California Hospitals Struggle with Earthquake Mandate

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Susan Neer with an X-ray machine

Susan Neer, chief administrastor of Indian Valley Hospital in Greenville, Calif., says she's usually too busy to worry about the seismic safety deadlines. Cy Musiker, KQED hide caption

itoggle caption Cy Musiker, KQED

California hospitals are mandated to be safe in the event of a major earthquake. The institutions most vulnerable to quake damage are the state's small, rural hospitals. But many say the cost of seismic retrofitting is too expensive. Cy Musiker of member station KQED reports.

RENEE MONTAGNE, host:

Californians know another big one will eventually come, an earthquake that could shake down bridges, homes, and office buildings. To prepare, the state has increasingly tightened its seismic codes, especially for hospitals. They are the only facilities required to meet seismic standards or be shutdown. There is little state funding for the upgrades, though. And many hospitals insist they don't have the money to meet the deadlines.

From member station KQED in San Francisco, Cy Musiker reports.

CY MUSIKER reporting:

In 1971, a major earthquake, magnitude 6.7, rumbled through Southern California's San Fernando Valley.

(Soundbite of documentary film)

Unidentified Man: (In film clip) Let's check the Veterans Hospital out first before we go into Ollie View(ph).

MUSIKER: A documentary film dramatized what happened when two hospitals collapsed, including the brand new veteran's hospital in the town of Sylmar.

(Soundbite of documentary film)

Unidentified Man: (In film clip) Doctors and nurses are pulling victims out of the ruins, digging barehanded at the rubble, trying to free the rest.

MUSIKER: Forty-six patients and staff died at the veteran's hospital that day. The Sylmar quake shook California lawmakers as well. They began an effort to set seismic safety standards for all hospitals. They set a deadline, the year 2008 for hospitals to be earthquake safe. So far, nearly half have been granted the extensions to 2013. But then there's an even tougher standard. By the year 2030, a hospital must be fully operational after a major quake.

Kurt Schafer directs the state agency overseeing the seismic safety of hospitals.

Mr. KURT SCHAFER (Deputy Director, Office of Statewide Health Planning and Development): In California, it's not an issue of if we're going to have earthquake. It's a matter of when. And we want our hospitals to be available in the aftermath of that kind of disaster.

MUSIKER: But today, more than 900 - nearly a third of California hospital buildings - are seismically unsafe. Hospital administrators have had years to improve their facilities, but they say they're in a bind. They can't finance retrofits or new buildings without going broke or cutting new services.

That's true even at Seton Medical Center, a hospital that knows first hand how devastating an earthquake can be. The Catholic order, the Daughters of Charity, built their first hospital in San Francisco and finished it just days before the Great Earthquake of 1906.

Sister WILLIAM EILEEN DUNN (Director, Daughters of Charity Mission, Seton Medical Center): It was ready to open, but it collapsed completely down to ground zero, I guess.

MUSIKER: That's Sister William Eileen Dunn, who wears the slate blue habit of her order. Sister Eileen says the Daughters of Charity rebuilt. But in 1957, when Dunn was a student nurse, another major earthquake shook San Francisco.

Sister DUNN: There was wall that fell down, but thank God there was nobody operating in that particular room. But it shook quite a bit. So it shook our nerves, too.

MUSIKER: This time, the sisters moved the hospital to its current location in Daly City, just south of San Francisco, but also, within a few miles of the San Andreas Fault.

(Soundbite of a woman's voice on PA system)

MUSIKER: The heart of the hospital is this building, with everything from emergency rooms to surgical suites.

Ms. BERNADETTE SMITH (President, Seton Medical Center): We are on the seventh floor of the Patient Care Tower.

MUSIKER: Seton Medical Center President Bernadette Smith says this tower is the part of the hospital that fails seismic standards. It's 40 years old. In an earthquake, it could collapse. Smith says Seton considered and rejected a retrofit of the building as a money pit - too expensive with no improvement in hospital infrastructure. But it will cost even more, $250 million, to build a new tower. Raising that kind of money by the state deadline, Smith says, would compromise Seton's mission. It's the largest provider of charitable care in the county.

Ms. SMITH: Most hospitals in California would speak to this, that without some financial assistance from the state, we'd have to look at what services we can provide and what we can't provide.

MUSIKER: California lawmakers have provided some financial assistance, but only to rebuild the state's children's hospitals. The bill for the rest of the industry is huge. Five years ago, the Rand Corporation estimated the total cost of retrofitting or rebuilding California's seismically unsafe hospitals at $41 billion.

State Representative JOHN LAIRD (Democrat, Santa Cruz): Not in my lifetime, or the lifetime of anybody I'm related too, is the state going to put $41 billion into hospital construction. It is just simply not going to happen.

MUSIKER: Assemblyman John Laird helped negotiate a huge bond issue going before voters in the fall. The bond provides billions of dollars for schools, roads, bridges, and levees, but not hospitals. In the meantime, the hospital industry has lobbied hard for a bill extending the deadline. It's run into major opposition, though, from California's powerful Nurses Union, which argues hospitals are big money makers, which can afford the cost of retrofitting.

And lawmakers like John Laird say putting off the deadlines would be irresponsible. Laird was a city council member in Santa Cruz in 1989 when the Loma Prieta earthquake devastated the city's downtown.

State Rep. LAIRD: People argue about this issue as if it's something that's abstract. It's not abstract at all. There will really be lives at stake. And some people think we have the luxury of a debate, but this issue could come up tomorrow if the earth decides to act.

MUSIKER: Analysts say the hospital industry is coming out of a long financial funk, but it's increasingly divided into the haves and have-nots. Large for-profit hospitals have the resources to rebuild, but not smaller non-profits like Seton Medical Center. The most vulnerable are California's small rural hospitals. There are more than 70 of them, and nearly all fail to meet the state's seismic safety requirements. Take Indian Valley Hospital in the town of Greenville, deep in California's Northern Sierra Nevada range.

Ms. SUSAN NEAR (Chief Administrator, Indian Valley Hospital): This is our X-ray suite, and it has all just been retrofitted with new X-Ray equipment.

MUSIKER: Susan Near is the hospital's chief administrator.

Ms. NEAR: So, we're really proud of that. We have a table that moves. It slides around…

MUSIKER: New X-ray and CAT scan. But hanging on the wall is a conductometer, a medical device so old no one here recalls what it's used for. The contrast repeats throughout the hospital: new equipment in an aging facility built of cinder blocks that could cave in in an earthquake. But administrator Near says she's usually too busy to worry about the seismic safety deadlines.

Ms. NEAR: You know, it's always there. You know, you don't forget about it. But just keeping the daily operations going and just surviving from day to day to make sure that the doors stay open is what you have to focus on. So you have your priorities.

MUSIKER: If Near can't meet the state deadline, the hospital must close.

Unidentified Woman #1: Tamara Alice.

Unidentified Woman #2: Not much.

Unidentified Woman #1: Not much?

MUSIKER: Closing Indian Valley would also mean dispersing 18 elderly patients who live in the hospital's long-term care unit. Mary Jane Merrick(ph) is visiting her mother this morning. She recently broke both her hips. Merrick says the nearest alternative nursing care is a two-hour drive away.

Ms. MARY JANE MERRICK: It would be hard, very hard. You know, because I also have my in-laws that are in this facility, also. So, I have a big stake with it staying open, you know. Earthquake doesn't bother me that much. The closing, that's the scary thing.

MUSIKER: The standoff between hospitals and lawmakers could get worse later this year. The Rand Corporation will update the cost of making California hospitals earthquake safe. Many expect the price tag to rise well above the $41 billion estimate of five years ago.

For NPR News, I'm Cy Musiker in San Francisco.

(Soundbite of music)

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