88 



Each year about 9,000 patients come from all over the world to participate as in- 

 patients in clinical studies. Patients are referred by their physicians and selected for 

 admission to the CHnical Center because they have an illness being studied in one of 

 the research programs. Additionally, there are about 145,000 outpatient visits a year 

 to the Clinical Center's Ambulatory Care Research Facility (ACRF). All patients vol- 

 untarily consent to participate in NIH studies and are treated without charge. 



The Clinical Center's design places laboratory research side-by- side with patient 

 care activities. This design promotes scientific interaction and facilitates rapid transfer 

 of discoveries to patient treatment applications. No university, medical center, or hos- 

 pital can match the Clinical Center's intellectual resources, its depth of scientific 

 knowledge, or its concentration of laboratory space and research beds under one roof. 

 The NIH Clinical Center continues to be a world leader in technology transfer; that is 

 the ability to take an idea from the' lab directly to clinical trials. For example, NIH 

 scientists were the first worldwide to use gene therapy to treat human disease. The 

 first little girl who received the therapy just celebrated her third year of healthy life. 

 Additionally, successful use of taxol to treat ovarian and breast cancer, gene therapy 

 protocols for drug resistant breast cancer, and new treatment approaches to Ak- 

 neimer's Disease have all emanated from research in NIH's intramural program. 



With over 1.3 million square feet, the original Clinical Center opened in 1953 as 

 the world's premier biomedical research facility. Primarily through the addition of the 

 Ambulatory Care Research Facility in 1980, the Clinical Center Complex today con- 

 tains approximately 3.0 million square feet and houses over 2,000 research laborato- 

 ries and approximately 6,800 employees. 



Designed by the General Services Administration (GSA) in the 1940's, the Clinical 

 Center contained the latest innovations in research design and building technology. It 

 is important to remember, though, the speed with which both building and medical 

 technology has advanced - we were still using the iron lung when the cornerstone to 

 the Clinical Center was laid by President Harry Truman. 



Having been built in 1950, the Clinical Center by 1990 was 40 years old and 

 medical research had advanced astronomically. To begin to address changing medical 

 research needs, modernization and improvementprograms have been undertaken to 

 repair and upgrade the hospital's infrastructure. These include: the Essential Mainte- 

 nance and Safety Program, undertaken as an interim measure to improve conditions 

 and address the most critical safety issues in the Clinical Center Complex; construc- 

 tion of the Ambulatory Care Research Facility (ACRF); and, construction of the A- 

 wing of the Clinical Center for AIDS research. 



Current Status of Clinical Center Infrastructure 



The Clinical Center faces additional challenges. The major utility infrastructure 

 systems within the original building that provide critical electrical power, lighting, air 

 conditioning, ventilation, and plumbing are outmoded and do not have the flexibility 

 or capacity to meet current research demands. These systems are at the end of their 

 useful lives and are potentially unsafe for maintenance staff, employees and patients. 

 For example, fume hood exhaust systems, critical for the safe containment of hazard- 

 ous materials, cannot satisfy even current user demands. This situation has forced 

 NIH to impose a moratorium on adding fume hoods in individual laboratories in the 

 Clinical Center - a policy that severely impacts both current and future research capa- 

 bilities. Beginning in 1981, funds were appropriated for the Clinical Center Moderni- 

 zation Program to address the functional and architectural deficiencies within the 

 existing Clinical Center. In FY 1991, the Clinical Center Modernization Program was 

 reoriented to address life, safety and utility renovations, such as fume hood problems. 

 To date, we have invested $70 million toward an overall $143 million effort to correct 

 such problems. Of the $70 million, the majority was spent on correcting functional 

 and architectural deficiencies. 



Perhaps the most disruptive and costly impacts stem from seemingly minor repairs 

 and renovations. For instance, the simple knocking down of a partition wall to com- 

 bine two lab units in the Clinical Center is often a major undertaking. Asbestos is 



