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Earthquake compliance spurs new designs

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January 1, 2018

For several years now, California hospitals have been in a mad dash not only to meet seismic standards set by the state after lessons learned from earthquakes past, but also to make sure they are ready for the next big quake (it’s been pretty quiet there, lately—at least seismically).

In the meantime, some really ingenious and high-tech designs have been developed as a result of the effort, and if you haven’t been paying attention you should take some notes, especially since experts say a good portion of the country’s hospitals lie in areas that are at risk of a moderately damaging earthquake.

In one of the most recent examples of brand-new technology in California hospitals, the new Loma Linda University Health medical complex will sport a new adult hospi-tal and expanded children’s hospital in two adjoining towers, according to a report in Health Facilities Management magazine.
The $1.2 billion project will include nearly 1 million square feet of new construction and is a major part of the health system’s strategy to combine the latest research and best healthcare practices with comprehensive preventive care. But perhaps most remarkable about this new facility’s design is its brand-new technology—it may make the hospital perhaps the most earthquake-proof in the country, and it would help keep the facility operational if a major earthquake strikes the San Jacinto Fault Zone.

A first-of-its-kind vertical earthquake isolation system is undergoing a plan and review process by California’s Office of Statewide Health Planning and Development (OSHPD); if approved, it will separate the building from the ground using more than 500 vertical shock absorbers that would provide an extra layer of protection to the new complex in the event of an earthquake. Working hand in hand with a lateral earthquake isolation system of sliding bearings and dampers, the vertical system would help to protect patients and staff from injury.

“Even though we still have a ways to go, today California’s hospitals are the safest in the world as a whole,” says Eric Reslock, assistant director of legislative and public affairs for the state’s OSHPD, which has been overseeing California’s project to bring hospitals up to seismic compliance standards set in 1994 following the Northridge earthquake that flattened 12 hospitals.

“It’s a pretty big mandate on hospitals,” Reslock says. “We’ve tried to make it as easy as possible on our part.”

By 2030, California hospitals must be retrofitted to remain standing and operational following a quake. Today, OSHPD estimates that around 90% of the state’s hospitals are ready for a major quake, and that’s a good thing considering that the U.S. Geological Survey gives a 93% chance of a major quake hitting the San Francisco Bay area within the next 30 years.

After a major quake hit the San Fernando Valley in 1971, killing 65 and causing more than $2 billion in damage, state officials began to take a serious look at inefficient building codes. Two years later, the state legislature passed what became known as the Alfred E. Alquist Hospital Facilities Seismic Safety Act, which required acute care hospitals to be designed and constructed to remain standing and operational after a major earthquake.

Then in 1994, the magnitude 6.7 Northridge quake hit. With the eventual loss of 12 hospitals that sustained major structural damage, it became clear that California’s hospitals were not ready for a large quake—and certainly could not be trusted to remain operational afterwards. Within 18 months, the legislature passed a new law that expanded the Alquist Act and set strict timelines for acute care hospitals to come into compliance with the seismic standards or risk losing state licenses.

The state’s OSHPD, under a state statute, created a series of “Seismic Performance Categories” (SPC) by which to grade the readiness of the state’s hospitals. By 2030, all hospitals must be rebuilt or retrofitted to meet California’s standards.

An estimated 251 buildings are still rated “SPC-1,” the highest risk category—down from more than 1,000 in 2001, according to OSHPD spokesman David Byrnes.

Another 629 buildings are rated “SPC-2,” the second highest risk. Not all of those buildings house patients; some may hold administrative offices, for example. But state law requires all buildings in the top two risk categories to close by 2030 unless they have been repaired or replaced. In addition, all SPC-1 buildings must be retrofitted to meet at least SPC-2 requirements by 2020 unless a hospital has received a specific deadline extension from OSHPD.

That’s a huge mandate for many hospitals, and many have chosen to go out of business or declare bankruptcy due to the stiff price tag of reaching compliance. The state never set aside money to fund the monumentally expensive mandate, leaving hospitals on their own.

Seismic regulations were adopted in 1994, but it took until 1999 for the state to create specific standards. In 2000, the estimated price tag for construction was initially $14 billion, rising to $24 billion by 2007. After the economic crunch of 2008, building costs skyrocketed, and the estimate has hovered around $110 billion since.

The ongoing cost of bringing 2,700 buildings at almost 500 of California’s hospitals into compliance by 2030, with the goal of keeping them not only standing during a quake but operational afterwards, has reached a staggering $110 billion statewide. That works out to about $2.5 million per hospital bed and doesn’t include financing costs, according to some estimates. The 17 county-owned hospitals in the state have had to seek municipal bonds or tax raises to afford projects, while others have had to find private funding.

When the state first created the mandates, many of California’s hospitals were so old and out of compliance that they were unlikely to meet the 2008 deadline requiring them to retrofit enough so they could withstand a large earthquake. As a result, many took advantage of an opportunity to extend that deadline to 2013, provided they could show a concrete plan to be compliant with the full law by 2020.

However, many hospitals, especially those in larger healthcare systems, have decided to rebuild completely rather than retrofit aging buildings that they’d eventually have to replace. The result has been a hospital construction boom in California that has produced some of the most earthquake-safe buildings featuring some of the best patient care amenities ever.

In Sacramento, Sutter Health has invested $11 billion since 2000 to build and improve healthcare facilities and to purchase advanced patient care technology, more than $7 billion to direct construction costs, and created or sustained nearly 200,000 jobs. The $750 million upgrade of Sutter Medical Center Sacramento, which opened in August, includes multiple facilities.

In Oakland, Sutter opened the $385 million, 11-story Patient Care Pavilion at the Alta Bates Summit Medical Center in August 2014. The hospital features 238 private, family-friendly patient rooms and a new emergency department designed to meet or exceed state seismic safety requirements; it also includes a 1,067-space parking garage.

In Santa Rosa, the $284 million Sutter Medical Center, an 80,000-square-foot facility that opened in September 2014 (and was challenged by another natural disaster in October 2017 when it was forced to evacuate for eight days in the wake of wildfires), features construction that’s both green and earthquake-resistant, and has state-of-the-art features, ADA-compliant private rooms, and a fully electronic patient records system. The hospital was built on soil that has been naturally compressed for six months to cut down on potential liquefaction, a phenomenon where loose soil takes on liquid properties during powerful earthquakes. Pipes and other infrastructure are built to absorb the energy of an earthquake.

Finally, the Zuckerberg San Francisco General Hospital opened its new $690 million Level I trauma center in May. In addition to being the city’s only such trauma center, it is the first in the city to have what is called a base-isolated foundation, capable of withstanding a monster 8.0-magnitude earthquake. The hospital sits in a bathtub-type foundation that is 40 feet deep on one end and 25 feet deep on the other, and 115 columns sitting on rolling disks will allow it to glide 30 inches in any direction during an earthquake. Glass is also designed to slide in place, and huge underground tanks will store 50,000 gallons of emergency water stores.




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