CARMEL MOUNTAIN RANCH -- Cost estimates for the new Palomar Medical Center have not previously included roughly $20 million that will be spent familiarizing employees with the new facility, relocating equipment and transferring patients, hospital officials said Monday.

Those efforts will take place primarily during the six months before the new hospital opens in early 2012, and during the first six weeks of operation, officials said at a meeting to discuss costs and cuts for the new hospital, under construction in western Escondido. Most of the employees and programs at the existing Palomar Medical Center in downtown Escondido will move to the new facility.

Hospital officials said they plan to pay a Maryland firm more than $1 million to help plan and coordinate the transition between the two facilities. A contract with the firm, Gilbane Transition Planning & Management, will be presented to hospital trustees this spring, officials said.

The rest of the money will pay for staff orientations, extra security personnel for the transition, testing many devices at the new hospital, ambulance trips to relocate patients on opening day, post-construction cleaning of the new hospital and many other hurdles associated with a new facility, officials said.

Marcia Jackson, chief planning officer for the hospital district that governs Palomar Medical Center and Pomerado Hospital, said the cost of such transitions typically amounts to between 2 percent and 3 percent of the construction budget.

That would put the transition cost for the $918 million Palomar Medical Center somewhere between $18 million and $27 million. But Jackson said she was confident the district could keep transition expenses at 2 percent, or roughly $18 million.

Hospital trustees said they were surprised the transition costs had not been included in previous budgets, and Trustee Nancy Bassett urged district staff members to avoid handing trustees large bills at the last minute.

Michael Covert, the district's chief executive, explained that many of the transition costs will be extra money for staff training, which will be included in the district's operating budgets for 2010-2011 and 2011-2012 instead of the capital budget for the new hospital.

Also on Monday, trustees cut another $1.4 million in frills from design plans for the new hospital and received updates on satellite clinics planned for Ramona and Rancho Penasquitos.

Trustees and hospital officials reduced the price tag of the new hospital from $957 million $918 million in January and February by deciding to use significantly cheaper building materials, by deleting conference rooms and by eliminating features such as spiral staircases, outdoor gardens and indoor media screens.

They also dramatically scaled back landscaping and eliminated water features, an outdoor playground, several gardens, a library, a meditation room, a conference center and a large electronic drape that would have displayed soothing images.

Those cuts were made to rein in sharply escalating costs for the new hospital, which has jumped in price from $773 million to $957 million in less than two years.

On Monday trustees saved another $1.1 million by eliminating "Circadian" lighting from patient rooms. Trustees acknowledged that the special lights probably improve healing, but said the presence of windows in each room make the lights an unnecessary luxury.

Trustees saved another $300,000 by reducing the facility's uninterrupted power supply by 50 percent. Dr. David Tam said the supply was not long-term power for emergencies, but something that would help equipment transition smoothly between normal power and emergency generators.

Monday's cuts reduced the estimated cost of the new hospital to $916.9 million.

On satellite clinics, hospital officials said they expect the Penasquitos clinic to go before the San Diego City Council in May or June, and that the county's Design Review Board will discuss plans for the Ramona clinic on March 26.

However, Trustee Marcelo Rivera said both clinics would need help from private sector partners in order to succeed.

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