Short of a nuclear power plant, there's probably nothing more complex than building a modern hospital like the Sutter Medical Center currently under construction off Highway 101.
From the freeway, the 200,000 square-foot, cream and rust-colored structure looks simple enough. Even when complete, the hospital will offer few hints to the complexity above its ceilings, where about 1 million cubic feet, roughly a third of the entire volume of the hospital, resides.
This is the realm of electrical and communications wiring, pneumatic tubing, medical gas tubing, heating and ventilation systems, reinforced metal framing for state-of-the-art imaging equipment, redundant fire-safety systems and much more.
It's a complex maze of systems and networks that gobbles up 6 feet of the 15-foot floor-to-floor space in the hospital. It's hard not to draw comparisons between the hospital's complex innards and those of the patients it will host a year and a half from now.
Standing in the boiler room, where massive steam generators and boilers were installed this past week on concrete slabs, Tom Minard, Sutter's senior project manager of hospital construction, searches for the right analogy.
"This is the heartbeat of the hospital," he said Wednesday, almost sheepishly. "It's what it is, really.
"In a commercial building, you don't have a lot of the systems you do in a hospital," Minard said, such as a system for distributing medical gases and multiple fire-protection systems.
Building code requirements significantly increase when you go from residential to commercial to hospital construction. That's why hospitals are not built every year, or decade for that matter. It's been more than 20 years since the last hospital — Kaiser Permanente Medical Center — was built in Sonoma County.
According to Paul Coleman, deputy director of the facilities division of the Office of Statewide Health Planning and Development, California law requires that hospitals be built to higher standards to protect patients and to be able to provide services to the public after a disaster.
That means hospital structures need to be built one and a half times stronger than other commercial buildings, he said.
"Hospitals also have to meet complex ventilation requirements that provide a comfortable healing environment, inhibit the spread of contagious diseases, protect patients with a suppressed immune system, and provide a sterile environment for invasive surgeries and other sensitive medical procedures," said Coleman in an email.
Sutter's $284 million hospital, scheduled to open after the Oct. 25, 2014, move date, will feature 40 general surgical beds, 20 obstetrical surgical beds, 12 ICU beds and 12 neonatal ICU beds.
Its emergency department will be equipped with 11 emergency treatment stations and 24 observation stations. Its imaging department will include CT, MRI, digital X-ray and nuclear imaging equipment.
Behind the drywall, feeding the gas, data streams, electricity and water that make all that work is a structural physiology that will make this the most advanced, self-sufficient medical facility in Sonoma County.
To keep track of all of the hospital's vital systems, the building was first constructed inside a computer, using advanced 3-D modeling. The modeling ensures that all the parts will fit in place before they are actually installed
"We're really 'virtually' building the building first," said Minard. "We're mistake-proofing the work before it comes together on the field."
In the old days, construction engineers and managers used to overlay construction plans over a light table and look for "clashes," he said. Now, the hospital's digital plans are run through a clash-detection program.