Healthy serendipity: environmental concerns played a key role in the design of this new medical complex

Architectural Review, The, May, 2005

Located on a rural site near the Catskill Mountains in upstate New York, the Patrick H. Dollard Discovery Health Center is a new diagnostic and treatment centre providing outpatient primary and specialist medical and dental services. Owned and operated by a not-for-profit healthcare agency, the new building forms part of a larger campus that serves children and adults with profound neurological and developmental disabilities. Some 220 adults and children live on site, with another 60 adults in nearby community residences run by the centre. Around 500 people from the wider mainly agricultural community also take advantage of its services. Until recently, medical facilities were scattered across the campus, and patients could be sent on long, stressful journeys off site for routine procedures, so the new clinic provides a much-needed centralised base and focus for treatment.

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Architects for the new building are Guenther 5, a New York-based practice which specialises in socially responsive architecture for healthcare and education bodies, underpinned by a strong environmental awareness. The new clinic takes its cues from local contexts--a remote pastoral setting, strong solar exposure and a windswept and snowy winter climate. Hunkered down in the landscape, the assemblage of low-rise, timber-clad volumes capped by metal monopitch roofs bear a distinct resemblance to barns or farm buildings. The architecture is modest, humanly scaled and consciously uninstitutional with the aim of transforming often negative perceptions of healthcare buildings. For many developmentally disabled adults and children, frequent medical visits are a source of fear and stress that can hinder effective diagnosis and treatment. So, for instance, the scale of the building is unimposing, natural materials are used wherever possible and all rooms have natural light and views. Though all this sounds obvious, the outcome is a thoughtful and unsentimental take on modern vernacular that in its unpretentious exterior and luminous interior has an almost Scandinavian air of sobriety and decency.

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The new clinic acts as a physical and metaphorical gateway to the rest of the campus. Formerly used for chicken farming on an industrial scale, the site was selected for its prominence and central location, and the impact of development on both the land and water reserves was minimised as part of a strategy of environmental restoration. Surrounding marshes and ponds feed into an underground aquifer that supplies water to an organic farm on the campus. Local ponds were rejuvenated, while a new collection pool channels rainwater and snow melt from the building to supply the farm.

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The large number of wheelchair-bound users might have predicated a single-storey structure, but the aim of reducing the building footprint while keeping ground-floor access at each level was achieved by partially embedding multi-storey volumes in the sloping site. To maximise daylight penetration, the clinic is organised around two long narrow parallel blocks that are slid slightly away from each other. The zone of their intersection becomes the entrance hall and communal cafe, wrapped around a compact hub of vertical circulation. The regular geometry of the boxes is fractured by a large activity space contained in a box that projects out from the main volumes. Surgeries and treatment rooms (for a range of services including physical and speech therapy, psychology, audiology and dentistry) are arranged off spinal corridors, but curved walls define a children's play area and enclose the hub of vertical circulation, adding a sense of fluidity to the internal organisation. Lifts, rather than stairs, are the primary means of circulation between floors--ramps are eliminated and stairs enclosed, so there are no obvious reminders of disability. Walls are lined with sisal, a renewable material that effectively absorbs the impact of wheelchairs.

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Though the brief did not initially specify that the building should be green, a happy serendipity occurred between the architects' investigation into alternative energy use (at the time oil prices were rising unpredictably) and the client's belief in a clear correlation between environmental health and patient well-being. Energy performance is optimised through a highly insulated building envelope, orientation, solar shading (through brise soleil and reflective metal roofs), natural light and the use of a geothermal heating and cooling system. Materials were sourced for their recycled content, biodegradability and life cycle costs--all timber, for instance, was locally or regionally produced.

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The clinic has completed its first heating and cooling cycle and has exceeded predictions of energy use of 27 per cent below a standard building, with cost savings of around $20 000 per annum. Its success is reflected in LEED certification (Leadership in Energy and Environmental Design) from the US Green Building Council. LEED is a voluntary, consensus-based rating system that evaluates the environmental impact of a building in terms of its siting, energy systems, materials and design; the clinic is only the second healthcare building in the US to gain certification. Apart from the obvious environmental benefits, the essential humanity and dignity of the architecture and the way in which it connects with its surroundings have a more subtle but no less important enhancing effect on the quality of life of its medically fragile users. C.S.