Preliminary sitework on a new Cherokee Indian Hospital could start as early as December.

The hospital has entered contract negotiations with a construction management company that would oversee construction of a new hospital, estimated to run between $50 to $65 million.

Tribal Council approved the selection of Alabama-based Robins & Morton earlier this month from about a dozen other firms that submited proposals.

“It seems to be moving. We were really glad to get that authority,” said Casey Cooper, CEO of the Cherokee Indian Hospital.

Because the hospital is still negotiating its contract with Robins & Morton, a more exact cost estimate for the project isn’t yet known.

But “We are going to build a hospital within that budget,” Cooper said.

A multidisciplinary panel ranked each company and then invited the top four for in-person interviews, Cooper said

Other multi-million dollar tribal projects, including a second casino in Murphy and an adventure park near downtown Cherokee, have become targets for people who say the tribe is over-extending itself financially. However, the hospital project has been spared backlash from enrolled members given its direct impact on improving and expanding health care on the reservation.

“There is not a greater priority for the tribe than to build a health system for its people,” Cooper said.

The new hospital will be nearly double the size of the current hospital, allowing the Eastern Band to offer additional medical services in-house and expand its office and waiting spaces. The waiting areas in the pharmacy and dentist’s office are particularly tiny.

“It is so small that we feel the community deserves much, much more,” Cooper said. “We believe it is beginning to hinder the ability to enhance our mission” — to improve the health of enrolled members.

Even with the expansion, however, the tribe will not be able to provide all the medical services people need, from childbirth to heart surgery, because there is not enough demand to support specialized doctors in those fields. Instead, health care providers will focus on Cherokee’s strengths, including primary care and disease control.

“Unless you have enough demand in your community to do things frequently and become really, really good at it, then you shouldn’t do it,” Cooper said.