Medical Sector Vital Signs Remain Healthy, But Work Expected to Level Off

by Mike Moore, Genoa Sibold-Cohn and Lucy Bodilly

Good Samaritan Hospital in Corvallis, Ore. recently started an 80,000 sq ft six story expansion of the existing facility. General Contractor is Andersen Construction, Portland.

Growing demand from baby boomers for health services has driven health-care work to record levels in recent years, but it appears to have peaked. In 2006, starts reached a record 109 million sq ft, up 1% from the previous year, according to McGraw-Hill Construction. The market began to cool in 2007, dropping to 100 million sq ft with clinics and nursing homes seeing the sharpest declines.

With projects now falling under greater financial scrutiny in light of the current credit crunch, Robert Murray, chief economist with McGraw Hill Analytics expects a further retreat to 98 million sq ft in 2008.

In Pacific Northwest markets, several large hospital projects wrapped up in 2007 including expansions at Evergreen Hospital in Kirkland, Wash., Overlake Hospital in Bellevue, Wash. and St. Vincent’s Hospital in Portland. Northern Oregon area hospitals still plan expansions and work is under way at Adventist Hospital, Providence Health Care facilities in the outlying areas and Good Samaritan Hospital in Corvallis, Ore.

Here is an update on some of the projects.

“Outpatient medical facilities are a totally different exercise in design and construction from normal office space” says Dan Ryan, president of Poulsbo-based Tim Ryan Construction. TRC, which just celebrated its 50th anniversary as a builder in 2007, has been building medical facilities for over ten years. Another Ryan company, Tim Ryan Properties, develops and owns specialized medical buildings.

“The requirements and costs are very different for each type of use,” says Ryan “Medical office versus outpatient surgery, MRI and CT installations, the ways an ophthalmologist's exam room differs from a family practitioner's. Each one is very different from the other.”

“Ceiling heights, flooring, walls surfaces, lighting, plumbing, traffic flows for patients versus staff, sound proofing, radiation shielding, vibration elimination.... everything changes from one type of use and medical specialty to another” says Bainbridge Island architect Jim Morss, of Morss Medical Architects.

“The real challenges arise when you deal with nuclear medicine, advanced imaging and surgery,” adds Dennis Kirkpatrick of Kirkpatrick Associates, whose design clients include Fred Hutchinson Cancer Research Center. “Lead lined drywall and stainless steel ductwork are just a couple of the special materials you have to budget for and work with.”

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The major problem facing contractors with little or no experience in medical projects is ensuring that all the necessary special requirements, materials and construction procedures are taken into account in the final bid.

“The devil is truly in every one of the details when it comes to medical construction,” says Ryan. “Just using lead-lined drywall in an x-ray area is not enough, you have to go back and put a lead cap over every nail you drive through the drywall. If you don't the nails act as little transmission lines for the radiation. That kind of thing can drive up man hours in a hurry.”

Some differences are a lot more difficult to deal with. Installing a surgical facility into a building designed for office use is one of the greatest challenges facing architects and contractors on medical projects.

“The normal nine or ten foot height between floors is not enough to accommodate all the electrical and gas lines, light supports and air handling equipment that must be centered over the operating area you need at least twelve feet,” says Ryan, who had to deal with just such a problem on a recent project.

“Then you have to deal with the HVAC requirements. An operating room must have a constant negative pressure flow of new air, and it must be at temperature. Office and patient areas need their own separate air handlers as well.”

Spaces for advanced medical imaging equipment pose another set of challenges. Rooms for Magnetic Resonance Imaging (MRI) equipment require heavy shielding against stray magnetic fields. Even the concrete floor must be shielded because of the rebar. Plus the extreme size and weight of the machines dictates that they are located on the ground floor and close to a large window to facilitate moving or replacement. That in turn creates potential problems from cars coming and going in the parking lot.

Many of the challenges facing contractors in building medical spaces are more mundane but equally important to the doctors and their patients. “The way you run the plumbing lines is determined by the type of practice,” explains Ryan.

“Ophthalmologists want every one of their patient rooms to be oriented exactly alike. That means the sink and cabinets are always on the right hand side when you enter the room. Which means you cannot run the water and drains to a common wall between two exam rooms, every room will have its own lines.

“Family practitioners are not so picky about the orientation of the sink and cabinets, but they want the doors of their exam rooms to be hinged on the opposite side from normal so that when the door opens it does not reveal the semi-nude patient sitting on the exam table,” he says.