Greater than half of the 410 hospitals in California have at the very least one constructing that seemingly wouldn’t be capable of function after a serious earthquake hit their area, and with many establishments claiming they don’t have the cash to satisfy a 2030 authorized deadline for earthquake retrofits, the state is now granting aid to some whereas ramping up strain on others to get the work accomplished.
Gov. Gavin Newsom in September vetoed laws championed by the California Hospital Affiliation that might have allowed all hospitals to use for an extension of the deadline for as much as 5 years. As an alternative, the Democratic governor signed a extra narrowly tailor-made invoice that enables small, rural, or “distressed” hospitals to get an extension of as much as three years.
“It’s an costly factor and a sophisticated factor for hospitals — unbiased hospitals specifically,” stated Elizabeth Mahler, an affiliate chief medical officer for Alameda Well being System, which serves Northern California’s East Bay and is enterprise a $25 million retrofit of its hospital in Alameda, on an island beside Oakland.
The talk over how seismically protected California hospitals ought to be dates to the 1971 Sylmar quake close to Los Angeles, which prompted a regulation requiring new hospitals to be constructed to face up to an earthquake and proceed working. In 1994, after the magnitude 6.7 Northridge quake killed at the very least 57 individuals, lawmakers required present services to be upgraded.
The 2 legal guidelines have left California hospitals with two units of requirements to satisfy. The primary — which initially had a deadline of 2008 however was pushed to 2020 — required hospital buildings to remain standing after an earthquake. About 20 services have but to satisfy that requirement for at the very least one in every of their buildings, though some have acquired extensions from the state.
Many extra — 674 buildings, unfold throughout 251 licensed hospitals — don’t meet the second set of requirements, which require hospital services to stay purposeful within the occasion of a serious earthquake. That work is meant to be accomplished by 2030.
“The significance of it’s exhausting to argue with,” stated Jonathan Stewart, a professor at UCLA’s Samueli College of Engineering, citing a 2023 earthquake in Turkey that broken or destroyed a number of hospitals. “There have been a variety of hospitals that have been intact however not usable. That’s higher than a collapsed construction. However nonetheless not what you want at a time of emergency like that.”
The influential hospital business has unsuccessfully lobbied lawmakers for years to increase the 2030 deadline, although the state has granted numerous extensions to particular services. Newsom’s signature on one of many three payments addressing the difficulty this yr represents a partial victory for the business.
Hospital directors have lengthy complained concerning the steep value of seismic retrofits.
“Whereas hospitals are working to satisfy these necessities, many will merely not make the 2030 deadline and be pressured by state regulation to shut,” wrote Carmela Coyle, president and CEO of the California Hospital Affiliation, in a letter to Newsom earlier than he vetoed the CHA invoice. A 2019 Rand Corp. examine paid for by the CHA pinned the value of assembly the 2030 requirements at between $34 billion and $143 billion statewide.
Labor unions representing nurses and different medical staff, nonetheless, say the hospitals have had loads of time to get their buildings into compliance, and that almost all have the cash to take action.
“They’ve had 30 years to do that,” Cathy Kennedy, a nurse in Roseville and one of many presidents of the California Nurses Affiliation, stated in an interview previous to the governor’s motion. “We’re kicking the can down the street yr after yr, and sadly, lives are going to be misplaced.”
In his veto message on the CHA invoice, Newsom wrote {that a} blanket five-year extension wasn’t justified, and that any extension “ought to be restricted in scope, granted solely on a case-by-case foundation to hospitals with demonstrated want and a transparent path to compliance, and together with sturdy accountability and enforcement mechanisms.”
He additionally vetoed a invoice directed particularly at serving to a number of hospitals operated by Windfall, a Catholic hospital chain.
However he signed a 3rd invoice, which permits small, rural, and “vital entry” hospitals, and a few others, to use for a three-year extension, and directs the Division of Well being Care Entry and Data to supply them “technical help” in assembly the deadline.
The state designates 37 hospitals as offering “vital entry,” whereas 56 are thought-about “small,” which means they’ve fewer than 50 beds, 59 are thought-about “rural,” and 32 are “district” hospitals, which means they’re funded by particular authorities entities known as “well being care districts.” They’ll search a three-year extension so long as they submit a seismic compliance plan and establish milestones for implementing it.
Debi Stebbins, government director of the Alameda Well being Care District, which owns the Alameda Hospital buildings, stated small hospitals face a giant problem. Despite the fact that Alameda could be very near San Francisco and Oakland, the tunnels, bridges, and ferries that join it to the mainland might simply be shut in an emergency, making the island’s hospital a lifeline.
“It’s an unfunded mandate,” Stebbins stated of the state’s 2030 deadline.
The Rand examine estimated the typical value of a retrofit at greater than $92 million per constructing, however the quantity might differ tremendously relying on whether or not it’s a constructing that homes hospital beds.
Small and rural hospitals can get some assist from the state through grants financed by the California Digital Cigarette Excise Tax, however HCAI spokesperson Andrew DiLuccia stated it could yield simply $2-3 million whole yearly. He added that the Small and Rural Hospital Aid Program has additionally acquired a one-time infusion of $50 million from a tax on well being insurers to assist with the seismic work.
Labor unions and critics of the extensions usually level to the big earnings that some hospitals reap: A California Well being Care Basis report printed in August discovered that California’s hospitals made $3.2 billion in revenue in the course of the first quarter of 2024. The examine notes that there “continues to be broad variation in monetary efficiency amongst hospitals, with the underside quartile exhibiting a internet revenue margin of -5%, in comparison with +13% for the highest quartile.”
Stebbins has had to assist her district determine a plan.
After Newsom vetoed a invoice in 2022 that might have granted an extension on the seismic retrofit deadline particularly for Alameda Hospital, the hospital system and its associate well being care district used parcel tax cash to assist again a mortgage.
The associated fee to retrofit might be about $25 million, and the system can also be investing thousands and thousands extra into different initiatives, akin to a brand new expert nursing facility. The development work is ready to be accomplished in 2027.
“Nobody desires issues crashing in an earthquake or the rest, however on the similar time, it’s a burden,” Mahler, the Alameda Well being System affiliate chief medical officer, stated. “How can we be sure that they get what they should keep open?”
This text was produced by KFF Well being Information, which publishes California Healthline, an editorially unbiased service of the California Well being Care Basis.
@AnnieSciacca
