems need complete upgrade Only one elevator accommodates a stretcher Add: Electrical system upgrade Asbestos abatement

20. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Elevator Mechanical Room

21. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Elevator Control Panels

22. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Ventilation System Upgrade Cost Estimate $5,000,000 - $7,000,000 End of life, does not meet code Current ceiling heights do not allow for proper replacement to meet code Add: Structural Changes (ceiling heights) Electrical upgrade Fire system upgrade Medical gas system upgrade Asbestos abatement

23. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Operating Room Air Handler Manual controlled, No humidification – original unit

24. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus General Air Supply – East Wing Dampers are not working, over 15 years ago 35% of coils were removed do to coils were leaking (frozen), no humidification Never reinstalled

25. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Medical gas system upgrade Cost Estimate $ 500,000 System does not meet code, any changes to the system will require the entire system be brought up to code Add: Structural changes (walls and ceilings) Asbestos abatement

26. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Asbestos Abatement Cost estimate $ 2,000,000 Must be factored in to any and all changes to SDC Add: Structural changes (walls and ceilings)

27. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Sanitary and Storm drain piping Cost Estimate $ 3,000,000 Does not meet code (Asbestos piping) Current piping is all cracked Requires major demolition to access prior to any potential repair Add: Structural changes (walls and ceilings) Asbestos abatement

28. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Plumbing Stack – Deteriorated Sewer Piping

29. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Deteriorated/ Cracked Piping all located in brick pipe chase

30. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Discovery of Sewer Piping Installation, after leak investigation

31. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Waterlines Cost Estimate $ 2,000,000 Does not meet code (galvanized piping) Current piping is corroding Risers are located in brick pipe chases Add: Structural changes (walls and ceilings) Asbestos abatement

32. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Hot Water Supply Line Corrosion

34. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Discovered During Recent Repair - Laundry

35. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Boilers - Replacement Cost Estimate $ 200,000 End of life RFP issues September 2010 for replacement of one boiler Add: Electrical upgrade Asbestos abatement

36. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Steam and Hot Water Boilers

37. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Deteriorated Boiler Tubing

38. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Chiller Replacement Cost Estimate $ 275,000 End of life Supplies only the OR Add: Electrical upgrade Asbestos abatement

39. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Operating Room Chiller

40. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Heating system upgrade (Radiant heating) Cost Estimate $ 210,000 End of life Add: Structural changes (walls and ceilings) Asbestos abatement There is an in-floor heating system on the first floor in part of the emergency, ambulatory care department and both side of the hallway in the West wing. Source of leak cannot be located as system is buried in concrete. This system is shut down and not in use.

41. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Electrical system upgrade Cost Estimate $ 1,000,000 System is obsolete Does not meet code Switched are no longer manufactured Add: Structural changes (ceilings and walls) Asbestos abatement

42. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Old Electrical Panels

43. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus OR Upgrades Cost Estimate $ 1,000,000 Does not meet current code and standards Consideration should be given to closing this section if continues to function as regular OR Add: Electrical upgrade Medical air systems upgrade Ventilation system upgrade Structural changes (walls and ceiling) Asbestos abatement

44. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Installation of negative pressure rooms Cost Estimate $ 500,000 Currently no negative pressure room Safety risk for airborne illness Current patients transferred to Chatham Add: Electrical system upgrade Medical air system upgrade Plumbing system upgrade Ventilation system upgrade Structural changes (walls and ceiling) Asbestos abatement

45. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Removal of Sewer tank Cost Estimate $ 40,000 – $ 50,000 Current Emergency Department partly build on a sewer holding tank 2010-2011 Capital plan – drain and connect to municipal line

46. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Structural/Building reinforcements upgrade Cost Estimate $ 2,000,000 Any changes in use or modification to the floor layout of the 1967 structure will require reinforcement of the structural system below the affected area. (Cohos pg. B-3)

47. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Renovation to patient rooms Cost Estimate $ 4,000,000 Current rooms do not meet code Washrooms are small and inaccessible Do not meet Infection Control standards – sinks are located outside of washroom Add: Plumbing upgrade Electrical system upgrade Ventilation system upgrade Medical air system upgrade Structural changes (walls and ceiling) Asbestos abatement

48. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Patient Washroom & Outside Sink

49. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus ED Renovations Cost Estimate $ 500,000 Emergency Department LHIN Hay study - physical plant is inadequate by current standards

50. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus Accessibility Accessibility for Ontarians with Disabilities Act, 2005 (AODA) Unable to determine cost at this point Add: Structural changes (walls and ceilings)

51. Facility Renewal and Capital Infrastructural Needs October 2010 – Sydenham Campus We require an investment of approximately $27,000,000- $30,000,000 to maintain this facility in an acceptable state Costs are construction related costs only. Relocation, moves, temporary set ups etc. needs to be factored into to overall project Additional Engineering study required if direction is to proceed with only sections of the building upgraded as systems are interconnected Recommendation – dedicated resources to maintain facility while proceeding to fast track cost of a new facility

52. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus

53. Roofing Cost Estimate $ 500,000 Multi year roofing plan in place HIRF investment planned for 2010

54. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Ventilation system upgrade Cost Estimate $ 4,000,000 End of life Does not meet code Current ceiling heights do not allow for proper replacement to meet code Add: Asbestos abatement Electrical system upgrade Structural changes (walls and ceiling)

55. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Obsolete Air Handling Unit PG.A43 Induction unit, Perimeter heating and cooling Dampers not working (manual controlled)

56. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Obsolete Air Handling Unit PG.A45 Part of Maternity SE/SW

57. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Fire system and wiring upgrade Cost Estimate $ 295,000 Some PGC is already done from previous renovations Other does not meet code, must bring system up to code when doing any renovations Add: Structural changes (ceiling heights) Asbestos abatement

58. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Building Envelope Cost Estimate $ 1,500,000 Moisture penetration from outside walls Repairs were done on South and South East walls Add: Asbestos Abatement

59. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Exterior Pillar

60. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Exterior Concrete Wall

61. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Medical gas systems upgrade Cost Estimate $ 500,000 Some upgrades were done with previous renovations Does not meet code Any changes to the system will require the entire system be brought up to code Add: Structural changes (walls and ceilings) Asbestos abatement required system shutdown for changes

62. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Elevator upgrades Cost Estimate $ 1,000,000 2 Elevators on the West wing 3 Elevators in the Centre 1 Elevator in centre is completely shutdown Add: Electrical system upgrade

63. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Center Elevator Mechanical Room

64. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus West Elevator Mechanical Room

65. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Asbestos Abatement Cost Estimate $ 2,000,000 Must be factored in to any and all changes to PGC Some areas amount and content is undetermined due to triple ceilings

66. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus West Mechanical Room – Interior Asbestos Walls

67. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Structural/Building reinforcement upgrades Cost Estimate $ 2,000,000 Any building expansion or changes, the existing foundations will need to be under pinned and enlarged to accommodate the additional loads

68. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Electrical system upgrade Cost Estimate $150,000 Replacements of obsolete panels Some areas were upgraded under previous renovations

69. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Electrical Panels

71. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Sanitary and storm sewer piping Cost Estimate $ 3,000,000 Current underground piping is deteriorated All underground piping repair need extensive construction to access (few have been done) Add: Asbestos abatement Structural changes (walls and ceilings)

72. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Starting of Corrosion – Sewer Piping PGC

73. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Sinks and toilet fixtures Cost Estimate $ 125,000 Infection controls issue as identified (overflow drains do not meet code)

74. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Heating system upgrade (radiant heat) Cost Estimate $ 250,000 End of life Add: Asbestos abatement

75. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Obsolete Terminal Induction Units - Patient Rooms – Original System 1969

76. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Installation of additional Negative pressure room Cost Estimate $ 100,000 Infection control and safety risk for patient and staff Add: Structural changes (walls and ceiling) Electrical upgrade Medical air system upgrade sprinkler system upgrade Ventilation system upgrade Asbestos abatement

77. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Medicine A/B, Patient room and washrooms accessibility Cost Estimate $ 300,000 Small, limited accessibility, patient and staff safety Changes needed to get patient beds into rooms Identified as safety issue at Executive Leadership Council Safety inspection

78. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Accessibility Accessibility for Ontarians with Disabilities Act, 2005 (AODA) Unable to determine cost at this point Current building does not meet code under Accessibility legislation

79. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus We require an investment of approximately $16,000,000 to maintain this facility in an acceptable state Costs are construction related costs only. Relocation, moves, temporary set ups etc. needs to be factored into to overall project Additional Engineering study required if direction is to proceed with only sections of the building upgraded as systems are interconnected

80. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Recommendation: Dedicated capital resources needed annually for next 5-10 years to maintain building to acceptable levels Continue to proceed with Master Program/ Master Planning costing out complete renewal replacement

81. Facility Renewal and Capital Infrastructure Needs October 2010 – Public General Campus Next Steps Priority list – safety issues and required capital Site visit with Engineers from Cohos Evamy October 28, 2010. Additional assessment and recommendations of capital projects as it relates to future development Clear vision of Sydenham site Contingency plans Dedicated capital

82. Facility Renewal and Capital Infrastructure Needs October 2010 – Sydenham Campus and Public General Campus This report was prepared by: Beth Hall Director, Support Services Harrie Bos Manager, Engineering Services