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By Diane Sussman
March 16, 2000
Photo: Corbis

In 1971, the 6.7-magnitude San Fernando earthquake rocked the Los Angeles bedroom community of Sylmar, ravaging its two hospitals. Fifty people died when the old brick Veterans Administration Hospital and the year-old, concrete Olive View Medical Center buckled and collapsed.

Jim Hazard, RN, who worked at the Olive View psychiatric hospital at the time, remembers the darkness, smoke, flying debris, and sensation of plunging 15 feet downward "The second floor stayed pretty much intact. The whole second floor just pancaked down to the first floor," he said. "I have to say, the patients had just been given Thorazine, so they were a lot more calm than we were."

It took 11 years and $48 million to rebuild Olive View (the VA hospital became a memorial park), but when the next major earthquake hit—the 1994 Northridge quake—the hospital sustained only minor damage.

Strict new standards

But other California hospitals are still feeling the aftershocks of the San Fernando quake in the form of legislation requiring extensive—and expensive—retrofitting for all hospitals built before 1973.

The retrofits are required under the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983, a state law initiated after the San Fernando earthquake requiring that hospital inpatient buildings be able to withstand the specific forces generated by a powerful earthquake. How much theoretical force a hospital must withstand depends on its location. Because of their many fault lines, the San Francisco Bay Area and Los Angeles face the strictest standards.

Hospitals must meet the first set of standards by 2008, and a second, more stringent set of standards by 2030. The 2008 standards require that all essential equipment—monitors, fire suppression systems, medical gas lines, and communications systems—be braced securely enough to stay put and keep working.

"The way the law reads, by 2008, hospitals basically have to ensure that the building is not going to injure staff or patients," said Darlene Schell, spokesperson for the Office of Statewide Health Planning and Development (OSHPD), the agency overseeing the regulations. "By 2030, the hospital is going to have to be fully operational, so that essentially there is no break in any services."

Hefty price tag

The legislation applies only to general acute care facilities—places where patients are either staying overnight or where they may be unable to move, such as surgical suites. It does not apply to clinics, administrative wings, labs, skilled nursing homes, or other areas where people are capable of getting themselves out of the building or are not hooked up to ventilators or other essential equipment. Officials estimate 470 acute care hospital facilities—a total of about 2,673 hospital buildings—will be affected.

Before bringing in the wrecking balls, hospitals must evaluate the potential seismic performance of each inpatient building or building component. The deadline for evaluation is Jan. 1, 2001. Factors that influence performance include the age of the building, its relationship to various fault lines, the composition of the underlying soil, and the materials used to construct the building, Schell said.

Buildings or wings unlikely to perform well in an earthquake must be upgraded, which could mean strengthening beams and columns or adding load-bearing walls. "The state is saying it wants patients to be safe, and we strongly support that. But it’s going to be expensive," said Roger Richter, senior vice president of the California Healthcare Association.

CHA officials believe statewide costs could run as high as $10 billion by 2008, and as high as $24 billion by 2030. "And I would call that a conservative estimate," Richter said. OSHPD officials believe the costs will be half that—about $5 billion by 2008, said David Keast, OSHPD legal counsel for the facilities division.

Faced with hundreds of millions of dollars in construction costs, some hospitals may simply have to close, Keast predicts. "It is going to be hard for many hospitals," he said. "According to state research, one-third of hospitals in the state are already dipping into their reserves and endowments in order to keep operating. This could be too much."

Billion-dollar question

How hospitals will pay for retrofitting is the billion-dollar question. "It’s the mother of all unfunded mandates," said Bob Merwin, CEO of Mills-Peninsula Health Services, headquartered in Burlingame, Calif., which faces an estimated $240 million in retrofitting costs. "I believe a number of hospitals will either merge, change their type of care, or go out of business. It takes a system of considerable size, like Kaiser or Catholic Healthcare West, to be able to afford it."

"It’s true that the legislation didn’t provide ways to pay for it," Keast said.

Even a healthcare giant like Kaiser Permanente may not be exempt. The HMO is already looking at moving some of its Oakland operations to nearby Summit Hospital, a move that could be hastened by a whopping retrofit bill. "Like all other hospitals in the state, we are going through studies right now," said spokesman Bob Eisensman. "We don’t know exactly what we’re going to do in Oakland, Calif., but retrofitting will certainly be part of the equation." Kaiser has 27 hospitals in the state, he added, the majority in urban areas near major fault lines.

Until the evaluations are in, Keast said, no one really knows which hospitals are the safest and which communities potentially stand to lose their hospitals.

But one thing is certain: Between now and 2030, the view from many hospital rooms is going to be cranes and girders. "This is really going to be a hot issue this year in the California legislature," Richter said. "People are just starting to become aware of the situation."