In order to respond to national and local trends in pediatric care, Children's Hospital needs to expand on our main campus and across the Puget Sound region.

Nationally, the need for pediatric specialty care is expected to grow more than 3.5% a year. A recent study by the Child Health Corporation of America, a national association of free-standing pediatric hospitals, shows that inpatient days for pediatric diseases overall are estimated to grow 3.1% annually through 2010. Causes include:

• Increasing severity of pediatric illnesses
• Increases in prematurity and low birth weight
• Increased prevalence of chronic conditions such as diabetes and developmental disorders
• Growing prevalence of obesity complicating hospital care
• More patients surviving childhood diseases, such as cancer, and utilizing health care services longer

Areas of pediatric care such as infectious diseases, premature birth related care and endocrinology are growing at even faster rates. At children's hospitals across the country, diabetes admissions increased nearly 17% between 2000 and 2003. These types of complicated diseases require more frequent and longer hospital stays. At Children's, more than 2/3 of our patients have chronic illnesses and we have been seeing an increase in length of stay over the past several years due to increasing severity of illness.

Children's patients come from Washington, Alaska, Montana and Idaho and in some of these areas we're experiencing a level of growth that exceeds national projections. Based on the 2000 census, almost 25% of King County residents, and almost 30% in Kitsap and Snohomish counties, were 18 or younger.

To care for our patients, we must modernize and grow the main hospital campus. Our new ambulatory care building is already at capacity and outpatient visits have grown 11% over the last four years with an increase of 5,000 visits from 2005 to 2006.

Currently, 100 of our 250 beds are in double rooms. To provide the best quality care, we seek to treat patients in single-patient rooms for infection control, privacy and comfort for families and the patient.

We realize that those living around our campus have legitimate concerns over growth related impacts. Children's is committed to working with the community so we can grow our facilities to meet patient needs, while addressing community concerns.

In the next five years, we anticipate needing 130 to 180 additional beds. Over the next 20 years, we project needing a total of 250 to 350 additional beds. Children's has experienced a growth rate of 6% over the last year - double the national averages for children's hospitals. To estimate bed need we looked at our occupancy and growth rates over the past 10 years, then factored in national data on use rates developed by a consortium of 40 of the nation's leading children's hospitals, expert opinion from pediatric planners and clinical specialists, and the Washington State Department of Health's own methodology for determining bed need. Because we are projecting bed need over the next 20 years, we have created a scalable and reasonable growth plan, which means that we will build additional beds only as they are needed.

It is important to note that determining the number of beds for a pediatric hospital is different than the healthcare services other hospitals provide to their patients. The serious, chronic illnesses Children's treats and the range of ages of patients from premature through 21 years require a variety of bed types, more space, and highly specialized facilities. Some types of beds such as incubators serve a very specific age group. This is an important consideration to take into account as we plan for the future.

For master planning purposes we used a design formula (based on national averages for similar children's hospitals) of 4,000 square feet per patient bed as the space needed to support hospital functions. This includes patient rooms and other accessory spaces such as operating rooms, playrooms, family areas, etc. If we assume a total of 600 beds at 4,000 square feet per bed, it equals 2.4 million square feet – adding approximately 1.5 million square feet to our existing campus.

This past year, the hospital has been operating at capacity, demonstrating there is a need for additional beds and square footage now. To assure timely admission to the hospital and access to an inpatient bed, the hospital needs to operate at 65 to 75% occupancy. Often times, Children's is operating at much higher occupancy levels. In January 2008 occupancy was at 98% and in March 2008 occupancy was at more than 100%. There were days when there weren't enough beds for all the patients that needed treatment.

Children's provides the most complete set of pediatric services available in the Northwest, many of which are not available at other hospitals in the region. For example, the only pediatric rheumatologists and pediatric transplant specialists in all of Washington, Alaska and Montana are located at Children's. If a child needs a heart, liver or intestine transplant, and Children's is full, the nearest facility providing this level of care is in California.

With national shortages of many key pediatric specialists, most community hospitals do not have the capacity to care for the most complex children with special health care needs, many of whom require multi-disciplinary care. Even among those community hospitals with pediatric units, most focus on obstetrics in their birth centers and not on caring for children with chronic pediatric disease. According to the Washington State Department of Health, in 2006 Children's provided nearly 70% of all the hospital days for King County children less than 14 years old, excluding newborns. We are committed to being a central resource for providing the full range of pediatric specialty care to our children locally and regionally, and we can only do so by continued growth at our Laurelhurst facility.

The simple answer is, the cost to build an entirely new hospital somewhere else would be cost prohibitive. Not only that, but given the critical shortage of pediatric specialists in this country, it would be unlikely that Children's could successfully staff two different inpatient locations 24 hours a day, seven days a week.

We believe we best serve our patients and best meet our financial responsibilities by expanding our current campus. Expanding a single location is beneficial to our patients because it allows us to continue to offer the best pediatric care and the widest range of pediatric specialists all in one place.

Where feasible, Children's is relocating and building select facilities off-campus so needed inpatient bed growth can happen on campus. We have proactively moved research facilities to the Research Institute in downtown Seattle and are building new outpatient facilities in Bellevue (expected to open in 2010), Everett and South King County. Children's currently has more than 20 outpatient facilities in the states we serve – Washington, Alaska, Montana and Idaho – which bring care closer to the families that need it and also reduces trips to our Seattle campus.

When patients come to Children's for psychiatric care, they often have other physical health conditions that require additional medical attention available at the hospital. We have many nationally-recognized pediatric sub-specialists at the hospital and patients receiving treatment at Children's benefit from their wealth of experience. A large interdisciplinary team made up of dieticians, nurses, occupational therapists, educators, physicians, psychologists, social workers, speech and language disorders specialists, and pediatric mental health specialists all work together to diagnose and treat patients. Another important element to understand is the mental health needs of children with life-long chronic illness. These illnesses present such a stress to families that support from mental health experts is often critical. Child psychiatry represents one of the greatest shortages in health care. Building a separate facility and separating specialists is not a viable option for many of the mental health patients served by Children's doctors and support staff.

Children's must apply for a Certificate of Need from the Washington State Department of Health and get state approval in order to build new beds. It is too early in the master planning process for Children's to apply for a Certificate of Need. The state requires that master planning, zoning and land use work be completed prior to the Certificate of Need process. In addition, Children's does not currently own the Laurelon Terrace property. It would be premature to apply for a Certificate of Need now as the master plan alternatives are being refined and decisions are still being made about the proposed development. An approved Certificate of Need expires two years after issuance so the timing of the application is very important.

The hospital's previous Certificate of Need from 2002 was based on patient projections from 1990 to 1999, the best data at the time. Analyses conducted by Field Associates are based on this old patient data and provide inaccurate projections. Children's bed projections are based on newer patient data and more current numbers from 1997 to 2007, along with current occupancy rates which have lately been as high as 84% to 98% occupancy.

The Seattle Municipal Code does allow for boundary expansion during the development of a Major Institution Master Plan though it does "discourage" the expansion of established major institution boundaries. The City Council has approved multiple boundary expansions since the major institution code was adopted. Two such institutions include Seattle Pacific University which was allowed a 14.3 acre boundary expansion in their 1997 master plan and Seattle University which was allowed a 13.7 acre boundary expansion in their 2000 master plan.

Part of the hospital’s proposed boundary expansion includes the Hartmann site. Keeping the Hartmann site in the MIO affords the CAC, and therefore the community, a role in decision making.

Laurelon Terrace is a condominium complex on 6.7 acres of property to the west of Children's Hospital. The Laurelon Terrace condominium board approached Children's to negotiate the sale of the property. Developing the Laurelon Terrace site results in a better design for the hospital and allows us to grow on the west side of the campus. The new development would be no higher than existing buildings, resulting in less view impairment and views from the northwest would be softened by terracing the buildings. Also, additional entrances on 45th and 50th would not be needed, keeping the majority of cars on Sand Point Way and away from the neighborhood streets. Overall, construction impacts to existing hospital facilities, staff, patients and neighbors are greatly reduced and the duration of construction would be much shorter.

Yes. The livability of the neighborhood near Children’s is vitally important to Children’s as well as the community. Children’s is developing a housing policy and program to address the need for safe and affordable housing in northeast Seattle for a variety of reasons:

• A safe home is necessary for the healthy development of every child. Children who experience homelessness or live in substandard housing are at greater risk of significant health problems.
• As an employer, Children’s is committed to attracting the very best talent, but is at a competitive disadvantage when employees must commute long distances to find housing they can afford because of the high cost of housing in Seattle.
• Children’s commitment to care for all children in the region who need our services, regardless of the family’s ability to pay, means that families with limited means travel from throughout the region for care at Children’s. Once in Seattle, families often experience significant difficulties securing housing so they can be near their child during care at Children’s.

Children’s will meet, and to the extent feasible and cost-effective, exceed housing replacement responsibilities related to Laurelon Terrace. Children’s will work with non-profit housing organizations and the City of Seattle Department of Housing and the Department of Planning and Development to establish a binding agreement for a specific package of replacement housing that addresses the City’s policy and program goals for comparable affordable housing and contributes to the replacement of at least 136 housing units in northeast Seattle. Participation in the development of affordable housing at Sand Point Magnuson will be a component of the agreement.

Before Children's Hospital can begin development, the Seattle City Council must first approve the extension of Children's major institution boundaries to include Laurelon. Then the City's Department of Planning and Development must approve the permits for construction by Children's at this location. If the development of Laurelon Terrace is approved in the final master plan, the earliest that Children's could begin development would be January 2010.

On November 10, 2008, the Final Master Plan and Final Environmental Impact Statement were published with the preferred development alternative of Alternative 7R. These documents will be reviewed by the CAC, Department of Planning and Development and the Hearing Examiner before the Seattle City Council makes a decision in 2009.

"MIO" is the acronym for "Major Institution Overlay." The City of Seattle's Land Use Code requires that Major Institution Master Plans specify the maximum allowable building height for specific areas ("districts") of the institution's campus. These height limits are referred to as the MIO.

As part of the master plan process, Children’s developed a Comprehensive Transportation Plan (CTP) to focus on sustainable transportation options. The CTP includes a Transportation Management Plan (TMP) to mitigate vehicle traffic related to master plan expansion by shifting even more employees and visitors from single-occupancy vehicles (SOV) to bicycling, walking, shuttle and transit. In addition, the CTP goes above and beyond the traditional TMP elements by including a substantial investment in transportation infrastructure improvements outside the hospital campus. The major Transportation Management Plan elements are:

• Robust shuttle-to-transit system linking Children’s to regional transit hubs
• Innovative bicycle programs including Flexbike(shared bicycle program) and Company Bikes which offers free bicycles to employees committed to cycling at least two days per week
• Increased financial rewards for employees who commute without driving alone
• Campus design and near-site improvements to encourage alternative transportation
• Intelligent Transportation Systems (ITS) for NE 45th Street / Montlake Boulevard / Sand Point Way NE to optimize the performance of key intersections and reduce vehicle delay and travel time
• Contributions to capital projects that will improve the Northeast Seattle transportation network
• Investments in walkable and bikeable Northeast Seattle
• Out-of-area parking

More information about the CTP can be found in the CTP section of the Final Master Plan.

Currently, about 10% of our patients arrive at the hospital by ambulance; in 2006 there were 3,300 ambulance trips to the campus. Ambulance traffic is likely to increase proportionally to the number of beds on campus. We currently have an agreement with the neighborhood to minimize siren noise near the campus and we will continue to do so.

Patients who arrive at the hospital via helicopter are in life threatening situations. Helicopter landings are monitored closely and have remained fairly consistent over the years with 4 to 6 landings per month and a five-year annual average of 60 landings per year. Children’s Health Facilities Planning and Development department used a standard population / use rate methodology to project future helicopter patient landings at Children’s. The projected landings per year are 62 by 2010, 71 by 2020 and 77 by 2030. For more information, read Appendix B of the Final Environmental Impact Statement.

The City of Seattle’s land use code for Major Institution Master Plans requires a plan for open space. Children’s Final Master Plan provides information about the proposed open space on pages 54-55 of the Development Program. The proposed open space system of plazas, gardens, courtyards and pathways will connect buildings with the surrounding public spaces around campus. The garden edge which surrounds the campus will be designed to minimize the visual presence of the hospital and the quality of the existing landscape screen along the south, east and north edges of campus will be continued. In addition, plazas, street frontages and roof gardens will be improved and a pedestrian connection between Sand Point Way NE to the Burke-Gilman Trail will be improved at the Hartmann site.