McCarthy Building Companies of Phoenix took an unusual approach - do whatever it takes to make it happen - to completing a complex $115 million Yuma Regional Medical Center renovation and emergency department expansion on time and within budget. 

"This was probably the most challenging hospital expansion project in the state at the time, and maybe ever," says David Clarkson, Project Director for McCarthy.

Operating one of the busiest emergency departments in Arizona, Yuma Regional needed more space to care for with greater privacy the 90,000 people who passed through the department annually, and plan ahead for future growth.  

"Our board spent a long time, more than a year, evaluating," says Machele Headington, Vice President of Support Services at Yuma Regional. "We wanted something that would accommodate the volume long term."

Before work on the ED could commence in May 2013, McCarthy had to surgically demolish the original Park View Hospital and several other structures. Construction began before the drawings were complete. McCarthy started on the early phases and completed interior remodels, and built utility bridges, and added a parking garage and a new campus loop road.

The original hospital had been built in the 1950s and then added on to as many as 40 times in different directions and areas, creating a scramble of utilities. Everything ran through that original facility. The old hospital was attached to three surrounding buildings holding some of the most critical areas of the hospital: the neonatal intensive care unit, laboratory, and the operating rooms.

"Anything from noise to vibration or disruption was significant and important to this client," Clarkson says. "It took a huge collaborative effort from everyone from day one."

Building a Team

McCarthy knew going into the project that it would require significant effort to ensure construction did not interfere with hospital operations. The construction firm co-located its preconstruction director in the same office with the architect ARCHSOL of Scottsdale, Arizona, for the entire yearlong design period. 

"We worked hand in hand with the architects," Clarkson says. "Everything they were designing, we were vetting from a cost and constructability standpoint."

As work began on site, Clarkson and a team of McCarthy workers from Phoenix relocated their families to Yuma, about three hours away. Those staff members socialized together.

"We bonded; all we knew was each other," Clarkson says. "We knew we were stuck together on this sand island. We worked hard together and played hard together."

McCarthy also hired as many local workers as possible. Rock Jensen, Administrative Director of Support Services at Yuma Regional, reports that the community got behind the project and was interested in its progress. 

"The success of this complex project was a collective effort," Headington says. "Staff, contractors, the city of Yuma and our community - all came together to ensure that the needs of patients remained paramount.  It could not have been done without those entities working well together. Everyone came with an open mind and a commitment to helping." 

Tapping High-Tech Resources 

One of the reasons Yuma Regional selected McCarthy was its reputation for using high-tech resources to improve outcomes. One of the first things McCarthy did was a 3-D laser scan of the existing structures, both the inside and outside. The scan helped them identify existing utilities, plumbing and electrical.

"It was absolutely worth the investment," Clarkson says.

The scan was incorporated into a building information modeling program, shared with the plumbing, mechanical and electrical contractors, which worked on the model to design their mechanical, piping and wiring systems and prefabricate those components to fit in ceiling spaces.

"Every pipe and piece of ductwork got prefabricated and shipped to the site, where they made the connection," Clarkson says. "It's the most efficient way to do it."

Headington reports she thought the technology was helpful, but it came in second to the commitment of the people involved in the project.

"The bricks and mortar is impressive but none of that is possible without the people who put their heart into doing it and doing it well," Headington says. "It all came down to connections of people focused on the right things."

Keeping Operations Functioning

With the next closest hospital three hours away, patients could not be transferred to another acute-care facility. Construction had to take place while hospital operations continued. Headington, who has worked at Yuma Regional for 27 years, thought this construction project was the least painful of any that had taken place.

"A lot of moves took place to make sure it was not disruptive," Jensen says. "Everything was coordinated, so there was no loss of operation."

Keeping the hospital operational included maintaining air conditioning while upgrading the central plant with two new air handlers with built-in fan redundancy and replacing the oxygen farm, a 50-foot tank that holds liquid oxygen to supply patient rooms. That required installing a new pad to hold the tank and all of the underground piping. Once complete, McCarthy brought in an oxygen tanker to temporarily supply the hospital with oxygen while crews moved the tank and completed the hook ups for the new oxygen farm.

"The hospital never lost service while moving that oxygen farm," Clarkson says.

Since the original hospital was at the center of everything, demolishing it created challenges for hospital staff moving patients within the facility. McCarthy kept pathways open, often building small portions of the new project, so transports could take place. The company tried to avoid temporary walkways to avoid unnecessary expenses.

"We would finish one little corner of the building with a corridor, so we could demo out another portion," Clarkson says.

McCarthy used multiple techniques to muffle sound and reduce vibrations. First, the team looked for the quietest means to the end. For instance, rather than driving piles, the McCarthy drilled piles and backfilled with concrete slurry.

"We used every method that was a quiet non-vibration method, whether it was more expensive or not, patient care came first," Clarkson recalls. "It was a day by day, minute by minute approach with the client."

McCarthy kept the client informed when any work that could create noise was scheduled. The team planned the work during less disruptive times. In some cases, McCarthy postponed and resequenced work by a month or more, until a premature baby was discharged from the NICU. The company also monitored sound and vibration. If the hospital called to complain about noise or vibration, McCarthy stopped work in that area and re-evaluated how to get the work done.

"Sometimes, it delayed progress to do that, but we had to," Clarkson says.

The new 71,118 -square-foot Emergency Department expansion, which increased bed capacity from 37 to 72, was built in the footprint of the old Park View Hospital. The structural steel building is supported by drilled caissons and has two below-grade cast-in-place concrete levels. Part way through the project, Yuma Regional decided to add two shell-floors, totaling 100,000 square feet, above the Department for future beds.

McCarthy finished construction in November 2016, beating the original goal of end of 2016. The team remains on site, completing some additional work.  

"It was an amazing project," Clarkson concludes. "We had a great team of expert individuals who got along, worked hard together and did whatever it took to work out solutions."