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Sustainable Engineering Within a Historically Sensitive Urban Context

Sarah Markovitz, AIA, NBBJ
Greg Soyka, LS3P Associates, Ltd.

The Medical University of South Carolina's Center for Advance Medicine is a 525,000-sqaure-foot hospital that houses inpatient beds, a heart and vascular center, and a digestive disease center.

The primary challenge in carrying out this project was how to integrate a large, technologically complex building within a historically sensitive urban context. Integrating mechanical and electrical systems into the context-sensitive architectural expression is a significant project success.

The main strategy to meld building and context was to reduce the apparent size by grouping similar functions into articulated masses. The patient tower houses the beds. A diagnostic and treatment (D&T) building houses procedure spaces. The tower and D&T building are linked by a multi-story conservatory that ties the interior to a large landscaped entry courtyard.

The tower and D&T building have their own roof-level mechanical space and though there are system interconnections, the equipment within each space is tailored to the individualized needs of the clinical program. Mechanical and electrical risers are integrated with public and service circulations systems, thereby creating large open floor plates that provide future flexibility for the ever-evolving clinical program.

Mechanical and electrical systems were further customized to meet the unique blend of Charleston’s technical challenges. Unstable soils made basements economically unfeasible, which put additional stress on floor plates already constrained by zoning laws. Seismic codes required a 20,000-gallon water storage tank that will supply fire-standpipes if public water supplies are disrupted. All equipment and piping systems are braced to limit displacement.

The need to provide the highest possible indoor air quality required an in-depth analysis so that supply louvers and exhaust systems could be properly located. Specialty consulting engineers are considered neighborhood sources of contaminants including boiler, generator, and laboratory exhaust. The modeling studies showed that intake louvers for the Tower would best be located on the north façade while the D&T louvers would be best located on the west façade.

Yet another challenge was energy efficiency in a hot, humid, marine environment. Recirculating air return systems were selected to minimize the need to continually dry-out and cool outdoor air. An economizer system has been provided to take advantage of the many temperature and humidity perfect weather days that Charleston experiences during late fall, winter, and early spring.


Sarah Markovitz is a senior medical planner in the NBBJ New York studio. She has 20 years of experience in the design and planning of complex healthcare environments. The current focus of her work is in improving healing and operational efficiency for her hospital clients.

Ms. Markovitz is a strong leader in evidence-based design and adds value to her projects, as well as to NBBJ's overall healthcare practice, through her diligent research and application of healthcare design performance measures. In project work, she embraces the concerns of staff, advocates for patients and families, and collaborates with clinical design consultants to reach the most effective solutions.

Greg Soyka, AIA, joined LS3P Associates, Ltd. and the Healthcare and Technology Group in 1999. With over 20 years of experience in architectural design, he has been the prime mover behind a number of clinical and research facility projects for MUSC and its Hospital Authority. Before moving to Charleston, Mr. Soyka worked in Chicago for 15 years. Projects at laboratory and animal facilities at Washington University in St. Louis and Northwestern University prepared him for the innovative assignments he tackles as a member of LS3P’s Healthcare and Technology Group.

More recently, Mr. Soyka has had extensive experience with biomedical research facilities including MUSC's Children’s Research Institute, MUSC’s Basic Science Building Cage Wash Renovation, and more recently, the Medical University Hospital Authority’s 650,000-square-foot Phase I Replacement Hospital with a remote, free-standing, 70,000-square-foot central energy plant, as well as MUSC's new 118,000-square-foot College of Dental Medicine.

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