California Hospitals Face Earthquake Retrofit Challenges
In California, the seismic safety of hospitals has become a pressing concern, especially as more than half of the state’s 410 hospitals have at least one building that may not withstand a major earthquake. With a looming 2030 legal deadline for earthquake retrofits, many hospitals are struggling to find the funds necessary to comply, prompting the state to take action.
Legislative Developments
In September, Governor Gavin Newsom vetoed a bill proposed by the California Hospital Association (CHA) that would have allowed all hospitals to apply for a five-year extension on the retrofit deadline. Instead, he signed a more limited bill that permits small, rural, or “distressed” hospitals to seek a three-year extension. This decision reflects a growing recognition of the unique challenges faced by smaller facilities, which often lack the financial resources of larger hospitals.
Elizabeth Mahler, an associate chief medical officer for Alameda Health System, highlighted the complexities and costs involved in retrofitting hospitals. The Alameda Health System is currently undertaking a $25 million retrofit of its hospital in Alameda, emphasizing the financial burden that such projects impose on independent hospitals.
Historical Context of Seismic Safety Regulations
The push for seismic safety in California hospitals dates back to the 1971 Sylmar earthquake, which led to legislation mandating that new hospitals be built to withstand seismic activity. Following the devastating Northridge earthquake in 1994, which resulted in significant casualties, lawmakers expanded these requirements to include existing facilities.
As a result, California hospitals now face two sets of seismic standards. The first set, originally due by 2008 but extended to 2020, mandates that hospital buildings remain standing after an earthquake. Currently, around 20 facilities have yet to meet this requirement for at least one of their buildings. The second set of standards, which requires hospitals to remain operational after a major earthquake, must be met by 2030. Alarmingly, 674 buildings across 251 licensed hospitals do not meet these standards.
The Importance of Compliance
Experts emphasize the critical nature of ensuring hospitals are both structurally sound and operational during emergencies. Jonathan Stewart, a professor at UCLA’s Samueli School of Engineering, pointed to the recent earthquake in Turkey, where many hospitals were damaged but remained standing, highlighting the need for facilities to be functional during crises.
Despite the urgency of these retrofitting efforts, the hospital industry has lobbied unsuccessfully for extensions to the 2030 deadline. While some facilities have received individual extensions, the broader push for a blanket extension has been met with resistance from state lawmakers.
Financial Implications and Challenges
The financial implications of retrofitting are significant. The CHA has estimated that meeting the 2030 standards could cost California hospitals between $34 billion and $143 billion. Labor unions representing healthcare workers argue that hospitals have had ample time to prepare for these requirements and that many possess the financial means to comply. Cathy Kennedy, a nurse and president of the California Nurses Association, expressed concern over the ongoing delays, warning that lives could be at risk if hospitals fail to meet safety standards.
In his veto message, Governor Newsom emphasized that any extensions should be granted on a case-by-case basis, with a focus on hospitals that demonstrate a clear path to compliance. He also vetoed a bill aimed at assisting specific hospitals operated by the Providence health system, further underscoring his administration’s cautious approach.
Support for Small and Rural Hospitals
While larger hospitals may have more resources, small and rural hospitals face unique challenges in meeting seismic safety requirements. The state has designated 37 hospitals as providing “critical access,” with 56 classified as small (fewer than 50 beds) and 59 as rural. These facilities can apply for a three-year extension if they submit a seismic compliance plan outlining their milestones for implementation.
Debi Stebbins, executive director of the Alameda Health Care District, noted that small hospitals are particularly vulnerable, especially in emergency situations where access to the mainland could be compromised. She described the state’s 2030 deadline as an “unfunded mandate,” highlighting the financial strain it places on smaller facilities.
Funding and Financial Aid
To assist with the costs of retrofitting, small and rural hospitals can access state grants funded by the California Electronic Cigarette Excise Tax, although this program only yields $2-3 million annually. Additionally, a one-time infusion of $50 million from a tax on health insurers has been allocated to help with seismic work.
Despite these efforts, critics point to the substantial profits that some hospitals have generated. A report from the California Health Care Foundation revealed that hospitals in the state made $3.2 billion in profit during the first quarter of 2024, raising questions about the financial priorities of these institutions.
The Path Forward
As hospitals navigate the complexities of seismic retrofitting, many are exploring various funding avenues to meet the 2030 deadline. For instance, the Alameda Health System has utilized parcel tax money to secure loans for their retrofit project, which is expected to cost around $25 million.
The ongoing debate surrounding hospital safety and compliance underscores the delicate balance between financial feasibility and the imperative to protect lives during natural disasters. As California continues to grapple with its seismic safety standards, the future of many hospitals hangs in the balance, with the stakes higher than ever.