Solid Foundation

Loma Linda, Calif., sits in one of the most earthquake-prone areas in the U.S., with the Loma Linda University Medical Center at the intersection of two relatively minor faults. However, just a few miles to the north is perhaps the best-known fault system in the world—the San Andreas. For much of the past half-century, the medical center was anchored by a 371-bed hospital dubbed the “cloverleaf” for its adjoining circular towers. Opened in 1967, the building was equipped with what was then state-of-the-art earthquake-protection technology: a series of vertical support beams integrated into its frame that work to keep it from shimmying during a quake.

In 1995, the state enacted stricter standards for earthquake safety, which call for hospitals to not only be able to withstand a major tremor—they must also be able to continue providing hospital services in its aftermath. This helped put into motion a project to replace the cloverleaf with the $1.5 billion dual-tower Dennis and Carol Troesh Medical Campus, completed in August. (The facility bears the name of the philanthropist couple who gave the lead gift of $100 million for its creation.)

The project presented the opportunity to not only meet modern seismic requirements but evolve the campus to provide a more patient-centered and operationally efficient care environment.

Critical updates
First addressing the immediate needs of the new standards, architecture and design firm NBBJ (Los Angeles) teamed up with engineers Arup (London) and Stantec (Edmonton, Alberta, Canada) as well as builder McCarthy Building Co. (St. Louis). The team installed a system of 126 base isolators in the new building’s basement level. Such installations work like a car’s suspension system, which uses shock absorbers to travel over rough ground without the occupants of the car directly feeling the bumps. “Basically, the base isolator system helps separate the structure from the earth’s shaking,” says Richard Dallam, partner at NBBJ. “During an earthquake, the base isolators will let the building move up to 47 inches in any horizontal direction without suffering any major damage.”

In addition to a reinforced concrete floor, the complex’s superstructure includes a 25,000-ton steel frame to further reinforce the structure, making it North America’s heaviest building. The result is a facility that’s “an elegant Sherman tank,” says Kerry Heinrich, CEO of Loma Linda University Health Hospitals, an affiliate of the Seventh-day Adventist Church.

Meanwhile, another shift was taking place. The Loma Linda medical center was also home to an existing children’s hospital that met current anti-quake standards. However, as planning for the project got underway roughly a decade ago, hospital officials also decided to investigate whether adding a children’s component to the new tower would create synergies and improve the care experience. The verdict: yes. “There’s critical sharing of resources that can be so important to our community by having proximity of both adult and children’s hospital services, such as obstetrical and pediatric care for mothers and babies,” Heinrich says. “If you have a children’s hospital without immediate access to adult services and vice versa, care can potentially be adversely impacted.”

Mapping out a design
The resulting 992,000-square-foot Dennis and Carol Troesh Medical Campus consists of a five-story pedestal, which houses separate children’s and adult emergency departments in the base; a 16-story adult hospital with 320 licensed beds; and a nine-story children’s tower with 84 beds. (About 280 beds in the existing children’s tower also continue to operate.)

In design charrettes for the project’s layout and look, the NBBJ team did a deep dive into the relationship between the medical center and its longstanding affiliation with the Seventh-day Adventist Church. One of the central stories about the founding of the hospital occurred in the early 20th century, when church co-founder Ellen White arrived at the Loma Linda site looking for a place for another sanitarium between the church’s existing ones in San Bernardino, Riverside, and Redlands, Calif. When she saw a defunct resort/convalescent home in Loma Linda, she is said to have declared “this is the place” and envisioned patients resting outdoors under a canopy of shade trees.

Inspired by this story, NBBJ sought to evoke that serene scene in the project, installing a stand of metal trellises flanking the new main entrance. “Those provide an element of tranquility and calm for those entering the hospital that Ellen White would appreciate,” says Dallam. “There’s also a functional aspect to this area: The space underneath the trellises can also be utilized as a triage area, in the event of a major disaster or medical emergency.”

Beyond the entrance, the project team created a variety of contrasting exterior faces for the towers to keep the volume of the structure from overwhelming patients and visitors as well as to help distinguish them. The front of the children’s tower features slats of dichroic architectural glass, which take on different colors depending on the time of day and viewing angle, and faceted precast concrete, which creates different shadows as the day progresses. The street-facing façade of the adult tower utilizes sheet glass that lets abundant natural light into the building. “These were cost-effective features that bring visual variety to the overall exterior and serve to make it more interesting and less intimidating,” says Jose Sama, partner and practice/design leader at NBBJ.

Inside, specific medical-service upgrades to the hospital podium include a three-fold expansion of its cardiac department from a former space in the cloverleaf that includes updated equipment for heart-related diagnostics and procedures; expanded cancer treatments, including hybrid operating rooms housing intraoperative MRI, CT, and fluoroscopy imaging systems; and an entire floor dedicated to the San Manuel Band of Mission Indians Maternity Pavilion, with 44 licensed obstetric beds, 11 labor and delivery rooms, three C-section rooms, and nine triage rooms. (That floor was made possible by a $25 million donation by the San Manuel Band of Mission Indians, another group the hospital has a long history with in the region.)

Patient rooms are located along the floors’ perimeter walls and feature floor-to-ceiling windows to bring in as much natural light as possible, while sliding glass entry doors allow the sunlight to filter into the interior corridors, where dual nurses’ desks are located outside each adjoining room. “That allows for more personalized attention and care,” says NBBJ’s Dallam.

Furthermore, the private patient rooms are designed with enough room and furniture for families to stay comfortably. As the medical complex is also a teaching hospital, the larger rooms provide enough space for medical students to accompany doctors on their rounds.

Looking ahead
Overall, Heinrich says the new medical center delivers an improved and updated care experience. “The patients and their families love the single-occupancy rooms with their abundant natural light and great views of the surrounding mountains,” says Heinrich. “And the staff loves it because the floor layouts allow such easy flow between their workstations and the patients.”

Additionally, NBBJ’s Dallam says the safety features are expected to give the project a life expectancy of at least 75 years, thanks to its sturdy steel frame and base isolator system. “We’re confident that beefing up the building’s infrastructure to make it capable of operating during an earthquake or other types of disasters is an investment that will pay dividends over the long run,” he says.

 

Project details:

Project name: Loma Linda University Medical Center Dennis and Carol Troesh Medical Campus

Project completion date: August 2021

Owner: Loma Linda University Medical Center

Total building area: 992,000 sq. ft.

Total construction cost: Confidential

Cost/sq. ft.: Confidential

Architect: NBBJ

Interior designer: NBBJ

General contractor: McCarthy

Engineers: Stantec/Arup

Builder: McCarthy

Carpet/flooring: Shaw, Daltile, Mannington, Stone Source

Ceiling/wall systems: Martin (design build)

Doors/locks/hardware: Assa Abloy

Fabric/textiles: Carnegie, Maharam, Momentum, Luum, Designtex, Architex, Bernhardt, Stinson

Furniture—seating/casegoods: National Office Furniture, Herman Miller, RFM, Humanscale, Krug, Spec, Allseating, Andreu World, Davis, Coalesse, Arcadia, Bernhardt, Martin Brattrud, Gressco, Weiland, OFS Brands

Handrails/wall guards: C/S Acrovyn, Altro

Headwalls/booms: Hill Rom/Trumpf

Surfaces—solid/other: Corian, Caesarstone, Cambria, Pointier, Lamin-Art

Wallcoverings: Carnegie, Maharam

Interior glass/resin: 3 Form, McGrory Glass, Forms & Surfaces, Lumicor

Matthew Hall is a freelance writer/editor based in Cincinnati. He can be reached at matt.hall56@icloud.com.

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