The costs to renovate and expand Harborview Medical Center, Washington's only highest-level trauma center, have increased by more than 70% since voters approved the project in 2020, to an estimated $3 billion.
The project includes a new 14-story medical tower that will add hundreds of patient beds, a new parking garage with hundreds of spots and a new behavioral health primary care clinic. The project also includes renovations and seismic retrofitting on Harborview's existing facilities.
In 2020, King County voters approved a $1.74 billion bond measure, backed by a property tax increase, to fund the county-owned hospital's renovation and expansion.
Progress on the project has been slow and halting, initially disrupted by the pandemic and then by a scope that has, at times, both expanded and contracted. It's also proved more complex than officials, led by former Executive Dow Constantine, predicted.
The tower, with seven new floors of inpatient beds, a new emergency department and surgical center, and a skybridge connecting it to the existing hospital, is now not expected to open to patients until 2032, a dozen years after voters approved the project.
The soaring costs have left elected officials searching for funding sources to fill the projected gaps.
The big sort of headline number is the $3 billion cost estimate," Metropolitan King County Councilmember Jorge Barón said at a briefing Tuesday. "How do we plan to pay for that overage in order for us to continue moving forward?"
Jeff Muhm, a special adviser to County Executive Girmay Zahilay, said they have been examining options to fill the funding gap.
"This is an all hands on deck situation," Muhm said. "We need to work with federal partners, state partners and look at all options."
The state Legislature, in 2024, gave counties the option of raising property taxes without a vote of the people to help fund the operation, maintenance and expansion of county-owned hospitals. Harborview is the only county-owned hospital in the state.
The County Council two years ago used that mechanism to raise money for Harborview that was then funneled into helping run the county's 13 public health clinics.
The planned tower has grown from 10 to 14 stories to accommodate more mechanical and electrical space as well as ambulance staging, said Anthony Wright, an engineer and division director with the county's Department of Executive Services. Parking has also been identified as a more pressing need than when the bond was passed in 2020, officials said.
While design of the project is underway and has been for years, construction has not yet begun and likely won't begin until next year. Construction on the new tower, the centerpiece of the project, is not slated to begin until early 2028.
Before that can begin, a whole suite of critical "make ready" projects need to be completed to ensure that Harborview can continue operating through construction. Roads need to be built to haul materials in and out, they need temporary power and water sources and ambulance turnarounds.
"It requires a tremendous amount of coordination and phasing so that these occur without disrupting operations, Wright said.
In the meantime, there's no guarantee that costs won't continue to rise. Wright said he expects the county to have an agreed upon guaranteed maximum price from their contractor in 2028.
Costs, he said, have risen both because the scope of the project has changed and because of outside inflationary reasons.
The first factor, Wright said, the COVID-driven construction inflation that saw costs soar for nearly all big projects that were planned immediately before the pandemic. At the same time, he said that costs for specific things like medical equipment, steel and copper have risen fasterthan regular inflation.
Tricky soil conditions on First Hill, found during geotechnical studies of the site, have meant that the project will need a more expensive foundation.
More recently, Wright said, tariffs imposed by the Trump administration have made contractors increase their prices and made them reluctant to make long-term pricing commitments. Increased fuel prices, driven in part by the war in Iran, have caused cost estimates for the project to rise.
And a surge in data center construction, which is fueling the AI boom, has driven demand for electricians and electrical infrastructure, causing delays and spiking costs. For instance, Wright said, they expect the new parking garage to be complete in late 2028. But that timeline is driven not by how fast it can be built, but how fast electrical switches can be manufactured and delivered to the project.
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