New Earthquake Standards Spur Hospital Upgrades

Hospital construction has become big business in California, where hospital owners are expected to spend as much as $24 billion during the next 30 years to bring buildings into compliance with the state’s tough new earthquake codes.

Hospital design work is already going into high gear, because the state’s 560 acute-care hospitals--defined as hospitals with overnight patient beds--must decide before Jan. 1, 2001, whether to reinforce old buildings, abandon them or construct new ones.

Administrators, however, are already worried that many hospitals will have a hard time paying for the heavy cost of reinforcement or new construction. And the heaviest financial burden is likely to fall on independent hospitals built before 1973, when seismic safety laws first applied to hospital construction.

Though the law is worrisome for hospital operators, it is good news for the architects, engineers and contractors who specialize in health-care construction.

“A lot of firms are being supported by this effort, especially structural engineers,” said architect Kenneth Liu, principal of the Santa Monica-based firm of Lee Burkhart Liu, which is designing the new County/USC Medical Center in East Los Angeles.

Health-care related design represents “70% of our practice, and it’s growing,” said William B. Roger, a senior partner and principal of SMP/SHG, a Santa Monica-based architectural firm that designed a new building for St. John’s Health Center in that city.

“Most architects [who specialize in health-care design] are looking like crazy for people who are qualified,” said architect Michael Bobrow, whose firm designed the newly built Arrowhead Regional Medical Center in Colton.

Structural engineer Trailer Martin, president of John A. Martin & Associates of Los Angeles, said work related to the hospital seismic safety represents “about 20% of our workload, and that’s expected to grow.”

Prior to the Northridge quake, in contrast, the demand for health-care work “was almost nonexistent,” Martin said.

The collapse of Olive View Medical Center following the February 1971 Sylmar earthquake spurred lawmakers to enact a succession of increasingly stiff laws for the seismic safety of hospital buildings.

In 1973, state lawmakers passed a law requiring structural reinforcements on California’s hospitals. That law, however, was not enough to prevent 28 hospitals in Southern California from losing at least one of their services--such as electricity or water--immediately after the January 1994 Northridge quake, according to the state health-care group.

Later that same year, lawmakers approved Senate Bill 1953, which set far higher standards for earthquake safety in the state’s hospitals. According to that law, all hospital buildings with patient beds must be able to withstand a major quake or be taken out of service by 2008. By 2030, all hospitals with in-patient beds not only must be designed to survive quakes, but must also be able to operate without any loss of service through such catastrophes.

The first deadline set by the law is on Jan. 1, 2001, when all hospitals with patient beds must submit reports to the Office of Statewide Health Planning & Development (OSHPD) that details both the current ability of hospitals to resist earthquakes, and the plans to remedy weaknesses.

That report will effectively trigger new construction projects, because of the time required to design and build hospitals, according to Roger Richter, senior vice president of the California Healthcare Assn., a Sacramento-based trade group that represents hospitals and clinics.

Hospitals often take five or six years to build, from the start of design to completion of construction, according to Richter. Hospitals that want to be open in 2008 must have a plan, and financing in 2001 or 2002 to reinforce existing buildings or build new, earthquake-proof facilities. (Exempted from the law are psychiatric hospitals and other facilities that are not categorized as “acute care.”)

Although the highest standard of earthquake safety--that of providing uninterrupted service through a major temblor--is not required by law until 2030, many hospitals are likely to build earthquake-proof facilities much sooner, according to architect Bobrow, principal of Bobrow/Thomas & Associates of Los Angeles.

“Hospitals are in a tight situation,” he said. “They must ask themselves, ‘Do we want to fund something that meets the standards for 2008, and then tear it down’ [to build another building that meets 2030 standards?]”

Also, many older buildings are unable to function efficiently for modern health-care practices. “You can’t fit a contemporary hospital into a chassis designed 30 or 40 years ago,” Bobrow said.

In general, hospitals are reducing the number of patient beds, and some are phasing out semiprivate rooms in favor of private rooms. Other hospitals want to include special rooms for family members and “health resource centers,” such as libraries, said architect Linda Taylor, principal of Taylor & Associates of Orange County.

California hospitals are expected to spend $10 billion meeting the 2008 standards, and another $14 billion after 2008 to reach the 2030 standards, according to the California Healthcare Assn., which based those numbers on a member survey done in 1994.

A major problem facing hospitals is that many were built before 1973, and will be illegal by 2008. Officials must determine whether those buildings are worth saving.

“What hospitals are grappling with right now is whether they should retrofit or rebuild, and neither is cheap,” Richter said.

Chris Tokas, manager of OSHPD’s seismic evaluation and seismic retrofit program, shied away from making generalizations about the fitness of older buildings. “Just because we have a large number of buildings built prior to [1973] does not mean that all of them are going to have problems,” he said.

SMP/SHG’s Roger, however, said that most buildings built before that year “will have a difficult time” meeting the new seismic standards in their existing condition.

“You are not going to see many old buildings brought up to current standards,” added Martin, the structural engineer. “It’s just too expensive.”

Although the 2008 deadline seems far away, a health-care industry expert said that, in planning terms, the deadline is right around the corner. “For a process that must be completed in 2008, you must have your financing lined up in 2002,” Richter said.

A further complicating factor is that hospitals are complex buildings that only a small number of architects and engineers know how to design, Richter said. “Next to nuclear power plants, hospitals are the most complicated buildings to design and construct, and there are relatively few designers and mechanical engineers and structural engineers who can do hospital work.

“And when you have a few hundred buildings in a short period of time that are going to need retrofitting and rebuilding, the supply and demand is just going to escalate the cost,” Richter said.

Money is indeed the biggest issue. Industry experts are concerned that hospitals will be unable to find financing, or will have a hard time paying off the debt, if they do. “There isn’t enough money in the entire health-care system in California to meet the mandate for every single hospital in the state,” said Beverly Hayon, a spokeswoman for Kaiser-Permanente. “Some hospitals will have to close,” she added. Hayon said she was not referring to any specific Kaiser Permanente facilities.

The timing is bad for many hospitals to take on more debt for earthquake proofing, according to Harry Anderson, a spokesman for Tenet Healthcare System.

“With Medicare reimbursements set and the managed-care costs increasing, hospitals these days are having a problem with their revenues,” he said.

Catholic Healthcare West, a San Francisco-based hospital system with 45 hospitals in California, has not determined its seismic safety costs, but estimates they are in “the mid-$100-million range,” according to Rebecca Havlisch, vice president of risk services.

She sounded ominous about the future of some hospitals in the chain, in view of the cost of retrofitting hospitals for seismic safety.

The hospital system, she said, “continues to be committed to the safety of our patients and our employees and will certainly come into compliance [with seismic safety laws,] but it may be making some very hard decisions in the near future.”