For two years, hospital officials rolled dice in a real-life game of Monopoly and hopped property to property on the Pittsburgh game board to find the best site to build a new hospital.

It turns out Children's Hospital finally did find its Boardwalk, but it came close to settling for Pittsburgh versions of Marvin Gardens.

In Lawrenceville, the new hospital now sits ready to open. While Monopoly features real estate named St. James Place and St. Charles Place, the hospital ultimately relied on St. Francis to provide the 10 acres where it built a majestic, colorful and highly organized hospital campus along Penn Avenue.

But getting to that point is a tale of persistence, setbacks and surges that ultimately overcame the inclination to wedge a big, new hospital into postage-stamp spaces in Oakland.

Roger A. Oxendale, Children's CEO and president of the Children's Hospital of Pittsburgh Foundation, said the board in 2000 conducted a study to determine the cost of renovating the current hospital on Fifth Avenue and DeSoto Street in Oakland. The oldest section of the hospital was built in the 1930s, with an addition to upgrade the emergency room and add auditorium and conference-room space, then another upgrade in the 1980s to build the middle tower.

But myriad additions in the tight space created a labyrinth, further aggravated by three elevator systems needed to access different sections of the hospital.

"Get on the wrong elevator and you are wandering," said Mary Jo Howard Dively, chairwoman of the hospital's board of trustees. "A decade ago we were sitting in the dark, crowded hospital in Oakland and thinking that clearly something had to be done."

The board study determined it would cost $185 million to upgrade electrical systems and rooms, without addressing problems with patient flow through the hospital maze.

"At that point we looked at it, and the board said it makes no sense to put that kind of money into a facility that doesn't work," Mr. Oxendale said.

So the board focused on building a new hospital or finding another building onto which a children's hospital could be attached.

The first candidate site was Magee-Womens Hospital of UPMC along Forbes Avenue. The board had three strategies: It could use hospital space not being used, build an addition onto Magee, or build a bridge or tunnel to connect the former Isaly's building across the Boulevard of the Allies with Magee for additional space.

Once again, the spectre of another tangled maze began to merge.

"It didn't work," Mr. Oxendale said, and "it didn't allow Magee-Womens or Children's any expansion capability."

And while the hospitals could have shared the neonatal unit, nurseries and intensive-care units, Magee lacked laboratory support and radiology services that would have had to be built on-site.

Next, Children's officials turned attention to the former LTV Steel site along the Monongahela River in Hazelwood, which offered lots of space but serious problems.

Not only was the road system to it less than ideal, but there also was concern about the potential of toxic materials requiring remediation at the old industrial site.

"It's one thing to put manufacturing there," Mr. Oxendale said. "But it's another thing to put a research facility and hospital on that site."

It also put too much distance between Children's and the University of Pittsburgh, creating a logistical nightmare for medical and academic staff members who divide time between the two.

In 2001, the board of trustees began negotiating to join the University of Pittsburgh Medical Center, whose officials suggested relocating Children's to UPMC Montefiore about a block away in Oakland.

That idea took root. UPMC acquired homes behind Montefiore to make room for construction of an outpatient facility and inpatient tower behind Montefiore, with another addition in front. The two new buildings would have been connected through Montefiore's seventh floor.

"But we were struggling with issues of parking and traffic congestion with hospitals becoming more concentrated in Oakland," Mr. Oxendale said. "There also was growing concern that construction would disrupt ongoing operations at Montefiore."

UPMC forged ahead with architectural plans, and Children's readied for the move to Montefiore. Then another option emerged.

Children's merged with UPMC on Oct. 31, 2001. About that time St. Francis Hospital in Lawrenceville decided to close due to financial struggles, and Highmark provided grant money enabling UPMC to buy that property.

Plans being developed for Montefiore were adapted to the St. Francis site. Demolition got under way. A psychiatric facility was renovated and expanded to become the Faculty Pavilion, with physician offices.

A parking garage was demolished to make room for the inpatient tower that serves as the central structure for the new 900,000-square-foot hospital. Sixty percent of the hospital building represented new construction, with 40 percent involving old St. Francis Hospital structures that were gutted, rebuilt and remodeled, Mr. Oxendale said.

But, in 2003, Children's and UPMC had a major disagreement over costs, including construction of a radiation oncology center and additional rooms on the Lawrenceville campus. UPMC felt the hospital was spending too much. Children's argued that children needing radiation treatments were too sick be taken by ambulance to UPMC's Hillman Cancer Institute in Shadyside.

"There was a very public dispute between Children's and UPMC," Mr. Oxendale said. "Ultimately UPMC and our board came to agreement that it made sense to have radiation oncology on site, and the facility was sized the way we had planned for it to be sized."

In turn, Children's agreed to cost-control measures, including forfeiting a fast-track process in favor of a bid-and-build approach to construction. The debate added a year to the project and led to the resignation of former Children's CEO Ronald Violi, who preceded Mr. Oxendale.

UPMC is responsible for $525 million of the $625 million total cost of the new hospital, with the Children's Hospital of Pittsburgh Foundation responsible for $96.8 million.

Jeffrey A. Romoff, UPMC president and CEO, said the decision to move to the St. Francis site, and include nearly all facilities there, "in hindsight was exactly the right decision."

"I think it is the best site," Mr. Romoff said.

Only Children's adolescent medicine clinic, weight management program, Down syndrome clinic, child development unit and some pediatric behavioral health services are staying in Oakland, according to Dr. Steven Docimo, the hospital's vice president for medical affairs.

That's because the clinics mostly serve patients who live in the neighborhood and surrounding areas, he said.

"These are busy programs based on the local population," Dr. Docimo said. "If you move a primary care practice 10 miles away, you will lose those clients or make them travel farther to be seen. It would be a major inconvenience for a lot of families."

The move to Lawrenceville also represents an effort by UPMC to discontinue concentrating all system hospitals in Oakland.

UPMC "is spreading its wings throughout the region," Mr. Romoff said. Although UPMC never will recover its investment in Children's, he said UPMC "preferred to do the right thing, however costly."

"We see Children's Hospital becoming a national and international treasure," he said. "This community did not have the resources to build a new children's hospital. That is why they cleverly looked at the arrangement with UPMC, and UPMC came up with the resources."

Mr. Oxendale said the result is a vibrant and inviting campus for children that features 1.5 million square feet of usable space with a medical staff of more than 700 board-certified pediatricians and pediatric specialists.

Patient flow will be vastly improved inside the spacious hospital that includes state-of-the-art MRI and CT scans, a hybrid catheterization laboratory and other improvements.

The number of beds also will grow from 262 in Oakland to 296 in Lawrenceville, with 79 critical-care beds and a 41-bed emergency department and trauma center. With its medical records fully computerized, the hospital expects to improve communications and reduce medication and tracking errors.

By repeatedly rolling the dice, reacting to circumstances and adjusting its decisions, the board and UPMC created a world-class facility designed to improve health outcomes for young patients.

"We believe that it will improve our rating," Mr. Oxendale said. "We believe it will obviously enhance patient and family experience and allow us to recruit additional researchers and pediatric specialists to Pittsburgh."

On Saturday, patients will be moved to the new hospital, which will open for business.

It represents the region's largest construction project, topping the price of PNC Park ($216 million), Heinz Field ($281 million), the David L. Lawrence Convention Center ($373 million), the Consol Energy Center ($321 million) and the North Shore Connector ($552.8 million).

"Looking back, it amazes me that we thought we could pull this off," Ms. Dively said. "It proves that great accomplishments are not done by a sweeping announcement ... but by thousands of right decisions."

First Published: April 26, 2009, 8:00 a.m.