Kentucky, Indiana and Ohio at Forefront of Green Building in the Healthcare Industry

July 2010

Green building design, construction and operation practices have gained widespread popularity in the health care industry in recent years, even considering the current challenging economic climate.  This trend is likely to continue because green building practices result in both decreased overall life cycle costs and healthier building occupants.  Kentucky, as well as its neighbors to the north, are bearing witness to this fact, as local hospitals are either seeking or have recently attained LEED certification, and Kentucky-based health care companies are emphasizing green building in their out-of-state facilities as well. 

GreenBuilding Background

According to the United States Environmental Protection Agency (“EPA”), green building is the practice of creating healthier and more resource-efficient models of construction, renovation, operation, maintenance and demolition.  The leading vehicles for green building implementation in the health care industry are the Green Guide for Health Care (“GGHC”), a health care industry driven system that was created by the American Society for Health Care Engineering in 2002 and the Leadership in Energy and Environmental Design (“LEED”) rating system administered by the U.S. Green Building Council (USGBC).

Adapting GreenBuilding to the Unique Needs of Health Care Facilities

There are a number of unique challenges in accomplishing standard green building practices in health care facilities, including, among others:

As a result of these differences, green building standards for the health care industry have taken longer to develop than other uses.  Until recently, the health care industry generally relied on GGHC in designing, constructing and operating a green building.  The GGHC is a voluntary self-certifying program that borrows from, but is not formally connected to the LEED rating system.  In a manner similar to the LEED system, GGHC gives a certain number of “credits” for each environmentally-friendly and energy-efficient characteristic incorporated into a building.  GGHC includes metrics for both construction and operations, which allows it to be used for existing facilities as well as new construction.  Because GGHC is a self-certifying system, health care entities who wish to use it must vouch for their own compliance with the program.

The LEED system, with its four levels of certification (Certified, Silver, Gold and Platinum), is the most well-established green building standard.  It certifies projects under the following certification regimes: new construction (LEED New Construction (“LEED NC”)), substantial renovations (LEED NC), minor renovations (LEED Operations & Maintenance (“LEED O&M”)), facility operations (LEED O&M) and leased space (LEED Commercial Interiors (“LEED CI”)).  It is also a third-party certification system, so in contrast to GGHC, it is a more rigorous and meaningful enforcement of green building standards.  Some health care facilities have elected to invest the extra time, money, and effort required for LEED certification. 

There are currently less than 40 other LEED-certified health care facilities of any type across the country.  The Boulder Community Hospital in Boulder, Colorado was the first hospital to be LEED certified, in 2003.  Jewish Hospital Medical Center South in Louisville, Kentucky was among the first to follow in 2006.  Indiana followed in 2007 with the Madison State Hospital Buildings 2, 21 and 31, and hosts a total of five LEED-certified hospital buildings.  Ohio follows with three LEED-certified hospitals.  Indiana, Kentucky and Ohio therefore account for 20 percent of the nation’s LEED-certified hospitals, all beating enviro-conscious California to the punch, which only recently witnessed its first LEED certification for a hospital on June 26, 2010, with the Laguna Honda Hospital and Rehabilitation Center in San Francisco. 

Despite a modest number of currently-certified LEED hospitals, there are approximately 350 hospitals that are currently under construction which are LEED-registered, indicating a desire to achieve LEED certification upon completion.  Kentucky hospital projects underway that are so registered are Kosair Children’s Medical Center (Brownsboro), Baptist Eastpoint Cancer Center, and Norton Brownsboro Hospital, all in the Louisville Metro Area.  In addition, Norton’s new Cancer Institute Radiation Center in Downtown Louisville, just under construction, has announced intent to seek LEED certification, as has Owensboro’s 780,000-square foot Medical Health Center, which just broke ground in June 2010. 

Luckily, for those looking for something more rigorous than the GGHC, but more tailored to health care than general LEED certification, the USGBC will soon issue a new LEED for Health Care rating system.  The new certification system will incorporate feedback from pilot projects that used GGHC and will be open to a public comment period before being officially implemented. 

Choices and Challenges

Those who are beginning the planning process for green health care facilities have three possible paths to choose from at this point: they can wait until LEED for Health Care is rolled out, use traditional LEED, or use GGHC.  All of these choices have positives and negatives: LEED for Health Care will likely become the new industry standard, but its exact requirements are not yet clear, so health care entities might have to delay their projects or could be taking a risk by committing themselves to a program under which they may not be able to obtain certification; traditional LEED is rigorous and well-recognized, but may impose unnecessary costs and difficulties when applied to the health care sector; and GGHC has clear metrics that are already tailored to health care construction and operations, but does not carry the same weight as LEED because it is a voluntary, self-certifying system.

There are certain actions, no matter what green building rating system decision makers elect to utilize, that health care facility decision makers must take in order to limit unforeseen cost, risk and liability.  It is important to make green building goals clear and specific early in the planning process.  A team of experienced professionals (architects, construction managers, contractors, lawyers and others) with quantifiable experience on past GGHC or LEED certified projects is also highly recommended.  These experts will be able to properly guide property owners with the unique issues that arise in connection with green building and thus help mitigate further risk. 

There are multiple legal risks in connection with green building that should be considered.  A small sample of these issues are as follows:

There are innumerable other legal issues associated with green building and leasing.  As this is an emerging area, it is important to work with professionals in order to avoid unnecessary liabilities when “going green.”


Green building design, construction and operation practices are likely to continue at an exponential growth pattern in the health care industry in the years ahead.  It is critical for facility owners, managers and stakeholders to fully understand the unique issues that arise for green building in the health care arena and work with a team of professionals that can help advise and minimize the risks associated therewith.

This article is published with the permission of Consilience, the blog of the Institute of Green Professionals.