The following is a press release written by William Miller, MD – Chief of Staff at Adventist Health – Mendocino Coast Hospital:
On February 3rd, a community forum was held to discuss how we should address the seismic compliance requirements for our hospital. This was sponsored by the Coast Democratic Club and included a solid line up of local leaders and moderated by Supervisor Ted Williams. The panel included Assembly Member Jim Wood, Chair of the Assembly Health Committee, Jason Wells, Hospital Community Board Chair, Judy Leach, administrator of the hospital, Amy McColley, Chair of the Mendocino Healthcare District Board, Jessica Grinberg, Past-Chair of the District Board, Lucresha Renteria, CEO of Mendocino Coast Clinics, Mary Kate McKenna, CEO of Mendocino Coast Healthcare Foundation, Supervisor Dan Gjerde, Ft. Bragg Mayor Bernie Norvell, Jim Hurst, Chair of the Measure C Committee, and myself.
While our hospital is compliant with current seismic requirements, California legislation requires all hospitals to meet a higher standard by 2030. To meet this requirement, plans must be submitted and approved in advance and construction must be completed by that date. Thus, while 2030 is 8 years from now, we need to move forward now to achieve compliance. The forum was an excellent, non-partisan beginning to this very important conversation.
Basically, there are three main issues that need to be considered. First, are the seismic requirements reasonable and if not is there opportunity to change them? Second, should we build a new hospital or simply retrofit our existing one? And third, what will the right size of our hospital be in terms of number of beds and services provided to meet the needs of the coastal community in 2030 and thereafter?
California’s coastal region, in fact, the entire western coast of North America, is a network of geological faults. Most of the population of California is distributed along the coastal side of the state with its two largest population areas, the Los Angeles Basin and the San Francisco Bay, both sitting over some of the most active faults.
Prior to 1973, California did not have robust requirements for buildings, including hospitals, to be constructed to withstand earthquakes. The Alquist Hospital Seismic Act of 1973 (SB 519) was the first serious attempt to make hospitals safer and is the foundation of all subsequent legislation. This was enacted in response to the San Fernando/Sylmar Earthquake in 1971. This 6.6 magnitude (Mw) quake located just a few miles south of Magic Mountain in LA caused extensive damage including the collapse of a VA hospital resulting in death of patients and staff. Another large earthquake occurred in the area in 1987. This was followed by the Northridge earthquake in 1994. This 6.7 Mw lasted almost 20 seconds with two 6.0 aftershocks and resulted in 57 deaths and over 9,000 injuries. Along with the collapse of multiple buildings, including several multi-level apartments, 11 of LA’s 80 hospitals suffered such serious damage that the patients had to be evacuated. This not only meant that those hospitals and their emergency rooms were no longer available to take care of the injured, the evacuation of patients to surrounding hospitals significantly increased the burden during the disaster.
The 1994 Northridge quake followed only five years after another large shake up, the Loma Prieta earthquake in 1989, which caused extensive damage along the San Francisco peninsula. Fortunately, Bay Area hospitals fared better, with only one suffering significant damage which was not severe enough to require its closure or evacuation of patients.
As a result of these events, in 1994 California legislators enacted SB 1953 with the intent on making all hospitals built after 1973 “earthquake resistant” by 2008. The legislation required that hospitals which could not afford to meet this requirement would be forced to close. Since then, there have been several modifications including the addition of requirements for skilled nursing facilities and repeated extensions to the deadline which is now set at 2030.
Another significant set of changes in the original legislation has further raised the requirements. So, while initially 40% of hospitals may have been already compliant, that number has dropped to less than 10%. In 2019, the California Hospital Association (CHA) declared that only 23 of California’s 418 hospitals would meet the 2030 seismic requirements.
In the forum last week, Assembly Member Jim Wood reported that the cost to bring all California hospitals up to the 2030 standard would be close to $150 billion. The state’s healthcare system simply does not have that much money. Rural hospitals are particularly challenged and concern is raised about the impact that closing multiple rural hospitals will have on those communities, further straining an already overburdened healthcare system.
These economic realities have led Wood to push for further modification of the current requirements, either by lowering them to something more achievable or finding ways for the State to help fund this otherwise unfunded mandate. CHA is lobbying for a further extension to 2037, however, this only kicks the can further down the road.
Turning now to our local situation, a study done in 2019 estimated the cost to bring our hospital, Adventist Health Mendocino Coast (AHMC), by retrofitting the current structure to be between $24 and $30 million while building a new, 25 bed hospital would require $100 to $120 million.
Jason Wells, President of AHMC’s Community Board of Directors, pointed out that our hospital meets all current seismic requirements and is a safe building. He also stated that Adventist Health’s commitment to this community remains strong and there is no intention of pulling out over the seismic challenges which were well known at the time of the affiliation and considered in part of the deal. A portion of the lease payments are going into a dedicated fund for meeting the seismic requirement that will total just over $18 million by 2030.
This leaves our community with the questions listed earlier. Further discussion is planned and the participation of all members of our community is essential. At the heart is the question of should we retrofit the existing building or construct a new hospital? If so, what size should it be? Lastly, how are we, as a community, going to raise the funds to pay for either of these contingencies?
The video recording of the forum can be found at: Coast Democratic Club Public Forum 2.03.2022 – YouTube
My own personal comments. It’s not prudent to wager our future on the hope that the legislature will relax the requirements. Hope is not a business plan especially since the Nurse’s union is opposed to relaxing the requirements. Next, the option of bringing the hospital into seismic compliance does nothing to improve a facility that will be 60 years old in 2030. Perhaps as much as $25M would be needed to modernize it. Next, by 2030, the Mendocino Coast Health Care District will have $26M tucked away for a new facility. All long term debt will have been retired. The District on its own could afford a hospital of some kind but outside help would be welcome. I don’t think, by the way, that a new hospital would cost $100M or more. The current estimate is $3.5M per bed which means a 25 bed hospital would cost $87M. There are other options to explore as well that would involve fewer beds and fewer costs.
What is needed now is an orderly process for selecting the appropriate option. The first step is to hire an architect-engineering company to do a feasibility study of the various options. With that as a basis, get input from the Adventist and others in the healthcare industry and then finally bring it to the public. The discussion with the public would include questions such as What services will the community want/need in 2030? Will there be sufficient housing for medical providers? Will there be new jobs with private insurance to offset the under reimbursement for MediCal and to some extend Medicare. (Those two categories of patients account for 85% of the total.)
The development of a successful, new healthcare facility is a multi-dimensional problem that involves not just the healthcare District but energetic leadership from the County and City of Fort Bragg as well as the involvement of local donors.