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Alta Bates Summit Medical Center, a 1,094-bed medical center in Berkeley, CA, built in the 1960s, was in great need of additional space. The hospital's emergency department (ED) was bursting at the seams while the radiology department was rapidly shrinking. The facility also needed to upgrade the building to meet the Americans with Disabilities Act requirements and California state laws that mandate earthquake-resistant construction. But when it decided that expansion was the best course of action, it faced opposition from some vocal neighborhood residents who feared that a bigger ED would bring more ambulance traffic, disrupting the neighborhood with noisy vehicles and sirens.