Alkek Expansion Pre-Submittal Conference October 5, 2006

Team Members Jim Waters, Project Director, Shell and Core Janet Sisolak, Project Director, Interior Build-out Pam Redden, Project Director, Clinical Operations Dan Butterwick, Chief Architect Greg Hudgins, Project Manager

Project Organization

Feasibility Study Conducted from December 2005 through July 2006

Impacts Evaluated Construction Impacts Design Impacts Operational Impacts Downstream Impacts

Construction Impacts Site Logistics/Staging Construction Access Construction Supply - Bates and Bertner Crane Placement & Removal Vibration/Noise Waterproofing Infection Control - dust Safety-dropped loads

Construction Impacts Site Logistics/Staging oCreate Contractor’s Entrance to Rotunda oRemoval of Canopies oClosing West Entrance to Rotunda

Construction Access Allow for emergency exits Keep reception desk open Keep construction traffic out of the main lobby Maintain access to Physical Therapy

Construction Impacts Construction Supply - Bates and Bertner Intermittent Lane Closures along Bertner and Bates will be required

Construction Impacts Crane Placement & Removal In existing empty staff elevator shafts

Construction Impacts Site Logistics/Staging Construction Access Construction Supply - Bates and Bertner Crane Placement & Removal Vibration/Noise Waterproofing Infection Control - dust Safety-dropped loads

Design Impacts Structure – continuation of concrete frame Use of lighter weight wall panels – fiber reinforced concrete HVAC Issues Electrical Issues Plumbing Issues Wind Tunnel Study

Impacts to Number of Beds per Floor Changes to Codes and Standards Increased Room Size Increased Toilet Size – all fully accessible Operational Improvements Additional space to accommodate Murphy Beds and to allow appropriate circulation for nursing Flexible Acuity Room Design

Current 52-Bed Floorplate

Proposed Floorplate – 40 – 44 beds

Design Impacts Maximize footprint by eliminating deep recesses at windows, put square footage back into patient room Overall appearance of the tower can be preserved

Design Impacts Shift stairs and major mechanical chases closer to elevator core, creating more support space directly adjacent to nursing unit Transition can happen at Level 13, the new mechanical floor

Elevators Infill two existing shafts for staff Create 6 new passenger cabs

Design Impacts Optimal sequence for future build-out oGrowth model may drive recommendation for build out (Inpatient vs. Outpatient vs. support) oSequence should minimize disruption to occupants as shell floors are built out.

Proposed Stacking Vacant during construction Shell

Operational Impacts Closing of Rotunda drive and west entrance Visitors - Garage 2 Valet Operations Access Flooding Exposure Discharges Patient Advocacy/Visitor Center/Porcelain Bird Collection 12th Floor/protected environment rooms PT/OT – Closure of gardens used for gait training and pet therapy

Alkek Drive and West Entrance –How can the duration be mitigated? G12 must be vacated –Potential staging area for contractor, but space must be preserved Operational Impacts Key Issues

Questions?