Design Flaws at Hospital Get Surgery

Hospital architecture is typically as bleak as a case of the flu, but UC San Diego’s $32-million addition to the UCSD Medical Center in Hillcrest helps cure some of its planning and design diseases.

Scheduled to open this summer, the 78,000-square-foot addition being built south of the existing hospital will provide a dramatic, more sensibly located new main entrance and a striking 11-story elevator tower that will give the complex a statelier identity.

The expansion will help tie this “campus” together with a more organized and contemporary look, but the design doesn’t push hard enough to break from the conservative envelope that has restricted hospital design for years. Colors are bland, some of the forms are institutional and boxy--standard hospital issue.

Unfortunately, not even this competent addition can entirely cover up the many planning and design flaws that have accumulated on this 43-acre site. The land--bounded by Dove Canyon on the west, Dickinson Street on the north, Front Street on the east and Arbor Street on the south--was first occupied by a county hospital in the late 1800s.

Architects Kaplan McLaughlin Diaz of San Francisco--who handled the addition’s design (Neptune Thomas Davis Architects of San Diego produced working drawings and are managing construction)--have grafted the new elevator tower to the old hospital with an 11-story connecting wing that houses offices, visitor circulation corridors and conference rooms.

The top of the stucco-and-glass tower was redesigned several times before achieving its current graceful resolution. White aluminum grillwork provides subtle decoration beneath a pair of straightforward “finials”--tall, narrow fins that project above the top floor.

As part of the expansion, the original hospital building received seismic safety upgrades. The most visible of these is a series of two-story steel cross braces that give the building a whole new look.

The new 11-story wing that connects the elevator to the old hospital is covered with two-story, glass squares proportioned to match the two-story pattern established by the reinforcing X’s on the original hospital.

Another portion of the expansion will house such outpatient services as surgery, hemo-dialysis (for kidney patients), bronchial examinations and heart and lung care. Patient rooms within the original hospital will be reconfigured with fewer than their present four beds, offering roomier accommodations more in keeping with today’s standards.

Visitors to the revamped medical center will notice, first of all, a much-improved entrance, relocated from the northern side of the original hospital building to the southern side of the addition. A long, free-standing pink granite wall consisting of a horizontal beam atop several square columns will invite visitors into a new three-story lobby rotunda.

The rotunda is sheathed in glass, shaded on the outside by a series of perforated aluminum sun screens. It ties together a new, three-story wing to the west with an existing three-story wing to the east. While the rotunda looks light, graceful and imaginative, the wings on each side epitomize the cold, brutal norm of hospital design, with their barren expanses of stucco and glass.

Kaplan McLaughlin Diaz, who also designed the Price Center (1990) and the International Relations and Pacific Studies (1989) building on the UC San Diego campus, clearly have Modernist leanings. The new addition has an honesty typical of the best Modern buildings.

The new exposed steel bracing on the original hospital serves a vital, structural purpose, but also a decorative one, adding to the building’s aesthetic impact. The addition’s tallest element--the 144-foot elevator tower--aptly symbolizes its essential public function of channeling visitors up through the building.

In the face of seemingly insurmountable odds, the architects have produced a workable, sometimes inspiring, design.

As part of a statewide expansion program during the early 1980s, the University of California system acquired county hospitals in San Diego, Davis and Irvine to be upgraded into more sophisticated university medical centers.

Hillcrest’s 465-bed, 11-story main hospital--designed by Paderewski Mitchell Dean Architects of San Diego and opened in 1961--is a boxy, undistinguished structure with an entrance that originally faced north, away from all major streets leading onto the property.

In 1989, the university opened a pair of buildings that make the original hospital look stunning by comparison.

One of these is the Ambulatory Care building (designed by SGPA Architecture & Planning of San Diego) on Front Street. For patients barely clinging to hope, this impersonal tan stucco-and-dark-glass box is reason enough to let go.

The second of this 1989 pair, the “multipurpose building” on Dickinson Street, to the northwest of the old hospital, is a similarly foreboding box of off-white panels and dark glass.

The main parking structure, at the southwestern corner of the site, makes for a long hike to some buildings.

And though parking seems tight, hospital administrators say the addition will not generate much new traffic, and there are no significant plans for new parking. Also, when the new $40-million, 120-bed John M. and Sally B. Thornton Hospital opens on the university’s La Jolla campus in 1993, it will take over some of Hillcrest’s patient load.

Also, the Hillcrest medical center has no unifying logic to its layout of buildings, some of which adhere to a 1978 master plan prepared by San Diego architects Tucker Sadler & Associates. (It was their excellent idea to move the main entrance to the southern side of the hospital).

There are no inviting public spaces, such as landscape walks and plazas, which could tie these disparate buildings together, and none of the key streets are played up as inviting public thoroughfares that might make stronger ties to the surrounding residential neighborhood.

But the hospital does have some worthwhile history. A simple, 1920s-era stucco house on Dickinson Street is reminiscent of houses designed by the late great San Diego architect Irving Gill. It adds a fleeting patch of period charm, as does the nearby circa-1916 North Annex building, designed in a similar style.

The challenge for the future, then, is to retain the best smaller buildings on the site, and to tie both small and large buildings together with an orderly and inviting auto and pedestrian circulation scheme.

With the new addition approaching completion, UCSD has commissioned a new master plan for its Hillcrest hospital site, to be prepared by Anshen + Allen of San Francisco. Among the goals of the plan, which probably won’t be finalized until next year, is to enhance Arbor Drive in front of the new addition to give the complex a prominent entry street and to add friendly public spaces, such as plazas or courtyards.

Hospital and university administrators plan to add buildings to the Hillcrest campus. They should loosen up a little and let smaller, more innovative architectural firms do some of the the designing.

Already, there has been encouraging movement in this direction. RNP Architecture and Planning, a rising young San Diego firm, has designed a new outdoor cafeteria that may be built.

And before the new addition, the medical center had commissioned San Diego architect and artist Tom Grondona to design an installation for the hospital’s cafeteria. This whimsical, temporary scheme would have included an “artifact aquarium” filled with odd scraps of debris from the addition’s construction. Hospital higher-ups decided not to proceed. They felt the installation would only appeal to a small group of hospital visitors and employees.

So Grondona’s project was scrapped, but maybe architects such as Grondona, who designed the wild and wonderful Claudia’s cinnamon-bun shop at Horton Plaza shopping mall downtown, will get a chance later on to bring new color, life and humor to the UCSD Medical Center.