Health care pulse check

Population growth, aging facilities prompt new medical construction

By Candy McCampbell

Health-care construction can be added to death and taxes as one of life's certainties.

The health-care construction market is "one of the largest, and fastest-growing construction segments," says John Hughes, vice president with FMI Corp. of Raleigh, N.C., a consultant to the construction industry.

He predicts annual growth in the 7 to 9% range for the next five years. And the cost per sq ft for building construction will rise from $179.69 last year to $205.79 in 2010. For hospitals, it will be $228.56 by 2010.

Medical projects will abound across the South Central region this year because of how health care is used and who is using it.

Many hospitals are facing unexpected growth in their areas as a result of a mobile population that chooses to retire in another city and because of growth of ethnic groups in the population, says Rick Wade, senior vice president of the American Hospital Association in Washington, D.C.

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"They're changing in ways they had not anticipated, such as adding or enlarging a birthing center or redesigning the emergency room," he says.

Another growth area is the rehab departments that are serving growing numbers of orthopedic and cardiac patients.

Hughes says the buildings themselves are aging and data show that approximately 60% of hospitals and 68% of health-care systems need to replace out-of-date buildings.

General contractors are increasingly becoming members of the planning team at the design stage of health-care projects, says Tim Baugus, vice president of Skanska USA Building, which has an office in Memphis.

It gives clients "real-time information … on how things are built and information on cost savings," he adds.

Projects that are negotiated from the early stages can result in savings to the client, he says.

"To be effective … you have to have a collaborative process," he says.

Following are a few of the significant health-care projects currently under construction in the region.

Gateway Regional Medical Center, Clarksville, Tenn. This 60-acre site was wide open when construction started last summer on the 510,000-sq-ft Gateway Regional Medical Center.

BE&K Building Group of Brentwood, Tenn., has the $120 million contract for the new hospital. The city ran water lines and BE&K built a sanitary sewer lift station to connect to the city lines, says Jason Adams, project manager.

The building is on two types of foundation: high-pressure cap grouting and stone columns -- 3 ft. diameter by 30 ft. deep -- with spread footings on top.

The 270,000-sq-ft first floor will house a dozen operating rooms, 2 MRIs and an emergency department with 37 exam rooms.

The project requires about 11,340 cu yds of concrete, 145 tons of rebar and 3,100 tons of structural steel. The exterior is a combination of brick, glass and EIFS, Adams says.

Coming from the old hospital will be a school of koi, which will go into an open-air pond off the main lobby and be visible through glass wells.

Construction started in July 2006 and completion is set for summer 2008.

University of Arkansas for Medical Sciences Patient Tower, Little Rock. Any expansion will be out, not up, on the 11-story patient tower that CDI Contractors Inc. of Little Rock is building to replace the existing hospital.

The $150 million contract also includes a five-story psychiatric research building and a four-level parking deck that will accommodate 1,000 cars.

"There's one building pad left on the south side of what we're doing … for a future south tower," says Scott Smith, project manager.

The 240-room hospital will be 558,000 sq ft, half of it sitting atop the 420,000-sq-ft parking deck. The other half is built on grade.

The structure is on drill piers, spread footings, continuous footings and sheer walls because of the hillside site.

It will house a new emergency and radiology departments, clinical lab and an interventional center combining surgery, radiology and cardiovascular services.

The 100,000-sq-ft psychiatric research building is connected to the tower. Work started in May and completion is expected in spring 2009.

St. Vincent's Hospital South Tower, Birmingham. This 210,000-sq-ft expansion is evidence of the payoff of planning and communication.

Brasfield & Gorrie LLC of Birmingham finished the $43 million job in December, three months early.

John Renfroe, project manager, credits superintendent Kennith Brown with using a team concept with all 16 subs and with assembling "anybody that may be affected in a sit-down meeting before we started doing anything."

Before construction on the seven-story building could start, the team had to deal with the main electrical feed to the existing hospital, bringing in structural engineers and geotechnical engineers for placement of foundation drill piers or caissons.

"We had a tolerance of 8 in," Brown says.

Fire codes required construction of a 1-ft-thick concrete wall between the expansion and existing building. It was poured as the building went up.

The ER, with 33 treatment rooms, is on the ground floor and all the mechanical units - including air handlers - are on the second floor. Upper floors can accommodate 180 patients.

East Alabama Medical Center Addition/Renovations, Opelika, Ala. Brasfield & Gorrie LLC of Birmingham joint ventured with Bailey-Harris Construction Co. of Auburn, Ala., on this $42 million job that includes adding four stories to a four-story tower and building a two-story addition.

The existing steel building already had a foundation and structure capable of supporting additional floors, so workers tied into the steel and went up, says Todd Jackson of Brasfield & Gorrie, project manager.

"We got the skin and steel enclosed, tore the existing roof off and put down a new single ply, then went back and tore off the waterproof membrane," he says.

The two-story addition has operating rooms and ties into the existing building with a bridge connector and through the existing lobby.

The renovation started in June 2005 and will be completed this summer.

Baptist Medical Center, West Tower Expansion, Jackson, Miss. This $41 million six-story, 170,000-sq-ft tower will replace a parking lot at the Baptist Medical Center campus.

But the lot will remain as a work pad until the foundations are finished, says Ed Hauser, project manager for Brasfield & Gorrie LLC, of Birmingham.

"A little bit of rain can shut you down for a while" with the area's problematic Yazoo clay, he says.

The contractor began construction on top of the existing parking lot, cutting the required 206 caissons through the asphalt, then excavating the site down 5 ft.

The tower, which joins the existing U-shaped building at the ends of two wings, will house women's and children's services and heart and vascular services.

Construction started in October and completion is expected in September 2008.

Washington Regional Medical Center Expansion/Renovation, Fayetteville, Ark. This almost 200,000-sq-ft project includes adding a fifth floor, expanding the emergency department and adding a second floor, new cafeteria and full kitchen and a free-standing, 60,000-sq-ft administrative services building.

The existing building column tops had plates for welded extensions, so column sites were "very carefully laid out," says Jim Minor, project manager for Baldwin & Shell Co. of Little Rock. Workers removed part of the roof, welded the column and flashed in the roof, but only what could be done in a day.

Once the walls and new roof were up and the area enclosed, the roof came out.

They had to cut through the structural slab to tie in plumbing in the rooms, so existing rooms involved were temporarily shut down according to a schedule.

Construction started in March and completion is set for February 2008.

St. Mary's North, Knoxville, Tenn. Johnson & Galyon of Knoxville, Tenn., had to carve out part of a hillside to build the six-story, 226,000-sq-ft hospital in this $45 million job.

"We had to haul off 500,000 yds of dirt," says Bill Gardner, project manager.

The hospital will have 75 beds and four operating rooms with space for two more, as well as radiology and other imaging rooms, a lab, pharmacy and dining area. The ER will have two trauma rooms and 10 treatment rooms.

The central plant is in a separate building that was doubled in size to 6,000 sq ft, to handle the new facility.

Construction started in July 2005 and completion is scheduled for April.