Dozens of hospitals remain at risk at quake hot spot

Hospitals in shaking zones

Map of hospitals in shaking zones.

When the 1994 Northridge earthquake damaged 11 hospitals, California legislators issued an ultimatum to hospital owners statewide:  Fix your highest-risk buildings by New Year’s Day 2008 or the state will shut them down.

The law might have brought a burst of new construction to the Inland Empire and a wealth of tough-walled hospitals designed to survive a major rupture on the southern San Andreas Fault, the most dangerous fault in the state.

That never happened.  Today, nearly four years after the initial deadline passed, more than 40 buildings at 10 hospitals in San Bernardino County are still rated highly collapsible, according to regulators’ reports and records obtained under the state’s Public Records Act.

The findings raise profound questions about the effectiveness of state rules, the ability of hospitals to bankroll construction projects and the chances that hospitals will operate after a major quake.

Championing the delays, the state Legislature repeatedly extended the 2008 deadline to 2013, 2015, even 2020, under pressure from hospitals that said they can’t afford the fixes.  

Hospitals would get even more leeway under a new law passed in April and signed by Gov. Jerry Brown, according to draft rules to be reviewed by the state Building Standards Commission. That worries critics who fear some hospital executives may postpone projects now on the drawing board just because they have more time.

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Some local hospital officials say they want to make the fixes but are hobbled by multiple financial woes -- lack of capital, smaller payments from insurers and government programs, more non-paying patients, or all of the above.

“It is the right thing to do, and yet we’re trying to contend with an unfunded mandate and the financial realities of the economy,” said spokeswoman Kathy Roche at Pomona Valley Hospital Medical Center in Pomona.

Critics say that the hospital industry is favoring cost savings over preparations for the kind of catastrophic earthquake long predicted for California.

“We have to stop gambling.  We’ve been on notice for a long time,” said Bonnie Castillo, government director at the California Nurses Association, which has fought deadline extensions.

Former Gov. Arnold Schwarzenegger voiced similar concerns when he vetoed a bill last year, complaining that it continued “the policy of extending seismic compliance deadlines without strong enforcement provisions.”

Locally, the delays have meant fewer fixes to high-risk buildings.

A review of state records for five local hospitals operating 19 of the highest-risk buildings indicates progress may be on the way, with many retrofits planned by the 2015 deadline.  The hospitals are: Community Hospital in San Bernardino, Kindred Hospital OntarioLoma Linda University Medical CenterRedlands Community Hospital and St. Bernardine Medical Center in San Bernardino.

Among those five hospitals, St. Bernardine is the only one to have an active repair plan on file with state regulators, records show.

Yet most planned fixes would boost their risk ratings only one notch, meaning buildings might still not be functional after a quake until 2030.  The new law would move up that deadline to 2020 for some hospitals.

Some key medical services are housed in high-risk buildings.

Loma Linda’s emergency department sits at the base of one of two buildings at high risk of collapse.  The hospital is the Inland Empire’s only Level I trauma center, treating its most critically injured patients.

At Pomona Valley Hospital, pediatrics, emergency, and intensive care services are located in two high-risk buildings.

Two buildings in Ontario and West Covina rank among the most fragile in the state, according to a 2010 investigation by California Watch.  One of them, Kindred Hospital Ontario, has a 31.8 percent chance of collapsing in a major quake, records show.

Although such scores are supposed to be public, they are not easy to find.   Residents curious about their own hospitals have to scour online charts and paper reports found only in Sacramento.  Even then, they may never find the data they’re seeking.

Regulators cannot force hospitals to test their buildings’ vulnerabilities, and hundreds of buildings have never undergone the state’s testing program.

The state Seismic Safety Commission recommended in 2001 that hospitals be required to post disclosure signs at the entrances to high-risk buildings.  But without legislative support, that remains a policy, not a law.

Recent earthquakes worldwide have heightened awareness of hospitals’ vulnerabilities.  So did Hurricane Katrina, which shut down two New Orleans hospitals, including one owned by Tenet Healthcare where 45 people died. Families sued Tenet, claiming it should have foreseen the hurricane and prepared for it.

They forged a settlement with Tenet that could be a bellwether for hospitals in quake-prone California, said Erin Fuse Brown, a visiting professor of law at Arizona State University.

Many California hospitals are making progress.  About 80 percent of them should be seismically compliant by 2015, said California Hospital Association spokeswoman Jan Emerson Shea in an email.

A few hospital groups have mustered the money to replace high-risk buildings with gleaming new ones such as the new Kaiser Permanente Fontana tower due to open in 2013.  

Kaiser has replaced a number of its hospitals around the state, aided by its size and a standardized design.   Its new Ontario hospital opening in November incorporates modern seismic safety features.

But for many hospitals, replacing or retrofitting key buildings can be tough.

“They may start on the road of strengthening them, but they can’t live through the construction job,” said Degenkolb structural engineer R. Jay Love, a specialist in hospital seismic projects who has worked with Kaiser, Sutter Health and Catholic Healthcare West.

Some hospitals with a mission of serving the poor are struggling to meet the mandate.  Catholic Healthcare West’s 237 hospital buildings statewide include 45, or 19 percent, rated as high risk, regulators said. Among them are a total of nine buildings at St. Bernardine and Community Hospital in San Bernardino.

“Many of the communities served by CHW have been among the hardest hit by the economic downturn,” spokeswoman Tricia Griffin wrote in an email, describing the hospital network as the largest private safety-net provider in the state. More than 60 percent of its patients are on Medicare or Medi-Cal.

Still, it plans to upgrade all its buildings by the 2015 deadline, Griffin said.

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Deborah Schoch

Senior writer Deborah Schoch reports on hospitals and health care delivery, nursing homes, environmental health and food. Her most recent articles have examined patient safety andhospital infections. She was a founding writer with the Center’s pilot project. Schoch spent 18 years as a staff writer at the Los Angeles Times, covering public health and the environment. She was a member of the Times newsroom teams that won Pulitzer Prizes for breaking news in 1992 and 1994. Schoch graduated from Cornell University and was a Nieman Fellow at Harvard University in 1999-2000, studying science, law and policy. Her work at the Center has won several honors, including first place in the 2010 Awards for Excellence in Health Care Journalism, from the Association of Health Care Journalists. She sits on the AHCJ board’s Right-to-Know Committee, which works to improve access to public health records.

© 2014 California Healthcare Foundation Center for Health Reporting