"You open it, you own it" is a principle well-known to contractors who do hospital renovations. From the moment that you cautiously pop open that first ceiling tile and spray water onto any mold particles lurking there, you become the owner of whatever you find up there during your renovation and you just can't walk away from a problem in a hospital on the grounds that you didn't cause it. You have to fix it.

So, here is my personal checklist of the "unknown" things I typically find in existing ceilings that I know darn well I will have to fix as part of my project: 

• Breaches in the fire compartment walls
• Fire stopping around items penetrating the fire walls
• Nonfunctional dampers
• Noncompliant electrical work
• Burned-out lamps in light fixtures
• Expired batteries in devices
• Stuck plumbing valves
• Misidentified fire detection devices (not in service with the system or not working)
• Improper supports for piping and ductwork
• Removal of abandoned cable (seriously folks, there is a global resource of copper lying in existing hospital ceilings in the form of abandoned cabling!)
• Improper supports for ceilings themselves
• Caulking
• Water infiltration damage including mold
• Pest control measures. This item does not refer to any members of the hospital staff, but rather to the crawling bugs, flying insects, stray birds, mice, rats, bats, cats, squirrels, and raccoons that I have encountered in ceilings at some of our older building sites.

I think it’s better to do some early recon, find these things, and tackle them early rather than waiting for a building inspector to bring them up at the 11th hour. At least we can finish with the satisfaction of knowing we left things better than we found them!