More than half of California’s 410 hospitals have at least one building that likely would not be able to operate after a major earthquake struck their region, and many institutions claim they have the time to meet the 2030 legal deadline. There is no money for. For earthquake reconstruction, the state is now providing relief to some while increasing pressure on others to complete the work.
Gov. Gavin Newsom vetoed legislation backed by the California Hospital Association in September. This will allow all hospitals to apply to extend the time limit by up to five years. Instead, the Democratic governor signed a more narrowly tailored bill that allows small, rural or “distressed” hospitals to get an extension of up to three years.
“It’s an expensive thing and a complicated thing for hospitals — especially independent hospitals,” said Elizabeth Mahler, MD, an associate chief medical officer for Alameda Health System, which serves the East Bay of Northern California and Is undertaking a $25 million renovation of its hospital. Alameda, on an island next to Oakland.
The debate over how seismically safe California hospitals should be dates back to the 1971 Sylmar earthquake near Los Angeles, which led to laws requiring the construction of new hospitals to withstand earthquakes and continue operating. Inspired. In 1994, after the magnitude 6.7 Northridge earthquake killed at least 57 people, lawmakers sought to upgrade existing facilities.
Both laws require California hospitals to meet two sets of standards. The first – which originally had a deadline of 2008 but was extended to 2020 – required hospital buildings to remain standing after an earthquake. About 20 facilities have yet to meet at least one of their building requirements, although some have received extensions from the state.
Many more – 674 buildings spread across 251 licensed hospitals – do not meet the second set of standards, which require hospital facilities to remain operational in the event of a major earthquake. This work should be completed by 2030.
“It’s hard to argue the importance of this,” said Jonathan Stewart, a professor at UCLA’s Samuel School of Engineering, citing a 2023 earthquake in Türkiye. “There were many hospitals that were intact but not fit for use. This is better than a collapsed structure. But that’s still not what you need in a time of emergency.”
The influential hospital industry has unsuccessfully lobbied lawmakers for years to extend the 2030 deadline, though the state has granted various extensions to specific facilities. Newsom’s signature on one of three bills addressing the issue this year represents a partial victory for the industry.
Hospital administrators have long complained about the enormous cost of seismic retrofits.
Carmela Coyle, president and CEO of the California Hospital Association, said in a letter to Newsom, “While hospitals are working to meet these requirements, many will not meet the 2030 deadline and are prohibited by state law. They will be forced to close.” Vetoed the CHA bill. A 2019 Rand Corp study The cost of meeting the 2030 standards statewide is set to be paid by CHA at $34 billion to $143 billion.
However, labor unions representing nurses and other medical staff say hospitals have plenty of time to bring their buildings into compliance, and most have the money to do so.
“They’ve had 30 years to do this,” Kathy Kennedy, a nurse in Roseville and one of the presidents of the California Nurses Association, said in an interview before the governor’s action. “We’re taking to the streets year after year, and unfortunately, lives are being lost.”
In his veto message on the CHA bill, Newsom wrote that a blanket five-year extension was not appropriate, and that any extension should be limited in scope, granted only to hospitals with demonstrated need on a case-by-case basis. . “In combination with a clear pathway to compliance, and strong accountability and enforcement mechanisms.”
He also vetoed a bill specifically directed at helping several hospitals operated by the Catholic hospital chain Providence.
But he signed a third bill that allows small, rural and “critical access” hospitals and certain others to apply for a three-year extension, and allows the Department of Health Care Access and Information to provide them with “technical assistance.” Gives instructions to provide. To meet deadlines.
The state designates 37 hospitals as providing “critical access.” An additional 56 are considered “small”, meaning they have fewer than 50 beds, 59 are considered “rural”, and 32 are “district” hospitals, meaning they are called “health care districts”. Are funded by special government entities. They can seek a three-year extension as long as they submit a seismic compliance plan and identify milestones to implement it.
Debbie Stebbins, executive director of the Alameda Health Care District, which owns the Alameda hospital buildings, said smaller hospitals face a bigger challenge. Even though Alameda is close to San Francisco and Oakland, the tunnels, bridges and ferries connecting it to the mainland can easily shut down in an emergency, making the island’s hospital a lifeline.
“It’s an unfunded mandate,” Stebbins said of the state’s 2030 deadline.
RAND study estimates average cost of retrofit over $92 million per building, but this amount can vary greatly depending on whether it is a building that has hospital beds.
Smaller and rural hospitals can get some help from the state through grants funded by the California electronic cigarette excise tax, but Andrew DiLucia, a spokesman for the Department of Health Care Access and Information, said it would only bring in a total of $2 million to $3 million annually. The Small and Rural Hospital Relief Program also received a one-time investment of $50 million from the tax on health insurers to help with earthquake work, he said.
Labor unions and critics of the expansion often point to the large profits enjoyed by some hospitals: A California Health Care Foundation report published in August found that California hospitals made $3.2 billion in profits during the first quarter of 2024. “This continues to be a wide variation in financial performance among hospitals, with the bottom quartile showing a net income margin of -5%, compared with +13% for the top quartile,” the study said.
Stebbins has had to help his district come up with a plan.
After Newsom vetoed a bill in 2022 that would have provided an extension on the seismic retrofit deadline specifically for Alameda Hospital, the hospital system and its partner health care district used parcel tax money to help a loan,
The retrofit will cost about $25 million, and the system is also investing millions in other projects, such as a new skilled-nursing facility. The construction work is targeted to be completed in 2027.
“Nobody wants things to come crashing down in an earthquake or anything else, but at the same time, it’s a burden,” said Mahler of Alameda Health System. “How do we make sure they have what they need to stay open?”
This article was created kff health newsA national newsroom that produces in-depth journalism about health issues.
