When most people in the Houston area think about healthcare, they think about the Texas Medical Center (TMC), world-class doctors, skilled nurses, hospitals, clinics and the facilities people depend on when they need care. But behind that healthcare system is another essential component that often goes unnoticed: Houston Water Infrastructure. Reliable water and wastewater systems help keep hospitals and medical facilities operating 24 hours a day, seven days a week—and that makes water infrastructure an important part of Houston’s healthcare resilience.
When most folks in the Houston area think about healthcare, they think about the Texas Medical Center (TMC), the best doctors in the world, skilled nurses, tier-one hospitals, clinics and the facilities where people go to when something seems to be array with their health.
But for those of us working on municipal public works projects, we know there is another side to the healthcare story. It’s water. Yes, water. Reliable water and wastewater infrastructure helps keep the Texas Medical Center operating 24 hours a day, 7 days a week. So, to say the least…
Water Is Crucial
…and we all know the importance of dependable water that supports handwashing, sanitation, equipment processing, cooling systems, preparing food or even specialized medical services such as dialysis. But did you know that federal agencies like the CDC developed specific guidelines for hospitals and healthcare facilities because of the critical nature of water for not only use in hospitals but also for emergency water-supply planning.
This is why the City of Houston Mayor John Whitmire sounded the alarm about a threat to homeland security if the TMC goes down due to no water or faulty water treatment facilities. He did so to stress the importance of investing in the cities almost 50-year-old water facilities like the East Water Purification Plant.”
What We Know About Houston’s Water Infrastructure Behind Healthcare
Houston’s water system serves households and more than 5 million people across the region. Two industries that are the system’s largest users are the Texas Medical Center and the region’s petrochemical facilities. This places water infrastructure squarely in the conversation about healthcare resilience especially when one of the most important pieces of the city’s system is the East Water Purification Plant (EWPP).
In April 2025, Mayor John Whitmire was candid about the condition of this plant:
“It’s barely running with tape and baling wire, and no one’s talked about it. I’m going to be very transparent; we’ve got to replace that.” (NewsRadio 740 KTRH)
The mayor also described the consequences of a significant failure as extending well beyond Houston:
“Pasadena, Bellaire, West U, they buy Houston water. Also, it furnishes water to the refineries, so it’s a homeland security issue.” (NewsRadio 740 KTRH)
Importantly, Mayor Whitmire said at the time that there was not an imminent crisis. His point was that Houston could not afford to continue postponing investment in critical infrastructure. (NewsRadio 740 KTRH)
And then there is the Texas Medical Center…
When I attended the recent City of Houston Public Works Industry Day a week ago, one engineering consultant that has been around a while shared with me some of the complexity with the city’s existing water infrastructure.
For example, one of Houston’s major water transmission lines is the South 60-inch line that carries roughly 35 million gallons of water a day from the East Water Purification Plant toward southwest Houston, including the Texas Medical Center service area.
When the City needed to perform a major condition assessment of this line, you couldn’t just shut off the water and get to work. It took roughly two years or more of planning and construction of alternate transmission capacity before the long-term shutdown could occur. Doing so was essential as it helped to minimize impact(s) to the TMC and other customers.
This was interesting news to me and what I call planning for continuity of service!
So, think about what happens when a dependable water source becomes uncertain inside a major healthcare facility. Patient care does not stop needing water because a water leak or faulty water facility stops working and is a problem outside of the hospital.
TMC is an ecosystem that continues to operate and where hundreds of thousands of people place their confidence in hospitals, clinics, etc. to be operating when needed.
Capital investment has to become functioning infrastructure
The good news is that Houston is already investing in its water system. And funding for the East Water Purification Plant has been allocated to some degree to start improvements.
In February 2026, Houston City Council considered approximately $19.9 million in additional funding for professional engineering and technical consulting associated with expansion of this plant. In June 2026, Houston City Council also considered additional engineering work involving rehabilitation of a plant control room and design of a new operations and maintenance facility showing more proof of the city’s commitment and investments in water infrastructure.
But in our lane, we know that allocating capital is only one part of delivering new infrastructure. After Engineering, environmental requirements and other scopes, permitting and regulatory approvals still must move.
The State gets involved in public water systems. The Texas Commission on Environmental Quality (TCEQ) reviews plans and specifications for new systems and significant changes to existing systems to help determine whether they can provide adequate quantities of safe drinking water. This regulatory process helps to protect the public and is a key part of projects’ delivery schedules.
When permitting and regulatory approvals are treated as simple administrative tasks, hiccups can surface during review that ultimately impact the project schedule.
Below are 5 Permitting and Regulatory Tips for Project Teams to Consider
- Start early and identify every reviewing agency during feasibility and design. Know who has approval authority and what can potentially become a regulatory showstopper before construction dates are committed.
- Be proactive and meet with the regulatory agencies upfront. If you wait until the design package is completed, then time has already been added to the project schedule. Major infrastructure projects design packages is best to hit reviewer’s desk early to begin important conversations about requirements, sequencing or changing regulations.
- Build regulatory approvals into the critical path. Â Construction permits and other regulatory gates need dates, owners and dependencies in the project schedule so identify and incorporate into the schedule as early as possible.
- Coordinate construction around continuity of service. When improvements involve existing infrastructure serving hospitals, neighborhoods and major industries, maintaining operations during construction becomes part of the regulatory and construction strategy.
- Manage approvals through Certificate of Compliance (COC) and not merely permit issuance. The objective is functioning water facilities and infrastructure.  Reviews, inspections, testing, commissioning and closeout all have to reach the finish line before certificate of compliance is issued. Stay in the game!
Here’s the bottom line between water and healthcare.
When someone turns on the faucet for any reason, dependable and safe water must be there. When equipment is running that requires water for cooling or other purposes, again, water must be there.
And with the City of Houston’s continued investment in water infrastructure and the support of PermitUsNow, engineers, consultants, suppliers, contractors and many others, more than 5 million people across the region including patients, staff and facilities in the Texas Medical Center can continue to depend on a reliable water system.
As healthcare owners and project teams plan the next generation of facilities, how early are water infrastructure, permitting and regulatory requirements entering the conversation?
