A rendering of a new $275 million medical complex designed by TEG Architects, of Jeffersonville. | Courtesy of TEG

A local architectural firm has designed a $275 million state-of-the-art medical center that will have to be built under tough conditions in a small city in North Dakota.

The center, for the private nonprofit Trinity Health, will cover more than 1 million square feet and will feature a six-story hospital and three helipads. It will draw patients from four states.

For TEG Architects, of Jeffersonville, the project presents tough challenges — but also big rewards, great experience for some of the younger partners and an opportunity to get nationwide recognition as one of the premier designers of health care facilities.

Wayne Estopinal

“This is the largest project we’ve ever done,” said Wayne Estopinal, the firm’s founder and president.

About 90 percent of the firm’s business comes from the health care-related projects, and Estopinal said that the industry’s infrastructure spending is finally moving ahead after years of paralysis brought on by the recession and uncertainty from the Affordable Care Act.

He said many health care CEOs were terrified by business conditions, which made them hesitant to push for expensive infrastructure investments. After the recession, TEG Architects said its revenue dropped precipitously.

In the last couple of years, though, industry leaders have realized that they cannot continue to provide quality care in aging facilities, Estopinal said. Many of the hospitals with which TEG is dealing were built three, four and more decades ago. Part of Trinity’s existing complex dates to 1923.

Construction on medical facilities grew by nearly 18 percent from the first half of 2015 to the first half of 2016, according to Revista, which tracks medical real estate information. In the first half of 2016, the value of planned medical real estate construction projects in the U.S. was $102.1 billion, compared with $86.7 billion a year earlier.

Estopinal said that his firm’s revenue had increased 15 percent in each of the last two years, and, barring any major economic changes, he expects growth to continue.

Minot medical center

The medical center that TEG designed for Trinity will include a six-story hospital and a three-story behavioral health services facility, according to a press release by the nonprofit. The center will have 208 beds, a 20-bed intensive care unit and a trauma center with 27 treatment bays. The 76-acre site also will provide 1,900 parking spaces, including a 350-space garage.

Trinity officials did not return IL’s phone inquiries.

Estopinal said that groundbreaking is expected for spring, with completion in 2019.

TEG landed the job for the center in part because Estopinal knows Trinity’s CEO from a prior collaboration.

The project has a cost that’s nearly $100 million higher than any of the company’s previous projects. Estopinal said that the firm’s work on the $185 million renovation and expansion of Union Hospital in Terre Haute, Ind., elevated TEG’s profile. Online Masters in Public Health named the project one of the Top 10 most architecturally impressive hospitals in the world.

“Word of mouth is pretty powerful,” the architect said.

Union Hospital in Terre Haute, Ind. was designed by TEG Architects. | Courtesy of TEG

Despite TEG’s experience in health care facilities, the Trinity project is presenting some unique challenges, primarily because of the climate in Minot, Estopinal said.

Minot is about an hour’s drive south of the Canadian border. The average low temperature in January is 4 degrees Fahrenheit, compared to Louisville’s 27. Minot’s average temperature is 42.1, about 16 degrees cooler than Louisville. It also gets 47 inches of snow every year, or about 34 inches more than Louisville.

“The climate here is very, very difficult,” Estopinal said.

He has visited the city when the temperature hovered near -27, excluding windchill. And it gets colder than that.

“The winters in Minot are brutal,” Estopinal said.

The firm has sought input from a specialist in Canada who is conducting thermal tests to make sure the walls can withstand the low temperatures.

“You can provide the best care in the world, but if they’re freezing inside, you’ve got a problem,” the architect said.

And, he said, many of the facility’s components — ceilings, pipe and duct work, showers — would be assembled far from Minot and then brought to the site.

“You’re able to do the construction in a more systematic manner and have high quality control that you just can’t out in the field,” Estopinal said.

Quality matters, not just from patient, employee and reputational perspectives, but in terms of dollars. TEG Architects is getting a fee for its services, but Estopinal said that if patient satisfaction scores fall below expectations, the firm could lose more than $500,000 of its fee.

“We want this thing to be really good,” Estopinal said.

TEG also designed Lynn Stadium for the University of Louisville. | Courtesy of TEG

He said the project also has provided great opportunities for some younger members of the firm to elevate their careers in health care design.

Kyle Wilson, a partner in the firm, told IL that the Trinity project’s complexity and climate required lots of coordination and precision.

For example, the harsh climate prompted TEG to make the walls thicker than normal, which allowed for the use of less powerful — and more efficient — heating equipment. The approach keeps heat inside, and potentially mold-inducing moisture out.

“Having that envelope tight is super important to us,” Wilson said.

Many of the facility’s areas have significantly different needs depending on their uses, from patient rooms to the trauma center and high-tech equipment ranging from ultrasound and computed tomography to magnetic resonance imaging. To design the areas properly, the architects broke the facility into small pieces and met with the people who would be using the spaces top make sure the design ideas aligned with the users’ expectations.

TEG’s preparation for the project included detailed volume analysis: How many MRIs did the hospital perform in the last three years and how many does it expect to do in the next five years? Wilson said the numbers provided guidance on the number of MRI machines the facility needs — or how it might adjust its hours of operation to satisfy the expected demand with fewer machines.

Another TEG project: Jeffersonville City Hall. | Courtesy of TEG

Estopinal, a Jeffersonville native and former Humana employee, said that from a size, complexity and climate perspective, the Trinity health project is offering TEG a unique opportunity to be part of a special project.

“For the next 25 to 30 years, our work is going to really save lives and improve the quality of health care that these folks realize in the upper plains,” he said. “For a bunch of men and women from Louisville and Southern Indiana, it’s quite a great accomplishment.