Healthcare Design - May 2016 - 94

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was that, subsequently, the floor-to-joist height had
been lessened to a point where the ductwork had
to be carefully coordinated to attain an 8-foot ceiling
height in all spaces. BIM and other drafting software
proved beneficial for this task.
Another challenge that arose during construction was a hard, wind-blown rain storm that soaked
the building's existing west masonry wall. During a
walk-through the following day, team members found
large pools of standing water on the interior floors.
Metal studs had already been placed on the exterior
walls, but fortunately no insulation had been installed
yet. After various options were considered for how to
resolve the issue, an exterior-finish insulating system
was installed over the porous brick surface on the
west wall. This was a cost-effective solution that
could be installed in a timely manner to maintain the
project schedule.
Another unforeseen condition was the discovery
that there were several large openings in the upper

Above: The clinic
registration and waiting
area features colorful
artwork and curved
wayfinding surfaces that
help subtly direct patients
to the proper locations
for assistance. Below: A
variety of materials, curved
surfaces, and landscape
artwork was used in the
main lobby/waiting area
to achieve a welcoming
appearance.

BRIAN MOBERLY/MOBERLY PHOTOGRAPHY

located. However, there was a vacant tract of land
just to the west that could serve as ADA parking for
patients and a drop-off zone.
With a bus stop also out front, where many
patients will arrive for care, the decision was made
to position the main entry at the northwest building
corner, with a new passenger elevator strategically
located there to facilitate the 6-foot transition to the
first floor from the front entry.
The new shaft was cut into the existing concrete
structure, which was reframed with steel, and the
below-grade elevator pit and foundations were excavated within the existing building. A side benefit to the
original 5-foot difference between the front and rear
of the first level was that it provided enough slab-tostructure height clearance to allow the construction
equipment inside for this extensive work.
More challenges ahead
Midway through the project design, the structural
engineer made another startling discovery: The
concrete-framed structure didn't meet current seismic
code requirements. To strengthen the structure laterally, a new 12-inch-wide concrete shear wall, spanning
23 feet and extending five floors, was inserted into the
existing construction. A foundation footing first had to
be built, then a phased process of cutting/resupporting each of the existing five concrete floors was carried
out, as the shear wall was framed and poured.
All new mechanical, electrical, fire protection, and
plumbing infrastructure systems had to be installed,
as well. One other ramification of raising the first floor

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Healthcare Design - May 2016

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