Walking through the former Pendleton Memorial Methodist Hospital, a facility in New Orleans East that was devastated by Hurricane Katrina, was an eerie experience, said Glenn Boardman, associate director of the healthcare real estate practice at Navigant Consulting Inc. 
"Every patient room calendar was stuck on Sept 5," he described. 
Boardman and Mark Ripple, partner at Eskew+Dumez+Ripple, shared this and other details of the 2005 storm's aftermath as part of the session "Repurposing an Acute Care Hospital–Against All Odds" during the Healthcare Design Conference on Sunday.
The hospital never reopened after the storm, nor was the community redeveloped. The question of exactly what should be done with this eastern arm of New Orleans was one that played out in local and national politics. With research showing the vulnerability inherent to the area in terms of possible future weather events, the question became: Is it worth it?
And while everything from housing to retail were needed to bring the community back to life, it became clear that without localized healthcare, the outcome for a rebuild wasn't favorable. When Mayor Mitchell Landrieu took office in 2010, he committed to the rebuilding of the area, which meant a hospital would be necessary.
Challenges for the project were plenty, the team said, including the fact that there was no existing hospital, no leadership, and no operator. But one thing was clear. "What we did had to be financially viable and market-driven," Boardman said. 
A hospital strategy group was established and the site was purchased from Universal Health Services. Daughters of Charity and Franciscan Missionaries of Our Lady signed on as operator, and funding was pursued that included grants and a HUD loan. 
Opening the new facility as soon as possible (the goal was December 2013) was a priority right from the start. To meet that goal, the team proposed a program that included a remote patient care pavilion that would be constructed first and followed by demolition of a portion of the existing building, remediation of the existing tower, and construction of a connecting bridge. But the long-term effects of this compromised plan came with a concern that "long after this deadline is over, we're going to be dealing with the consequences of this facility," Ripple said.
Instead, another approach was to demolish first and then build a patient care pavilion in the cleared area that would be directly connected to the existing structure. 
In the end, Plan B won out, and the resulting project includes a three-story pavilion that houses an ED, imaging, and surgical suites as well as a renovated East Tower where patient rooms, ICU, and public spaces like the lobby, cafeteria, and chapel are located. 
But the real story behind the transition of the old space to the new came down to one word: resiliency. "There was real pressure from day one," Ripple said. 
While several levels of resiliency were considered, the decision was made to not create a facility where patients and staff would defend in place due to the significant investment it required. Instead, the hospital group chose a long-term approach in the case of disaster but with a plan that the building would be evacuated within 72 hours. 
To support that plan, critical services like surgery and imaging were designed on higher floors of the facility so that they could safely remain in operation even in Katrina-level flooding, while services located on the first floor were more "sacrificial" in nature. The central plant is located on the roof of the pavilion, and a helipad and ramps to the ED provide exit points even in flood conditions.
But for those involved in the planning process, the discussion surrounding resiliency wasn't an easy one. It's probable that Katrina is a once-in-a-lifetime storm, but fear remains nonetheless. "The arguments regarding resiliency were often subjective and emotional. The ground rules are constantly changing," Ripple said. 
In terms of other design approaches, without department heads to consult or staffers to invite to charrettes, the team was left without a user group to further develop design. Instead, it turned to a similar recent New Orleans project to serve as the baseline, from headwall to building envelope design. 
"That was a critical decision," Ripple said. 
Today, the team reports it's on schedule and under budget. With a substantial completion date anticipated in spring 2014 with an open shortly after, the focus now is on planning for activation and move management.