VA Lakeland Community Based Outpatient Clinic

Summarize the project's program, features and achievements?

To meet the growing needs of the Lakeland, Florida area's more than 23,000 Veterans, the U.S. Department of Veterans Affairs is consolidating their multiple facilities in the area into one expanded Community Based Outpatient Clinic (CBOC). At 132,000 square feet—five times bigger than the existing clinic spaces—the facility will be better suited to meet patients' needs both now and in the future. As a build-to-suit lease project, the Development, Design, and Construction teams partnered to create a healing and human-centered space that uses the latest technology to elevate quality of care. The facility offers multiple services to the Veteran community it serves. The facility includes 90 Primary care exam rooms, 24 Mental Health treatment rooms, 24 Specialty clinic spaces, 4 Audiology booths and supporting spaces, 2 Xray's, a CT, MRI, 2 ultrasound, and bone density spaces within radiology. In addition, there are eight dedicated blood draw stations, a dedicated lab, a full pharmacy including a narcotics vault, an optometry suite, and a full physical therapy suite with dedicated prosthetics fitting.

The Project Team's approach to the site layout and design prioritizes Veterans and their support teams. From the orientation of the main visitor entry drive to the parking layout, close attention is paid to natural wayfinding that will help a visitor understand how to access the facility. Site amenities include a Flag Plaza honoring Veterans that offers places for rest and reflection, a Healing Garden that allows for respite and relaxation, and a Rehabilitation Courtyard for physical exercise and ability strengthening.

What obstacles were overcome related to the schedule, budget, program, specification, site, etc. on this project?

The project was initiated in the early days of the COVID era, which required all participants to be remote for the first two years of the project design. During this period, material availability, procurement, and costs for processed and manufactured goods were highly volatile. The team elected to utilize a structural concrete tilt-up building design solution because it offered the optimal flexibility to support the project program, while also offering a reliable, durable, and resilient construction system that returned control of the critical path back in the hands of the trades on site.

The project site selected presented complex design and construction challenges. The 26-acre site contained pastures and wetlands, but it served as a spoils site for a phosphate strip mining operation. It was comprised of deep, uncontrolled fill of highly unsuitable material. This required the installation of 32,000 wick drains and a substantial surcharge program to make the site accessible. It was still necessary to export nearly 100,000 CY of unsuitable material. In response to the challenging site, the building is set on a total of (475) 14" concrete piles. The team installed over 26,000 linear feet of precast concrete piles under the building. The building rests on foundations that are located on a series of pile caps, tied together with 36" deep grade beams and supporting a 10" structural concrete slab. The tilt-up concrete panels, coupled with the deep foundations and structural grade beams, create a rigid building system to accommodate environmental factors, including hurricane wind loads.

Please communicate any engineering complexities or unique features of the panel design for this project?

The tilt-up concrete envelope offered the team flexibility in terms of design, it also provided a greater level of cost control. The conceptual design utilized several textures and finishes to create a visually stunning aesthetic. The tilt-up concrete wall panels allowed the team to develop rhythm and texture in the building envelope without the burden of changing construction types.

Having control of the tilt-up structure on site allowed the team to pivot in response to developing schedule constraints. One engineering challenge this created was documenting and inspecting tilt reinforcement prior to concrete placement. Our team used aerial drone photography to inspect and document the tilt panels as they were being formed, reducing travel and inspection costs, and keeping production moving. The team worked to coordinate and align openings to create uniform panels, we had very few instances where openings on each floor were directly related. This created somewhat eccentric or unbalanced panels that required careful consideration while picking and setting, particularly while walking panels from the casting beds.

The building includes four fire egress stairs, and two bank elevator shafts. We moved each of these to tilt wall rather than introducing CMU to the project. With the proper fire rated joints, the tilt-up panels encompass the entire rated shafts for these elements. The speed at which these went in place allowed the team to set stairs and ensure a safe construction site much earlier in the project.

What is the potential for this project's impact on the community and/or environment?

The project's overall community impact is significant. Designed to consolidate services for over 23,000 Veterans living in the Lakeland, Florida area, the new Community Based Outpatient Clinic will dramatically improve these Veterans' access to care. As a consolidation, this facility brings together services from several smaller clinics around the community to simplify Veterans' access to care. During the initial outfitting of this project, the VA discovered mold in their existing clinic that forced them to abruptly shut it down. At the time, this building was being outfitted and ramped up for service. The development team, along with the VA, were able to push to expedite the first patient date and bring care back online to the local Veteran population.

From an environmental point of view, the total project achieved two Green Globes certification through Green Building Initiative (GBI). In our original plan, the concrete for building and foundations was planned to use a fly-ash additive during construction; however, the local construction market in the Lakeland, Florida area was busy, and the concrete materials were being rationed. To accommodate the schedule, the fly-ash was removed. While not the desired direction for these issues, this highlights again the flexibility that the tilt wall solution offered this team to respond to adversity as it arose through the project.