Project Specs
Project Name Los Angeles County+University of Southern California (LAC+USC) Medical Center replacement project
Location Los Angeles
Total floor area 1.5 million square feet
Number of floors 8
Number of beds 600
Project cost $1 billion
Construction cost $625 million
Groundbreaking April 2003
Opening November 2008

Project Team
Owner Los Angeles County
Architect HOK/Lee, Burkhart, Liu Inc. (LBL) Associated Architects
General Contractor MCH Contractors (a joint venture of McCarthy Building Companies Inc.,
Clark Construction Group and Hunt Construction Group)
Construction Manager Jacobs
Interior Designer HOK/LBL Associated Architects

MEP Engineering M-E Engineers Inc.  Structural/Civil Engineering KPFF Consulting Engineers  Medical Equipment Planning Chambers Equipment Consulting  Medical Planning HOK/LBL Associated Architects and Healthcare Planning Inc.  Low Voltage Systems Arup  Food Service Marshall Associates Inc.  Aviation Planning Heliplanners  Security Buford Goff & Associates Inc.  Architectural Hardware Consulting Erbschloe Consulting Services  Acoustics Newson Brown Acoustics  Lighting Design Lighting Design Alliance Inc.  Radiation Physics Therapy Physics Inc.  Material Handling/Vertical Transportation Lerch Bates  Code Consulting Schirmer Engineering Corp.  Landscaping Rios Clementi Hale Studios

In a billion-dollar project that spanned 10 years from programming through commissioning, Los Angeles County has replaced five existing hospitals, including its original, iconic General Hospital building, with a modern, 1.5 million-square-foot facility. The Los Angeles County+University of Southern California (LAC+USC) Medical Center, a Level 1 trauma center and tertiary care facility affiliated with USC’s Keck School of Medicine, is the largest capital project ever undertaken by the county.

It includes an eight-story, 600-bed inpatient tower; a seven-story outpatient building; a five-story diagnostic and treatment building; and an underground central utility plant.“This was an opportunity to create a new vision for the delivery of health care in a public hospital setting,” says Project Director Charles Siconolfi, AIA, ACHA, LEED AP, director of health care planning and design for HOK, an architecture firm with offices worldwide. 

BUILT FOR CARE Featuring clean lines and a simple color palette, the inpatient tower lobby provides a reassuring sense of purpose.

The medical center was designed by HOK and Los Angeles-based Lee, Burkhart, Liu Inc. (LBL) Associated Architects. The project was managed by the Los Angeles County Department of Public Works, with construction management by Jacobs, Pasadena, Calif., and general contracting by MCH Contractors, a joint venture of McCarthy Building Companies Inc., St. Louis, Mo.; Clark Construction Group, Bethesda, Md.; and Hunt Construction Group, Scottsdale, Ariz.The original hospital building served Los Angeles County for nearly a century, during which time it secured a place in American culture as the birthplace of Marilyn Monroe and the hospital shown for years in the credits of the popular soap opera, “General Hospital.” The 1994 Northridge earthquake damaged the aging building, necessitating its replacement.

Modern care

In designing the new facility, the architects did not want to imitate the original, Beaux Arts-style building, says Kenneth Lee, LEED AP, principal-in-charge for LBL. The sleek new buildings, clad in a combination of glass curtain wall and aluminum-colored metal panels, present a lower profile on the horizon than their predecessor, with a modern design symbolizing the care inside.

The civic importance of the building is underscored by the design of the main lobbies, says Siconolfi. Wood and stone elements highlight these large public spaces. Throughout the rest of the building, simple, functional materials with an emphasis on economy, durability, cleanability and infection control were used. The minimal color palette is designed to create a calming effect, with brighter colors used only to distinguish key destinations in the facility.

WARM & COZY This labor and delivery room demonstrates that a public hospital need not lack comforting touches for patients.

The outpatient tower includes clinics for radiation oncology, psychiatrics, pediatrics, women’s services, dental care, orthopedics and ophthalmology. With the exception of highly specialized areas, the clinics have a similar design to allow the spaces to be easily renovated for other purposes.

The ORs in the diagnostic and treatment tower are organized in a modular configuration to allow flexibility as surgical technologies change.

The ED, the largest in Los Angeles County, is organized into separate components for trauma, urgent care, psychiatrics, pediatrics and adult acute care. Each of these areas has its own nursing core and distinct space. Trauma rooms are located next to the ambulance entrance, with the public entrance on the opposite side of the department. From here, patients are triaged to the appropriate care area.

The first floor of the inpatient tower includes a 24-bed jail unit, operated by the county sheriff's department and designed to provide a secure environment for caregivers and incarcerated patients. The remaining patient units are arranged four per floor, with each L-shaped unit organized toward the central, vertical circulation core. With the entry point located midway through each floor, walking distances are reduced.

Maximum design

The inpatient tower and central utility plant are designed to remain operational following the maximum earthquake anticipated for the site, which could be expected to occur once every 500 years.

For the diagnostic and treatment building, the project team far exceeded this minimum code requirement, designing the building to withstand a once-every-1,000-year earthquake, measured at magnitude 8 on the Richter scale.

“That’s the lifeboat building. In any type of event, that building has to stay operational,” says Joelle Hertel, senior vice president, Clark Construction, and director of the McCarthy-Clark-Hunt joint venture.

The building is base-isolated, with a structure founded on elastomeric bearings designed to move laterally with the motion of an earthquake to reduce the amount of force transmitted up the building.

A shallow moat, covered with panels, extends about four feet around the perimeter of the tower to provide a space in which the building can move as much as 22 to 24 inches side-to-side.

A large expansion joint between the diagnostic and treatment tower and the inpatient and outpatient towers on either side is designed to allow movement between the interconnected structures.

Mechanical, electrical and plumbing systems leading from the central utility plant have seismic restraints designed for forces associated with the maximum credible earthquake for this site.

The hospital also has sufficient emergency power generation, water and fuel storage and waste tanks to stand alone for up to 72 hours.

‘Brand-new Cadillac’

Moving from the older hospital building into a new, state-of-the-art health care facility has been like “going from a Model T to a brand-new Cadillac,” says Gus Pizarro, of the hospital’s facilities operations department.

Kamel Youssef, project director for Los Angeles County during construction, says the new building is attracting high-quality teachers and residents to the medical center.

“It’s doing great,” Youssef says. “Everybody is really happy with it.”

Sidebar - Efficiency is key to project design

A lighthearted atmosphere prevails in the outpatient building childcare center.   The LAC+USC Medical Center was designed to provide the Los Angeles County Department of Health Services with many opportunities for capital and operational savings. The health system serves 10 million residents and provides the majority of uncompensated medical care in the county, making efficient design an especially critical aspect of the facility replacement project.  “The project elements are configured such that centralized diagnostic and treatment services … serve inpatients and outpatients, while maintaining separate paths of travel for each,” says Charles Siconolfi, AIA, ACHA, LEED AP, project director and director of health care planning and design for HOK. “This aspect of the design created efficiencies in reduced square footage, reduced staff and higher utilization of major medical equipment.” The centralized layout also provides for greater collaboration among caregivers. In the surgery department, for example, inpatient and outpatient surgical prep and recovery areas were built adjacent to one another, so they can share staff. The emergency department provides clear sight lines for caregivers and ample floor space for busy times.   The ED waiting area is immediately adjacent to the main waiting room of the outpatient clinic tower. “This allows for its use during ED overflow times,” says Kenneth Lee, LEED AP, principal-in-charge for Lee, Burkhart, Liu Inc. Lee notes that because the ED and clinics get their heaviest use at opposite times of the day, their waiting areas are unlikely to be full at the same time. Outdoor access from the medical center’s main lobbies enables patients and visitors to take advantage of Los Angeles’ mild climate and use the facility’s gardens as adjunct lobby space. Durable precast concrete was used at grade on the building’s exterior, given the large number of people and vehicles expected at the facility. On the interior, multiple levels of wall protection were installed to keep the building looking new. A limited accent color palette is used for efficient maintenance. An operating room in the diagnostic and treatment building displays the new hospital’s high-tech hardware.

Sidebar - Wayfinding for the masses

Each year, the LAC+USC Medical Center has more than 40,000 admissions, serves nearly 140,000 emergency department patients and records 900,000 outpatient visits. To simplify wayfinding for the large number of people expected at the medical center’s replacement facility, the architects broke the project down into manageable parts. In contrast to its Beaux Arts-style predecessor, the new LAC+USC Medical Center features a sleek design emphasizing the modern care found within.   The medical center is organized into three distinct, interconnected elements: an inpatient block, a specialty outpatient clinic block and a central diagnostic and treatment block. Each of these multistory spaces is visible from the street. The glazing on each tower provides a visual clue to that tower’s purpose; windows on the inpatient tower are scaled to patient rooms, while areas of major public movement in the clinics are identified by vast expanses of glass. Areas of vertical circulation are also clear from the exterior. These cues help people begin to orient themselves as they approach the facility. Architectural elements that reach toward the street make the building’s entrances easy to locate. The entrance to the outpatient building, adjacent to convenient patient parking and bus transit stops, features a canopy, wall and colonnade. A progression of canopied spaces and a large patient drop-off area highlight the entrance to the inpatient tower. Clusters and rows of trees, as well as hardscape elements, help guide the eye to each of the facility’s main front doors. The corridor and clinic lobby/waiting area in the outpatient building expands on the hospital’s modern look with clean interior elements.   Registration and information points are organized around the perimeter of the lobby spaces, to further aid patients and visitors in locating their destinations within the building. Naturally lighted, glass-walled corridors on the upper floors provide exterior views that serve as reference points from inside the facility. “The building provides clues to the user at every stage,” says Charles Siconolfi, AIA, ACHA, LEED AP, project director and director of health care planning and design for HOK.