Hospital Shake-Up : Some Centers Off to Running Start in Race to Meet Quake Rules

Imagine the next decade as a long-distance marathon for California hospitals.

State law requires that by 2008, a majority of facilities that care for acutely ill patients meet tough new building standards to help them withstand a big earthquake. Hospitals are scrambling to decide if they should retrofit their buildings, use them for something besides acute care, close them or build new ones.

Hospitals with money and manpower are already racing ahead. Others with little means may never reach the finish line.

“There’s a tremendous advantage to those who get their projects going first. The longer a hospital waits, the greater the competition will be for the best contractors, architects, engineers--the best minds,” says Gary Jabara, director of real estate and facility engineering at White Memorial Medical Center in East Los Angeles.

Never mind all that hand-wringing by health-care experts over excessive numbers of hospitals and vacant beds--suddenly, Southern California is on the brink of a boom in hospital construction.

About 2,500 hospitals throughout the state must spend an estimated total of $10 billion to $20 billion to meet building standards that were tightened after the Northridge quake. Those facilities deemed collapse hazards--the majority of California hospitals--must revamp their buildings by 2008; others have until 2030 to upgrade.

“Almost every building will have to do something,” said Kurt Schaefer, a deputy director at the Office of Statewide Health Planning and Development, the agency in charge of the standards.

Wealthier hospitals see the mandate as a chance to create new facilities geared to more discriminating patients, managed-care needs and new technologies.

Consider Riverside County’s new hospital, scheduled to open in February in Moreno Valley. Riverside County Regional Medical Center will gather, process, store and transmit patient information.

“This will be the first hospital in the country that’s totally digitized,” said Bill Sheldon, assistant administrator, who says a mass of fiber-optic equipment will do much of the work.

Images gathered via X-ray, CAT scan or ultrasound will be digitized, transmitted throughout the hospital, added to a patient’s record and made available to a physician anywhere in the hospital, emergency room or outpatient clinic, he said.

“You are going to have a totally computerized patient record, so all information gathered on a patient is accessible from one computer terminal,” he said.

Surprisingly, some hospitals even plan to add beds.

“There are probably twice as many hospital beds available in the community as will be needed in the future, but in many cases, those are the wrong kind of bed,” said Nolan Draney, chief executive at Saddleback Memorial Medical Center in Laguna Hills.

Draney noted that while managed care and innovation in medical procedures have cut demand for beds for the moderately ill or recuperating patient, the demand for intensive-care beds has increased.

“We find fewer people coming to the hospital than they did in years past, but they now usually come sicker than before,” he said. So Saddleback’s plans to build a new emergency center include 22 additional beds in intensive care.

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Already, hospital architects, structural engineers and planners report they’re extremely busy--and the trend should hit the construction trades in a year or two.

“We are on an increasing bubble of activity. Many of the projects are in the design and planning stage,” said Ken Liu, of Lee, Burkhart, Liu Inc., a Santa Monica firm designing a replacement hospital for UCLA. With its $437-million federal grant, UCLA “intends to come back as the leading academic center in the country,” Liu said.

Four dozen hospitals are scheduled to receive a total of $2 billion to repair damage caused by the Northridge quake.

The quake, which hit Jan. 17, 1994, had a magnitude of 6.7. It damaged a few hospitals so severely that they temporarily moved operations into parking lots.

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Afterward, the state inspected 475 hospitals for damage and declared 28 unsafe. Two-thirds of these were tagged yellow for their dangerous conditions, with entry limited to emergency cases. The rest were tagged red--extreme hazards in risk of collapse.

Every hospital marked unsafe was built before a 1973 law toughened the building code. Hospital officials estimate that two out of three hospitals statewide were built before 1973.

But newer buildings also sustained damage to nonstructural systems, such as for air conditioning, heating and water. As a result, the state required all hospitals to evaluate their acute-care buildings, submit a plan for upgrades, and, for those deemed collapse hazards, finish structural improvements by 2008.

Hospitals now on the drawing board will be dramatically scaled down.

Take Los Angeles County-USC Medical Center, for example.

The institution operates out of a hulking Depression-era structure, originally built during a tuberculosis epidemic to house 2,070 patients. Now its staggering size makes it ill-suited for modern medicine.

Medical personnel must walk half the length of a football field to escort a patient from the emergency room to the elevator up to surgery on the 15th floor. Microbes infest its extra-thick walls, making the place unsuitable for modern procedures such as organ transplants, which require super-sanitary conditions.

“It’s a beautiful building architecturally but very antiquated,” says Miguel Santana, a spokesman for Los Angeles County Supervisor Gloria Molina. “We’re basically running a Third World hospital.”

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The center--whose $468-million federal grant makes it the top recipient among institutions damaged by the quake--remains the nation’s busiest public hospital. But in the era of managed care and noninvasive surgery, it serves fewer than 700 bedridden patients a day.

Political squabbles continue over how many beds the hospital needs, but the new structure will definitely be smaller than the existing building.

Likewise, White Memorial wants to use its $90-million grant to put up a friendlier building with the feel of a neighborhood clinic.

“It’s not a Taj Mahal. It’s a medical mall,” said Jabara of the center’s plan for a three-story building to replace one twice that high. The new center, intended to cater to a community that walks or takes public transportation, will be built next to a new transit station.

The future hospital will house operating rooms, huge by today’s standards, that can hold enormous imaging machines. Intensive-care units will be bigger, and so will areas for patients staying less than a day. Patients’ family members may sleep overnight on a window seat that converts into a cot.

Even the traditional assembly-line approach to childbirth will change.

Thirteen years ago, when architect Linda Taylor gave birth to her son at Hoag Memorial Hospital Presbyterian in Newport Beach, she “went into a labor room, then a delivery room, then a recovery room, then a postpartum room. They moved you all around, up and down the halls.”

Now Taylor’s Newport Beach architectural firm is designing a Hoag addition that will enable women to go into labor, give birth, recover and tend their newborns all in the same room.

“It’s more like coming into a nice hotel room,” Taylor says.