As a healthcare architect specializing in access compliance, I receive this question a lot. In many cases the question comes with a sense of outrage that OSHPD has gone out of bounds. Let me answer this question first, and then provide some explanation and history.

As a healthcare architect specializing in access compliance, I receive this question a lot. In many cases the question comes with a sense of outrage that OSHPD has gone out of bounds. Let me answer this question first, and then provide some explanation and history.

The implication of this is huge. The text that was developed by OSHPD for the 2013 CBC 11B-805 includes the following subsections:

  • 11B-805.1General
  • 11B-805.2Patient bedrooms and resident sleeping rooms
  • 11B-805.3Waiting rooms
  • 11B-805.4Examination, diagnostic and treatment rooms
  • 11B-805.5Patient change areas
  • 11B-805.6Handwashing fixtures, lavatories and sinks
  • 11B-805.7Built-in cabinets and work surfaces

The specific requirements within these subsections take accessibility requirements to a whole new level. Let me provide two examples:

  • 11B-805.4.1 Beds, exam tables, procedure tables, gurneys and lounge chairs. “A 36-inch minimum wide clear space shall be provided along the full length of each side of beds, exam tables, procedure tables, gurneys and lounge chairs.”
  • 11B-805.6 Handwashing fixtures, lavatories and sinks. All handwashing fixtures, lavatories and sinks shall comply with Section 11B-606. (Accessibility requirements for lavatories and sinks).

With the understanding that 11B-805 does indeed apply to medical office buildings, there is a whole new set of requirements that profoundly affects the design, construction, and code compliance efforts of medical office buildings.

Connecting the Dots

The code-based explanation of why this is our new reality starts in Division 2 Scoping. Specifically, let’s look at scoping Section 11B-223 “Medical care and long-term care facilities”. The heading is “Medical care and long-term care facilities”. The very first line in this section is:

“11B-223.1General. In licensed medical care facilities and licensed long-term care facilities where the period of stay exceeds 24 hours, patient bedrooms or resident sleeping rooms shall be provided in accordance with 11B-223 and 11B-805.”

This throws some readers into a false notion that the entire section 11B-223 is all about ‘licensed’ facilities ‘where the period of stay exceeds 24 hours’. They frequently argue that a medical office building is not a ‘licensed’ facility, and they do not have periods of stay that exceed 24 hours... therefore, this whole section doesn’t apply to medical office buildings. That is not true. It simply happens to be the first subsection. In reality, Section 11B-223 covers ‘medical care and long-term care facilities’, whether the period of stay is over or under 24 hours. As we see in the subsections of 11B-223, it covers:

  • 11B-223.1General (licensed facilities, exceeding 24 hour care, patient bedroom requirements)
  • 11B-223.2Hospitals, rehabilitation facilities, psychiatric facilities, and detoxification facilities
  • 11B-223.3Long-term care facilities
  • 11B-223.4Professional offices of healthcare providers

For the purposes of this discussion, it is the 11B-223.4 line item that provides the ‘smoking gun’ proof. This is where the code specifically addresses medical office buildings, albeit, using the term ‘professional offices of healthcare providers’. The text of 11B-223.4 is one simple sentence:

  • 11B-223.4 Professional offices of healthcare providers.Professional offices of healthcare providers shall comply with Section 11B-805.

Voila ! The code specifically requires ‘professional offices of healthcare providers’ to comply with 11B-805.

An important, but somewhat obvious point needs to be made here: Yes, when we talk about ‘medical office buildings’ they are essentially the same thing as the ‘professional offices of healthcare providers’. Technically, they aren’t exactly the same thing, but when discussing the implications, we end up with the same result. For the sake of accuracy, a medical office building is just a building, and as such, it could be viewed as a generic, non-medical office building. Once a tenant is defined as a ‘medical provider’, then section 11B-223.4 is applicable. For the purposes of this discussion, it is understood that when we talk about ‘medical office buildings’, we are talking about the specific tenant space of a medical provider.

Medical Care Facilities

Some would argue that the code does not define ‘medical care facilities’ and that it is therefore a little unclear what types of facilities are covered under 11B-223. As it turns out, ‘medical care’ is defined in the 2013 CBC in Chapter 2, Section 202:

“Medical care. Care involving medical or surgical procedures, nursing or for psychiatric purposes.”

Thus, a ‘medical care facility’ would be a facility in which ‘medical care’ is provided.

Professional Offices of Healthcare Providers

To me, the ultimate ‘proof’ is simply in the non-technical understanding of the term ‘professional office of healthcare provider’. Is the office space intended for people to go seek medical advice or treatment? Do we fully expect that doctors and nurses will be practicing there? Are the people that deliver this advice and/or treatment somehow licensed or certified to practice in the State of California?

If the answers are yes, then I would have an awfully hard time standing before a judge trying to explain why the offices of a medical practice that we are discussing is somehow not a ‘professional office of a healthcare provider’.

History

For those that wonder, how did this come to be? The 2010 CBC did not have these requirements, but the 2013 CBC does... what changed, and why?

There is a logical explanation that can be described as three independent actions:

  1. DSA carried forward the 2010 text of 1105B.3.2 For many years, medical office buildings have fallen under the Section 1105B.3.2 of the CBC, and DSA simply carried it forward for adoption in the 2013 CBC, relocating it to Section 223.4

    The 2010 text reads as follows:
    1105B.3.2 Business and professional offices. Areas to be made accessible include the following:
    1. Client and visitor areas and office areas, together with related toilet rooms.
    2. Conference rooms, counseling rooms or cubicles and similar areas
    3. Employee work areas shall have a minimum of 36-inches clear width access, except as modified in other portions of these regulations. See 1133B.6.1 and 1133B.6.2.
    4. Professional medical and dental offices shall be made accessible and shall also comply with Section 1109B.

    Section 1109B was the “I” occupancy code section that has unofficially been the ‘OSHPD’ section and contained all OSHPD-driven “I” occupancy access requirements.

    DSA effectively lifted the 2010 Section 1109B.3.2.4 as it has existed for a long, long time, and re-inserted it in the 2013 CBC at the most logical place that there is in scoping... Section 223, and created a sub-number 4 (which does not exist in the ADA version of 223). Especially note that the ‘pointer’ to the ‘OSHPD’ section (previously 1109B, now 11B-805) has always been there.

    The reality has been that the 2010 CBC version of 1109B had nothing in it of any consequence to medical office buildings. They were ‘pointed’ to a section that had no real impact to them. That has now changed.

  2. DSA now uses the term ‘professional offices of healthcare providers’. In what I assume was a DSA effort to standardize the code language, DSA changed the term from ‘professional medical and dental offices’ to ‘professional offices of healthcare providers’. I believe this to be an effort to align with the elevator exception language of 11B-206.2.3 Exception 1.1 which speaks to the issue of not needing an elevator in specific multi-story office buildings…except when it is the “professional office of a healthcare provider”. I believe this change to be inconsequential.
  3. OSHPD Proposed Big Changes for the 2013 CBC. While DSA made every effort to remain access-neutral in the re-formatting efforts of the 2013 CBC, OSHPD cut across the grain, and proposed some substantial changes in what had previously been an ‘I” occupancy section of code (1109B). The changes were not access-neutral, and in my opinion expand the accessibility requirements in an unprecedented way.

    As most of you know, under California law, DSA has the responsibility to develop access language for non-residential uses. Therefore, the OSHPD proposal had to be worked into the DSA framework for the newly formatted 2013 CBC. DSA choose to accept the OSHPD proposal despite its non-neutral expansions, and placed the new language quite logically in 11B-805.

Conclusion

For well over a year now, I have participated in countless discussions regarding this topic. Each time that an architect, building official, or building owner encounter these requirements for the first time, there is a massive “OMG! This can’t possibly be!” These discussions often include nearly-desperate questioning of the code language and intent. Unfortunately, as much as I would like to come to a different conclusion…this is our new reality. 11B-805 does indeed apply to the ‘professional offices of healthcare providers’. Not just in my opinion, but also in the opinion of both DSA and OSHPD.

Bill Zellmer is a California licensed architect and certified Access Specialist with over 30 years of professional experience in various capacities including:

  • Architect performing barrier removal work (2009-2012)
  • Accessibility field surveyor (2010-2014)
  • OSHPD Senior Architect (1995 – 2009)
  • Sutter Healthcare in-house accessibility expert (2014-2015)
Submitted by Bill Zellmer