Despite California’s stalled plans for an online tracking system for hospital seismic retrofitting, 80 percent of hospitals are said to be on schedule.
On Feb. 9, 1971, a magnitude 6.6 earthquake shook Southern California’s San Fernando Valley, killing 65 people and seriously injuring 2,000. Because most of the deaths occurred in a veterans’ hospital, the state Legislature in 1973 passed the Alfred E. Alquist Hospital Facilities Seismic Safety Act, requiring all acute care hospitals at risk of collapse be retrofitted to withstand an earthquake.
Eleven years later, following the 1994 Northridge earthquake, the Legislature passed two bills that strengthened the act’s requirements and set deadlines to meet them. Hospitals must determine which buildings are at risk of collapse during a major earthquake (with a magnitude of 7 or greater)
and therefore must be seismically retrofitted to remain standing during and after a temblor by 2013. By 2030, they must be seismically retrofit to be able to remain operational immediately following an earthquake.
Even with deadlines in place and standards being set, several obstacles remain — including the high costs of new hospital construction and the lack of funding and financial incentives for the hospitals to complete the work. To keep track of progress, California passed a law in 2009 requiring hospitals with acute care facilities in buildings that face a high risk of collapse during an earthquake to report their progress and expected timeline for completion during a one-year time span.
In November 2009, the Office of Statewide Health Planning and Development (OSHPD) awarded a contract to Accela to build the foundation of a new system that would replace the agency’s mix of paper and electronic processes for tracking hospital construction projects. The move was intended to improve accountability of both the OSHPD and hospitals’ design teams and to help projects move through the approval process.
Reports showed that 80 percent of hospitals are on track to be retrofitted by 2015. According to data posted on the OSHPD site, 129 hospitals with 403 buildings will meet the state’s hospital seismic requirement by January 2013. Another 55 hospitals with 153 buildings will be compliant by 2015.
The remaining 20 percent plan to complete seismic retrofitting by Jan. 1, 2020, though not every facility that’s planning compliance after 2015 has been verified as eligible for such an extension, said OSHPD spokesman David Byrnes.
While the California Hospital Association (CHA) supports the goal of seismically safe hospitals, it notes that the challenge has been to carry out and finance the required retrofitting in a way that doesn’t jeopardize patients’ access to care.
“A number of hospitals will not be able to comply with the seismic deadlines for financial, scheduling or other practical reasons,” said CHA President and CEO C. Duane Dauner in a statement. “It is essential that lawmakers and hospital officials work collaboratively to address these barriers and keep hospitals open for patients.”
One obvious barrier is cost. The cost of making these seismic improvements ranges from $45 billion to $110 billion, according to a 2007 study by the Rand Corp. And financing could double the cost. Complying by 2030 with the mandate that acute care hospitals remain operational following an earthquake could add 20 percent to construction costs.
The CHA plans to sponsor legislation this year to help the remaining hospitals comply with the mandate, said spokeswoman Jan Emerson-Shea. Details of what the legislation is expected to look like will follow additional analysis of the information reported.
A new Web-based system may improve the accountability of the OSHPD and hospital design teams by tracking hospital construction projects. Once fully implemented — expected in January 2012 — the Facilities Development Division (FDD) will use the e-Services Portal to track health-facility plans, reviews and construction, facilitate inspections and certifications, and ensure compliance with state-mandated seismic safety standards.
“New programs, as well as changes to existing ones made by changes in the Hospital Seismic Safety Act, would require a substantial investment for reprogramming and modifying an archaic program that was on the verge of becoming unstable,” Byrnes said. The current tracking system, Logbook, was created in the early ’90s and allows for limited electronic plan submission and review, letting users check the status of projects, but it doesn’t provide any analytical capabilities.
According to the OSHPD, the number of projects under review by the FDD has increased substantially since the original system was implemented. Also, the estimated cost of projects under review by the agency has grown from $2 billion to $23 billion annually, prompting the office to replace the system. The new portal was originally scheduled to go live in summer 2010, but California’s budget difficulties have pushed development back to April 2011, meaning citizen access and the system’s wireless components for field staff are scheduled for deployment by July 2011.
Even with 80 percent of hospital buildings reportedly on track to meet 2015 seismic safety construction deadlines, hospitals question how to fund the projects with their slim operating margins, which averaged less than 4.5 percent between 2004 and 2008, the OSHPD reported in testimony before a 2010 state Senate health committee hearing on seismic safety of hospitals.
Before the same committee, Mike Boyd, executive director of facilities, planning, design and construction at the University of California, Davis, Sacramento campus, testified that the university system expected to invest $2.75 billion by 2011 in hospital construction projects, which was partially prompted by seismic safety mandates. Of the total investment, 77 percent came from bonds and long-term debt, and 19 percent came from a FEMA grant.
In Los Angeles, the county’s Department of Health Services is on schedule and within budget to complete seismic retrofitting projects at five hospitals it oversees using bond capacity already approved by voters, said John Shubin, the department’s director of capital projects. The increased time frames to get approval on projects from the OSHPD, he said, have been built into project schedules and budgets.
And following the new Logbook’s implementation, the OSHPD expects to roll out a Plan Review Report Card section of its e-Services Portal, though the timing hasn’t been determined. “Because of resource constraints during the past two years,”
Byrnes said, “FDD has put this project on hold and does not currently have an estimated time frame for its reactivation.”
When implemented, the report card would track: the amount of time that planning documents have stayed with the FDD and hospital design teams; the number of back-checks for a project; the length of the time it took for a plan to be approved from start to finish; and if any of these factors were above or below average.
“For those projects that perform below average, the hospital owner may wish to consider steps to improve project performance in the future,” Byrnes said. “This may result in selecting a different design team, providing the design team with a better defined program and/or performance expectations, more direct involvement by hospitals’ owners to assure better outcomes for their projects, etc.”