(1)The Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983 (act) establishes, under the jurisdiction of the Office of Statewide Health Planning and Development, a program of seismic safety building standards for certain hospitals constructed on and after March 7, 1973. A violation of any provision of the act is a misdemeanor. The act requires an owner of a general acute care inpatient hospital, no later than January 1, 2030, to either demolish, replace, or change to nonacute care use all hospital buildings not in substantial compliance with the standards established pursuant to the act or seismically retrofit all acute care inpatient hospital buildings so that they are in substantial compliance with those standards. The act requires, before January 1, 2020, the owner of an acute care inpatient hospital whose building does not substantially comply with described seismic safety regulations or standards to submit to the office an attestation that the board of directors of that hospital is aware that the hospital building is required to meet a specified deadline for substantial compliance with those regulations and standards.

(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

SENATE THIRD READING

STR Bill Id:SB 758

Author:(Portantino)

As Amended Ver:August 24, 2020

Majority vote

SUMMARY:

Extends the existing deadline requiring general acute care hospitals (GACHs) to be fully operational after an earthquake by two years, from January 1, 2030, to January 1, 2032.

Major Provisions

COMMENTS:

Background on 2030 Seismic Safety Compliance Requirements. In the early morning hours of February 9, 1971, California experienced the San Fernando Valley (also known as Sylmar) earthquake. Collapsed buildings at the Veteran's Administration Hospital caused 47 of the more than 60 deaths attributed to the earthquake. Olive View Medical Center also experienced heavy damage, causing three deaths – one death caused by a collapsing structure, and two others as a result of the loss of power to their life support systems. Several other hospitals were impacted and had to evacuate. As a result, in 1973, the Legislature passed the Alquist Act, which required all new hospital construction to meet stringent seismic safety standards. The original Alquist Act did not apply to existing buildings, partly because of the expectation that older hospital buildings would be replaced with conforming buildings over time. However, by the time the 1994 Northridge earthquake occurred more than 20 years later, 80% of hospital beds were still in pre-1973 non-conforming buildings. The Northridge earthquake caused significant structural damage to a number of hospitals, with one hospital evacuated because of severe diagonal cracking, and another evacuated because of a potential loss of vertical support. From a structural standpoint, hospitals constructed after the Alquist Act withstood the earthquake relatively well. Comparisons of hospital buildings constructed before and after the 1973 standards showed that the Alquist Act was very important in limiting structural damage. However, the Northridge earthquake revealed that for health care providers and emergency services planners, nonstructural damage is a serious threat to patient safety and a hospital's capacity to function. In two cases, nonstructural damage was so severe that hospitals were forced to close. In other facilities, damage to heating and ventilation systems and sprinklers forced major evacuations, even though there was no significant structural damage to the buildings.

The Northridge earthquake experience prompted the Legislature to update the Alquist Act in 1994 in order to bring older hospital buildings into compliance with structural requirements by 2008 (which was subsequently delayed through various bills over the years), and to adopt additional requirements that would ensure hospitals, by January 1, 2030, would not only remain standing, but would also remain operational following a major earthquake (referred to as "2030 compliance").

The bill that updated the Alquist Act following the Northridge earthquake was SB 1953 (Alquist), Chapter 740, Statutes of 1994. SB 1953 required the Office of Statewide Health Planning and Development (OSHPD) to create seismic performance categories for hospitals depending on the risk of collapse, and the ability to remain operable following an earthquake. Specifically, SB 1953 required OSHPD to create structural performance categories (SPCs), as well as nonstructural performance categories (NPCs) for "nonstructural systems that are critical to providing basic services to hospital inpatients and the public after a disaster." Each hospital building receives both an SPC and an NPC rating. According to OSHPD, the SPC requirements can be thought of as protecting the skeleton, while NPC requirements ensure the organs and other tissues that are necessary for a human body to function will remain safely attached to the skeleton. It is important to note that a licensed facility, or hospital, is often made up of several buildings on its campus. Many hospitals may have one or more buildings that are 2030 compliant, while other buildings still need to be retrofitted or replaced.

The chart below shows the status of SPC compliance of hospital buildings as of December 24, 2019. It is important to note that this chart shows the compliance level of individual buildings, not hospitals. For example, the chart shows 646 buildings, or 20.6% of all buildings, are still SPC 2 and therefore not yet 2030 compliant. However, these buildings are spread across 251 licensed facilities, which is well over half of the 418 licensed facilities in California:

For more detail regarding SPC and NPC definitions and requirements, please see the Joint Assembly & Senate Health Committee "Primer on Hospital Safety Requirements." Seismic Safety Background Paper {pdf} (https://ahea.assembly.ca.gov/sites/ahea.assembly.ca.gov/files/Final%20Seismic%20Background%20Paper.pdf)

The NPC requirements, unlike SPC requirements, are cumulative, and not different options. For example, a hospital is first required to achieve NPC 2, which ensures that the nonstructural components that are necessary for a safe evacuation are braced and anchored. Next, a hospital is required to achieve NPC 3 status, which ensures that at least the critical care areas are able to continue to function following an earthquake, and so on.

The chart below shows the status of NPC compliance of hospital buildings as of December 24, 2019. Compared to the SPC compliance chart, the vast majority of buildings have not yet met 2030 standards. However, because NPC requirements generally do not involve decisions on whether to rebuild or replace, hospitals are more able to delay compliance with NPC requirements until closer to the deadline.

As the data from OSHPD reveal, there are very few remaining buildings that are at risk of collapse in an earthquake. With regard to the 2030 requirement to remain operational, 75% of hospital buildings are already 2030 compliant with regard to the more expensive SPC requirements. However, the remaining SPC 1 and 2 buildings, which must be taken out of service by 2030 or rebuilt to the SPC 4D standard, are spread across more than 250 hospital campuses. The California Hospital Association (CHA) commissioned the RAND Corporation to update its prior estimates of the cost of future seismic safety compliance with a particular focus on the 2030 deadline. The RAND Corporation estimated that California hospitals still face a financial obligation potentially collectively totaling more than $100 billion, depending in part on the extent to which hospitals replace buildings rather than retrofit.

Financial Impact of COVID-19 on hospitals. According to a June 2020 California Healthcare Foundation Brief (CHCF), "The Financial Impact of COVID-19 on California Hospitals," before the pandemic, the state's hospitals averaged nearly 257,000 inpatient and four million out-patient visits each month. As COVID-19 containment efforts took effect, patient volume fell as hospitals canceled elective and non-urgent care. The CHCF brief shows outpatient services, representing about 40% of total California hospital volume, decreased by over 50% in the 60 days after the statewide shelter-in-place order went into effect. Emergency department visits, approximately 60% of all inpatient admissions in California, dropped 40% to 60% in the same period. The CHCF brief states that hospital executives report operating expenses increased with COVID-19 surge preparations, including acquiring personal protective equipment, ventilators and other intensive care unit equipment, and that salary and benefits for physicians and other workers (typically 50% of a hospital's operating expenses) grew with a rise in overtime and temporary staffing needs. Before the pandemic California hospitals averaged $8.7 billion in monthly net patient revenue for all inpatient and outpatient services. The CHCF brief estimates that total net patient revenue in California hospitals is falling by $3.2 billion per month, a reduction of 37% from pre-COVID-19 levels. Some of the reduction in revenue has been offset by the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act. As of May 2020, California hospitals have secured just under $3.5 billion in CARES funding.

According to the Author:

Every day hospitals serve their communities and must remain vigilant and prepared to handle any emergency. The author states that as hospitals continue to grapple with the long-term financial impacts of the COVID-19 pandemic, scarce resources should be focused on preparedness for myriad types of disasters rather than inflexible infrastructure requirements that address just one category of emergencies. The author notes that this bill will provide hospitals with needed regulatory relief by extending the seismic deadline from 2030 to 2037, requiring certain hospital buildings to be fully operational following an earthquake.

Arguments in Support:

CHA is the sponsor of this bill and states that when COVID-19 hit, hospitals responded quickly, converting physical space, suspending many procedures and services, purchasing personal protective equipment for employees and staff, hiring additional staff, and more. CHA states that this response was unprecedented, and it has come at a high cost for all hospitals at the front lines of the COVID-19 fight. CHA points to a study from Kaufman Hall that found that the COVID-19 pandemic is likely to lead to long-term changes to financial stability and care delivery in California hospitals. However, the next seismic mandate looms. Currently, 95% of hospitals have met the first requirement to withstand a major earthquake. CHA notes that now that buildings are safe for patients and employees, they must focus on the 2030 requirement that hospitals must be operational after a major earthquake. CHA points to the recent RAND Corporation report which analyzed hospital seismic mandate costs to meet the 2030 seismic requirement. CHA notes that the price tag is estimated to be more than $100 billion but may even be higher after factoring in financing and other costs. As the study notes, hospitals bear the entire financial burden for the required upgrades. Planning for massive infrastructure projects of this size must start now. CHA concludes that at a time when hospitals' budgets have been crippled by the pandemic, an extension of the mandate is critical given the extensive work and expense that need to be considered, and they strongly support a state-led advisory committee to re-examine the state's response to all disasters, including a seismic event.

Arguments in Opposition:

The Earthquake Engineering Research Institute (EERI) is opposed to this bill and states that it alters the current seismic safety standard such that facilities currently out of compliance must only be certified as capable of providing services for 72 hours following a seismic event by 2030. This arbitrary limitation implies that an acute care facility could be operated in a damaged state for 72 hours, which would not be suitable for long-term use. EERI notes that this is problematic because the 72 hour utilization of a damaged facility would potentially involve significant risk to the community, especially in light of the potential for additional damage from aftershocks.

Arguments in Opposition Unless Amended: Service Employees International Union State Council (SEIU California), is opposed to this bill and notes that the proposed seven-year extension in this bill is far too long and would leave many communities unprotected and without access to care following a major earthquake. Hospitals have known for many years that they would need to meet the 2030 seismic deadlines, and a seven-year delay is unjustified. SEIU California concludes that they would oppose anything more than a one-year extension, and that any extension should require hospitals to meet additional requirements and reporting standards such as requiring hospitals that have not met the 2030 requirement to submit annual financial data including cash on hand, and attest that the board of directors is aware that the hospital needs to meet the 2030 deadline. The California Nurses Association is opposed to this bill unless it is amended, and urges the committee to consider a one-year extension, commiserate with the length of time of the pandemic.

FISCAL COMMENTS:

According to the Assembly Appropriations Committee:

1. Staff costs to OSHPD in the low hundreds of thousands of dollars to develop and implement emergency code change regulations (Hospital Building Fund).
2. Minor costs to the California Office of Emergency Services and Emergency Medical Services Authority.

VOTES:

SENATE FLOOR: 38-0-0

YES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dodd, Durazo, Galgiani, Glazer, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Jones, Leyva, McGuire, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Stone, Umberg, Wieckowski, Wiener, Wilk

ASM HEALTH: 12-0-3

YES: Wood, Mayes, Aguiar-Curry, Bigelow, Burke, Carrillo, Flora, Limón, McCarty, Ramos, Santiago, Waldron

ABS, ABST OR NV: Bonta, Nazarian, Rodriguez

ASM APPROPRIATIONS: 17-1-0

YES: Gonzalez, Bigelow, Bauer-Kahan, Bloom, Bonta, Calderon, Carrillo, Chau, Megan Dahle, Eggman, Fong, Gabriel, Eduardo Garcia, Petrie-Norris, Quirk, Robert Rivas, Voepel

NO: Diep

UPDATED:

VERSION: August 24, 2020

CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0003254

Date of Hearing: August 18, 2020

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

SBPCA Bill Id:SB 758

Author:(Portantino) – As Amended Ver:August 6, 2020

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill extends by seven years the existing deadline requiring general acute care hospitals (hospitals) to be fully operational after an earthquake, from January 1, 2030, to January 1, 2037. This bill also:

1. Requires the California Department of Public Health (CDPH) to convene an advisory committee to make recommendations on strengthening the response of the health care delivery system in the event of a disaster.
2. Requires the Office of Statewide Health Planning and Development (OSHPD) to revise building code regulations to reflect the revision of the deadline to meet seismic and deems such changes emergency regulations.

FISCAL EFFECT:

1. Costs of an unknown amount to OSHPD, as OSHPD’s role would be based on the outcome of the advisory committee’s report to the Legislature and subsequent direction or legislation. OSHPD, however, would require $460,000 annually to develop and implement emergency code change regulations (Hospital Building Fund).
2. One-time costs to CDPH of $500,000 to $750,000 (Licensing and Certification Fund) to convene the advisory committee, to make recommendations on strengthening the response of the health care delivery system in the event of a disaster and to submit a report based upon these recommendations to the Legislature by November 1, 2022.
3. Minor costs to the California Office of Emergency Services (Cal OES) and Emergency Medical Services Authority (EMSA) for representatives to serve on the advisory committee.

COMMENTS:

1. Purpose. According to the author, in this time of uncertainty with respect to potential disasters as well as the financial standing of hospitals, hospitals should be focused on preparing for a host of different threats rather than directing resources to addressing just one category of emergencies. Accordingly, this bill provides regulatory relief to hospitals with respect to a seismic compliance deadline nearly a decade from now, providing an additional seven years for hospitals to come into compliance. It also requires an advisory committee to be convened by CDPH to study and make recommendations on how California’s health care system, including hospitals, can be ready for the next disaster.
2. Background. Seismic requirements for hospitals were established following the 1971 Sylmar earthquake in the San Fernando Valley. Following the 1994 Northridge earthquake, these requirements were strengthened. That year, the state established a schedule for hospitals to meet seismic safety goals. It established Structural Performance Categories (SPCs) to measure a hospital building's risk of collapse, and instituted deadlines for retrofitting or reconstruction. SPC-1 buildings are at the highest risk of collapse and are considered a threat to public safety, while those categorized as SPC-5 are expected to maintain services even in the case of a severe earthquake.

Subsequent legislation has provided for additional seismic compliance extensions and extensions whereby hospitals can continue to provide services without being upgraded. January 1, 2020, was a major deadline for hospitals at high risk of collapse.

OSHPD works closely with hospitals to monitor plans for seismic compliance. In order to grant prior extensions, OSHPD considered the structural integrity of the building, the loss of essential healthcare services to the community should the hospital be closed, and the financial hardship that the hospital may have experienced.

1. Current Status of Compliance in California. According to OSHPD, 646 separate buildings across 251 licensed facilities are not yet compliant with the 2030 standard. These buildings are in the SPC-2 category, meaning they may not be repairable or functional following strong ground motion. A RAND study commissioned by the California Hospital Association found compliance is projected to cost hospitals more than $100 billion collectively.
2. Support. This bill is sponsored by the California Hospital Association (CHA) and is supported by numerous individual hospitals and health systems. Hospitals note the unpredictability in demand for health care services and financial uncertainty due to the COVID-19 pandemic, which will damage the financial standing of hospitals and compromise their ability to make the investments necessary to meet the deadlines. CHA also notes planning for large infrastructure projects is a phased, multi-year effort, necessitating the change in deadline from 2030 to 2037.
3. Opposition. Service Employees International Union State Council (SEIU California) and the California Nurses Association both oppose this bill unless amended. SEIU California notes previous seismic extensions were accompanied by conditions to show progress to compliance with the standards. Similarly, CNA requests additional financial data whereby extensions could be considered only for small or rural hospitals with a true funding crisis. Both groups seek changes to better balance stakeholder interests on the advisory committee.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: August 4, 2020

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

SBPCA Bill Id:SB 758

Author:(Portantino) – As Amended Ver:July 27, 2020

SENATE VOTE: Vote not relevant.

SUBJECT: Health and care facilities: disaster and seismic preparedness.

SUMMARY: Enacts the Health Care Delivery System Preparedness Act and requires the Department of Public Health (DPH) to convene a Health Care Delivery System Preparedness Advisory Committee (Advisory Committee) to make recommendations on strengthening the response of the health care delivery system in the event of a disaster. Extends the existing deadline requiring general acute care hospitals (GACHs) to be fully operational after an earthquake by seven years, from January 1, 2030, to January 1, 2037. Specifically, this bill:

1. Extends the existing deadline requiring GACHs to be fully operational after an earthquake by seven years, from January 1, 2030, to January 1, 2037.
2. Requires DPH, on or before January 1, 2021, to convene an Advisory Committee to make recommendations on strengthening the response of the health care delivery system in the event of a disaster, including, but not limited to an a earthquake or pandemic.
3. Requires DPH to convene the Advisory Committee in consultation with the Office of Emergency Services (OES), Emergency Medical Services Authority and the Office of Statewide Health Planning and Development (OSHPD).
4. Requires the State Public Health Officer to appoint the membership of the Advisory Committee which will consist of no fewer than nine and no more than eleven individuals experienced in health care, public health, and emergency preparedness, including, but not limited to, all of the following:
   1. One representative of an association representing county health organizations;
   2. Two representatives of an association representing multiple types of hospitals and health systems;
   3. Two representatives of an association representing skilled nursing facilities;
   4. One representative of an association representing physicians;
   5. Two representatives of organized labor; and,
   6. One representative of consumers.
5. Requires the State Public Health Officer to offer the County Health Executives Association of California to provide a representative of its association to serve as the member described in 3) a), above.
6. Requires DPH, on or before November 1, 2022, to submit a report to the Legislature based on the recommendations of the Advisory Committee regarding health care delivery system preparedness in the event of a disaster, including but not limited to, an earthquake or pandemic. Requires the report to include, but not be limited to recommendations relating to all of the following:
   1. The current and future availability of telehealth, including its impact on the need for physical space for health care providers;
   2. Projected capital costs for health care facilities by provider type;
   3. An alternative to the requirement for hospitals to be fully operational following an earthquake;
   4. Development, updating, and implementation of health care facility emergency operations and surge plans;
   5. Consumer access to care;
   6. Impact of various disaster preparedness strategies on health care affordability and the cost to consumers and employers;
   7. Funding sources for implementing the recommendations, including public health infrastructure and emergency response;
   8. Improving state and county regional emergency preparedness plans within available resources and capacity;
   9. Considerations for rural communities;
   10. Resource coordination between the state stockpile of supplies for public health emergencies and medical health operational area coordinators (MHOACs) with the health care delivery system;
   11. Transportation of patients by local emergency management services agencies including transportation to alternative care sites;
   12. State and local health officer coordination of public health guidance;
   13. Infection control policies of health care facilities;
   14. Training and exercises on emergency preparedness policies and procedures by health care facility and volunteers; and,
   15. Health care facility policies and procedures for safely evacuating patients, including transportation, methods of tracking patients, and transporting necessary medications, supplies, and medical records with an evacuated patient.
7. Specifies that the provisions described in 2) through 6) above are repealed as of January 1, 2024.

EXISTING LAW:

1. Establishes DPH which, among other functions, licenses and regulates health facilities, including GACHs and skilled nursing facilities (SNFs).
2. Requires, pursuant to state regualtions, a GACH to have a written disaster and mass casualty program developed and maintained in consultaition with repesendtatives of the medical and nursing staff, administration, and fire and safety experts. Requires a copy of the plan to be available on the premisises for review by DPH, and requires the program to cover disasters occuring in the community and widespread disasters. Requires the program to provide for at least the following:
   1. Availability of adequate basic utilities and supplies, including gas, water, food and essential medical and supportive materials;
   2. An efficient system of notifying and assigning personnel;
   3. Unified medical command;
   4. Conversion of all usable space into clearly defined areas for efficient triage, for patient observation and for immediate care;
   5. Prompt transfer of casualties, when necessary and after preliminary medical or surgical services have been rendered, to the facility most appropriate for administering definite care;
   6. A special disaster medical record, such as an appropriately designed tag, that accompanies the casualty as he is moved;
   7. Procedures for the prompt discharge or transfer of patients already in the hospital at the time of the disaster who can be moved without jeopardy;
   8. Maintaining security in order to keep relatives and curious persons out of the triage area; and,
   9. Establishment of a public information center and assignment of public relations liaison duties to a qualified individual. Requires advance arrangements with communications media to be made to provide organized dissemination of information.
      
3. Requires a SNF, pursuant to state regulations, to have a written external disaster and mass casualty program plan. Requires the plan to be developed with the advice and assistance of county or regional and local planning offices and to not conflict with county and community disaster plans. Requires a copy of the plan to be available on the premises for review by DPH, and to include at least the following:
   
   1. Sources of emergency utilities and supplies, including gas, water, food and essential medical supportive materials;
   2. Procedures for assigning personnel and recalling off-duty personnel;
   3. Unified medical command including a chart of lines of authority in the facility;
   4. Procedures for the conversion of all usable space into areas for patient observation and immediate care of emergency admissions;
   5. Prompt transfer of casualties when necessary and after preliminary medical or surgical services have been rendered, to the facility most appropriate for administering definitive care and procedures for moving patients from damaged areas of the facility to undamaged areas;
   6. Arrangements for provision of transportation of patients including emergency housing where indicated and procedures for emergency transfers of patients who can be moved to other health facilities, including arrangements for safe and efficient transportation and transfer information;
   7. Procedures for emergency discharge of patients who can be discharged without jeopardy into the community, including prior arrangements for their care, arrangements for safe and efficient transportation and at least one follow-up inquiry within 24 hours to ascertain that patients are receiving required care;
   8. Procedures for maintaining a record of patient relocation;
   9. An evacuation plan, including evacuation routes, emergency phone numbers of physicians, health facilities, the fire department and local emergency medical services agencies and arrangements for the safe transfer of patients after evacuation;
   10. A tag containing all pertinent personal and medical information which shall accompany each patient who is moved, transferred, discharged or evacuated;
   11. Procedures for maintaining security in order to keep relatives, visitors and curious persons out of the facility during a disaster;
   12. Procedures for providing emergency care to incoming patients from other health facilities; and,
   13. Assignment of public relations liaison duties to a responsible individual employed by the facility to release information to the public during a disaster.
       
4. Requires, pursuant to federal law, health care facilities, including GACHs and SNFs, to develop and maintain an emergency preparedness plan, updated every two years, that must meet the following standards;
   1. Be based on and include a documented, facility-based and community-based risk assessment utilizing all-hazards approach;
   2. Include strategies for addressing emergency events identified by the risk assessmen;
   3. Address patient population, including, but not limited to, persons at-risk; the type of services the facility has the ability to provide in an emergency; and continuity of operations, including delegations of authority and succession plans; and,
   4. Include a process for cooperation and collaboration with local, tribal, regional, state and federal emergency preparedness officials’ efforts to maintain an integrated response during a disaster or emergency situation.
5. Establishes the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983 (Alquist Act), to ensure that hospital buildings are designed and constructed to resist the forces generated by earthquakes and requires OSHPD to propose building standards for earthquake resistance and to provide independent review of the design and construction of hospital buildings.
6. Establishes timelines for hospital compliance with seismic safety standards, including a requirement that buildings posing a significant risk of collapse and a danger to the public (referred to as structural performance category 1 [SPC-1] buildings) be rebuilt or retrofitted to be capable of withstanding an earthquake, or removed from acute care service, by January 1, 2008, and a requirement that hospital buildings be capable of remaining intact after an earthquake, and capable of continued operation by January 1, 2030.
   
7. Defines the following:
   1. A GACH as, a hospital that provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services; and,
      
   2. A SNF as a health facility that provides skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis.
8. Establishes the California Emergency Services Act (ESA), which authorizes the Governor to proclaim a state of emergency when specified conditions of disaster or extreme peril to the safety of persons and property exist. Establishes, pursuant to the ESA, the OES which is responsible for coordinating statewide emergency preparedness, post disaster recovery, mitigation efforts, and the development, review, approval, and integration of emergency plans.
   
9. Defines a “state of emergency” as the duly proclaimed existence of conditions of disaster or of extreme peril to the safety of persons and property within the state caused by such conditions as air pollution, fire, flood, storm, epidemic, riot, drought, sudden and severe energy shortage, plant or animal infestation or disease, the Governor’s warning of an earthquake or volcanic prediction, or an earthquake, or other conditions, other than conditions resulting from a labor controversy or conditions causing a “state of war emergency,” which, by reason of their magnitude, are or are likely to be beyond the control of the services, personnel, equipment, and facilities of any single county, city and county, or city and require the combined forces of a mutual aid region or regions to combat, or with respect to regulated energy utilities, a sudden and severe energy shortage requires extraordinary measures beyond the authority vested in the California Public Utilities Commission.
10. Authorizes the Governor to make, amend, and rescind orders and regulations necessary to carry out the provisions of the ESA, requires the orders and regulations to have the force and effect of law, and requires orders and regulations, or amendments or rescissions to orders and regulations, issued during a state of war emergency or state of emergency to be in writing and to take effect immediately upon their issuance.

FISCAL EFFECT: This bill, as amended on July 27, 2020, has not been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, every day hospitals serve their communities and must remain vigilant and prepared to handle any emergency. The author states that as hospitals continue to grapple with the long-term financial impacts of the COVID-19 pandemic, scarce resources should be focused on preparedness for myriad types of disasters rather than inflexible infrastructure requirements that address just one category of emergencies. The author notes that this bill will provide hospitals with needed regulatory relief by extending the seismic deadline from 2030 to 2037, requiring certain hospital buildings to be fully operational following an earthquake. The author concludes that, to assess the readiness of the health care delivery system in California for the future disasters, whatever form they may take, this bill requires DPH to convene an advisory committee of experts to assist DPH in making recommendations on how California’s integrated health care system, including hospitals, can be ready for the next disaster.
   
2. BACKGROUND. California has suffered numerous natural disasters in the last several years including fires, earthquakes and a pandemic.

Fires. As noted in the background paper from a May 2019 hearing of the Joint Legislative Committee on Emergency Management entitled, “The 2019 Wildfire Season: Are We Prepared?,” the state’s fire season is now almost year round. More than 25 million acres of California wildlands are classified as under very high or extreme fire threat. Increased development in the wildland-urban interface (WUI) has placed more residents in the potential path of destruction. Today, approximately 25% of the state’s population (over 11 million people) lives in high fire-risk areas, including the WUI. As a result of the 2017 Tubbs Fire, Kaiser Permanente Medical Center in Santa Rosa had to evacuate 123 patients in two and a half hours as the fire encroached on the facility parking lot.

Earthquakes. The Ridgecrest earthquake of July 4 and 5, 2019, (and a large aftershock on June 3, 2020), occurred north and northeast of the town of Ridgecrest, California, approximately122 miles north-northeast of Los Angeles. Eleven months later, a 5.5 aftershock took place (the largest of the sequence) to the east of Ridgecrest. The aftershock, (now considered the mainshock), was the most powerful earthquake to occur in the state in 20 years (after the 1999 Hector Mine earthquake). An estimated 20 million people experienced the July 4^th foreshock, and approximately 30 million people experienced the mainshock. Ridgecrest Regional Hospital, a 25-bed critical access facility located on the edge of the Mojave Desert had to evacuate due to flooding, the result of a water pump on the roof that failed, along with several broken water lines. When the buildings at Ridgecrest were designed (including buildings designed post-2000), fixed and flexible pipe connections were both options under the building code. Fixed pipe connections were used at Ridgecrest consistent with other similar hospital construction. Because of the observed water damage seen at Ridgecrest and other facilities after a seismic event, code standards were changed to require flexible pipe connectors. The flexible connectors allow movement between the water piping systems and equipment, minimizing the chances that there will be a crack at the connection.

Pandemic. The first case relating to the COVID-19 pandemic in California was confirmed on January 26, 2020. A state of emergency has been in place in the state since March 4, 2020. A mandatory statewide stay-at-home order was issued on March 19. As of July 22, 2020, DPH reported 413,576 confirmed cases and 7,870 deaths due to COVID-19. As of July 2020, California has the highest number of confirmed cases in the United States. Also that month, the state surpassed the 400,000 mark, but a lower per capita infection rate per population for the state's over 40 million residents. California's positivity rate, a key indicator of community spread, is trending upward in the 14-day average. Hospitalization rates are also trending upward in the 14-day average. As of July 21, 2020, the seven-day average positivity rate is 7.5% and the 14-day average positivity rate is 7.5%. As of July 21, local health departments have reported 20,231 confirmed positive cases in health care workers and 111 health care worker deaths statewide.

• 1. Background on 2030 Seismic Safety Compliance Requirements. In the early morning hours of February 9, 1971, California experienced the San Fernando Valley (also known as Sylmar) earthquake. Collapsed buildings at the Veteran’s Administration Hospital caused 47 of the more than 60 deaths attributed to the earthquake. Olive View Medical Center also experienced heavy damage, causing three deaths – one death caused by a collapsing structure, and two others as a result of the loss of power to their life support systems. Several other hospitals were impacted and had to evacuate. As a result, in 1973, the Legislature passed the Alquist Act, which required all new hospital construction to meet stringent seismic safety standards. The original Alquist Act did not apply to existing buildings, partly because of the expectation that older hospital buildings would be replaced with conforming buildings over time. However, by the time the 1994 Northridge earthquake occurred more than 20 years later, 80% of hospital beds were still in pre-1973 non-conforming buildings. The Northridge earthquake caused significant structural damage to a number of hospitals, with one hospital evacuated because of severe diagonal cracking, and another evacuated because of a potential loss of vertical support. From a structural standpoint, hospitals constructed after the Alquist Act withstood the earthquake relatively well. Comparisons of hospital buildings constructed before and after the 1973 standards showed that the Alquist Act was very important in limiting structural damage. However, the Northridge earthquake revealed that for health care providers and emergency services planners, nonstructural damage is a serious threat to patient safety and a hospital’s capacity to function. In two cases, nonstructural damage was so severe that hospitals were forced to close. In other facilities, damage to heating and ventilation systems and sprinklers forced major evacuations, even though there was no significant structural damage to the buildings.
     
     The Northridge earthquake experience prompted the Legislature to update the Alquist Act in 1994 in order to bring older hospital buildings into compliance with structural requirements by 2008 (which was subsequently delayed through various bills over the years), and to adopt additional requirements that would ensure hospitals, by January 1, 2030, would not only remain standing, but would also remain operational following a major earthquake (referred to as “2030 compliance”).

The bill that updated the Alquist Act following the Northridge earthquake was SB 1953 (Alquist), Chapter 740, Statutes of 1994. SB 1953 required OSHPD to create seismic performance categories for hospitals depending on the risk of collapse, and the ability to remain operable following an earthquake. Specifically, SB 1953 required OSHPD to create SPCs, as well as nonstructural performance categories (NPCs) for “nonstructural systems that are critical to providing basic services to hospital inpatients and the public after a disaster.” Each hospital building receives both an SPC and an NPC rating. According to OSHPD, the SPC requirements can be thought of as protecting the skeleton, while NPC requirements ensure the organs and other tissues that are necessary for a human body to function will remain safely attached to the skeleton. It is important to note that a licensed facility, or hospital, is often made up of several buildings on its campus. Many hospitals may have one or more buildings that are 2030 compliant, while other buildings still need to be retrofitted or replaced.

The illustration below shows the SPC level a hospital can achieve to be 2030 compliant based on the year the hospital was constructed:

The chart below shows the status of SPC compliance of hospital buildings as of December 24, 2019. It is important to note that this chart shows the compliance level of individual buildings, not hospitals. For example, the chart shows 646 buildings, or 20.6% of all buildings, are still SPC 2 and therefore not yet 2030 compliant. However, these buildings are spread across 251 licensed facilities, which is well over half of the 418 licensed facilities in California:

For more detail regarding SPC definitions and requirements, please see the Joint Assembly & Senate Health Committee “Primer on Hospital Safety Requirements.” Here is the link to the paper: Seismic Safety Background Paper {pdf}.

The NPC requirements, unlike SPC requirements, are cumulative, and not different options. For example, a hospital is first required to achieve NPC 2, which ensures that the nonstructural components that are necessary for a safe evacuation are braced and anchored. Next, a hospital is required to achieve NPC 3 status, which ensures that at least the critical care areas are able to continue to function following an earthquake, and so on. The NPC standards are as follows:

• • 1. NPC 1. The building does not meet any bracing and anchorage requirements.
       
    2. NPC 2. The following systems in the building are braced or anchored according to the California Building Standards Code: communications systems, emergency power supply, bulk medical gas systems, fire alarm systems, and emergency lighting equipment and signs in the means of egress. Hospitals had to meet at least the NPC 2 standard by January 1, 2002.
       
    3. NPC 3. This standard requires NPC 2 compliance, plus specified additional bracing and anchorage requirements in critical care areas, clinical laboratory services spaces, pharmaceutical service spaces, radiological service spaces, and central and sterile supply areas. Hospitals had to meet this standard by January 1, 2008, unless an extension or exemption was approved. Extensions generally tracked the extensions given to SPC 1 buildings, so some buildings are not required to achieve NPC 3 until January 1, 2024.
       
    4. NPC 4. This standard requires NPC 3 compliance, plus all architectural, mechanical, electrical systems, components and equipment, and hospital equipment to meet bracing and anchorage requirements. Hospitals are required to meet this standard by January 1, 2024 or 2030 depending on the building’s seismic risk category and extension request requirements.
       
    5. NPC 4D. This is a new category assigned to existing hospital buildings that are in compliance with NPC 3 requirements, and have additionally achieved one of three levels with regards to emergency preparedness. Level 1 specifies all systems and equipment are in compliance with NPC-3; Level 2 requires all services and utilities from the source to Level 1 areas must be anchored and braced; and Level 3 requires all systems and equipment to be anchored and braced so that additional services, as determined by the hospital in its Operational Plan, are functional and available to the public after a seismic event. NPC 4D became effective on January 1, 2017. Hospitals are required to meet this standard by January 1, 2030.
       
    6. NPC 5. This final standard requires the hospital building to meet NPC 4 or NPC 4D, plus have onsite supplies of water and holding tanks for sewage and liquid waste, sufficient to support 72 hours of emergency operations, which are required to be integrated into the plumbing systems. Additionally, an onsite emergency system, as defined in the California Electrical Code, must be incorporated in the building electrical system for critical care areas, and the system is required to provide for radiological service and onsite fuel supply for 72 hours of acute care operation. Hospitals are required to meet this standard by January 1, 2030.

The chart below shows the status of NPC compliance of hospital buildings as of December 24, 2019. Compared to the SPC compliance chart, the vast majority of buildings have not yet met 2030 standards. However, because NPC requirements generally do not involve decisions on whether to rebuild or replace, hospitals are more able to delay compliance with NPC requirements until closer to the deadline.

As the data from OSHPD reveal, there are very few remaining buildings that are at risk of collapse in an earthquake. With regard to the 2030 requirement to remain operational, 75% of hospital buildings are already 2030 compliant with regard to the more expensive SPC requirements. However, the remaining SPC 1 and 2 buildings, which must be taken out of service by 2030 or rebuilt to the SPC 4D standard, are spread across more than 250 hospital campuses. The California Hospital Association commissioned the RAND Corporation to update its prior estimates of the cost of future seismic safety compliance with a particular focus on the 2030 deadline. The RAND Corporation estimated that California hospitals still face a financial obligation potentially collectively totaling more than $100 billion, depending in part on the extent to which hospitals replace buildings rather than retrofit.

b) Financial Impact of COVID-19 on hospitals. According to a June 2020 California Healthcare Foundation Brief (CHCF), “The Financial Impact of COVID-19 on California Hospitals,” before the pandemic, the state’s hospitals averaged nearly 257,000 inpatient and four million out-patient visits each month. As COVID-19 containment efforts took effect, patient volume fell as hospitals canceled elective and non-urgent care. The CHCF brief shows outpatient services, representing about 40% of total California hospital volume, decreased by over 50% in the 60 days after the statewide shelter-in-place order went into effect. Emergency department visits, approximately 60% of all inpatient admissions in California, dropped 40 to 60% in the same period. The CHCF brief states that hospital executives report operating expenses increased with COVID-19 surge preparations, including acquiring personal protective equipment, ventilators and other intensive care unit equipment, and that salary and benefits for physicians and other workers (typically 50% of a hospital’s operating expenses) grew with a rise in overtime and temporary staffing needs.
Numerous press accounts have reported that thousands of nurses, doctors and other medical staff have been laid off or furloughed or have taken a pay cut since mid-March, from major facilities such as Stanford Health Care to tiny rural hospitals to private practitioners. Across the nation, job losses in the healthcare sector have been second only to those in the restaurant industry, according to the federal Bureau of Labor.

Before the pandemic California hospitals averaged $8.7 billion in monthly net patient revenue for all inpatient and outpatient services. The CHCF brief estimates that total net patient revenue in California hospitals is falling by $3.2 billion per month, a reduction of 37% from pre-COVID-19 levels. Some of the reduction in revenue has been offset by the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act. As of May 2020, California hospitals have secured just under $3.5 billion in CARES funding.

c) State and Federal Disaster preparedness requirements for health care facilities. On September 30, 2019 CMS published in the Federal Register the Medicare and Medicaid Programs; Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction; Fire Safety Requirements for Certain Dialysis Facilities; Hospital and Critical Access Hospital Changes To Promote Innovation, Flexibility, and Improvement in Patient Care Final Rule (Final Rule) which revised some of the emergency preparedness requirements for providers and suppliers. The Final Rule establishes national emergency preparedness requirements for participating providers and certified suppliers to plan adequately for both natural and man-made disasters, and coordinate with Federal, state, tribal, regional and local emergency preparedness systems. The Final Rule also assists providers and suppliers to adequately prepare to meet the needs of patients, clients, residents, and participants during disasters and emergency situations, and to provide consistent requirements across provider and supplier-types, with some variations. The new emergency preparedness Final Rule is based primarily off of the hospital emergency preparedness Condition of Participation as a general guide for the remaining providers and suppliers, then tailored based to address the differences and or unique needs of the other providers and suppliers (e.g. inpatient versus out-patient providers). The requirements are focused on three key essentials necessary for maintaining access to healthcare during disasters or emergencies: safeguarding human resources, maintaining business continuity, and protecting physical resources.

d) Recent State Auditor Report. A December 5, 2019 report by the State Auditor, “California Is Not Adequately Prepared to Protect Its Most Vulnerable Residents From Natural Disaster,” notes that the State’s emergency management system designates local governments, such as counties, as primarily responsible for emergency preparedness and response. In that role, the local governments should develop emergency response plans (emergency plans) that adequately prepare them to protect all residents, including the most vulnerable. The audit reviewed the extent to which three counties’ emergency planning incorporated best practices and the effect that not following those best practices had on their responses to recent wildfires, and determined that the counties have not adequately followed key practices for emergency planning, including having emergency plans for alerting, evacuating, and sheltering residents and assessing the needs of their communities in advance of disaster events. As a result, the counties are less prepared for future natural disasters, which may place the residents for whom they are responsible at greater risk of harm. In particular, the three counties have not adequately prepared to protect people with needs that cannot be met by traditional emergency response and recovery methods. Within the emergency management community, those needs are referred to as access and functional needs. Under state law, people with access and functional needs include, among others, older adults and people with disabilities, chronic conditions, temporary injuries, and limited English proficiency. The audit concludes that, although everyone is vulnerable during a natural disaster, people with access and functional needs are even more vulnerable, and as a result, these individuals have historically been disproportionately affected by natural disasters.

1. SUPPORT. The California Hospital Association (CHA) is the sponsor of this bill and states that when COVID-19 hit, hospitals responded quickly, converting physical space, suspending many procedures and services, purchasing personal protective equipment for employees and staff, hiring additional staff, and more. CHA states that this response was unprecedented, and it has come at a high cost for all hospitals at the front lines of the COVID-19 fight. CHA points to a study from Kaufman Hall that found that the COVID-19 pandemic is likely to lead to long-term changes to financial stability and care delivery in California hospitals. However, the next seismic mandate looms. Currently, 95% of hospitals have met the first requirement to withstand a major earthquake. CHA notes that now that buildings are safe for patients and employees, they must focus on the 2030 requirement that hospitals must be operational after a major earthquake.

CHA points to the recent RAND Corporation report which analyzed hospital seismic mandate costs to meet the 2030 seismic requirement. CHA notes that the price tag is estimated to be more than $100 billion but may even be higher after factoring in financing and other costs. As the study notes, hospitals bear the entire financial burden for the required upgrades.

Planning for massive infrastructure projects of this size must start now. CHA concludes that at a time when hospitals’ budgets have been crippled by the pandemic, an extension of the mandate is critical given the extensive work and expense that need to be considered, and they strongly support a state-led advisory committee to re-examine the state’s response to all disasters, including a seismic event.

4) OPPOSITION. The Earthquake Engineering Research Institute (EERI) is opposed to this bill and states that it alters the current seismic safety standard such that facilities currently out of compliance must only be certified as capable of providing services for 72 hours following a seismic event by 2030. This arbitrary limitation implies that an acute care facility could be operated in a damaged state for 72 hours, which would not be suitable for long-term use. This is problematic because the 72 hour utilization of a damaged facility would potentially involve significant risk to the community, especially in light of the potential for additional damage from aftershocks. EERI notes that it goes against the need for acute healthcare facility operations during the intermediate (weeks to months) recovery period per the Federal Emergency Management Agency’s National Disaster Recovery Framework. EERI strongly urges communities to develop Community Resilience Plans that address not only public safety and emergency response, but also what is needed for full recovery. These plans must identify what communities need to do to plan for the recovery of their Social and Economic Institutions and the built environment that supports them. EERI concludes that hospitals and plans to maintain public health are at the top of the list of what should be addressed by community resilience plans that include the availability of full-service acute care hospitals.

1. OPPOSE UNLESS AMENDED. Service Employees International Union State Council (SEIU California), is opposed to this bill unless it is amended to better balance stakeholder interests, ensure that the outcome of the stakeholder process is not predetermined, and reflects the need to protect patients and workers at California’s hospitals. SEIU California also notes that, given the long history of the seismic requirements, almost all previous seismic extensions were accompanied by a condition to show progress to compliance with the standards. SEIU California states that it cannot support the creation of an Advisory Committee unless the make-up of the committee is balanced between labor and those that have tried to weaken the seismic standards. SEIU California contends that the proposed seven-year extension in this bill is far too long and would leave many communities unprotected and without access to care following a major earthquake. Hospitals have known for many years that they would need to meet the 2030 seismic deadlines, and a seven-year delay is unjustified. SEIU California concludes that they would oppose anything more than a one-year extension, and that any extension should require hospitals to meet additional requirements and reporting standards such as requiring hospitals that have not met the 2030 requirement to submit annual financial data including cash on hand, and attest that the board of directors is aware that the hospital needs to meet the 2030 deadline.
   
   The California Nurses Association (CNA) is opposed to this bill unless it is amended, and urges the committee to consider a one-year extension, commiserate with the length of time of the pandemic. CNA also requests the committee amend this bill to include rigorous standards that allow the state to collect audited financials, cash on hand reports and other information to ensure only small or rural hospitals with a true funding crisis will be eligible for this extension. California hospital chains have received billions of dollars in funding from the federal relief bills and are likely to receive more in the next round. Additionally, CNA urges the committee to require hospitals submit a compliance schedule to the state, to protect against endless extensions, with no intention to ever actually comply. And finally, CNA requests amendments to this bill to make the advisory committee balanced between industry and working people, rather than its current version which is heavily biased towards management.
   

6) RELATED LEGISLATION.

• 1. AB 2968 (Rodriguez) requires, by January 1, 2022, OES to develop best practices for counties developing and updating a county emergency plan and requires OES to establish a process for a county to request a OES review of its plan and technical assistance. AB 2968 is currently pending in the Senate Governmental Organization Committee.
  2. AB 2047 (Aguiar-Curry) requires individuals with Alzheimer’s disease and dementia to be integrated into each county’s emergency response plan during the next plan update and calls for the inclusion of protocols for alerts and warnings to the access and functional needs population.

7) PREVIOUS LEGISLATION.

• 1. AB 2190 (Reyes), Chapter 673, Statutes of 2018, provides for an extension of the January 1, 2020, hospital seismic safety deadline of up to 30 months (until July 1, 2022) for hospitals that plan to replace or retrofit a building to at least the 2020 standard of SPC-2, and up to five years (until January 1, 2025) for hospitals that plan to rebuild to the SPC-4D or SPC-5 standards that meet 2030 standards.
  2. AB 2591 (O'Donnell) of 2018 would have permitted a hospital owned by the City of Long Beach to request an additional seismic safety extension before January 1, 2025, of the seismic safety requirement that hospital buildings be rebuilt or retrofitted in order to be capable of withstanding an earthquake. AB 2591 was heard in the Assembly Health Committee on April 14, 2018 and was held in Committee.
     
  3. AB 908 (Dababneh), Chapter 350, Statutes of 2017, authorizes Providence Tarzana Medical Center in Los Angeles to request an additional extension, until October 1, 2022, of the seismic safety requirement that hospital buildings must be rebuilt or retrofitted in order to be capable of withstanding an earthquake.
     
  4. AB 81 (Wood), Chapter 63, Statutes of 2015, permitted a hospital in the City of Willits to request an eight-month deadline extension of a seismic safety requirement that hospitals be rebuilt or retrofitted to be capable of withstanding an earthquake, which it is currently required to meet by January 1, 2015, so that this hospital could have until September 1, 2015, to meet this seismic safety requirement.
     
  5. AB 2557 (Pan), Chapter 821, Statutes of 2014, permitted a hospital located in the Counties of Sacramento, San Mateo, or Santa Barbara or the City of San Jose, that had received an additional extension of the January 1, 2008, seismic safety requirements under specified provisions of existing law to January 1, 2015, to request an additional extension until September 1, 2015, in order to obtain either a certificate of occupancy or a construction final from the OSHPD.
     
  6. SB 90 allowed a hospital to seek an extension for seismic compliance for its SPC-1 buildings of up to seven years based on the following elements: the structural integrity of the building, the loss of essential hospital services to the community if the hospital closed, and financial hardship.
     
  7. SB 499 (Ducheny), Chapter 601, Statutes of 2009, required all general acute care hospitals that have SPC-1 buildings to report to OSHPD by November 1, 2010, and annually thereafter, on the status of their compliance with the seismic safety deadlines.
     
  8. SB 306 amended the Alquist Act to permit hospitals to delay compliance with the July 1, 2008 seismic retro deadline, and the 2013 extension, to the year 2020, by filing a declaration with OSHPD that the owner lacks financial capacity to comply with the law.
     
  9. SB 1661 (Cox), Chapter 679, Statutes of 2006, authorized an extension of up to an additional two years for hospitals that had already received extensions of the January 1, 2008 seismic safety compliance deadline if specified criteria were met, and required specified hospital reports to be posted on the OSHPD website.

1. SUGGESTED AMENDMENTS.
   1. As currently drafted the Advisory Committee created by this bill is made up primarily of health care industry representatives and does not specifically include membership for rural health care representatives, local level emergency preparedness providers, or people with disabilities, among others. In order to ensure more inclusive representation, the Committee may wish to amend this bill to include additional Advisory Committee participants as follows:
      1. An additional representative from an organization representing health care workers;
      2. A representative from an organization representing older adults and people with disabilities.
      3. A representative from a rural hospital or Critical Access Hospital; and,
      4. A representative from an organization for local emergency medical services providers.
   2. In order to allow for a more robust conversation regarding how best to plan for disasters in California, the Committee may wish to amend the bill as follows:
      1. To require the Advisory Committee to explore a variety of possible alternatives to existing seismic requirements, including the level of seismic risk by region, rather than the current language with makes a change to the seismic safety requirements a foregone conclusion;
      2. To require the Advisory Committee to ensure recommendations are in compliance with all state and federal disaster preparedness requirements; and,
      3. To require the Advisory Committee to look at audit recommendations discussed in 7) f) above when assessing future disaster preparedness needs.
   3. This bill requires the report submitted by the Advisory Committee to include recommendations on “the impact of various disaster preparedness strategies on health care affordability and the cost to consumers and employers.” This provision seems to imply that costs of any disaster preparedness should be borne by consumers and/or employers or that limits on disaster preparedness should be imposed due to overall impact on health care affordability. This bill already requires the report to make recommendations on funding sources. Additionally, state and federal disaster planning requirements are required to be based on and include facility-based and community-based risk assessment, and to address patient populations, including, but not limited to, persons at-risk; the type of services the facility has the ability to provide in an emergency; and, continuity of operations, including delegations of authority and succession plans. The Committee may wish to remove the provisions regarding the impact of disaster preparedness on affordability.

9) The Committee is suggesting technical amendments to this bill as follows:

• 1. To specifically include fires in list the of disasters; and,
  2. To correct an error in the reference to local emergency medical service authorities.

REGISTERED SUPPORT / OPPOSITION:

Support

California Hospital Association (sponsor)

Adventist Health

Alameda Health System

Alliance of Catholic Health Care

Alta Hospitals Systems

Alvarado Hospital Medical Center

Antelope Valley Healthcare District

Association of California Healthcare Districts

Bear Valley Community Healthcare District

Beverly Community Hospital Association/Beverly Hospital

Cedars-Sinai Medical Center

Centinela Hospital Medical Center

Chino Valley Medical Center

City of Alameda Health Care District

College Hospital Costa Mesa

College Medical Center

Community Hospital of Huntington Park

Community Medical Centers

Desert Valley Hospital

Dignity Health

District Hospital Leadership Forum

Eastern Plumas Health Care

Emanate Health

Encino Hospital Medical Center

Garden Grove Hospital Medical Center

Good Samaritan Hospital of Bakersfield

Good Samaritan Hospital of Gardena

Healdsburg District Hospital

Huntington Beach Hospital

Huntington Hospital

Jerold Phelps Community Hospital

Kaweah Delta Health Care District

Kern Medical

Kern Valley Healthcare District

La Palma Intercommunity Hospital

Loma Linda University Adventist Health Sciences Center and its Affiliated Entities

Los Angeles Area Chamber of Commerce

Mad River Community Hospital

Mammoth Hospital

Marshall Medical Center

Mayers Memorial Hospital District

MemorialCare

Memorial Hospital of Gardena

Montclair Hospital Medical Center

Monterey Park Hospital

NorthBay Healthcare

Northern Inyo Hospital

Oak Valley Hospital District

Orchard Hospital

Paradise Valley Hospital

Private Essential Access Community Hospitals

PIH Health

Pomona Valley Hospital Medical Center

Providence St. Joseph Health

Redlands Community Hospital

Ridgecrest Regional Hospital

San Bernardino Mountains Community Hospital District

San Dimas Community Hospital

San Gabriel Valley Economic Partnership

San Gorgonio Memorial Hospital

San Joaquin Valley Rehabilitation Hospital

Scripps Health

Sharp Healthcare

Shasta Regional Medical Center

Sherman Oaks Hospital

Sierra View Medical Center

Sonoma Valley Hospital

Sophie Hahn, Vice Mayor of Berkeley

Stanford Health Care

Tahoe Forest Health System

Tenet Healthcare Corporation

Trinity Hospital

University of California

University of Southern California

Valley Presbyterian Hospital

Washington Township Health Care District

West Anaheim Medical Center

Opposition

Earthquake Engineering Research Institute (previous version)
Structural Engineers Association of California

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097

 THIRD READING  

Bill No: SB 758

Author: Portantino (D)

Amended: 3/27/19

Vote: 21

SENATE HEALTH COMMITTEE: 8-0, 4/24/19

AYES: Pan, Stone, Durazo, Grove, Hurtado, Mitchell, Monning, Rubio

NO VOTE RECORDED: Leyva

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

SUBJECT: Hospitals: seismic safety

SOURCE: California Hospital Association

DIGEST:

This bill requires hospitals that have a building that is not in compliance with the January 1, 2030 seismic safety standard, to report to the Office of Statewide Health Planning and Development what services are provided in each building of that hospital.

ANALYSIS:

Existing law:

1. Establishes the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983 (Alquist Act), to ensure that hospital buildings are designed and constructed to resist the forces generated by earthquakes and requires the Office of Statewide Health Planning and Development (OSHPD) to propose building standards for earthquake resistance and to provide independent review of the design and construction of hospital buildings. [HSC §129675, et seq.]
2. Establishes timelines for hospital compliance with seismic safety standards, including a requirement that buildings posing a significant risk of collapse and a danger to the public (referred to as Structural Performance Category 1 (SPC-1) buildings) be rebuilt or retrofitted to be capable of withstanding an earthquake, or removed from acute care service, by January 1, 2008, and a requirement that hospital buildings be capable of remaining intact after an earthquake, and must also be capable of continued operation by January 1, 2030. [HSC §130060, §130065]
3. Permits OSHPD to grant an extension of up to five years to the 2008 deadline, which would be January 1, 2013, for hospitals for which compliance will result in a loss of health care capacity, as defined. Allows OSHPD to grant various further extensions beyond this, including up to seven years to January 1, 2020, in part based on the loss of essential hospital services to the community if the hospital closed, and financial hardship. [HSC §130060, §130061.5]
4. Requires OSHPD to provide the Legislature with an inventory of the SPC category of each hospital building before June 1, 2019. [HSC §130062(k)]
5. Requires the owner of a hospital whose building does not substantially comply with the seismic safety regulations that are required as of January 1, 2030, to submit to OSHPD an attestation that the board of directors of that hospital is aware that the hospital building is required to meet the January 1, 2030 deadline for substantial compliance with those requirements. [HSC §130066]

This bill requires the owner of an acute care inpatient hospital, by January 1, 2021, whose building does not substantially comply with the January 1, 2030 seismic safety standards, as specified, to report the services provided in each building of the acute care inpatient hospital by updating an existing submission to OSHPD attesting that the hospital is aware of the requirement to meet the 2030 deadline.

Comments

1. Author’s statement. According to the author, this bill amends AB 2190 (Reyes, Chapter 673, Statutes of 2018) enacted last year, to require hospitals to provide additional information to OSHPD. This bill additionally requires hospitals to describe the services provided in each building of the acute care inpatient hospital. This information is necessary to help OSHPD implement existing seismic safety regulations and standards, as well as consider seismic safety standards and response for future seismic requirements.
2. Hospital seismic requirements. Following the 1971 San Fernando Valley earthquake, California enacted the Alquist Act, which mandated that all new hospital construction meet stringent seismic safety standards. In 1994, after the Northridge earthquake, SB 1953 (Alquist, Chapter 740, Statutes of 1994) required OSHPD to establish earthquake performance categories for hospitals, and established a January 1, 2008 deadline by which general acute care hospitals must be retrofitted or replaced so that they do not pose a risk of collapse in the event of an earthquake, and a January 1, 2030 deadline by which they must be capable of remaining operational following an earthquake. Subsequent legislation allowed most hospitals to qualify for an extension of the January 1, 2008 deadline to January 1, 2013.

OSHPD categorizes hospitals into five SPCs. SPC-1 is the category of buildings at most risk of collapse in an earthquake, and it is these hospitals that were originally required to be taken out of service or retrofitted by January 1, 2008, which has since been extended for some hospitals to January 1, 2020. Buildings in SPC-2, 3, 4, and 5 are generally categorized based on when they were built and the building code regulations in effect at that time. Hospital buildings in any of these categories may be used up until January 1, 2030, at which time hospitals must either meet SPC-5 requirements, or under recently adopted regulations, the new category of SPC-4D. SPC-5 generally requires new construction for any building constructed before 1989, while SPC-4D allows for some more recently constructed buildings to be retrofitted and still be compliant with January 1, 2030 standards.

In addition to the SPC categories, there are also non-structural performance categories, or NPCs, which also go from NPC-1 to NPC-5. NPC requirements are focused on enabling hospitals to continue providing services after an earthquake, such as bracing and anchoring equipment, utilities and services. NPC-5, which hospitals are required to meet by January 1, 2030, requires onsite supplies of water and holding tanks for sewage and liquid waste, sufficient to support 72 hours of emergency operations, and must be integrated into the building plumbing systems.

1. RAND report on cost of compliance. The California Hospital Association commissioned a RAND Corporation report that was recently released, entitled “Updating the Costs of Compliance for California’s Hospital Seismic Safety Standards.” According to this report, California hospitals still face a significant financial obligation between now and 2030, and depending on assumptions regarding retrofit versus new construction and future cost escalation, the statewide price tag for compliance could range from $34 billion to $142 billion. According to the RAND report, there are a variety of options for providing regulatory relief or flexibility, including providing additional flexibility in the timing of compliance deadlines, rethinking what it means for hospitals to remain operational after a seismic event, and streamlining the administrative processes associated with seismic compliance projects. RAND suggested that decisionmaking regarding future changes, if any, would be aided by more comprehensive analysis of the benefits of the policy, as well as improved data collection and reporting regarding seismic projects and their costs.
2. Concerns. The California Nurses Association (CNA) and SEIU California both submitted letters of concern. According to CNA, hospitals not only need to protect the patients, workers, and visitors inside, they need the ability to continue providing treatment after an earthquake. SEIU California states that the basis for its concern is that the author and sponsor of this bill have indicated their intention to use this bill to address the broader question of compliance with the 2030 seismic deadline. SEIU California states it believes in upholding the intent of the Legislature in passing the 2030 standard, to ensure that hospitals are not only safe structures post-earthquake, but that they are useful in the provision of life-saving emergency and other health care treatment in the wake of a major seismic event. According to SEIU California, during the Northridge earthquake in 1994, the primary cause for the disruption of life-saving emergency hospital care was nonstructural damage. Water, power, and necessary diagnostic machines were so severely damaged that it forced the evacuation of 600-700 patients throughout Los Angeles. SEIU California states that it was this experience, of having to transfer patients from a compromised facility to other, already overwhelmed hospitals in the region, due to lack of power, water, and the ability to fully function that prompted the existing 2030 standards.

CNA states that the sponsor of this bill have left this bill in a “substantive spot” form to avoid a policy committee debate, but they have been clear about their intentions of seeking to get out of having to meet some seismic safety thresholds entirely. Proposals of this magnitude should not be kicked down the road to be reviewed later.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

SUPPORT: (Verified 5/15/19)

California Hospital Association (source)

Alliance of Catholic Health Care

District Hospital Leadership Forum

Private Essential Access Community Hospitals

OPPOSITION: (Verified 5/15/19)

None received

ARGUMENTS IN SUPPORT: The California Hospital Association (CHA) is sponsoring this bill, and states that by 2022, all hospital buildings in California will be able to withstand a major earthquake. Now that their buildings are safe, CHA states that hospitals are turning their focus to the 2030 requirement to be fully operational after a major earthquake. CHA states that as hospitals, lawmakers, and other stakeholders consider this requirement, it will be important to understand where specific services are offered on a hospital campus. This bill supports this effort by requiring hospitals to report to OSHPD the services provided in each building of the acute care inpatient hospital. CHA points to the RAND report estimating the cost of meeting seismic compliance at $100 billion or more, and states that ensuring hospitals remain able to provide essential care following a disaster will require stakeholders to find the most effective, efficient way to ensure care can continue to be delivered.

The Alliance of Catholic Health Care and the District Hospital Leadership Forum make similar arguments in support.

Prepared by: Vincent D. Marchand / HEALTH / (916) 651-4111

5/15/19 16:25:34

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: SB 758

SUBJECT: Hospitals: seismic safety

SUMMARY:

Requires hospitals that have a building that is not in compliance with the January 1, 2030 seismic safety standard, to report to the Office of Statewide Health Planning and Development what services are provided in each building of that hospital.

Existing law:

1. Establishes the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983 (Alquist Act), to ensure that hospital buildings are designed and constructed to resist the forces generated by earthquakes and requires the Office of Statewide Health Planning and Development (OSHPD) to propose building standards for earthquake resistance and to provide independent review of the design and construction of hospital buildings. [HSC §129675, et seq.]
   
2. Establishes timelines for hospital compliance with seismic safety standards, including a requirement that buildings posing a significant risk of collapse and a danger to the public (referred to as SPC -1 buildings) be rebuilt or retrofitted to be capable of withstanding an earthquake, or removed from acute care service, by January 1, 2008, and a requirement that hospital buildings be capable of remaining intact after an earthquake, and must also be capable of continued operation by January 1, 2030. [HSC §130060, §130065]
3. Permits OSHPD to grant an extension of up to five years to the 2008 deadline, which would be January 1, 2013, for hospitals for which compliance will result in a loss of health care capacity, as defined. Allows OSHPD to grant various further extensions beyond this, including up to seven years to January 1, 2020, in part based on the loss of essential hospital services to the community if the hospital closed, and financial hardship. [HSC §130060, §130061.5]
4. Requires OSHPD to provide the Legislature with an inventory of the SPC category of each hospital building before June 1, 2019. [HSC §130062(k)]
5. Requires the owner of a hospital whose building does not substantially comply with the seismic safety regulations that are required as of January 1, 2030, to submit to OSHPD an attestation that the board of directors of that hospital is aware that the hospital building is required to meet the January 1, 2030, deadline for substantial compliance with those requirements. [HSC §130066]

This bill: Requires the owner of an acute care inpatient hospital, by January 1, 2021, whose building does not substantially comply with the January 1, 2030 seismic safety standards, as specified, to report the services provided in each building of the acute care inpatient hospital by updating an existing submission to OSHPD attesting that the hospital is aware of the requirement to meet the 2030 deadline.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, this bill amends AB 2190 (Reyes, Chapter 673, Statutes of 2018) enacted last year, to require hospitals to provide additional information to OSHPD. This bill would additionally require hospitals to describe the services provided in each building of the acute care inpatient hospital. This information is necessary to help OSHPD implement existing seismic safety regulations and standards, as well as consider seismic safety standards and response for future seismic requirements.
2. Hospital seismic requirements. Following the 1971 San Fernando Valley earthquake, California enacted the Alquist Act, which mandated that all new hospital construction meet stringent seismic safety standards. In 1994, after the Northridge earthquake, SB 1953 (Alquist, Chapter 740, Statutes of 1994) required OSHPD to establish earthquake performance categories for hospitals, and established a January 1, 2008, deadline by which general acute care hospitals must be retrofitted or replaced so that they do not pose a risk of collapse in the event of an earthquake, and a January 1, 2030, deadline by which they must be capable of remaining operational following an earthquake. Subsequent legislation allowed most hospitals to qualify for an extension of the January 1, 2008 deadline to January 1, 2013.
   
   OSHPD categorizes hospitals into five Structural Performance Categories (SPCs). SPC-1 is the category of buildings at most risk of collapse in an earthquake, and it is these hospitals that were originally required to be taken out of service or retrofitted by January 1, 2008, which has since been extended for some hospitals to January 1, 2020. Buildings in SPC-2, 3, 4, and 5 are generally categorized based on when they were built and the building code regulations in effect at that time. Hospital buildings in any of these categories may be used up until January 1, 2030, at which time hospitals must either meet SPC-5 requirements, or under recently adopted regulations, the new category of SPC-4D. SPC-5 generally requires new construction for any building constructed before 1989, while SPC-4D allows for some more recently constructed buildings to be retrofitted and still be compliant with January 1, 2030 standards.
   
   In addition to the SPC categories, there are also non-structural performance categories, or NPCs, which also go from NPC-1 to NPC-5. NPC requirements are focused on enabling hospitals to continue providing services after an earthquake, such as bracing and anchoring equipment, utilities and services. NPC-5, which hospitals are required to meet by January 1, 2030, requires onsite supplies of water and holding tanks for sewage and liquid waste, sufficient to support 72 hours of emergency operations, and must be integrated into the building plumbing systems.
3. RAND Report on cost of compliance. The California Hospital Association commissioned a RAND Corporation report that was recently released, entitled “Updating the Costs of Compliance for California’s Hospital Seismic Safety Standards.” According to this report, California hospitals still face a significant financial obligation between now and 2030, and depending on assumptions regarding retrofit versus new construction and future cost escalation, the statewide price tag for compliance could range from $34 billion to $142 billion. According to the RAND report, there are a variety of options for providing regulatory relief or flexibility, including providing additional flexibility in the timing of compliance deadlines, rethinking what it means for hospitals to remain operational after a seismic event, and streamlining the administrative processes associated with seismic compliance projects. RAND suggested that decisionmaking regarding future changes, if any, would be aided by more comprehensive analysis of the benefits of the policy, as well as improved data collection and reporting regarding seismic projects and their costs.
4. Current status of 2030 seismic compliance in California. Hospital buildings (each licensed hospital can have a number of separate buildings) are required to be SPC-3, 4, 4D, or 5 by 2030. According to OSHPD, 2,307 out of 3,106 hospital buildings are compliant with 2030 in terms of the SPC standard. For the NPC standard, all hospital buildings are required to by NPC-5 by 2030. Only 23 out of 3,246 currently meet that standard (the number of hospital buildings that have NPC ratings is higher than those that have SPC ratings as some structures such as utility tunnels and equipment yards are not assigned SPC ratings).

1. Prior legislation. AB 2190 (Reyes, Chapter 673, Statutes of 2018) provides for an extension of the January 1, 2020 hospital seismic safety deadline of up to 30 months (until July 1, 2022) for hospitals that plan to replace or retrofit a building to at least the 2020 standard of SPC-2, and up to five years (January 1, 2025) for hospitals that plan to rebuild to SPC-4D or SPC-5 standards that meet 2030 standards. Additionally, required OSHPD to provide the Legislature with an inventory of the SPC category of each hospital building before June 1, 2019, and required hospitals that do not comply with the January 1, 2030 deadline to submit an attestation to OSHPD that it is aware of the deadline.
   
   AB 908 (Dababneh, Chapter 350, Statutes of 2017) permits Providence Tarzana Medical Center in Los Angeles to request an additional extension, until October 1, 2022, of the seismic safety requirement that hospital buildings be rebuilt or retrofitted in order to be capable of withstanding an earthquake.
   
   AB 81 (Wood, Chapter 63, Statutes of 2015) permits a hospital in the City of Willits to request an eight-month deadline extension of a seismic safety requirement that hospitals be rebuilt or retrofitted to be capable of withstanding an earthquake, which it is currently required to meet by January 1, 2015, so that this hospital could have until September 1, 2015, to meet this seismic safety requirement.
   
   AB 2557 (Pan, Chapter 821, Statutes of 2014) permits a hospital located in the Counties of Sacramento, San Mateo, or Santa Barbara or the City of San Jose, that had received an additional extension of the January 1, 2008, seismic safety requirements under specified provisions of existing law to January 1, 2015, to request an additional extension until September 1, 2015, in order to obtain either a certificate of occupancy or a construction final from the OSHPD.
   
   SB 90 (Steinberg, Chapter 19, Statutes of 2011) allows a hospital to seek an extension for seismic compliance for its SPC-1 buildings of up to seven years based on the following elements: the structural integrity of the building, the loss of essential hospital services to the community if the hospital closed, and financial hardship.
   
   SB 499 (Ducheny, Chapter 601, Statutes of 2009) requires all general acute care hospitals that have SPC-1 buildings to report to OSHPD by November 1, 2010, and annually thereafter, on the status of their compliance with the seismic safety deadlines.
   
   SB 306 (Ducheny, Chapter 642, Statutes of 2007) amends the Alquist Act to permit hospitals to delay compliance with the July 1, 2008 seismic retro deadline, and the 2013 extension, to the year 2020, by filing a declaration with OSHPD that the owner lacks financial capacity to comply with the law.
   
   SB 1661 (Cox, Chapter 679, Statutes of 2006) authorizes an extension of up to an additional two years for hospitals that had already received extensions of the January 1, 2008 seismic safety compliance deadline if specified criteria were met, and required specified hospital reports to be posted on the OSHPD website.
2. Support. The California Hospital Association (CHA) is sponsoring this bill, and states that by 2022, all hospital buildings in California will be able to withstand a major earthquake. Now that their buildings are safe, CHA states that hospitals are turning their focus to the 2030 requirement to be fully operational after a major earthquake. CHA states that as hospitals, lawmakers, and other stakeholders consider this requirement, it will be important to understand where specific services are offered on a hospital campus. This bill would support this effort by requiring hospitals to report to OSHPD the services provided in each building of the acute care inpatient hospital. CHA points to the RAND report estimating the cost of meeting seismic compliance at $100 billion or more, and states that ensuring hospitals remain able to provide essential care following a disaster will require stakeholders to find the most effective, efficient way to ensure care can continue to be delivered.
   
   The Alliance of Catholic Health Care and the District Hospital Leadership Forum make similar arguments in support.
3. Letters of concern. The California Nurses Association (CNA) and SEIU California both submitted letters of concern. According to CNA, hospitals not only need to protect the patients, workers, and visitors inside, they need the ability to continue providing treatment after an earthquake. SEIU California states that the basis for its concern is that the author and sponsor of the bill have indicated their intention to use this bill to address the broader question of compliance with the 2030 seismic deadline. SEIU California states it believes in upholding the intent of the Legislature in passing the 2030 standard, to ensure that hospitals are not only safe structures post-earthquake, but that they are useful in the provision of life-saving emergency and other health care treatment in the wake of a major seismic event. According to SEIU California, during the Northridge earthquake in 1994, the primary cause for the disruption of life-saving emergency hospital care was nonstructural damage. Water, power, and necessary diagnostic machines were so severely damaged that it forced the evacuation of 600-700 patients throughout Los Angeles. SEIU California states that it was this experience, of having to transfer patients from a compromised facility to other, already overwhelmed hospitals in the region, due to lack of power, water, and the ability to fully function that prompted the existing 2030 standards.
   
   CNA states that the sponsors of this bill have left the bill in a “substantive spot” form to avoid a policy committee debate, but they have been clear about their intentions of seeking to get out of having to meet some seismic safety thresholds entirely. Proposals of this magnitude should not be kicked down the road to be reviewed later.

SUPPORT AND OPPOSITION:

Support: California Hospital Association (sponsor)

Alliance of Catholic Health Care

District Hospital Leadership Forum

Oppose: None received

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