When Kaiser Permanente decided to open a medical office building in Portland, Ore., one site in particular caught the health system’s eye. A former location of now-defunct consumer electronics retailer Circuit City, the one-story, 32,000-square-foot structure in the Gateway neighborhood of East Portland boasted a convenient location with easy access to public transportation. In alignment with its support for healthier communities, Kaiser Permanente had already committed to the reuse of existing structures where possible rather than creating new buildings. With the Circuit City location having been vacant for more than three years, Kaiser Permanente took the plunge in 2010 and purchased the property out of receivership.

Kaiser Permanente’s move also supported Portland’s own strategy for the neighborhood, identified as one of five “eco districts” in the city that have been established through a coordinated effort between public and private entities to foster sustainable development practices through collaborative community partnerships.

To achieve the sustainable reuse of the building, Kaiser Permanente brought on board a Portland-based project team of Soderstrom Architects (architecture, interiors, and sustainability design), Mazzetti (mechanical, electrical, and sustainability engineering), TM Rippey (structural and civil engineering), and Andersen Construction (general contracting).

Seeing what you have
The goal in converting the big-box site is to transform an unsustainable building into a more sustainable one, and Kaiser Permanente is seeking LEED for Healthcare (LEED-HC) certification. But the effort came with challenges in determining what exactly the system had to work with in the space and how best to go forward.

“Deconstructing a facility is more challenging than demolishing a building and starting from scratch,” says Matt Justiniano, senior project manager and owner representative for the project. In this case, since the original building was designed for retail use, there were compromises that Kaiser Permanente had to make in order to fit its new medical program into the confines of the existing space. For one thing, the building didn’t have windows; the only openings were egress and storefront doors. The lack of natural daylight was a big issue. So the design team studied the building shell and determined how to install more than 60 windows in its concrete block wall.

The positioning of the structure also wasn’t optimal, with an L-shaped configuration and large west exposure causing plenty of glare and heat gain issues. The distance between columns was too close and irregular, making it challenging to design a standardized office layout. The project was also limited in that there was only one option for an entrance that opens to the parking lot and has realistic public access. All of these existing conditions drove a significant portion of the design and organization of the building.

And once the team cut into the building shell, it was found that in order to insulate the concrete, a previous contractor had filled it with asbestos-containing material called Vermiculite, which was outlawed before the building was constructed in the 1990s—coming as a surprise to everyone. No one on the project team had seen it before. To remediate the material, the team had to knock holes in the walls and use a special vacuum to remove it safely and legally, and bring the building up to current environmental regulations.

Making the space work
There were numerous issues evaluated and analysis performed on everything from insulating and waterproofing the building to the building mechanical system. There are challenges in this type of building conversion specifically due to the height of the existing structure. The clear space inside the building varied between 18 and 24 feet—significantly higher than a single-story medical office needs to be but not high enough to put in a second floor. The team varied the ceiling heights and added roof monitors not only to provide daylighting to interior spaces but to help break up the expansive volume of unused space above the ceiling. Just like having too little space creates challenges for installing all the building services (ductwork, piping, electrical, IT cabling, etc.), too much space creates challenges of its own, including how the interstitial space is insulated, how the mechanical systems are suspended from an elevated structure, and how acoustical privacy is created.

Additionally, the existing water system didn’t support the service required for a medical facility. A retail building like Circuit City will typically have one set of public restrooms and a limited number of other plumbing fixtures, while the clinic requires many more toilet rooms, as well as sinks in every exam room and treatment space. The whole water supply and waste system had to be replaced to accommodate the new use.

Sustainable savings
As part of the building deconstruction process, the interior was gutted and more than 90 percent of materials removed was able to be recycled, including floor covering, roof membrane (rubber), sheet rock, metal studs, the ceiling system (including the wiring, mechanicals, and duct work), display cabinets, and shelving. The team achieved the LEED 75 percent recycling goal and is anticipating points for exemplary performance in recycling. Andersen Construction maximized cost savings and recycling rates by sorting high-value materials like metal and concrete on-site, while lower-value materials were commingled for sorting and weighing off-site. With demonstrated cost savings through segregating valuable metals, construction and demolition debris recycling is good for the bottom line. For less valuable materials, commingling diverts materials from the waste stream, but fewer or no dollars are generated through recycling. Kaiser Permanente has also made a commitment to reduce energy in its existing buildings by 10 percent and greenhouse gas emissions by 30 percent by 2020. While the system uses energy modeling to meet its energy goals, it also requires lifecycle costing for all of its facilities, looking at total cost of ownership by comparing a variety of building systems’ upfront and operational costs, including maintenance. Mazzetti worked with contractors on pricing and used energy modeling to calculate how much energy each option would use as well as associated costs. Based on this energy modeling, a variable refrigerant flow system with dedicated outdoor air and a heat recovery unit was selected. In a variable refrigerant flow system, heating and cooling are transferred through the refrigerant rather than through water or air. In addition, outside air is provided through a separate, decoupled energy recovery ventilator, which extracts heat from the exhaust air stream to preheat or precool outside air. This system is estimated to save more than 40 percent of annual energy use, which well exceeds Kaiser Permanente’s 25 percent energy reduction goal.

The water conservation goal to achieve LEED-HC Gold was a 30 percent water use reduction over baseline, based on LEED plumbing fixture standards. Water conservation measures included low-flush toilets, low-flow urinals, low-flow sinks and faucets, and Energy Star-rated, water-conserving ice machines. Adaptive and drought-tolerant plantings will also help reduce water use in landscaping. The plan estimates a savings of 42,000 gallons of water over one year. For domestic hot water, Kai
ser Permanente chose a tankless hot water system for on-demand water. There are no sterilization needs at the facility, limited showers, and low demand for hot water.

The Kaiser Permanente facility is in the end stages of completion and slated for a Fall 2013 opening. There were many lessons learned in the process that can help prepare for future projects, not least of which is to prepare for the unexpected: We don’t truly know what surprises we may find until we open the box.


Janet Brown is a contributing editor for Healthcare Design. She’s the director of facility engagement for Practice Greenhealth and the director of content and outreach for the Healthier Hospitals Initiative. She can be reached at jbrown@practicegreenhealth.org.