How to build a hospital in Mangilao

By Vincent Akimoto

The back road to Anderson is known as the "Highway to Heaven" to too many local families whose loved ones have died on that desolate, dark, broken-down road in rural Mangilao, where the governor of Guam wants to build the new Guam Memorial Hospital.

For the past eight years, Gov. Lou Leon Guerrero has claimed she was the only one who could save GMH from ruin, regain national patient safety accreditation and build a new, better GMH.

In the meantime, the back road to Anderson remains a deadly, dangerous two-lane road with no sign of structural repair underway.

Building a new hospital is a massive undertaking that integrates complex architectural design, specialized medical engineering and strict regulatory compliance. The process typically unfolds over several years and across three primary phases: planning, design, and delivery.

Before breaking ground, you must define the "why" and "how much." 

The Joint Commission on National Hospital Safety Accreditation has declared GMH unsafe, while Gov. Leon Geurerero considers it irredeemable.

Selectively interpreting a 2019 Army Corps of Engineers survey of a dangerously decrepit GMH, Gov. Leon Guerrero unilaterally decided that it was a "no-brainer” to abandon GMH and move GovGuam’s medical campus to Mangilao.

Gov. Leon Guerrero apparently had the Guam Economic Development Agency commission market research to identify local healthcare gaps and the market demand for specific medical specialties. Somebody was apparently sole-sourced to create a comprehensive business plan detailing the hospital's mission, financial projections, and operational strategies to secure $770 million in funding from investors or government grants.

Funny thing is, somebody didn’t spend much time talking to the private physicians who provide care to more than 92 percent of Guam’s population.

Thus, for the past seven years, Gov. Leon Guerrero has been fighting in vain to shove her Mangilao Medical Campus down everybody’s throat.

Hospitals require more than standard office or residential architecture; they must support evidence-based design to improve patient outcomes. Hospital design should be based on patient flow, ensuring minimal walking distance for nurses and efficient movement of supplies. Building design should integrate smooth, easy-to-clean surfaces and advanced HVAC systems to maintain sterile environments and prevent hospital-acquired infections.

The new Guam Memorial Hospital design should prioritize natural light, outdoor views and intuitive "wayfinding" (signage and color-coded paths) to reduce patient and visitor stress. Ideally, hospital designers should work with existing hospital physicians, allied health staff, and patients.

Critical infrastructure, such as fire safety systems, must be prioritized. Methodical installation of specialized medical gas pipes, backup power generators, and emergency water supplies is paramount. Technological integration of cutting-edge medical equipment and advanced IT systems for electronic health records must be done with extra care.

Some experts estimate that the new GMH information technology system alone may cost over $800 million, thus rivalling the brick-and-mortar investment.

Once built, every system (from fire alarms to MRI machines) must be tested and certified before the first patient arrives. While construction is underway, medical professionals must be recruited, and mandatory licenses, such as fire safety, pharmacy, and health department certificates, must be obtained.

To build a new GMH in Mangilao, the back road to Anderson must be fixed; the archeological survey of the land needs to be publicized; the environmental impact upon the aquifer and wildlife needs to be assessed; and the public utilities infrastructure needs to be enhanced.

All this stuff needed to be done yesterday.

Unfortunately, as best we can tell, rather than work with local stakeholders, Gov. Leon Guerrero's design team aggressively kicked out GMH patient advocates like Ken Leon Guerrero and shut out Guam’s medical doctors from the design process.

Thus, Gov. Leon Guerrero has demonstrated a hubristic prioritization of personal politics over medical staff autonomy and patient advocacy. Rather than work collaboratively, Gov. Leon Guerrero has chosen the path of dictatorial rule, risking the safety and welfare of us all.

While the governor ickers impotently with the Guam legislature, Attorney General Doug Moylan and all the good doctors on the island, the current GovGuam hospital is killing too many brown babies and their mommas.

Over the past seven years, GMH has deteriorated substantially and is now considered one of the dirtiest hospitals in America and a documented source of life-threatening, hospital-acquired bacterial infection and sepsis.

Instead of celebrating the building of hospital parking stalls, the governor should be at GMH every day fixing the leaking roof, cleaning the God-forsaken moldy walls and rescuing the little sick children from the pyrogenic, fiery electrical panel, which no one seems to be in too much of a rush to fix.

The people of Guam deserve much better than this.

Dr. Vincent Akimoto is physician and owner of American Medical Clinic.

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