asc management
State Rulings Raise Building Costs
We followed the building codes to the letter in constructing our ASC. But the state wanted changes.

By Larry Patterson, M.D., and Ray Mays

We began construction of our surgery center in May 2001. Although the State of Tennessee hadn't officially approved our final drawing package, it did approve the foundation package to allow us to start the site work. The state approved the entire package a few months later. The construction process continued smoothly throughout the next 11 months and was completed in April of 2002.

In this article I'll focus on two building code opinions that added almost $250,000 to the project cost.

A Ruling Increases Costs

Our first code issue involved the definition of "emergency power." Hospital construction codes govern ASCs in our state, and our plans had called for backup power supplied by a series of batteries that would provide power to the ASC for 4 hours.

The state engineer's office decided that "emergency power" meant that critical systems in the building had to be capable of operating uninterrupted for at least 24 hours. The state also said that critical systems included the HVAC system for the entire building, plus all of the electrical systems in the ASC itself.

We did our best to argue that, by definition, ambulatory surgery was a surgery that required a patient stay of no more than 11 hours and 59 minutes. In fact, the state mandated that a patient had to be transferred to a hospital if he required more bed time than 11 hours and 59 minutes. Using that definition, there was no need for us to provide emergency power for more than 12 hours.

We also argued that our surgical protocol called for all surgeries to stop if power was lost. These arguments fell on deaf ears. Our options were to appeal the ruling or purchase a $220,000 generator capable of handling the load of all of the critical systems. We purchased the generator to get the facility up and running and to avoid lost revenue that would result from arguing with the state.

More Unexpected Changes

Our next unexpected expense was also a code issue. This time, it was the state fire inspector. Prior to construction, the contractor receives authorization from the state engineer to proceed with the construction "as drawn." It's stamped, notarized, sealed and delivered to the job site, and must remain at the job site with the project foreman at all times.

Every 2 weeks during construction, the state fire marshal inspected the work done in the preceding weeks and signed off on the fire inspection portion of the contractor's checklist. He would look at the plans with the state engineer's stamp on them to ensure that the contractors were staying within the "as drawn" guidelines.

A few weeks from project completion, the fire marshal decided that we needed to install sprinklers outside of the building in the covered driveway. He explained to us that in case a car or delivery vehicle caught fire in the covered area, we had to be able to extinguish the blaze, lest it spread to the building proper. Though the "as drawn" plans were approved by seemingly everyone in Tennessee, this guy had the final authority to stop the project in its tracks.

Outside water pipes can freeze in the winter, so the fire marshal wanted a "dry sprinkler system." This would have been a great expense and would have required a completely new set of architectural drawings. In the end, we compromised with the fire marshal by installing a "wet system" and using a 50% anti-freeze solution in the system. The added expense was a little more than $20,000.

The take-home lesson from our experience with these issues is that one should be prepared for the unexpected. The final cost of the project is known when the last contractor's truck leaves the parking lot.

Larry Patterson, M.D., is practice owner, and Ray Mays is practice administrator of Eye Centers of Tennessee, a general ophthalmology practice serving 300,000 residents of middle and east Tennessee. You can reach Ray Mays at raym@ecotn.com.

In May 2002, Eye Centers of Tennessee, LLC, a five-location practice serving a large portion of middle and east Tennessee, began operating its own ASC. Each month, practice owner Larry Patterson, M.D., and practice administrator Ray Mays provide information they believe will be helpful to other practices considering planning and building their own ASCs. This column is part five of the series.