Eliza Coffee Memorial Hospital was built for the future 68 years ago, but hospital officials say the future now has no room at the aging facility.

In the Certificate of Need documents filed in December to build a replacement facility for ECM, officials listed a multitude of reasons why the facility cannot continue to provide the patient-centered care needed to excel in a competitive health care market. At the top of that list is the outdated and functionally inefficient building.

When RegionalCare purchased ECM, ECM East and Shoals Hospital in July 2010 from Coffee Health Group, the contract stipulated a 300-bed replacement facility for ECM would be built.

ECM was constructed at its current site in 1943-44 and has seen only two major additions in the past 30 years — the tower housing administration, along with the intensive care and critical care units, was completed in 1981, and three floors were added to the west side of the main structure in 1989.

ECM and its peripheral facilities, such as the behavioral health area, is 406,000 square feet. The new facility will be 555,000 square feet if the CON application is approved.

Tom Whetstone, spokesman for ECM, said the past additions have made the facility a bit of a maze to navigate and the landlocked site makes it impossible to add square footage.

"We are at our maximum in terms of building upward," Whetstone said. "If we were to add to the building, we'd take away from parking, which we already don't have enough of. There are times now that we have to park on the streets and apologize to our neighbors."

The Marengo Street site is surrounded by residential developments.

The space issues are even more evident inside the hospital.

Patient rooms often are cramped and bathrooms in many rooms are not in compliance with the Americans with Disabilities Act, said Beth Ware, director of patient care services.

Ware has worked at ECM for 25 years and has seen much of the evolution of hospital care first hand. She said before she entered nursing, patients used hospitals for routine doctor's checkups, which are now done at outpatient clinics.

"Patients would check into the hospital for those checkups, see the doctors and check out," she said. "You can imagine that type of care didn't require as much space as someone admitted to the hospital now. Today, if you are in the hospital, you are very, very sick."

That means more equipment, machines and people are in and out of patient rooms during a stay, she said.

"We do well with what we have, but the situation is not optimal," Ware said. "When this facility was built, no one could have anticipated the technology boom we have experienced. We now have computers in every room."

In the emergency department, the staff struggles with the lack of space. ECM has 24 emergency department beds. The new facility proposes 45, which will reduce patient wait time, said Kevin Bowling, director of emergency services.

Bowling said when an emergency room patient needs a CT scan, MRI or catheterization procedure, that patient not only has to leave the emergency department, but must change floors for those procedures.

Bowling said in the new proposed facility, those departments will be adjacent to the emergency department, saving valuable time for patients and hospital staff.

Bowling said with the current emergency department entrances, ambulances arrive with patients just to the left of where walk-in patients enter the emergency department. Because of the proximity of those entrances, it is possible for a walk-in patient to view a trauma patient arriving via ambulance, he said.

"It just isn't the best situation for our patients entering the emergency room," he said.

Whetstone said findings by an architecture and engineering firm that inspected the site before the Certificate of Need application was filed noted renovating and repairing the facility would be impossible.

Floor to ceiling heights are not consistent throughout the hospital, which makes it necessary to use ramps to transition from one area to the next. In patient rooms and other areas of the hospital, ceiling heights are too low to incorporate some state-of-the-art technology.

Ware said this is especially true in surgery suites where ceiling heights don't allow for the installation of robotic surgery apparatuses.

The facility isn't being allowed to just deteriorate, however. Between July 1, 2010, and Dec. 31, 2011, since RegionalCare purchased the facility, the firm spent $11 million in capital improvements to the facility. That includes electrical repairs, parking deck repairs and equipment purchases.

"The purchasing that is going on now is with the thought that (the equipment) will move with us into the new facility," Whetstone said.

Hospital officials said it is no longer a wise investment to continue to pour money into repairs.

Ware said adding a pneumatic tube system to efficiently and automatically transport patient lab samples directly to hospital laboratories would cost millions of dollars in the current facility. An even more costly renovation would be to replace the emergency generator system that runs critical equipment in the event of power outages. The generator system cannot produce the power supply needed to operate computer systems in patient rooms during power outages, meaning nurses and physicians must manually record medications and other care given during a power outage.

"When the power comes back up, that information has to be entered into the computer," Ware said. "And having everything digital is one of the ways that we make sure each patient is getting the care prescribed. It is one of our checks."

Even with the space and logistical struggles at ECM, patients are still in good hands, Whetstone said. The hospital meets Life Safety Code standards and is inspected by The Joint Commission, an independent and not-for-profit organization that accredits and certifies more than 19,000 health care organizations and programs in the United States, and the Alabama Department of Public Health.

Whetstone said if a facility receives an outstanding rating from the Joint Commission, which ECM has, inspections are required every three years. In between those inspections, the state Health Department does a validation inspection as a double check to ensure the Joint Commission findings are accurate. In six years, ECM has had two inspections by the Joint Commission and two from the state, Whetston said.

"We do well with what we have," he said. "But we want to do more and just don't have the space."

But while the care given at ECM meets the standards required by state and federal guidelines, the care also needs to meet standards of comfort for the patient, Ware said.

"Everything we want out of a new facility has the patient in mind," she said.
Once construction on the new facility begins, ECM, Downtown Florence Unlimited, city officials, the University of North Alabama, neighborhood residents and others with an interest in the ECM property will form a group to talk about uses and the future of the ECM campus, Whetstone said. But no such group has been formed yet because ECM is at least three years from being replaced, he said.

"Once work on the new hospital starts, we will begin seriously discussing what to do with this facility," Whetstone said. "We know that is an important issue to the people in our neighborhood, and we are going to work to come up with a solution and use that is suitable for everyone and the area."

ECM's problems

Issues related to the aging and deteriorating ECM facility as listed in the Certificate of Need application:

• An outdated and functionally inefficient physical plant.
• A facility that is not designed to efficiently accommodate outpatients.
• Patient rooms that are too small and are dated in appearance.
• Many patient bathrooms are not compliant with the Americans with Disabilities Act and would be difficult and costly to upgrade.
• Aging, and in some instances, obsolete mechanical systems.
• Facility design makes way-finding very difficult.
• Different floor heights between sections of the hospital require transition ramps, which make patient transports, particularly with bariatric patients, difficult.
• Inadequate floor-to-ceiling heights in patient rooms and other areas of the hospital limit practicality of renovation.
• Renovation on-site will be expensive and will not resolve all the deficiencies.
• Multiple leaks in roofing and expansion joints throughout the building.
• Limited installation of pneumatic systems within the hospital, requiring hospital staff to hand-carry clinical lab samples from patient floors to the laboratory.
• Surgical suites and recovery areas are undersized and outdated.
  Inadequate storage throughout the facility.
• Medical records, radiology, radiologist reading area, emergency room and all waiting areas are undersized.
• Number of public and service elevators inadequate and too small to easily accommodate a patient bed, accompanying staff and equipment.
• Existing campus cannot accommodate a complete replacement without closing facility during construction.
• Existing facility cannot easily adapt to address the health care needs of the region.
• While appropriate when the facility was originally constructed in the early to mid 1940s, the existing site is landlocked, adjacent to residential neighborhoods and is not a desirable location for a modern, regional medical center.