AN overseas company with significant experience in hospital build-out has been brought in to help manage the delay-plagued $4-billion renovation project at Cornwall Regional Hospital (CRH) in Montego Bay, Health and Wellness Minister Dr Christopher Tufton said yesterday.

“What we’ve done now is try to strengthen the management process by bringing in a management entity that has significant hospital experience. The company will act as the quality assurance agent for the project. So we’re hoping that we can get standards established and maintained as the contractors work. We’re hoping that that will significantly reduce the variation challenges that we’ve had in the past,” Dr Tufton told the Jamaica Observer.

“We will have a local project manager, but we’ve embedded in that process, representing the Government, a commissioning agent that examines all proposed work to be done — the quantities, the costings — look and reconcile that against the project and assesses on an ongoing basis value for money, so it hopefully will help to reduce variations and provide guidance, through the Government, to the contractors doing the work,” Tufton said.

The company, WSP, is based in the USA and is said to be one of the world’s leading engineering consulting firms. Its senior vice-president is Gary Hamilton, a Jamaican with extensive experience as a project manager and is engineering design lead for a variety of market sectors, but with special focus on health-care facilities.

In 2016, air quality issues were identified on three floors of the hospital resulting in relocation of services. The following year, with the problems continuing, 123 beds were relocated to the quadrants at Cornwall and Falmouth hospitals.

A heating, ventilation and air-conditioning (HVAC) consultant was contracted to design a HVAC system for the first five floors at CRH. At the same time, additional structural defects and mould growth were identified during the assessment period.

That resulted in the building being evacuated, except the Radiotherapy Department, and a local company was contracted for the total rehabilitation of the building.

“The project was identified as HVAC and infrastructural upgrade and was divided into phases (1,2 (A&B) and 3) for ease of implementation,” a health and wellness ministry document states.

But work on the project has been lagging, and yesterday Tufton identified the procurement process, as well as variations in the scope of work that have been significant enough to give him cause for concern.

“The project has a naturally slower implementation because of the nature of it, given that you have a renovation exercise that takes place on an active hospital compound, so the approach to the renovation has to be different because it’s not a sterile site,” Tufton said.

“In fact, it’s a site which you try to keep sterile, by virtue of the nature of the hospital, but it is difficult and it does slow down some of the work because you’re treating people at the same time, so infection-prevention and control measures are necessary and perhaps more than usually so because of the nature of where the project is located and what’s happening on the physical compound at the same time,” he added.

Tufton said the brownfield nature of the project has resulted in the scope of the work changing constantly “because what was originally a HVAC system problem then became a total stripping down of the entire building and addressing everything from plumbing to electrical, to roof, removal of the broiler, etc”.

He also said the management of the project underwent a number of reviews because of capacity issues and the need to try and achieve the type of understanding of the process required to build out hospitals.

“So there have been substantial challenges with finding the capacity to provide the combined effort of technical work, project management and contract delivery, which has seen variations, in some instances significant, and for me very concerning because it told me that, in a substantial way, there is not much capacity in Jamaica for major hospital build outs, and understandably so because we haven’t built a hospital in Jamaica for more than 25 years.

“So just like how we go abroad [for a company] to build a highway, a hospital is a specialised vehicle that involves things like infection-prevention and control, precision air flow for that and several other things. Frankly, it’s not an apartment building,” Tufton said.

“It’s not just about contractors, it’s about all the technical inputs, the work that goes into making the job complete — the pre-contract work, the project management work — have seen several variations… I’m talking about variations where in one case a contract varied up to 100 per cent,” he said.

Tufton also expressed frustration with the procurement process, saying that while he acknowledges and accepts its importance, it has been a substantial contributor to the delays.

“We have seen perhaps half the time, from 2017 to now, spent in procurement processes, even in cases where we’ve had emergency contracting or limited tender arrangements,” he said.

In one case the work required remained in the procurement process for 13 months. In another it sat for 11 months. All told, the project has suffered from procurement delays totalling 47 months.

“That has been quite a frustrating experience, because each time we try to recalibrate to address the concerns to strengthen the management and so on, we go through a process where we literally have to wait, because a lot of the things you have to do before you do the other, you can’t do multiple things one time in the substantial part of the work,” Tufton explained.

“I am not, in any way, seeking to divert responsibility. The truth, though, is that it’s a highly unusual project — one of the most unusual that Jamaica will see,” the minister said.

“I fully understand the concerns of the people of western Jamaica. The truth is that Cornwall Regional continues to provide significant services to the people, and I pay tribute to the doctors, nurses and other health-care staff because they’ve been working very hard and they continue to perform thousands of tests, surgeries, dialysis, cancer treatment, in-patient care, delivery of babies weekly. All of those things continue. It’s not like the facility has come to a halt, but I do appreciate that to see the main building being empty and not enough work going on is a stark reminder of the real challenges, and it does generate, understandably so, emotions and concerns,” Tufton said.