In the coming years, hospitals in the Central Valley and across the state will have to undergo serious modifications in order to remain up and running in the event of a major earthquake, but for many, there’s fear the costs may take them down before any natural disaster.

The rules come as part of Senate Bill 1953. Passed in 1994, the bill requires hospitals to meet improved seismic standards that would not only allow for a hospital to survive an earthquake, but also remain operational. But it’s also brought concerns for many hospital administrators. Among them is Gary Herbst, CEO for Kaweah Delta Medical Center in Visalia.

 

Preparedness and plan B

According to Herbst, there’s more to earthquake preparedness than just the building. In July, two significant earthquakes struck Southern California, causing flooding at the Ridgecrest Regional hospital. The incident necessitated hospital staff to move patients — and their means of care — to an older, undamaged location built five decades ago.

The protocols and handling of the situation, Herbst elaborated, showed preparedness for a seismic emergency that goes beyond structure. He argues that the human factor — especially having emergency contingency plans in place — is what can make or break a hospital in the event of a natural disaster. In Kaweah Delta’s case, they’ve arranged for the Visalia Convention Center to be their emergency center.

“I think that was an interesting event for the Legislature to see the hospital was right in the middle of this earthquake and very capably took care of all its patients,” Herbst said. “And health care continued.”

 

High costs, low risks

Under SB 1953, hospital buildings constructed before 1973 were automatically given a standard building code (SBC) designation of 1, with a compliance deadline of Jan. 1, 2020. This was no problem for the eastern and western expansions at Kaweah Delta, which may be used indefinitely beyond 2030. The main Mineral King Wing is another story. The four-story structure, which houses 221 acute care beds, was built in 1969, four years before the cutoff year.

However, a geological study on the hospital conducted by the Federal Emergency Management Agency (FEMA) found that due to the distance between Kaweah Delta and the nearest fault line and the unique geology of the area, the structure would have a .01% chance of collapsing from a major earthquake. The seismic energy, Herbst said, would dissipate well before it could reach the hospital.

With this information, the leaders at Kaweah Delta were able to bring their hospital down to an SBC-2 rating, but they still have to comply with state standards, which are blanketed across California with little to no consideration for location.

“The state basically said: ‘That’s a federal study,’” Herbst explained. “’That’s the federal government. We’re the state government and we make our rules.’ So they are essential providing a uniform requirement across all hospitals. They do not look at hospitals uniquely.”

 

Pony up

In order to comply, Herbst and others at the hospital have been weighing their options. This has included retrofitting and bracing the Mineral King wing, constructing sheer walls to prevent swaying or even removing the third and fourth floor to lower the profile. Regardless of the method, it won’t be cheap, and Kaweah Delta is just one of many hospitals in California with SBC-1 and 2 designations that won’t receive public funding despite costs that could go into the billions statewide.

“Every hospital’s having to come up with that money on their own and many won’t be able to,” Herbst said. “And so they may close, or significantly cut back their services because they can’t use those beds.”

“If we follow through with this standard, we will likely close hospitals,” Carmela Coyle, president of the California Hospital Association, told the Associated Press, adding that 38% of hospitals in California operate at a loss as it is.

Making matters more complicated for Kaweah Delta is the ongoing expansion of its emergency department. This project will cost of $36 million in tax-exempt revenue bonds. The expansion has not been hindered by the seismic standards demands and is on track to be completed by the fall of 2020, but it’s that much more money that won’t be able to go towards the state’s requirements.

 

Bad memories

The seismic standards for hospitals have also been a point of significant concern for Adventist Health- Tulare (formerly Tulare Regional Medical Center). For many in the Tulare community, memories of the construction of the hospital’s tower (created to meet the needs set by SB-1953), and the financial problems entailed with it, are still fresh. Further misgoverning by their managing company, Healthcare Conglomerate Associates (HCCA), would culminate in the hospital filing for bankruptcy in 2017. The hospital came under the control of Adventist Health last year.

There are still plans to finish the tower, but according to Sandra Ormonde, CEO for the Tulare Local Healthcare District, estimates to complete the tower start at $40 million depending on final design, timing and phasing. She added that various smaller projects have been completed, with others ongoing until additional funding is made available. But despite a rocky past, they still remain confident.

“Steps have been taken to identify and mitigate factors that contributed to the situation in 2017,” Ormonde said. “The District is moving forward with its primary goal of providing access to quality health care, even while overcoming financial challenges.”

Much like Kaweah Delta, Ormonde stated that an extensive emergency preparedness plan is already in place, should an earthquake ever occur.

Currently, the California Hospital Association is working with members of the California State Legislature to mend the gap between medical centers and the state. In the meantime, Kaweah Delta and others must budget and prepare for the necessary measures.