R2-D2s of Medical Robots Are Set for Debut : New State-of-the-Art Navy Hospital in Balboa Park Billed as Largest Military Facility

Robots whir quietly along invisible tracks while their human colleagues hang pictures of daffodils and lilies, adding finishing touches to the new, high-tech, state-of-the-art Navy Hospital set to open this month in Balboa Park.

With 760 beds, a main corridor the length of three football fields and a total of 1.2 million square feet of space, it is billed as the largest military hospital in the world and one of the largest hospitals in the country.

To Rear Adm. H. James T. Sears, it’s simply “the best hospital in the world today.”

But there was a time only a few months ago when Sears, head of the Navy’s Southwest Medical Region, was more guarded in his hopes for the new facility, 18 years in the planning.

“We did not have the funds or the people to open the hospital,” Sears said. “At one point I protested and said: ‘Hey, we have to do this right. It would be a shame to open this magnificent facility without sufficient staff.’ ”

His complaints to superiors at the Pentagon fell on deaf ears for a time last year, and Sears threatened to delay the hospital’s opening.

“There was some resistance at first,” Sears said. “Then they said: ‘Hey, you’re right.’ And I got the support I needed to run the hospital.”

As services are gradually reduced at the hodgepodge of buildings that make up the old hospital in Balboa Park, the Navy is preparing to move in the first patients next Saturday. The hospital will open on time, according to officials, and was completed for $25 million less than the $293 million authorized by Congress in 1980.

“We were working from a facility that essentially was built in 1922,” Sears said, adding that the old buildings were inconvenient for patients and staff and “right in the flight path for Lindbergh Field.”

The new hospital building, however, was designed to be considerably more soundproof, Sears said, with the nursing tower that contains most of the patients’ rooms located farthest from the flight path.

As a young Navy psychiatrist in the 1970s, Sears worked on plans for the new hospital’s psychiatric unit. Now, he is responsible for the construction and operation of the entire project.

‘One-in-a-Million Opportunity’

He views his job as a “one-in-a-million opportunity,” describing the hospital’s design as “magnificent” and its equipment as “the Rolls-Royce in the field.”

The facility, which will serve a military-related population of some 400,000, will feature:

- Beds for 760 patients, nearly all in two-patient rooms, rather than the large open wards at the old hospital.

- A surface parking lot with 1,323 spaces and a three-level parking structure with 744 spaces.

- Rubberized joints connecting sections of the building as a precaution against earthquake damage.

- Outpatient clinics to handle the projected 50,000 outpatient visits each month.

- Several machines that are relatively rare and represent the newest medical technology, including a lithotriptor, which breaks up and eliminates kidney stones without surgery, and an MRI, or magnetic resonance imager, which accomplishes some functions of an X-ray machine but without using radiation.

- Eighteen operating suites with seamless walls to help keep the rooms as sterile as possible, and a 20-bed recovery room.

- A system of pneumatic tubes to transport reports, specimens and X-rays throughout the complex.

- Individual color televisions for each bed, with speakers and remote controls mounted in the side-rails of the beds.

-A decontamination station constructed outside the emergency room for treating patients who might be contaminated with radioactive or other material.

But the equipment that seems to capture the attention of wide-eyed staff members as they go through orientation sessions is the fleet of 25 robots that roam the hallways.

The shiny metal machines, about waist-high, travel on their own down back hallways and up and down in special

elevators, trans porting medicine, supplies and meals to remote reaches of the complex.

Only a Slight Nudge

Most patients will not encounter the machines--called AGVs, or automated guided vehicles--because they are programmed to follow special wires hidden under the floors of the back corridors designed for the staff.

If a distracted staff member fails to notice an advancing robot, he or she will feel only a slight nudge from a thickly padded bumper. The robot will then stop and must be restarted and sent back on its way.

If it gets lost, a homing device will tell an operator back at the warehouse just where the robot has wandered off to. But during several trial runs in recent weeks, there were few problems, Sears said.

The robots serve as an integral part of a new meal service system that remains untested at the hospital. The robots, using a device similar to a forklift, pick up large steel containers of food trays prepared at a central warehouse and deliver them to nursing stations several hours before each meal. In the case of breakfast, the trays arrive the night before.

The food is chilled, but not quite frozen, and the various compartments of each plastic tray, called “sea chests,” are brought to the proper temperature just before meal time. In theory, at least.

Skeptical of System

Sears is slightly skeptical of the system and has vowed to test the food himself before it is served to patients. A similar system was attempted at a hospital in the East, he said, with less than appetizing results.

“The patients were very unhappy with the food at the other hospital where it was tried,” he said.

“I’m told you have to use different recipes. It has to do with the starches,” Sears said. “But what I’m told is once they get the recipes right, it will be fine.”

Sears said he is not overly concerned that the hospital might be too dependent on highly automated systems.

“Everything these days is high tech,” he said, adding that if a system breaks down, “we have a manpower pool of students, or we can go to one of the local commands for help. It’s going to take us a month or so to get this all working.”

The long-range benefit of the hospital’s modernized design and automated systems will be to “dramatically” reduce medical costs, Sears said.

‘Trouble Controlling Costs’

In addition, the Navy will be able to treat a significantly higher number of patients who now must be referred to private physicians, Sears said. The Navy’s annual medical bill for those patients is $137 million in San Diego alone, he said. Up to 40% of that amount can be saved as the new hospital begins to treat them, he said.

“What we’re seeing now is terrible trouble in controlling costs,” Sears said. “What we’d like to do is set up a system of high-quality, low-cost medical care as a sort of a national example.”

Some of the anticipated savings will come from simple design decisions that not only make the hospital more efficient, but also make the structures more pleasing to patients.

“Where we really take a big stride forward is just the design of the hospital,” Sears said. The hospital was designed by Navy personnel working along with three architectural firms. “The plans were looked at very closely from the patient’s perspective,” Sears said.

Most patient rooms are located along airy, triangular courtyards with views of trees and plants. The design makes the maximum use of natural light inside and also provides outside walkways to reduce indoor traffic and cut down on noise and cleaning costs. Inside, pastel-colored walls, high ceilings and large photographs of flowers provide a peaceful atmosphere.

Arranged in Triangles

The patient rooms are arranged in triangles, with nursing stations at the center of each triangle, providing the staff with a direct view into nearly all the rooms.

Also, the clinic areas are laid out so that outpatients who have the hardest time getting around, such as pregnant women and orthopedic patients, will have the shortest distance to walk.

Other design elements, such as making the maximum use of natural light, are pleasing to the patients and cost-effective, Sears said.

Windows are treated to allow light in on sides of the building that tend to be cool and to reflect light on sides that tend to be warm, he said.

A sophisticated “climate control system” is run by a small weather station on the roof. The station gauges wind speed, humidity and temperature, with readings fed into a computer for analysis.

If it is cool outside and too warm inside, fresh air will automatically be pumped in. Also, a power plant kicks in at peak times so that the hospital can avoid the high peak usage rates charged by utilities.

Earth Tones Don’t Clash

The building--constructed of steel, concrete, stucco and glass--has an exterior of natural and earth tones worked out in conjunction with the city, so as not to clash with the surrounding park areas.

This kind of consideration followed more than a decade of acrimony between the Navy and various local officials and groups that objected to the use of the Florida canyon site, considered to be one of the prime natural open spaces in the urban area.

So strong was the opposition that in 1979, during a mayoral election, the city’s voters were asked whether Florida Canyon should be leased to the Navy for the new hospital. More than 60% of the voters were against the plan.

Years of political and legal fighting followed, but the Navy persisted and a land swap was worked out giving the city the old hospital site in exchange for the new.

“We like to think the city is getting 35 of the most beautiful acres in the city,” Sears said. Over the next year, Navy officials will consider the establishment of a burn unit, one of the few services the hospital does not offer, Sears said.

Also in the future is a plan to become part of the San Diego area’s trauma system, which would make the hospital’s extensive emergency services available to civilians.