Questions & Answers on Building Issues

How many buildings at Middlemore Hospital are affected by weather tightness and potentially, mould as a result?

CM Health has significant weather tightness issues in four buildings – Scott, Macindoe, Kidz First, Manukau Elective Surgical Centre.  Random testing of different parts of the buildings has revealed that cladding is likely to require repair and/or replacement.  The deterioration of cladding has led to leaking in some parts and as a consequence mould growing inside the building. 

There are other buildings that have cladding issues but they are not as serious as the four buildings above.

 

What buildings are affected?

The buildings that require immediate remedial work are Scott Building, Kidz First, Manukau Super Clinic, McIndoe Building (which includes the ambulance bay).

Scott is prioritised for works because it is the most high risk building of cladding falling off and risks to public safety.  It is also the ‘prototype’ for testing the works method and the largest building that requires remediation.

In short, we cannot confirm the cost of cladding the remaining buildings until we start work on the Scott building and get a better estimate of time, costs and risks – this is why there are no detailed proposals yet for Kidz First, Macindoe and Manukau Elective Surgical Centre.  We have, however, estimated the total cost of recladding to be more than $40m.

 

What about reports of sewage leaks at Middlemore Hospital?

Media have recently reported that Middlemore Hospital has ongoing issues with sewage leaking down walls. This is not correct.

The occasional plumbing leak is not uncommon in any building, particularly a hospital where we have a high density requirement for ensuite facilities. Some of these leaks are the result of materials being put down our waste system that shouldn’t be, leading to blockage.

We continue to monitor and repair all infrastructure, including sewage pipes.

In 2017 we had two serious incidents of sewage pipes needing repair work in the following two places:

  • Ward 1 on Ground Floor of Scott building in November 2017– a pipe junction cracked and required replacement;
  • Retail area October 2017 – this was due to pipe joinery requiring replacement.

These were immediately repaired and did not have a negative impact on staff or patients. We respond to these incidents as part of our normal maintenance response.  

It should be noted that both these leaks are related to the sewer stacks in the Scott building. Unlike our sewer stacks elsewhere in the hospital, the Scott building stacks are PVC and are more prone to breakage.

With the re-cladding of the Scott building, the replacement of the façade will enable these stacks to be inspected and replaced should that be necessary to ensure their future integrity. In the event that existing sewer leaks become evident, the hospital has risk mitigation plans to isolate and prevent any related health risk to patients, staff, contractors and the public.

It is important that any leakage is reported as quickly as possible to the Facilities team.

 

Is the mould a public health risk?

Currently, while interior walls and exterior cladding is intact, there is no risk of mould affecting patients, staff or the public. The safety of patients, staff and visitors is paramount and we have been assured by our infection specialists that the presence of fungal growth presents no safety risk while the walls remain intact. This is because the cavity between the internal and external walls provides sufficient protection.

When works start, however, we will have in place the necessary protections.  This will include regular monitoring and checking by Infection Control team.  They will sign off our progress for patient and staff safety every step of the way.

 

What about the cladding? Is it safe?

We have in place a programme to regularly monitor cladding on the high risk parts of buildings.  If additional fixtures are required to secure cladding, this work will be actioned as part of our normal maintenance programme.  Facades are regularly monitored and barriers installed if/as required.

A contract to re-clad the Scott building has recently been signed between Counties Manukau Health and Hawkins 2017 Ltd, a subsidiary of Downer.

The contract represents an important first step in fixing a number of Counties Manukau DHB facilities

The remediation work will be carried out whilst Middlemore Hospital remains operational. There will be an immediate start to a 25 week design and material importation period, followed by an 11 stage construction period of 644 working days. 

Construction work has been tailored to mitigate disruption and allow patient care to continue throughout with careful selection of tools for the work at hand alongside physical barriers to address noise transfer and keep out any debris.

 

Why did it take so long for CM Health to comment on the weather tightness issue?

On release of the OIA to the media, the questions around public safety were immediately addressed by CM Health.

We advised that the safety of our patients, staff and visitors is paramount and the presence of mould in our buildings is not a safety risk.

Due to on-going contractual obligations, we have not been able to discuss some of the issues regarding weather tightness.

We are hopeful that these issues will soon be resolved and remediation work will be able to be started.

 

What is CM Health doing to ensure the safety of patients, visitors and staff?

There is no risk until remediation work commences. Infection experts are checking off all construction plans and work processes at each step. There will always be an airtight seal between construction work and patient areas and no air intake in proximity to the work. We will also be erecting appropriate barriers to ensure that passers-by are not in the area.

We have rechecked panels on sections of buildings that were highest risk (Scott, McIndoe) to apply repairs.  Those repairs mean additional fixtures (screws) to secure the panels.  We will do this regularly while the works are being planned to those areas that are not yet scheduled for works.

With the recent signing of the contract between CM Health and Hawkins 2017, a subsidiary of Downer, remediation work will be carried out whilst Middlemore Hospital remains operational. There will be an immediate start to a 25 week design and material importation period, followed by an 11 stage construction period of 644 working days. 

Construction work has been tailored to mitigate disruption and allow patient care to continue throughout with careful selection of tools for the work at hand alongside physical barriers to address noise transfer and keep out any debris.

Hawkins is using innovative design solutions such as a 'breathable building wrap' to ensure that the increased water tightness of the building does not lead to internal condensation issues later. A High Pressure Laminate product from Austria has been selected for both durability and fire safety integrity.

When works start, we will have in place all the necessary protections. The designed methodology will be carefully adhered to throughout. This will include regular monitoring and checking by Infection Control teams. They will sign off our progress for patient and staff safety every step of the way.

CM health will also be erecting appropriate barriers to ensure that passers-by are not in the area, and will continue to recheck panels on sections of other buildings that may be high risk (for example the KidzFirst and McIndoe buildings) to apply repairs.

 

What about asbestos. What air monitoring is CM Health undertaking?

There are 2 types of air monitoring for asbestos currently undertaken at CM Health:

  • Air monitoring as part of remediation work (in accordance with the current code of practice and regulation)
  • Background/reassurance monitoring where a potential risk has been identified and/or monitoring has been recommended

The air monitoring for remediation work has been carried out in the Galbraith building, including basement plant rooms, the sub-basement and PABX room, and the plant room in Esme Green.

As further remediation projects are approved we will continue to carry out appropriate monitoring.

Background monitoring has, and continues to be, undertaken in the Galbraith building only.

Areas that have undergone initial assessment are in the basement (corridor, Phlebotomy, PABX, plant rooms 4 and 6, and Clinical Records), the operating rooms, and laboratory.

Repeat monitoring is being carried out

  • Corridor Basement - twice weekly since Sept 2017
  • Operating Rooms – x1 per 2 months since August 2017
  • Plant Room 6, post remediation scheduled 1x per 3

None of the locations being monitored to date have exceeded the minimum level 0.01 fibres/ml (trace level).

 

What precautions will be implemented when remediation works are undertaken?

When works commence and walls are demolished, testing will commence.  Testing to date has been primarily to inform how we may undertake the construction works.  The building of barriers will happen when the works are about to commence and before barriers are breached.  This may include blocking off spaces to staff, patients and the public.

 

How long have you known about the issues with these buildings?  Why have you kept this quiet?

The systematic failure of the compressed sheet cladding system utilised on these buildings progressively became well known throughout New Zealand over many years, however it wasn’t until the failure of the cladding on the Scott building in 2012 that the extent of the problem at Middlemore Hospital was realised.

 In 2012, in fine conditions, a cladding panel fell from the Scott Building near the entry to the Day Dialysis unit. CM Health took immediate action to protect the public and to secure the panels at greatest risk. This lead to subsequent investigations that identified the panel system had failed by systemic failure compounded by poor workmanship issues.  Following investigations on Scott, CM Health further investigated the effects on buildings that were built around the same time and using the same materials as the Scott building.

The problem buildings are those that were built around the year 2000.  Building codes of the day allowed non-treated timber and the use of direct fixed painted compressed sheet cladding reliant on back seals.  Over time, the consequence of non-treated timber and the cladding itself deteriorating has resulted in water damage.

Recladding issues with four buildings have been on CMDHB’s work programme.  This means we have been gathering technical expert advice (including the Alexander and Co report) to assess the extent of damage by testing random sites.  This work has also involved piloting how a remediation works might happen in a live operating hospital.  We have also been consulting with senior clinicians and managers through our normal decision making bodies (e.g. Hospital Management Team) to scope the approach to replace cladding.

We have also been preparing business cases and proposals for the Board endorsement for the full remediation.  The cost of all the buildings are not yet formal proposals because we are still working out cost estimates.  We believe we need to start with Scott building first to test how the works method may work, how complex (or simple) the works might be and build up a more accurate estimate of costs to remediate the following buildings.

We have not kept these issues quiet although we have been limited in what we can say publicly because we are still in negotiation with a contractor to undertake the works.  We are pleased to confirm that the Minister of Health and Minister of Finance both agreed additional funding so that we can start work on the Scott building last week.

 

What recourse have you had with the builders?

CM Health took legal action against the design build contractors and eventually accepted a cash settlement in 2017.  A contract to remedy those defects and install a compliant cladding system is currently being negotiated and close to signing.

The confidential settlement with Hawkins was arbitrated by the building disputes tribunal and only covered the Scott building as we had no legal recourse on the other buildings. This is because by the time the issues with the other three buildings (which are older than the Scott building) came to light, it was outside the 10 year limitation period in which claims could be made against the builder.  Please note that with any kind of construction dispute a building owner only has 10 years to bring a claim from the date of the building work.

Comment has been made that the settlement was low compared to cost of remediation.  The settlement took into account that the new cladding would improve the building, extending its life and adding value.

 

How long is this going to take?

The current estimates suggest that it will take about 5 years to complete recladding works assuming we start this year.  This is because we will be undertaking the work while the hospital remains operational.  We have preferred this approach because we cannot close beds given our acute demand pressures – particularly over winter.  We will also start with the Scott building, learn from the first few months of experience and then be able to plan the remaining buildings based on those learnings

 

There has been comment in the media about power supply. Is the electrical power supply to CMDHB Facilities reliable?

CM Health considers the electrical power supply to CMDHB facilities, including Middlemore Hospital and the Manukau Superclinic to be reliable.

There have been three power supply incidents mistakenly represented as one in media reports.

Power outage 9 October 2017

The Middlemore high voltage supply cables tripped on high current at 1.18 pm on Monday 9 October 2017. All generators in the affected area, apart from two, operated as expected. The two generators covering KidzFirst and the McIndoe building started but due to various control issues, did not connect for nine minutes.  

Critical functions are not affected by these types of issues and saw no loss of power supply because they continually run on batteries via Uninterruptible Power Supplies (UPS). The batteries are constantly being recharged via the Essential Power supply/generators.  During those nine minutes patients and staff saw a loss of power and the activation of emergency lighting.

The Middlemore high voltage circuit breakers have since been reviewed and adjusted and consultants will undertake an asset remediation review.

Power outage 11 March 2018

Transpower had a transformer issue that affected a significant part of Mangere including Middlemore Hospital from approximately 4.15pm to 5.30pm.

During this time the six generators supplied power to the Essential Power, after the standard 20 seconds it takes for them to connect to the power supply. Critical functions are not affected by these sorts of outages because they run on batteries via Uninterruptable Power Supplies (UPS).

Patients and staff experienced a 20 second loss of essential power before the generators took over. Non essential power was affected from 4.15pm to 5.30pm.

Non Essential power issue at Counties Manukau SuperClinic 3 April -28 May 2017

Vector owns and operates the 2 high voltage power cables which supply the Manukau Health Park (of which the Superclinic is a part).  One HV cable supplies the Essential Power system (which is backed up by a CMDHB generator), the other HV cable supplies power to the Non Essential power system.

We have experienced one significant fault.

At approx. 5.45 pm 3 April 2017 the Vector Non Essential high voltage power supply cable faulted. This resulted in the Manukau Health Park having HV mains power for the Essential Power system and no power for the Non Essential Power system. This is a normal system design. 

The CMDHB emergency generator, which is reserved for the use on the Essential Power system, was not subject to a power failure and as a result was not required to start, as per normal system design.

CMDHB engineering staff attended the outage in conjunction with Vector staff.  Initial investigations were undertaken to determine the fault was on the high voltage supply side.

At approximately 7.30pm CMDHB engineering staff manually started the CMDHB emergency generator and manually operated switches to allow the emergency generator to supply the Non Essential power. 

This design feature allowed CMDHB the flexibility to use the emergency generator for the Non Essential supply, and provided resilience to the overall system.

Vector undertook emergency investigations to locate the fault, which was underneath the building.  Vector determined the fault to be unrepairable.  Vector supplied and connected a large temporary generator over the night of 3 April. This meant the HV mains were supplying Essential Power and the Vector generator was supplying Non Essential power.

When the Vector generator was on-line, the CMDHB generator was stopped and again switched to provide back-up to the Essential Power supply.

The period that Vector provided a generator to cover the Non Essential power system was from 3 April to 28 May. No surgeries were cancelled or postponed as a result. There was a half hour delay to the beginning of the day on 4 April.

Vector has subsequently replaced the 2 original HV cables with 2 larger capacity cables which will also cater for future electrical load at Manukau Health Park.

CMDHB has ongoing projects to further increase resilience of the power system. This is referred to in the Indicative Facilities Capital Requirements table under the Remediation Programme heading. There is a line which refers to Manukau Power Resilience Upgrade. The figures are 17/18 $1 million; 18/19 – 21/22 $2 million; Total $3 million.