Photography: @ John Durant Photography

It began with a feasibility study done in 2002 by Karlsberger, the Columbus, Ohio-based Architecture firm, on the expansion possibilities of the Children's Hospital of Austin. The study showed there was limited room for growth on the existing site and an alternative site proved to be unpopular with physicians, even if less expensive than the site ultimately chosen. Austin had a 700-acre airport that was relocating, offering to would-be developers a not-so-clean slate-a brownfield site-as the unlikely location for a 169-bed, 473,000-square-foot children's hospital.

It was from such incongruous beginnings that emerged Dell Children's Medical Center of Central Texas, the world's first LEED (Leadership in Energy and Environmental Design) Platinum-certified inpatient hospital, the highest level recognized by the United States Green Building Council (USGBC).

The hospital owners, the Seton Family of Hospitals (owned by St. Louis-based Ascension Health), and Karlsberger healthcare designers led by Joseph F. Kuspan, AIA, director of design, brought it off the hard way. Driven by Robert I. Bonar, Jr., DrHA, president and chief executive officer of the hospital, LEED Platinum was set as the goal from the onset of the project-this at a time when the Green Guide for Health Care (not to mention LEED for Healthcare) was but a gleam in the USGBC's eyes. The LEED points ultimately earned by Dell-all 54 of them-were based on meeting the healthcare-unfriendly criteria of LEED for New Construction.

Joe Kuspan did not see this in itself as a major obstacle: “We see these documents as overlapping pretty well, with the Green Guide, in effect, a companion piece to the LEED program. LEED for Healthcare, though, when it is finalized, will make achieving LEED Platinum a bit more possible than it was for us.”

What made it possible for the Dell designers was a purpose-built freestanding natural gas-fired power generating plant (figure 1) occupying approximately an acre of the total 32-acre property-a cogenerating endeavor by the local power company Austin Energy. The plant would supply electricity, steam, and chilled water to the facility for a negotiated rate, in the process saving the facility's owners more than $6 million in construction costs. Most of this was plowed back into the design and implementation of more green features. “This was the key factor to Platinum,” says Kuspan.

The importance of the cogenerating plant could be measured not only in terms of construction cost savings and green investment, but for a lion's share of the 10 LEED points given for energy efficiency. “In striving to meet the ASHRAE 90.1 mechanical code, which is very aggressive for energy efficiency,” says Kuspan, “we were only able to improve on this by 17% through design alone-for example, distributing mechanical systems to minimize duct runs, minimizing the size and number of fan motors and fans, developing right-sized air handling units stacked below rooftop heat-recovery units, and avoiding overdesign in general. With the power plant, the facility's net energy efficiency went up from 29% efficiency with the use of a coal-fired power plant that would normally have supplied the hospital, to 75%. It accommodated the around-the-clock energy utilization of hospitals, and provided clean, reliable power with no surges and minimal line loss. And there were no boilers or chillers to install.”

Dell Children's Medical Center is also the only hospital to achieve a LEED point for daylighting. The hospital achieved daylighting in 75% of spaces, including 35% of diagnostic and treatment areas.

Major LEED points were awarded in several other areas, as well-for example:

  • 13 of a possible 14 points were achieved for sustainable sites, which included a soil erosion and sedimentation plan conforming with EPA standards

  • 11 of a possible 15 points for Indoor Environmental Quality, which included the use of low-emitting materials

  • 5 points for Innovation, with included establishment of an integrated pest management plan

  • 4 of a possible 5 points for Water Efficiency, which included water-efficient landscaping (figure 2) and a 15% reduction in potable water use

  • 2 points for diverting 91.21% of on-site-generated construction waste from landfill

  • 2 points for having 37.12% of total building materials originate locally (figures 3 and 4)

Documentation of all this was daunting, says Kuspan: “It takes a lot of work, a lot of coordination of architects and engineers, to document all these points. It's time-consuming, comprehensive, and needs to be accounted for in the project schedule. We look at it, though, as an important research project in sustainable design. What we want to do now is document the effect of all of this on patient outcomes, patient care satisfaction, staff satisfaction and retention, length-of-stay, use of pain medication, and so forth. This is where the rubber meets the road with green design and is the logical next step.” HD

For further information, contact Joseph F. Kuspan, AIA, Director of Design, Karlsberger, at 614.461.9500 or, or visit

Healthcare Design 2009 June;9(6):24-27