California seismic safety rules pose expensive challenge for Sonoma County hospitals

If a major earthquake were to hit Sonoma County, Healdsburg District Hospital’s original structure that currently houses inpatient services would not collapse or endanger patient lives, according to its current seismic rating.

While services at the hospital’s 11-year-old emergency department would likely be uninterrupted by a big temblor, the hospital’s original 50-year-old structure would probably be incapable of caring for patients. Hospital officials say retrofitting the facility’s original footprint to keep it operational after an earthquake - as required by a looming state deadline - would cost $15 million or more.

That’s a lot of money to spend on bracing walls, removing bricks, drilling holes and installing pilings in a concrete slab foundation, on a part of a facility that may not even be needed after an earthquake. For twice that amount, the hospital could get a whole new inpatient wing and skilled nursing facility or a slew of facilities upgrades, said Joe Harrington, CEO of Healdsburg District Hospital.

“With $30 million we would replace aging infrastructure, including a new HVAC system, new medical gas and oxygen system and bigger operating room suites,” Harrington said.

Across the state, health care executives like Harrington are facing the prospect of spending tens of millions of dollars to retrofit aging hospital facilities by 2030, as required by state seismic safety rules, or face closure. Local hospital officials and their advocates are asking state legislators to re-evaluate the 2030 deadline, and they question whether such a one-size-fits-all requirement should be applied to all hospital facilities.

“There will be unintended consequences,” said Carmela Coyle, president and CEO of the California Hospital Association. “This is very expensive. For some (hospitals), they will have to make the decision to either retrofit, rebuild or close.”

According to a recent report by RAND Corporation, the requirement that every hospital building remain operational after a major earthquake by Jan. 1, 2030 could cost hospitals across the state more than $100 billion. The hospital association said that number could double due to inflation and financing costs.

The state’s hospitals have already invested billions of dollars in the past two decades to ensure they remain standing after a major earthquake. As a result of that investment, Coyle said all hospitals in the state will be earthquake safe by 2022.

“Do we need all acute care available or just emergency services?” Coyle asked. “The price tag raises the question: is there another way to ensure services without spending the kind of money required here?”

Coyle said spending billions to retrofit non-emergency care hospital buildings could further drive up health care costs and further destabilize hospital budgets, especially for smaller rural and district hospitals that are already under great financial strain.

“We are about to add $100 billion to the price of health care,” Coyle said. “From a consumer perspective, what is the best way to ensure that care is available and is there a less expensive option for doing that?”

In 1971, a year before Healdsburg District Hospital was built, a moderate 6.6 magnitude temblor in San Fernando Valley brought down two hospitals and killed 47 people. The Sylmar earthquake prompted state lawmakers to enact the Alquist Hospital Seismic Safety Act of 1973, requiring hospitals to be designed and constructed to withstand a major earthquake.

Legislators fully expected old hospitals would gradually be replaced by newer structures and by 2000 most hospitals would be up to code. But that didn’t happen, and after the 1994 Northridge earthquake, the Alquist Act was expanded to require all hospitals to be free from the risk of collapse during a big earthquake by 2008, a deadline later extended to 2020.

In Sonoma County, all hospital facilities have met that deadline and are designed to remain standing after a quake. However, several have not yet met the 2030 requirement to ensure they remain operational after a major earthquake. And though it might seem like that’s a long way off, hospital officials say it can take up to 10 years to plan for and carry out either a hospital retrofit or new construction.

“We’ve been having discussions over the last year about our options,” Harrington said. “We want to be sure that we’ve done our homework and know what the best options are.”

In the past 16 years, Santa Rosa Memorial Hospital, which is operated by St. Joseph Health in Sonoma County, has spent $8.5 million retrofitting, remodeling and building new facilities to meet the state’s seismic safety standards. With the exception of one hospital building that houses inpatient services, all other Memorial facilities are currently rated to withstand an earthquake and remain in operation.

“While not at risk of collapse, this building may not be suitable for extended operations following a large earthquake as the 2030 seismic safety standards currently demand,” Tyler Hedden, interim chief executive of St. Joseph Health, said in an email.

Hedden said the hospital leadership team is evaluating what to do with the space, trying to balance the “large financial burden” of seismic laws with preserving access to critical health care services after an earthquake.

Kaiser Foundation and Sutter Health hospitals in Santa Rosa, as well as Sonoma Specialty Hospital in Sebastopol and Petaluma Valley Hospital all meet the 2020 and 2030 seismic requirements.

Expensive retrofitting to meet the 2030 requirements would merely ensure continued operation, but it would likely add no new services, technology or facilities to the aging buildings. That’s a tough pill to swallow for hospital executives with limited budgets.

It took Sutter Health six years to plan, design and build the new Sutter Santa Rosa Regional Hospital on Mark West Springs Road, said Dan Conwell, director of planning, architecture and design for Sutter Health system.

The hospital, which opened in 2014, cost nearly $300 million to build. For that price, Sutter not only obtained seismic safety, it also got state-of-the-art technology in each and every part of the hospital, including its building management system, heating and air conditioning, its nurse call system, fire alarm systems, security systems, electronic medical records system - all the things that likely didn’t exist in older hospitals when the Alquist Act was enacted in 1973.

In the town of Sonoma, it would cost more to retrofit the local hospital than to completely replace the new wing. Kelly Mather, CEO of Sonoma Valley Hospital, said the emergency department, surgery wing and skilled nursing facility meet the 2030 requirement. But the hospital’s central wing, built in 1958, and inpatient tower, built in 1970, do not.

“It’s $100 million dollars to rebuild the inpatient tower,” she said. “Retrofitting would be $150 million.”

Mather said retrofitting would require a major redesign and expansion of hospital rooms in order to bring them up to code. Keeping the old building would probably not be worth it, she said.

When asked what she could do with $100 or $150 million were the hospital not required to meet the 2030 deadline, Mather laughed.

“What would we do with $100 million? Honestly I don’t think we need $100 million,” she said. “Certainly, that would be a nice gift from a donor, and we would probably create an endowment.”

This week, lawmakers in Sacramento are expected to hear the outline of a bill that would call for a re-examination of the 2030 deadline.

The hospital association has thrown its support behind SB 758, a bill by Anthony Portantino, D-La Cañada Flintridge, that spearheads discussion on possible alternatives to the 2030 requirements, said Jan Emerson-Shea, a spokeswoman for the hospital association.

“We are working with (Portantino), our members and other stakeholders to craft a workable solution to the challenges presented by the current 2030 requirements,” Emerson-?Shea said.

The RAND report, a peer-reviewed study that was funded by the hospital association, found that more than a third of California’s hospitals are currently in some type of financial distress. The share of financially strapped hospitals could increase to half if the standards are not modified, the report said.

Sen. Bill Dodd, D-Napa, whose district includes Sonoma Valley, said he supports a re-evaluation of seismic requirements.

“It’s important we’re proactive to make sure hospitals are ready for earthquakes,” Dodd said. “At the same time, we must ensure any requirements we place on them are done in a smart way and don’t hurt their ability to continue operating and serving our communities.”

Dodd said he sees Portantino’s bill as an opportunity to discuss the best way to resolve earthquake safety issues facing struggling hospitals.

A spokesman for Dodd said the senator is waiting to see the final language before he takes a position on it.