More than half of California’s 410 hospitals have at least one building, but they likely won’t be able to operate if a major earthquake hits the area, and many are closed by the legal deadline of 2030. They claim they don’t have the funds to protect it. Regarding seismic retrofitting, the state is currently granting relief to some people while increasing pressure on others to complete the work.

Gov. Gavin Newsom in September vetoed a bill backed by the California Hospital Association. All hospitals would then be able to apply for an extension of up to five years. Instead, the Democratic governor signed a more narrowly tailored bill that grants small, rural or “distressed” hospitals an extension of up to three years.

“This is an expensive and complex issue for hospitals, especially independent hospitals,” said Alameda, which serves Northern California’s East Bay and is undergoing a $25 million hospital renovation. said Elizabeth Mahler, the health system’s chief medical officer. Alameda is on the island next to Oakland.

The debate over how seismically safe California hospitals should be goes back to the 1971 Sylmar earthquake near Los Angeles. This earthquake led to legislation that requires new hospitals to be built so that they can withstand earthquakes and continue operating. In 1994, after the magnitude 6.7 Northridge earthquake killed at least 57 people, lawmakers called for renovations to the existing facility.

These two laws require California hospitals to meet two standards. The first, originally set for 2008 but postponed to 2020, required hospital buildings to survive the earthquake. About 20 facilities still don’t have at least one of their buildings meeting that requirement, while others have received extensions from the state.

An additional number of buildings (674 across 251 accredited hospitals) do not meet the second standard, which requires hospital facilities to remain functional in the event of a major earthquake. The work is expected to be completed by 2030.

“It’s hard to argue with its significance,” said Jonathan Stewart, a UCLA Samueli School of Engineering professor, citing the 2023 earthquake in Turkey that damaged or destroyed several hospitals. “There were a number of hospitals that were intact but unusable. It’s better than a collapsed structure, but still not what you need in an emergency like that.”

The state has granted various extensions to specific facilities, but the influential hospital industry has unsuccessfully lobbied lawmakers for years to extend the 2030 deadline. Newsom’s signing of one of three bills this year addressing the issue represents a partial victory for the industry.

Hospital administrators have long complained about the high cost of seismic retrofits.

“Hospitals are working to meet these requirements, but many will miss the 2030 deadline and will be forced to close by state law,” said Carmela Coyle, president and CEO of the California Hospital Association. ” in a letter to Newsom. vetoed the CHA bill. a 2019 Rand Corporation Survey The cost paid by CHA pegged the cost of meeting the 2030 standards from $34 billion to $143 billion statewide.

But unions representing nurses and other health care workers say hospitals have plenty of time to adapt their buildings and most have the funds to do so.

“They’ve had 30 years to do this,” Kathy Kennedy, a Roseville nurse and one of the presidents of the California Nursing Association, said in an interview ahead of the governor’s action. “Every year we go through hardships, but unfortunately lives are being lost.”

In his veto message for the CHA bill, Newsom said a across-the-board five-year extension was unwarranted and that any extension would be “limited in scope and limited to hospitals with demonstrated need on a case-by-case basis.” It should be allowed, combined with a clear path to compliance and strong accountability and enforcement mechanisms.”

He also vetoed a bill specifically aimed at supporting hospitals operated by the Catholic hospital chain Providence.

But he signed a third bill, allowing small, rural “critical access” hospitals and some other hospitals to apply for a three-year extension, and requiring the Department of Healthcare Access and Information to It directed hospitals to provide “technical assistance.” Meet deadlines.

The state has designated 37 hospitals as “critical access” hospitals. A further 56 hospitals are “small” hospitals, meaning they have fewer than 50 beds, 59 are “rural” hospitals, and 32 are “district” hospitals, meaning they receive funding from special government agencies called “health districts.” It is believed that there are. They can seek a three-year extension as long as they submit a seismic compliance plan and identify milestones to implement it.

Debi Stebbins, executive director of the Alameda Medical District, which owns the Alameda Hospital building, said small hospitals face big challenges. Despite Alameda’s proximity to San Francisco and Oakland, the tunnels, bridges and ferries connecting Alameda to the mainland can easily be shut down in an emergency, making the island’s hospital a lifeline.

“This is an unfunded mandate,” Stebbins said of the state’s 2030 deadline.

RAND research estimates the average cost of renovations as follows: Over $92 million Each building has a different amount, but the amount can vary widely depending on whether the building will house hospital beds.

Small, rural hospitals can receive some help from the state through grants funded by California’s e-cigarette excise tax, but Andrew DiLucia, a spokesman for the Department of Health Care Access and Information, said they will not benefit from it. He said the total annual profits would be only $2 million to $3 million. He added that the Small and Rural Hospital Relief Program is also receiving a one-time injection of $50 million from taxpayers to health insurance companies to support seismic construction.

Unions and critics of the extension often point out that some hospitals reap huge profits. California hospitals made a profit of $3.2 billion in the first quarter of 2024, according to a California Healthcare Foundation report released in August. There is wide variation in financial performance among hospitals, with the top quartile having a net profit margin of +13%, while the bottom quartile has a net profit margin of -5%. ”

Stebbins had to help the district come up with a plan.

The hospital system and its affiliated health districts used parcel taxes to help after Newsom vetoed a bill in 2022 that would have allowed an extension of the seismic retrofit deadline for Alameda Hospital, among other things. loan.

The renovation cost about $25 million, and the system is also investing millions more in other projects, including a new skilled nursing facility. Construction work is expected to be completed in 2027.

“No one wants to have things destroyed in an earthquake or something like that, but it’s also a burden,” said Alameda Health System’s Marler. “How can we make sure we have what we need to stay open?”

This article was created by KFF Health Newsa national newsroom that produces in-depth journalism about health issues.