digital edition
Tom Bonner
Glass curtain walls and garden courtyards connect patients to the outdoors.


Palomar Medical Center

Escondido, California
CO Architects

Nature Nurtures: Evidence-based research on the integration of landscaping and high-tech medicine meet in a lush, resortlike California hospital.

By Greg Aragon
July 2013
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Medical centers for some time have seen the psychological and physical benefits of connecting clinical settings with the natural environment outside the hospital walls. Data gathered and evaluated shows convincingly that this connection reduces stress in patients, visitors, and staff. Last August, Palomar Health opened a new 11-story, $956 million facility in Escondido, California, a few miles from the Pacific Ocean, that sets a new precedent for integrating architectural design, program, and setting.


Location Escondido, California (Escondido Creek watershed)

Gross area 740,000 ft2 (68,748 m2)

Cost $956 million

Date completed June 2012

Annual purchased energy use (based on simulation) 242 kBtu/ft2 (2,750 MJ/m2), 7.5% reduction from base case

Annual carbon footprint (predicted) 48 lb CO2/ft2 (236 kg CO2/m2)

Program Emergency services, staff support, café, surgical rooms, patient care, outdoor areas


Aluminum curtain wall Shengxing Glass and Cladding Systems

Glass PPG Solarban 60, Solarban 70XL

Tubular skylights Solatube Model 750DS Daylighting System with OptiView Diffuser

View all team & sources

Palomar Medical Center
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Palomar Medical Center (PMC) is the 28th Pebble Project, a joint research effort between the Center for Health Design (CHD) and selected health-care providers. Pebble Projects are CHD's main research initiative. Their goal is to improve health-care facilities using evidence-based design to maximize patient care, environmental performance, and operational efficiency. So successful is PMC that CHD has acknowledged it as the first Fable Hospital (an ideal health-care facility) for incorporating a majority of evidence-based design findings into its program.

"The whole idea for this project is a high-rise hospital set in a garden that goes up through the building," says Frances T. Moore, an associate principal with CO Architects, the Los Angeles–based firm that designed the project.

Moore, who served as project architect on the 740,000-square-foot PMC, says the blurring of landscape and the built environment promotes healing through a series of gardens, trees, courtyards, and light wells that bring nature and daylighting to all 288 patient rooms, as well as operating and waiting rooms, nurses' stations, lobbies, and even the basement.

"The unique thing about this building is the access to nature and views and the fact that these were created in spaces that are normally reserved for staff," says Barbara Hamilton, LEED Green Associate and sustainability manager for the hospital.

One such space is the first-floor emergency department (ED), which sees 79,000 patients a year. Here the design team introduced a two-story atrium with large glass walls behind the main desk, so everyone entering can instantly see plants, trees, and available sunlight.

"In the last emergency department there were four white walls so the sound echoed, and there was a blaring TV," says Catherine Prante, Palomar's director of emergency services. "This area is now calm and soothing. We have sunlight that comes through, so not only is it wonderful for my staff that spend long hours here, it's also nice for patients and families."

Prante says the gardens also help "de-escalate" people coming through the ED and make it easier to work with them in a "dignified way." She says the new design has caused ED customer-service approval ratings to soar from below 10 percent to above 90 percent.

Above the ED is the Interventional Platform, or surgery and procedures floor, where daylight enters labs, corridors, and even the operating rooms through light wells and two garden atria. "The amount of daylight that is integrated into the deepest parts of the hospital is unique," says Moore. "Anywhere you are on this floor you have an immediate connection to the outdoors. I don't know of any other hospital project in the country that has this level of connection to nature from inside these clinical areas."

Skylights on an undulating 1.5-acre green roof filter light into the hospital's three-story glass atrium. Planted with more than 20,000 California drought-tolerant succulents, the roof has not only become a positive symbol for the healing process, but it also reduces ground reflectance and solar-heat gain in the tower's interiors and is integrated into the stormwater-management system. Landscape designers Spurlock Poirier planted roughly 900 trees and myriad gardens across the 37-acre site.

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