Patients rushed to Harborview Medical Center by helicopter need to take ambulance rides around the block to reach the renowned Seattle trauma center, and once they’re admitted, they have to share crowded spaces.

That’s because Harborview’s helipad isn’t connected directly to its emergency department. And because the hospital has scant single-bed rooms.

King County could solve those and other problems, Harborview leaders contend, by constructing a new tower and undertaking other capital projects on the hospital’s First Hill campus, which the county owns. But the upgrades wouldn’t be cheap.

A group of hospital stakeholders is likely to vote Wednesday to recommend that County Executive Dow Constantine and the County Council place a $1.7 billion bond measure on the November ballot to revamp Harborview. The group, created by the council in 2018, signaled its unanimous support last week.

The executive and council don’t have to do what the Harborview Capital Planning Leadership Group recommends. The group includes Constantine staffers and two council members, however.

Voters have previously approved bond measures for the hospital, most recently in 2000. That 20-year, $200 million measure is about to expire.


“We’re going to be putting together the best plan that we can that meets our generational obligation,” Constantine said in an interview at Harborview, which is managed under contract by the University of Washington. “Everybody knows that the services provided here are important.”

Presidential-election ballots are sought after for tax increases because they draw more voters, so there are other ideas under discussion this year besides the Harborview project. Seattle may try to replace bus-service taxes that are set to expire, and various players are talking about putting a big-business tax on the ballot. The climate crisis could also grab attention.

But placing multiple taxes on one ballot can be risky, and Constantine says Harborview matters most. State law requires that bond measures win 60% approval, with turnout equal to or greater than 40% of the votes cast in the previous election. SEIU Healthcare 1199 Northwest, a large union that represents many Harborview employees, is backing the plan.

“I will do my best to make sure we do not have multiple tax measures on this ballot,” Constantine said. “I have only some of the authority around that … But this is important enough that I believe other people will think twice.”

Constantine’s administration estimates that a 30-year, $1.7 billion bond measure would cost property owners up to 15 cents per $1,000 of assessed value in the first year. The owner of a home with an assessed value of $580,000 would pay up to $90.

A 20-year version would cost up to 18 cents per $1,000, or up to $105 per year for the same homeowner. That homeowner is paying about $18 this year for the current Harborview bond measure.


The hospital’s leaders say the dollars are needed to revamp what has become an outdated campus.

Harborview is the only Level 1 trauma center for Washington, Idaho, Montana and Alaska. The hospital has 413 beds, but only 40 are in single-bed rooms, and 20 of those are reserved for psychiatric patients.

Most rooms contain two or more beds, separated by curtains. Patients are doubled up in Harborview’s intensive care unit and burn unit, which lack special sections for children. They share bathrooms and hear each other as they undergo medical treatments.

Some emergency department patients are assigned to gurney bays, while others must make do with beds in hallways.

Double-bed rooms were the norm decades ago, but single-bed rooms are now the industry standard, said Paul Hayes, Harborview’s chief executive officer. Patients heal better when they have peace and quiet, Hayes said.

Harborview leaders want to build the new tower on property now used as a park. They say a 10-story building could accommodate 360 single-bed rooms. The tower would cost about $952 million, according to a consultant hired by the county.


A helipad on the new tower would connect to a new emergency department below. The changes would allow the hospital to treat many more patients during a disaster scenario, said Clayton Lewis, a Harborview trustee.

“The single-bed rooms would give us surge capacity,” Lewis said.

Officials say that on a typical day the hospital has enough demand to use every bed but must leave up to 50 beds vacant to comply with infection protocols.

“Harborview treats and cares for our county’s most vulnerable individuals,” Hayes said. “We really need to use the best layout available.”

Harborview’s old tower, a landmark built in 1931, would be renovated for administrative purposes and would receive seismic upgrades. The hospital’s east clinic would be demolished to provide new open space.

Renovations and seismic upgrades for other structures would cost $700 million, bringing the total price tag to $1.66 billion, according to the county.

The planning group’s members debated last week whether to recommend other projects and tentatively agreed to add $77 million. That money would pay for a new behavioral-health building, up to 120 respite beds and some other improvements.


During recent community engagement sessions, participants said they hoped Harborview would do more to address behavioral health needs. Respite beds serve people too healthy for a hospital bed, yet too sick to be on their own.

“A lot of people are homeless. They have health issues and mental-health issues,” said planning group member Gregory Francis, who was homeless when he moved to Seattle a decade ago and who received care at Harborview.

“Respite (beds) would provide them with a place to get the treatment they need, with the support services there to get them into housing,” Francis said.

Councilmember Rod Dembowski, a planning group member, asked whether people had been asked in the engagement sessions about the need to raise taxes to upgrade Harborview. The answer was no.

“We’re going to have to ask voters to write a check,” he reminded the planning group.

The county should consider seeking state assistance because the hospital serves all Washingtonians, Dembowski said. Maybe the Legislature could allocate money to the behavioral health project, the council member said.

“I want to build a behavioral health program that brings together the best in patient care and research,” he said. “That’s my top priority.”

The planning group considered recommending that the county also seek bond money to build housing with support services at Harborview to address homelessness. The group ultimately decided not to include that in the bond request.