At midnight on December 20, 2008, Baker Concrete, Monroe, Ohio, placed a 17,500-cubic-yard mat slab in 24 hours. As part of the new MD Anderson Office complex, this building consolidates their office locations in Houston's Texas Medical Center and provides ultimate protection from hurricanes and tropical storms that occasionally reach the area.

With the 60,000-square-foot mat ranging from 7 to 12½ feet in thickness, ready-mix trucks arrived every 40 seconds to supply the eight concrete boom pumps onsite. The placement required 100 crew members working in three shifts to place the concrete. Ready-mix producer TXI, Houston, brought in several trainloads of aggregate to five of their batch plants and dedicated 100 ready-mix trucks to service the project.

The mat slab will support three buildings joined together: one 26-story building, another with 21 stories, and a five-story structure. Garrett Benson, Baker's project manager for the construction, says the owner decided to use heavier structural concrete construction. So the floors are constructed with “long-pan” forms with beam pockets as deep as 30 inches. All the columns are cast-in-place concrete, while precast concrete panels are used to construct the curtain walls. The buildings will house office staff, computers and servers, and records and archives.

The Texas Medical Center is a huge complex of constantly growing hospitals and research buildings, which is representative of continual growth of the health care industry. Ed Sullivan, chief economist for the Portland Cement Association (PCA), Skokie, Ill., predicted in its Spring 2009 “U.S. Cement and Construction Forecast” that hospital and institutional building construction will rise to $18 billion in 2009, a 1.9% increase from last year. That may not seem like much, but all other nonresidential building construction sectors are lower than last year—as is portland cement consumption. Sullivan says American health care has come through an era with a focus on fewer overnight stays in hospitals and increased outpatient services. “But long-term demographics are changing. More people are getting older and there will be increased demand for health care.”

Concrete placement at the Texas Medical Center required 100 crew members working in three shifts. PHOTO: JOE NASVIK

As with most construction projects, funding remains a challenge. Tom Fromm, the health care construction leader for Skidmore Owings & Merrill (SOM), Chicago, says traditional funding for health care facilities comes from philanthropy, public funds, investments, and operating budgets. But given the present economy, none of these funding sources, other than federal funding, are strong.

The decision to use structural concrete or structural steel for hospital construction is much more complicated than you might expect, says Robert Klute, a partner in the firm Hosking Klute Healthcare (HKH), Chicago. As facility consultants, HKH provides defined functional and operational building program requirements for health care clients before design work begins. Klute says hospital projects involve multidisciplinary teams of architects, engineers, construction managers/contractors, owners, clinicians, financial advisors, and consultants. The recommendation about materials to be used for a building's structural frame, he says, often is made by the CM/GC well before the design process begins and is driven primarily by cost. Local conditions—such as the status of labor contracts, the availability of skilled labor and skilled contractors, and the competition between suppliers—all play a part in the decision. Fromm says SOM always considers both structural steel and concrete in their initial design work so clients can judge cost differences. Projects today often go to structural steel construction, he says, “But when clients want fast-track construction, concrete often wins out.”

The choice between structural concrete or steel-frame construction can come down to something as simple as floor penetrations. Hospitals typically require a tremendous number of them, both during construction and as buildings modernize over time. Steel frames with concrete on metal deck floors are easier and less expensive to core. However, structural concrete handles building vibration better. Fromm says concrete dampens vibration, and with medical equipment becoming more sensitive to movement, concrete is preferred.

Morley Construction starts work on the foundation walls for the new $1 billion Palomar Medical Center West hospital in Escondido, Calif. PHOTO: SEAN FLEMING

Morley Construction, Santa Monica, Calif., is the structural concrete contractor building the Palomar Medical Center West hospital in Escondido, Calif. The publicly funded project in San Diego County has a price tag of nearly $1 billion. It may sound like a lot of money for a 732,000-square-foot building with an adjacent central facilities plant, but this amount is now the average cost for new hospital construction.

Sean Fleming, Morley's project manager for Palomar Medical Center West, says the funding for the hospital was committed five years ago with the passing of a public bond measure. The bidders for the project included a small group of pre-qualified contractors evaluated on past work and their understanding of hospital construction. From an approved list, the low bidder won the job. This fast-track project will become a community hospital, touted as the most state-of-the-art facility in the nation. The building uses a moment-frame structural-steel superstructure with concrete floors over metal deck, and a structural concrete basement.

In spite of the high price tag of hospital construction and the difficult economic climate, a number of hospital projects are either in the planning stages or going through the construction process. It's a good time to build because bids today are very competitive.