`Big is better' doesn't always work: Having seen things go awry before,
urbanists are skeptical about McGill Super-hospital
By: PIETER SIJPKES , Montreal architect
this opinion article appeared first in the Montreal Gazette
Saturday, February 3, 2001
Last month, 28 professionals, most of them planners and architects, issued a press release questioning whether abandoning five of Montreal's downtown hospitals for a single new facility would improve health care for the city's residents in the long run.
The McGill University Health Centre, responsible for the hospitals, has strongly favoured the new so-called ``superhospital'' on abandoned railway land near the Vendome metro.
From the beginning the MUHC has mounted a considerable public-relations effort to support the decision, from TV advertising to paid inserts in the Sunday Gazette, featuring partisan testimonials week after week.
Meanwhile opponents of the project have taken to daily newspapers' letters-to-the-editor columns, alternative papers and press releases. The latest stage in the debate is public hearings (the next two are on Wednesday and Friday) on what to do with the existing hospitals if the new facility goes ahead. The suggestion that grabbed the biggest headlines so far was an offer by an American developer to buy all the old buildings.
Despite the energy and ink expended, the question of whether to upgrade or to vacate has never been publicly scrutinized. This despite a recent poll by the magazine l'Actualite indicating that a majority of Montrealers as well as a majority of English and French medical doctors don't believe the move to centralized facilities is a productive way to improve health care.
While the 28 signatories to the recent opposing press release (published in the community newspaper Place Publique) are but a small percentage of the people questioning the MUHC's procedures so far, it is worth noting the number of planners and architects among them. Six of the signatories hold or held posts as directors of schools of architecture or planning at Laval, Universite de Montreal and McGill and many of the others are staff members.
Why so much opposition from this quarter? Because these professionals see parallels to the ill-fated but well-meant mega-projects of the past. They have spent a good part of the last 30 years evaluating what went wrong with large-scale buildings, which at one time were their professions' stock in trade. Many of them know from experience that what was being touted as ``state of the art,'' quickly became retrograde.
The debate about the merits of big vs. small and gradual vs. radical has been discussed by writers such as Jane Jacobs in The Death and Life of Great American Cities (1961), in Christopher Alexander's treatise A City is not a Tree (1965), and Robert Venturi's seminal book Complexity and Contradiction in Modern Architecture (1967). They all made clear that complexity and overlap is desirable and necessary in a city, while ripping out large parts of the urban fabric is usually costly, perilous and counterproductive.
The example of the Maison Radio-Canada comes to mind. A fortress-like tower surrounded by parking lots replaced hectares of perfectly serviceable housing. Then there was Victoriaville, a community at the entrance to the Victoria bridge, demolished to make way for an Expo 67 parking lot.
Luckily, Montreal is one of the few cities in North America where we have an above-average record in not fixing urban problems with the clean-slate approach. Housing-driven slum clearing has been rare. The 1958 Jeanne Mance housing project, by its modest size, was relatively benign. Cite Concordia (now called La Cite) was stopped before it could engulf all of the McGill ghetto. And thousands of small-scale public-housing projects have successfully been inserted over time into the city fabric.
This rather unheralded success story is based on learning from the large-scale fiascoes in the U.S. and Europe. A film showing 20-year-old high-rise blocks of the Pruitt Igoe development in St. Louis being blown up in slow motion is a standard fare in the education of architects.
No wonder one statement in particular in one of the recent MUHC infomercials raised a red flag to many planners and architects: ``Indeed, the very scope of this project (the MUHC) is one of its strongest points.''
The fact that a declining number of hospital beds are needed and that there is a trend toward miniaturization of equipment make the MUHC's current five facilities ideal candidates for restructuring. In this context, certainly some segments of an ensemble might be demolished or a new element added. Difficult access? An ambulance, taxi and bus lane can be created just as was done on the bridges and in downtown.
Health care for a large population presents planners with a complex equation. The idea that one - even well-planned - facility is a solution is as risky as putting your faith in a long-term weather forecast.
The 25-year gestation period of the new superhospital in Paris is ample witness to that. Its design and construction dragged on because no real stable ``solution'' could be found to a multitude of problems that cropped up during its construction.
The hospital is now open. Planners and architects are not surprised that there have been serious problems with the centralized computer systems, and that there has already been an outbreak of Legionnaire's disease. Population shifts in the past quarter-century have also made the location of the facility far from ideal.
The MUHC's budget escalation (before a brick has been laid), and serious problems with the site (before a spade of soil has been turned) are but the first signs of what I call the Robert Moses Method.
As parks commissioner of New York in the 1950s and '60s, Robert Moses got through big projects like this: use the first budget for the excavation, the second budget for the foundation and so on. Public funds will inevitably continue to flow on an unfinished building.
Jean Drapeau, despite his avant-garde housing policies, was himself a student of the Moses Method. We are still paying for installations we never needed: the Olympic pool is covered over for trade shows, the stadium is empty and the Velodrome houses monkeys. Meanwhile, the cutting-edge Molson Centre - remember the ballyhoo when it opened? - has gone from being a $250-million asset to a liability in five years.
Instead of pining over how to reuse the vast assemblage of hospital buildings, an in-depth analysis of the existing facilities - with all options open - is what is needed. This process should be followed up by a public discussion of all the options.
Time consuming? Yes. Messy? Yes, on occasion, because the real world is not a clinic, and restructuring long-established institutions brings up many issues (such as traditions, unions and clashing egos) that might seem intractable. But if done in a spirit of openness, the process has a greater chance of serving the public interest.
In the 1970s, Montreal architect Ray Affleck summed up his preference for an evolutionary approach to solving urban problems when he mused that ``the search for absolute efficiency may well be a death wish.''
-Pieter Sijpkes teaches architecture at McGill University.