Sulpizio Center UCSD

Rooftop gardens brimming with succulents, a lobby filled with natural light, expanded parking, a senior housing community and a new cardiovascular center highlight the prognosis of area health care businesses. Some experts see the next few years as an opportunity to “pull out all the stops.” Others plan to tread more lightly, with projects that address neighbor concern or solve parking crunches.

“Since SB 1953 (which requires hospitals to comply with seismic safety deadlines) in 1994, many hospitals saw the writing on the wall,” says Steven A. Escoboza, president and CEO of the Hospital Association of San Diego and Imperial Counties. “They opted, if they have the capital financing flexibility to go ahead and rebuild. Less so to meet compliance retrofitting-wise but to plan wholesale rebuilding of their hospital facilities. A lot has happened already. You have those getting close to completion, in the case of Sharp, and you have these others who didn’t have the financing capability.”

Working To Expand Education

UCSD’s medical campuses in La Jolla and Hillcrest are growing to great dimensions. From new teaching space to additional examination rooms to a brand new cardiovascular center, the medical center is doing more to accommodate students and patients.

In response to patient demand and an increase in research, expansion began last year on the Shiley Eye Center. UCSD has secured commitments of $9 million in private support to increase existing clinical space by 13,000 square feet, more than 50 percent, and will add examination rooms, a registration area and a new waiting room on the first floor.

Second floor improvements will increase faculty and research space. The Ratner Children’s Eye Center will add several new examination rooms, doubling its clinical examination space.

For educational as well as patient purposes, UCSD School of Medicine will begin construction in 2008 on its $60 million, 82,000-square-foot Telemedicine and Medical Education Center. Nearly $36 million of the funding is coming from Proposition 1D with philanthropy making up the difference.

One part of this project will provide the space to do and teach teleconsultation, allowing physicians to connect via technology with people in underserved, distant areas who need specialty consultation.

The second part of the building is for the Program In Medical Education. For the first time in more than 20 years the University of California schools of medicine have been allowed to increase their classes. The space will enable UCSD to go from 122 to 134 students with the idea that those extra students are going to focus their studies specifically on a program in health equity and train them to develop skills to look for and correct health care disparities.

“We know certain populations get different health care than others, said Maria Savoia, vice dean of medical education. “For instance the deaf community and the developmentally disabled. Sometimes health care delivered to them is different.”

These students take an extra year of study to look at areas where disparities exist, discover why they exist, and then try to fix those disparities.

A state-of-the-art auditorium and simulation center will be included in the new center. Skidmore, Owings & Merrill is the architect on this project, which should be complete in 2012. Savoia says she has been working nearly 20 years on this and it “has been great fun” seeing it finally come together.

Thornton Hospital in La Jolla has begun construction on the $172 million, 128,000-square-foot Sulpizio Family Cardiovascular Center. “This is the first cardiovascular center in San Diego,” says Jim Cleaton, UCSD director of health care design and construction. “It has its own entrance and looks really neat.”

Described as a glass-wrapped building, the new center will include medical research, education and patient care. Incorporated into the design are windows allowing a 360-degree view of nature-inspired elements, atrium, water features and gardens to aid healing.

Designed by Baltimore-headquartered RTKL, the new center is funded through hospital reserves, debt financing and philanthropy, including a $10 million donation from Richard and Maria Sulpizio. It is scheduled to open in summer 2010.

Thornton Hospital will see a $115 million, 128,000-square-foot addition in four stories, which include four new catheterization labs, four operating rooms, a pre-op/post-op unit and an expanded emergency department.

Within the space are 28 patient beds — 12 intensive care and 16 internal medicine — a non-invasive cardiology unit and an outpatient clinic. Technological additions include high-speed computed tomography and replacement of the magnetic resonance imaging unit. The fourth floor will provide space for 100 faculty.

“There is extensive money being put into staying not only current but, with some technology, being on the leading front,” Cleaton says.

From Plateau To Plateau

In Hillcrest, UCSD’s hospital will undergo more than $100 million of construction to expand the ER, add a neonatal intensive care unit and upgrade the infrastructure. Expansion plans will add a post-anesthesia care unit and in-patient MRI.

It’s not just the big projects that keep Cleaton busy. He says he constantly is overseeing million-dollar infrastructure upgrades that include the mundane but necessary upgrades to elevators, generators and sprinkler and air handler systems.

PPH Has Ambitious Replacement Plan

Palomar Pomerado Health

Palomar Pomerado Health in North County is taking improvements to the ultimate level and has “very ambitious” plans to replace Palomar Hospital in Escondido with a new hospital twice the size. Dirt has been turned on a 37-acre site off Nordahl Road to build an 11-story, 7,000-square-foot hospital. Outpatient components, infrastructure and 150,000 square feet of medical offices are planned.

“If you have the opportunity, which is rare, to build a new hospital, you start to look at things like efficiencies and how to get people around in a convenient way,” says Michael Shanahan, director of facilities, planning and development for PPH.

Shanahan says he wanted to challenge the issues of today’s hospitals and sent committees out to research the best ways to practice medicine. The healing environment was investigated, as was care through the patient’s eyes, safety, air quality and noise reduction.

Grading approvals have been granted, plans are nearly complete and are being checked by the state. “It is a very beautiful building and very iconic,” Shanahan says. The buildings have vertical conservatories that include natural and lighting environments. “People don’t like abstract art when they are sick,” Shanahan says. “People don’t like to be challenged when they don’t feel good.”

Flexibility will be built into the new building allowing the bed count to grow from 453 to 600. A floorspace measuring three football fields by one and a half allows consolidation of admissions, pre-operation and post-operation areas. All the procedure rooms will be built around that platform.

The operating rooms will merge three technologies onto one floor: conventional radiology, cardiology and general surgery. “You get great efficiencies in terms of taking care of somebody both in an admissions standpoint to pre-operative to discharge,” Shanahan says. “We’ve been able to consolidate our resources onto one floor and design something that is much different.”

The vast floorspace is void of support columns. Shanahan designed it this way so that technology and space could be rearranged to keep up with future technology changes. Looking into his crystal ball, Shanahan sees his hospital of the future changing around the patient. Instead of moving patients to different floors and rooms as they recover from procedures, the rooms will move and adapt around patients. “Nurses won’t be pushing beds up and down halls anymore,” he says.

Covering such a vast floorspace is a vast roof. Instead of creating a rolled asphalt heat producer, Shanahan has planted the roof. Nestled within that warm soil will be California succulents. Although the succulents don’t require much watering, Shanahan has made plans to utilize water from the hospital’s cooling plant in the gardens. He says about 42,000 gallons of water will be saved each month. “I can conserve water and I can recycle it,” he says. Other adaptations include energy efficiencies and lighting controls. This makes the hospital a better environmental steward as well as creating a much nicer healing atmosphere.

PPH comprises Palomar Medical Center in Escondido and Pomerado Hospital in Poway. As a public nonprofit, the system is supported by local property taxes and a $496 million bond initiative. The other half will come from the institution.

Designed by CO Architects of Los Angeles, the new hospital contractor is Rudolph and Sletten of San Diego. Completion is planned for 2011. PPH also is working on redevelopment of the current Palomar Medical Center campus in Escondido for specialty inpatient, outpatient and wellness services and the expansion of Pomerado Hospital in Poway. The cost for all three projects is $983 million.

Environmental Design Not Just For The Big Guys

Also with designs on conservation and an eye on efficiency, La Maestra Community Health Center has broken ground in City Heights to build a new clinic. This will be among the first community clinics in the county to seek the Gold Leadership in Energy and Environmental Design certification.

To qualify for the certification, the building will showcase energy-efficient and environmentally responsible materials, fixtures and operations. LEED sustainable site development, water savings, energy efficiency, materials selection and indoor environmental quality. Hernando Miranda of Soltierra Inc. will oversee the LEED certification process with Richard Cornelius of Richard Yen & Associates working as project architect and Joe Troya of Consolidated Contracting Services as the builder. The project cost is $24 million and the new building is scheduled to open December 2008.

La Maestra has been providing health care and community services since 1990. With a staff of 147 doctors, nurses, counselors and social workers who speak 19 different languages, the clinic sees more than 55,000 patient visits per year.

Kaiser Meets Needs, Keeps Buildings Updated

Kaiser Permanente

Kaiser Permanente has been working on two projects in the region.

Kaiser opened its 21st medical building in San Diego County last month in Oceanside. Construction on the 8,300-square-foot office, which includes pharmacy, laboratory and radiology services, began in January. Six doctors provide primary and pediatric care with all medical personnel cross-trained to care for both children and adults.

The outpatient office also will offer limited radiology and laboratory blood draw services and an onsite pharmacy.

Throughout the region, Kaiser continues to upgrade the infrastructure of its buildings. At another medical building in Kearny Mesa, tenant improvements are 80 percent complete and will allow for the relocation of physical therapy and specialty care services to the building.

Sharp Makes Space For Technology

Sharp Memorial has construction under way on a 315,000-square-foot, 334-bed hospital next to its existing central San Diego location that will tout the latest technological advancements. This $190 million project, which began in February 2005, will provide San Diego with its first new hospital in more than 15 years.

Made up of eight levels and seven stories, the new building will include a surgery center with 10 advanced surgery suites, with specialized designs for orthopedics, cardiac surgery, neuro-trauma and transplantation.

An emergency and trauma center will provide 42 emergency treatment bays and 10 emergency observation beds. Plans include 48 intensive care beds, 126 intermediate care beds and 160 acute care beds. For recovery, the hospital is outfitting its private patient suites with a flat screen television, Internet connection and sleeping area for family members. The new private rooms replace the 301 existing rooms, of which only 76 were private.

Current buildings were built in 1955 and 1973 and do not have the space or features to adapt to evolving technology and changes in-patient care. Most likely by 2015 one of the tower buildings will become offices and provide outpatient care, another will be shortened by five floors to comply with seismic laws, says Sandy Noon, vice president of strategic campus planning and development.

More than $44 million of the $50 million capital campaign has been raised to build the new hospital. Upon completion, the project is estimated be about $200 million. Gilbane Building Co. of Rhode Island is doing the work. NBBJ is the architect. Completion is slated for summer 2008 with patient occupancy beginning in August.

In East County, Sharp Grossmont is ramping up Pase II of the emergency department and Critical Care Unit Buildout. At $38 million, this will add about 75,000 feet of space, making way for 24 new critical care beds, increasing capacity to 48 beds. Jaynes Corp. anticipates work will begin by December with completion in 2009.

Scripps Paves Future With Parking Plans

Scripps Health has a 10-year plan with an estimated cost of more than $2 billion in hospital improvements throughout the county. None of the projects include glitzy new windows or rooftop gardens, but all are imperative to patient care.

Chris Van Gorder, president and CEO of Scripps Health, says he is amazed at how long it takes in some cases to get the land use approval, and cautions that any date attached to a project could actually be plus or minus a year or two.

“Every community is a little different and every project impacts the community different,” Van Gorder says. “We are trying to be extraordinarily sensitive and work with the communities. We are not trying to ramrod these projects down anybody’s throat.”

Most important to any existing upgrades and future plans are parking structure upgrades. “These are really tricky projects,” Van Gorder says. “We have to remain fully functional and not impact the community negatively while we are under construction.”

Scripps La Jolla is under construction on a 1,350-stall, eight-level parking structure. By first completing parking, space is freed for expansion while parking still is available for patients and staff.

Work will finish in 2008 and make way for a new 141,000-square-foot, six-story office building to be completed in mid-2009. A few years out, sometime in 2012, speculative planning includes a new cardiovascular institute.

Next, Scripps Mercy plans to begin work this year on an emergency department renovation and expansion that will increase space to 27,000 square feet. Construction should be complete by late 2009. Parking construction plans include a 640-stall, six-level parking structure with four levels above ground and two below. Construction will begin in 2008.

Scripps Rancho Bernardo

Already under way is a $20 million, 146,000-square-foot, outpatient care clinic in Rancho Bernardo. Work began in August and completion and occupancy are slated for August 2008. Reno Contracting Inc. is building the six-story clinic across the street from Scripps’ current Rancho Bernardo clinic. Touting an additional 60,000 square feet, the new building will allow for expanded services and new technology.

Enhancements will include a high-tech, fully digital imaging center, including digital mammography; expanded urgent care and primary care services; onsite ambulatory surgery; and improved parking. More than 80 physicians and 250 employees representing 25 specialties will practice at the new Rancho Bernardo facility.

Scripps Memorial Hospital Encinitas will undergo seismic retrofitting in 2008 with additional plans to increase parking in 2009 followed by a 68,000-square-foot addition to its medical building and a new two-story critical care building that will house a 24-bed emergency department.

Work is slated to begin on a 735-stall, four-level parking structure at Scripps Green Hospital in La Jolla in spring 2008. Upon completion, summer 2009 construction will begin on a specialty outpatient cancer center.

Much of the construction is in response to parking shortages, Van Gorder says he doesn’t see much sense in rushing to buy new technology for the clinics before they are ready with the space.

“Unlike a lot of communities across the nation that are either static from a population growth standpoint or declining, Sandag continues to project increases in population,” Van Gorder says. “We have to anticipate that and build health care facilities to be able to meet their needs in the long term. Much of the work is in response to SB 1953 but also is tied to the growth of the community and our mission to meet community health care needs.”

On a smaller scale, H.G. Fenton is beginning work on the Carlsbad Medical Center, the future home of Scripps Health’s first medical offices in Carlsbad. Scripps will lease space for physicians’ offices and outpatient services. South County plans include the relocation of Scripps Mercy Medical Group’s Bonita location to a larger space in EastLake that will accommodate more physicians’ offices and offer more patient services.

Paradise Planned For Seniors

Outside the hospital realm, adjacent to but independent of Paradise Valley Hospital in National City, Generations Design & Construction and Adventist Health are creating an oasis for those 55 and older. Landscape preparations began in August to make way for Paradise Village, a 12-acre, gated campus that will provide 405 independent living units and 92 assisted living units.

Planners are pulling out all the stops when it comes to comfort and tenant satisfaction in this $120 million project, says Norm Smith, Paradise Village executive director. Two fountains, a putting green and tennis courts will adorn the property. Sky bridges will connect all eight of the buildings. The center will feature a two-story open atrium, two restaurants, coffee shop and a deli.

Included in the community are a chapel, library, billiards lounge, credit union, art studio, beauty salon, barber shop and 212-seat auditorium for movies, theater and live music. A wellness center will offer strength training and aerobics, Olympic-size lap pool and walking trails. A medical clinic will offer optical, hearing and dental care, podiatry and pharmacy. To top it off are maid service, meal plans and transportation.

And, what community would be complete without Wi-Fi? The coffee shop will be wired for remote computer users it as well as provide computer stations.

Monthly rental packages start at $2,700 for a one bedroom with den and go upwards of $4,100 for a penthouse measuring more than 2,000 square feet.

Generations Design & Construction in Portland, Ore., has the task of moving the dirt starting January 2008 and completing construction by summer 2009.