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Feature Story- September 2004

Design-Build Proves Healthy Approach to MD Anderson's Ambulatory Clinical Building

New Cancer-Care Facility Gets Fast-Track Treatment

By Rob Patterson

The new Ambulatory Clinical Building at the University of Texas M.D. Anderson Cancer Care Center in Houston, which will be fully operational by February, is expected to serve about 1,500 patients per day along with approximately 6,000 to 7,000 daily visitors and 1,700 employees.

Ground was broken for the building, which is called the ACB, in July 2001, and the facility will be substantially finished next month. "The schedule was incredibly aggressive," said Janet Sisolak, project director for M.D. Anderson's Capital Planning and Management Department. "When I look at what we were able to do in four years, it is phenomenal. We are looking at a building that was not in anybody's imagination from the get go." She said the design-build method of delivery helped greatly in the complex project's rapid timeline from inception to completion. "It was a lot better than our last project, which took 10 years from programming to occupancy," Sisolak added.

The basic facts of the building are impressive: The 1,256,204-sq.-ft. structure was built by Hensel Phelps Construction Co. of Greeley, Colo., under a $297 million design-build contract. The three-level, underground, 474,400 sq.-ft.-parking garage and the first two aboveground stories are poured concrete; the six levels atop are structural-steel frame with reinforced-concrete walls, floors and ceilings. The eight aboveground stories total more than 750,000 sq. ft. of interior space and terraces.

"One amazing thing about it is the enormity of the footprint," said Gary Owens, project architect for Houston-based FKP Architects Inc. "Each floor is 95,000 sq. ft. It's like three office towers sitting side by side."

There are massive amounts of materials behind the façade of Texas pink granite (on the first two levels) and precast concrete (on the upper six stories) interspersed with large expanses of glass. "It's a big concrete job and it's also a big steel job," said Brad Cumpton, general superintendent for Hensel Phelps. Within the ACB are 110,000 cu. yds. of concrete and 4,800 tons of structural steel. The mat for the foundation took 11,000 cu. yds. of concrete. "We had 110 concrete trucks shuttling in and out in a 13-hour period," said Randy Barr, project manager for Hensel Phelps.

The building's interior includes 4 million lbs. of lead shielding to encase up to eight linear accelerators on the ground floor and the nuclear medicine clinic on level six. In order to accommodate such heavy, high-tech machines as the linear accelerators and MRIs, some of the floors are built to withstand 350-500 psi loads. The ACB budget also included $108 million of equipment above the project cost.

As one of the leading cancer treatment facilities in the world, M.D. Anderson planned the ACB to be state of the art now and projects 50 years of use from the building.

The ACB grew out of a master plan process at M.D. Anderson that began in the mid-1990s. With a projected 60 percent increase in volume and the need for 1.5 million sq. ft. of space to accommodate that by 2009, "we were in the fall back and punt mode to do what we could to increase our physical plant," Sisolak said. "We tried to come up with a plan to bring online as fast as possible additional outpatient facilities."

The initial strategy was to build a 600,000-sq.-ft. generic office building with flexibility for clinical services and offices as well as technological and medical advances. As plans developed, so did the building. Ultimately, an outpatient center separate from the main hospital was envisioned with diagnostic imaging, radiation, oncology and clinical services.

M.D. Anderson contracted with the team of Hensel Phelps and FKP for the design-build project. When the process was between schematic design and design development, further outpatient services were added. Offices for the outpatient facility staff were separated into an adjoining 425,000-sq.-ft. Clinical Office Building recently completed by Hensel Phelps and connected to the ACB by a five-story pedestrian bridge.

Another change came when M.D. Anderson also hired architects Kaplan McLaughlin Diaz of San Francisco to enhance the aesthetics of the skin and other elements. The firm came up with "a transparent building," said design architect Mohinder Datta of KMD, referring to the large glass walls on the ACB. "We wanted to find a way for the patient-physician team to be expressed through architecture. We tried to do it through that transparency. We've made sure the building was something that was approachable at many levels."

And as the design progressed in its development, M.D. Anderson stressed both staff and patient input into the process. "At the front end of the project, one of the things that we did were some intensive patient focus groups," Sisolak said. A common request was for space that would provide a mental escape.

And so the ACB hardly resembles a hospital. Eight lanes of roadway going through one end of the building ease patient drop-off. From there it's a short walk across exposed aggregate terrazzo and an escalator ride up to the main lobby level.

On the second level, laid out in a spoke configuration around a check-in area, is a range of amenities and services. A cafeteria with a carpeted dining area and adjacent terrace offer the ambience of a fine restaurant. Nearby are a chapel, library and learning center, demonstration kitchen for dietary instruction, gift shop and an appearance center.

"They tried to create a positive environment for the people who will come here," Barr said.

Chinese marble provides accents on the second level along with Anigre wood, used most notably at the front end of the pharmacy. Large aquariums and a water wall add a sense of life and tranquility. On the top floor, two outdoor terraces with live plants and shaded trellises offer patients a natural environment.

For the diagnostic, treatment and clinical levels, removable windows on the ground floor provide access for new linear accelerators to be rolled in. On the fourth floor, removable exterior panels allow advanced MRI machines to be lifted in by crane. Pathways to the installation rooms are 30-ft. wide to accommodate the equipment.

In addition to the lead-lined spaces, the MRI rooms were shielded in siliconized steel-and-plate copper to deflect stray signals, which required exacting specialty work to hermetically seal all the conduits. For containing the output of the linear accelerators on the ground level, the 5-ft.-thick floors contain 12 in. of solid lead lining surrounded by concrete.

Each treatment area required specific solutions. For instance, in the chemotherapy pharmacy, the ventilation system filters 75 air changes an hour to exhaust fumes from highly toxic chemicals.

Since the ACB represents a campus approach to M.D. Anderson's expansion, an 1,800-ft. pedestrian bridge was constructed to connect it with the main hospital. At 30-ft. wide, it can accommodate golf carts for transportation. It also features a pneumatic tube system that runs from different floors of the ACB through the bridge to the main hospital, enabling the ambulatory facility to quickly send samples to the hospital's labs for tests and analysis.

"It's a neat experience to work on something like this," said Cumpton, the general superintendent for Hensel Phelps. "The people at M.D. Anderson may cure cancer one day."

Key Players:

Owner: The University of Texas System, M.D. Anderson Cancer Center, Houston

Owner Representative: Bill Daigneau, Vice President of Operations & Facilities Management, M.D. Anderson Cancer Center

General Contractor: Hensel Phelps Construction Co., Greeley, CO

Design Architect: Mohinder Datta, Kaplan McLaighlin Diaz, San Francisco

Project Architect: Gary Owens, FKP Architects Inc., Houston

Civil and Structural Engineer: Walter P. Moore, Houston

Pedestrian Bridge Contractor: Martin K. Eby Construction Co., Houston

Concrete: Amigo Building Corp., San Antonio; Baker Concrete Construction, Houston; Southern Star, Houston

Curtainwall: Standard Glass & Mirror Inc., Houston

Drywall: Marek Brothers Systems Inc., Houston

Electrical: Henderson/Wayne Electric, Houston