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Ruthie Gonsoski, RN, was the charge nurse during an unusually busy night on the fifth-floor labor and delivery unit at Northridge Hospital Medical Center when the lights went out, the floor rolled, ceiling tiles began falling and a window imploded, scattering glass throughout one room.

Although it only took a few minutes for power to be restored, it “seemed like years” recalls Gonsoski, whose first concern was patient safety when the 6.7 earthquake struck at 4:31 a.m. Jan. 17, 1994.

“We organized the patients,” Gonsoski said. “The moms were the calmest; the fathers were more hysterical.” Assessing the situation—the smell of smoke, leaking water, falling tiles—she decided not to wait for help and the delivery team nurses took the families down a staircase with cracked walls to safety.

Gonsoski later learned that the hospital was at the epicenter of the earthquake. In the first 48 hours after the temblor, the hospital staff treated more than 1,000 walk-ins while caring for the existing patients. The labor room nurses set up shop at the front of the building and triaged and discharged women and their newborns. They also commandeered an ER space and delivered four more babies as the sun rose over the San Fernando Valley.

“Even though we had an earthquake, there were 20 deliveries that day,” said Gonsoski, who is now a perinatal educator. She added that eight hours after the big shake, the nurses were able to safely return to the fifth-floor department. “The staff really pulled together. If there’s one thing I’ve learned, it’s that we’re ready for anything.”

Sound structures

Considered a moderate temblor, the Northridge earthquake caused 23 California hospitals to suspend some or all of their services and resulted in more than $3 billion in hospital-related damage, according to the California Healthcare Association. In its aftermath, the state Legislature passed SB 1953, which requires all acute care inpatient hospitals in the state to either be retrofitted or rebuilt by 2008 to survive earthquakes without collapsing or posing the threat of significant loss of lifeby 2013 if the buildings are expected to remain in use 30 years from now. The law further mandates that by 2030, all hospitals must be seismically strong enough to withstand a quake and be reasonably capable of providing services afterward.

The California Seismic Safety Commission said hospitals built in accordance with the Alfred E. Alquist Hospital Seismic Safety Act of 1973 were successful in avoiding structural damage during the Northridge quake; however, nonstructural damage to plumbing and ceiling systems was extensive.

The CHA said that although California hospitals support seismic safety, the price tag for construction costs alone under SB 1953 is estimated at $24 billion, putting financial strains on many hospitals, particularly those in rural areas of the state struggling to survive. A report by the RAND Corp. puts the costs even higher—at $41 billion—when adding the expenses of architects, engineers, land purchases and other factors.

“We support the goal of the law,” CHA Vice President Jan Emerson said. “Our biggest issue is the cost. This is a completely unfunded mandate.” She said the 2008 date was also arbitrary and that many of the 2,700 inpatient buildings affected by the law at about 471 acute care hospitals could be phased out as their 40- to 50-year life cycles expire during the next decade.

Emerson said only about 40 percent of the buildings were identified by the California Office of Statewide Health Planning and Development as being in the highest danger of collapse during a quake, and most of them were in high-risk quake zone areas. Rebuilding is a decision that takes time and money, and the location and structural integrity of the building should be factors in setting seismic standard deadlines, she said.

Emerson also said 51 percent of the state’s hospitals are losing money and that 50 or 60 hospitals—many rural—eventually could be forced to close because of the high cost, complexities and deadlines for seismic compliance. Even the lesser $24 billion estimate is equivalent to the total combined, undepreciated assets of all California hospitals, she said.