Art of the Possible
A new ambulatory-care clinic for a remarkable institution seeks to become the
nation's first LEED-certified healthcare facility.
By Ken Shulman
Photography by David Allee and Katie Murray for Metropolis
October 2003
It's not always easy being green--particularly for the health-care profession.
Strict state-mandated regulations regarding air exchange levels and temperature
make it difficult for architects to create energy-efficient heating-and-cooling
systems for hospitals and clinics. Materials used in therapeutic and diagnostic
services are often environmentally unfriendly and occasionally noxious.
Both normal and critical patient care consume enormous and constant quantities
of electricity and heating fuel. But it wasn't just these obstacles that
made Robin Guenther lukewarm about designing a clinic at the Center for
Discovery, a residential school for children and outpatient facility for
disabled persons in upstate New York.
"Early on in my career, I had an interview to do a job at a facility
for disabled children," says Guenther, principal at Guenther5, a New
York firm specializing in health-care design. "It was an enormous
single structure, like a nursing home, with large amorphous wings of double-loaded
corridors filled with kids in wheelchairs as far as you could see.
It was just so overwhelming; I couldn't imagine what we could do there.
The experience was so depressing that I swore I would never work in that
environment."
In 1999 Guenther met with Patrick Dollard, executive director of the center,
in her New York office. Dollard was interviewing for an architect to
design an on-campus diagnostic and treatment center for residents and outpatients.
The pair spoke for a while, and Dollard gave her a copy of the center's
annual report. Guenther is certain that Dollard sensed her ambivalence,
although he was sensitive enough not to mention it. "All he said,"
she recalls, "and this was right when he was leaving, was 'I think
you should come and see the place.'"
Created in 1948 by a small group of dedicated parents of disabled children,
the Center for Discovery is home to 275 residents ranging in age from 5
to 90. Another 100 children frequent the facility's classrooms, while the
center's clinic provides medical services to an additional 500 people in
the vicinity. Located in Harris, New York--about 90 miles from the George
Washington Bridge and only a few miles from the area's once thriving borscht
belt hotels--the Center for Discovery is a loosely woven patchwork of paths,
pasture, farmland, and 27 small to medium-size residential homes nestled
across 300 acres in the foothills of the Catskill mountains.
The new clinic, designed by Guenther5 and opened in March, is easily the
most visible structure on campus. But it's easy to miss the Discovery Health
Center from the road. Shaded and decentralized, the facility has few institutional
attributes or characteristics. More than a health-care facility, it resembles
an upscale retirement village or rustic residential development. Only the
sight of children rolling down paved paths in wheelchairs--each child at
the center spends time outdoors every day, no matter how fragile they are--hints
at the nature of the facility.
"We were determined to develop a place for folks whom no one else could
care for," Dollard says. "To provide services for people who just
twenty years ago were not even considered human." In 1980, the year
Dollard returned to his native Sullivan County to take a job at the center,
its staff numbered 20. Today the Center for Discovery employs nearly 1,000
people, including physicians, nurses, teachers, social workers, physical
therapists, and psychologists. There are even riding instructors at Milligan
Hill, the center's recently constructed equine-assisted therapy center.
"We wanted to create a place where we might concentrate on what our
people could do, instead of wasting time feeling bad about what they couldn't."
In the 23 years of his tenure, Dollard's leadership and optimism transformed
a relatively small isolated institution into an ambitious, innovative, and
exceptionably livable community. The private community runs on an annual
budget of $50 million, much of which comes from government grants, private
foundations, and fund-raising campaigns led by grateful parents.
"We spent years looking at facilities," says Lynn Schwartz, of
Rye, New York, whose 27-year-old son, Tony, came to live at the center in
1995. "Here they provide our children with everything that is provided
for a normal child. My younger daughter had a prom at her high school. Tony's
class had a prom at the end of the school year here. Most of our children
here aren't verbal. Yet they can see a psychologist if they want to. One
day a board member suggested it might be good for the children to ride horses.
Now we have the equine center."
What the center didn't have until recently was a centralized clinic providing
necessary primary care for its residents. The center had always offered
essential clinical services, but its components were spread out across the
campus. Many primary-care features were lacking; residents needed to be
transported to facilities in Westchester or Manhattan for dental, neurological,
psychiatric, ophthalmologic, and dermatological treatment. The system was
inconvenient and complicated, and worst of all it disrupted the vital rhythms
the staff had worked so hard to establish. Schwartz recalls that whenever
Tony--who suffers from a genetic disability and is neither verbal nor ambulatory--needed
to see a dentist, he had to be bused to a regional hospital and put under
full anesthetic simply to have his teeth cleaned.
Built at a cost of more than $8 million--the clinic is funded by $1 million
in state and private grants, and a $7 million bond--the new clinic is a
low-slung barnlike structure cut into the Catskill foothills along a north-south
axis. Inspired by regional vernacular--only the four oversize vertical banners
with images of the center's smiling children define the building and
its proud purpose--the building sits on the reclaimed site of a defunct
poultry farm, with views of pasture and woodlands to the east and the center's
community-sponsored organic farm to the northeast.
The most remarkable physical feature of the clinic is its geothermal heating
system. Water is passed through 40 wells sunken beneath the property and
into a pumping station, where its temperature is electrically boosted from
54 to 94 degrees. The heated water is then pumped through conduits into
the building. In summer, ambient-temperature water circulates through the
same conduits to cool the building. Other sustainable features include daylighting
of interior spaces, passive solar components, shading devices to reduce
solar gain, recycled building content, and water-efficient landscaping.
Guenther and her collaborators were rigorous in the selection of materials,
eliminating PVCs and other substances that emit noxious fumes.
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To disabled individuals and their families, the observation deck of the new
primary care facility at the Center for Discovery in upstate New York is a
breath of fresh air. |
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The physical therapy/ occupational therapy room is used for both diagnosis and
long term rehabilitation. The specification of green materials throughout the
space was a unique challenge. |
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In the pediatric waiting area continuous carpeting is used to insure zero
change in threshold--allowing wheelchair-bound kids greater freedom of
movement--and durable blue glass tiles resist wear and tear caused by
wheelchairs knocking into walls. |
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The new Milligan Hill Equine Assisted Therapy Center, located a quarter-mile
away and connected by path, gives individuals a chance to exercise dormant
muscles while interacting with animals. |
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A universally designed raised-bed garden connects residents with nature. |
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In the durable medical equipment area, an individual's range of movement and
physical alignment is carefully assessed. During this process--which can take
up to one week--a newcomer is taken through a series of exercises that includes
climbing a wall to measure how far you can extend your arms and legs and a
"gate analysis"--where you are photographed walking along the window
with the support of a bar. |
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