CARMEL MOUNTAIN RANCH -- Seeking to rein in the sharply escalating cost of the new Palomar Medical Center, hospital trustees voted Monday to eliminate $21.4 million in upscale features from the design plans for the 11-story hospital.

The changes include using significantly cheaper building materials, deleting conference rooms and eliminating features such as spiral staircases, outdoor gardens and indoor media screens.

Trustees struggled with many of Monday's cuts, expressing concern that the "no-frills" approach might make the hospital look less like the opulent and impressive "hospital of the future" that the community was promised in 2004 before approving a $496 million facilities bond.

But trustees also agreed that the cuts were crucial because of $184 million in recent cost increases for the new hospital, which has jumped in price from $773 million to $957 million in less than two years.

The increases have been blamed on faulty initial estimates and unexpected complications transferring equipment to the new hospital from the current Palomar Medical Center.

The cuts will make only a small dent in those increases, but hospital district officials said Monday that they found cost reductions worth an additional $17 million in late January.

They also said new plans to hire an outside energy provider could shave $68 million more by eliminating the need for a central power plant in the hospital, which is under construction near the border between Escondido and San Marcos.

This change would increase the hospital's long-term energy costs, but the initial savings still would probably make it worthwhile, according to Dr. David Tam, the hospital administrator who presented the proposed cuts to trustees during a special meeting Monday in Carmel Mountain Ranch.

Tam said that the remaining $80 million in cost increases could possibly be covered by canceling plans for Poway's Pomerado Hospital new medical tower, which would save about $91 million.

But trustees are not scheduled to make any formal decisions on Pomerado until this summer.

The $17 million in cuts made in late January included dramatically scaling back landscaping by using smaller trees and shrubs, Tam said.

Some recent construction contracts have also been cheaper than expected, he said.

The $21.4 million in cuts approved Monday include eliminating water features, an outdoor playground, several gardens, a library, meditation room, conference center and a large electronic drape that would display soothing images.

Hospital officials said some of these features might eventually become part of the hospital if donors are found to pay for them.

But there will be no turning back on another set of Monday's cuts, because they involve using cheaper materials for many features, including indoor railings, the building exterior and the wooden headboards planned for patient rooms.

Trustees also decided to eliminate plans to certify that the facility was built according to the latest energy-efficiency and environmental specifications.

They expressed a commitment to follow "green" principles, but said the $500,000 cost to certify that approach was too high.

Trustees expressed the most concern about the switch to cheaper materials.

Dr. Alan Larson said switching proposed glass handrails to metal made him worry that the third floor might look like a prison, and fellow trustee Nancy Bassett persuaded her colleagues to reject a plan to eliminate the hospital's outdoor stone veneer.

Larson also objected to eliminating the proposed playground.

"It seems to me to be really chintzy," Larson said. "You're going to have all these kids running around in the lobby."

But Michael Covert, chief executive of the hospital district, said the current Palomar Medical Center functions fine without a playground.

And Trustee Marcelo Rivera said cost overruns dictate that "the wish list has to be pared down."

In other news, district architect Mike Shanahan told trustees that construction of the new hospital was about three months behind schedule, and that the new projected opening date was January 2012.

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

Correction: Hospital trustee misidentified

In this article, hospital trustee Nancy Bassett was misidentified.

We apologize.