Dallas County commissioners learned Tuesday that part of the old Parkland Hospital will be reused even after the new $1.27 billion replacement hospital opens next year.
That fact was not included in a briefing prepared for Tuesday's meeting with commissioners by Parkland officials. Commissioners pried it out during intense questioning about progress on the new hospital.
"Why haven't you said anything to this court? Why? Why are we having to probe and finding out this way as opposed to you bringing it to us?" Commissioner John Wiley Price asked.
"Perhaps we were not clear in our communication; I apologize for that," said Cobie Russell, Parkland board member.
Commissioner Elba Garcia said plans to reuse the old buildings also caught her by surprise.
"I personally do not know about these changes," she said. "I didn't know they were taking place."
Parkland officials said outpatient clinic patient demand has already exceeded projections for 2017, when 243,817 visits were forecast.
Last year, Parkland clinics treated 314,325 people, 28.9 percent more than the 2017 projection.
Parkland's interim chief financial officer, Ted Shaw, said a new outpatient clinic to help meet that demand was to be included in the new hospital, but it would have cost $165 million, more than Parkland could afford.
Commissioner Mike Cantrell said the trend toward higher patient demand was anticipated when voters approved the new hospital in 2008.
"We knew what was taking place, so this shouldn't be a surprise to anybody," Cantrell said.
"Commissioner Cantrell, I can only tell you that the numbers that were in the plan, the volumes that were in the plan, were far less than what we're actually experiencing," Shaw said.
Now, Parkland plans to spend $12 million for a bridge across Harry Hines Boulevard between the old and new hospitals and $25 million to renovate two 1980s buildings for an expanded clinic at the old hospital campus.
"They're pretty good buildings," Russell said. "They work well. We've talked to the physicians that work in those buildings, and they find those agreeable buildings."
Cantrell interrupted Russell.
"Everyone hearing that? When we're trying to build a $1.2 billion facility? We did not hear that," Cantrell said about the need for a new building years ago.
"And as a board we didn't either," Russell said. "Things have changed."
Parkland officials also said emergency room visits have soared far higher than forecast, with more than 195,000 in 2012 compared with the prediction for 2017 of around 153,000.
Commissioners thought new Parkland clinics in outlying areas would help reduce visits to the Parkland emergency room and the central hospital clinic.
"You do that by building clinics in the community," Price said.
Parkland already operates seven clinics around Dallas County for preventive and minor medical care.
County Judge Clay Jenkins said the Pleasant Grove area, miles from the nearest Parkland Clinic, has a large population eligible for care from the public hospital.
Jenkins said it is not clear where Parkland plans to get the money to renovate the old hospital buildings for clinic space now.
"And we need to address that, so if this money is coming out clinics and it's not in a budget we've approved, that's a concern," Jenkins said.
Russell said plans are due to be finalized at an April 22 Parkland Hospital Board meeting and she would return to commissioners with more details in May.
Price said it appears important decisions have already been made without records to support it.
"They're making decisions every day based on information that they don't have solidified in terms of writing, and I'm just very concerned," Price said.