More than half of the 410 hospitals in California have at the least one constructing that probably 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 reduction to some whereas ramping up strain on others to get the work carried out.
Gov. Gavin Newsom in September vetoed laws championed by the California Hospital Association that might have allowed all hospitals to use for an extension of the deadline for as much as 5 years. Instead, 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 expensive thing and a complicated thing for hospitals — independent hospitals in particular,” mentioned Elizabeth Mahler, an affiliate chief medical officer for Alameda Health System, which serves Northern California’s East Bay and is endeavor a $25 million retrofit of its hospital in Alameda, on an island beside Oakland.
The debate over how seismically secure California hospitals must 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 least 57 individuals, lawmakers required present services to be upgraded.
The two legal guidelines have left California hospitals with two units of requirements to satisfy. The first — 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 least considered one 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 practical within the occasion of a serious earthquake. That work is meant to be carried out by 2030.
“The importance of it is hard to argue with,” mentioned Jonathan Stewart, a professor at UCLA’s Samueli School of Engineering, citing a 2023 earthquake in Turkey that broken or destroyed a number of hospitals. “There were a number of hospitals that were intact but not usable. That’s better than a collapsed structure. But still not what you need 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 problem this yr represents a partial victory for the business.
Hospital directors have lengthy complained concerning the steep price of seismic retrofits.
“While hospitals are working to meet these requirements, many will simply not make the 2030 deadline and be forced by state law to close,” wrote Carmela Coyle, president and CEO of the California Hospital Association, in a letter to Newsom earlier than he vetoed the CHA invoice. A 2019 Rand Corp. study 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 employees, nonetheless, say the hospitals have had loads of time to get their buildings into compliance, and that the majority have the cash to take action.
“They’ve had 30 years to do this,” Cathy Kennedy, a nurse in Roseville and one of many presidents of the California Nurses Association, mentioned in an interview previous to the governor’s motion. “We are kicking the can down the road year after year, and unfortunately, lives are going to be lost.”
In his veto message on the CHA invoice, Newsom wrote {that a} blanket five-year extension wasn’t justified, and that any extension “should be limited in scope, granted only on a case-by-case basis to hospitals with demonstrated need and a clear path to compliance, and in combination with strong accountability and enforcement mechanisms.”
He additionally vetoed a invoice directed particularly at serving to a number of hospitals operated by Providence, a Catholic hospital chain.
But he signed a 3rd invoice, which permits small, rural, and “critical access” hospitals, and a few others, to use for a three-year extension, and directs the Department of Health Care Access and Information to supply them “technical assistance” in assembly the deadline.
The state designates 37 hospitals as offering “critical access,” whereas 56 are thought-about “small,” that means they’ve fewer than 50 beds, 59 are thought-about “rural,” and 32 are “district” hospitals, that means they’re funded by particular authorities entities known as “health care districts.” They can search a three-year extension so long as they submit a seismic compliance plan and establish milestones for implementing it.
Debi Stebbins, govt director of the Alameda Health Care District, which owns the Alameda Hospital buildings, mentioned small hospitals face an enormous problem. Even although Alameda may be very near San Francisco and Oakland, the tunnels, bridges, and ferries that join it to the mainland may simply be shut in an emergency, making the island’s hospital a lifeline.
“It’s an unfunded mandate,” Stebbins mentioned of the state’s 2030 deadline.
The Rand examine estimated the typical price of a retrofit at more than $92 million per constructing, however the quantity may fluctuate vastly relying on whether or not it’s a constructing that homes hospital beds.
Small and rural hospitals can get some support from the state by way of grants financed by the California Electronic Cigarette Excise Tax, however HCAI spokesperson Andrew DiLuccia mentioned it might yield simply $2-3 million complete yearly. He added that the Small and Rural Hospital Relief 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 typically level to the massive earnings that some hospitals reap: A California Health Care Foundation report revealed 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 wide variation in financial performance among hospitals, with the bottom quartile showing a net income margin of -5%, compared to +13% for the top quartile.”
Stebbins has had to assist her district work out 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 accomplice well being care district used parcel tax cash to assist again a loan.
The price to retrofit will likely be about $25 million, and the system can also be investing tens of millions extra into different initiatives, akin to a brand new expert nursing facility. The development work is ready to be accomplished in 2027.
“No one wants things crashing in an earthquake or anything else, but at the same time, it’s a burden,” Mahler, the Alameda Health System affiliate chief medical officer, mentioned. “How do we make sure that they get what they need to stay open?”
This article was produced by KFF Health News, which publishes California Healthline, an editorially unbiased service of the California Health Care Foundation.
Annie Sciacca:
@AnnieSciacca
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