State doing little to track hospitals with severe seismic safety risks

November 7, 2010

By Christina Jewett
California Watch

State authorities and hospital officials have discovered serious structural weaknesses at more than a dozen hospital buildings, but they have taken few steps to notify the public about the facilities or require a detailed inventory of hundreds of other potentially dangerous sites.

More than a dozen hospital buildings in the Bay Area and Southern California face the highest-known chances of crumbling during an earthquake, based on a complex mash-up of each building’s structural strength, distance from a fault line and expected ground motion, California Watch has learned.

While the problem of hospital safety has been widely debated, few people know how little California is doing to detect its riskiest hospital buildings. Regulators do not require hospital owners to determine a collapse risk for every building they own, making it impossible to know which should be fixed first.

The state is focused on nearly 700 hospital buildings that were identified in the 1990s as potentially dangerous. Public health officials can revoke a hospital’s license – effectively shutting down the facility – if it doesn’t retrofit, replace or remove patients from those buildings by 2013 or 2015.

But with this mandate looming, state authorities have determined the collapse risks for only 90 of the nearly 700 structures. Among those potentially dangerous buildings, 14 carry collapse risks of nearly 10 to 32 percent, far higher than the score officials consider reasonably safe – which is set at 1.2 percent.

Public officials and hospital authorities expect dozens of hospitals to miss their deadlines to shore up or evacuate key buildings. Even so, the state is unlikely to order a mass shutdown of hospitals, a scenario some deem just as life-threatening as a quake.

The state doesn’t force hospitals to determine their collapse risks – the process is voluntary. The lack of an authoritative inventory of the riskiest buildings concerns people who work in these facilities.

“Those are odds we don’t want to mess with,” said Stephanie Roberson, legislative advocate for the California Nurses Association, which has opposed extending the seismic safety deadline for hospitals. “It’s our patients that are at risk in these facilities.”

Hospital buildings with high collapse risks include those at Kindred Hospital in San Leandro and the California Hospital Medical Center in Los Angeles. The collapse risk is 20 percent for the original building at Hollywood Community Hospital in Hollywood based on a 6.4 magnitude quake, according to analyses completed in 2008 and 2009.

When calculating a collapse risk score, the state accounts for the strongest-likely quake that could erupt from the closest fault to each hospital building. Seismologists predict that California will almost certainly see a 6.7-magnitude or stronger quake within 30 years.

With the threat of a major quake always looming in California, the state’s hospitals face an expensive building tab, once estimated at more than $110 billion.

The California Hospital Association has been outspoken about the problem, saying the retrofitting requirements under the 1994 mandate are built around arbitrary deadlines. Last year, the group helped push through a deadline extension until 2020 for hospitals under financial hardship – but without consideration of collapse risk.

Gov. Arnold Schwarzenegger vetoed efforts to extend the deadline this year.

Four decades of laws

The death of three hospital patients at Olive View Medical Center in the San Fernando Valley during the 1971 Sylmar earthquake spurred lawmakers to pass landmark seismic safety legislation.

The magnitude 6.7 Northridge quake in 1994 inspired an even more stringent law that set deadlines for hazardous hospital buildings. Structural engineers – using the best technology at the time – concluded that 1,100 buildings were at risk for collapse and needed to meet seismic safety deadlines, which were then set for 2008.

The goal, though, seemed increasingly impossible, given the enormous costs. To winnow the list of highest-risk hospitals, state officials turned to newer technology: a program called HAZUS that used information about a hospital’s structure and ground motion to produce a “collapse risk” score.

In 2007, Schwarzenegger and state lawmakers passed a law allowing hospitals with a low enough score to be placed in a lower-risk category and see their seismic safety deadlines moved to 2030.

Charles Kircher, a Mountain View structural engineer who helped develop HAZUS for California, said the program accounts for likely ground acceleration near the hospital, a building’s range of motion during a quake and how well its frame might withstand the shaking.

When those factors are taken into account, the program spits out a collapse risk score. And for the six-story main building at Citrus Valley Medical Center’s Queen of the Valley campus in West Covina, the program produced one of the highest collapse risks in the state – 30 percent in the event of a 7.1 magnitude quake.

Kircher reviewed a state record provided by California Watch and said the “deadly sins” present at the Queen of the Valley campus in West Covina, for example, include a first floor that may not support the upper five stories and a structure that’s likely to shake unevenly in a quake.

“They definitely should do something about this building,” Kircher said.

A spokeswoman for Citrus Valley’s Queen of the Valley campus said hospital administrators are working with a structural engineer to determine what work is needed. The hospital has not submitted upgrade plans to state authorities.

By Oct. 1, state officials had received construction plans for six of the 14 hospital buildings that face a 10 to 32 percent collapse risk, records show.

Chain has high-risk buildings

Kindred Healthcare owns two of the three hospitals with the highest-known collapse risks in the state: a hospital in San Leandro with a 24 percent collapse risk in a magnitude 7.3 quake and Kindred Hospital in Ontario with a 32 percent collapse risk in a magnitude 7.2 quake. Its Los Angeles main hospital building has a score of 13 percent.

The firm’s 91-bed Ontario hospital has the highest-known collapse risk in the state, at 32 percent. The facility also had a profit margin that exceeded that of most California hospitals in 2008.

The hospital posted a 20 percent profit, far more than the average 3 percent profit for California hospitals that year, according to reports by state hospital finance authorities. Although the facility is required to report its financials to the state, it has no mandate to warn patients or staff of the precise risk its hospitals pose.

“If I had known (the collapse risk) when dad was there last summer I probably would have worried about it the entire time,” Cheryl Nakao of Walnut Grove wrote in an e-mail to California Watch. She said her father stayed in the Ontario facility for three weeks.

Anita Cook was a clerk and technician at Kindred’s 99-bed San Leandro facility, where patients tend to stay for 50 days, state records show. Cook worked for 16 years at the four-story hilltop building. It has a 24 percent collapse risk, the third-highest known risk in the state.

“That’s terrible,” said Cook, who expressed concern that she had not been trained in how to help patients in case of a quake.

She said she went out of her way to dance for patients on birthdays or call them “handsome” and “diva” to cheer them up. State hospital authorities and hospital management, she said, should take the same care in ensuring that staff know how to help save lives in case of a quake.

“(Management) gets paid to protect patients,” Cook said. She was fired this month for what she described as outspoken advocacy for patients and staff.

Kindred Hospital San Francisco Bay Area issued a statement saying it does not discuss internal personnel issues but noted that it reviews emergency plans during orientation with new employees.

The company also emphasized that it does look out for staff. A May presentation to investors said Kindred’s management philosophy includes “taking care of our people” and focusing “on quality and customer service.”

The company plans to meet all seismic safety deadlines by 2013, according to a statement sent to California Watch. Kindred officials said they have spent $3.5 million in engineering and construction for the upgrades.

This story was edited by Robert Salladay.

California Watch, the state’s largest investigative reporting team, is a project of the independent, nonprofit Center for Investigative Reporting. Contact the reporter at cjewett@californiawatch.org.

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