Annmarie Adams is a professor in the School of Architecture at McGill University in Montreal and author of Medicine by Design: The Architect and the Modern Hospital, 1893-1943. Adams is skeptical of working architects who contend that hospitals can't be repurposed.
“Of course they're going to promote new construction. Have you ever seen cats when you're opening a can of cat food?” Adams says. “I think many old hospitals have the potential for new use. It's never really explored.”
Richard Longstreth, an architect and director of the graduate program in historic preservation at George Washington University in Washington, acknowledges that rapid change in healthcare delivery tends to make hospital buildings obsolete, at least for their original purpose. The idea of so-called adaptive reuse, in which a building is altered to make it fit for a purpose different from its original use, has been around for about 40 years and is becoming more widespread in planning generally, Longstreth says.
“Department stores have become offices. Office buildings have become hotels. Lofts have become residences. Gas stations have become offices. Schools have become apartments or offices. There's no end to the creative reuse of buildings in that way,” he says. “There's generally a mindset that replacement is the preferable course. When there's the money to do that, that's the route taken.”
One cost consideration that is starting to tip in favor of reuse involves the energy implications of tearing down an old building, carting away the debris and constructing a new one, a concept known as embodied energy, Longstreth says. It represents the energy that went into constructing the building and that would be expended to demolish it and removing its remains. Accounting for this, along with the energy expended to construct the new building provides a more realistic assessment of the energy efficiency of new buildings.
USC's Sloane mentions one example that bears watching in his own backyard: the fate of the old General Hospital at 676-bed LAC/University of Southern California Medical Center, Los Angeles. The new facility opened in 2008, and the old hospital sits empty today, Sloane says. “They say they're going to reposition it, readapt it, but we're going to see,” he says. The old hospital is well-known from its use as the exterior backdrop for the long-running soap opera “General Hospital.”
Balkany of the Gropius Coalition notes another Chicago example that bears watching, the original Prentice Women's Hospital on the campus of 873-bed Northwestern Memorial Hospital, which was replaced by the new Prentice that opened in 2007. Architectural preservation group Landmarks Illinois has placed the original hospital, designed by Bertrand Goldberg, on its list of Ten Most Endangered Historic Places for 2010.
For an academic medical center, there is almost always the chance to use an old hospital as office space, Harvey of HKS says. When it comes to preservation for “a healthcare system in the community that is really having to focus on its bottom line—that becomes a much more challenging discussion,” he says. It takes a lot of creativity to make a profitable development out of preserving an older building, he adds.
A good example of this, Harvey says, came at the second Parkland Hospital in Dallas, the brick buildings that replaced the original wood-frame structure and served as the main hospital till 1954. Crow Holdings, a Dallas-based investment firm, redeveloped the hospital and a nurses' quarters and has two more buildings in the works, with other parcels still available on the 9.5-acre campus for future development, according to Crow's website.
“The new developments generated revenue to support the preservation,” Harvey says.