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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.

Single-Family Home Permits In Sonoma County

Year: 2016

Permits: 581

Year: 2015

Permits: 236

Year: 2014

Permits: 292

Year: 2013

Permits: 295

Year: 2012

Permits: 279

Year: 2011

Permits: 431

Year: 2010

Permits: 280

Year: 2009

Permits: 359

Year: 2008

Permits: 546

Year: 2007

Permits: 904

Source: California Homebuilding Foundation

On Tuesday, "we put in the 20,000-gallon fuel tank, and it went right down on its bolts," Minard said, adding that rapid advances in building information technology have revolutionized construction planning.

In the event of an earthquake, multiple safety features — again, hidden to most people — are built into the hospital.

The hospital, which appears to be one structure, is actually constructed as three individual structures separated by a 14-inch gap. At each gap, the tubing, wiring and duct work that carries the hospital's life blood is designed to be flexible so the systems can absorb the movements of an earthquake and keep operating.

The hospital is equipped with four emergency generators, of which only two are required to run the hospital if it loses all power from PG&E.

The hospital is also equipped with two 600-foot water wells and an on-site water treatment facility, as well as a 350,000 gallon water storage system under the hospital that could supply water to fire sprinklers and fire hydrants.

Its water and sewage system is designed to comply with a 2030 state seismic requirement that all hospitals must be capable of remaining operational for 72 hours following an earthquake.

The hospital is also equipped with a state-of-the-art system of smoke compartments with fire and smoke-resistive walls and automatic smoke and fire dampers. In the event of a fire, the compartments allow certain sections of the hospital to be sealed off from those inundated with smoke during a fire, allowing patients to be moved to safety.

On the second floor of the hospital is something called the "battery room," which is equipped with an emergency power supply that keeps all the hospital's systems running during the seven seconds it takes for the emergency generators to kick on after a blackout.

Coleman of OSHPD said all these and other complex systems make for very congested spaces above ceilings, which often require higher floor-to-floor heights than other building types.

"Dedicated space is needed for special medical and building operations equipment, and rooms must be adequately sized and have appropriate support spaces to perform the special, complex medical procedures that are done in modern hospitals," Coleman said.

To date, a significant amount of the new Sutter Medical Center's internal organs have been installed, and workers are now beginning to wire the facility's data and communications systems, said Wayne Carley, a Sutter project manager.

"Now, we're starting to wire and smarten up the building," he said.

(You can reach Staff Writer Martin Espinoza at 521-5213 or martin.espinoza@pressdemocrat.com.)

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