Healthcare HVAC systems are among the most critical and capital intensive assets that influence patient safety, compliance, energy, and long term capital performance. This mechanical breakout examines how design, maintenance, and operational decisions affect HVAC reliability, asset life, and total cost of ownership. Attendees will review common deficiencies across air handling systems, cooling plants, condensing equipment, and building pressurization, including negative pressure conditions. The session highlights the financial and risk reduction value of preventive maintenance and connects system condition, deferred maintenance, and equipment assessments to capital planning equipment replacement and lifecycle optimization.