Among the researched and reported articles and news items throughout the pages of Behavioral Healthcare magazine and Behavioral.net, behavioral health professionals have an opportunity to share their thoughts, opinions and expert advice through blogs. Each of our bloggers has a niche of the field that they tend to center their topics around – fundraising, facility design, leadership, technology, etc.
One of Behavioral Healthcare’s bloggers is James "Jim" Hunt, AIA, a practicing architect and facility management professional with over 30 years of experience. His blogs share insights into facility design and safety.
To get to know each of our bloggers a little better, we asked them to reflect on the following question:
“What was the most important/toughest personal or professional lesson you ever learned? When and how, or from whom, did you learn it? And, how did that lesson change you or the way that you work or lead life?”
Jim: The most important personal/professional lesson I ever learned was that it doesn’t matter what the code book, regulation or law says, it is ALWAYS open to the interpretation of a person and that person can make it say anything they want.
This lesson began in the late 1970’s and was fully impressed upon me in 1981. I was a member of a design team that was creating a 166 bed, new construction replacement hospital for a private, non-profit mental health organization. The first paragraph of the New Construction chapter of the National Fire Protection Association’s 101 Life Safety Code for institutions clearly stated, in essence, that if patients were capable of self-preservation in an emergency, the building could be designed under another chapter of that code document.
In the hospital’s opinion, their patients were capable of self-preservation in an emergency. All were ambulatory, the hospital maintained, adding that even suicidal patients would likely be the first persons out of a burning building because of their need to be in control of the circumstances of their own demise. Several outside experts were consulted and written agreement with the self-preservation provision was provided by state and national psychiatrists, as well as other professionals. There was even a letter from a Joint Commission staff member. (We were later told that that person was a temporary employee who did not have the authority to sign that letter.)
As a result of this documented, expert opinion, the patient living unit portions of this project were designed according to the “Residential” requirements of the NFPA 101 Life Safety Code.
By early 1981, everything was progressing well and the buildings were about 90% complete. The hospital was undergoing its regular tri-annual survey by what is now known as The Joint Commission. The surveyor was trying to get the organization to make some changes to its existing structures, while the hospital was resisting because those buildings were to be abandoned in about 9 months. The surveyor then asked to see the new buildings and was given a tour. Almost immediately, the surveyor stated that The Joint Commission would not accredit this facility as a hospital because it did not comply with the Institutional Chapter of the NFPA Code.
Eventually, a very complex solution was devised. It involved a number of physical changes, a series of revisions to fire separations, and a very complicated “tip-toe” through the code that required the granting of several “equivalencies” regarding specific design details. These efforts enabled the project to be completed as a hospital and operated for many years.
At the end of a meeting at The Joint Commission’s headquarters, after the design equivalencies had been granted, I commented that even though the buildings did not fit a strict interpretation of the Code, I was professionally very confident that the buildings were safe. I added that, in the event of an emergency, there was a significantly higher likelihood that everyone would be able to escape them safely than other buildings I had designed that were much more “code compliant.”
The buildings functioned as a psychiatric hospital for over 20 years. And, although a number of potentially serious incidents occurred over that time – including at least two occasions when portions of these buildings were filled with dense smoke – there was never a single injury or life lost due to fire or emergency.
I always found it interesting to observe architects, engineers, and code authorities as I toured them through these buildings. I enjoyed watching to see how knowledgeable they were about the code. Some would start noticing things immediately and eventually ask, “How did you get by with this?” Other, less knowledgeable professionals would view a feature, then simply nod or comment on how nice the feature looked.
Through the years, a number of surveyors said that the building’s design equivalencies never should have been granted and that the facility would not be able to use them forever. The buildings were vacated a few years ago and have since been demolished, so this story can now be told.
The lesson I learned, which served me well throughout my 40-plus year career, is that the most important factor in successful completion of a project is not just to “know the codes,” but to know the interpretation of codes and regulations that is held by the “Authorities Having Jurisdiction” (AHJ). Today, when I consult on the design and construction of behavioral health facilities in the US and Canada, I always caution my clients to verify everything with the appropriate regulatory authorities.