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Alta Bates Summit Medical Center, a 1,094-bed medical center in Berkeley, CA, was in great need of more space in its emergency department (ED). But when it decided that expansion was the best course of action, it faced opposition from some vocal neighbors. In the end, the hospital received permission to build, thanks to a strong communications effort bolstered by already-fostered community support. The hospital, whose buildings were constructed in the 1960s, found its ED bursting at the seams and its radiology department using less and less space. The facility needed upgrading to meet the Americans with Disabilities Act requirements and California state laws that mandate earthquake-resistant construction.