October 1, 2003
Art of the Possible
A new ambulatory-care clinic for a remarkable institution seeks to become the nation’s first LEED-certified healthcare facility.
It’s not always easy being green—particularly for the health-care profession. Strict state-mandated regulations regarding air exchange levels and temperature make it difficult for architects to create energy-efficient heating-and-cooling systems for hospitals and clinics. Materials used in therapeutic and diagnostic services are often environmentally unfriendly and occasionally noxious. Both normal and critical patient care consume enormous and constant quantities of electricity and heating fuel. But it wasn’t just these obstacles that made Robin Guenther lukewarm about designing a clinic at the Center for Discovery, a residential school for children and outpatient facility for disabled persons in upstate New York.
“Early on in my career, I had an interview to do a job at a facility for disabled children,” says Guenther, principal at Guenther5, a New York firm specializing in health-care design. “It was an enormous single structure, like a nursing home, with large amorphous wings of double-loaded corridors filled with kids in wheelchairs as far as you could see. It was just so overwhelming; I couldn’t imagine what we could do there. The experience was so depressing that I swore I would never work in that environment.”
In 1999 Guenther met with Patrick Dollard, executive director of the center, in her New York office. Dollard was interviewing for an architect to design an on-campus diagnostic and treatment center for residents and outpatients. The pair spoke for a while, and Dollard gave her a copy of the center’s annual report. Guenther is certain that Dollard sensed her ambivalence, although he was sensitive enough not to mention it. “All he said,” she recalls, “and this was right when he was leaving, was ‘I think you should come and see the place.’”
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Created in 1948 by a small group of dedicated parents of disabled children, the Center for Discovery is home to 275 residents ranging in age from 5 to 90. Another 100 children frequent the facility’s classrooms, while the center’s clinic provides medical services to an additional 500 people in the vicinity. Located in Harris, New York—about 90 miles from the George Washington Bridge and only a few miles from the area’s once thriving borscht belt hotels—the Center for Discovery is a loosely woven patchwork of paths, pasture, farmland, and 27 small to medium-size residential homes nestled across 300 acres in the foothills of the Catskill mountains.
The new clinic, designed by Guenther5 and opened in March, is easily the most visible structure on campus. But it’s easy to miss the Discovery Health Center from the road. Shaded and decentralized, the facility has few institutional attributes or characteristics. More than a health-care facility, it resembles an upscale retirement village or rustic residential development. Only the sight of children rolling down paved paths in wheelchairs—each child at the center spends time outdoors every day, no matter how fragile they are—hints at the nature of the facility.
“We were determined to develop a place for folks whom no one else could care for,” Dollard says. “To provide services for people who just twenty years ago were not even considered human.” In 1980, the year Dollard returned to his native Sullivan County to take a job at the center, its staff numbered 20. Today the Center for Discovery employs nearly 1,000 people, including physicians, nurses, teachers, social workers, physical therapists, and psychologists. There are even riding instructors at Milligan Hill, the center’s recently constructed equine-assisted therapy center. “We wanted to create a place where we might concentrate on what our people could do, instead of wasting time feeling bad about what they couldn’t.”
In the 23 years of his tenure, Dollard’s leadership and optimism transformed a relatively small isolated institution into an ambitious, innovative, and exceptionably livable community. The private community runs on an annual budget of $50 million, much of which comes from government grants, private foundations, and fund-raising campaigns led by grateful parents.
“We spent years looking at facilities,” says Lynn Schwartz, of Rye, New York, whose 27-year-old son, Tony, came to live at the center in 1995. “Here they provide our children with everything that is provided for a normal child. My younger daughter had a prom at her high school. Tony’s class had a prom at the end of the school year here. Most of our children here aren’t verbal. Yet they can see a psychologist if they want to. One day a board member suggested it might be good for the children to ride horses. Now we have the equine center.”
What the center didn’t have until recently was a centralized clinic providing necessary primary care for its residents. The center had always offered essential clinical services, but its components were spread out across the campus. Many primary-care features were lacking; residents needed to be transported to facilities in Westchester or Manhattan for dental, neurological, psychiatric, ophthalmologic, and dermatological treatment. The system was inconvenient and complicated, and worst of all it disrupted the vital rhythms the staff had worked so hard to establish. Schwartz recalls that whenever Tony—who suffers from a genetic disability and is neither verbal nor ambulatory—needed to see a dentist, he had to be bused to a regional hospital and put under full anesthetic simply to have his teeth cleaned.
Built at a cost of more than $8 million—the clinic is funded by $1 million in state and private grants, and a $7 million bond—the new clinic is a low-slung barnlike structure cut into the Catskill foothills along a north-south axis. Inspired by regional vernacular—only the four oversize vertical banners with images of the center’s smiling children define the building and its proud purpose—the building sits on the reclaimed site of a defunct poultry farm, with views of pasture and woodlands to the east and the center’s community-sponsored organic farm to the northeast.
The most remarkable physical feature of the clinic is its geothermal heating system. Water is passed through 40 wells sunken beneath the property and into a pumping station, where its temperature is electrically boosted from 54 to 94 degrees. The heated water is then pumped through conduits into the building. In summer, ambient-temperature water circulates through the same conduits to cool the building. Other sustainable features include daylighting of interior spaces, passive solar components, shading devices to reduce solar gain, recycled building content, and water-efficient landscaping. Guenther and her collaborators were rigorous in the selection of materials, eliminating PVCs and other substances that emit noxious fumes.
The 28,000-square-foot two-story clinic is light and airy, with large vertical glazed window panels defining much of the second floor. Built to fit the contours of the hill behind it, the building affords access on both of its floors. There is a noticeable absence of barriers between rooms and floors. The broad street entrance leads directly into an open reception and waiting space lit by oversize windows. A strong emphasis on natural lighting helps mute distinctions between interior and exterior space, an ideal feature for a region whose winters are among the longest and coldest in the country. The rear of the building offers views of landscaped field, organic farm, and barnyard animals grazing outside the windows of the treatment rooms.
The new clinic has no expressed staircases; even the fire stairs are concealed. Residents, visitors, and staff move from one floor to another by elevator. There are no wheelchair ramps—functional features for the disabled but also constant reminders of disability and its stigma. “The school is predicated on breaking down barriers for the kids, on letting them enjoy life,” says project architect Peter Syrett, who joined Guenther5 in late 1999, attracted in part by the possibility of directing the Center for Discovery project. “For them, stairs become an emblem of limitation. A ramp is better, but it still requires someone to push them. You want these kids to feel enabled, to feel there is nowhere they cannot go.”
The Center for Discovery clinic was not conceived as a green building. Dollard began thinking about an on-campus clinic in the early 1990s and presented the idea to his board of directors in 1996. He’d already interviewed several architects when acquaintances recommended he speak with Guenther in early 1999. Guenther had a reputation for eliminating barriers between patients, families, clinical personnel, and caregivers. For the Naomi Berrie Diabetes Center at Columbia Presbyterian, she created an informal central sitting area to replace the traditionally sterile waiting room. At New Yorkp;Presbyterian, she used sliding barn doors in the pediatric-care rooms to help the children retain pleasant memories of their treatments.
It took just one visit to the center for Dollard to transform Guenther’s resistance into enthusiasm; it took a little longer for Guenther to convert Dollard to the idea of going green. That summer the pair began discussing alternatives to heating with oil. Several buildings in Sullivan and nearby Mohawk Counties had effectively installed geothermal heating systems. With Sullivan County’s relatively affordable electricity rates, geothermal was a promising and viable alternative to oil. The proposed system also offered another potential advantage for the center and its residents. “Geothermal energy with ground-source heat pumps marry very well with radiant slab heating,” Guenther explains. “Most of the people who would be using the center were in wheelchairs. They’d be spending a lot of time on the ground. It made sense to have a warm floor. Just as it made sense not to have any radiators or heating elements in a room with wheelchairs.”
Once Guenther and her colleagues had sold Dollard on the idea of geo-thermal energy, they began moving incrementally toward a more environmentally responsible design. The architect encountered little resistance. “We kept raising the bar, and they stayed right with us,” Guenther says. “First we talked about saving energy. Then we started talking about eliminating vinyl and using nontoxic materials. We talked about the environmental footprint and integration with the earth.”
For the design profession, the elimination of vinyl is particularly significant. Used broadly in all types of construction because of its low cost, vinyl sheets and tiles have been shown to decay in as few as five years, introducing potentially noxious substances into the air. “This is a very big deal,” says Jeff Logan, director of design at Anshen & Allen, a San Francisco firm specializing in large-scale health-care projects. “Vinyl and other PVCs are ubiquitous, even in health care. The fact that someone was able to eliminate them, even in a relatively small facility, is enormously important. It shows others that it can be done.”
In March 2000 the United States Green Building Council (USGBC) created its Leadership in Energy and Environmental Design (LEED) initiative to recognize and certify specified levels of sustainable design and environmental compliance. Since its inception the USGBC has awarded one of its four LEED levels (certified, silver, gold, platinum) to 61 projects. Eight hundred and fifty additional projects are under evaluation, including the clinic at the Center for Discovery. LEED status has been awarded to furniture factories, campus buildings, even to wineries, but it has never recognized a health-care facility. Guenther and her colleagues proposed that the clinic be built to meet LEED certification standards. The center’s board agreed. This fall Guenther5 will present the project to USGBC; they hope to receive LEED certification by the end of the year. If their hopes are realized, the clinic will become the first LEED-certified health-care facility.
Born to resolve a problem of care, the new clinic evolved over a series of months to take its final shape as the emblem and signature structure of the center. “Architecture has the power to give physical expression to an institution and its purpose,” Guenther says. “What is it that you do better than the guy down the street? Once I raised the possibility of going green—and once they saw how clearly that integrated with everything they were doing—it was impossible for them to choose anything else.”