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Maine Medical Center is proposing a $512 million expansion that would increase the footprint of the hospital’s main campus in Portland by about 25 percent.

The expansion, which would dwarf Maine Med’s previous projects, calls for adding 20 operating rooms but would not change the total number of beds. Instead, many more of the hospital’s 637 beds would be in private, single-patient rooms. All 128 of the new patient rooms would be single-patient spaces.

The reduction in double-occupancy rooms follows a national trend aimed at increasing the comfort of patients facing serious surgeries or illnesses.

Assuming all of the permits and approvals are obtained, Maine Med expects the project – which would add 300,000 square feet to the main campus – to be completed in 2022.

The cornerstone of the expansion would be a 270,000-square-foot, glass-paneled building facing Congress Street for housing the new operating and patient rooms, and featuring a new main entrance. It would replace the main entrance off Bramhall Street that is accessed by winding through a West End neighborhood.

“It will look nice, very dramatic,” said Richard Petersen, president and CEO of Maine Med.

A room in the maternity ward is one of Maine Medical Center's newer larger rooms.

A room in the maternity ward is one of Maine Medical Center’s newer larger rooms. Shawn Patrick Ouellette/Staff Photographer Shawn Patrick Ouellette/Staff Photographer

The project would be funded by a combination of reserves, financing and fundraising. The hospital system needs to obtain approval from the state and local governments, including a Certificate of Need from the state.

A major driving force behind the expansion is the desire by hospital executives to move toward single-patient rooms, to enhance patient comfort and privacy and to help reduce bottlenecks throughout the system. In a 2016 survey of hospitals undergoing renovations by Health Facilities Management magazine, 66 percent of respondents said they will be converting semi-private rooms to private rooms.

Maine Med currently has 303 double-occupancy rooms. Hospital officials don’t know yet exactly how many of those would be eliminated when the new single rooms are completed.

“It’s not the standard of care anymore,” said Petersen, referring to double-occupancy rooms. “Our ultimate goal is to have all private rooms for all patients.”

PRIVACY FOR PATIENTS, FAMILIES

The expansion also would add two floors with 30,000 square feet and 64 extra in-patient beds to the East Tower, which was built in 2009. To make room for the 270,000-square-foot building on Congress Street, Maine Med plans to raze the existing employee parking garage built in 1972, construct a 1,176-space parking garage at the intersection of Congress and Gilman streets, and add three floors of parking to the existing visitor parking garage on Congress Street. Also, Maine Med would build outpatient offices off-site at an undetermined location.

The helipad would move from the top of the employee parking garage to the East Tower once the project is completed.

Dr. Joel Botler, senior vice president of medical affairs at Maine Med, said patients who have undergone major surgeries, such as for cancer treatment, currently are crammed into small double rooms with little privacy and space for visiting family members.

Staff at Maine Medical Center attend a morning meeting to discuss the number of beds versus the number patients coming in. The hospital plans an expansion that will add 64 inpatient beds.

Staff members at Maine Medical Center attend a morning meeting to discuss the number of beds versus the number patients coming in. The hospital plans an expansion that will add 64 inpatient beds. Shawn Patrick Ouellette/Staff Photographer Shawn Patrick Ouellette/Staff Photographer

“These are sometimes very difficult, sensitive conversations with patients and their families, and to share a room with a stranger it becomes very uncomfortable,” Botler said.

In addition to patient comfort, the expansion will make the hospital run more smoothly, officials said. That’s because in-patients at Maine Med, on average, have more severe illnesses than even five to 10 years ago, Botler said, and more of them require single rooms for their care.

While Maine Med will not add beds, having more single-occupancy rooms will alleviate bottlenecks plaguing the system, officials said.

Some patients at Maine Med – because of the severity of their illness or because they have an infectious disease – must be in single rooms. On some days, 50 or more double-occupancy rooms are converted to single rooms, reducing the actual capacity of the hospital.

The expansion would allow for more efficient use of existing space and reduce the bottlenecks that result in some patients waiting several hours for a room. The new operating rooms would be more spacious and a better fit for high-tech medical equipment.

Petersen said the new building will be designed and constructed to allow for future expansions and additional floors if necessary.

“This won’t be the end of construction at Maine Medical Center,” Petersen said.

Half of the expansion would be paid for with existing reserves and fundraising, and the other half through borrowing. Petersen said the cost of borrowing would represent a roughly 1 percent rise in current health care expenses at the hospital, although he said it was difficult to say exactly what the expansion’s impact on health care costs would be.

The proposed new entrances to Maine Medical Center.

The proposed new entrances to Maine Medical Center.

HOSPITAL’S BIGGEST EXPANSION

The latest renovation is the biggest expansion project in Maine Med’s history, hospital officials said.

The hospital opened in 1874 and has expanded throughout its history, including a series of upgrades in recent years.

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In 2015, Maine Med completed a $40 million expansion by adding five operating rooms in a 40,000-square-foot, two-story addition. That followed a $176 million expansion in 2009 that included the 185,000-square-foot East Tower, where the maternity ward is located, and other renovations.

Mercy Hospital, which is owned by Brewer-based Eastern Maine Healthcare Systems, also has recently upgraded its facilities, completing a $162 million expansion at its 42-acre Fore River campus in 2008 that included a five-story, 150,000-square-foot hospital. In 2014, Mercy announced an $80 million to $100 million expansion project at the Fore River complex that would add about 250,000 square feet of hospital space and nearly 170,000 square feet of new offices by 2019.

Even though Maine’s population is stagnant at 1.3 million, officials say more patients are being referred to Maine Med for a myriad of reasons, including an aging population that needs more health services, and increasing specialization of treatments that are now more likely to be done at Maine Med and not at outlying hospitals. Also, the average patient staying overnight at the hospital has more severe illnesses than years ago, since many conditions that used to require overnight stays now receive outpatient treatment.

Maine Med had 36,296 admissions in fiscal year 2009-10, climbing to 40,193 in 2015-16.

During a recent morning “huddle” meeting in the Maine Med cafeteria, dozens of employees representing various parts of the hospital grappled with the logistics behind capacity versus demand. The screen showing incoming and outgoing patients resembled an airport monitor.

On that day, the hospital was operating at 90 percent capacity, which would be good for a hotel, but is running too close to capacity for a hospital, officials said.

Some patients need specialized rooms or can’t be in double-occupancy rooms, which can cause lengthy wait times for some patients. A frequent bottleneck occurs after emergency room treatment, when some patients – “boarders” in hospital lingo – can end up waiting 12 or more hours in the emergency department for a room.

LONGER PATIENT WAITS FOR A BED

Sheila Parker, vice president of patient care services, took the microphone during the morning huddle to direct traffic and hear from others how demand versus supply would shape up for the day. Managers used color codes to indicate how close their hospital wing was to capacity, with green indicating plenty of room, to yellow, orange and code red, meaning zero or little capacity to accept new patients.

Parker said the capacity problem has become more acute in the past two to three years.

Cara Small, an RN at Maine Medical Center, prepares to administer morning medication to a patient.

Cara Small, a nurse at Maine Medical Center, prepares to administer morning medication to a patient. Shawn Patrick Ouellette/Staff Photographer Shawn Patrick Ouellette/Staff Photographer

“Patients are waiting longer and longer for beds to open up,” she said.

During a subsequent tour of the hospital, the contrast between the new hospital wings and older sections was stark: In the new operating wing, families waited in areas bathed in natural light, and patients had privacy both before and after surgery.

In the older surgery center, a narrow hallway was crammed with equipment and hospital personnel by the semi-private rooms. The waiting area was crowded and felt shoehorned into a space in the hospital’s lower level.

Rhonda DiPhilippo, nurse director for medical surgical rooms, where patients recover after surgeries, said the double rooms are not as comfortable for the patients and their families. It also makes it more difficult to prevent infections when patients are sharing rooms after surgery.

“It’s very personal and private to be sick, and we are asking them to share those experiences with strangers,” DiPhilippo said.

In the maternity ward in the newer East Tower, women and their families enjoy spacious rooms with couches and a whirlpool.

DEMAND FOR SERVICES TO GROW

Botler, the senior vice president of medical affairs, said that although the comfort of maternity patients is important, many of the sickest patients are still crowded into semi-private rooms.

He said he doesn’t see demand for patient services at Maine Med abating. In fact, it is expected to increase in future years as more specialized treatments are done at Maine Med and not at hospitals in Bangor, Lewiston, Augusta or rural parts of the state.

Botler said one example is stroke treatments, which used to be done at other hospitals but are now often conducted at Maine Med because the Portland doctors use new clot-busting surgical tools that are only available at Maine Med. He said those surgeries likely will continue to be funneled to Maine Med.