Kallmann & McKinnell

Behemoths of North Brooklyn I: Woodhull Hospital

"The Woodhull Medical and Mental Health Center in North Brooklyn is a rust-colored machine of steel and glass that rises out of the urban jumble of Flushing Avenue with immense self-assurance and power.

While it opened just yesterday, it is a monument to a different time - it recalls the days when the stark and often harsh lines of modernist architecture seemed to hold a promise of urban salvation.

Woodhull was designed in the late 1960's by the architectural firm of Kallmann & McKinnell and finished in 1978; it was to be New York City's great leap into modern hospital design.

Great leaps are often expensive, and the political controversy over the cost of operating Woodhull - which was designed to have 60 percent of its patient rooms as private rooms - was so substantial that the hospital sat, structurally complete but empty and unused, from 1978 until this year." [1]

"Woodhull is like no other hospital in New York City, and like few in the United States. It is not only its enormous size - the building is so long that inside corridors stretch to nearly 700 feet - but also every fact of its interior layout that indicated a desire to rethink the ways in which hospitals should be designed.

It is a rethinking that seems now, in the light of the years since Woodhull was first conceived, to be in some ways dated, and in other ways remarkably advanced.

For whatever its faults - and they are many - this building is one of the monuments of modern architecture in New York City. It was designed with genuine concern for both its occupants and staff, and its failures seem very much the failures of the years from which Woodhull's basic design came.

The first of these failures, surely, is size. Woodhull contains more than 600 patient beds, and it is far and away the largest building in its neighborhood; its 10 stories tower over everything around it, and can be seen from blocks around. When such vast size is combined with such commitment to the modernist architectural vocabulary, the result is a building that looks something like a cross between a 1920's factory and the Centre Pompidou in Paris, rendered in rust-colored Cor-ten steel.

Whether this is the right image for a health-care facility is not the sort of question that was raised very often in the late 1960's, but it is one that it is impossible not to raise now. The trend in hospital design has moved toward smaller, more intimate facilities, toward the sort of buildings that can be understood easily by the people who will use them.

Woodhull is so enormous that even the clearest layout causes some confusion, not to mention a tendency toward signs like 'To Concourse C,' which give the visitor the feeling that he is in an airport, not a place intended to heal the sick." [1]

"These problems are more than incidental, since the physical image a health-care facility projects can play a real role in the success with which it is able to serve a community. Woodhull looks every inch an institution, at least as much as any old hospital facility in this city does. And if size is part of this, the austere modernism of its design contributes to it further.

Today, as the trend in architecture has moved toward more familiar, warmer buildings that rely, at least in part, on more traditional architectural elements, we would be less likely to see Woodhull's determined modernism as the ideal style for the image a health-care institution should project.

But all of that said, this is still a strong and in some ways deeply impressive design, both in terms of the image it projects and in the way it will actually function.

So far as image is concerned, the positive aspect is a simple one to understand - most of this city's hospitals, both public and private, are so old and physically decrepit that there is a real appeal to anything that is new, light and clean. Even if Woodhull does not strike the kind of note we would consider ideal for a hospital today, no one could possibly consider it anything but an improvement over the kind of hospital building most New Yorkers are used to.

Indeed, it is an improvement even over several new hospital structures, such as the Annenberg Building at Mount Sinai Hospital, another monolith of rust-colored steel.

Where Annenberg is an actively hostile presence on the cityscape - with a confusing warren of unpleasant spaces inside - Woodhull is at least visually appealing. And it has numerous interior features that represent real advances in hospital design, at least for New York City." [1]

"The public spaces on the average are brighter and more welcoming than those of virtually any other New York hospital. But the most important feature of the interior is the use of a triple corridor system on the patient floors - one corridor in the middle for staff, deliveries and the movement of patients, and corridors along each wall for visitors.

The peripheral corridors are window-lined, and the patient rooms have a door at each end to provide access to one of these corridors as well as the central corridor. The rooms have windows on the visitor corridor to permit natural light.

It is a system used originally in the Kaiser Medical Center in Oakland, Calif., but never in New York until Woodhull, and it has both clear advantages and disadvantages. By creating what is in effect a ''backstage,'' efficiency can presumably increase, and visitors are spared awkward confrontations with patients on stretchers.

On the other hand, since the only windows patients have are on the windowed corridors, patients desiring privacy can only get it by closing the curtains on the corridor, thus cutting off all their natural light.

Though Woodhull's high ratio of private rooms seems luxurious, it emerged from the belief, which underlay most of the design decisions in the entire building, that a higher initial cost would be repaid by decreased operating costs - a view that seems contradicted by the city's assumption that operating costs would be high, which led to the long delay in the hospital's opening." [1]

"So far as the private rooms are concerned, the hospital's planners have argued that private rooms yield economy by permitting a more flexible distribution of patients, since beds do not have to go empty if there are no male patients to match with other males, or females to match with other females, in shared rooms.

In any event, there is certainly no sense of extravagance to these private rooms - they are very small, more like large cubicles than real rooms. While they are handsome and efficiently laid out, there is one crucial flaw - in many of the rooms, the bed is positioned in such a way as to make it impossible for the patient lying in bed to look out the window.

On balance, however, Woodhull is a kind of achievement - certainly a determined attempt to respond seriously to the weaknesses of New York's older hospital buildings. There is even a kind of nobility to this structure, commanding North Brooklyn as it seems to do. If machines for healing were what hospitals were supposed to look like, Woodhull would be ideal." [1]

"A space odyssey that landed at this juncture of Williamsburg, Bedford-Stuyvesant, and Bushwick, this machine for health was the most technologically and architecturally up-to-date, and the most expensive, hospital of its time. The self-weathering steel has acquired a deep purple-brown patina on this bold, cubistic place. Great human-high trusses span 69 feet, within which workers can adjust the complex piping and tubing that serve the rooms and laboratories above and below these interleaved service levels. Kallman & McKinnell's first and major monument was the competition-winning Boston City Hall. With this machine for medicine they have created a superbuilding, a somewhat scary ode to health, dedicated more to the efficiency of health economics than to the serenity of its clients. Widely reviewed in architectural literature, it has won many prizes." [2]

"Woodhull Hospital, designed as one of the world's most innovative and visually striking hospitals and completed three years ago, is now unlikely to open before 1983, according to New York City officials. That would be nearly a decade after it was originally scheduled to open as a municipal hospital in Brooklyn.

City and state officials attribute the long delays to a series of labor strikes and endless design changes during construction and to the city's reluctance afterward to open a hospital it says will be a financial burden to operate.

Since Woodhull was completed in 1978, it has loomed forbidding and silent over the scarred landscape of the Williamsburg and Bedford-Stuyvesant sections. The 610-bed hospital, a huge steel and glass structure that overwhelms the surrounding neighborhood, cost the city more than $200 million to build - more than twice the projected cost - and many items, expected to add millions more, are still to be counted. In addition, the city has spent nearly $70 million in interest payments on bonds that financed the project and on security and mothballing expenses.

In return, the city has so far received only small fees for allowing the modern interior of the 10-story hospital to be used as a set for films, such as All That Jazz." [3]

"Opening Woodhull, at the intersection of Broadway and Flushing Avenue, will create immense staff-recruitment problems and involve expensive new renovations, which city officials say preclude putting the hospital into operation before 1983.

'But what it really comes down to is the city has got to bite the bullet on Woodhull,' said Joseph T. Lynaugh, a former Health and Hospitals Corporation president.

Stanley Brezenoff, the new president of the city agency, likens the opening to the launching of an assault. 'We are considering a beachhead strategy,' Mr. Brezenoff said in an interview. The initial objective, he said, will be to gain a foothold on the hospital's first floor in the outpatient clinics and then to occupy it floor by floor.

So many problems remain that the Health and Hospitals Corporation has taken the unusual step of asking a private health-care management company to open Woodhull. Officials assert, however, that the city itself intends to operate the facility.

These officials acknowledge that opening Woodhull, which will replace the obsolete and rundown Greenpoint and Cumberland Hospitals in northern Brooklyn, will cost far more than keeping it closed. The hospital's projected Medicaid and Medicare reimbursement rates, while high, are not expected to come close to offsetting operating costs. That will force the city to make up the difference with its tax levy funds, the officials say.

They say the Koch administration is committed to opening Woodhull, however, because leaving it shut would be a source of embarrassment as well as a waste of money.

When the hospital opens, it will operate with a state-set Medicaid reimbursement rate of more than $400 a day per patient. That would make Woodhull one of the nation's most expensive hospitals, though it is a community hospital and not designed to provide the sophisticated care available at major teaching hospitals in the city and at some of the big municipal hospitals, such as Bellevue.

The officials say that the further delays are likely to intensify the controversy that has surrounded Woodhull since it was planned 14 years ago by Mayor John V. Lindsay's administration as the first municipal hospital in the country to provide private rooms for most of its patients." [3]

"The two mayors since Mr. Lindsay have said that they were saddled with a costly new hospital that they neither created nor wanted. For Abraham D. Beame, the decision was easy. Amid the city's fiscal crisis in 1975, he let the construction of Woodhull lag because, as one of his aides noted at the time, 'Who would expect the city to rush opening an expensive new hospital at a time when it was going broke?'

That meant the decision to open Woodhull was left to Mayor Koch, who regards the hospital as a financial disaster. He has also complained about its workmanship, contending, for instance, that the roof leaked. Mr. Koch has considered giving Woodhull away and has tried to persuade the Federal Government to take it over as a prison.

There was no institution either rich enough or willing to take over Woodhull, however, and Federal prison officials said that the building would have posed a serious security problem.

As the Mayor begins his re-election campaign, Woodhull's continued mothballing threatens to create political problems for him. The poor black and Hispanic neighborhoods that surround Woodhull have waited with increasing impatience for it to come alive and provide them with thousands of jobs as well as health care.

Woodhull has generated considerable debate about its construction and design. City officials say that cost overruns were caused by construction delays, shoddy workmanship, strikes and what they say was confusion created by the Health and Hospitals Corporation's changing orders.

Mr. Lynaugh, the agency's former president, describes the hospital's construction as a 'classic mismanagement problem from the past.'

Woodhull is a prototype of several innovative construction and design concepts that were meant to hold down building costs and give the hospital maximum flexibility and income. All the ideas were strongly recommended by a 1972 Congressional study.

One of these innovations was the so-called 'fast track' building method. To escape the soaring construction costs of the early 1970's, it was decided to build Woodhull without having a completed design - and the hospital was built piece by piece. It was expected that the cost of correcting any mistakes that might result would still be lower than the added price inflation would bring if construction was delayed.

What went wrong was that construction was halted by an unusual number of strikes. Moreover, city officials said that 40 separate construction contracts led to mistakes that were extremely costly and time consuming to rectify, nullifying some of the 'fast track' advantages.

The State Facilities Development Corporation, the agency that was in charge of building Woodhull for the city, blames the Health and Hospitals Corporation for many of Woodhull's problems. It said the main reason the ''fast-track'' building method did not pay off was that the agency had requested an endless series of construction revisions at a time when the city agency was undergoing management upheavals." [3]

"One of the new design ideas at Woodhull was the construction of work spaces between floors, known as interstitial space. The spaces, large enough for a man to walk through, were designed to allow renovations without expensive reconstruction or disruption of services. However, engineers say the ceilings are so thin that something heavy dropped from the space above could break through.

Perhaps what has generated the most controversy is the fact that most of the facility's rooms will be private. Before Woodhull, every municipal hospital, including the newly constructed North Central Bronx and Lincoln Hospitals, had large semiprivate rooms. However, some hospital economists argued in the late 1960's that private rooms would raise a hospital's occupancy rate by at least 10 percent, which would give the city more reimbursement income than it would receive for half-empty wards.

Federal officials also argued at the time that private rooms would help decrease the cost of patient care. They said that private rooms would eliminate the need to separate patients because of sex, illness or incompatibility. Because all of Woodhull's beds can be used without concern for those factors, it means that the city escaped the cost of having to build a 700-bed hospital to get the same result.

Officials in the city's Human Resources Administration also contended that poor people had a right to the privacy and dignity accorded wealthier patients. But they said it was the economic advantages of private rooms, and not humanitarian considerations, that persuaded the State Department of Health to approve the plan.

Woodhull's construction also involved expensive innovations that were calculated to save operating costs decades later. The concept is called 'life-cycle cost analysis' - jargon for saying that Woodhull was built like a two-pants suit. For example, the hospital's elevator columns extend two floors above the building so that the shafts will be in place if the city decided to add two floors.

Even now, municipal hospital officials are considering more changes. The most radical, and one that would reverse one of Woodhull's major concepts, would be the closing of its outer visitor corridors.

Woodhull was patterned after the Kaiser Foundation Hospital in Redwood City, Calif., an eight-story building with three long corridors. The central corridor is for the medical and support staff, while the outer corridors are for visitors.

At Woodhull, the three corridors run 700 feet, longer than two football fields. The outer corridors give visitors direct access to patient's rooms without their getting in the way of the staff. On the inner corridor, patient care is concentrated around nursing units so that nurses, physicians and patients do not have to walk from one end to the other.

Now, however, officials of the hospitals corporation say they are considering closing the two visitor corridors because making them secure might be too costly. Closing the two corridors would require visitors to walk through the central corridor, thus rejecting one of the hospital's central design concepts.

Many of the misgivings about Woodhull center on whether the city can recruit enough nurses and then pay them to staff its private rooms.

Frances Fesko, the associate director of nursing at Bellevue, was a key city consultant when Woodhull was being planned. She said in an interview that she had expressed concern that the city faced the prospect of a severe nursing shortage.

'But we were told that we suffered from a city hospital mentality and the hospital was built as if these problems did not exist,' she said.

According to Mrs. Fesko, municipal hospital patients should receive an average of 3.8 nursing hours a day, a figure, she said, that is hardly ever realized now given the city's worsening shortage of nurses. She said Woodhull would need 4.2 hours, or roughly 10 percent more a patient. 'How in the world can we care for patients in private rooms when we do not have enough nurses?' she asked.

Other critics question the building of Woodhull's 400-seat auditorium, with a soaring cathedral ceiling and expensive appointments - in a hospital that is not designed to provide advanced medical training.

There also are questions about the extensive enclosed parking spaces that cost $6 million at a municipal hospital that will care for poor patients, most of whom do not presumably have families with automobiles.

City hospital officials have also concluded that Woodhull's emergency room is too small and cannot accommodate the expected crush of patients. There are plans to renovate the room before the hospital opens.

The hospital's psychiatric wing on the fifth floor was built without anticipating the security requirements for disturbed patients. So it, too, must be redone." [3]

"Nonetheless, Woodhull has strong advocates. Allan W. Pearson, the Health and Hospitals Corporation's chief engineer at Woodhull, says Woodhull is an 'outstanding' hospital. He said the building's computerized energy system would be 25 percent cheaper to run than conventional ones. 'There is a problem with the roof,' he acknowledged. 'But it doesn't leak, at least not yet.'

Lloyd Siegel, an architect and hospital planner who played a major role in designing Woodhull, said he still regarded the hospital as 'astounding.' Mr. Siegel, in an interview from his office in Chicago, where he is in private practice, said that one of the major economic problems of building hospitals in a conventional way was that they lost 10 percent of their value each year 'because of their incredibly expensive obsolescence.'

Mr. Siegel, who is a former deputy administrator in the city's Human Resources Administration, said that Woodhull would provide better care at a lower cost because it was designed to be renovated at minimum expense and disruption.

'I feel we are even more correct about Woodhull today than we were 14 years ago,' he said. As city officials wrestle with the problem of opening a hospital they do not want, David Corkette, an elevator maintainence worker hired by the corporation, spends his days running Woodhull's 13 empty elevators. He does this to 'exercise' the wire cables so that they will not develop humps from hanging motionless on the drive wheels.

And nearby, at the New Canaan Baptist Church at 519 Marcy Street, the Brooklyn Interfaith Coalition has conducted prayer meetings in the hope that their voices can bring down the tall chain-link fence that surrounds Woodhull." [3]