For decades, California lawmakers have worried about how hospitals will hold up in an earthquake. In 1973, legislators passed the Alfred E. Alquist Hospital Seismic Safety Act directing California hospitals to make sure they can withstand strong shakes expected soon. The U.S. Geological Survey puts the odds at 80% to 90% that a significant earthquake of 7.0 or higher on the Richter scale will hit Southern California in the next 20 years. There’s a 62% chance for such a quake in Northern California before 2030, according to the USGS.

Devastating earthquakes recently in Haiti and Chile refocused attention on hospital preparedness. A 7.0 quake — about the magnitude of Haiti’s quake — could wreak havoc on California’s infrastructure. An 8.8 quake — the size of Chile’s quake — would deliver more than twice the jolt of the Northridge quake in 1994 and more than three times the energy of the Loma Prieta quake in 1989 which brought down freeways, bridges and buildings in the Bay Area.

The rules — and deadlines — covering seismic safety of California hospital buildings have changed over the years.  In 1994, the Legislature amended the 1973 legislation to require hospitals to replace or retrofit the most at-risk buildings by 2013. Designated as Structural Performance Category 1, these buildings are considered hazardous and at risk of collapse or significant loss of life in the event of an earthquake.

Financially rocked by recession, hospitals sought relief from the expensive proposition of seismic upgrades. Last year, a new law was passed that delays state deadlines for hospitals to meet seismic safety standards until 2020 or 2030. That law could save California hospitals billions of dollars over the next several years, according to experts.

This year, another seismic safety bill, SB 289 by Denise Ducheny (D-San Diego), is working its way through the Legislature. SB 289 would further refine seismic regulations and hospital compliance.

We asked stakeholders to predict the seismic future for hospitals in California.  Will one more piece of legislation help solve the decades-old issue? What more can government and hospitals do to solve the dilemma?

We got responses from: 

• Roger Richter, senior vice president of the California Hospital Association
• Zenei Cortez, co-president of the California Nurses Association and National Nurses Organizing Committee
• Sue Currin, CEO, San Francisco General Hospital and Trauma Center
• LeRoy King and Steve Gilbert of St. Joseph Health System

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Balance Between Seismically Safe Hospitals, Access to Care

Roger Richter Senior vice president, California Hospital Association

Earthquake-compliant hospital buildings is a worthy public policy goal.  California’s hospitals support this goal, and considerable progress has been made.  The issue is not if hospital buildings should meet even higher seismic standards, but when and how the upgrades are financed and implemented

When SB 1953 was enacted in 1994, the estimated cost to comply with this unfunded mandate was $14 billion.  In the intervening years, however, that price tag has skyrocketed — and could be as high as $110 billion without financing costs by 2030.

SB 1953 is the largest unfunded mandate in the history of the state of California. At the same time, the ability of hospitals to pay for this mandate has declined sharply. 

Many hospitals and health systems that once were believed to be capable of financing seismic improvements have discovered that they can no longer afford to do so because of the recession.  Nearly half of the state’s hospitals are operating in the red, and several are on the brink of bankruptcy.

Additionally, the freezing of the credit markets and the increased costs of borrowing money mean that many hospitals cannot access the capital necessary to fund seismic projects. 

According to recent reports submitted to the Office of Statewide Health Planning and Development, it is estimated that up to 278 hospital buildings might not be able to comply with the current seismic mandate deadline of 2013/2015.  In many cases, these are buildings that house such basic hospital services as surgery, laboratory and pharmacy. 

Under current law, hospital buildings that don’t meet the 2013/2015 deadline will be forced by the California Department of Public Health to close their doors to patient care.  As a result, closure of buildings with these basic services may result in entire hospitals being forced to shut down.

Although several legislative and regulatory “adjustments” have been adopted over the past decade, most have either been limited in scope or approached from a “one-size-fits-all” perspective. The challenges in meeting the seismic mandate, however, are multifaceted and do not lend themselves to simplistic solutions. 

Legislation that incorporates a mix of options including compliance waivers and funding assistance is needed.  A case-by-case assessment of each hospital building and its surrounding infrastructure is essential. 

If highways, bridges, electricity, sewer and water systems, etc. are not accessible following an earthquake, having a seismically safe hospital building might be of limited use.

Policymakers should ensure that no hospital building is closed simply because it cannot meet an arbitrary compliance deadline.  Additionally, the state, in coordination with local public health officials and emergency medical services agencies, must make certain that each county has adequate “surge capacity” to respond in disaster situations. 

The infrastructure needs of local communities must be taken into consideration and balanced with the hundreds of millions of dollars that are being spent to make hospitals seismically safe.

We Should Not Continue To Gamble

Zenei Cortez Co-president, California Nurses Association/National Nurses Organizing Committee

We should not need the reminders of the catastrophic earthquakes in Haiti and Chile to recall the many fault lines that crisscross California posing a continual threat to life and property in our state, especially when it comes to the healing process for those in medical need following the shaking. 

But apparently too many in Sacramento do.

Hospitals collapsing or enduring severe structural damage in an earthquake is not just a foreign experience, of course, but one repeated over and over in California. Strengthening safety standards for our hospitals has been on the legislative docket since passage of the 1973 Alfred E. Alquist seismic bill to place seismic safety on the industry’s priority list for capital improvements and require them to plan accordingly. 

California’s hospitals have also been aware of this need since 1994 when new legislation was passed following another major quake in Southern California. That bill required hospitals to comply with seismic safety standards by a specific set of deadlines, starting in 2008.

Yet, to date, some 145 hospital buildings remain out of compliance with seismic safety standards, a total of 278 hospitals, factoring in projects that are “on hold.”

Sadly, at the behest of the California hospital industry, we have seen a series of legislative giveaways to big hospital corporations to avoid meeting the deadlines.

These have included SB 1661 — which authorized the Office of Statewide Planning and Development to grant an additional two-year extension of the Jan. 1, 2013, deadline — and a host of other special interest bills for the hospitals. 

The latest legislative gift, SB 499, grants hospitals who fail HAZUS reclassification an SB 1661 extension which allows hospitals an additional two years to comply, even though hospitals made the conscious choice to be re-classed by HAZUS.

In time, we fully expect the California Hospital Association to demand further concessions to grant the remaining non-compliant buildings a pass through some other legislative fix or manipulation of HAZUS risk factors. 

A hospital corporation’s failure to plan for future construction needs is no excuse to jeopardize the safety of patients and hospital employees in the event of an earthquake by delaying the deadline again.  As we have long said, if a hospital has not complied between 1994 and 2008, why do we believe they will comply in 2015, 2020, or in 2030? 

California’s nurses know firsthand the devastation that an earthquake can bring. As Haiti, Chile, and, the earthquakes in California should signal, the one building that Californians will most need standing following a serious earthquake is their community’s acute care hospital.

Coincidently, California’s disaster preparedness planning designates acute care hospitals as the point of service contact for the public. 

Nurses and other health care workers are at the front lines when devastation occurs. We cannot and will not be silent and allow legislators to continue to pass seismic extensions which permit many of California’s largest corporate chains to avoid their responsibility to make their buildings seismically safe.  The devastation is real, death is real and in a seismically active state as California, we cannot continue to gamble.

We Need Better Planning, Preparation

Sue Currin CEO, San Francisco General Hospital and Trauma Center

California is a place of superlatives.

It has been the biggest, the best, the first in many arenas such as health care, technology, entertainment, higher education and environmentalism.

Lately, we’re at the other end of the spectrum. Home to millions of uninsured and unemployed, vying for worst in education and prisons, grappling with a huge deficit, stripping-down our public services, with no end in sight.

Today we stand at a crossroads. What course will we chart? That’s the same question posed by the hospital seismic safety problem.

As the chief executive officer of the only trauma center in San Francisco, I know first-hand the critical — and universal — nature of emergency health care services. It doesn’t matter who you are.

If you live in, work in or visit San Francisco or northern San Mateo County, you could be our patient. A car or bike accident would bring you here, as would a violent crime, or fall at work or play.

We take nearly one-third of the city’s ambulance traffic. When the president comes to town, we stand ready to treat him. In an earthquake, fire, natural or man-made disaster, we are the first responder and the place that will care for the wounded.

So, should San Francisco General be seismically safe? Should we remain open and operational after an earthquake? We are fortunate that the people of San Francisco answered that question with a resounding YES when 84% of them voted in November 2008 to authorize financing of our new hospital.

Thanks to their support, we broke ground last October. Our $887.4 million project is good for the city’s future and the local economy right now, creating an estimated 3,000 jobs during construction.

Clearly, addressing the infrastructure needs of the community is a smart short- and long-term move. If we don’t, we risk the horrible price of human suffering and death, as the recent earthquakes in Haiti and Chile remind us.

Yet, right here at home our neglect in this area has led us to dilemmas like the one facing so many hospitals today. Which path to the future will we take?

If we want to be proud of California again, we need to engage in better planning and preparation for the days to come. That means recognizing their connection to the present.

OSHPD Needs More Resources

LeRoy King and Steve Gilbert Northern California Regional Director of Construction, St. Joseph Health System, and Vice president, Facilities and Construction, St. Joseph Health System, respectively

When California allowed hospitals that could demonstrate “diminished capacity” to extend seismic retrofitting deadlines from 2008 to 2013, St. Joseph Health System was among the first health systems in the state to apply for and receive that diminished capacity extension system-wide.

Today our health system averages 89% compliance with the 2013 seismic requirements across nine of our general acute care hospitals in California.  Six out of these nine hospitals have reached 100% compliance, including Santa Rosa Memorial and Petaluma Valley hospitals in Sonoma County. 

We are working to bring our remaining hospitals into full compliance by 2013/2015 in part by constructing new acute-care hospital buildings, which could be on a more extended timetable. 

In addition, several of the buildings in our inventory have been reclassified under the HAZUS process. With respect to SB 289, some California hospitals would benefit if this latest bill sponsored by Sen. Ducheny could expand on her previous bill, SB 306, which granted hospitals an extension from 2013 to 2020 provided they could comply with more stringent 2030 structural standards a decade earlier.

This would save hospitals from racing to retrofit by 2013 only to replace that work through reconstruction by 2030. Our health system facilities do not stand to benefit from such expanded provisions, but others in the state could. 

Additional language has been proposed for SB 289 that would allow further schedule flexibility for those hospitals actively working towards meeting the deadlines, which our health system would support.

Overall, the more time and flexibility the state affords hospital providers — who face widespread financial challenges and delays due to backlogs in governmental review processes — the more we will be able to maintain critical health services in the communities we serve.

Upon initiation of the review and permitting process, California hospitals pay permit fees directly to OSHPD, and these fees are determined by a given facility project’s construction cost.

Therefore, the governor needs to allocate sufficient resources to OSHPD to expedite the efficient plan review and field inspection processes required for seismic upgrades and building replacement projects.  OSHPD has been a very cooperative strategic partner in helping us upgrade and replace our facilities, but delays related to furloughs during the past 12 months to 18 months point to OSHPD’s need for more resources to speed project approvals and inspections so more hospitals can meet retrofitting deadlines. 

Hospital owners also need to be responsible in the plan submission process as many hospital systems in California have been late to initiate these retrofits, resulting in a bottleneck of permit requests pending with OSHPD that compounds the problem.