Hospital readiness on shaky ground
This story was originally published in the San Gabriel Valley Tribune.
Recent earthquakes - in Chile, Peru and Japan - have shown that even if a hospital's walls survive the shaking, it may suffer internal damage to pipes and equipment, shutting off water and power and leaving hundreds of injured residents without a haven for emergency care.
That kind of damage is proving the Achilles' heel of hospital seismic safety, say some experts who urge fixes such as emergency backup generators, bolted-down equipment and anchored water tanks.
Photo gallery:Seismic construction at Presbyterian Intercommunity Hospital
Many facilities locally and statewide are still years or decades away from making nonstructural internal fixes, even though they are required under California law.
State legislators have rolled back deadlines repeatedly, to 2020 or even 2030, responding to hospitals' plea for leniency. Hospital officials say that while they want to do the fixes, costs can be prohibitive.
Yet something as small as a broken water pipe can flood patient rooms and damage electrical systems, engineers say.
"If the sprinkler system fails, the entire building can be shut down for weeks. Patients would need to be evacuated," said Tara C. Hutchinson, a UC San Diego structural engineering professor studying how such damage affects hospitals.
The loss of even a handful of facilities could hobble medical care in communities near the southern San Andreas Fault, with its 59 percent probability of at least one magnitude-6.7 earthquake or larger in the next 30 years.
The consequences could be massive.
An estimated 14,000 Los Angeles County residents would be injured and 1,060 killed in a magnitude-7.8 earthquake centered at Bombay Beach on the Salton Sea, according to a landmark U.S. Geological Survey scenario designed for the 2008 ShakeOut earthquake preparedness drill.
Under the scenario, shaking will cause buildings to collapse, create falling debris and increase traffic accidents when drivers lose control. Fires that follow also will cause deaths and injuries.
Even if the area's hospitals and their patients survived such a quake, most facilities with serious internal damage almost certainly could not help the injured.
"Over and over, water shuts down facilities," said Mark A. Pickett, a University of Toledo engineering professor who critiqued local hospitals for the 2008 USGS study, concluding that many would be crippled in the scenario quake.
One UCLA analysis found that only one hospital in the San Gabriel Valley and Whittier area would be fully functional after the 2008 scenario's magnitude-7.8 quake: the 626-bed Huntington Hospital in Pasadena.
According to the analysis, based on estimates, six of the region's 16 hospitals would have to be closed following such a quake, and would need assistance evacuating. Another seven hospitals in this area would be closed to new patients, but able to maintain their existing patients, the analysis concludes, though some of the hospitals may have made improvements since the 2008 analysis.
Yet stronger pipes, wiring and other fixes do not appear to be a priority in Sacramento.
The state's landmark seismic safety law for hospitals, passed after 1994's magnitude-6.7 Northridge earthquake, focused on bricks-and-mortar structural problems, requiring that hundreds of older medical buildings must be retrofitted or replaced so patients inside would be protected in a quake.
"The intent was to reduce the risk of injury or death from the collapse of buildings," said Paul Coleman, deputy director of the state Office of Statewide Health Planning and Development, which regulates hospital safety.
The law's $2 million-a-bed price tag makes it the largest unfunded mandate in state history, said Jan Emerson-Shea, spokeswoman for the California Hospital Association.
"We're choosing to spend $110 billion to bring hospitals into compliance, with not one dime of public money," she said.
Many hospitals have asked for extra time to rebuild or retrofit, explaining they are financially strapped as they wrestle with the sour economy, scarce financing, lower reimbursements and a surge of uninsured patients.
They're even further behind in meeting deadlines for nonstructural fixes such as plumbing and backup power, state records show.
As of 2009, 1,357 hospital buildings statewide had not made fixes that should have been finished at the start of 2002, according to a December 2009 report from state regulators.
Another 1,233 buildings, or 95 percent of buildings statewide, had not yet done improvements due by Jan. 1, 2013, according to the report.
And some hospitals don't anticipate meeting that 2013 deadline.
Two local hospitals - Methodist Hospital of Southern California in Arcadia and Presbyterian Intercommunity Hospital in Whittier - have received waivers from state authorities to postpone certain incremental nonstructural requirements for some of its buildings until 2030.
Greater El Monte Community Hospital, Monterey Park Hospital and Whittier Hospital also have applied for similar waivers.
State Sen. Ed Hernandez, D-West Covina, who heads the Senate Health Committee, explained that the waivers and extensions have been made to help hospitals that are already struggling to stay open in a poor economy and difficult health care system.
"It would be a worse problem to have them close," Hernandez said. "The ones that are really struggling, are the safety net hospitals - the ones in poor communities, the ones that rely on federal and state funding. They are having a tough time."
State officials caution that some hospitals may have completed upgrades, but they do not have up-to-date statistics.
That is because hospitals are not typically required to report their progress on nonstructural work, leaving the public and disaster planners in the dark.
Most hospitals have until 2030 to complete nonstructural fixes and to prove they have enough backup fuel, batteries, water and wastewater tanks to operate for 72 hours after a major earthquake.
That's a smaller reserve than experts advise for residents living near major faults such as the southern San Andreas, considered the fault most likely to produce an earthquake above magnitude 7 in the lower 48 states.
USGS seismologist Lucile M. Jones, lead author of the 2008 ShakeOut scenario, calls nonstructural fixes essential for keeping a hospital open.
"It's as important for functionality as the structural issues," she said. "What if your oxygen tanks roll around after an earthquake and smash your computers?"
Registered nurse Kathy Carder was working in the intensive care unit at Santa Monica Medical Center during the 6.7-magnitude Northridge quake when the power failed, shutting down patient ventilators and turning monitor screens black.
She remembers clenching a flashlight between her teeth as she "bagged" one patient, squeezing a bag with her hands to pump air in and out of the lungs.
At Holy Cross Medical Center in Mission Hills, Lionel Ventura, 20, critically injured in a car accident, died after power went off and his ventilator stopped working.
Learning from Northridge, some hospitals have installed new sophisticated safeguards to keep the power on and equipment working.
County-owned Arrowhead Regional Medical Center in Colton was one of the first hospitals in the state rebuilt to comply with the 1994 law. The $647million project is designed to withstand a magnitude-8.3 earthquake, with nonstructural features such as water and steam pipes that sit on rollers.
The pipes themselves are flexible, using technology designed for underwater lines at offshore oil rigs. The hospital's 750,000-gallon tank holds a five-day supply of water, and its diesel supplies can power electric generators for two weeks, officials said. Yet its nonstructural features need more fixes, scoring only two on the state's five-point scale, state records show.
Similarly, Presbyterian Intercommunity Hospital has installed larger, stronger and more flexible plumbing and electrical connections in its Shannon Tower, built in 2005, and is doing the same in a new tower under construction, according to Dave Klinger, the hospital's vice president of facilities. And anything that can move in the buildings requires bracing and restraints, he said.
But at some aging hospitals, fixes to pipes and power systems can cost more than constructing an all-new building, experts say.
Some wonder if those fixes are worth the money.
Staff writers Rebecca Kimitch and Andrew Edwards contributed to this story.