There's nowhere to go but up.
That's a fact of life for landlocked hospitals, prompting many of them to acquire the air rights above their facilities as they seek to expand operations.
One such hospital is Boston Shriners Hospital for Children, which was in dire need of space larger than its 29-year-old building offered.
The 30-bed hospital considered opening a new facility at another site, but few locations were practical because of their high cost or prohibitive local ordinances. Relocating also would mean severing its physical tie to prestigious Massachusetts General Hospital, which is linked to the Shriners facility through an underground tunnel.
Shriners decided to turn to the heavens for help.
The hospital chose to replace its three-story, 80,000-square-foot building with a nine-story, 200,000-square-foot facility that would add 100 feet in height compared with the old building. The additional height required the hospital to obtain the air rights above its existing structure.
In order to build vertically, various clearances were needed, including approvals from the surrounding neighborhood, the city and various state agencies.
Once the approvals were given, a very specific environmental plan was put into progress, said Benjamin T. Rook, chairman and chief executive officer of Odell Associates, the Charlotte, N.C.-based architectural firm that designed the new Shriners building. Because the project site is bordered by residences, certain ordinances had to be met, including noise limits and restrictions on hours of construction.
Shriners is one of the first hospitals to erect such a structure above an existing building in the U.S., Rook said.
What's unique about the project is that patients, staff and medical equipment were moved from the old floors to the new floors above without any major distress to facility operations. When the lower floors were demolished, the building stood 150 feet high, supported by five steel columns and connected to the ground level by a glass atrium.
The two-phase construction project began in May 1992 and is expected to be completed in late 1998.
The first phase, completed in October 1996, involved building the five upper floors of the new nine-story hospital and demolishing the existing floors below.
The new floors house the following departments:
Mechanical systems on the fifth floor.
Outpatient clinic, physical therapy and family services on the sixth floor.
Reconstructive services unit, child-life therapy and an educational facility on the seventh floor staffed by two full-time teachers.
Acute-care beds and surgical facilities on the eighth floor.
Administration, physician offices and cafeteria on the top floor.
Phase two, which is in progress, began in October 1996. It involved excavation and construction of 21/2 levels of below-grade parking and reconstruction of floors one through four.
The first floor will include an auditorium and reception area; expanded facilities for research will be housed on the second and fourth floors; and public relations, human resources, patios and family-living quarters will be on the third level.
"I think this project will change the way urban hospitals expand," Rook said. "This will be a major trend nationally and internationally once facilities realize that they can evaluate their air rights and move up if necessary."
Another hospital that exercised its air rights is the Hospital for Special Surgery in New York. The 138-bed specialty facility, recognized as the first orthopedic hospital in the U.S., opened in 1863. It's now part of the 14-member New York Hospital Care Network.
Budget and space constraints forced the hospital to consider expanding its 45-year-old building over FDR Drive, a major arterial highway in New York.
"After assessing the merits of over 30 architectural opinions, it was determined that the most viable option for expansion was to take advantage of the hospital's air rights over FDR Drive," said John M. Kenney, president of Architecture for Health, Science & Commerce, the Tarrytown, N.Y.-based firm working with the hospital.
The hospital and architect settled on a design that renovated 135,000 square feet of the old facility and added more than 173,000 square feet in new construction. The estimated cost was $74.4 million.
The unique aspect of the project is where the new construction started-two stories above FDR Drive. The six-story addition started over the highway with the first floor aligning with the third floor of the existing facility.
Because of the overhang as well as the road's proximity to a river, the regulatory approval process for the plan was almost as complicated as the design. In the end, it took approvals from eight state and local regulatory agencies, spanning a five-year period starting in 1985.
Construction began in 1993, and it was completed in January. Renovation work on the old facility is expected to be completed by year-end.
"Hospitals are facing many new challenges, the most complex being how they can efficiently expand and upgrade for ambulatory- and managed-care services and simultaneously cut costs and control operating expenses," Kenney said. "In many instances, this necessitates a creative use of space, especially for urban institutions where space may be limited and land values high."