King County voters will decide in the Nov. 3 election whether to spend $1.74 billion on renovation and expansion projects at Harborview Medical Center in Seattle. Proposition No. 1 would approve bonds to fund the projects at the hospital on First Hill and would authorize property-tax increases to repay the bonds over 20 years.

Owned by the county and operated by UW Medicine as a teaching hospital, Harborview is the only Level I trauma and burn center for Washington, Alaska, Idaho and Montana.

Its mission includes serving vulnerable populations, and the hospital has played a crucial role in the Seattle area’s response to the COVID-19 pandemic — accepting patients from the initial outbreak at a Kirkland nursing home, converting an intensive care unit into a COVID-19 unit and converting a homeless shelter into a COVID-19 recovery center.

“We’re talking about COVID today, but who knows what’s next,” Paul Hayes, a registered nurse and Harborview’s chief executive officer, said in an interview last week.

The projects would include a $952 million new medical tower with single-bed rooms and a new emergency department; seismic upgrades; renovations to clinics and offices; and a new building dedicated to behavioral health.

Prop 1 also would create space for 150 respite beds, which help homeless people recover after hospital stays rather than returning to the streets; only 34 are available now. An Involuntary Treatment Act Court at the hospital, which handles noncriminal petitions to detain people with mental illnesses and which has seen case volumes soar, would be enlarged.

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The tax increases would vary, year to year, with the largest occurring between 2026 and 2036. The average hike would be 8 cents per $1,000 of assessed value, and the owners of a home of median assessed value would pay about $75 per year, on average.

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The new Harborview bond measure would replace a measure from 2000 that has cost the median home about $13 per year, on average.

Per state law, bond measures like Prop 1 must win 60% approval.

Hospital’s needs

Founded in 1877 and moved to First Hill in 1931, Harborview now has 413 inpatient beds and is governed by a county-appointed board of trustees.

Even before COVID-19 emerged, county and Harborview officials were saying the hospital needed to be renovated and expanded, describing conditions there as outdated and overcrowded.

Most patient rooms at Harborview have two beds separated by curtains; the occupants share bathrooms and hear each other receive treatment. There are double-bed rooms even in the hospital’s intensive care and burn units, which lack special sections for children. Many emergency department patients are assigned to open bays, while others make do with beds in hallways.

“Our mortality statistics are world class, but you can come in with terrible trauma and you’re going to be sharing a room and it’s going to be noisy,” said Dr. John Lynch, Harborview’s infection-control director.

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The pandemic has squeezed the hospital even more. When Harborview’s COVID-19 unit displaced an intensive section, beds had to be cleared elsewhere. The hallways are scattered with supply carts.

Day and night, Lynch’s team swaps patients around to keep viruses from spreading, waking them up to move them between rooms. The work is like playing Tetris with human lives, he said.

“People from the ICU take beds in the emergency department, which means we have patients in the waiting room, and the last thing you want in a pandemic is people hanging out together,” he said in an interview Tuesday.

To that point, a COVID-19 outbreak in a surgical unit has killed one patient and infected three others, Harborview announced Friday. Ten staffers have tested positive and more are quarantining due to possible exposures. “We have a lot of shared spaces and a lot of very sick people,” Lynch said Friday, suggesting less cramped conditions for staffers might have prevented transmission.

A planning group convened to study potential improvements recommended the bond measure earlier this year. County Executive Dow Constantine sent the proposal to the Metropolitan King County Council, which voted unanimously to send the measure to the ballot.

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While Harborview’s construction plan wouldn’t add beds, the new tower’s single-bed rooms would allow the hospital to keep more beds occupied. The hospital has enough demand to use all of its beds but today must leave up to 50 vacant every day to keep sick patients isolated, per infection protocols.

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The 10-story tower would be built on park space overlooking Interstate 5. Harborview’s old tower, an Art Deco landmark, would be renovated for administrative purposes, and an existing clinic building would be demolished to provide new park space.

The new tower would render care “in a more efficient and effective way, in an environment designed to promote healing,” Hayes said. Each patient room would accommodate modern equipment and guests, he said.

The seismic upgrades also are vital, Lynch added. “You don’t want to have to shut down Harborview” during a massive earthquake, he warned.

Pending voter approval, work on the various projects could start by 2023.

Taxpayers outside King County aren’t being asked to contribute directly to the Prop 1 projects, though they sometimes rely on Harborview’s trauma care. Last year, only 220 of 16,073 trauma-related admissions to Harborview (about 1.4%) involved people from outside King County, said Kelli Carroll, director of special projects for Constantine.

People from other Washington counties and from Alaska, Idaho and Montana do contribute to the hospital in other ways, because state and federal funds support Harborview’s operations, Carroll said. When people from outside King County visit the hospital they’re billed just like King County residents, Carroll added.

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Unopposed campaign

The county voter guide statement supporting Prop 1 is attributed to Constantine, University of Washington President Ana Mari Cauce and Harborview nurse Katy Brehe. No one volunteered to write a statement opposing Prop 1 for the voter guide, and there’s been no organized campaign against the measure.

Prop 1 has been endorsed by the union SEIU 1199NW, which represents nurses, technical workers, social workers and other employees at Harborview, and by the Seattle Building and Construction Trades Council. Endorsers also include the Seattle Metropolitan Chamber of Commerce and numerous local Democratic Party organizations.

Harborview Health for All, a political committee created to support Prop 1, had raised more than $790,000 as of Oct. 13. The campaign’s largest donors include Susan Brotman, whose late husband co-founded Costco ($50,000); businessperson Michael Garvey ($50,000); SEIU 1199NW ($25,000), the Washington State Building and Trades Council ($25,000); Microsoft ($25,000); and PEMCO Insurance ($25,000).

The campaign spent $32,000 on polling in August and recently began running a video advertisement this month on cable television and social media.

Prop 1 is likely to pass with the required 60% approval, according to the campaign’s polling. When EMC Research surveyed 639 likely voters by landline, cell phone and text, 66% of respondents expressed support while 29% expressed opposition and 5% said they didn’t know.

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