ESCONDIDO -- Projected construction costs for the new Palomar Medical Center have ballooned from $773 million to $957 million in less than two years, prompting hospital trustees to consider scrapping plans for a central power plant and scaling back other expensive features.

Trustees said Thursday that the $184 million increase might also cause them to cancel plans for Poway's Pomerado Hospital new medical tower, which was a key element of a $496 million facilities bond that voters approved in 2004.

The public health district would save $91 million by eliminating the Pomerado tower from its facilities master plan, district officials said Thursday. Officials said the tower could still be built eventually, if donors are found or if revenue from the new Palomar Medical Center is as strong as predicted.

District officials said the cost increases would not affect plans to remodel the old Palomar Medical Center and build a medical and retail village in downtown Escondido, because those plans rely primarily on money from private sector partners the district is seeking.

Deleting the central power plant at the new Palomar Medical Center would save $68 million, officials said. But it would increase the long-term energy costs for the 11-story facility, which has been under construction since 2007 near the border between Escondido and San Marcos.

Officials said they could also save more than $60 million by eliminating some expensive features planned for the new hospital, such as gardens, terraces, community rooms, outdoor stonework and the rooftop helicopter pad.

Dr. David Tam, the administrator who presented the new cost estimates Thursday night, said trustees would need to decide on the central power plant within three months and decide on plans for the Pomerado medical tower within six months.

Tam said some of the other design changes for the new hospital would have to be made quickly, but that others could wait nearly until construction is complete in 2011.

Tam struggled to explain why the costs of the new hospital had increased so much since the $773 million estimate was presented to trustees in May 2007.

He said $42 million of the increase was related to transferring equipment from the old Palomar Medical Center to the new one. He said another $74 million was based on a new contractor refining the design plans for the facility, some difficulties grinding granite at the site and state officials mandating design changes based on accessibility and other issues.

The rest of the increase is based on confusion about whether the previous contractor had included the central power plant in the design plans, he said.

Cost increases for construction projects were the norm in 2005 and 2006, and cost estimates for the new hospital increased from the initial $531 million to $773 million during that time. But construction costs have leveled off recently in most cases, as prices for concrete and steel have plummeted.

However, hospital officials said they have not benefitted as much from the savings because hospitals are unusual buildings with atypical features.

Cost estimates for all the work planned at Pomerado have increased from $175 million to $201 million since May 2007, but the possibility of canceling the new tower have made those numbers somewhat academic. Total expenditures at Pomerado would drop to $85 million if the tower is scrapped.

District trustees said Thursday that the new cost estimates called for quick and significant action.

"I think we're going to have to make some very serious decisions," said Trustee Ted Kleiter, who suggested that a task force be formed. "We're well beyond what we can afford."

But Dr. Marcelo Rivera, another trustee, said the district should be prudent about the changes because some cost cutting might seem ill-advised to people 30 or 40 years in the future who suffer from inadequacies at the new hospital.

And Trustee Nancy Bassett said the district should be wary of changes that save money on construction, but increase the hospital's long-term operating costs.

"We don't want to save money up front and then end up paying for it for the rest of our lives," Bassett said.

Contact staff writer David Garrick at (760) 740-5468 or dgarrick@nctimes.com.