Title
It is recommended that the Capital Improvement Committee receive a report on Natividad Medical Center’s key capital projects from January 1, 2026, through July 31, 2026.
Report
RECOMMENDATION:
It is recommended that the Capital Improvement Committee receive a report on Natividad Medical Center’s key capital projects from January 1, 2026, through July 31, 2026.
SUMMARY:
Natividad Medical Center (NMC) is responsible for managing, operating, and maintaining facilities and roads within the NMC campus. The Natividad Project staff administers capital projects focused on strategically upgrading the hospital by reconfiguring and remodeling the campus to better accommodate healthcare services.
DISCUSSION:
Below is a list of active and new projects that Natividad is prioritizing as key capital improvement initiatives. These projects encompass a broad range of needs, including campus roadway improvements, departmental tenant improvements, and utility upgrades. Collectively, these initiatives are intended to enhance the hospital’s overall appearance, improve the patient experience and satisfaction, and ensure that all critical utility systems operate reliably, efficiently, and to the highest standard.
Active Projects
Parking Lots and Roadwork:
The NMC campus needs significant roadway and parking improvements, including restriping and resurfacing parking lots, adding parking spaces, and resurfacing the main roadway. The main roadway has extensive asphalt damage that requires removal and replacement to prevent further deterioration.
Natividad staff worked closely with a civil engineer to develop the project scope and specifications. The project team also worked with a Job Order Contractor (JOC) to value engineer the project and prioritize the areas with the most damage.
The project is close to meeting the available budget and moving forward with the latest price proposal. An additional $900,000 in funding has been allocated, bringing the remaining project balance to $906,609.
Med Surg 3 Refresh:
This project represents an important opportunity to modernize and renovate the third floor of the Medical/Surgical Unit, which has not undergone significant updates since its original construction in 1999. The comprehensive remodel will transform all patient rooms, corridors, and nurse stations, creating a more comfortable, efficient, and healing environment.
Patient rooms will be upgraded with computerized charting capabilities, new casework, and updated tile finishes in patient bathrooms and shower areas, enhancing both functionality and aesthetics. Collectively, these improvements will elevate the overall quality of the facility and support the delivery of safe, high-quality patient care in a modernized setting.
The Natividad project team has partnered with HGA Architects, and the construction documents have been completed and approved by Health Care Access and Information (HCAi).
Following the Board's approval to solicit competitive bids on October 21, 2025, Natividad advertised and solicited bids for the renovation and modernization of the Medical-Surgical Inpatient Unit on the third floor of Building 500. Because only one bid was submitted, moving forward with an award would limit competitive evaluation and may not yield the most advantageous outcome for Natividad and the County. Staff recommended that the County reject all bids, modify the bid documents to attract wider participation and improve competitiveness, and approve the re-advertisement of the "Notice to Bidders" for Project No. 9600-55, Medical-Surgical 3 Renovation, in a newspaper of general circulation.
The Project will go back to the Monterey Board of Supervisors to advertise with the revisions described. As a result of the bid rejection and revisions, the completion date has been revised from December 2026 to December 2028. An additional $7,100,000 in funding has been secured to support the project, resulting in a revised remaining project balance of $7,605,675.
ER Modular Building:
The Emergency Department (ED), located on the first floor of Building 500, provides critical care for patients with urgent and emergent medical needs. To enhance timely access to appropriate emergency services, a planned ER Modular Building was proposed in alignment with Natividad’s mission, vision, and values.
Addressing ED overcrowding remains a top priority, as it directly affects the delivery of safe, high-quality care. Research demonstrates that delays in treatment can lead to prolonged wait times, higher rates of patients leaving without being seen, increased elopement, and overall decreased patient satisfaction.
Administrative leadership conducted a comprehensive evaluation of the feasibility, costs, and operational benefits of utilizing modular construction to expand or enhance the existing ED. Considerations included patient capacity, patient flow optimization, and whether the solution would best serve as a temporary or long-term strategy. Following this assessment, Natividad’s leadership determined that capital resources would be more effectively invested in a permanent, single-story expansion of the Emergency Department to ensure sustainable growth and long-term operational efficiency. This project has incurred expenditures totaling $601,482 with a remaining balance of $7,195,068. As Natividad is no longer moving forward with this project, the project balance has been re-allocated to the new Emergency Department Expansion project.
New Projects
The Natividad Project team is taking a new approach for the new, larger scale projects. The team is strategically obtaining construction cost estimates at key stages throughout the design process to develop a more accurate understanding of the total project cost. This approach will support appropriate capital financing and help ensure the projects are completed on time and within budget.
Historically, estimating project costs primarily based on square footage has not provided sufficient accuracy, which has led to cost increases, delays, and change orders. Implementing a step-estimating approach will allow the team to progressively refine project costs throughout design, identify potential issues earlier, and make more informed decisions. This approach will ultimately provide greater cost certainty and improve project delivery overall for the following projects.
Emergency Department (ED) Expansion:
The ED Expansion Project proposes increasing Emergency Department (ED) treatment capacity to manage peak patient volumes better while maintaining safe, high-quality care, improving patient satisfaction, and supporting positive clinical outcomes. The initiative is designed to address current space limitations that contribute to longer wait times, increased rates of patients leaving without being seen (LWBS) or eloping, decreased patient satisfaction, and potential impacts on the quality of care. The project includes developing a flexible staffing plan, evaluating necessary equipment and supplies, identifying physical plant modifications to meet regulatory requirements and enhance the patient experience, and establishing and communicating an effective patient flow process to physicians, department leaders, and staff.
Natividad Medical Center has partnered with local architect Kasavan Architects, with subject matter expert support from Huddy HealthCare Solutions, to engage key user groups in developing a modern, efficient, patient-centered Emergency Department that supports Natividad’s vision of providing accessible, high-quality, high-value health care services.
The proposed design will expand and enhance the Emergency Department by adding two trauma bays, 11 examination rooms, a dedicated decontamination shower and examination room, three rapid medical evaluation rooms, and improved staff circulation and workflow. The project will be implemented in two phases. Phase one will focus on new construction and minor renovation of the existing Emergency Department. Phase one will increase treatment capacity and improve operational efficiency. Phase two will include construction of a new entrance designed to enhance patient and visitor security, improve screening and access, strengthen wayfinding, and provide more efficient access to the appropriate areas within the facility.
As of July 31, 2026, current design expenditures for this project are $385,991. The remaining project balance of $7,984,867 in capital is still available for design, soft costs, and a portion of construction. Additional capital will be required to completely fund the project.
Non-Structural Performance Category (NPC)-4 Building 600A/600B Removal of Acute Care Services:
Senate Bill (SB) 1953 is a California law that establishes seismic safety requirements for hospital buildings to help ensure they can withstand earthquakes and continue providing patient care afterward. The overall goal of SB 1953 is to ensure that California hospitals remain safe and functional following a major earthquake. SB 1953 is an unfunded state mandate, and hospitals must comply by January 1, 2030.
NPC-4 is a hospital seismic standard that requires hospital equipment, utilities, ceilings, and architectural elements to be secured so they can withstand an earthquake and continue functioning safely.
This project includes separating two buildings as one of the buildings will not meet seismic compliance in 2030, constructing a new corridor, and relocating essential services to the compliant building. The two areas will be physically separated by a 4-hour fire rated wall. The newly constructed corridor is the gateway from the main hospital to the Mental Health Unit.
Additional work will include relocating utilities and installing new seismic bracing to improve the seismic resilience of building systems and components. The project will also include construction of a new medical gas tank storage yard and the anchorage and bracing of storage racks to provide appropriate seismic restraint for critical non-structural components and stored materials.
The Natividad project team has partnered with 19-Six Architects, and the construction documents are currently undergoing backcheck review with HCAi. As the review has progressed, several comments have required more extensive revisions to certain structural components of the design. 19-Six is developing the necessary revisions and preparing a proposal for the related additional design services. The available project balance is expected to be sufficient to cover these additional costs.
The current project budget is $2,649,400. As of July 31, 2026, expenditures for design services and HCAi fees total $1,846,741, leaving a remaining project balance of $802,658. This balance does not include construction administration services.
NPC-5 Installation:
In addition to meeting NPC-4 standards, the hospital must also meet NPC-5 standards per SB 1953. NPC-5 requires the building to first satisfy NPC-4 requirements, including appropriate seismic anchorage and bracing of applicable architectural, mechanical, electrical, and hospital equipment and systems. NPC-5 adds specific 72-hour emergency-operational capabilities, including onsite water supplies and provisions for sewage and liquid-waste handling, integration with the building plumbing systems, an onsite emergency electrical system for critical-care areas, provisions supporting radiological services, and an onsite fuel supply sufficient for 72 hours of acute care operation.
The project includes installation of an above-ground domestic water storage tank and an underground waste storage tank, both designed in accordance with the facility’s Water Rationing Plan and the NPC-5 upgrade application approved by the State of California. The above-ground domestic water storage tank will be located within a new enclosed yard at the north end of the campus, while the underground waste storage tank will be installed next to the existing parking lot “E” on the south end of the campus. The work will also include installation of isolation and shut-off valves to allow domestic water service to be limited to acute-care buildings during an emergency event, as well as connections to existing domestic water and waste systems and associated controls coordination.
The Natividad project team has partnered with 19-Six Architects, and the construction documents are currently undergoing backcheck review with HCAi. The plan-check comments have been received and are being addressed by the design team. Based on the comments received and reviewed to date, no major revisions to the construction documents are anticipated. While the scope may continue to evolve through the backcheck process, the current project balance is expected to be sufficient to complete the remaining design work.
The current project budget is $1,199,992. As of July 31, 2026, expenditures for design services and HCAi fees total $1,016,020, leaving a remaining project balance of $183,972. This balance does not include construction administration services.
OTHER AGENCY INVOLVEMENT:
This report is scheduled to be presented to the Capital Improvement Committee.
FINANCING:
Capital projects are funded by NMC’s approved capital funding. Where capital projects exceed $100,000, funds are transferred from NMC Enterprise Fund 451 to NMC Capital Strategic Fund 404 to ensure funding is available for approved projects. Funds are transferred from the Capital Strategic Fund to the NMC Enterprise Fund as expenditures are paid to vendors.
Prepared by: Brian Griffin, Project Manager (831) 783-2605
Approved by: Andrea Rosenberg, Assistant Administrator, (831) 783-2562
Attachments: Project Matrix