Hi-Desert Medical Center (HDMC), a 59-bed primary care hospital in Joshua Tree, Calif., currently provides basic emergency services, onsite radiology, laboratory, intensive care unit, surgical services, a birthing center, cardiopulmonary, infusion services, and state-of the-art diagnostics services to more than 53,000 people within a 1,800-square-mile area. Hi-Desert Memorial Health Care District hired Moon Mayoras to design expansions to the hospital’s Critical Care and Women’s Services Centers to accommodate a growing need for care in the Morongo Basin, including Twentynine Palms to the east and Yucca/Morongo Valleys to the west.

HDMC currently features four ICU beds in an obsolete single ward configuration, which do not accommodate the needed volume of critical care positions, thus resulting in significant outmigration to other facilities. In addition to the bed shortage, the four-bed ward design presents one of the worst ICU configurations based on current critical care standards, and creates concerns by HDMC over both patient safety and infection control. The ICU expansion will provide additional single-occupancy inpatient beds to meet the required capacity while allowing for segregation of medical and post-operative surgical critical care for increased infection control.

The Critical Care Expansion rooms were designed with built-in sleepers and additional space to accommodate overnight stays. The design also designates ICU family waiting areas for larger numbers of extended family members—an important consideration for the surrounding demographic.

HDMC has identified women’s service growth as a strategic market initiative. The facility, which currently employs a four-bed LDRP room model, is currently experiencing more than twice the number of annual births than when the facility was first opened in 2000, and is anticipated to incur a substantial increase in the future as a result of physician recruitment efforts for that service line. MMA’s Women’s Services Center expansion design will replace the existing Labor/Delivery/Recovery/Postpartum (LDRP) rooms with a new eight-bed LDRP unit that will provide patients with increased comfort and privacy. This expansion will also feature a second dedicated cesarean section (c-section) room, which will eliminate the impact of unscheduled c-sections on the surgical operating room suite.

The LDRP rooms were designed with the entrance at the headwall side of the room opposed to the footwall to increase patient privacy from the corridor and the room entrance during delivery. This layout grants easier patient access to window views located off-center at the footwall without requiring her to turn her head sideways as is customary in a conventional patient room. This feature provides great benefit to long-term antepartum patients who may reside in this same room for several weeks.

While performing functional space programming to determine the most efficient design to meet HDMC's project objectives, MMA discovered a means for accommodating supplemental capacity in the future to meet long-term growth without incurring additional building costs. MMA’s LDRP Expansion design can be converted from an LDRP model of delivery to a Labor/Delivery/Recovery (LDR) concept to provide capacity for 70 percent growth well after completion of the Critical Care and Women’s Services Expansion project.

The exterior of the Critical Care and Women’s Services Expansion was designed to match HDMC’s existing split-ribbed concrete masonry unit (CMU) façade. By mirroring the existing exterior, originally designed using the late 1960’s-era modernist desert vernacular prevalent in the high desert communities, the expansion design creates continuity and a seamless appearance between the existing facility and new additions.


Joshua Tree, California

Square Footage


Construction Cost


Project Year

2017 (est.)

Major Publications