MUSC's Hospital Replacement

Hospital Built to Withstand Hurricanes, Earthquake, Floods

By Scott Judy

The construction and design team for the Medical University of South Carolina's $190 million Hospital Replacement project in Charleston had the task of building a facility that could overcome hurricanes, earthquakes, floods and terrible soil conditions.

And the hospital is one of the few, if only, major health-care projects in the country to meet both the 2000 International Building Code's significantly enhanced seismic requirements for Charleston - now on a par with the U.S. West Coast - as well as its hurricane/windload criteria.

"We had to consider so many different things," said Tom Doyle, partner with structural engineer Korda/Nemeth Engineering of Columbus, Ohio, and the project's lead engineer. "About the only thing we didn't have to consider was drifting snow."

Additionally, lead architect NBBJ of New York had another hurdle to overcome - getting approval for an overtly modern building from Charleston's conservative and historic-focused Board of Architectural Review.

All of those challenges have been overtaken in an expedited fashion, however, and less than 18 months into construction, the team is an estimated nine months ahead of the contract completion schedule and expects to have the building's exterior completed by August.

"We're extraordinarily pleased with the innovation and drive of our construction team," said Chris Malanuk, director of strategic planning for MUSC Medical Center and project director.

The Project

Construction of the MUSC project, referred to as the Center for Advanced Medicine, is funded by a $401 million mortgage loan from the U.S. Department of Housing and Urban Development - the second-largest commitment ever made under the Federal Housing Administration's Section 242 Hospital Mortgage Insurance program. The loan is expected to save the hospital approximately $110 million over the life of the mortgage, according to FHA.

The current project is merely the first phase of a 20-year master-planned rebuilding of MUSC's Charleston campus, which originally opened in 1955. (The hospital was founded in 1823 and became part of the state's higher education system in 1913.)

The first phase includes the development of a four-story diagnostic and treatment building, seven-story patient tower and a garden atrium that connects the two structures. The 641,000-sq.-ft., 156-bed facility will provide cardiovascular and digestive services.

The project also includes a $38 million central energy plant that will supply utilities for all future phases. The plant became operational in June.

A 1,500-car, eight-story parking garage has yet to start construction.

"We set out to develop this property and design it in a way that we can take all of the existing inpatient and outpatient capacity and migrate them to a separate campus," Malanuk said.

BGKS, a joint venture of Birmingham, Ala.-based Brasfield & Gorrie, and M.B. Kahn Construction and Southern Management Group, both of Columbia, S.C., won the competition to serve as construction manager-at-risk and has a $154 million GMP contract. Brasfield & Gorrie is focused on the hospital structure, while M.B. Kahn is leading construction of the energy plant and new incoming infrastructure.

The Design

The MUSC project has demanded much from its architects and engineers. First, due to capacity issues at its existing facility, the owner needed design to be completed as quickly as possible.

While an optimum occupancy percentage is between 80 and 85 percent, "We've been running at 95-plus percent for some time," Malanuk said. Also, due to significant population growth in the region, even without any increased market share, MUSC expects it will need 150 additional beds within the next several years.

Design work began in January 2003, and designers were able to finalize schematics and a complete program by that April.

"They cranked it out," Malanuk said. "We were having user-group discussions concurrently with shaping the building. So every day we would come up with program changes. It was just an amazing, incredibly dynamic process."

Also dynamic would be the building's architectural design.

Timothy Johnson, partner with NBBJ in New York, was onsite frequently for the project's first year and moved to Charleston for the schematic and program design crunch time.

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"He really tried to get a feel for the community and he hit it off well with the city," said Hal S. Currey, project adviser with MUSC. "We wanted it first to be something that would work, and also something that the community could accept."

Johnson added: "We had quite a schedule in front of us." Moreover, to address the concerns of community leaders, who were focused on Charleston's rich historic flavor, "There would have been no other way to do it, frankly, because we lived the project. Living down there was part of it."

And while the MUSC design is definitely modern, Johnson said it is built upon what he calls the "genetics of Charleston." For instance, he said, much of Charleston's cultural feel comes from its historic homes, which are often narrow and vertical. They often incorporated a garden between adjoining homes to allow ocean breezes to naturally cool the area.

Johnson's design takes that concept to a much larger scale.

"We started with a more horizontal (space), which created the garden and the drop-off, then also the more vertical mass, which were the beds, which was relevant to a housing paradigm that was part of the fabric of Charleston," he said. "We took that same sort of model of the streetscape of old Charleston with vertically proportioned buildings and gardens … and we blew that up a little bit. We were pulling these genetic elements from the past and reimplementing them in a contemporary way."

A signature contemporary element is the glass curtain wall, which adorns the south side of the seven-story patient tower's exterior and continues down into the atrium section that connects the two buildings.

"That (curtain wall) was sort of abhorred by some of the more traditionally minded folks" who wanted brick, Johnson said. "They had a very different image of the building in mind. But as we talked through the type of glass we were using, which was transparent and not reflective like a building in Miami might be, we convinced them that material was going to feel much less heavy and much less daunting in the skyline of the city."

MUSC was supportive of NBBJ throughout, Currey said.

"The design was incredibly important," he added. "It's the gateway to our campus, and it had to look good."

The building's exterior also incorporates metal panels, precast concrete panels, punch-out windows and other materials.

The challenge for engineer Doyle was at least three-fold: overcome the soil conditions; design for a seismic event; and design for a hurricane-induced windload of more than 200 mph. (The project site was a part of the Ashley River a century ago. Also, almost all of the soil in the Charleston area is constantly settling over time.)

To engineer for both criteria, Doyle said the designers first had to figure out which standard would be foremost for each area of the building. For example, for the seven-story, curtain-walled patient tower, the hurricane/windload standard was the dominant requirement.

"Whenever you're dealing with seismic requirements, columns generally get bigger and the connections get a lot stronger," Doyle added. "In a seismic zone, any connection that has to do with the seismic restraint of the building generally has to be designed for the full strength of the members into that joint. So the connections get a lot more stout."

The poor soil conditions actually magnified the seismic issues that had to be overcome, he added.

Moreover, because the area's soil would continue to settle after construction, the foundation and bottom floor had to be designed and built as a self-supported deck instead of a mat slab. The overall project includes approximately 1,800 concrete piles driven to about 105 ft. deep. Every pile cap is tied together via a 1-in. thick structural slab.

To address the flooding issue, the building's first floor was designed as a parking structure, with the rest of the building starting 10 ft. above that. The lowest level features watertight mechanical rooms that can be sealed off so the building can allow floodwater through. Built-in pumps would then pump out any floodwater once the waters start to recede.

Accelerated Plan

About the time of the notice to proceed date, BGKS approached MUSC with a plan to dramatically accelerate the construction schedule. If approved, it would shave about nine to 10 months off the schedule - a potentially financially rewarding scenario for the owner, mostly because of the capitalized interest it can accrue.

The plan essentially involves dividing each building into numerous smaller segments and thus enabling BGKS to minimize its subcontractor crews.

Ultimately, all parties signed on, and on Feb. 14, 2005, the first piling was driven in the southwest corner. By April, pile caps and foundation structure was being formed, even as pilings were still being driven on other parts of the project. By June, the first corner of the building received its first piece of steel - even as crews were still driving piles. By July, the first elevated deck was poured.

"Everybody really had to agree on it," said Dan Mortimer, senior superintendent for BGKS. "When you have a venture this large, with this many entities involved, you've got to have everybody working together or it's messy."

A potential for a "messy" disruption to the schedule rested with the exterior skin, which incorporates five different elements and includes the curtain-wall system. To overcome that, both BGKS and NBBJ assigned managers to focus specifically on the building's skin.

"You've got so many different components and different start and termination points," Mortimer said. "Everything is about tolerances - for glass, for panels. Dimensional control is critical." BGKS also hired Williams & Associates as an exterior skin consultant.

Even with all the focused attention, the schedule sometimes "has to take a back seat to getting it right," Mortimer said. "The two goals are: it doesn't leak, and it looks good. Schedule's important, but if you don't meet the 'look good' or 'doesn't leak' criteria, everything else doesn't really matter."

There still is plenty of work to do, but the team likes its chances of finishing ahead of schedule.

"The risk with the soil is behind us," Mortimer said. "The structure is behind us. The major things we still have out there on the horizon would be medical equipment, and we've made great strides towards getting all of that information in. Weather still could be an issue. But right now we are cautiously optimistic."