1. The Hospital Seismic Mandate: A Balance Between Seismically Safe Buildings and Forced Closures Presented to the Bay Area Earthquake Alliance August 27, 2009 Roger Richter, Senior Vice President California Hospital Association

2. Alfred E. Alquist Hospital Facilities Seismic Safety Act  1971 Sylmar Earthquake – 50 Hospital deaths  1973 HFSSA for New and Major Renovations – 1967-1973 Medicare and Medi-Cal Boom  1983 CSSC “California at Risk” – 19% of GACH Beds Compliant

3. Alfred E. Alquist Hospital Facilities Seismic Safety Act (Con’t)  1989 Loma Prieta Earthquake – Two hospitals structural damage – Many had non-structural damage  1994 Northridge Earthquake – $3 Billion in hospital damage – SB 1953 (Chapter 740) 1994 Statutes

4. SB 1953 Implementation History  Based on SPC and NPC gradations  FEMA 178 only evaluation methodology  Approximately 1,100 hospital buildings at seismic risk

5. Hospital Building Seismic Classification SPC-1 Potential Collapse 2008/2013/2015/2020 SPC-2 Life/Safety – Non-Operational2030 SPC-3, 4 and 5 Remain Operational2030 & Beyond Also NPC Requirements

6. SB 1953 Implementation Issues  Many issues arose: –Access Compliance/ADA –Non-structural costly –Some service areas would have to be inefficiently retrofitted in a piecemeal manner –Addressing non-compliant buildings affected compliant –With the late 90’s and early 2000’s building boom contractors and subs lost interest in complex hospital work –Mid-2000’s cost and shortage of materials

7. Projected Mandate Costs (without financing costs): 1994HBSB SB 1953 Cost Estimate$14 billion 2002CHA Consultants Estimate $24 billion (2006 = $40 billion) 2002RAND Estimate Up to $41 billion (2006 = $68 billion) 2006DAVIS Langdon 66% increase 2003-2005 2007RAND EstimateUp to $110 billion

8. SB 1953 Deadlines Unrealistic  1994 the first year California hospitals had negative O.M.  Force hospitals to close  Extended 2008 to 2013 & 2015  2030 by 2020 for financially stressed  HAZUS – approximately 50% of SPC-1s qualify for SPC-2

9. California Hospitals and the State Economy

10. Status of the Seismic Mandate SPC-1 875 SPC-2 288 SPC-3 380 SPC-4 819 SPC-5 361 Source: OSHPD June 2, 2009 Hospital Buildings by SPC Classification

11. San Francisco County Map Key SPC-1 Hospital SPC-2 Hospital SPC-3/4/5 Hospital County Boundary SPC Breakdown SPC-134 SPC-2 4 SPC-3 6 SPC-4 7 SPC-5 2

12. Marin County Map Key SPC-1 Hospital SPC-2 Hospital SPC-3/4/5 Hospital County Boundary SPC Breakdown SPC-1 7 SPC-2 5 SPC-3 2 SPC-4 1 SPC-5 3

13. Sonoma County Map Key SPC-1 Hospital SPC-2 Hospital SPC-3/4/5 Hospital County Boundary SPC Breakdown SPC-116 SPC-2 2 SPC-321 SPC-415 SPC-5 7

14. Napa County Map Key SPC-1 Hospital SPC-2 Hospital SPC-3/4/5 Hospital County Boundary SPC Breakdown SPC-1 6 SPC-2 0 SPC-3 6 SPC-4 3 SPC-5 6

15. Solano County Map Key SPC-1 Hospital SPC-2 Hospital SPC-3/4/5 Hospital County Boundary SPC Breakdown SPC-1 3 SPC-2 0 SPC-3 7 SPC-4 8 SPC-5 9

16. Contra Costa County  139 Map Key SPC-1 Hospital SPC-2 Hospital SPC-3/4/5 Hospital County Boundary SPC Breakdown SPC-1 14 SPC-2 7 SPC-3 14 SPC-4 18 SPC-5 14

17. Alameda County Map Key SPC-1 Hospital SPC-2 Hospital SPC-3/4/5 Hospital County Boundary SPC Breakdown SPC-144 SPC-220 SPC-326 SPC-419 SPC-517

18. San Mateo County Map Key SPC-1 Hospital SPC-2 Hospital SPC-3/4/5 Hospital County Boundary SPC Breakdown SPC-1 24 SPC-2 7 SPC-3 9 SPC-4 3 SPC-5 6

19. Santa Clara County Map Key SPC-1 Hospital SPC-2 Hospital SPC-3/4/5 Hospital County Boundary SPC Breakdown SPC-1 41 SPC-2 10 SPC-3 20 SPC-4 19 SPC-5 13

20. Nine County Bay Area Totals Bay AreaState # Buildings% % SPC-11893687532 SPC-2551028811 SPC-31112138014 SPC-4931881930 SPC-5771536113

21. Where Does the Seismic Mandate Go From Here? Extensions 2013 to 2015 for all hospitals 2030 to 2020 for all hospitals Additional annual extensions for extenuating circumstances Fines for extensions for up to 5 years