In the aftermath of the 1994 Northridge earthquake, legislatures moved swiftly to establish strict standards to regulate the safety of hospitals. The idea was to ensure that medical facilities would withstand future quakes and remain open to treat injured people. Buildings would be examined and those that didn’t pass muster would have to be fixed or torn down and replaced. It would be a building program on massive scale an estimated $50 billion overall all the while medical facilities would stay open. It would also be against the clock, with a hard deadline of 2030, not to mention the threat of a future quake looming large at every turn. It is an ambitious plan, and as of last year, $10 billion in hospital planning and construction were underway statewide, according to the Office of Statewide Health Planning and Facilities Development Division, the state agency supervising the transitions. There’s just one problem: not a penny of that $50 billion comes from the state. Instead, facilities have been forced to come up with the cash or face shutting down. “The cost of unfunded mandates such as the earthquake retrofitting in the state of California is billions of dollars,” said Kerry Carmody, administrator for the 254-bed Providence Holy Cross Medical Center in Mission Hills. “We have to pay for it.” A history of quakes Ever since the Long Beach earthquake of 1933 sent buildings tumbling and killed 115 people, the California State Legislature and various municipal governments have rushed legislation to require certain seismic standards in public buildings. The Field Act, passed after the Long Beach quake, set standards for schools and public buildings. After the 1971 Sylmar earthquake in which a hospital collapsed, the legislature passed the Alfred E. Alquist Hospital Seismic Safety Act, which requires new hospitals to withstand major earthquakes. Old buildings, however, were grandfathered in and the legislature amended the Alquist Act in 1994 following the Northridge earthquake. The new rule required that every hospital building in the state be inspected for structural deficiencies. In response, officials from the state’s 442 acute care facilities in the late 1990s used an 11-article evaluation procedure to scrutinize more than 2,000 campus buildings for structural stability and safety issues. Because hospitals often grow in spurts with new buildings rising alongside dated buildings still in use, many campuses had structures deemed perfectly safe right beside dangerous buildings threatening to fall over. Thirty-seven percent of buildings examined were found to pose significant risk to the public and could collapse; some 175 hospital buildings were safe, but could pose a threat in a big quake. To fix the problems, the state established a series of deadlines. The first deadline was Jan. 1, 2002, in which all hospital emergency systems had to meet code. That meant upgrading communication, power, gas and alarm systems. The second will be in 2008 and requires the hospitals with significant risk to meet certain seismic standards and structural bracing, such as ducts and elevators, with some extensions available to as late as 2013. It essentially stipulates that all hospital buildings have structural integrity and will not collapse in a temblor. The final deadline is 2030, in which all of the standards, regardless of extensions, must be met in other words that all hospitals both remain in tact and operational after a major quake. A bill passed by the legislature this fall would allow some hospitals that have started retrofits but fell short because of delays or material shortages an extension to 2015. Fix it or risk it? The staggered deadlines have caused a rift in the medical world about how to tackle the issues: fix an existing building, build a new one, risk closure or hope that the state will change the deadlines. Already every hospital in the Valley has asked for extensions. Others are struggling to find money. “To continue running, we’ll have to find ways to finance it,” said Carmody the administrator for Holy Cross, which is “99 percent” compliant with state standards, save for a few upgrades of the hospital’s physical plant. Still, as part of the Providence Health System chain, which also owns Providence St. Joseph Medical Center in Burbank, funding wasn’t as large of an issue for Holy Cross than if it were a small medical facility. The hospital is bond financed and is helped by philanthropy. Such community donations paid for the hospital’s new $7.5 million emergency room. It also helped fund the fixes at Providence St. Joseph Medical Center, which is tearing down its faded hospital building on the northeast side of its campus at Alameda Avenue and Buena Vista Street and replacing it with a $71 million patient care tower. For the rest of the campus, crews have been working to bring the existing building up to regulations, said hospital spokesman Dan Boyle. “Right now, we’re completely up to standards.” Officials at Kaiser Permanente are taking a similar tact for its aging facility in Panorama City, which is being replaced by a new, 400,000-square-foot hospital, said Virginia Baca, a hospital spokeswoman. Seismic concerns have also prompted Northridge Hospital Medical Center to retrofit one of its structures and replace two others. The $26 million project includes adding concrete walls in the basement and sheets of steel to its primary diagnostics and core building, which houses the radiology, surgical, pharmacy and surgery department, said Ron Rozanski, vice president of operations. The construction, which started in July 2005, will bring the structure up to the state-required seismic standards when it opens in December 2007, Rozanski said. The hospital is also poised to replace two buildings that do not meet seismic standards. Rozanski said it was determined to be far cheaper to build a new structure versus fixing the old ones. “In strengthening an old building, it really is quite costly,” he said. “Then you have the second problem of disrupting your hospital activities.” Rozanski, who has worked in the healthcare industry for 30 years, said one of the major challenges of the current retrofitting work is coordinating the crews to minimize impact on the existing facility. “I’m having to constantly relocate departments when we get in their area,” he said. “It’s like a checker game.” It’s much easier to just build a new facility. Early plans call for 130 beds, although specifics still have to be hammered out, he said. The preliminary budget is $120 million, although it will all but certainly balloon, Rozanski said. Crews could break ground as soon 2009 and finish by 2013. “If the state stays with the 2013 rule, it’ll have to be built by 2013,” he said. Glendale Adventist Medical Center has also met all standards to date and received an extension until 2013 to upgrade structural components on existing buildings, said Alicia Gonzalez, a spokeswoman for the hospital. The hospital is also opting to build anew, and is erecting a seven-story patient tower, medical office building, ambulatory surgical center and parking structure. It’s costing well over $100 million, much of it generated through an active foundation. Others are not as lucky to have deeppocketed donors, forcing some hospital administrators to wait out the deadlines in hopes that the state will either pony up the money for the fixes or loosen standards. Other costs The issue is mainly about cash, a fact complicated by the high overhead, high nurse-to-patient ratios and insurance woes hospitals have been grappling for decades. The California Healthcare Association, a trade group representing hospitals statewide, found that 54 percent of hospitals in the state are operating in the red, which makes securing money to finance construction projects difficult. High tech hospital projects also tend to cost more, both in materials and labor, but also specialized architects and engineers. Even more challenging is that retrofits are not as financially beneficial or eyecatching as a new cancer center or maternity ward, said California Healthcare Association spokeswoman Jan Emerson. “Seismic retrofitting is purely a bricks and mortar activity that will not bring in any new patients to help pay for the construction,” she said. For many hospitals, that’s a hard pill to swallow. “It always comes down to finances,” said Lisa Knapp, a spokeswoman for Verdugo Hills Hospital in Glendale. She said hospital officials so far haven’t decided when, how or if it will fix its facilities, and doesn’t expect to make a decision before the end of the year. “We’re always looking at what options make sense financially,” Knapp said. “We’re still receiving plans and figuring out which one makes sense.” West Hills Hospital is taking a similar approach, said spokeswoman Jill Dolan. “As most other hospitals have done, we have requested extension of the 2008 deadline which extends it to 2013. We continue to evaluate the most feasible way to retrofit,” she said. Valley Presbyterian Hospital is also at compliance it just built a 188-bed patient tower but the hospital is struggling to figure out how to meet the 2013 deadline for the existing 1951 facility, said hospital Chief Human Resource Officer Gregg Yost. The issue is “the dollar value associated with it and whether the hospital can afford it,” he said. For Valley Pres, the money simply isn’t there. “Right now I don’t believe we’ve gotten to the funding portion,” he said. In the end, hospitals like Valley Pres will be faced with a difficult choice: fix it or risk it all while the price tag zooms past the estimated $50 billion it will cost statewide. The California Healthcare Association thinks that budget will at least double in coming years. “Keep in mind that the budget for the state of California is slightly more than $100 billion,” Emerson said. “The cost of compliance is continuing to skyrocket.”
