Client: Eisenhower Medical Center
Architect: Boulder Associates, Inc. (Curtis Chong, James Lenhart, Juan Ramos, Jessica Claflin, Darci Hernandez)
Interior Architecture: Jain Malkin Inc. (Denise Burkett, Jain Malkin, Jamie van Meurs, Casscia Murray, Kelly Kreuzinger, Christie Mayer)
Lighting Design: Jain Malkin Inc.
Landscape Architect: RGA Landscape Architects, Inc.
MEP Engineering: JBA Consulting Engineers, Inc.
Construction: WDL Construction
Photography: Ed LaCasse Photography
Total Building Area (sq. ft.): 96,000
Cost/Sq. Ft.: $560
Total Project Cost: $54 million
Since the heyday of Frank Lloyd Wright, architects have received kudos for blending their creations with their natural surroundings. Wright's Prairie Style was all about designing structures that seemed to emerge organically from their environment. And, in that sense, Wright has been done proud by the Eisenhower George and Julia Argyros Health Center.
The ambulatory care center recently opened by the Eisenhower Medical Center in La Quinta, California, evokes the surrounding desert and mountain ranges-both outside and inside. The intent was to give Coachella Valley residents living 20 miles east of Palm Springs a primary care clinic where they would feel at home and comfortable within the surroundings of their hauntingly beautiful neighborhood. Recently HEALTHCARE DESIGN Contributing Editor Richard L. Peck asked key participants in the Argyros Center design process-Ali Tourkaman, vice president for support and construction services at Eisenhower; Juan Ramos, project manager with Boulder Associates; and Denise Burkett, project manager and team design leader with Jain Malkin Inc. (Interior Architecture), to discuss the concepts and collaboration behind a facility offering comprehensive primary care services to this fast-growing community.
Juan Ramos: The building is on a plateau next to a dry channel, and you can see the great range of mountains to the south. Because the facility is in a desert setting, the entry is modeled after Bedouin tents. These tensile structures, made of a PTFE fabric membrane, seemed to make sense for the setting. The fabric was stretched over tensile steel frames, which required quite a bit in the way of structural support columns that were angled and cantilevered, with 11 design iterations in all. The structure also employs a water diversion system to deal with desert downpours-rain is infrequent but heavy when it does rain-with diverters rather than gutters and custom scuppers and downspouts.
Ali Tourkaman: The idea of a desert concept for the design was ours but also based on feedback from the city of La Quinta. We wanted a building that respected its surroundings and fit in with the community and neighborhood. We wanted in no way to cheapen the building by taking out features that helped it to blend in with the environment. For example, this could easily have been a stucco structure, but we didn't want to take out the terra cotta tiles.
Ramos: The terra cotta tiles enabled us to provide a rain screen system suspended on a series of vertical and horizontal rails and slats outboard of the building, with an insulated membrane behind the exterior skin. This provided a much better R-value for insulation and a great aesthetic, with the sandy-colored, textured tiles fitting in with the desert surroundings. We also did very careful sunshade analysis to see which rooms would be getting the most light during the day and to reduce their solar heat gain, while still using enough glass to take advantage of the views to the mountains. We used three sunshade techniques: vertical louvers; passive fabric shades mounted on outriggers; and metal eyebrows, especially on the north side, which had lots of indirect lighting and offered great views of the valley and mountains.
Denise Burkett: The three stones in the fountain were conceived by Rob Parker, the landscape architect, and represent the San Bernardino, San Jacinto, and Santa Rosa mountain ranges, which shelter the Coachella Valley and contribute to its desert climate. The water is significant in the historic reference to the healing hot springs found throughout the valley and known for hundreds of years for their restorative powers. This exterior feature suggests the oasis theme that is mirrored in the interior garden oasis.
Burkett: People find healing in nature, so we wanted to incorporate elements from the desert of water, wind, sun, and earth and express them in the interior spaces and architecture. A garden oasis centered in the lobby features the calming sound of water over granite. A “desert rain” sculpture is suspended above and provides the movement of a soft breeze with stylized rain threads and translucent clouds. This commissioned art sculpture also leads your eye to the oculus, which is a dramatic elliptical skylight for your eye to travel to the desert sky and beyond. The elliptical shape is an unexpected element in the design of the lobby and
becomes a bold interior architecture feature. This element gradually opens as it reaches floor level to incorporate a seating niche and custom area rug with swirling motifs.
Ramos: We're very proud of this feature; the detailing involved was tricky to do. The basic structural challenge was how do you do something that is cone-shaped, with a skylight above, surrounded by a finished two-story plaster wall? The way it is designed, light enters and washes the cone with a changing quality of light throughout the day. This is not a typical structural feature of most buildings but, at the end of the day, we were able to construct it with only one RFI.
Burkett: The sun is clearly illustrated in the large circular illuminated sculpture that greets you as you enter the main lobby. This resembles inverted parasols, with bright silk fabric gathered in layers and lighted from within. Of course, the fabric has been treated to avoid the problem of overheating. The sun sculpture is a striking visual experience for people seated beneath it and, again, is part of the theme of bringing the outside in.
Ramos: There wasn't a lot of ceiling space for this feature, and it required careful positioning and structural support, with lots of coordination with our engineers in locating overhead piping and ductwork. It turned out to be a stunningly beautiful work.
Tourkaman: The designers talked about evoking wind, earth, water, and sun as a way of acknowledging the natural elements of this area and bringing them inside, and they truly brought it off.
Burkett: The earth element is expressed in the stained concrete of the main lobby flooring. Each department has its own identity established by combinations of the vibrant colors of the desert. Sconces and art provide visual distraction and contribute to the character of each department. These include, for example, urgent care, radiation oncology, orthopedics, diagnostic imaging, and the executive health center-some areas involving more stress than others and therefore requiring more calming, subdued features. Auditory and visual healing elements were addressed by adding television monitors in treatment spaces and waiting areas. Nature images and music play continuously from the Continuous Ambient Relaxation Environment Channel, which was developed specifically for healthcare environments.
Tourkaman: We appreciated the flow of the seating in various waiting areas. People seated here can have privacy, if they wish; they're not forced to sit across from each other or in long rows next to each other. We wanted in no way to resemble a bus stop.
Burkett: The Executive Health Center on the third floor is a VIP area for individuals to receive complete physicals while enjoying the views of the desert and mountains and experiencing the amenities of a spa, such as rain shower heads, Italian tile in the locker rooms, and monogrammed towels and robes. We were particularly excited about two special features in the lobby: an illuminated dome with lighting that cycles through the colors of the spectrum and the vibrant original artwork of Joe Novak.
Ramos: The owner wanted a specific look, feel, and aesthetic, and allowed us designers the freedom to follow through with this. I learned from this project that, when you have an owner who is committed to core values and to what's best for the project, this trickles down to everyone. The result is a building that Denise and I are very proud of.
Burkett: In essence, the building is really about the patient experience. When people visit a healthcare facility, it is often at the most stressful times in their lives. So the challenge and goal of the built environment is to reduce that stress as much as possible. The feedback we have received from the client is that we have achieved the goal of creating a healing environment by expressing elements of the desert and honoring the healing connection that people have with nature.
Tourkaman: I believe the Argyros Center really has achieved all its goals. In 18 years of developing projects for the Eisenhower Center, I'd have to say this is my favorite. And the key to making it work, in my view, was getting feedback from all user groups from the start, from schematic design to finishes, furniture, and lighting. Patients, staff, departmental representatives-everyone is proud today to have had a hand in this. HCD
Eisenhower George and Julia Argyros Health Center of the Eisenhower Medical Center, La Quinta, California Healthcare Design 2011 February;11(2):40-48