Hospitals stand on shaky future
When the 1994 Northridge earthquake damaged 11 nearby 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 Southland 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 30 buildings at 9 San Gabriel Valley and Whittier area hospitals are rated at a "significant" risk of collapsing and posing a danger to the public after a strong earthquake, 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 for some hospitals, 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.
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's very costly, added to the costs of the projects are the costs of repaying debts, interest. The state just drops it on everybody... Most hospitals have a very hard time," said Dave Klinger, vice president of facilities and real estate for Presbyterian Intercommunity Hospital.
"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," added 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 of local hospitals operating dozens of the highest-risk buildings indicates progress may be on the way, with many retrofits promised by the 2015 deadline.
Yet many planned fixes would boost their risk ratings only one notch, meaning buildings may not significantly jeopardize life, but may not be repairable or functional following a strong earthquake.
More strict requirements don't kick in until 2030. The new law would move up that deadline to 2020 for some hospitals.
Two buildings in West Covina and Ontario rank among the most fragile in the state, according to a 2010 investigation by California Watch. One of them - the main building at the Queen of the Valley campus of Citrus Valley Medical Center, has a 30.36 percent chance of collapsing in a major earthquake, state regulators have found.
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. Patients and 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 tower at Methodist Hospital of Southern California in Arcadia, which opened last month, and the tower being built at Whittier's Presbyterian Intercommunity Hospital, expected to open next year.
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 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.
"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.
Reporter Rebecca Kimitch contributed to this report.
Following the laws
California s landmark 1994 law set strict deadlines for hospitals to improve the seismic safety of their buildings. Legislators repeatedly extended those deadlines as hospitals voiced concerns about costs, most recently last spring. Key laws:
Senate Bill 1953:Law requires that all buildings at highest risk of collapse must be rebuilt or retrofitted by Jan. 1, 2008. Buildings not meeting deadline must be removed from service. Five-year extension granted to some hospitals, such as those with key role in local health care services (granted to 414 hospitals).
S.B. 1801Extends deadline to 2013 for some hospitals.
S.B. 1661:Extends deadline to 2015 for some hospitals.
S.B. 306:Delays deadline for hospitals that could show they lacked the money to remove riskiest buildings from service by 2013. Hospitals must have Medi-Cal contracts and provide care to under-served patients. Mandated replacement of those buildings by 2020 (granted to 24 hospitals).
S.B. 499Extends deadline to 2015 for buildings that failed state seismic testing. Mandates that hospitals granted delays must be doing construction on fixes. First law to require hospitals with highest-risk buildings to file annual reports with state.
S.B. 608:LDelays deadline up to five years past 2013 for certain hospitals.
S.B. 90:Delays deadline to 2020 to retrofit or replace highest-risk buildings. Extensions granted on case-by-case basis. Buildings must undergo state seismic testing. Hospitals must obtain building permits by July 2018. Law still not final. Emergency regulations now under review in Sacramento.
SOURCES: California Office of Statewide Health Planning and Development; State Senate Health Committee reports.