For healthcare executives concerned about the damage earthquakes cause hospitals, Sunday's earthquake just south of the California/Mexico border—and its aftershocks—were no shocker.
However, the fact that it did almost no damage to the state's 2,000 hospital buildings—except one in El Centro near the epicenter—was a surprise. Seismic safety is a concern for dozens of California hospitals with buildings that don't meet seismic compliance now, and won't by the state's deadline, 2013 or, in some cases, 2015.
According to the state agency that certifies the integrity of hospital structures, California has a 99% chance of experiencing an earthquake with at least a magnitude of 6.7, a 46% chance of a 7.5, and a 5% chance of an 8 within the next 30 years. The chance of a temblor originating within the state between the years 2013 and 2020 is 23%.
That's according to a report issued last month by the Office of Statewide Health Planning and Development before a state hearing on hospital seismic safety March 3. That report estimated that as many as 65 hospitals with between 85 to 278 buildings may not meet those deadlines. If they aren't in compliance by the deadline, the hospitals will have to stop providing acute care.
The number varies depending on how many hospitals that had begun retrofit or rebuilding projects—and should have completed them—had to delay them because of the economic downturn.
For 60 of those buildings, according to the state report, hospitals reported "no compliance information at all."
The number of hospitals also is in flux, as politicians, industry trade groups, and the California Hospital Association grapple with how to keep the healthcare system stable in the next four years. Taking a hospital out of business for lack of seismic compliance would be a severe move.
But from the state's perspective, the threat that a hospital itself may be so structurally fragile that it could cause harm to patients and staff is something the agency must work to avoid. A destroyed hospital won't be available to treat the injured, and would take years and cost millions to rebuild—and its absence could retard the community's long-term economic growth and limit access to care.
That's why state laws mandate hospitals to shore up to meet seismic compliance, be razed and rebuilt or be converted to a use that does not involve acute patient care.
The problem is that most of the state's older hospital buildings are built in the state's most seismically active regions, shown on a map as a long roughly 30- to 60-mile wide swath of red labeled "Zone 4," running from Crescent City near the Oregon border to the southern tips of San Diego and Imperial counties. The recent quake occurred just below that southern tip.
Jan Emerson, spokeswoman for the California Hospital Association, quotes from a 2007 Rand report estimating the cost for hospitals to become compliant with state law is "as high as $110 billion, without financing costs." She declined to comment further, saying only that CHA is working on the issue with legislation.
According to the state's March report, structural engineers have determined that all hospital buildings used for acute care that fall into the category called Structural Performance Category, or SPC-1, must be "removed from service" by 2013, whereas SPC-2 buildings must be removed from service by 2030.
As of 2010, 825 of the state's 2,627 of acute care hospital buildings were said to be in the worst shape, category SPC-1, while 200 fell into SPC-2.
Of those 825, 321 buildings have active compliance or replacement projects, 74 received extensions to 2020, and 142 will have to be withdrawn from acute care by 2013. But 104 buildings belonging to 64 hospitals "are under review and have no other plans for compliance."
For hospital infrastructure systems that aren't structural, but are nevertheless critical for patient care, such as emergency power systems, fuel storage, and gas lines, 2,000 fell into NPC-1, the category that do not meet requirements for withstanding an earthquake.