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Hospital to Enhance Air Force Care at Lackland

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San Antonio is home to a new military medical center, now rising at Lackland Air Force Base. The $457-million, 645,000-sq-ft Lackland Ambulatory Care Center is a state-of-the-art replacement hospital that will become the largest ambulatory care center the Dept. of Defense has built to date.

U.S. Air Force photo/Senior Airman Kevin Iinuma
Installation: Workers install electrical wires and air conditioner ducts in the "A" wing at Lackland Ambulatory Care Center.
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Development of the new facility was driven by the Base Realignment and Closure Act (BRAC) of 2005, an initiative that consolidated all military medical training and health care in the San Antonio area.

"BRAC 2005 directed that Wilford Hall at Lackland was going to become a large outpatient facility," explains Jack L. Sullivan, vice president at HDR Architecture Inc. "In the end, the Air Force received authority to develop, design and construct a new outpatient clinic at Lackland Air Force Base, with the idea that Wilford Hall would ultimately be demolished."

Phase after Phase

While phased projects are certainly nothing new, the approach required at Lackland presented the project team with considerable coordination challenges.

"One of the unique things about this project, and challenging, was that it's a phased military construction contract. So the overall program was broken apart into phases and each phase was separately authorized and funded in Military Construction Congressional appropriations," Sullivan says. "Each phase also had to be designed and constructed as a 'complete and usable facility' in case subsequent phases were not authorized."

The hospital was initially conceived as a single project, but it ended up being split into four phases, with different contractors winning various phases.

"So the phased construction has its own set of problems associated with it because the initial phase was a design-build project and the second and third phases are design-bid-build," explains Mary Hix, assistant area engineer with the U.S. Army Corps of Engineers in San Antonio.

HDR joined in 2009 as architect-of-record, following approval of the overall concept by Air Force Medical Services Agency and Defense Health Agency to do phase one using early contractor involvement.

"Midway through, the Corps decided they wanted to convert the phase-one acquisition method to design-build," Sullivan explains. "We were awarded subsequent task-order contracts to design phases two and three. In addition, we were retained to provide design oversight of the first phase design by the design-build team, and HDR was also tasked to provide construction-phase-services support for all three phases."

The original programmed amount consisted of four phases totalling $480 million, including 680,000 sq ft of clinic space, a new central energy plant, a parking garage and overall site improvements. Phase one ended in November, and phases two and three are still under construction.

The $90-million phase two is at 90%, with completion expected by January. Phase three should be done in June 2015. Valued at $92.5 million, this phase is around 75% complete. A fourth and final phase that includes demolishing Wilford Hall is planned for 2015-2016 but is contingent on government funding.

"Money is funded annually for these projects, and they have to be awarded and completed in a certain time frame. Initially, they ran out of time in getting everything together in the first phase, so it went to design-build," Hix explains. "Then there was time to complete design on the remaining two phases. So we have three different contracts that are trying to tie into existing infrastructure and then into buildings that are being constructed or have been constructed."

Although the overall design concept of what the building would include, along with bridging documents, was complete, "the first phase contractor had his own designer and the option to change quite a few things that would not match up with subsequent phases," Sullivan explains. "We did run into that, as the structural-steel system is different between the first phase and phases two and three. We had to come back and make changes to our design in two and three to accommodate what the first phase design-build contractor had accomplished."

The facility has four wings connected by a common concourse and courtyard gardens between the wings.

Skanska USA is acting as general contractor on phases two and three. The company says careful coordination is key to keeping work on all phases in line.

"When phase one [was under construction] and with Skanska working on phases two and three, we had to have dedicated coordination meetings with the other general contractor on site to coordinate construction efforts," says Ryan Aalsma, project executive at Skanska. "We had to coordinate some activities with the phase-one contractor, designers, engineers and directors and on-site field management, and we had weekly meetings with them. Then we also had dialogue between HDR and the other designer."

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