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2 The information contained herein has been prepared for the express use of Louisiana State University Health Care Services Division and should be considered strategic and confidential. Reproduction and distribution beyond the named recipients is strictly prohibited. ADAMS 2006

3 Disaster Damage Supplement Charity Hospital Post-Disaster Planning, MCLNO 0606 August 30, 2006 Background In October 2005, LSU Health Care Services Division (LSU HCSD) commissioned a Facility Inspection Team that included ADAMS and the ISES Corporation (facility engineers) to prepare an initial damage assessment of Charity Hospital that would recommend corrective measures, complete with cost estimates, to feasibly bring the facility back to usable condition. The assessment was based solely on visual and non-destructive observations, a review of a pre- Hurricane Katrina facility condition report and discussions with facility personnel. The Facility Inspection Team recommended that due to the extensive nature of the direct damage, the associated repair costs and the indirect telegraphed damages from the destruction of systems that originated in the flooded basement, Charity Hospital be replaced. ADAMS asserts that any further investment in Charity Hospital constitutes a poor investment, and after such expense, the facility would remain inappropriate for the delivery of modern healthcare. LSU HCSD requested the ADAMS report as soon as possible in order to begin making critical policy decisions with respect to the Medical Center of Louisiana at New Orleans (MCLNO). Due to the short interval between the disaster and the creation of ADAMS report, ADAMS realized that many items would need to be revisited as more information was obtained related to matters such as direct and telegraphed damage, pricing and cost escalation. Indeed, ADAMS was able to glean more information after the submission of the original report to LSU HCSD through a series of interviews, conference calls, on-site visits and workshops with various individuals, including architects, general contractors, FEMA consultants, facility engineers, structural engineers and Houston, Texas healthcare providers affected by Tropical Storm Allison in As a result, ADAMS has prepared below a supplemental narrative complete with photographs to support the narrative s statements. This document is not intended to replace the original report but rather augment it. Moreover, ensuing visits to Charity Hospital served only as confirmation of the Facility Inspection Team s assertion; therefore, ADAMS reiterates its recommendation stated in the October 2005 report Because Charity Hospital has suffered such extreme catastrophic damage due to Hurricane Katrina, it is infeasible to repair. It is anticipated that this report will be given to a third-party architectural/engineering (A/E) firm who can validate these findings as LSU HCSD moves forward in producing a Project Scope Development document with corresponding fee estimates. Because the A/E firm will be tasked to develop cost estimates, no cost claims will be made here other than estimates given to ADAMS in the course of information gathering. At this point, ADAMS would like to note to the engaged A/E firm that: The Facility Inspection Team noted in its original report that non-standard inspection methods may be required to further define the scope and costs to repair some of the noted damage. To date, these methods have not been undertaken. The basement Project Worksheet (PW) has been written, the area has been gutted, and debris has been removed; therefore, the damage contained therein will not be comprehensively re-addressed in this report. However, ADAMS will address specific omissions from the PW. ADAMS of 21 Disaster Damage Supplement_083006

4 In October 2005, the Facility Inspection Team also focused on accessibility, health and fire/ life safety issues. Many of those systems, while originating in the basement, had elements throughout the building. Because these systems are critical to safe, quality healthcare, the argument was made that those systems would have to be replaced due to the damage, and that simply bringing those elements back online would be detrimental to the health and well-being of patients. ADAMS did not re-address those issues in this report. June 2006 Site Visit Representatives from ADAMS toured Charity Hospital in late June The purpose of the tour was to meet with Bob Arnold, MCLNO Facilities Director, as well as Lloyd Held, Eustis Geotechnical Engineering, to further qualify damage to the hospital exterior and upper floors due to Hurricane Katrina. During the tour of Charity Hospital, several areas of storm damage and potential concerns were observed and documented, with respect to the damage of various areas such as the site, foundation and upper level. Where applicable, ADAMS has included excerpts from the October 2005 report to further underscore the severity and pervasiveness of damage to the areas described. Areas of damage are described below in order of systems: Site There were areas of sidewalk that were impacted and showed signs of rapid lifting and settling. Not all cracks had plant growth or staining, however, indicating a recent event. ADAMS findings concurred with the October 2005 initial Hurricane Damage Assessment that stated: Water and wind damage due to Hurricane Katrina washed substrate away and caused walkways and drives to weaken and crack. They are no longer true-to-plane, and the walking surfaces are severely eroded. Apparent recent sidewalk cracking. Apparent recent sidewalk cracking. ADAMS of 21 Disaster Damage Supplement_083006

5 Other site damage that was noted in the initial Hurricane Damage Assessment included: At the entrance to the front grounds, the site features two pavilion buildings. These define a gate and formal entrance to the hospital at the front. The West and East Pavilions have sustained extensive damage as a direct result of Hurricane Katrina. Water rose to a depth of 6 feet and remained there for approximately 2 weeks. This damaged all interior surface areas, including floors, walls, ceilings and windows. The exterior and interior are in poor condition. Replacement of the glass block and glazing, doors and interior finishes, along with complete accessibility upgrades, are all needed in this facility to restore it. Foundation and Stair Complex Noting that the stair and basement are on different foundations, ADAMS found that the connection of the exterior stair to the block panels of the building showed signs (cracks and block movements) of differential settlement or torque, ostensibly from extreme wind motion. The facility and geotechnical engineer stated that subsequent to the levee breaks, the basement of Charity Hospital filled with floodwater, ranging in places from 8 to 12 feet deep, which placed an extra 600 lbs/sf weight on the piles. This additional building weight would have stressed the foundations unilaterally in a vertical descending motion, initiating the settlement process. After three weeks of the stagnant floodwater s presence, the basement was pumped clean. This would have de-stressed the building in a vertical ascending motion and triggered the settlement process again. ADAMS asserts that the prevailing geotechnical conditions remain highly questionable. Although further settling of the foundation could have put additional pressure on pipes and windows, as well as caused minor member issues and pitch in drains and joint cracks throughout the building, the observed cracks and block movements would have been created due to the buoyant effect experienced by the additional weight placed on/then removed from the basement foundation, and consequently, would not have been experienced by the fixed stair complex. Further compounding the torque and movement forces is the fact that the stair has a support wall that could have acted as a sail during the storm. ADAMS recommends that the engaged A/E firm obtain historical elevations of the stairwell and compare them to the current torqued stair complex elevation. The structure at the exterior stair and other later additions should be investigated to determine the amount of potential impact due to differential settlement and the reactivated settlement. The results should be analyzed to determine if the foundation has been compromised or if the facility can support the anticipated loadings of a fully utilized facility as it did prior to the storm. ADAMS of 21 Disaster Damage Supplement_083006

6 Movement of attached wall at exterior stair. Cracks in wall at stair connection. Underside of connection detail for exterior stair. Cracking at stair connection due to shear. Separation of wall at exterior stair. ADAMS of 21 Disaster Damage Supplement_083006

7 Recent separation at foundation wall joints. Recent separation at foundation wall joints. Racked landing at exterior stair. Recent separation at foundation wall joints. Recent separation at foundation wall joints. ADAMS of 21 Disaster Damage Supplement_083006

8 Separation and racking of landing on exterior stair. Additional cracking at interior face of exterior wall at exterior stair. Cracking at interior face of exterior wall at exterior stair. The initial Hurricane Damage Assessment indicated that: Top of exterior wall at exterior stair displaying continuous cracking. There is significant cracking around the main entrance and the south emergency exit stairway areas as a direct result of Hurricane Katrina and the subsequent flooding. Water appears to have undermined the entrance areas, allowing substrate soils to wash away, thus leaving walk areas to collapse and settle and foundations to be undermined and exposed. Cracks are readily apparent at the entrance areas. ADAMS of 21 Disaster Damage Supplement_083006

9 Exterior Wall and Windows The Facilities Director stated that several panels from an upper level floor were dislodged from the building and crashed down onto the exterior of the building. The upper floors would have also experienced a great deal of racking forces in the hurricane, and it is possible that more panels could have been loosened, though they have not yet fallen off the building. ADAMS recommends that the skin of the building be checked to ensure continuity and adequate attachment of the façade panel materials. The suspected cracking may also facilitate water intrusion and algae growth into the exterior wall withe, as it would no longer be sealed. The 2005 Facility Inspection Team report noted about the exterior: There is stair-step and vertical cracking of the panels. Past repair work is visible in many panels. Old caulking is becoming brittle, and pointing is deteriorated. Pointing and construction joint caulking are necessary throughout the structure. Hurricane-related filth and dirt have stained this building, primarily at the lower floors. Sandblasting will be needed to render this building more antiseptic and restore its appearance. This should be done within the next year. Some stone pointing may also be needed following the cleaning process. All of the exterior doors are in extremely poor condition. The water associated with the flooding which took place due to Hurricane Katrina destroyed all exterior doors and associated hardware. There are approximately 3,500 windows in Charity Hospital. There are many windows that were blown out, cracked, broken and pitted. The windows also showed signs of wind infiltration around the frames from the force of the wind. In addition, there could be water infiltration into the exterior wall at the broken seals, and this should be investigated by the A/E firm. Given that the majority of the windows that failed were recently installed and probably will not be able to be sealed adequately to meet hospital code standards, coupled with the Missing limestone panel and window damage. age and condition of the older windows, all windows should be replaced. ADAMS believes that a similar precedent may have been set on a similar project in Florida, where FEMA allowed a hospital impacted by a recent hurricane to replace all of its windows because the hospital was unable to seal them after the hurricane. The 2005 Facility Inspection Team examined the windows and noted that: The windows in this hospital are predominantly original, steel-framed units. Hurricane Katrina destroyed approximately 30 percent of the existing windows on various floors, while rendering the remaining windows suspect. Overall, the windows are in very poor condition, including missing panes of glass, as a direct result of the hurricane. (Some) windows appear to have been upgraded within the last ten years. The remaining windows are so damaged and deteriorated that there is a potential safety issue for anyone below the windows. It is common that the frames are completely rusted through, and insects can enter through the frames. Glass panes have the potential to release from their position and become a hazard for persons on the ground. Infiltration at the windows is so extensive that HVAC air balance and the establishment of pressure gradients across the building envelope are not possible. ADAMS of 21 Disaster Damage Supplement_083006

10 Broken window with sheared connector at exterior. Broken windows and wall staining. Damaged seal at exterior of window. Broken windows and wall staining. Damaged seal and window at exterior stair. Broken windows and wall staining. ADAMS of 21 Disaster Damage Supplement_083006

11 The building canopies were also damaged by the storm and should be replaced. The canopy connections should be checked since they too would have acted as a sail in the winds and would have experienced extreme forces of torque. Roof Damaged emergency room sign and canopy. Although FEMA noted no roof or MEP roof damage, ADAMS observed that there were two stairwell roof areas that were almost completely blown off. They occur at stair towers at the 18 th floor. The debris from these roofs was blown onto lower roof areas at the 13 th floor and into mechanical equipment, knocking that equipment over and offline. ADAMS recommends that the roofs be replaced. The stair towers should also be repaired, since water damage migrated down the stair shafts from the lost roof areas. Lower roof with debris from damaged roof areas. Stair tower roof area damage. Roof area blown off due to wind damage. ADAMS of 21 Disaster Damage Supplement_083006

12 The ballast on other older roof areas has been blown off, and areas of exposed underlayment are visible. Where the ballast was lost and exposure introduced, those areas have blistered and been raised. ADAMS recommends that the roofs on these buildings also be replaced. New hospital building codes would not allow the roof to receive simply a patch and new ballast. Opened mechanical shaft due to wind damage. Damaged roof duct due to wind shear. Additional damaged roof mechanical duct and housing. In the Facility Inspection Team s initial report, much of the aforementioned was noted. After the hurricane, however, it was also noted that: Approximately half of the roofing had been replaced with an asphalt cap sheet topped, built-up installation. The remaining built-up roofing applications on this building were already deteriorated and blistered, and there was evidence of roof leaks. Hurricane Katrina further damaged all of the roof membrane. To facilitate the repairs and drying-out of this building, the entire roof should immediately be replaced with a modified bitumen application. All deteriorated and suspect insulation is to be replaced with new insulation, properly sloped to drain, and all necessary flashing is to be installed. Interiors Damaged roof vents and intakes. The ceiling tiles have all been exposed to high levels of humidity and are in non-conditioned space as a result of the storm. The tiles are sagging and, in many cases, are stained and/or damp. ADAMS recommends that all ceiling tile in the entire building be replaced. The grid is racked in some areas due to blown windows or adjacent damage. ADAMS also recommends that the grid be replaced in the areas of damage. ADAMS of 21 Disaster Damage Supplement_083006

13 Moldy, damaged ceiling tile. Moldy, damaged ceiling tile. The glued tile ceilings are also climate sensitive and are falling and sagging in areas throughout the building. An additional complication is that the mastic that attaches these tiles is suspected of asbestos. Therefore, ADAMS recommends that not only the tiles be removed and replaced, but also that the mastic be encapsulated or abated. The initial Hurricane Damage Assessment examined the ceiling tiles and stated: Approximately two-thirds of the ceiling area has tile, either the lay-in type, concealed grid or glue-on. Many of the ceiling tiles sustained significant damage from the hurricane and from occupants in the building after the hurricane. After the entire building has been cleaned and disinfected, the replacement of soiled tiles is recommended. The floor in the upper level gym is also suspected of asbestos. This floor is peeling, cracking and in overall poor condition. This floor would need to be replaced. Again, the attaching mastic is suspected of asbestos. There are areas of 9x9 tile that are damaged by water and would need to be replaced. The 9x9 tile and the attaching mastic are also suspected of asbestos. Damaged ceiling tiles and exposed mastic. ADAMS of 21 Disaster Damage Supplement_083006

14 Water damage at upper level gym floor. Hole in upper level gym roof. Paint is peeling in areas, especially along the exterior wall, and would need to be cleaned and/ or repainted. There are areas that may have peeling lead paint, and ADAMS recommends that these areas be investigated and abated if shown to be hazardous. Interior wall water damage cracking paint and bubbling wall. Interior wall water damage. Interior wall and ceiling water damage. ADAMS of 21 Disaster Damage Supplement_083006

15 Interior wall and ceiling water damage. Broken windows have allowed water intrusion. There are areas in office spaces that appear to be plaster or drywall and seem to be impacted by water infiltration, as they show signs of buckling, bubbling and soft spots. ADAMS recommends that the walls be replaced where this has occurred to prevent mold infiltration. Damaged wall area exposing interior and mold infiltration. Damaged wall area exposing interior and mold infiltration. ADAMS of 21 Disaster Damage Supplement_083006

16 The Facility Inspection Team noted upon visiting Charity Hospital in September 2005 that: The applied interior finishes in this building sustained significant damage from Hurricane Katrina and from those who sought shelter in the building following the hurricane's departure. After the entire building has been cleaned and disinfected, it is recommended that all the applied finishes be renewed in the next year. ADAMS stands by the initial recommendation that the entire interior of the building be cleaned, since mold and water damage are evident throughout the shafts and skin. Because of the pervasive nature of the damage and stagnancy of the air, cleaning and mucking will need to be done on all levels. ADAMS believes that the mold remediation alone would be at least $7.0M, if recent price estimates of $7.00 to $10.00 per square foot are accurate. Elevators The elevators are moldy, and those that are in use function poorly. The elevators need cleaning and repair. One elevator door used on the tour was racked, making it difficult to close the door and allow for travel. ADAMS recommends that the cabs be replaced and the shafts cleaned. There was no visible mold, but mold was still evident in a strong odorous manner. Prevalent mold growth in patient room. Currently, temporary repairs are being conducted on two elevators, while permanent repairs are being conducted on two freight elevators. Otis has provided a quote to Charity Hospital of $2.5M to repair all elevators. Documenting the damage to the vertical transportation system, the Hurricane Damage Assessment Team stated that: Flooded elevator pit. The facility is served by 29 elevators which consist of hydraulic machines, geared machines and gearless machines. Water, muck, debris and septic residue are present at the basement level and have damaged the pits, hatches and landings, hydraulic/ geared machines, controllers and other equipment. To aid in the repairs to this building and to bring it back to a safe and usable condition, several of the elevators should be brought back online immediately after the basement is rendered antiseptic. A complete modernization of these elevators is recommended within the next year. The work to get these elevators online would include cleaning and refurbishing the pit and replacement of the basement hatches and landings. ADAMS of 21 Disaster Damage Supplement_083006

17 Plumbing It was well documented that the plumbing distribution system was antiquated prior to the storm. Water flowed throughout the system and functioned, and facilities staff addressed repairs as events occurred. However, Hurricane Katrina disrupted everyday use of the plumbing distribution system and fixtures, allowing water to stagnate. This condition requires that the distribution system be cleaned thoroughly, though the system is in such a state that the required cleaning methods would create extensive damage due to old joints, leaking and cracking. But for Hurricane Katrina, however, this system would still function. ADAMS suspects that the cleaning of the system, due directly to Hurricane Katrina, would create more costs due to repair than outright replacement. The 2005 Hurricane Damage Assessment Team noted: Hurricane Katrina caused extensive damage to the plumbing systems. The building has cast-iron, hub-and-spigot drain piping and soldered copper supply piping networks that are over forty-years old. Leakage and cracking are present in the water supply and drain piping in several areas where it could be observed. The plumbing fixtures are old and in very poor condition. Broken fixture valves were causing or have caused leaks on almost every floor. There are showers, tubs and specialty sinks that are no longer in use. It is recommended that the existing water supply piping, sanitary and storm drain piping and all plumbing fixtures be demolished and replaced. Mechanical Systems As alluded to previously, several areas of damage were noted on the roof, including damage to vent pipes, fans, vents and ducting. The areas where the duct or pipe connections were opened up due to the wind shearing off the exposed elements, water infiltration and water migration down mechanical and electrical shafts were evident. All of the mechanical and electrical shafts in the building could be host environments for mold growth, and insulation would also be impacted. There are areas of duct connections that would act as conduits for water infiltration into the duct system. As a result, ADAMS recommends that the ductwork be cleaned and that the roof openings be repaired before the building would be suitable for use. There is debris that is evident in the mechanical openings on the roof. ADAMS recommends that the ducts be cleaned and blown out, as well as decontaminated for mold growth. Pipe insulation would be more susceptible to contamination on chilled water piping in the nonconditioned spaces of the building, especially in the high-humidity environment after the storm and due to the natural environment of the area. In addition, the pipe fitting insulation is suspected of asbestos. All pipe joint insulation has been exposed to contaminants and is potentially hazardous. Therefore, ADAMS recommends that all pipe insulation be abated and replaced. Also, there is evidence of bent piping in areas where the ceiling is damaged, possibly due to flying debris. ADAMS recommends that this be investigated and repaired. ADAMS of 21 Disaster Damage Supplement_083006

18 Exposed damaged asbestos pipe wrap and piping. Exposed damaged asbestos pipe wrap and piping. Exposed damaged asbestos pipe wrap and piping. More affected asbestos pipe wrap and piping on 1 st floor. Outside of the flooded basement and other areas where rainwater and/or plumbing leaks have damaged interior structures, the HVAC equipment and ductwork are structurally sound and in working condition. However, the ductwork and other HVAC system components still contain dirt, mold, bacteria and other dangerous contaminants from the horrible conditions during and after the hurricane. The ductwork and HVAC equipment should be cleaned and decontaminated in order to meet ASHRAE standards for acceptable indoor air quality (IAQ). Exposed damaged asbestos pipe wrap and piping. ADAMS of 21 Disaster Damage Supplement_083006

19 This should include the removal and disposal of mold, dirt, debris and other contaminants from the ductwork, as well as the cleaning, decontamination and reconditioning of all supply, return and exhaust ductwork, diffusers, grilles, heating and cooling coils, dampers, blowers and other components of the HVAC system. The air distribution system should be tested and balanced. The rooftop HVAC equipment has suffered varying degrees of damage caused by the hurricane. Several fans/air vents were completely missing, thereby exposing the building interior. Other rooftop equipment is showing visible damage and deterioration which would make it inoperable. It is recommended that all rooftop exhaust fans, relief air vents and air-cooled condensers be replaced in their entirety. Damaged roof mechanical ducts and equipment. Damaged roof mechanical duct and housing. Electrical Systems ADAMS noted that the buss duct on the roof at the 13 th floor was damaged and in need of replacement. It would also be advisable to replace components such as the main panel boards and circuits on the 480V system downstream. The entire electrical system should be meggered out to determine if any shorts or arcing are occurring in the systems and/or cabling as a course for life safety. This is especially important due to the nature of the potential damage and the potential for fire in a building damaged to the extent of Charity Hospital. The system could be compromised due to the fact that it was subjected to saltwater submersion. In addition to the above, all exterior wall and/or shaft wall outlets and devices should be tested for continuity. The same would apply to the fire protection system. Electrical buss duct on 13 th floor. ADAMS of 21 Disaster Damage Supplement_083006

20 There is evidence of light fixture damage. All damaged light fixtures should be replaced. The low voltage systems have exposed wires and should be replaced in areas where the ceiling was damaged due to the stress on the wire and connections that could have been caused by the storm. Electrical systems were noted in the original Hurricane Damage Assessment: The switchgear and oil-filled transformer that provide 120/208 voltage for the first three floors are located in the basement. They were submerged by the flood and are in need of replacement. It is recommended that the entire primary electrical system be replaced to ensure reliable power to building occupants. Main switchgear components should include a ground fault main circuit breaker, draw-out distribution breakers for ease of maintenance, digital metering for remote control/monitoring and transient surge protection. Basement ADAMS has reviewed the FEMA Project Worksheet (PW) for the basement and made the following observations regarding FFE omissions related to: Telephone and other Information Technology Radiology/Oncology Suite, including CT and Linear Accelerator Cath Lab Equipment Dietary Equipment As mentioned above, there is documented, damaged and exposed asbestos in the basement in the form of pipe insulation that apparently was not addressed in the initial FEMA PW. It has been recommended that a line-by-line assessment between the FEMA PW and the original Hurricane Damage Assessment be conducted. The party undertaking the reconciliation of the reports should note the aforementioned omissions in the analysis. This analysis should then become the baseline for the estimate of cost for damages. Mitigation Although not within the scope of ADAMS damage assessment, a substantive portion of repair costs will be required for future mitigation through relocation of critical systems. Mitigation projects for Charity Hospital may include, but are not limited to, the following: Relocating primary electrical system and associated high-voltage gear out of the flood zone. - The 2005 Damage Assessment Team noted: It is recommended that the primary electrical system be relocated out of the flood zone area or that alternative protective measures be put into place to prevent damage by flooding in the future. ADAMS of 21 Disaster Damage Supplement_083006

21 Sealing and flood proofing the service tunnel entering the basement at the southeast corner. Relocating all emergency power related equipment and generators out of the flood zone. While implementing the above projects constitutes a good first effort, ADAMS asserts that the feasibility of true flood mitigation is marginal at any reasonable expense, and further adds to an already poor investment of resources. Concluding Comments While structural systems such as columns, beams and flooring are in functional condition, these and other building components most likely received additional damage, both direct and telegraphed, that would not be evident in a walkthrough without intrusive investigation and destructive testing. ADAMS recommends this investigation and testing be done, at a minimum, at the shafts and exterior wall locations. Additionally, there are areas of the ceiling that were subjected to the elements, as well as some interior wall areas, and these areas should be investigated as well. If damage, mold and/or contaminants are found upon initial testing, then more investigation would be warranted. As this report and the accompanying photographs have shown, the second formal site visit to inspect Charity Hospital served not only as confirmation of the Facility Inspection Team s initial findings, but also allowed the team to more specifically document items that were vague or went unaddressed (due mostly to the lack of inspections attributed to the unsafe conditions) in the initial report. This report, taken in conjunction with the initial report, more readily defines the pervasive nature and magnitude of the damage to Charity Hospital, both direct and telegraphed, and should be used as a basis in development of the Project Scope. ADAMS of 21 Disaster Damage Supplement_083006

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