In November of 2020, in the darkest depths of the Covid-19 pandemic, King County went to voters asking for approval on a new bond that would enable Harborview hospital's biggest expansion in decades. As the only Level I trauma center across a four-state region that includes Washington, Alaska, Idaho, and Montana, Harborview is a medical facility with oversized importance, and overcrowding on the existing campus had been a mounting crisis for years.
Voters signed onto the plan, to the tune of more than 76% approval, giving the green light to $1.74 billion in new funding for some of the aging campus's most urgent upgrades. At the heart of the expansion is a new, 10-story hospital tower, set to be perched over I-5 where a parking garage now stands. But six years later, cost increases are threatening that plan, with the timeline to open that new tower now pushed from 2028 to late 2031 at the earliest.
As costs increase with inflation, unexpected issues have also added costs as the expansion advances through planning and into design. A briefing at the King County Council in late May spelled out where things currently stand: County officials now expecting the project to cost at least $2.25 billion. King County's hired contractors, Mortenson and Perkins&Will, are giving an even higher amount to complete the work – $2.43 billion.
"We're in step two, which is schematic design, but it's a modified step two because the contractor and the county are not aligned as to what we believe the cost of the various components of this hospital are," Tony Wright, director of King County's Harborview Construction Infrastructure Division, told councilmembers.
This isn't the first time the Harborview bond plan has run into issues. Three years ago, the county set up what was dubbed an "Ordinance Workgroup" to determine how to handle increased program costs. That group ultimately proposed scaling back several major elements, including three floors of the new tower that are now planned to be built but left "shelled" and fully completed later when more funding is available.
Frustration is mounting at the King County Council over the project's trajectory.
"The costs are just escalating out of control," King County Councilmember Claudia Balducci told Wright. "It is very frustrating to hear about major system elements, without which we can't deliver this project, because you were there the entire time on every single aspect of planning this reduced scope, and now we're saying we can't even deliver this reduced scope."
One factor pushing costs higher? Parking. Despite the county not identifying parking supply as a major issue when the bond program was being developed, coordination around maintaining the number of spaces on campus has jumped to the forefront of planning. The View Park I garage, set to be demolished to make way for the new tower, contains 350 spaces that Harborview administrators are wary of losing, citing potential impacts on patient access in the wake of a shift toward outpatient‑centric operations.
To make up for those lost stalls, King County is designing a large parking structure at 9th Avenue and Alder Street, built with the intention of later adding medical space above. The costs on that new garage have ballooned, to a staggering $160 million. The county wants to have that new garage open before construction on the tower starts – scheduled for early 2028 – and yet that new garage isn't fully funded.
Even without the View Park parage, Harborview contains more than 2,000 parking stalls campus-wide, including more than 600 at the Ninth & Jefferson (P2) garage, and 300 at the Patricia Steel Building (P3).
Demand for parking at Harborview will always outstrip supply, given the hospital's urban campus. Earlier this year, the King County Auditor's office noted the potential for the larger issue of parking demand on campus to subsume the simple issue of replacing the lost stalls from View Park I.
"Moving forward with parking solutions before the Bond Team clearly delineates proportionality and funding sources for non-bond-related parking construction increases the risk that building additional parking could increase costs and impact the Bond Team’s ability to deliver the approved program plan," an Auditor's Office report from March noted.
Unexpected costs have popped up elsewhere, too.
Seattle's energy code now requires buildings like the new tower to be 100% electric, a fact that isn't in alignment with previous cost assumptions nor the county's goal for the hospital – the regional emergency management command center during natural disasters – to be able to rely on backup gas power.
Instead, the new plan is to convert part of the Harborview campus into an "energy district" – which would entail upgrading several other existing buildings. The added costs to do that are approximately $90 million, though the county expects to recoup that over time, thanks to Seattle City Light's new large load policy that would make monthly electricity costs on the new medical tower incredibly pricey.
The campus expansion plans also include a new "loop road" to be built between the new tower and I-5 for additional access points to the new building. This would essentially be an elevated bridge given the geography of the area, and requires a lease from the Washington State Department of Transportation (WSDOT), which has already rejected an initial lease request.
Without the loop road, the project could save $75 million, but it would require evaluation of "safety and patient‑access impacts," which includes the need for buy-in from Seattle Fire.
Steffanie Fain, who served on the Harborview board of trustees before being elected to the County Council last year, echoed Balducci's frustration with where things currently stand.
"None of these are new things. The parking garage that we are looking to build on Ninth and Alder was actually intended as a cost-saving measure, because the original tower plans involved digging down into the earth and having an underground parking garage, and in order to not have to do that and have increased costs," Fain said. "So, when I see additional costs as increasing the cost of this project, it's very disturbing to me, because this was intended to actually save the project costs."
With immediate parking needs at the heart of the county's current approach to delivering this expansion, it's also not clear that all of the options to manage transportation – outside of a new $160 million garage – have been fully exhausted.
Tim Pfarr, a spokesperson for King County's Facilities Management Division, referred The Urbanist to the draft Transportation Management Plan being developed in coordination with the City of Seattle, after we inquired about the Harborview campus's commute trip reduction policies. That plan notes a goal of 25% of employees commuting by single-occupancy vehicle during traditional office hours – a figure that was nearly 40% in 2024.
"Harborview promotes commuting alternatives for staff but will always need to have onsite access for patients so that they can receive the care they need," Pfarr said.
The coming months will be a critical one for the overall expansion plan, as the county and its contractors attempt to get on the same page when it comes to total cost. If they can't, King County may be forced to look for a new set of firms.
"What we will do is get to a guaranteed maximum price. That happens later on. That guaranteed maximum price is where the negotiation is," Wright said in response to concerns over the contractor's proposed price. "There's a bunch of stuff where I think their numbers are soft, and I don't intend to give... I want them to make a profit, but not very much of one."
Jeff Muhm, a special advisor in Executive Girmay Zahilay's office, also weighed in on the commitment to moving this project forward as approved by voters.
"I just wanted to state that Executive Zahilay is committed to delivering this project, working with all of you, UW Medicine, and the board in finding ways to make this happen," Muhm said, noting that the County now has access to a special property tax to fund hospitals that was approved by the legislature in 2024. "We think there is ample ability of the tax to continue to support Harborview operations and to find ways to make up for some of these shortfalls, but we would need to work with the hospital, meaning UW Medicine and the board, [and] the council to come up to game that out."
Members of the county council appear more alarmed.
"What concerns me is you have someone who's presumably knowledgeable about what it's going to take to build this project, and they're telling us this is what it's going to cost, and we're telling them, well, we don't have that much money," Councilmember Rod Dembowski said. "That sounds like a recipe for big trouble to me."
Amy Sundberg
Ryan Packer
