In 2008, an exuberant crowd gathered on every level of the multistory lobby to dedicate the new 181,000-square-foot DePaul Patient Tower addition to HealthEast St. Joseph’s Hospital in downtown St. Paul, Minn. As leader of the HOK design team for the project, I was especially moved by the number of Sisters of St. Joseph Carondelet, many elderly or infirmed, who made the special trip for the occasion.

More than $10 million was donated by the community toward the $52.4 million construction cost for the rejuvenation of St. Joseph’s Hospital, which was founded by the Carondelet order during the cholera outbreak of 1853, making it the first hospital in Minnesota and the oldest institution in St. Paul.

Fast forward 12 years to December 2020 and a somber crowd of 100 or so St. Joseph’s staff members gathered in the cold outside the darkened lobby with candles and prayers to mourn the closing of their hospital. A Facebook group documents the empty floors of 90 acuity-adaptable specialty services beds, catherization labs and operating rooms.

The news of St. Joseph’s demise hit me hard. I’ve been a healthcare architect for 38 years and have seen some of my projects renovated and re-renovated, expanded, and re-clad. But never has one of my prominent projects closed in such a short time span. The patient tower was featured on the cover and as a feature article in the March 2009 issue of Healthcare Design.

The project was presented at multiple conferences highlighting how it contributed to St. Paul’s master plan vision of urban revitalization and improvement in the overall quality of life for its community. The single-handed, acuity-adaptable, outboard-toilet patient rooms were copied by other architects for their new bed towers. Most importantly for me, our project team including the client, architects, program manager, engineers, and contractor became good friends and even had a five-year reunion.

So what went wrong?

According to the Minneapolis Star Tribune, St. Joseph’s became part of Fairview, another nonprofit  health system, as part of a 2017 merger with HealthEast, which hastened its losses by concentrating more inpatient psychiatric services there. (For more on the story, check out this Star Tribune article.) This all did not bode well for St. Joseph’s, which saw its once ambitious cardiology and neurology programs moved to suburban hospitals.

The organization, now called M Health Fairview, has a new stated goal to turn St. Joseph’s into a health and wellness center, concentrating on outpatient mental health once the COVID-19 crisis is over. How they will accomplish this adaptive reuse, I do not know.

This change from a once-vibrant acute care hospital to a mothballed, empty building raises many questions in my mind. Was the initial strategic plan flawed? As the architecture firm on the project, we created a very customized solution to a unique program and challenging site, assuming it would be the frontispiece to a phased redevelopment plan.  That plan was well considered by the health system but never moved forward. These were heady pre-Great Recession times when even the stair rails could be custom patterned, and our design reflected the history of St. Paul as we assumed this building would be a landmark hospital for years to come. No what ifs.

This industry now knows that rapid change is not just a possibility but inevitable in healthcare and the structures that house it. Changes in market conditions, technology, clinical practice, operations, and even unexpected pandemics will affect how projects will be utilized in the future. As healthcare designers, we need not only address the current program but also the adaptability or flexibility of our buildings for the unforeseeable.

Rest in peace, St. Joseph’s Hospital. I hope whatever you become in the future serves to improve the health of the community in ways we cannot begin to contemplate.

Sheila Cahnman, FAIA, FACHA, LEED AP, is president, JumpGarden Consulting LLC. She can be reached at