The future location for this tower is located immediately adjacent to the emergency wing of the existing St. Joseph’s hospital in Hamilton, Ontario. HCM is a recognized shoring contractor that will take on many challenges relating to foundation design. On this particular project, HCM took on the tasks of shotcrete shoring, caissons, micropiles, excavation, site services, and demolition with the constraints of limited access and project complexity. A portion of the work was to be performed indoors, which required special care towards the patients of the hospital and the HCM workers. The original design for this inside work included conventional pad footings dowelled in to existing caissons five feet below the finished floor. The soil conditions are unique on this project due to the fact that the site is situated at the bottom of the Niagara Escarpment where bedrock is on an incline. This increased the depth required for adequate bearing stratum, requiring the entire area to be excavated and the perimeter shored. To save costs to all parties involved, HCM proposed an alternate to the original design to provide hand-dug caisson caps around the existing caisson and column construction. Caissons were excavated to depths of 18 feet below the finished floor using reinforced compression rings and shotcrete shoring to reach adequate bedrock. The above innovations were the optimal solution for this portion of work resulting in another successful hospital project by HCM on budget, on time.