It could be the ultimate trend in healthcare recycling: Renovating an existing building and turning it into a healthcare facility—although, in some cases, “transforming” may be a more accurate description of the project.
Vacant “big box” retail stores, unused schools and empty office parks are some of the more notable of these projects. Similarly, large properties with vast expanses of open space—think golf courses and car dealerships—in older suburban communities are being redeveloped as hospital campuses.
The recycled healthcare building with perhaps the most interesting history is the one that houses the North Shore-Long Island Jewish Health System Center for Advanced Medicine's Monter Cancer Center. Located in the Long Island community of Lake Success, N.Y., the center occupies some 37,000 square feet of a massive 1.4 million-square-foot, one-story building that served as the first home of the United Nations General Assembly.
The location was also a manufacturing facility, first for the Sperry Gyroscope Co. where, at its peak, at least 20,000 people worked making aircraft instruments and missile gyrocompasses for the Allied forces during World War II. The facility was later used by Unisys Corp. for aerospace-related production and then by Loral Corp. and Lockheed Martin Corp. for making ballistic missile and submarine navigation systems.
“We like to say, ‘They used to make wea-pons of war here, and now we make weapons against cancer,' ” says Meredith Feinberg, North Shore's vice president of the cancer service line. “That's a powerful thing to be able to say.”
Architects from Philadelphia-based EwingCole took what was described as a “vacant industrial box” and created a $17 million facility that won an Honorable Mention in the 2007 Modern Healthcare Design Awards.
During the contest, awards judge Gerald Oudens, a principal with Chevy Chase, Md.-based Oudens Knoop Knoop & Sachs Architects, called the project a “textbook transformation,” and praised how architects took advantage of the existing high ceilings and three 120-foot-long skylights.
The Monter Cancer Center now anchors North Shore's Center for Advanced Medicine, which also has facilities for ambulatory surgery, urology and imaging services.
Feinberg says there is a semicircle of national flags around the door that served as the entrance to the U.N. space, but most people remember the building as the home of Sperry Gyroscope because it once employed so many people.
“People come in all the time—not just patients, but staff and family members—and they say ‘My grandfather,' or ‘My father' or ‘My uncle used to work here,' ” Feinberg says. “Or they'll say, ‘I remember riding with my grandfather on a golf cart or a tractor around this place.' We hear it every day.”
Huntington (W.Va.) Internal Medicine Group converted a former Wal-Mart store into a “true medical mall.”
This year, two of the winners in the Modern Healthcare
design competition were renovation or redevelopment projects (Sept. 7, p. 19).
One property that garnered a 2009 Honorable Mention, the Stanford Medicine Outpatient Center, has a less-illustrious history than the Monter Center but equally successful results.
When Internet companies Excite and @Home merged to form Excite@Home in May 1999, a Redwood City, Calif., office park served at its headquarters. The company filed for chapter 11 bankruptcy protection in October 2001. Soon other dot-com companies based in the 13-building Midpoint Technology Park also vacated the premises.
Stanford Medicine took over four buildings and about 11 acres. In a project that cost about $110 million, architects with San Francisco-based Anshen & Allen renovated the space for seven outpatient clinics: dermatology, digestive health, imaging, orthopedic surgery, pain management, sports medicine and a 20-bed sleep-medicine facility. The transformation was completed in February.
SSM St. Clare Health Center, located in an unincorporated area in suburban St. Louis, received a Citation award in this year's Design Awards competition and was built on a 54-acre site where the Lakewood Golf Course opened in 1961. It was a nine-hole course, including three that were later redesigned by famed golfer Hale Irwin. On one hospital wall hangs five glass containers of golf balls and a sign explaining that, during construction, one 8-iron club and enough golf balls to fill 17 five-gallon buckets were found on the property.
Designers took advantage of the rolling terrain, and the hospital was built in a low bowl-shaped area. According to Kurt Spiering, vice president and leader of the national healthcare practice group at Milwaukee-based HGA Architects and Engineers, the hospital's “ground” floor is really its second floor, which allows its lobby windows to offer tree-top views. “This made the project fun,” Spiering says, adding that the project became affectionately known as “the treehouse.”
In the Chicago suburbs, a similar tale is being told.
Although it accounts for only about one-fifth of the newly created, 52-acre campus where Elmhurst (Ill.) Memorial Healthcare's $470 million, 866,000-square-foot replacement hospital is being built, when most motorists of a certain age zip past the highway-friendly location they will always know it as the former site of the Celozzi-Ettleson Chevrolet dealership. According to 22 years of iconic local commercials, it was the place “Where you always save more money!”
“We get that a lot,” says Kyle Bauer, public relations coordinator for Elmhurst Memorial. “Because of the commercials, it is very recognizable.”
The existing 317-bed Elmhurst Memorial Hospital opened its first building on the north side of town in 1926 and eventually grew to fill out its 13-acre campus, which was landlocked in a residential neighborhood. In 1999, it opened its Center for Health outpatient, radiology and physician office complex on approximately 15 acres by the south edge of town near the dealership, which closed in October 2000.
The system eventually combined the Center for Health and Celozzi-Ettleson parcels with some land owned by the local fire-protection district as well as several residential properties to create its new campus.
The new hospital, with 259 private rooms, is expected to open in fall 2011.
In New York, the new laboratory and office building for Weill Cornell Medical College has an automobile-related history as well. Located on Manhattan's Upper East Side, the facility at 407 E. 61st St. was built about a century ago as a Rolls-Royce showroom and was eventually turned into a parking garage.
The building's provenance is sketchy, though its owners were apparently involved in a precedent-setting lawsuit in the 1960s with the Savoy Hilton—which was famous for its Sunday cocktail dances and as the home of the Trader Vic's Polynesian-style tiki bar/restaurant from 1958 until the building's demolition in 1965. In 1968, the New York State Appellate Court ruled in 407 E. 61st Garage, Inc. v. Savoy Fifth Avenue Corp., that there was not a breach of contract when the hotel ceased operation in the midst of a five-year deal with the garage to store the vehicles of the hotel's guests. Now the case is cited in numerous contract disputes.
The renovation project, managed by New York-based Tishman Construction, began in September 2007 and Weill Cornell researchers moved in this past August.
“It's a mechanical wonder,” says Jonathan Lyons, the project director and a Tishman vice president, describing how a “100-something-year-old” parking facility was transformed into a state-of-the-art medical laboratory accommodating the needs of 200 researchers and administrative staff. “As far as a change of occupancy, this is probably as extreme as you can get.”
The original four-story structure was gutted, with only the exterior walls and the interior steel skeleton remaining. A fifth floor was added using bricks that matched the material of the original walls, the steel was reinforced and a basement was dug—which proved to be a difficult task. “We hit rock at 30 inches and we went down about 15 feet,” Lyons says.
Robert Accardi, Tishman's executive vice president, describes the structure as a “pretty good, solid building,” that had become “a little tired.”
“We coined a phrase: ‘They don't build them like they used to—thank God,' ” Accardi says, who adds that a lack of real estate options helped lead Weill Cornell to take on the challenging project. “Trying to find anything in the Upper East Side is not so easy.”
As a finishing touch, antique brass light fixtures were refurbished on the building's exterior.
“I think people walk by and don't have any idea what goes on inside,” Lyons says.
But the property is hardly the oldest building on the street. Next door is the Mount Vernon Hotel Museum & Garden, which serves as the headquarters and parent chapter of the Colonial Dames of America organization. The building is said to be among the oldest in Manhattan. Across the street, however, is a building that the men at Tishman just describe as “a big black box.”
But big-box buildings need not be disparaged, for they, too, can have healthcare uses.
In January 2006, the Huntington (W.Va.) Internal Medicine Group opened the HIMG Regional Medical Center, which it describes as a “true medical mall” and it's a description that's hard to argue with. HIMG's more than 60 physicians practice in a renovated Wal-Mart that had been vacated in 2004 on the day a Wal-Mart “Supercenter” opened less than two miles away.
In addition to its own doctors who cover some 17 specialties and an imaging center, the building has tenants that include a pharmacy, a home oxygen and home hospital equipment retailer, home healthcare service, and obstetrics and gynecology, orthopedic, pediatric and chiropractic practices. Also on the premises are a gourmet coffee shop and the Apple-a-Day Cafe. Medical-related services include free healthcare screenings, blood drives and education programs on diabetes plus ballroom dancing and yoga exercise classes.
The retrofit was done by BBL Medical Facilities, an Albany, N.Y.-based plan, design and build firm, and the project included 17,000 square feet of new construction and 130,000 square feet of renovated space. John Wodoslawsky, a vice president with BBL, says the project cost just under $16.5 million and that included architecture, engineering, interior design, built-in cabinetry and casework, site work and actual construction.
Regarding the Weill Cornell project, both Lyons and Accardi say retrofitting offered fewer bureaucratic hoops to jump through than building new. In Huntington, BBL representatives say the same thing, but there were other factors as well.
‘Big box' cost savings Paul Trigger, senior vice president with BBL, notes that there is a cost advantage to buying a big-box facility from the retailer that used to operate it. Because Wal-Mart didn't want a competitor to move into the space, Trigger says they were more open to selling the building to the medical practice at a lower price.
Wodoslawsky notes the advantages to renovating a vacant facility. Usually renovations are done in phases as operations migrate between old and new spaces as the construction goes on around them. Because the building was empty, he says, BBL could “renovate at will.”
The Wal-Mart store provided easy highway access and it had become a place the community had gotten in the habit of driving to, but the fact that medical group was a noncompeting company to Wal-Mart added to the economies of the location, Trigger says.
“Sometimes the location is a premium, and the client is willing to pay more for it; and in some cases, speed may be the critical ingredient,” Trigger explains. “In this case, they hit the home run: They got location, speed and economy in one package.”
HIMG notes that its strategy is contrary to what other practices are doing. It consolidated everything in one conveniently located building, while other practices are always working to determine where to open a new strategically placed satellite office.
Duke University Health System makes no apologies for following the latter course, although it's doing so in its own unique way.
Working with the Lincoln Community Health Center, the Duke Community Health/Duke University Health System has opened three small clinics in underserved Durham, N.C., neighborhoods in the past six years. All have been retrofit projects.
The five-exam-room Lyon Park Clinic opened in April 2003 in what had been a vacant elementary school. A home that once was used for mental health services and then left vacant was turned into the five-exam-room Walltown Neighborhood Clinic in January 2005. In August of this year, Duke and Lincoln Community opened the furthest facility from the Duke campus, the six-exam room Holton Wellness Center, which was also a vacant school.
“It filled up with patients almost as quickly as it opened, so it is obviously filling a real need,” says Duke health system planner Duncan Yaggy.
Yaggy adds that the retrofits were done out of practicality and not out of any kind of symbolic effort. “I don't think there was serious conversation of the buildings as neighborhood icons,” Yaggy explains, especially with the last project. “The building is there; the steel is still good. You had a building that had life in it, and you might as well use it.”