$498m OK'd for MGH project

As dawn broke yesterday, Dr. Alasdair Conn, the emergency room chief at Massachusetts General Hospital, turned on his computer and received his daily dose of bad news: 17 patients languished in the ER, with no beds available upstairs in the hospital.

"If you ask me what keeps me awake at night, it's the fact that we have overcrowding in our emergency department," Conn said. "Frankly, it gets very cramped. But emergency department overcrowding is not an emergency problem; it's a hospital overcrowding problem."

Conn shared his story with the state's Public Health Council, which then unanimously approved a $498 million expansion at Mass. General, the costliest hospital project in the history of the state, according to the Department of Public Health .

A 10-story building will rise next to the hospital's entrance on Fruit Street, boosting the number of beds from 902 to 1,052, while the roster of operating rooms will grow from 52 to 71.

Expected to open in October 2011, the building reflects the ambitions of Mass. General and responds to the shrinking of the hospital industry in Massachusetts over the last two decades. As recently as 1985, the state had 113 full-service hospitals. Now, there are 76.

Hospitals closed as managed-care companies restricted patient stays in the 1980s. Beginning around the same time, advances in technology allowed more medical procedures to be performed in doctor's offices or outpatient surgical suites.

But now, baby boomers are aging and emergency rooms are overflowing.

A state-mandated review by the Department of Public Health concluded that the Mass. General expansion was warranted, in no small part because of the chronic ER crowding there and at Boston's other big teaching hospitals.

On average, emergency patients at Mass. General wait seven to eight hours to be transferred from the ER to a hospital bed. Ambulance drivers are regularly told to take patients elsewhere.

"It clearly has been a longstanding issue at the General and has been a huge access issue for the community," said Dr. Alan Woodward, a member of the Public Health Council and emergency chief at Emerson Hospital. "We all know it compromises care in a serious way. How do we pull out all the stops to fix this as quickly as possible?"

The Mass. General expansion will increase the number of treatment bays in the emergency room from 44 to as many as 65, Conn said. But what's more pivotal, he said, is the addition of patient rooms: There will be 128 new beds on medical-surgical wards and 22 new intensive care suites.

Building the new tower, which administrators pledged will hew to rigorous environmental standards, will require intricate construction choreography, with the demolition of three older structures on the congested Mass. General campus.

"One can't help but think this is going to be a bit of a nightmare when you are building this," said Dr. Muriel Gillick, a Public Health Council member who is a physician with Harvard Vanguard Medical Associates.

As part of its deal with the state to win approval for the expansion, Mass. General had to promise to give something back to the community: $18.6 million to help seniors in Beacon Hill, to pay for mental health services for the homeless in Boston, and to combat substance abuse in Revere, Charlestown, and Winthrop, among other programs.

That quid pro quo is required under state regulations. Although there is no precise formula, hospitals historically have pledged they will invest the equivalent of 3.5 percent to 5 percent of the cost of a project to community initiatives.

Stephen Smith can be reached at stsmith@globe.com.