On January 27, 2026, the Puyallup City Council authorized a development agreement with MultiCare that sets the rules for twenty years of construction at Good Samaritan Hospital — a new patient tower, an expanded central utility plant, new parking structures, and a campus that grows from roughly 1.24 million square feet to as much as 2.25 million. But the first construction crews on campus are not building any of that. They are remodeling the kitchen.
That sequence is not an accident, and it is the most honest thing in the plan. Before a hospital can add 160 beds, it has to be able to feed the people who will fill them — and Good Samaritan’s kitchen, by its own operations chief’s account, is already out of room.
The busiest front door in East Pierce
Start with why this campus has to grow. MultiCare describes Good Samaritan’s emergency department as recently ranked the fourth busiest in the nation — the health system does not name the ranking, but it publishes the volume behind the claim: more than 160,000 patients a year through the ED, and inpatient volumes averaging 21,000 a year. Good Samaritan is, in MultiCare’s words, the only provider of inpatient care in East Pierce County. When this hospital is full, the county’s next option is a drive to Tacoma.
That is the demand side of the master plan the council adopted on June 10, 2025, after a final environmental impact statement issued the month before. The plan runs twenty years on a 34.86-acre campus and is organized in four major phases — a horizon long enough that the facilities team planning phase one is also, whether they like it or not, planning for colleagues who have not been hired yet.
Why the kitchen is the critical path
“The kitchen is the heartbeat of this campus,” Nathan Butts, Good Samaritan’s associate vice president of hospital operations, told MultiCare’s own newsroom. “So we’re still producing over 1,000 meals a day out of just one tray line. This new expansion is going to allow us to quadruple that.”
One tray line, a thousand meals a day, and a campus about to add beds: food service here is not an amenity being upgraded, it is a utility at capacity. The project Abbott Construction began in late 2025 remodels the existing kitchen and builds new space alongside it — new storage, ware wash, cooking, and office space in the development agreement’s itemized scope, then new tray-makeup and cooking lines, with all-new appliances and equipment. In the agreement’s language, this is enabling work: construction that exists to make the patient tower possible. A tower that opens before its kitchen can feed it is not an opening; it is a queue.
Every facilities manager who has sequenced a campus buildout knows this shape. The glamorous project — the tower — sits at the end of a chain of unglamorous ones: the plant, the kitchen, the parking, the ambulance bay. The chain is the plan. Good Samaritan’s documents simply say it out loud, in a filed agreement anyone can read.
What the plan actually builds
The centerpiece is a new patient care tower carrying the 160 new licensed inpatient beds the state Department of Health approved in a certificate of need back in August 2023, plus 30 observation beds — and one detail that tells you the plan expects to be outgrown: a shelled floor, built empty, sized for up to 40 more inpatient beds when the county needs them. Between the tower and the shelled floor, the agreement anticipates the campus accommodating up to roughly 200 licensed beds.
The environmental review’s first phase wraps the tower in the infrastructure it needs: a new parking garage, a small expansion of the emergency department, an expansion of the existing central utility plant, and the tower shell buildout. The utility plant line deserves a plant manager’s pause. A central plant is sized to a campus; expand the campus by a million square feet over twenty years and the plant has to be expanded ahead of the load, in a building that cannot go down while you do it. The phases after the first are deliberately looser — two medical office buildings of about 100,000 square feet each, a second parking garage, a 90,000-square-foot central support tower, a 30,000-square-foot expansion of the existing Dally Tower — and the environmental review is blunt that everything past that first phase is speculative, built as needed, as the hospital decides.
The agreement is itself a facilities instrument
Most hospital construction fights a quiet war with the calendar: permits expire, codes change, street-improvement requirements arrive all at once at the worst phase. The development agreement is Good Samaritan’s answer, and for facilities teams it may be the most transferable idea in the whole project. Under Washington’s development-agreement statute, the agreement vests the development standards that govern the campus — for ten years from execution, on a plan whose term runs twenty — and codifies permit-processing timelines the city and the health system had first sketched in a nonbinding memorandum in October 2024. The timelines lean on the state’s 2023 permit-streamlining law, SB 5290, which the city’s planners cited when they briefed the council.
The street work gets the same treatment. Instead of requiring every frontage improvement up front, the agreement phases curb, gutter, sidewalk, and lighting work to the construction phases that trigger it, and builds in a procedure for reassessing traffic impacts if a future building’s size or scope changes. For a campus that will be a construction site for two decades, that is schedule certainty purchased in advance — the municipal version of a long-lead equipment order.
The ambulance bay is the pressure valve
The agreement’s other piece of enabling work is smaller and more urgent. The hospital’s ambulance bay — already improved under conditions in the master plan and the environmental review — gets an immediate phase of work tied to the emergency department expansion, aimed at vehicle queueing, with a larger ambulance expansion to follow. At the January council meeting, a local first responder told the council that ambulance activity on 12th Avenue had risen, in the record’s words, “from 6 a week … to at times 6 a day,” and asked the city to look at the street infrastructure well beyond the hospital’s frontage.
That is what growth looks like from the cab of an ambulance: not a bed count, a queue. The development agreement treats the queue as infrastructure — phased, conditioned, and tied to certificates of occupancy — which is to say, it treats ambulance access as a utility the campus has to build, not a complaint the neighborhood has to file. On a campus whose emergency department is among the busiest in the country, the bay is plant equipment.
Twenty years on a campus that never closes
Everything above happens on a working hospital — the only inpatient hospital in its half of the county — that does not get a single closed day in twenty years. That is the discipline this site has written about before, from the infection-control side: building inside a hospital that never closes is a phasing practice before it is a construction one. Good Samaritan is that practice at campus scale and decade scale: containment and dust control become traffic control and utility cutovers; the one-project infection-control plan becomes a twenty-year sequence in which every phase has to leave the hospital fully operable for the next.
It also makes Good Samaritan the sharpest example in the county of the pattern this series mapped in Pierce County’s facility types: a Level III trauma center whose building program is being driven, visibly and on paper, by the volume of the community around it. The plan’s first visible act is a kitchen. The plan’s last act, sometime in the 2040s, is a campus twice its current size. Between those two points is twenty years of facilities work — most of it, as usual, in the buildings nobody photographs.
Sources: MultiCare Vitals, “Good Samaritan Hospital expansion kicks off with kitchen remodel”; City of Puyallup, Good Samaritan development agreement (authorized January 27, 2026) and final EIS fact sheet (May 21, 2025); Puyallup City Council records, December 2, 2025 and January 27, 2026, via Citizen Portal. Master plan adopted by the Puyallup City Council, Ordinance No. 3322, June 10, 2025.
Run facilities in Pierce County? Tell us what we missed — corrections and practitioner quotes are credited by name, by org, or fully anonymously, your choice. We’d rather cite the people who do this work than describe it from outside.