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Posts about Hospitals


A court just halted DC's McMillan development

DC's highest court just blocked development at the McMillan Sand Filtration Site. This is a setback for the city's effort to turn an empty yet historic field, which previously served to filter drinking water, into a complex of housing, offices, and more active parks. This may not be end of the project, but it's added some significant new hurdles.

McMillan's silos. Photo by Elliot Carter.

The 25-acre site along North Capitol Street was established in 1905 as a way to purify the water of the Washington Aqueduct. The water ran through 25 underground vaults which filtered out impurities. But we don't filter water this way any more, and in 1986 the federal government declared it surplus.

For years now, DC (which now owns the site) has been trying to work with a consortium of developers, called Vision McMillan Partners, who won a bidding process to redevelop the site. The plan would include 655 units of housing, office space for Children's Hospital, and retail.

The development plan. Image from Vision McMillan Partners.

A park would keep part of the site open, and preserve the above-ground silos (the concrete tubes in the image above). The developers would also try to restore one of the vaults for people to explore and experience. Other vaults are not stable enough and could collapse, so they would be removed.

This week, DC officials held a groundbreaking ceremony for the project, but Thursday, a court opinion halted further progress.

What the court said

The court opinion hinged on two project approvals. First, the DC Zoning Commission, the hybrid federal-local board which has the final say (except this court) on zoning, approved this project. It was a Planned Unit Development, which is where a project gets some relief from zoning in exchange for community benefits.

Second, this site is a historic landmark. DC's law allows demolishing some historic resources, either because of financial hardship or to construct a "project of special merit." The Mayor's Agent for Historic Preservation, the administrative judge who decides such cases, determined this did qualify as special merit.

A 3-judge panel of the Court of Appeals vacated both approvals and sent the project back for another opinion, and possibly more hearings, before both.

Opponents have waged a sign campaign as well as a legal one. Photo by Jonathan Neeley.

The zoning case is all about the Comp Plan

The DC Zoning Commission, which approved the project, is required to follow DC's Comprehensive Plan. However, the Comp Plan is often compared to the Bible: it says whatever you want to read into it.

Contradictory policies in the Comp Plan simultaneously say, for instance, that DC needs more housing but should preserve open space; that established neighborhoods should be protected but there should be infill development; that there should be density near transit stations but then a map shows low density in that area.

In approving the project, the DC Zoning Commission traded off among some of these conflicting priorities. An while I am not a zoning attorney (and haven't yet heard back from the ones I called), it appears the Court of Appeals understands this. However, the judges say that the Zoning Commission didn't adequately explain why it was choosing to honor the policies it did over the ones it did not.

The court doesn't prohibit high-density development

Some of the project would have larger buildings which qualify as "high density" in DC's land use categories. One part of the Comp Plan is a map, the Future Land Use Map or FLUM, which shows density levels in different areas, and McMillan is not colored red for high density. It's a combination of "moderate density commercial," "medium density residential," and "parks, recreation, and open space."

The Future Land Use Map around McMillan.

Opponents argued that since some buildings are high density, those aren't permitted here. However, the court disagreed, saying two things: First, on a large site like this, there could be some tall buildings and some short ones which essentially average out to moderate or medium density, and that's okay. Second, the Zoning Commission has the perogative to weigh the map's colors against the other provisions of the Comp Plan.

(Lawyers will parse how consistent this is with a recent case in Brookland, with two of the same three judges, where the court basically took the map literally and rejected a project for not matching its categories.)

However, the judges say that the Zoning Commission must explain its reasons for weighing some factors over others. The judges seem to take issue with some factors not being adequately explained. They have instructed the Zoning Commission to make another decision, potentially after more hearings, that better explains this:

The Commission stated that permitting high-density development on the northern portion of the site was "a critical and essential part of fulfilling the parks, recreation, and open space designation of the [FLUM], while at the same time achieving other elements of the Comprehensive Plan and the city's strategic economic plan."

[Friends of McMillan Park, a leading opposition group] argued before the Commission, however, that the other policies reflected in the Comprehensive Plan could be advanced even if development on the site were limited to medium- and moderate-density uses. The Commission neither provided a specific basis for concluding to the contrary nor stated reasons for giving greater weight to some policies than to others. We therefore vacate the Commission's order and remand for further proceedings.

The court worries about environmental impacts and housing costs

Environmental Impact Statements are an important tool to ensure that governments don't run roughshod over the environment. However, they require a lot of analysis by those advancing any project, and often that gives courts an opportunity to nitpick one or another of scores of analyses in the EIS. For example, the Purple Line, which is clearly better for the environment than everyone driving, was blocked for EIS deficiencies because the Maryland judge quibbled with ridership projections.

The court here may be adding some EIS-like procedure to approval of projects like this. The judges say that the Zoning Commission did consider environmental impacts, but not as thoroughly as it should have. That wasn't their reason for remanding the project, but it points to a way these judges might find fault with a subsequent approval as well.

(The environmental benefit of dense development in the core of the city is that it lessens pressure to build sprawl in farms at the edge of the region. This is an area of some disagreement between Smart Growth environmentalists and others that fight for open space regardless of its location.)

Opponents further argued that the project would "accelerate gentrification, increase land values, and result in a net loss of affordable housing." The opinion doesn't get into the policy issues here, simply saying that the commission didn't sufficiently address these either.

In reality, this project will not lead to a loss of affordable housing because it is creating more affordable housing. Having housing here is not going to push up housing prices nearby as compared to not having housing here. The opponents are making economic arguments that are intuitively true to some but contradicted by economic research, but it seems the judges identify with those arguments.

Is this "special merit"?

The court also vacated the Mayor's Agent approval to demolish much of a historic resource to construct a "project of special merit." This part of the ruling seems to pose an even higher hurdle for the project, as the court did not only find that the Mayor's Agent failed to sufficiently explain himself.

Rather, the court disagreed with the overall definition of "special merit." The Mayor's Agent in essence found that the affordable housing, medical office needs, and other overall economic development value of the site outweighed the historic preservation value.

If I'm reading the opinion right, it seems this court disagrees. Special merit can be things like outstanding architecture and also a "specific feature of land planning." That term is pretty vague, and the court is not at all convinced by the more general conclusion from the Mayor's Agent:

"If the special-merit inquiry could appropriately focus on the "totality" of the benefits arising from a project,
then presumably the Mayor's Agent should also take into account all of the project's adverse impacts. Under such an approach, the Mayor's Agent would function essentially as a second Zoning Commission, evaluating all of the benefits and adverse impacts associated with projects requiring a permit from the Mayor's Agent. We conclude that the Preservation Act assigns the Mayor's Agent the more discrete role of determining whether one or more specific attributes of a project, considered in isolation or in combination, rise to the level of special merit, thus triggering a balancing of those special-merit benefits against historic-preservation losses.
The developers weren't clear about whether some cells could be preserved, at least according to the judges. The Mayor's Agent dealt with that by requiring an additional step before the developers could demolish the cells, but the judges don't feel that is sufficient.

Finally, the judges pose one more, perhaps quite big hurdle:

Among other things, an applicant seeking approval to demolish or subdivide a historic landmark bears the burden of showing that demolition or subdivision is "necessary." ... "The applicant must show that it considered alternatives to the total demolition of the historic building and that these alternatives were not reasonable." Although an applicant need not demonstrate that there are no other feasible alternatives, an applicant "should be required to show that all reasonable alternatives were considered."
In short, to be able to demolish a historic resource, the court is saying that the property owner needs to show that there is no "reasonable" other way to preserve the historic resource. This creates a high hurdle.

Photo by Ted Eytan on Flickr.

The preservation law doesn't deal well with situations like this

Perhaps such a hurdle is appropriate. After all, if someone's talking about demolishing a really special, historic building, these kinds of obstacles seem intuitively sensible.

But this isn't a single, really significant building; it's a giant 25-acre site. The preservation law seems somewhat ill-suited to such things, because it doesn't provide for weighing various needs. If something is historic, it's historic. There's no "a little bit historic," and the law doesn't say the Mayor's Agent can consider how the historic value weighs against the need for housing, tax revenue, medical office space, or active (rather than fenced-off) parks.

The Mayor's Agent had, in other cases, used the "special merit" category for such situations, but this court decision throws that into doubt. DC makes it easier to designate things as historic than in some other places, but also somewhat easier to make changes as well; that may be changing.

If DC wants to be able to continue to add housing, it will eventually have to reckon with the twin trends of running lower on empty land and having more and more land designated as in historic districts or sites.

Historic preservation is valuable, but it needs to be weighed against other factors as well amid the various priorities for the city. If the court is going to reduce the Mayor's Agent's powers, perhaps the DC Council needs to amend the law to broaden them again.


In DC, access to medical care really depends on where you live

We know that emergency vehicles take longer to get to DC residents who live east of the Anacostia River, but how does where people live in DC affect their access to non-emergency medical care? Fewer clinics, pharmacies, and vaccine locations east of the Anacostia River means access to non-emergency medical care is more difficult there as well.

Photo by Jared Hansen on Flickr.

Health clinics

Let's say you come down with the flu. Your first stop may be a clinic. Since 2010 many urgent care clinics, like MedStar PromptCare, and retail clinics, like CVS Minute Clinic, have opened across DC. These walk-in clinics provide immediate care for injuries and illnesses that don't require an emergency room visit, such as your flu-like symptoms, but also infections, sprains, and minor wounds.

DC's eight wards. Image from the DC Office of Planning.

Retail clinics are staffed by nurses with a more limited range of services, while urgent care clinics have doctors who can provide more complex treatment, like stitches.

DC is split up geographically into eight wards, each of which has a representative on the DC Council.

No urgent care or retail clinics have opened in Wards 4 or 8 since 2010, and nearly 70% of all DC's clinics are in Wards 2 and 3.

All graphs by the author.

This gap is partially filled by community health centers. Community health centers receive federal funding to provide primary care to underserved populations. One such clinic, Unity Health Care, operates a community health centers in all wards except 2, 3, and 4, with varying degrees of walk-in services.


Once you've been diagnosed by a clinic with the flu, your next trip is probably to the pharmacy. This may be more difficult east of the Anacostia; Wards 7 and 8 have the fewest pharmacies of any ward. Combined, they have a total of 18 pharmacies. This is less than Wards 2, 3, and 6 individually, and equal to the number of pharmacies in Ward 1.

Places to get vaccines

Hopefully you won't get the flu at all because you thought ahead and received a flu shot—and you were able to actually get the shot. Vaccine locations are another area of disparate care across the District.

There are fewer vaccine locations east of the Anacostia, including both Wards 7 and 8, than any other individual Ward.

For this post, I got pharmacy locations through a FOIA request to the DC Department of Health; I didn't include pharmacies located in hospitals. Vaccine and clinic data came from the DC Open Data portal, as well as I verified the data through internet searches and phone calls. You can find complete code for this on my github page.


Ambulances take longer to reach you if you live east of the Anacostia River

Ambulances in DC generally take longer to respond to neighborhoods east of the Anacostia River, and the river itself seems to be part of the cause. This map, which I made using data obtained from DC FEMS under the Freedom of Information Act, shows areas of the city where the proportion of all critical 911 calls where an ambulance took more than 10 minutes to arrive at the scene from the time they were notified.

Graphic by the author, with data from DCFEMS.

When Julette Saussy, the former head of emergency medical services for DC, resigned last February, she wrote an open letter to the city explaining her reasons. In the letter she mentions Robert Leroi Wiggins, a 35-year-old man stabbed in the Benning Ridge neighborhood on January 27, 2016. After 18 minutes, an ambulance finally arrived and transported Mr. Wiggins to a hospital. Four days later, he succumbed to his injuries. Ms. Saussy suggests that he might have survived if the ambulance had reached him sooner.

Tragic stories like Mr. Wiggins' are not unheard of. In September 2015, a 5-month old baby stopped breathing, but the nearest ambulance was over seven miles away, and in March 2016, a gunshot victim waited over 30 minutes for an ambulance.

A disproportionate number of these stories seem occur in neighborhoods east of the Anacostia River.

Response times are quick close to DC's core, and particularly slow in Ward 7

Three anecdotes do not constitute a trend, but according to the data, ambulances responding to critical 911 calls east of the Anacostia seem to have difficulty meeting the city's own standards for ambulance response times.

DC's contract with the private ambulance company, American Medical Response (AMR), stipulates that the company is expected to respond to 90% of all calls in less than 10 minutes. Applying this standard on a per-neighborhood basis allows us to see where response times are adequate and where they are not.

Take a look at the map above. Areas that tend to meet the 10%-or-less standard are clustered around the center of the city, near the preponderance of DC's medical facilities and high-speed travel corridors. Areas east of the Anacostia fare much worse, particularly from about noon to the early evening and in Ward 7 neighborhoods at the eastern edge of the city.

There are fewer medical resources in the eastern parts of the District

According to Andrew Beaton of DC FEMS, this is the result of busy ambulances accumulating in the western portion of the city.

"The greatest number of EMS calls resulting in patient transport are heavily concentrated in the center of the District and, to a lesser degree, in two areas south of the Anacostia River," Beaton said.

"Response times during the day are affected by traffic and pedestrian density, especially at intersection choke points, reducing the mobility of ambulances and resulting in average response speeds of 15 miles per hour or less. The Anacostia River and Interstate 295 also represent geographic barriers difficult to overcome many times during the day. When combined with high call volume—especially unpredictable surges—this can result in longer ambulance response times in the southern areas of the District. "

Traffic on bridges across the Anacostia—a problem recent infrastructure changes have exacerbatedand a complete lack of trauma centers east of the Anacostia creates a recurring situation where ambulances struggle to reach patients.

Mr. Beaton indicates that since the contract with AMR started, response times have fallen city-wide. Any improvement is good, but increasing the number of ambulances on the road and augmenting FEMS resources are short-term improvements. They do not address the underlying structural issues: the chokepoint across the bridge and the dearth of trauma centers east of the Anacostia .


New bike lanes and dedicated bus lanes could connect Columbia Heights and Brookland

People want more ways to get around by foot and on bike in the corridor that runs from from Columbia Heights to Brookland, and they want them to be safer. After receiving that message, DDOT drafted potential plans for making it happen.

The study area. All image from DDOT.

DDOT's Crosstown Multimodal Transportation Study focuses on an area defined by Kenyon and Harvard Streets between 16th and Park Place; Irving Street and Michigan Avenue around the Washington Hospital Center; and Michigan Avenue from the hospital center to South Dakota Avenue. Cars in the area zip along Irving and Michigan, but for people on bikes and foot, there isn't a safe or easy way to get around (a fact compounded by the congestion once drivers get to either side of the hospital).

Also, the area's transit isn't great. Both the H2 and H4 bus routes connect the Columbia Heights Metro Station, the Washington Hospital Center, and the Brookland Metro Station along the Irving/Columbia Road-Michigan Avenue corridor. However, Medstar also provides shuttle service on the same route between the hospitals and the Columbia Heights Metro every 10 minutes during rush hour and 30 minutes during other times. This service largely duplicates WMATA's service and adds additional traffic to already congested streets.

After the first public workshop about the study, nearly 700 people commented on how to address all of these issues. Back in April, DDOT unveiled three concept plans for the corridor. Here's a summary:

A new street grid

Each of DDOT's proposals suggests removing the Michigan Avenue overpass and creating a street grid west of the hospitals. Doing so would go a long way in making the area safer for people on foot and bike, as it'd get rid of unnecessary high-speed ramps and car lanes; it'd also mean chances to add new green space. How many surface streets are in that grid depends largely on where bus and bike lanes need to be.

One of the options for a new street grid.

More options for bike riders

Those who gave DDOT input were clear that they'd like to see more bike connections, and that those connections be made made up of space that's only for bikes. The proposals include a few options for doing that, from protected bikeways that run in both directions to off-street lanes next to pedestrian walkways.

Around the hospitals and toward Columbia Heights, the stronger proposals would create bike lanes in one of the existing travel or parking lanes. With one exception in one proposal, bikes and buses would not share the same lanes, and west of the hospitals, bike lanes and bus lanes would not be on the same streets.

One option is to add a bike lane along Michigan Avenue.

Dedicated bus lanes

The plans aim to improve bus service (shorter trips, specifically) by creating dedicated lanes for buses. While the extent of dedicated lanes varies among the concepts, they all suggest dedicated lanes on either Irving Street, Columbia Road, and/or Harvard Street west of the hospitals. This would be accomplished by using one lane currently used during rush hour and parking during off peak hours.

The dark blue lines are dedicated transit lanes.

No more cloverleaf

None of DDOT's three options would do away with the North Capitol Street overpass. All of them, however, would replace the freeway-style, cloverleaf-shaped ramps that run between North Capitol and Irving with more direct connections. Doing so would make it much easier to keep car speeds down and control traffic flow.

The cloverleaf is on its way out.

DDOT has scheduled its third Crosstown Study workshop for June 9th at Trinity Washington University. You can give input on the potential plans there.

In addition to the third workshop, DDOT will have two Public Engagement Events on Saturday, June 11: one in Brookland, at the Monroe Street Farmers Market (716 Monroe Street NE), and one on the west side of the Columbia Heights Metro station (3030 14th Street NW).


Three ways to build in Forest Glen without creating more traffic

As new homes, offices, and shops sprout around the region's Metro stations, Forest Glen has remained a holdout due to neighborhood resistance to new construction. But that may change as WMATA seeks someone to build there.

Metro wants to redevelop this parking lot. All photos by the author.

Last month, the agency put out a call for development proposals at Forest Glen, in addition to West Hyattsville and Largo Town Center in Prince George's County and Braddock Road in Alexandria. WMATA owns 8 acres at Forest Glen, most of which is a parking lot, and developers have already expressed interest in building there.

Forest Glen should be a prime development site. While it's on the busy Red Line, it's one of Metro's least-used stations. It's adjacent to the Capital Beltway and one stop in each direction from Silver Spring's and Wheaton's booming downtowns. Holy Cross Hospital, one of Montgomery County's largest employers with over 2,900 workers, is a few blocks away. But since Forest Glen opened in 1990, not much has happened.

On one side of the Metro station is a townhouse development that's about 10 years old, while across the street are 7 new single-family homes. The land the parking lot sits on is valuable, and it's likely that WMATA will get proposals to build apartments there because the land is so valuable. But zoning only allows single-family homes there, the result of a 1996 plan from Montgomery County that recommends preserving the area's "single-family character," due to neighbor concerns about traffic.

Townhouses next to the Forest Glen parking lot.

As a result, whoever tries to build at Forest Glen will have to get a rezoning, which neighbors will certainly fight. It's true that there's a lot of traffic in Forest Glen: the Beltway is one block away, while the adjacent intersection of Georgia Avenue and Forest Glen Road is one of Montgomery County's busiest. While traffic is always likely to be bad in Forest Glen, though by taking advantage of the Metro station, there are ways to bring more people and amenities to the area without putting more cars on the road.

Make it easier to reach Metro without a car

Today, two-thirds of the drivers who park at Forest Glen come from less than two miles away, suggesting that people don't feel safe walking or biking in the area. There's a pedestrian bridge over the Beltway that connects to the Montgomery Hills shopping area, a half-mile away, but residents have also fought for a tunnel under Georgia Avenue so they won't have to cross the 6-lane state highway.

Montgomery County transportation officials have explored building a tunnel beneath Georgia, which is estimated to cost up to $17.9 million. But county planners note that a tunnel may not be worth it because there aren't a lot of people to use it.

And crossing Georgia Avenue is only a small part of the experience of walking in the larger neighborhood. Today, the sidewalks on Forest Glen Road and Georgia Avenue are narrow and right next to the road, which is both unpleasant and unsafe. WMATA has asked developers applying to build at Forest Glen to propose ways to improve pedestrian access as well, and they may want to start with wider sidewalks with a landscaping buffer to make walking much more attractive. Investing in bike lanes would also be a good idea.

Provide things to walk to

Another way to reduce car trips is by providing daily needs within a short walk or bike ride. The Montgomery Hills shopping district, with a grocery store, pharmacy, and other useful shops, is a half-mile away from the Metro. But it may also make sense to put some small-scale retail at the station itself, like a dry cleaner, coffeeshop or convenience store, which will mainly draw people from the Metro station and areas within walking or biking distance. Some people will drive, but not as many as there would be with larger stores.

Putting shops at the Metro might also encourage workers at Holy Cross to take transit instead of driving, since they'll be able to run errands on their way to and from work. Encouraging this crowd to take transit is important, since hospitals are busy all day and all week, meaning they generate a lot of demand for transit, making it practical to run more buses and trains, which is great for everyone else.

Provide less parking

Whatever gets built at the Metro will have to include parking, not only for commuters, but for residents as well. While Montgomery County's new zoning code requires fewer parking spaces, each apartment still has to have at least one parking space. Even small shops will have to have their own parking. The more parking there is, the more likely residents are to bring cars, which of course means more traffic.

Thus, the key is to give future residents and customers incentives to not drive. The new zoning code does allow developers to "unbundle" parking spaces from apartments and sell or rent them separately. Those who choose not to bring cars will then get to pay less for housing. The code also requires carsharing spaces in new apartment buildings, so residents will still have access to a car even if they don't have their own. If Montgomery County ever decides to expand Capital Bikeshare, the developer could pay for a station here.

And the developer could offer some sort of discount or incentive for Holy Cross employees to live there, allowing hospital workers to live a short walk from their jobs.

No matter the approach, there are a lot of ways to build in Forest Glen without creating additional traffic. A creative approach can do wonders for the area's profile and elevate the quality of life for residents there.

Public Safety

Prince George's picks Metro station site for new hospital

Prince George's County Executive Rushern Baker made the smart growth choice early this week, selecting the Largo Town Center Metro Station for a new $650 million, 259-bed regional medical center.

Photo by the author.

The decision caps a year-long campaign by the Coalition for Smarter Growth and community smart growth advocates to demonstrate the benefits of putting the new hospital at a Metro station. It will replace the existing Prince George's Hospital Center in Cheverly.

Operator Dimensions Healthcare will announce its official decision tomorrow. The organization's full board will vote on the recommendation for a new hospital site after its executive committee meets today.

With a projected influx of over 2000 workers each day, the new hospital will spur mixed-use development at one of Prince George's 15 mostly-underutilized Metro stations. Thousands of workers and visitors in this transit-accessible location presents a prime opportunity to create a walkable, mixed-use facility that could ultimately anchor a vibrant new downtown for Prince George's.

During the selection process, officials seriously considered rival site Landover Mall, which is over a mile away from any Metro station. From the beginning, placing the hospital at the shuttered mall seemed to be a given, especially considering that the University of Maryland Medical Systems Corporation was rumored to seek a site with 120 acres. In the end, a much smaller site with Metro access emerged as an important component for the winning site.

There are major economic, environmental, and social justice advantages to putting the hospital at a Metro station. While much hospital construction of the last 50 years has been increasingly spread out on large campuses, many new successful hospital centers take advantage of leading urban designs, compact footprints, access to transit, and mixed-use environments.

Area around Largo Metro considered for possible site(s). Map courtesy Prince George's County.

Smart growth advocates have pushed hard to encourage Prince George's officials to choose such a location for the medical center. Together with leading hospital design and construction experts, the Coalition for Smarter Growth released a series of case studies to encourage officials to choose the Largo site in February.

Building on the momentum of those case studies, the Coalition for Smarter Growth delivered a petition with over 1000 signatures and sent hundreds of emails to county officials asking that the hospital be placed at a Metro station. In February, a community meeting drew over 300 Prince George's residents in overwhelming support for a Metro-accessible medical center.

The path to a smart growth hospital is not over yet. Many decisions can happen during the design and construction phase that will advance or diminish the positive impact the medical center can have on the county. The IRS and Census Bureau headquarters at the New Carrollton and Suitland Metro stations are prime examples of "what not to do" when locating a major employer at a Metro station.

Despite future hurdles and a history of sprawl projects like Konterra and Westphalia, this decision shows the Baker administration's and state's commitment to smart growth and transit-oriented development. Putting the new regional medical center at Largo Town Center pursues the promise of real transit-oriented economic development with a more than half-billion dollar investment.

The effort offers Prince George's the opportunity to take advantage of existing transit connections not only to provide better access to quality healthcare, but to build the kind of mixed-use district that study after study shows is where people want to live, work, and play. This regional medical center can be a true catalyst for that kind of healthy smart growth development.

If you live in Prince George's and think this is a good decision, you can take a moment to thank County Executive Baker for his leadership and smart choice here.


Hospital case studies point the way for Prince George's

What's the difference between a hospital that's a springboard for economic development, and one that's not living up to its potential? Answer: Design, location, and connectivity. Local groups compiled a set of case studies to point the way as Prince George's County moves forward with its proposed Regional Medical Center.

Image from ZGF.

The new hospital is an important healthcare facility for the county, and as an employer of 2,000 workers, it can also catalyze economic development in an area where new investment has lagged.

Hospital officials are rumored to be interested in a sprawling 80-120 acre suburban-style site away from Metro, likely the old Landover Mall site. The sponsors of the case studies hope that these examples of great hospitals, designed by leading architectural firms, can help decision-makers understand the benefits of a more mixed-use, compact and transit-oriented site.

Matrix of case studies. Click to view full size.

Envision Prince George's Community Action Team for Transit-Oriented Development, the Coalition for Smarter Growth, and American Institute of Architects Potomac Valley collected the design case studies. They provide examples of mid- to large-scale hospitals with footprints of 1.5-48 acres. In fact, larger hospitals (measured in number of beds) are at the lower end of this range of acres, while the smaller hospitals tended to occupy more land area.

While Prince George's continues to pursue additional federal offices (like the new FBI headquarters), a new $600 million medical center could be one of the best opportunities to jump-start transit-oriented development at one of the county's 15 underutilized Metro stations.

In contrast to courting federal agencies, the state and county control the decision about where to locate and how to design a new medical center. Not encumbered with stringent federal security requirements, a regional medical center offers a better opportunity to connect to surrounding uses and fuel spinoff economic activity than an FBI or Homeland Security building.

Why a smaller, urban footprint?

Hospitals must plan for growth, and a working "rule of thumb" for traditional suburban or rural 200-bed hospitals (similar in size to the Prince George's facility) is a minimum of 40 acres. This footprint provides a suburban or rural site with room for the initial building, associated drop-offs, parking, and room for future growth. Growth is common in medical facilities, whether for outpatient clinics, specialty centers, or the hospital itself.

Seattle Children's Hospital. Photo from ZGF.

Hospitals in a more urban context plan for similar growth, but within sites that are typically 10 acres or less. This smaller footprint offers several benefits over a suburban medical campus. Connecting a hospital center to a larger mixed-use environment where people can work, shop, and live helps attract and retain highly sought-after skilled healthcare workers. By better integrating into the surrounding community, an anchor institution like this can support a vibrant, walkable, thriving new hub.

Designers also point to sustainability benefits from a more urban design and context. A limited footprint disturbs less land and reduces the heat island effect. Placing a more compact medical center in an urban hub also allows for more environmentally-friendly transportation choices with frequent transit service, and walk and bicycle options for short trips. Driving and parking will remain an important mode of access, but a more urban hospital allows for lower parking supplies, greater access for those who do not have a car, and the choice to take some trips on foot or by bicycle.

While a footprint of 10 acres may seem small compared to a suburban campus of 40 acres or more, hospital complexes around the country and beyond are developing successful, busy hospitals on sites as small as a few acres.

The just-released case studies of 11 successful moderate to small-footprint hospitals of comparable size to the planned Prince George's regional medical center share 3 common success factors: access, flexibility for future growth, and a connection to the surrounding environment.

Success factor: Access

An important factor for any healthcare facility is convenient and easy access to and from the site. High-quality public transportation, stores and services, and housing within walking distance create opportunities for staff and visitors to get outside the hospital while still being nearby, and enable some to come and go without having a car.

Access to Champ de Mars medical center. Image from CannonDesign.

Several of the examples in the report show major hospitals that are integrated into city blocks. Hospital staff and visitors have easy access to a local services and transit options. For example, the Kaiser Permanente Los Angeles Medical Center is a 448-bed hospital, 7 stories tall situated on 3 acres of land. Within a block is the Red line light rail station and major bus routes.

GWU hospital entrance. Photo from Smithgroup JJR.

Closer to home, the 6-7 story, 371-bed George Washington University Hospital occupies 2 acres. The front door of GWU Hospital opens onto the busy entrance of the Foggy Bottom Metrorail station and is embedded in a thriving urban district that mixes health, university, private office, retail and housing uses in a highly walkable, transit-accessible environment.

Medical facilities woven into the fabric of a larger mixed-use district served by transit can have an advantage when competing for medical professionals who desire to be in a lively, diverse place, and need flexibility with their commutes in a two-worker household.

Success factor: Flexibility for future growth

While suburban hospitals are typically designed with extra acreage to accommodate future growth, urban medical centers can anticipate similar growth, but plan smartly within a more constrained footprint.

Main entrance, American Hospital Dubai. Image from AECOM.

Planning a smaller-footprint facility guides planners to take into account their overall surroundings, making better use of pedestrian connections to the surrounding community and supporting services. In the case of both the vertical high rise addition to Mercy Medical Center in Baltimore, with the 260-bed Bunting Center inpatient hospital on 1.5 acres, and the 350-bed American Hospital Dubai campus on 11 acres, planning for growth accounted for the sites' larger surroundings.

The hospital designers from AECOM point out that an urban design and location provides significant advantages in offering the ability to walk to a nearby restaurant to avoid yet another meal at the hospital cafeteria or the convenience of staying at a nearby hotel for someone visiting a sick relative.

Success factor: Connection to green spaces

Numerous studies show that access to outdoor places and views of green spaces create a state-of-the-art healing environment. But urban hospitals don't need to concede healing green features to their suburban and rural counterparts. Roof gardens, courtyards, and natural light are all achievable in small-footprint hospital centers.

Roof garden view, Bunting Center at Mercy, Baltimore. Rendering from AECOM.

The centerpiece of the Bunting Center at Mercy Hospital healing environment is a multilevel roof garden, accessible on various floors and overlooked by room occupants above the midway point along the rise of the building. The 9th floor garden offers direct access from the ICU waiting room.

On the 28 acre campus of the 600-bed Seattle Children's Hospital, 41% of the campus is dedicated as open space. Pedestrian paths are provided throughout the facility to promote walking and offer outdoor connections.

Innovative design and urban context show the possibilities

The 11 case studies offer examples of innovative architectural design, connectivity to the surrounding context, access to transit, green features and compact footprints. These features highlight how a regional medical center for Prince George's and Southern Maryland could establish a new leading healthcare facility that not only attracts the staff and patients it needs to succeed, but fits into a larger district that thrives on the influx of activity.

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