Expert Witness in Ambulatory Surgery Center Design and Construction
Bernstein & Associates, Architects, through its principal William N. Bernstein, AIA, has provided expert witness services in matters involving the design and construction of ambulatory surgery centers (ASCs), office-based surgery practices, and related properties. Attorneys litigating cases that involve construction defects, operating room and procedure room design and air-handling problems, infection-control and ICRA failures, medical gas and emergency power problems, sterile processing and instrument reprocessing workflow defects, scope reprocessing room and decontamination area design issues, recovery (PACU and Phase II) area design problems, accessibility violations, fire safety and egress issues under the applicable occupancy classifications, water infiltration and building envelope failures, tenant fit-out disputes in medical office buildings housing ASCs, licensing and certificate-of-need disputes affecting design, phased-construction and occupied-renovation problems, and other claims related to the design and construction of ambulatory surgery centers require an expert witness architect who understands both the applicable building codes and standards and the practical realities of how those requirements are applied in the design, construction, and renovation of real ambulatory surgery centers.
About Ambulatory Surgery Center Design and Construction
Ambulatory surgery center design and construction encompasses a range of outpatient surgical facility types, including multi-specialty ambulatory surgery centers, single-specialty ambulatory surgery centers (orthopedic, ophthalmology, gastroenterology/endoscopy, ENT, plastic and cosmetic surgery, pain management, oral and maxillofacial surgery, and others), office-based surgery (OBS) practices, hospital-based outpatient surgery departments, endoscopy centers, and the support spaces that serve them, including operating rooms, procedure rooms, pre-operative areas, recovery (PACU and Phase II) areas, sterile processing departments, scope reprocessing rooms, soiled and clean utility rooms, medical gas storage, and staff and patient support spaces.
The design and construction of ambulatory surgery centers is governed by a complex framework of technical standards, including the applicable building code (for example, in New York City, the New York City Building Code), the International Building Code, ICC A117.1, NFPA 101 Life Safety Code, NFPA 99 Health Care Facilities Code, ASHRAE 170 ventilation standards for operating rooms and procedure rooms, ADA requirements, the FGI Guidelines for Design and Construction of Outpatient Facilities, CMS Conditions for Coverage for Ambulatory Surgical Centers, AAAHC and Joint Commission accreditation standards, AAMI ST79 standards for sterile processing, and state and local department of health requirements such as those administered, in New York, by NYSDOH (including Article 28 licensure requirements) and, for office-based surgery, by the AAAASF, AAAHC, or Joint Commission accreditation required by New York Public Health Law § 230-d.
Disputes commonly arise over construction defects affecting building envelopes, interior finishes, and specialty clinical spaces; infection-control failures and ICRA non-compliance during phased construction in occupied medical office buildings; operating room and procedure room air-handling, pressurization, humidity, and temperature control problems; failures of medical gas, vacuum, waste anesthetic gas disposal (WAGD), and emergency power systems; sterile processing workflow defects including non-compliant separation of soiled and clean functions and inadequate decontamination room pressurization; scope reprocessing room layout and ventilation deficiencies; non-compliant accessibility features; inadequate fire-rated assemblies and egress under the applicable occupancy classifications (Ambulatory Health Care under NFPA 101, and Business or Institutional under the IBC depending on the level of care and number of patients incapable of self-preservation); tenant fit-out and landlord-tenant matters in medical office buildings; licensing and certificate-of-need issues affecting room counts, room sizes, and design features; and disputes arising from phased-construction and occupied-renovation projects in operating ASCs. Responsibility for compliance with the applicable standards is shared, in different ways, among the ASC operator, the landlord, the design professional, the contractor, subcontractors, specialty vendors, infection-prevention staff, and the party responsible for ongoing maintenance, and litigation in this area frequently turns on the allocation of responsibility for design decisions, construction means and methods, and post-occupancy maintenance.
Expert Witness Services Related to Ambulatory Surgery Center Design and Construction
Expert witness services in ambulatory surgery center design and construction matters typically include a careful review of the project documents (drawings, specifications, submittals, RFIs, change orders, permits, certificates of occupancy, ICRA plans, ILSM plans, department of health filings and approvals, certificate-of-need approvals, accreditation survey reports, commissioning reports, operating room air balance reports, and as-built conditions), a site survey to measure and document the conditions at issue, comparison of those conditions against the applicable building codes, life safety codes, healthcare facility guidelines, accessibility standards, and industry standards of care, review of construction administration records and maintenance histories, and the preparation of clear, well-supported opinions regarding the cause of the defect or failure, the responsibility of the various parties, and the standard of care applicable to the design, construction, and maintenance of ambulatory surgery centers.
An effective ambulatory surgery center design and construction expert witness must be able to explain technical requirements — operating room and procedure room air-handling and pressurization, infection-control and ICRA requirements, sterile processing and scope reprocessing workflow and ventilation, medical gas and emergency power design, fire-rated assembly construction, egress geometry under Ambulatory Health Care and Business occupancy classifications, accessibility clearances, recovery area design, and building envelope detailing — in plain language to judges, juries, arbitrators, and mediators, and must have the credentials, written record, and courtroom-ready communication skills to render credible opinions.
Mr. Bernstein is a Yale-trained, NCARB-certified, LEED-accredited, registered architect. He has expertise in architectural design, engineering design, and construction as the founder/owner of an architectural firm, Bernstein & Associates, Architects, (1990-present) and as the founder/owner of a construction project management firm, Empire Projects, Inc. (2003-Present). He has been the expert witness (as of May 2026) on (40) cases involving design and construction (2006-present) across the United States and Internationally.
Mr. Bernstein’s ambulatory surgery design experience spans multi-specialty and single-specialty ambulatory surgery centers, office-based surgery practices, hospital-based outpatient surgery departments, and pain management facilities, including new construction, renovation, and conversion of office-based surgery practices to licensed ambulatory surgery centers. This depth of hands-on architectural design experience — from program development, code analysis, and department of health filings through construction administration and commissioning — provides the technical foundation needed to render credible expert opinions on ambulatory surgery center design and construction disputes.
Contact
Please contact Bernstein & Associates, for expert witness services related to the design and construction of ambulatory surgery centers.