medical center of new orleans charity hospital executive summary feasibility study

8/12/2019 Medical Center of New Orleans Charity Hospital Executive Summary Feasibility Study

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The Foundation for Historical Louisiana

Medical Center of New Orleans - Charity Hospita

RMJMHILLIER 3

TABLE OF CONTENTS

INTRODUCTION

PROJECT DIRECTORY

ACKNOWLEDGMENTS

PREAMBLE

SCOPE OF WORK

METHODOLOGY

ASSESSMENT FINDINGS

STATEMENT OF SIGNIFICANCE

URBAN DESIGN ANALYSIS

FUNCTIONAL ANALYSIS

CONCEPT PLAN

FUNCTIONAL NARRATIVE

IMPLEMENTATION

CONCLUSION

CONCEPT PLANS

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Medical Center of New Orleans - Charity Hospital

RMJMHILLIER

The Widener Building, Suite 1500, One South Penn Square, Philadelphia, PA 19107-3502T +1 215 636 9999 F +1 215 636 9989 www.rmjmhillier.com

August 19, 2008

Foundation for Historical Louisiana

P.O. Box 908

Baton Rouge, LA 70821

RMJM Hillier is pleased to submit our final report on the Charity Hospital building to the

Foundation for Historical Louisiana and the named parties in House Concurrent Resolution #89.

Our findings indicate that after over 75 years, the building has held up remarkably well throughhurricanes, major calamities, neglect and deferred maintenance. Thanks to the original design

vision and the construction of the building, our findings indicate that there is no compelling

reason for this historic landmark structure not to be rehabilitated to its full potential. Our

analysis and planning study demonstrates that Old Charity can be renovated at a reasonable

cost, has the floor plates to accommodate a world class hospital and this work can be

accomplished more expeditiously than undertaking a new building project in an unknown location

with all the associated and time lost in challenges of such an effort.

This enclosed Executive Summary presents our findings. The complete report includes all of

our documentation and back-up information. We trust that both documents provide you with

the information necessary to make informed decisions regarding the future of this important

landmark structure to the citizens of Louisiana, especially New Orleans.

In conclusion, after 12 weeks of intense assessments, using state of the art technology, in-

depth study by experts, and up-to-date healthcare planning efforts, we believe that this

venerable landmark can have a great future as a world class medical facility that will symbolize

the rebirth of New Orleans.

The RMJM-Hillier Design Team has looked at many critical factors in this feasibility study, and

we have determined that all of them can be resolved in a positive way. Naturally, there is a

significant cost to doing that, but we believe the cost of resolving any issue will be far less than

the cost of a comparable new building. The factors include:

1. The building envelope, including exterior walls, windows, and roof, can be effectively restored.

2. The structural system is sound, and by adding a limited number of beams in certain areas, it

will be fully functional.

3. All interior partitions, celings, and finishes will be removed, to make sure that no

environmental concerns remain.

4. Existing floor plates are workable and complimentary for a first class healthcare facility,

except for the 3rd floor, which we do propose enlarging.

5. The basic volumetric composition of the building, which has large lower floors acting as a

functional podium to support bed floors above, will work well as a modern hospital.

6. New interior fit-out of the entire building, as well as an innovative entrance atrium, is

necessary. The floor plans included in this report show how Charity can be transformed into

a modern healthcare facility.


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7. The recommended design will meet the latest code requirements for hurricane-force winds,and the hospitals floor levels are all above the Katrina flood line.

The cost of all of the above work is included in our construction cost estimate, provided by

VJ Associates, an experienced estimator for both hospital and historic preservation projects.Their estimate comes to a total of $484,000,000. In order to have an apples to apples costcomparison, RMJM-Hillier asked VJ Associates to also estimate the construction cost ofthe new hospital facility that is being planned in New Orleans, and added the cost for landacquisition. The resulting comparable number is approximately $620,000,000. Our findingsindicate that at a minimum, Charity can be restored and renovated at a cost of approximately20% less than the cost of building a comparable new building on a new site. This percentagewill undoubtedly increase when taking into account other construction costs of the newhospital, such as the demolition of the structures on the new site and the associatedremediation.

Beyond base construction costs, we also believe there would be significant savings in years oftime of construction required for Charity, as compared to building a new facility. Having thisvaluable and structurally sound building shell already in place should save at least two years

off the delivery date of a new building, which would require acquiring a very large parcel ofland, relocating the people who live there, and building from scratch a brand new building. Thisexpedited schedule is a compelling reason to restore and renovate Charity instead of buildingnew. It will provide a significant savings in construction costs by reducing the timeline for laborand material costs escalation. It will also reduce soft costs such as the cost of borrowingmoney over a longer time period, and the expenditures associated with operating temporaryfacilities for an extended period. Finally, it will put the hospital on a prompter path towardsgenerating a revenue stream.

The answer to the question of whether or not Charity can be re-made into a modern hospitalis yes. This will require a significant investment, but it is a cost-effective option that will saveconsiderable time. Our view, based on facts and figures, along with our experience in healthcareand preservation projects, is that the design concept presented here in this assessment hasa high potential for success. We urge the named parties to seriously consider this option for

providing an excellent hospital facility in New Orleans.

Sincerely yours,

R. Stephen McDaniel, AIA

Principal


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PROJECT TEAM MEMBERS

RMJM HILLIER, ARCHITECTS

WAGGONNER & BALL, ARCHITECTS

ROBERT SILMAN ASSOCIATES

GEORGE BALLARD GEOTECHNICS, INC.

R. G. VANDERWEIL ASSOCIATES

LANGAN ENGINEERING AND ENVIRONMENTAL SERVICES, INC.

VJ ASSOCIATES COST CONSULTANTS


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ACKNOWLEDGMENTS

This Feasibility Study represents an effort by the Project Team,under the direction of the Foundation for Historical Louisiana,

Baton Rouge, LA, to arrive at a plan that provides guidance onhow to take best advantage of the significant and spectacularfeatures of Charity Hospital, address the functional and pro-gramming needs of a state-of-the-art healthcare facility andprovide appropriate and proper stewardship of a historic re-source that has been an intricate part of the community fabricfor over 250 years.

The Report is the result of several months of collaborative ef-forts, including archival research and photographic documenta-tion, and investigations of existing conditions and developmentof recommended treatments by the project team, informed byinput from LSU and community representatives.

During the course of preparing the feasibility study, the RMJM-Hillier/Waggonner & Ball design team was supported by RobertSilman Associates (structural engineers), GB Geotechnics (ther-mal imaging and non-destructive testing), R. G. Vanderweil En-gineers (mechanical, electrical and plumbing engineers), LanganEngineering (hazardous materials assessment), and VJ Associ-ates (cost estimating). The team was also supported by BriceBuilding Company, who provided a lift for access, and assistancein completing localized investigative probes.

The design team would like to thank the Foundation for Historical

Louisiana (FHL) board members for their insights and excellentsupport for this project. The project team would particularlylike to acknowledge Sandra Stokes, FHL Executive Vice Chair, forher enthusiasm in embracing the historic preservation issues ofthis project, her coordination efforts, and for her tremendouscontributions towards making the preparation of this FeasibilityStudy possible.


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EXECUTIVE SUMMARY

PREAMBLE

Since its beginnings, New Orleans Charity Hospital has beenat the forefront of healthcare, from its early breakthroughsin anesthesia, and the establishment of the first blood bank tothe recent installation of a hyperbaric chamber. As the lon-gest continually operating hospital in the United States, thehistory of healthcare has been written on its walls. Charitywas designed as a teaching hospital, embracing the conver-gence of healthcare, medical research, technology and medicaleducation. Its mission of providing healthcare for all within aneducational setting fostered the growth of the surround-ing medical community and schools of medicine. Its proximityto LSU Medical School, Tulane School of Medicine, the VA and

University Hospital, as well as residential neighborhoods, theCentral Business and Municipal Districts, the Superdome andthe French Quarter, ensured that Charity was firmly rooted inits community as a beacon for healthcare supporting patientsfamilies and caregivers. That is, until it was determined thatthe impacts of Hurricanes Katrina and Rita were reason forthis landmark to be shuttered and abandoned as a medicalfacility.

In 2006, the Louisiana Legislature, by unanimous vote, passedHouse Concurrent Resolution No. 89 (HCR 89), put forth byRepresentative Odinet, charging the Foundation for HistoricalLouisiana (FHL) to do an independent assessment of Big Char-

ity Hospital. The FHL was to work with the State office ofFacility Planning in the Division of Administration, the LouisianaRecovery Authority, and the LSU Board of Supervisors in thisevaluation and () report finds to each of those entities andto the legislature upon completion of the evaluation.

In March of 2008, the FHL issued a Request for Qualificationsfor the preparation of an Existing Conditions and FacilitiesAssessment Report on the Big Charity Hospital building at1532 Tulane Avenue in New Orleans, Louisiana. In May 2008, thedesign team lead by RMJM Hillier was selected to completethe feasibility study, as laid out in HCR 89.

Figure 0.0.2 -Artists Rendering of Charity Hospital.

Figure 0.0.1 -Contextual Historic Rendering of CharityHospital.


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SCOPE OF WORK

The first key decision of the Design Team was to determine thescope of the conceptual study.

HCR-89 requires the assessments of .the first three floorsof the structure, excluding the basement, to determine their

viability for interim use to provide medical services including

emergency services, psychiatric services, and establishment of

clinics and subspecialty clinics.

HCR-89 also requires that the independent evaluation team evaluate the operating room and intensive care units todetermine the feasibility restoring the trauma unit to pre-Hur-

ricane Katrina status, thereby making trauma services avail-

able to the citizens while a new trauma unit is being designed,

funded, and built, thereby reestablishing a revenue stream that

will be essential to the viability of a new facility and examine

and evaluate the entire Big Charity structure to determine theadvisability of repairing or restructuring the entire facility.

On June 10, 2008, the FHL and RMJM Hillier met with Dr Mi-chael K. Butler, Chief medical Officer of LSU Health ServicesDivision and Danny Mahaffey, Director of Facility Planning todiscuss programming for the Charity Hospital study. They stat-ed that interim medical and clinical services were already beingprovided at Lord & Taylor and that interim emergency serviceswere already being provided at University Hospital, renderingthe provision of interim medical facilities at Charity unneces-sary. Letters from the State Commissioner of Administrationand from the State Director of Facility Planning confirmedthat interim use is currently addressed by the reconfigura-tion of University Hospital, the return of mental health carethrough the lease at DePaul Hospital, and the use of renovatedspace at the New Orleans Adolescent Hospital.

It must be noted that focusing on the first three floors onlywould not have been a prudent and cost effective way of ad-dressing both interim and long term potential reuse scenarios.The first three floors comprise the base/podium of the entirebuilding supporting the tower section both structurally and interms of building systems. Activating only three floors wouldrequire creating a dedicated new base building infrastructure

for the three floors (boilers, chillers, base distribution, etc),and separating all vertical chases and connections betweenthe base and the tower portion of the building. A significantabatement program far larger than the three floors wouldalso have to be undertaken to ensure that the three floorswould be free of contaminants and hazardous substances.Finally, the exterior envelope would require repairs and windowreplacement, and a considerable waterproofing and envelopeprotection effort would have to be undertaken above thethree floors to ensure that there are no moisture threats

Figure 0.0.3 -Image of Charity Hospital DuringConstruction.Image from the Book New Orleans Charity Hospital: A Story of Physicians,

Politics, and Poverty By John Salvaggio, M.D.; courtesy of Dr. Russell Klein

and Louis Castaing, Louisiana State University Medical School Alumni

Affairs Files.

Figure 0.0.4 -Image of Charity Hospital at Present,From Across Tulane Avenue.


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from areas still in serious need of repair.

Furthermore, assuming that renovating the first three floorswas accepted, the long term use of the remainder of the build-ing would be far more expensive than renovating the entirebuilding as a vacant facility, given the fact that there would beintensive construction - the equivalent of erecting a new hos-pital above an occupied medical critical care facility.

As a result of all of the above considerations, the option ofinterim use was no pursued by the design team.

Before Katrina all floors of Charity Hospital were in use. Newlyrenovated state of the art facilities sat next to outdated non-compliant departments. Hazardous materials such as asbes-tos, lead and mold, as well as outdated mechanical systemswere a major concern. The fact that the facility had to remainup and running made any much needed renovations and infra-

structure upgrades extremely difficult to undertake and costly.Indeed, it would have been almost impossible to upgrade thebuilding to a state of the art facility without massive tempo-rary relocations of departments and the disruptions that suchan approach would cause.

Now that the building has been vacated, a new opportunitypresents itself: to reassess the potential of this historic land-mark to be reborn as a world class healthcare facility. Indeed,the condition assessment findings demonstrate that manyissues requiring remediation affect the building as a whole,and the extent and cost of mitigation, abatement, repairs andbuilding systems upgrades required for a limited re-use of

existing clinical operating rooms and intensive care units is notfunctionally optimal, or cost-effective.

The design team concludes that the best approach is to ad-dress the entire Charity structure, with a comprehensive, inno-vative design that would allow a permanent re-use of the coreand shell of the building, provide state-of-the-art facilities andamenities for a modern hospital and Level 1 trauma facility, andrespect and enhance significant historic features. This com-prehensive renovation work would use available funds promptlyand effectively, and be completed within three-and-a-halfyears, quicker than it would take to build a new structure, andat lower cost. This approach also takes advantage of exist-

ing associated structures on adjacent sites in order to housenecessary support system(s). Using the existing infrastruc-ture of tunnels, utilities and bridges that connect these sites,support facilities would be upgraded to meet current coderequirements and would be designed to continue to supportadjacent facilities such as the VA and Tulane. Services withinCharity could be shared with the VA. Inpatient bed floors couldbe rented out to the VA during construction of its new hos-pital, allowing built-in future expansion for the Medical Cen-

Figure 0.0.5 - Present Condition of a Typical Corridor.

Figure 0.0.6 - Present Condition of West Wing Roof.


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ter. Additional long term hospital expansion could be servedthrough LSU-owned sites to the West, and South across Gra-vier Street. LSU currently owns 23 buildings on adjacent sites,many of them ideal for functioning as the ambulatory-carecomponent of the Medical Center, as they did prior to Katrinaas well as to provide flexibility for change and long term futuregrowth of the Medical Center.

The previous experience of the design team working withpeople in the healthcare community in New Orleans has af-forded us the opportunity of discovering a history of com-passionate care and a dedication to the supporting clinicalprograms. A renovated state-of-the-art Charity Hospital, withnew technology and centers of excellence, will once again pro-vide such compassionate and efficient care. The revitalizationof the hospital will be an important step in the redevelopmentof New Orleans, reinforcing the value of sustainability - notdemolition and social displacement - as a key component of

the future of architectural development. It also underscoreshow sound preservation principles can be creatively integratedwith modern design parameters, including the most stringenthealthcare requirements. The rich history of the architecturein the city is a fundamental part of the citys success, andthere can be no better example of leadership and commitmentto sustainability, redevelopment and growth in areas ravagedby Katrina, than the reuse of a nationally significant and iconichistoric landmark, such as Old Charity.

Figure 0.0.7 - Proposed Main Entrance Along TulaneAvenue.


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METHODOLOGY

House Concurrent Resolution No. 89 (HCR-89) requires thatthis feasibility study assess the condition of the facility andevaluate its potential uses as a location from which medical

services may be offered to the population of the Greater NewOrleans area and evaluate the entire Big Charity structure todetermine the advisibility of repairing or restructuring the en-

tire facility. RMJM-Hillier and the Design Team complied withthese requirements with an extensive existing building condi-tions assessment and the development of a concept design.Together, these components inform the determination of thefeasibility of the re-use of Charity Hospital, and the costs as-sociated with such a renovation.

ASSESSMENT

The assessment component of this report includes four steps:

Historical analysis of the physical and historic contextof Charity Hospital.

Discovery process to describe, understand and assessthe physical conditions of Charity Hospitals envelope (masonry faade and windows), structural framing, and buildingsystem(s).

Evaluation of the suitability of building site, floor plateand architectural layout to accommodate the functional andclinical needs of a cutting edge hospital with new technologyand centers of excellence. Summary analysis of the findings of the historicalbackground and context, the discovery process, and the archi-tectural evaluation.

The historical analysis of the physical and historic context ofCharity Hospital provides an overview of the history of thehospital, a discussion of previous site uses, and a descrip-tion of the building and site arrangement. It then uses thesecomponents to assess the architectural, cultural, technologi-cal and historical significance of the structure. This analysis isessential to recognize the historical integrity and significanceof the building.

The discovery process aims to identify existing conditions,their extent, and the probable factors that caused or contrib-uted to them, through a multi-layered approach that includes:

Field comparison of drawings and existing arrange-ments;

Review of historic photographs and descriptive ac-counts pertaining to various renovation and construction cam

Figure 0.0.8 - Historic Photograph of Charity HospitalTaken Shortly After Construction Completed.

Figure 0.0.9 - Original Structural Plan of the TwelfthFloor Auditorium.


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paigns;

Review of photographs and descriptive accounts per-taining to Hurricane Katrina;

Review of Hurricane Katrina damage assessment re-ports and proposed mitigation ;

Photographic documentation;

Survey-level observation of accessible surfaces;

Thermal imaging of the elevations and non-destructiveexploration at select locations

Investigative probes and observation of concealedconditions at select locations;

Discussion of conditions and problems with facilityoperations and maintenance personnel;

Notation of materials conditions;

Review of the evidence yielded by the above investiga-tion

The design team reviewed full size copies of select original en-gineered drawings for the Charity Hospital of Louisiana MainBuilding New Orleans project obtained from the LouisianaState University Health Sciences Center (LSUHSC-MNCLO)Facilities Management Department archives. The drawings

include architectural, structural and MEP systems drawings,ranging from January 1937 to January 1938. Drawings showingconstruction details in areas where observed existing condi-tions were considered to be in poor to critical conditions werehelpful in identifying factors causing the deterioration anddeveloping recommended treatments.

The design team also reviewed drawings obtained from LSUH-SC archives that inform the scope and nature of more recentconstruction campaigns of the past thirty years. The draw-ings helped clarify the timeline and observed conditions, andassisted in the determination of a period of interpretation forthe recommended treatments.

After this initial review, the project team completed a prelimi-nary existing condition reconnaissance and photographic doc-umentation of the hospital, followed by extensive survey levelobservations of envelope features, structural components, andmechanical, electrical and plumbing (MEP) distribution systems.The observation included the following:

Visual observations conducted from the ground and

Figure 0.0.10 - View of the Center Tower from the WestWing Roof.


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accessible roofs using binoculars, and including all visible sur-faces, with the exception of areas concealed by adjacent build-ing components or structures. The scope of visual observa-tion include the faade masonry and windows, building systems,and potential hazardous materials

Non destructive testing of the faade assemblythrough thermal imaging, complemented by impulse radarassessment and metal detection. Thermal imaging providesinformation on the typical thermal characteristics of eachfaade, including confirmation of the summer diurnal ther-mal cycle (faade temperature change). Impulse Radar dataand metal detection collected at specific locations providescomplementary information on concealed features, such asdepth of stone and embedded steel.

Investigative probes to confirm envelope assemblydetails noted on the drawings and through non-destructive

testing, and ascertain visually the condition of select embed-ded steel elements. Investigative probes were conducted atthree locations identified by the design team after a review ofthe historic architectural and structural drawings, and prelimi-nary field observations.

The assessment includes a due diligence hazardous materi-als (hazmat) assessment that included an inspection of thebuilding to identify the presence/absence of asbestos contain-ing materials (ACM), Lead Based Paint (LBP), PolychlorinatedBiphenyls (PCB)/Mercury containing electrical components,and microbial impacted materials. The assessment includedsampling, laboratory testing of samples collected and an item-

ized inventory of hazmat identified in the building.

The assessment was conducted concurrently with an analy-sis of the building site, floor plate and architectural layout toevaluate their suitability to accommodate the functional andclinical needs of a cutting edge hospital with new technologyand centers of excellence.

A final summary analysis of the findings of all of the aboveresulted in a qualitative rating of all observed conditions, witha focus on the envelope, structural framing, building systems,and floor plate. This was followed by conclusions as to whatareas or components might require remediation.

CONCEPT PLAN

The conceptual plan focuses on the feasibility of the re-useof Charity Hospital, with a collaborative design vision integrat-ing current healthcare design principles with sound preser-vation techniques, and sustainable technology. This is real-ized through programmatic analysis, preliminary layout plansand stack diagrams, recommendations for the treatment of

Figure 0.0.11 - Measurement of a Cracked MasonryUnit.

Figure 0.0.12 - Thermal Imaging of the Main Courtyard,East Wing.

Figure 0.0.13 - Selective Probing to Determine WindowAssembly Attachment.


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historic fabric, and the remediation of the limited deficienciesnoted in the assessment.

The feasibility study concludes with a description of the workitems that will be required to implement the proposed reno-vation, detailed conceptually in technical narratives, conceptdesign drawings and preliminary sketches and diagrams thatform the basis for the feasibility study implementation budget.


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ASSESSMENT FINDINGS

BUILDING ENVELOPE

Non-destructive testing confirms that all of the scanned

areas of the faade exhibit similar arrangements of embeddedstructural steel columns, with a repeating pattern of varyingfacing block thicknesses, and no additional faade anchoring.This is consistent with the design details provided in the origi-nal structural and architectural drawings.

A thermal imaging analysis of daily temperature variationswithin the masonry envelope concludes that it is unlikely thatdimensional changes due to thermal expansion of either theframe or the wall assemblies are a significant factor in theobserved masonry conditions.

In general, the faade masonry does not exhibit any significant

failures, flaws, or distress. The conditions observed are con-sistent with the period and quality of construction, the assem-bly detailing, and the normal weathering over seventy years.Overall conditions observed throughout the building envelopeinclude deteriorating mortar joints and soft joints, heavy at-mospheric soiling, localized instances of water runoff streak-ing, copper and ferrous staining, and biological growth, as wellas miscellaneous spot soiling (mortar, guano, paint).

The pattern of diagonal cracks between the first and thirdfloors appears to be the result of differential structuralsubsidence, and became apparent within one year of comple-tion of the structure. The presence of any residual move-ment taking place can be confirmed using crack monitors andstrain gauges over a cycle of seasons. This will help determinewhether the cracks are progressive or cyclic, and inform theproposed interventions.

The pattern of vertical cracks at select building corners islikely the result of stress from the corrosion of the embeddedsteel columns. The presence of corroding embedded steel wasindicated at these areas of masonry distress through the non-destructive testing, and subsequently confirmed when limiteddestructive probes were done.

Instances of non-structural cracks observed in faade stoneunits require minimal treatment; limited areas of more exten-sive cracks where the integrity of the masonry unit may havebeen compromised, require more elaborate interventions.There is limited displacement of faade limestone units atareas where the original detailing provided inadequate bondingof the limestone skin with the masonry backing. This displace-ment is sometimes exacerbated by a building orientation thathas resulted in high moisture retention, or areas of waterentry that may result in embedded steel corrosion and corro-

Figure 0.0.14 - Typical Biological Growth Found onCourtyard Elevations.

Figure 0.0.15 - Corner Cracking with Exposed CorrodedSteel and Failing Cementious Repairwork.


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Figure 0.0.16 - Image of Cracking Due to Settlement Shortly Afterthe Buildings Completion (ca. 1940).Image from the Book New Orleans Charity Hospital: A Story of Physicians, Politics, and

Poverty By John Salvaggio, M.D.; courtesy of Dr. Russell Klein and Louis Castaing, Louisiana

State University Medical School Alumni Affairs Files.

Figure 0.0.17 - Diagram Showing the Locations of Structural SteelElements Behind the Exterior Masonry.

Figure 0.0.19 - Photographic Documentation of Location at Present. Figure 0.0.18 - Thermal Imaging of ca. 1940 Image, IllustratingRetained Moisture in Facade and Directional Cracking.


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sion jacking.

This report concludes that the cracks and displacements ob-served in the faade have not translated into the main buildingstructural element assembly. There are no fatal flaws in thebuilding envelope that would impede the rehabilitation of Char-ity Hospital into a state-of-the art healthcare facility.

WINDOWS

The majority of the existing windows have exceeded their lifeexpectancy. All windows, both original and replacement, havebeen significantly damaged through alterations, lack of main-tenance and the effects of Hurricane Katrina.

ROOF

The roof and associated rainwater drainage system will require

complete replacement.

BUILDING STRUCTURAL STEEL FRAME

The observation of accessible areas did not indicate any signof distress in the structural elements. Investigative probeshave demonstrated the presence of corrosion at limited areasof embedded steel, most notably the corner columns; however,there is no physical evidence that corrosion has affected thestructural integrity of the building as a whole.

The load capacity of the pan-joist system is suitable for theproposed use; the load capacity of the one-way corridor slabs

remains in question. Applying current code requirements andconcrete design standards and using the design informationavailable in the original documents yielded service load capaci-ties less than desirable. However, site observation has foundno slab areas exhibiting significant distress, and performanceover the years does not appear to have been deficient.

To reconcile this apparent discrepancy it will be necessary toobtain additional information on the existing slab, and poten-tially conduct testing in order to develop a more accurateestimate of the floor load capacities and verify whether anyform of enhancement is necessary. For the purposes of thedevelopment of the cost estimate of proposed work items,

this report assumes the more conservative approach that theslabs will require some form of structural enhancement.

Additional areas that will require reinforcement design includeareas supporting new heavy medical equipment and appliances,such as MRIs and radiation rooms, or new mechanical equip-ment, and new vertical circulation and mechanical shafts.This report concludes that there are no fatal flaws in thebuilding structural integrity aand capacity that would impede

Figure 0.0.20 - Typical Original WindowFrame.

Figure 0.0.21 - Deteriorated Rooftop HVAC Units.


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the rehabilitation of Charity Hospital into a state-of-the arthealthcare facility.

BUILDING SYSTEMS

All of the electrical distribution equipment located in the base-ment was damaged from the flooding during Hurricane Katrinaand are no longer suitable for use. Furthermore, the configu-ration of the existing essential power system does not meetcurrent codes; the fire alarm system throughout Charity Hos-pital is a mix of old devices and newer devices installed as partof a retrofit. All of the electrical power distribution system,distribution equipment, emergency generators, and existingessential power system will require replacement

The heating, ventilation and cooling (HVAC) equipment rangesfrom large air handlers to multipurpose air conditioning units,located in mechanical rooms from which air distribution duct

and risers branch out in all three component wings. Most ofthe existing equipment is beyond normal life expectancy and isno longer suitable for use. The HVAC system in Charity Hospi-tal will require full replacement.

Much of the plumbing infrastructure (distribution piping andequipment) is more than 40 years old and beyond its usefullife expectancy. Numerous renovations since 1939 have taxedthe existing plumbing systems beyond their intended func-tional capability. The plumbing infrastructure at the base-ment suffers from flood and post-flood damage as well assuspected extensive wear, and fixtures and equipment in manyareas do not meet modern standards for use in non-ambula-

tory healthcare facilities. Medical gas systems have becomecontaminated from the flood and post-flood time periods andcannot safely be reused. It is strongly suspected that thepotable water distribution system is extensively contaminatedand should not be reutilized. The plumbing system in Char-ity Hospital, including infrastructure, fixtures and equipment,potable water distribution system, wastewater managementsystems, and medical gas systems will require full code-com-pliant replacement.

HAZARDOUS MATERIALS

In general the paint associated with building components is

identified to be non-lead based paint. However; asbestoscontaining materials are present in friable and non-friableforms, as are PCB-containing ballasts/capacitors, mercuryvapor lamps, and florescent light bulbs. There is also substan-tial mold growth on surface materials, and it is highly likely thatelevated mold spore concentrations also exist behind walls andabove ceiling plenums.

Figure 0.0.22 - Selective Probe Revealing Steel RelievingAngle Behind Exterior Masonry.

Figure 0.0.23 - Deteriorated Mechanical Equipment.


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STATEMENT OF SIGNIFICANCE

Charity Hospital possesses National Architectural Significanceas a premier example of Art Deco architecture in transitionto streamline modern in New Orleans, designed by the firm of

Weiss, Dreyfous & Seiferth (WDS), which also designed the ArtDeco State Capitol in Baton Rouge. The architecture achievesits power of effect through mass, sober symmetry, unity ofdesign and simple yet effective, decorative details. The designalso maximizes the use of the site through vertical design, andwith an H-shaped floor plate that suits programmatic needsand optimizes density without sacrificing natural light.

Charity Hospital possesses National Cultural Significance as apublic welfare institution and unique model of publically fundedcare for the poor and uninsured that has serviced New Or-leans indigent community continuously since the first CharityHospital was established in 1737 - one of the longest continu-

ously running hospitals in the nation. Charity is also culturallysignificant as a preeminent medical teaching institution at theforefront of medical practices and training since its first daysin Jean Louis Hall, and as an institution that always admittedblack patients in the South, first slaves then freedmen, wellbefore post-Civil War laws banning racial discrimination.

Charity Hospital has National Technological Significance as oneof the two largest hospitals in the country when constructed,a state-of-the-art facility of its time, and a hub of innovation.When completed, it was the largest state hospital for acuteand contagious diseases in the world, and offered both Tulaneand LSU medical schools equal laboratory and clinical facilities.Over the years, it remained one of the richest clinical experi-ences for training physicians, at the forefront of key techno-logical innovations such as early intravenous technology andearly prototypes of iron lung technology.

Charity Hospital has National Historical Significance as themost extensive representative of the hospice charity health-care model, constructed in New Orleans as part of GovernorHuey Longs Share the Wealth program. It is also significantas an illustration of the changing twentieth century healthcarelandscape in Louisiana, and the competition between stateowned institutions and a burgeoning private institutions sec-

tor.

Although Charity Hospital is a landmark with national, regionaland local architectural, cultural, and historical significance, notall of its components have the same level of significance. Thefunctional hierarchy is reflected in the original significanceof the spaces, with main assembly areas containing the mostarchitectural and technologically significant features. Circula-tion and support service(s) areas are of a scale matching thatof the building, but with they exhibit few features of

Figure 0.0.24 - Main Entry Courtyard and Original Ser-pentine Walkways.

Figure 0.0.25 - Historic Image of Charity HospitalTwelfth-Floor Amphitheater (ca. 1947).


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particular significance.

Over the years, various renovation campaigns, shifts in use, andattrition have resulted in some loss of original building fabric.Throughout, the hospital has retained significant exterior andinterior historic fabric, with a high degree of architectural ortechnological design and finish, which could be preserved or re-stored. These mainly include the main building limestone-cladfacades, the Tulane Avenue courtyard, pavilions and coveredwalkways, the first floor main entrance and lobbies, the twelfthfloor auditoriums, and the east and west wing sun rooms.Appropriate treatment of these areas is key to the interpreta-tion and stewardship of this exceptional resource.


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URBAN DESIGN ANALYSIS

The site of Charity Hospital is ideal for a healthcare facility.Proximity to the downtown and surrounding neighborhoodsmake it easily accessible by both vehicle and pedestrian. The

proximity of I-10 makes it ideal for a level-1 trauma facility.Clinical and academic experiences are enhanced by the abilityto draw students and faculty from LSU Medical School, TulaneSchool of Medicine, and University Hospitals.

Figure 0.0.26 - Site Access Diagram.

Figure 0.0.27 - Connection Diagram Illustrating theRelationship Between Charity Hospital and the City ofNew Orleans.

Figure 0.0.28 - Diagram Illustrating Site Access viaInterstate 10.


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FUNCTIONAL ANALYSIS

As an essential services building, Charity is well suited forhurricane and flood resistance. After the levees broke dur-ing Katrina there was only flooding in the basement, and the

hospital remained accessible from the street via 5-ton armytrucks. The hospitals first floor level did not flood and is abovethe required flood level. The mass and width of the footprintsof the building give it ample stability for resisting high windloads. The punched openings are suitable for the installationof hurricane proof windows.

The design of Charity Hospital is a simultaneous compositionof elegant towers that meet the ground, and a wide-floor-plate podium with narrow-floor-plate blocks above. Architec-turally, the design and setbacks emphasize the verticality ofthe building. Functionally, they conform to modern healthcarefacilities standards, providing a podium to accommodate large

and complex medical and surgical functions, which support thebed tower floors above.

The existing floor to floor height is 17-0 at the 1st and 2ndfloors, ideal for operating rooms and diagnostic facilities andall elements that make up a modern diagnostic and treatmentpodium. The third floor is 13-0 and would easily accommodatean obstetrics department with its Cesarean procedure rooms.Remaining floors 4 and above are 12-6, perfect for inpatientbeds.

The building footprint, with its H-shape, complies with modernhospital design goals of enhancing daylighting and providingviews from all rooms. The first floor can be adapted to complywith modern hospital design criteria for a wide podium for thefirst two or three floors, because of the large size of depart-ments, such as operating rooms, radiology and emergency ser-vices, that make up the diagnostic and treatment podium. Onthe upper floors, the east and west wings widths and columnspacing lend themselves to state of the art code compliantprivate patient rooms and corridors. A life and safety codeanalysis indicates that there are a number of generally non-compliant existing conditions throughout the building, suchas door size, clearance, and hardware, egress issues such asexcessive common paths of travel, inappropriate stair widths,

corridor widths, or required partition fire-rating. Elements toremain will require remediation or corrective action approvedby the local authority having jurisdiction.


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CONCEPT PLAN

As people are living longer and medical procedures are becom-ing more expensive, the health care industry is recognizing theneed for early diagnosis, focus on wellness and education and

the importance of being rooted in the surrounding community.Modern state of the art facilities are becoming more and moreconnected with their surroundings, incorporating communityspaces, retail and wellness centers: inviting places that areas much about health and life as they are about treatment.Charitys location and interconnectedness and its familiarityas a healthcare icon for New Orleans make it extremely wellsuited as a location for a state of the art healthcare facilitythat embraces its neighbors.

As the health of the planet and the cost of energy are be-coming increasing concerns, modern healthcare facilities areembracing sustainable design more than ever before. There is

no building type that warrants a healthy facility more than ahospital; the re-use of existing buildings is the most sustain-able building strategy. Its sheer size of one million square feetmakes the demolition of Charity a major undertaking. In addi-tion, its proximity to downtown and the surrounding communitymake it ideal for encouraging walking and the use of publictransportation, fostering health, neighborhood safety and theconservation of resources.

The design vision for Charity is one that integrates cuttingedge healthcare design with sound preservation principles,and sustainable technologies. Tomorrows Charity Hospital willbe the optimal patient centered environment. It will be opera-tionally and aesthetically balanced, family-centered, and willprovide a positive environment for patients and visitors, usingwater features, soothing music, pleasant smells, and accessto art and to indoor and outdoor healing gardens. Restoredhistoric features will provide the reassurance of familiarity, andreminders of a better past. All of these are linked to shorterlengths of stay, elevated mood, higher patient satisfaction, andincreased quality of life for hospital patients.


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Figure 0.0.30 - Proposed Entry Portals Along North Facade.


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FUNCTIONAL NARRATIVE

The new hospital is planned and designed with staff efficiencyin mind, in order to provide a facility which supports and pro-motes family centered care and patient safety, while enhancing

staff productivity and essential wayfinding. The idea is to cre-ate the best patient and family experience, with facilities thatare comfortable and simple to navigate. The design also rein-forces existing teaching relationships and clinical partnerships.New spaces supporting the balance of academic medicine andbest clinical practice offer the opportunity for new space andstronger collaboration.

Public entrances, such as the main lobby and the walk-inemergency room are located at the first level with access toall major public elevators. A new covered, air conditioned mainhospital lobby in the Tulane Avenue courtyard houses cafeteriadining, registration, waiting areas, and entries into the elevator

lobbies, as well as entrance portals for hospital service linesthrough openings cut into the building. Complete separationof vertical transportation is realized as elevator systems, oldand new, are reorganized to allow distinct separation betweenpublic and staff, support services and patients, materialsmanagement and support services distribution and trash andrecyclables movement. An additional set of elevators providesa distinct and separate connection between trauma/emer-gency and surgery/intervention.

All critical services and functions are located on the 1st levelor above in order to maintain operations during major cata-strophic events. As a result, there are no basement functions;all normal support services functions are located in the lowerlevels of the hospital above.

All mechanical support services, with limited exceptions, arelocated on an entirely dedicated 4th floor, allowing completeseparation from the clinical environment, and limiting unau-thorized or inadvertent access.

The new Charity Hospital will provide Level 1 Trauma care onthe first floor, organized in treatment areas zoned to createteam areas and reduce disorganization in the environment.The reuse of the existing hyperbaric chamber is an integral

part of the Level I Trauma Center. Integrated Team Stationsfor the Trauma/Resuscitation rooms will be incorporated intothe general exam team areas to provide flexibility. Radiology/Imaging located in the department to facilitate efficiency inreducing steps and minimizing patient movement.

The second level is the center for interventional procedures,surgery and diagnostic imaging, providing state of the art sur-gical services for the Level 1 Trauma center. It is a dedicatedinpatient surgical/procedure environment supporting the ED,

Figure 0.0.32 - Vertical Circulation Diagram.

Figure 0.0.31 - Proposed Functional Stacking Diagram.

Figure 0.0.33 - Proposed Center of ExcellenceReception.


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Figure 0.0.35 - Proposed Atrium Interior.

Figure 0.0.34 - Second Floor Reception from Parking Garage.


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and a wide range of patient types, from minimally invasiveand interventional cases to inpatient surgical suite offeringstandardization and future flexibility in space utilization. Thesecond level also includes state of the art diagnostic imagingservices, with deployed radiology modalities close to specificpatient populations supporting a collaborative care environ-ment.

Womens Center Services are consolidated on the third level.The proposed model for Obstetrical care is a Labor, Delivery,Recovery room with Post Partum rooms sized for roomingin. Antepartum beds are located with LDR suite for patientsafety; the GYN inpatient unit is located on the fifth floor.

The fifth to eleventh floors are fitted out with single bed inpa-tient nursing units and associated support functions as pro-grammed. These standardized, same-handed, identical patientroom units follow one of todays most publicized recommenda-

tions related to designing for patient safety. The units includeendoscopy, clinical research inpatient unit, intensive care bedunits (ICU) with ICU pharmacy and e-ICU, inpatient bed units,acute care rehabilitation and rehabilitation therapy centers,crisis intervention unit, dialysis and neo-natal ICUs. Alsoincluded are inpatient noninvasive cardiology and neurology,impatient pulmonary services, inpatient pharmacy, biomedicalengineering, environmental services, and patient escort servic-es. A distinct, separate and secure inpatient unit is dedicatedto prisoners requiring inpatient treatment. The eleventh flooralso includes on-call suites and physicians lounges.

The twelfth and thirteenth floors are dedicated to general

behavioral health and dual diagnosis beds, acute behavioralhealth/alcohol-drug abuse beds and behavioral support space.A new atrium and stair connects both floor for shared whereday facilities will be constructed.

The fourteenth floor and all floors above house administrativefunctions. The eighteenth floors double height space, origi-nally a gymnasium, may be fitted out as a multi-purpose space.

A separate Support Services Building is proposed to house themajority of support services such as materials management,laundry, bulk food service, core laboratory. This includes centralreceiving, bulk storage, deliveries via underground tunnels as

well as small truck deliveries and daily (or as needed) supplydistribution to each patient care area in the new hospital. TheLaboratory/Pathology Department is to provide comprehen-sive services to all patients served by the hospital, as well asgeneral lab work to a range of external customers, such asthe VA or local hospitals, and other nearby hospitals, if plannedappropriately. All semi-tractor trailer traffic will be shifted tothe Support Services Building.

Figure 0.0.36 - Proposed Patient Suite Plan.

Figure 0.0.37 - Proposed Patient Suite.

Figure 0.0.38 - Proposed Sixth Floor Circulation Space.


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Figure 0.0.40 - Proposed Entry via Tulane Avenue.

Figure 0.0.39 - Proposed Atrium and Main Entrance.


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IMPLEMENTATION

The proposed concept design represents the Project Teamsexacting commitment to provide excellence in healthcare whilerespecting and enhancing this unique historic resource and

complying with the Secretary of the Interiors Standards forthe Treatment of Historic Properties, 1995. It offers an opti-mal, patient-centered, hospital experience that takes advan-tage of significant and spectacular features of Charity Hospi-tal, and provides proper stewardship of a historic resource byreturning it to the public as a center of excellence and com-passion in healthcare for the community.

Charity Hospital is a historic landmark and symbol, but it isalso a healthcare facility, with practical implications in termsof operational requirements, logistics, security concerns, andpublic visitation. Because of the unique nature of the needsof a healthcare facility, there will always be a tension between

preservation and stewardship concerns, and non-preserva-tion factors such as functionality, codes and regulations, publicvisitation, special equipments, etc. The key factor in decidingwhat future changes might be acceptable for Charity Hospitalwere preservation of extant historic fabric, and reversibility offuture changes and/or improvements.

The scope of work for the Charity Hospital renovation and ret-rofit consists of complete demolition, abatement and mitiga-tion of the interiors, preserving and restoring certain historicelements such as the existing main lobby, and a full new build-ing fit out as required to create a modern state of the art446 bed Inpatient Hospital. The scope of work also includes allremedial work required to address code deficiencies that wereidentified in the building assessment phase, and limited build-ing additions. Some of the work is part of the base bid; otherwork consists of alternates that have been included in thecost estimate

The base work includes:

Improve access and circulation with a new two-lanepatient drop off for vehicular patient access from TulaneAvenue, a new Emergency Department entry for walk -in withnew drop-off ramp, and a new air conditioned glass enclosed

addition in the Tulane Avenue courtyard;

Improve vertical circulation with the removal of exte-rior stairs and constructing new interior and exterior verticalcirculation;

Improve stormwater and subsurface water drainagewith a new storm drainage system to convey rainwater fromthe roof of the building to site storm sewers and a new pe-ripheral drainage system discharging to the site storm system;

Figure 0.0.42 - Parking Diagram Along LaSalle Street.

Figure 0.0.41 - Two-Lane Patient Drop-Off Along TulaneAvenue.


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Figure 0.0.44 - Proposed Rehabilitation of Historic Lobby.

Figure 0.0.43 - Proposed Atrium Space.


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New utility services, including domestic water ser-vice, fire service, sanitary sewer, storm water, natural gas, sitelighting and electric supply;

Repair the faade masonry to reduce water entry andmoisture saturation, improve original detailing where required,restore deteriorated masonry assemblies, improve appear-ance, performance and durability of masonry, and facilitatelong-term maintenance. The work will include stone repairs,masonry repointing and cleaning.

Replace all doors and windows with new doors, win-dows or louvers required to accommodate the new mechanicalsystems. All windows and louvers meet hurricane-borne debrisrequirements.

Provide structural reinforcement at corridor slabs,and as needed to accommodate new vertical shafts, mechani-

cal equipment, or programmatic needs and related medicalequipment.

Infill existing courtyards on the south side of thebuilding with new construction up to the third floor, to accom-modate the emergency department on the 1st floor, interven-tional diagnostic suite on the second, and obstetrics and thesterile processing department on the 3rd floor.

Restore the main lobby to its original state by remov-ing later additions, reconstructing the original configurationof the lobby as documented in historic photographs, drawingsor narratives, recreating the 1939 flooring, wall and ceiling

finishes, including the molded crown, to match existing, and de-signing an information desk that is compatible with the overallarchitectural fabric and decorative features.

Restore the twelfth floor auditorium in the same man-ner.

Rehabilitate remaining building interior to suit theproposed program and projected capacity, with the demoli-tion, abatement and mitigation of the interiors, and a full fitout with additions as required to create a modern state of theart inpatient hospital. Whenever possible, extant elementsor features of original construction are incorporated in the

design.

New building systems including fire protection, generalplumbing and specialized drainage systems, water service, gas,clinical and vacuum systems, electric, IT/communications, secu-rity, and heating, cooling and ventilation systems.


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Alternate work beyond the base building includes:

Convert the existing basement to a secured staffparking garage that will extend below the new atrium space,and that will include minimal finishes that will require only hosedown after catastrophic flooding.

Construct a new 900-car multi-story parking garageoff site that includes support services and laboratory facilitieson the first floor, all above flood level.

Construct a new helipad.

Provide accessibility to roofs at the twelfth floor toprovide exercise yards.

The Project Team envisages a forty-two month implementationperiod, including six months in design and a three year con-

struction period.


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CONCLUSION

The Design Team has looked at many critical factors in thisfeasibility study, and has determined that all of them can beresolved in a positive way. There is a significant cost to do-

ing that, but we believe the cost of resolving them will be farless than the cost of a comparable new building. The factorsinclude:

1. The building envelope, including exterior walls, windows,and roof, can be effectively restored.

2. The structural system is sound, and by adding a limitednumber of beams in certain areas, it will be fully functional.

3. All interior partitions, ceilings, and finishes will be re-moved, to make sure that no environmental concerns remain.

4. Existing floor plates are workable and complimentaryfor a first class healthcare facility, except for the 3rd floor,which we do propose enlarging.

5. The basic volumetric composition of the building, whichhas large lower floors acting as a functional podium to supportbed floors above, will work well as a modern hospital.

6. New interior fit-out of the entire building, as well asan innovative entrance atrium, is necessary. The floor plansincluded in this report show how Charity can be transformedinto a modern healthcare facility.

7. The recommended design will meet the latest code re-quirements for hurricane-force winds, and the hospitals floorlevels are all above the Katrina flood line.

The cost of all of the above work is included in our construc-tion cost estimate, provided by VJ Associates, an experiencedestimator for both hospital and historic preservation projects.Their estimate comes to a total of $484,000,000. In orderto have an apples to apples cost comparison, RMJM-Hillierasked VJ Associates to also estimate the construction costof the new hospital facility that is being planned in New Or-leans, and added the cost for land acquisition. The result-

ing comparable number is approximately $620,000,000. Ourfindings indicate that at a minimum, Charity can be restoredand renovated at a cost of approximately 20% less than thecost of building a comparable new building on a new site. Thispercentage will undoubtedly increase when taking into accountother construction costs of the new hospital, such as the de-molition of the structures on the new site and the associatedremediation.


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TRADE COST 305,009,649$ 349,753,000$

GENERAL CONDITIONS 5.00% 15,250,482$ 5.00% 17,487,650$

Subtotal 320,260,132$ 367,240,650$

GC OVERHEAD & FEE 3.50% 11,209,105$ 3.50% 12,853,423$

Subtotal 331,469,236$ 380,094,073$

BOND / INSURANCE 2.00% 6,629,385$ 2.00% 7,601,881$

SUB TOTAL : CONSTRUCTION COST 338,098,621$ 387,695,954$

DESIGN CONTINGENCY 15.00% 50,714,793$ 15.00% 58,154,393$

Subtotal 388,813,414$ 445,850,347$

ESCALATION 13.13% 51,031,761$ 20.00% 89,170,069$

Subtotal 439,845,175$ 535,020,417$

CONSTRUCTION CONTINGENCY 10.00% 43,984,517$ 5.00% 26,751,021$

TOTAL PROJECT COST 483,829,692$ 561,771,438$

LAND ACQUISITION -$ 58,320,000$

TOTAL PROJECT COST 483,829,692$ 620,091,438$

TOTAL PROJECT COST ROUNDED 484,000,000$ 620,000,000$

Notes:

1 - Construction Cost Estimate by V. J. Associates

2 - Cost estimate includes base building only for Charity Hospital and base building and land acquisition for new hospital.Cost does not include any auxiliary structures.

3 - Construction cost includes labor and materials, contractor general conditions, overhead and profit, bond and insurance,design and construction contingencies, and cost escalation4 - Land acquisition costs based on MCLNO Master Plan - Adams 2007 - Cash Flow Forecast - Escalated 8% to 2008

New Hospital on New Site1,000,000 SF 1,000,000 SF

Charity Hospital


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CONCEPT PLANS

SITE PLANS

GROUND FLOOR PLAN

SECOND FLOOR PLAN

THIRD FLOOR PLAN

SIXTH-THROUGH-EIGHTH FLOOR PLAN

EAST SECTION

NORTH SECTION


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