New Nantucket hospital is being built to survive a Category 5 hurricane

Aug. 06--NANTUCKET -- The new Nantucket Cottage Hospital scheduled to open by year's end is prepared for a blow -- a really big blow.

The 106,000-square-foot, 14-bed hospital is being built to hurricane design specifications established by Miami-Dade County -- some of the strictest in the country, according to David B. Kelly, senior associate with Boston architectural firm Cannon Design, which designed the building.

Building according to the Florida code will allow the hospital to withstand Hurricane Irma-strength winds of 185 mph, rather than 150 mph as specified by Massachusetts building codes, Kelly said.

"The term is resiliency," Kelly said. "It's survivability."

"If we don't have the (medical) helicopters flying or the boats running, it's the only place to get medical care," said Janet Schulte, who has toured the hospital currently under construction in her capacity as director of Nantucket's Department of Culture and Tourism.

Massive 5-foot-by-5-foot concrete footings fortified by mesh, Andersen Stormwatch windows and a double-hulled exterior building shell will help the new hospital stand up to Category 5 winds, said Kelly and Dennis Patnaude, the hospital's facilities director.

Redundancies, such as analog and digital phone lines and access to satellite phones, mean the hospital will be able to exchange information with emergency services on and off island, Patnaude said.

"You could lose all services and still have communication," he said.

The mandate to meet Miami-Dade codes came from Boston-based Partners Healthcare, of which Nantucket Cottage Hospital is a member, Kelly said.

It's possible because the new hospital is being built from the ground up, cheek by jowl with the existing facility next door on Prospect Street, Patnaude said.

"This is a once-in-a-lifetime opportunity to be involved in a complete hospital replacement," Patnaude said. "It is designed to meet or exceed all applicable codes."

The existing gray-shingled facility built in 1957 will be torn down when the new hospital is complete, by the end of the year or shortly after, said Nantucket Cottage Hospital spokesman Jason Graziadei.

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The design team and hospital officials are relying on lessons other hospitals learned the hard way to protect the new facility, Patnaude said.

Some of those lessons came out of New York, where Bellevue Hospital had to evacuate hundreds of patients following Superstorm Sandy in 2012 after flooding inundated the basement and knocked out the electricity.

The new Nantucket Cottage Hospital won't even have a basement. It would just be wasted space that could be inundated in flash floods and torrential rains, even though the hospital is located on an island high point, Kelly said.

The boiler room, currently located in the basement of the existing hospital, will be shackled to the flat roof of the new hospital, hidden behind peaked mansard roof lines along with other mechanical works, including two massive generators, Patnaude said.

Electrical transformer switches will be located on the second floor instead of the first, in the event of flooding, Patnaude said.

The fuel-pumping room is being built at grade level, but will have waterproof curbing like an inverted bathtub, Kelly said.

The six-over-six Andersen windows have multiple fastenings and have withstood objects hurled by hurricane-force winds in ballistic tests, Kelly said.

The shell of the building is constructed almost like two walls, with a water and vapor barrier between the inner and outer skin, Kelly said.

The design also will improve the energy performance of the building; Patnaude hopes it will be LED-certified as a gold building.

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"It's a great accomplishment for a hospital," he said.

The new hospital, which is 30 percent larger than the existing hospital, also will have a larger capacity to go days without supplies, Kelly and Patnaude said.

On an island 30 miles off the coast that was battered and isolated by this winter's nor'easters, that is a comforting thought to residents.

"We go for two or three days without boats often here," Schulte said.

While the Centers for Medicare and Medicaid Services require hospitals to be self-sustaining for 96 hours, Nantucket Cottage Hospital will have enough food for seven to 10 days and generator fuel for many days, Patnaude said.

The new hospital will have 27,000 gallons of fuel on-site for the dual-purpose generators, more than three times the current capacity of 8,000 gallons of oil and propane, Patnaude said.

The plan during storms and hurricanes is for the hospital to serve as a shelter only for those in medical need, including women in their last trimester of pregnancy and individuals who need electricity to run their oxygen supplies or who rely on visiting nurses for wound care.

Others seeking shelter will be directed to the American Red Cross shelter at Nantucket High School.

Patnaude said he couldn't say how much more it cost to build a hospital up to Miami-Dade codes, since the higher standards were incorporated from the very beginning, and less strict plans were never put out to bid.

The building's $89 million price tag, which includes the cost of permitting and relocating other buildings on campus, has been funded by donations and philanthropy, Graziadei said.

The final cost is estimated to run about $120 million, Graziadei said. That includes housing for staff, from environmental services to physicians.

Another challenge architects faced was building a state-of-the-art, hurricane-resistant hospital while also meeting local historic requirements.

The result is a multi-angled structure with dormers and eaves lined with golden shingles that will soon turn gray in the Nantucket ocean air.

"This isn't going to jump out at you -- 'Oh, here's the hospital,'" Patnaude said. "The building product itself is part of the community."

Patnaude and Kelly are so confident of the capabilities of the new hospital that they say it would take a truly catastrophic event to cripple it.

Once a hurricane hits, it's too late to transport patients, said David M. Faunce, executive director of the Southeastern Massachusetts EMS Council for Region Five, which works with hospitals to coordinate emergency planning from the Cape and Islands up to the Brockton area.

"You need to make decisions early," Faunce said.

The Massachusetts Department of Public Health is working with hospitals to develop a Patient Placement Coordinator Plan that would support evacuations and patient transport "during a catastrophic emergency as was seen during Hurricane Harvey in (Texas)," according to agency spokeswoman Ann Scales.

The department will consider issuing waivers to ambulance services to allow for alternate destinations during hurricanes and weather events, Scales wrote in an email.

Hospitals operate incident command systems, while nursing homes are part of a mutual aid coalition called Mass MAP that springs into action during weather emergencies, Faunce said.

"Whether it's Martha's Vineyard or Nantucket, you're on an island," Faunce said. "They really have to make sure they have everything they need."

"You know, when there's no planes or boats running you really do feel the edges of the sea," Schulte said.

-- Follow Cynthia McCormick on Twitter: @Cmccormickcct.

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