A New Chapter

Hard hats, heavy equipment and long stretches of fencing are common sights on Greenbrae’s Bon Air Road these days. MGH 2.0 is underway, turning part of Marin General Hospital’s campus into a construction zone. While the primary goal is building a hospital to meet California’s new seismic standards for health care centers, it’s also an opportunity to build a visionary facility to accommodate the evolution of medicine and serve Marin County residents for decades to come. “This hospital is going to be a jewel when it’s complete,” says Marin Healthcare District CEO Lee Domanico.

The path to a new hospital began in 1994 after several health care centers sustained substantial structural damage in the Northridge earthquake in Southern California, leading state legislature to upgrade requirements. The rationale for SB1953, an amendment to the Alfred E. Alquist Hospital Seismic Safety Act of 1973, was that hospitals must continue operating in the aftermath of a disaster, so they require more rigorous safety standards than the norm. A lengthy study followed to identify health care facilities unable to survive a large temblor, and results released in 2001 showed 37 percent of the state’s acute-care hospitals built before 1973 were at risk of collapse in a major quake—Marin General Hospital among them.

The hurdles

MGH was the pride of Marin County when it opened as a publicly owned hospital during the building boom of the 1950s, but by 2001, it had been in service for 49 years. The original two buildings, the East Wing and Central Building, didn’t meet the state’s increased requirements to continue operating, so the best solution was to build a replacement. Sutter Health, however, was 16 years into a 30-year lease to operate the hospital and they had financial control. Both Marin Healthcare District (MHD) and Sutter disagreed over who should be responsible for the costs. Complicating the scenario further, divisive political discourse had Sutter supporters facing off against proponents of returning the hospital to community control. Several years of contentious wrangling ensued, but finally, in 2006, MHD and Sutter reached an agreement to terminate the lease early, clearing the way for building a new hospital.

MHD formed an operating board as its subsidiary to run MGH, and one of the board’s first steps was to hire Domanico to set up the hospital’s operating company. Taking the helm in January 2008, his initial challenge was steering the hospital’s transition from a private to a public entity. It was a process that culminated two and a half years later, at the stroke of midnight on June 30, 2010, when Sutter departed, and returned the hospital to community control. MHD was ready to move forward with a new hospital, and Domanico, who’d overseen the construction of El Camino Hospital in Mountain View and Delta Hospital in Concord, had the requisite experience to head the project. First, though, he had to find a way to pay for it.

MHD decided to go to the public and placed Measure F, a $394 million general obligation bond, on the ballot in an election on November 5, 2013. Domanico was optimistic. The measure required a two-thirds majority, and “Polling showed that an overwhelming majority would support hospital rebuilding,” he recalls. Predictions proved correct, and more than 68 percent of voters approved the measure. With a major portion of the funding assured, MGH was on track for the construction of a new hospital. The projected cost is $535 million, so the bond won’t cover the entire tab, but “We’re in the process of seeking philanthropic support, and the donor community has responded favorably,” says Domanico, who adds that MHD might also take on a small amount of debt.

The vision

The new state-of-the-art hospital, known as MGH 2.0, will be at the forefront of current trends in medicine. It also will be spacious, filled with natural light and have rooftop and mezzanine gardens. Domanico explains that it’s designed to be a “feeling environment,” taking into account everything a patient senses, and the priorities are healing, caring for patients and keeping them safe. “The new building will help us do all three of those things,” he says.

Building a new hospital is a lengthy process with myriad details, and when contractors break ground to begin construction early this year, architecture firm Perkins Eastman (formerly LBL) based in New York City will reach the six-year mark on the project. Jason Haim, MGH 2.0’s architect, explains that the site is challenging because it’s against a steep hillside and, with only 19.7 acres, options are limited for locating the required hospital building considering existing structures which remain in operation.

The current campus is a cluster of buildings, with the Triangle Building (aka the West Wing), which was built in the 1980s and meets seismic standards, being the most prominent. Plans include a 260,000-square-foot hospital replacement building and an addition to the Triangle Building. The current two hospital buildings will undergo renovation so they can be repurposed for administrative use. A new five-story, 100,000-square-foot ambulatory services building will come later, when funding is available, so it needs a placeholder. The hospital also has to have parking, loading docks and patient access. With that knowledge, the architects started looking at the site to determine the possible placement of new buildings and figure out how to fit all the necessary facilities. “We looked at a variety of schemes that would provide an appropriate solution,” says Haim, and then they created a master plan for development with the new four-story hospital going vertical to maximize the use of available space.

With the master plan in hand, the next step was for architects to examine the inner workings of the hospital and define every space to determine what the components should be. Schematic design followed to produce the layout and actual floor plan. After that they moved on to design development in order to determine what would go into each room. As part of an ongoing process, the architects met with administrative, medical and support staff to get their input and keep them informed. Haim and his colleagues, who are medical architects, know how health care professionals work. His team walked MGH staff through the design to explain the reasoning behind various elements. Design can be somewhat abstract until people see actual renderings. “When they see it on pen and paper or in a 3D model, you get the ‘aha’ moment,” says Haim.

Dr. Patrick Bennett, a urologist and chief of staff at MGH, found it helpful for the architects to work with the medical staff. He explains that, when MGH staff first saw the schematics, they thought they should have more input. The staff had been involved early in the process, but a considerable amount of time had passed, and so the architects began holding meetings—50 at last count—to go over the specific functionality and features of the plan to make sure the staff understood everything. “The staff didn’t understand the complexities,” says Bennett, and so the architects explained they’re building a hospital that will work well for the next 50 years, as well as details of the design. At one point, several staff members took a field trip to El Camino Hospital to see a 21st century hospital first hand, and “It was eye-popping to see what they’d done down there,” he says.

Bennett observes that people do the best they can in the current hospital, but the emergency room and  operating rooms aren’t big enough, in part because advances in medical technology create the need for larger spaces for equipment. The new hospital will provide bigger procedure rooms so personnel can move around easily and safely, and some services will be situated closer together, which will translate to better care for patients. He points out that patients have to leave treatment areas and go to a different part of the hospital now if they require MRIs. He says, “The experience for patients and families can be difficult in spite of everyone’s best efforts to deliver state-of-the-art care in a space we have outgrown.”

The details

In a departure from traditional design, a square module will give the new hospital flexibility so it can adapt as health care evolves and continue to function well for the next 40 or 50 years. Nurses’ stations will be central and distributed, and patient rooms will be around the perimeter of the building, giving each one a view to bring the outside in. The size of many of the rooms are doubling in size to meet current design standards. With the patient rooms we’re going to all private rooms,” he says. The comfort of patients is a top priority, and this design will separate patients from more populated corridors to give them dignity and privacy. Emergency and imaging will be co-located, putting services for patients in close proximity. A cath lab, where doctors perform procedures such as installing pacemakers, will be on the surgical floor. As part of its operational mandate, MGH receives patients from San Quentin State Prison, and the new design will allow them to get treatment out of the community’s sight.

“From an aesthetic standpoint, this building is going to be absolutely beautiful. We’re using a very warm color palate that will make patients and their families more comfortable,” says Haim. He adds that the new hospital is designed to integrate indoors and outdoors, and the landscaping will help with the appearance and how patients feel about themselves, as well as being one of the organizing elements of the buildings. “We’re going for more of a hospitality feel than a clinical feel,” says Haim.

Landscape architect Joe Runco, of SWA in Sausalito, describes the landscape design as a contrast to the contemporary building. It will define the spaces, creating clear edges to differentiate the hospital grounds from the adjacent neighborhood and accent points of entry. Fully planted and accessible rooftop and mezzanine gardens will provide a foreground to the view beyond, making the most of MGH’s unique setting, with its view of Mt. Tamalpais, the Corte Madera Creek and the wetlands. The goal is to give patients contact to living plants that change with the seasons and let them see outside, as exposure to nature promotes good health.

Landscaping, however, also comes with challenges. Runco describes MGH 2.0 as a complex project on a hillside site with rocks and thin soil, as well as several narrow planting spaces, various bio retention areas, swales and basins, which are important for cleansing water, throughout the site. He plans to use native and drought-tolerant materials, but must take care in selecting appropriate species. “Planting in health care situations is sensitive sometimes,” he says, pointing out that, while plants that attract insects and pollinators are beneficial for the environment, bees can be a concern, as can fragrance. “We definitely have to be wary of allergens,” he says. So as much as he’d like to use medicinal plants and species that attract bees and butterflies, he has to be careful and take such issues into consideration.

The future

Bennett reports that landscaping appears to have a psychological effect that aids healing and says, “Patients do better in better facilities.” He’s looking forward to a hospital that’s as impressive as the staff that works there and makes patients feel like they’re in a healthy place. “Finally, we’re going to have the kind of facility that the residents of Marin—and the physicians, nurses and staff at MGH——deserve,” he says.

The future looks bright. When MGH 2.0 opens its doors in 2020, Marin County will have a brand-new hospital designed to deliver the best in 21st century medicine. “You only get to build a hospital every 50 years or so,” says Domanico. “It’s a very exciting time to be at Marin General Hospital.”