Canadian Architect

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The Hospital, Future and Past

A colloquium asks: how can hospitals adapt to the demands of ever-changing medical technology? And what should be done with hospitals deemed out-of-date, such as Montreal’s Royal Vic?

January 1, 2016
by Peter Sealy

Northwich Park Hospital was among the first hospitals designed for expansion. (Photo courtesy London Northwest Healthcare Trust)

Northwich Park Hospital was among the first hospitals designed for expansion. (Photo courtesy London Northwest Healthcare Trust)

TEXT Peter Sealy

Last fall, a colloquium in Montreal entitled Hospital / Hôpital examined the hospital’s importance as a political, cultural and architectural artefact. From the labour strife behind the creation of Modernist hospitals in West Virginia to the historic ties between the Sainte-Justine children’s hospital and Montreal’s working-class francophone community, 19 presentations sketched out the many links between hospitals and the communities they serve. A particular highlight was the screening of Robert Cordier’s film Miracles in Modern Medicine. Created for Arthur Erickson’s Man and His Health pavilion at Expo 67, the film shows six interventions involving humans and machines at Montreal hospitals. It was recently rediscovered by Stephen Palmer of the University of Windsor; both Cordier and Palmer were on hand to present this glorious example of high-tech medicine as popular entertainment.

Woodhull Medical and Mental Health Center in Brooklyn was also an early example of a hospital designed to accommodate changing technology. (Image: Bruce Wood)

Woodhull Medical and Mental Health Center in Brooklyn was also an early example of a hospital designed to accommodate changing technology. (Image: Bruce Wood)

While several presenters explored the interplay between changing medical technology and hospital design, McGill Assistant Professor David Theodore, MRAIC, went one step further by asking: what happens when the hospital not only has to respond to the present state of medical practice, but to its (unforeseeable) evolution? “Ever since the hospital became
a technological machine, circa 1970, every hospital began laying claim to be the hospital of the future,” said Theodore. To avoid creating buildings that were already outdated before opening, architects “had to find a way to build the hospital first, and then design it afterwards.” Among the devices deployed in this Sisyphean task: the central spine around which pavilions could be added or expanded at John Weeks and Richard Llewelyn Davis’ Northwich Park Hospital in London, England (1970), and the interstitial service floors used in Gerhard Kallmann and Michael McKinnell’s Woodhull Medical and Mental Health Center in Brooklyn (1978).

For Theodore, the spectre of obsolescence, in which “we can’t, it seems, practise twenty-first century medicine in twentieth-century buildings,” is “a kind of medical crisis in which the patient never recovers.” This is precisely this situation now facing the Royal Victoria Hospital, left empty following the McGill University Health Centre (MUHC)’s recent move to its new Glen Yards site. In her presentation, McGill Professor (and former Director of the School of Architecture) Annmarie Adams, FRAIC, revisited a bitter kerfuffle from the mid-1990s when she criticised the MUHC’s initial proposal to demolish the Royal Vic’s postwar buildings while converting its earlier pavilions into condominiums. The MUHC’s “swift and vicious” response was a harbinger of the deafness and outright corruption that would plague the super-hospital project. Regrettably, 19 years later, we are only a little closer to finding out what will happen to the Royal Vic. For Adams, this is both lamentable and unacceptable. “Part and parcel of being a responsible architectural client is assuring the future of the original site,” she said.

The future of the existing Royal Vic buildings is uncertain. (Photo: Mirna Wasaf)

The future of the existing Royal Vic buildings is uncertain. (Photo: Mirna Wasaf)

The buildings left empty by the MUHC may fall into ruin, leaving demolition as the only option. Such “needless demolition” occurred in Calgary, London, Toronto, Ste. Agathe and St. John’s. On the flip side, Adams presented successful examples of hospital reuse from Australia and the United States. Noting Montreal’s long tradition of re-appropriating buildings for new functions, Adams expressed her wish that McGill University would acquire the Royal Vic site and put it to academic uses, a move that “makes sense, given the location and history of the institution.” The Royal Vic presents a spectacular architectural range across its 14 buildings spanning from 1893 until a century later. However, McGill’s present proposal for classrooms, laboratories and offices involves demolishing all of the Royal Vic’s postwar buildings.

While Adams’ presentation eloquently addressed the issues surrounding the Royal Vic’s reuse for a non-healthcare purpose, she also noted her disappointment that a way had not been found to keep the Royal Vic as a hospital. “If we can afford to gut the Royal Vic to remake it as a university, why couldn’t we gut it to remake it as a hospital?,” she asked.

View of the MUHC’s new Glen Yards campus. (Photo: Don Toromanoff)

View of the MUHC’s new Glen Yards campus. (Photo: Don Toromanoff)

The new MUHC, located west of downtown, cast a large shadow over the proceedings. While none of the presenters directly examined its architecture, Mary Hunter and Tamar Tembeck (both from McGill University) came closest with their insightful survey of public art in the new hospital. The MUHC’s funding model was subject to a scathing condemnation
by the University of Waterloo’s Heather Whiteside, who denounced the recent rise of Public-Private Partnerships (P3s) in Canadian healthcare projects. The disastrous dénouement of the
MUHC’s P3 process continues to shock those familiar with its details. Whiteside’s stance is unequivocal: not only do P3s fail to reduce inefficiency, “P3s themselves are corruption.” Private-sector financing is more expensive and risks are never truly transferred to the private partners, leaving taxpayers to pay extra when P3s work as they should and on the hook when they don’t.

While the colloquium focused on hospitals, both the first and last presenters questioned their central role in our healthcare system—especially in the present fiscal environment, where hospitals compete for scarce funding with clinics and other primary care vehicles. Gregory Marchildon of the University of Toronto noted how—in spite of the general assumption that hospitals play too great a role in healthcare—successive healthcare reforms have often simply reinforced hospital-centric models. This sentiment was echoed by Damian Contandriopoulos of the Université de Montréal, who charted the rocky future facing hospitals over the coming decades and questioned their utility in delivering healthcare outcomes efficiently.

The difficulty of managing and funding our healthcare system—widely acknowledged as the cornerstone of Canada’s postwar social democracy—looms large. While the controversies surrounding the new MUHC will likely subside with time (the successful incorporation of the former Royal Vic into the McGill campus would certainly help), the Canadian hospital will remain an urgent matter.

Held at the McCord Museum on October 1-2, 2015, the Hospital / Hôpital colloquium was jointly organized by McGill University’s Institute for Health and Social Policy and the Centre for Interdisciplinary Research on Montréal.

Peter Sealy is a doctoral candidate at Harvard University.