Existing law, the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983, establishes a program of seismic safety building standards for certain hospitals. Existing law requires hospitals that are seeking an extension for their buildings to submit an application to the Department of Health Care Access and Information by April 1, 2019, subject to certain exceptions. Existing law requires that final seismic compliance be achieved by July 1, 2022, if the compliance is based on a replacement or retrofit plan, or by January 1, 2025, if the compliance is based on a rebuild plan. Notwithstanding the above provisions, existing law authorizes the department to waive the requirements of the act for the OConnor Hospital and Santa Clara Valley Medical Center in the City of San Jose if the hospital or medical center submits a plan for compliance by a specified date, and the department accepts the plan based on it being feasible to complete and promoting public safety. Existing law requires, if the department accepts the plan, the hospital or medical center to report to the department on its progress to timely complete the plan by specified dates. Existing law imposes penalties to a hospital that fails to meet its deadline.

This bill would additionally authorize the department to waive the requirements of the act for Providence St. Joseph Hospital and Providence Eureka General Hospital in the City of Eureka, Providence St. Jude Medical Center in the City of Fullerton, and Providence Cedars-Sinai Tarzana Medical Center in the City of Tarzana. The bill would specify additional dates for the hospital or medical center to report to the department on its progress, would authorize the department to grant no more time than is necessary for the hospital to fully comply with the standards, and would impose a fine of $5,000 per calendar day if the hospital fails to comply with specified requirements or demonstrate adequate progress, as specified.

This bill would declare that it is to take effect immediately as an urgency statute.

Existing law, the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983, establishes a program of seismic safety building standards for certain hospitals. Existing law requires hospitals that are seeking an extension for their buildings to submit an application to the Department of Health Care Access and Information by April 1, 2019, subject to certain exceptions. Existing law requires that final seismic compliance be achieved by July 1, 2022, if the compliance is based on a replacement or retrofit plan, or by January 1, 2025, if the compliance is based on a rebuild plan. Notwithstanding the above provisions, existing law authorizes the department to waive the requirements of the act for the OConnor Hospital and Santa Clara Valley Medical Center in the City of San Jose if the hospital or medical center submits a plan for compliance by a specified date, and the department accepts the plan based on it being feasible to complete and promoting public safety. Existing law requires, if the department accepts the plan, the hospital or medical center to report to the department on its progress to timely complete the plan by specified dates. Existing law imposes penalties to a hospital that fails to meet its deadline.

This bill would add additionally authorize the department to waive the requirements of the act for Providence St. Joseph Hospital and Providence Eureka General Hospital in the City of Eureka, Providence St. Jude Medical Center in the City of Fullerton, and Providence Cedars-Sinai Tarzana Medical Center in the City of Tarzana to the hospitals for which the department may waive the requirements of the act. Tarzana. The bill would add specify additional dates for the hospital or medical center to report to the department on its progress. progress, would authorize the department to grant no more time than is necessary for the hospital to fully comply with the standards, and would impose a fine of $5,000 per calendar day if the hospital fails to comply with specified requirements or demonstrate adequate progress, as specified.

This bill would declare that it is to take effect immediately as an urgency statute.

Existing law, the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983, establishes a program of seismic safety building standards for certain hospitals. Existing law requires hospitals that are seeking an extension for their buildings to submit an application to the Department of Health Care Access and Information by April 1, 2019, subject to certain exceptions. Existing law requires that final seismic compliance be achieved by July 1, 2022, if the compliance is based on a replacement or retrofit plan, or by January 1, 2025, if the compliance is based on a rebuild plan. Notwithstanding the above provisions, existing law authorizes the department to waive the requirements of the act for the OConnor Hospital and Santa Clara Valley Medical Center in the City of San Jose if the hospital or medical center submits a plan for compliance by a specified date, and the department accepts the plan based on it being feasible to complete and promoting public safety. Existing law requires, if the department accepts the plan, the hospital or medical center to report to the department on its progress to timely complete the plan by specified dates. Existing law imposes penalties to a hospital that fails to meet its deadline.

This bill would add Providence St. Joseph Hospital and Providence Eureka General Hospital in the City of Eureka, Providence St. Jude Medical Center in the City of Fullerton, and Providence Cedars-Sinai Tarzana Medical Center in the City of Tarzana to the hospitals for which the department may waive the requirements of the act. The bill would add additional dates for the hospital or medical center to report to the department on its progress.

This bill would declare that it is to take effect immediately as an urgency statute.

 VETO  

Bill No: SB 1119

Author: Newman (D), et al.

Enrolled: 8/30/24

Vote: 27 - Urgency

SENATE HEALTH COMMITTEE: 9-0, 4/3/24

AYES: Roth, Nguyen, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Wiener

NO VOTE RECORDED: Glazer, Smallwood-Cuevas

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/16/24

AYES: Caballero, Jones, Ashby, Becker, Bradford, Seyarto, Wahab

SENATE FLOOR: 39-0, 5/21/24

AYES: Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

NO VOTE RECORDED: Allen

SENATE FLOOR: 39-0, 8/28/24

AYES: Allen, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

NO VOTE RECORDED: Alvarado-Gil

ASSEMBLY FLOOR: 73-0, 8/26/24 - See last page for vote

SUBJECT: Hospitals: seismic compliance

SOURCE: Providence

DIGEST:

This bill extends the dates by which four hospitals owned by Providence are required to comply with seismic safety standards, including two hospitals in Eureka, one hospital in Fullerton, and one hospital in Tarzana.

ANALYSIS:

Existing law:

1. Licenses and regulates health facilities, including general acute care hospitals, by the California Department of Public Health (CDPH). [HSC §1250, et seq.]
2. 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 Department of Health Care Access and Information (HCAI) to propose building standards for earthquake resistance and to provide independent review of the design and construction of hospital buildings. [HSC §129675, et seq.]
3. 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 (which has since been extended for various hospitals to various dates), and a requirement that hospitals must also be capable of continued operation by January 1, 2030. [HSC §130060, §130065]
4. Permits HCAI 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 HCAI 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]
5. Permits HCAI, under legislation enacted in 2018, to provide for an extension of the January 1, 2020 deadline in 4) above, for up to 30 months (until July 1, 2022) for hospitals that plan to replace or retrofit a building to meet the 2020 standard, and up to five years (January 1, 2025) for hospitals that plan to rebuild to a standard that meets the 2030 requirement. [HSC §130062]
6. Provides for penalties of $5,000 per calendar day for failure to comply, or failure to meet any agreed upon milestone toward complying, with the provisions in 5) above. [HSC §130062(d)(3) and (e)(3)]
7. Requires the owner of an acute care inpatient hospital whose building does not substantially comply with the January 1, 2030 seismic safety requirement described in 3) above, to submit to HCAI, by January 1, 2020, an attestation that the board of directors of that hospital is aware that the hospital building is required to meet this requirement. [HSC §130066]

This bill:

1. Extends the dates by which specified buildings at four hospitals owned by Providence are required to comply with seismic safety standards, which under current law are required to meet the 2030 standard by January 1, 2025, as follows:
   1. For Providence Cedars-Sinai Tarzana Medical Center Patient Tower, to January 1, 2026;
   2. For Providence St. Joseph Hospital in the City of Eureka, Original Hospital and Central Plant, to January 1, 2027;
   3. For Providence Eureka General Hospital in the City of Eureka, Original Hospital, 1950 Addition Building, 1955 Addition Building, 1957 Addition Center Building, and 1957 Addition West Side Building, to January 1, 2027; and,
   4. For Providence St. Jude Medical Center in the City of Fullerton, Main Building, Canopies, and Boiler Room, Basement Expansion, and West Building, removal from acute care service or demolition, to January 1, 2027.
2. Specifies that HCAI can grant no more time than is necessary for the hospital to fully comply with the seismic safety standards.
3. Establishes quarterly reporting dates for these hospitals to submit to HCAI to update their progress toward compliance to accommodate the length of extensions in this bill.
4. Permits HCAI to revoke the seismic compliance waiver for these Providence hospitals if a hospital fails to timely report progress that HCAI deems sufficient to complete their plans, unless due to unforeseen circumstances outside of the control of the hospital, and the hospital has been given at least 90 days written notice with an opportunity to cure the noncompliance.
5. Contains an urgency clause that will make this bill effective upon enactment.

Comments

1. Author’s statement. According to the author, the COVID-19 pandemic created a cascade of challenges requiring hospitals to focus on ensuring adequate capacity and critical patient care. The Providence hospital organization currently has three hospitals in California—St. Jude Medical Center in Fullerton; St. Joseph Hospital in Eureka; and Providence Cedars-Sinai Tarzana Medical Center in Los Angeles—which are in the midst of rebuild plans. While Providence has endeavored to meet the seismic deadlines for California hospitals established in statute for each campus, due to a variety of circumstances beyond its control, particularly the impacts of the pandemic, these three hospitals will not be able to fully achieve seismic compliance in time to avoid significant financial penalties. Without the deadline extension proposed in this bill, the hospitals will be faced with the reality of being unable to renew their licensure under CDPH, leading to a loss of vital patient care in their communities.
2. Background on 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 HCAI 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.

HCAI 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 multiple times. 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 more 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 original five-year extension to January 1, 2013, the Legislature has passed additional bills allowing hospitals to extend the deadlines for retrofitting SPC-1 buildings beyond the 2013 deadline. SB 306 (Ducheny, Chapter 642, Statutes of 2007) permitted a hospital owner to comply with seismic safety deadlines and requirements in current law by replacing all of its buildings subject to seismic retrofit by January 1, 2020, rather than retrofitting by 2013 and replacing them by 2030, if the hospital meets several conditions and HCAI certifies that the hospital owner lacks the financial capacity to meet seismic standards, as defined. SB 90 (Steinberg, Chapter 19, Statutes of 2011) allowed a hospital to seek an extension for seismic compliance for its SPC-1 buildings of up to seven years (no later than January 1, 2020) 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.

1. Providence hospitals affected by this bill are operating under a seismic deadline extension passed in 2018. In 2018, the Legislature passed AB 2190 (Reyes, Chapter 673, Statutes of 2018) which was intended to allow the last remaining hospitals that had not yet met the

SPC- 2 standard, to meet the mandate without fear of closure should they have a construction or financing delay. AB 2190 provided two paths: a 30 month extension (to July 1, 2022) for hospitals that submitted a retrofit plan or a “replacement plan” (relocating acute care services or beds from nonconforming buildings into a conforming building); or alternatively, a five year extension (to January 1, 2025) for hospitals that submitted a rebuild plan to construct a new building that would meet the 2030 standard. The Providence hospitals affected by this bill were all granted extensions to January 1, 2025, by which time they should be 2030 compliant in terms of SPC status.

In order to receive the extension to July 1, 2022 for a retrofit or replacement plan, the hospital and HCAI were required to identify at least two major milestones relating to the compliance plan to be used as a basis for determining whether the hospital is making adequate progress toward meeting the new seismic compliance deadline. The hospital needed to start construction by April 1, 2020, and meet any agreed upon milestone, or be subject to a $5,000 fine per calendar day until the requirements or milestones are met. Similarly, hospitals seeking an extension to January 1, 2025 for a rebuild plan had to work with HCAI to identify major milestones, begin construction by January 1, 2022, and are also subject to the daily $5,000 fine for failure to meet requirements or agreed upon milestones. AB 2190 permitted HCAI to grant adjustments to the deadlines to meet milestones or other requirements as necessary to deal with specified delays, but HCAI was prohibited from extending the final seismic compliance dates of July 1, 2022 for replacement or retrofit plans, and January 1, 2025 for rebuild plans. Hospitals granted extensions under AB 2190 are required to provide a quarterly status report to HCAI until seismic compliance is achieved. However, since that time, there has been legislation granting additional extensions for specific hospitals.

1. Background on the Providence hospitals affected by this bill and their seismic compliance status.
2. Providence Cedars-Sinai Tarzana Medical Center. Providence Cedars-Sinai in Tarzana is licensed for 204 beds. According to HCAI, one building is under an AB 2190 rebuild extension, and the facility has been under three ownerships during the full extension period: Tenet, Providence, and Providence/Cedars-Sinai Joint Venture. The compliance plan anticipated new construction to replace this building. The building decanted of known acute care functions following occupancy of the new patient wing in October of 2023 and relocation of the Neonatal Intensive Care Unit in December 2023. The work remaining to convert the SPC-1 building to a non-acute care building is disconnection of utilities and life safety systems from the conforming buildings, and HCAI deems this remaining work achievable by the end of the current extension. According to Providence, constructing the new patient wing took longer than anticipated, and they need additional time to complete the utility and building separation work associated with removing the old building from acute care services. The design team is engaged and they are working toward the first HCAI-issue milestone.
3. Providence St. Joseph Hospital in the City of Eureka. Providence St. Joseph in Eureka is licensed for 138 beds. According to HCAI, the hospital currently has one SPC-1 building under an AB 2190 rebuild extension and has missed mutually agreed upon milestones. The compliance plan began with one new building approved and built. When nearing completion, HCAI discovered that general acute care services remained in the nonconforming building. Providence then commenced working with HCAI on a series of amendments to their AB 2190 milestones, none of which have been met. Providence has not submitted plans to resolve the non-conforming conditions. Compliance work has not progressed since January 2020. According to Providence, planning has been underway for years and make ready projects have been completed to move several impacted departments out of the non-compliant space, and noted that utility separation work had started and was paused due to COVID. Providence states a design team and general contractor have been engaged.
4. Providence Eureka The General Hospital. The General Hospital is a 15-bed rehabilitation center, and is operating under a consolidated license with its parent facility, Providence St. Joseph in Eureka. According to HCAI, there are five SPC-1 buildings at The General Hospital under an AB 2190 rebuild extension. The buildings house acute rehabilitation nursing. The extension was originally approved to relocate services to the St. Joseph campus. Current plans reflect relocation of services to a new construction at Providence Redwood Memorial Hospital in Fortuna, approximately 20 miles away. Construction of the new facility has not progressed since July 2019, with environmental damage requiring mitigation due to lack of building protection.

According to Providence, the new location for the acute rehabilitation unit project at Redwood Memorial in Fortuna was started in approximately 2017-2019, and HCAI temporarily paused the project to validate construction plans and schedules. COVID further paused the relocation work. Providence states that a design team and general contractor have been engaged.

1. Providence St. Jude Medical Center in the City of Fullerton. Providence St. Jude is licensed for 320 beds. According to HCAI, there are three SPC-1 buildings left unresolved following completion of a replacement tower in 2014. All three SPC-1 buildings are adjacent to SPC-conforming buildings, whose operations could be impacted by the nonconforming buildings in the case of a major seismic event.

According to Providence, pre-COVID, the healthcare industry projected increased outpatient utilization and decreased inpatient utilization, which led to the determination to remove acute care services from these buildings. However, those outpatient projections were not realized across the industry, and a strategy shift was needed to address the increasing inpatient needs at St. Jude, which resulted in the seismic requirements now becoming applicable. A design team has been engaged, and a general contractor was contracted in March for preconstruction scoping.

1. Letter of concern. The Service Employees International Union California (SEIU) submitted a letter of concern, stating that this bill grants an extension to certain hospitals that have already received an extension under AB 2190. SEIU states that it is time that these hospitals meet these standards and not continue to delay these important safety updates. SEIU states they look forward to continued dialogue and discussion on compliance with California’s 2030 seismic standards.

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

SUPPORT: (Verified 9/30/24)

Providence (source)

Alliance of Catholic Health Care

Calabasas Councilmember Ed Albrecht

Calabasas Councilmember David Shapiro

California Hospital Association

Cedars-Sinai

City of Eureka

City of Fullerton

Fullerton Fire Department

Humboldt County Board of Supervisors

Humboldt County Sherriff’s Office

Los Angeles County Board of Supervisors

North Orange County Chamber of Commerce

Orange County Supervisor Doug Chaffee

Orange County United Way

South Orange County Economic Coalition

Valley Industry & Commerce Association

West Valley-Warner Center Chamber of Commerce

OPPOSITION: (Verified 9/30/24)

California Nurses Association

ARGUMENTS IN SUPPORT: This bill is sponsored by Providence, which states that this bill would authorize narrow, case-specific extensions of the seismic compliance deadlines of AB 2190 for three Providence hospitals. Specifically, this bill would authorize two additional years for Providence St. Jude Medical Center in Fullerton and Providence St. Joseph in Eureka, and an extension of one additional year for Providence Cedars-Sinai Tarzana Medical Center. Providence states that failure to meet current seismic deadlines would result in the revocation of a hospital license, and this bill is needed so that these hospitals can maintain critical access to care while making progress toward their respective deadlines. Cedars-Sinai writes in support that it is critical to maintaining access to care, especially as Providence serves significant Medicare and Medi-Cal populations. Cedars-Sinai states that the COVID-19 pandemic led to shifting financial priorities and conditions, requiring many hospitals to focus on ensuring adequate capacity and patient care at the expense of progress toward seismic compliance mandates. The Fullerton Fire Department writes in support that it has been local partners with Providence St. Jude Medical Center for decades, and the majority of their incident volume is transported to that hospital. The Fullerton Fire Department states it is important that beds remain available for patient care while hospital leadership continues to work deliberately toward meeting the state seismic safety requirement.

ARGUMENTS IN OPPOSITION: The California Nurses Association (CNA) is opposed to this bill, stating that this bill would delay seismic compliance requirements for four Providence hospitals spread out across California. Such preferential treatment for one hospital owner is arbitrary and unduly endangers patients as well as health care providers and workers in the event of an earthquake. CNA states that Providence’s delay is part of the hospital industry’s decades-long fight against seismic safety compliance ever since the passage of a law that required hospitals to be operational after an earthquake. CNA states that Providence has had plenty of opportunities over the past 30 years to develop compliance plans, and they have plenty of resources to meet the requirements.

GOVERNOR'S VETO MESSAGE:

This bill would provide an extension to seismic safety compliance deadlines for four Providence hospitals: St. Joseph Hospital and General Hospital in the City of Eureka, St. Jude Medical Center in the City of Fullerton, and Cedars-Sinai Tarzana Medical Center in the City of Tarzana. The magnitude 6.6 Sylmar Earthquake in 197 l caused the collapse of several hospitals, rendering many incapable of providing emergency care. As a result, the Legislature passed the Alfred E. Alquist Hospital Seismic Safety Act in 1972, requiring new hospitals to be constructed to ensure they can provide emergency services after a disaster. Later in 1994, this requirement was extended to include pre-1973 hospitals, following the Northridge earthquake. The law set 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 full collapse, and a January l, 2030 deadline by which they must be capable of remaining operational. The vast majority of California hospitals have taken the necessary steps to prevent a full collapse in the event of an earthquake, and are now working to meet the higher standard of remaining operational. The Department of Health Care Access and Information (HCAI) categorizes the probable seismic performance of a building's structural systems and risk to life into five Structural Performance Category (SPC) ratings. An SPC-l category building has the lowest rating, indicating a significant risk of building collapse in a major earthquake. The law that required all SPC-1 buildings to be retrofitted or replaced by 2008 - to avoid a full collapse - has been extended multiple times, most recently through a final January 1, 2025 deadline. It is this deadline, for the most dangerous and highest-risk hospital structures, that the bill proposes to extend again. This bill requests an additional extension for ten buildings at significant risk of collapse in a major earthquake (SPC-1) located across the four named hospitals in parts of California known for seismic activity. All Californians depend on the hospitals in their communities for reliable, highquality health care services and emergency response in times of need. We trust our hospitals with our own lives and the lives of our loved ones. I cannot in good faith support a further extension to the 2008 SPC-1 deadline, knowing that these buildings may collapse in the event of an earthquake. According to the U.S. Geological Survey, Northern California faces a 72 percent chance and the Los Angeles region faces a 60 percent chance of a magnitude 6.7 or greater earthquake by 2043. The question is not if California will experience a significant earthquake, it's when. Without the deadline extension proposed in this bill, the four hospitals will be faced with the reality of fines or being unable to renew their license under the California Department of Public Health (CDPH), leading to a potential loss of hospital care in their communities. As such, I encourage the named hospitals at risk of non-compliance with the 2025 SPC-1 deadline to prioritize the remaining work, and I am directing HCAI and CDPH to provide technical assistance as needed.

ASSEMBLY FLOOR: 73-0, 8/26/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Robert Rivas

NO VOTE RECORDED: Cervantes, Lee, Ortega, Rendon, Rodriguez, Zbur

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

10/16/24 14:16:28

**** END ****

 UNFINISHED BUSINESS  

Bill No: SB 1119

Author: Newman (D), et al.

Amended: 8/19/24

Vote: 27 - Urgency

SENATE HEALTH COMMITTEE: 9-0, 4/3/24

AYES: Roth, Nguyen, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Wiener

NO VOTE RECORDED: Glazer, Smallwood-Cuevas

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/16/24

AYES: Caballero, Jones, Ashby, Becker, Bradford, Seyarto, Wahab

SENATE FLOOR: 39-0, 5/21/24

AYES: Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

NO VOTE RECORDED: Allen

ASSEMBLY FLOOR: 73-0, 8/26/24 - See last page for vote

SUBJECT: Hospitals: seismic compliance

SOURCE: Providence

DIGEST:

This bill extends the dates by which four hospitals owned by Providence are required to comply with seismic safety standards, including two hospitals in Eureka, one hospital in Fullerton, and one hospital in Tarzana.

Assembly Amendments move the provisions of this bill to a different code section, add a requirement that limits HCAI to approving no more time than is necessary for the hospital to fully comply with the seismic safety standards, and specify the fine amount ($5,000) for failure to comply as the same amount in specified in existing law.

ANALYSIS:

Existing law:

1. Licenses and regulates health facilities, including general acute care hospitals, by the California Department of Public Health (CDPH). [HSC §1250, et seq.]
2. 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 Department of Health Care Access and Information (HCAI) to propose building standards for earthquake resistance and to provide independent review of the design and construction of hospital buildings. [HSC §129675, et seq.]
3. 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 (which has since been extended for various hospitals to various dates), and a requirement that hospitals must also be capable of continued operation by January 1, 2030. [HSC §130060, §130065]
4. Permits HCAI 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 HCAI 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]
5. Permits HCAI, under legislation enacted in 2018, to provide for an extension of the January 1, 2020 deadline in 4) above, for up to 30 months (until July 1, 2022) for hospitals that plan to replace or retrofit a building to meet the 2020 standard, and up to five years (January 1, 2025) for hospitals that plan to rebuild to a standard that meets the 2030 requirement. [HSC §130062]
6. Provides for penalties of $5,000 per calendar day for failure to comply, or failure to meet any agreed upon milestone toward complying, with the provisions in 5) above. [HSC §130062(d)(3) and (e)(3)]
7. Requires the owner of an acute care inpatient hospital whose building does not substantially comply with the January 1, 2030 seismic safety requirement described in 3) above, to submit to HCAI, by January 1, 2020, an attestation that the board of directors of that hospital is aware that the hospital building is required to meet this requirement. [HSC §130066]

This bill:

1. Extends the dates by which specified buildings at four hospitals owned by Providence are required to comply with seismic safety standards, which under current law are required to meet the 2030 standard by January 1, 2025, as follows:
   1. For Providence Cedars-Sinai Tarzana Medical Center Patient Tower, to January 1, 2026;
   2. For Providence St. Joseph Hospital in the City of Eureka, Original Hospital and Central Plant, to January 1, 2027;
   3. For Providence Eureka General Hospital in the City of Eureka, Original Hospital, 1950 Addition Building, 1955 Addition Building, 1957 Addition Center Building, and 1957 Addition West Side Building, to January 1, 2027; and,
   4. For Providence St. Jude Medical Center in the City of Fullerton, Main Building, Canopies, and Boiler Room, Basement Expansion, and West Building, removal from acute care service or demolition, to January 1, 2027.
2. Specifies that HCAI can grant no more time than is necessary for the hospital to fully comply with the seismic safety standards.
3. Establishes quarterly reporting dates for these hospitals to submit to HCAI to update their progress toward compliance to accommodate the length of extensions in this bill.
4. Permits HCAI to revoke the seismic compliance waiver for these Providence hospitals if a hospital fails to timely report progress that HCAI deems sufficient to complete their plans, unless due to unforeseen circumstances outside of the control of the hospital, and the hospital has been given at least 90 days written notice with an opportunity to cure the noncompliance.
5. Contains an urgency clause that will make this bill effective upon enactment.

Comments

1. Author’s statement. According to the author, the COVID-19 pandemic created a cascade of challenges requiring hospitals to focus on ensuring adequate capacity and critical patient care. The Providence hospital organization currently has three hospitals in California—St. Jude Medical Center in Fullerton; St. Joseph Hospital in Eureka; and Providence Cedars-Sinai Tarzana Medical Center in Los Angeles—which are in the midst of rebuild plans. While Providence has endeavored to meet the seismic deadlines for California hospitals established in statute for each campus, due to a variety of circumstances beyond its control, particularly the impacts of the pandemic, these three hospitals will not be able to fully achieve seismic compliance in time to avoid significant financial penalties. Without the deadline extension proposed in this bill, the hospitals will be faced with the reality of being unable to renew their licensure under CDPH, leading to a loss of vital patient care in their communities.
2. Background on 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 HCAI 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.

HCAI 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 multiple times. 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 more 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 original five-year extension to January 1, 2013, the Legislature has passed additional bills allowing hospitals to extend the deadlines for retrofitting SPC-1 buildings beyond the 2013 deadline. SB 306 (Ducheny, Chapter 642, Statutes of 2007) permitted a hospital owner to comply with seismic safety deadlines and requirements in current law by replacing all of its buildings subject to seismic retrofit by January 1, 2020, rather than retrofitting by 2013 and replacing them by 2030, if the hospital meets several conditions and HCAI certifies that the hospital owner lacks the financial capacity to meet seismic standards, as defined. SB 90 (Steinberg, Chapter 19, Statutes of 2011) allowed a hospital to seek an extension for seismic compliance for its SPC-1 buildings of up to seven years (no later than January 1, 2020) 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.

1. Providence hospitals affected by this bill are operating under a seismic deadline extension passed in 2018. In 2018, the Legislature passed AB 2190 (Reyes, Chapter 673, Statutes of 2018) which was intended to allow the last remaining hospitals that had not yet met the

SPC- 2 standard, to meet the mandate without fear of closure should they have a construction or financing delay. AB 2190 provided two paths: a 30 month extension (to July 1, 2022) for hospitals that submitted a retrofit plan or a “replacement plan” (relocating acute care services or beds from nonconforming buildings into a conforming building); or alternatively, a five year extension (to January 1, 2025) for hospitals that submitted a rebuild plan to construct a new building that would meet the 2030 standard. The Providence hospitals affected by this bill were all granted extensions to January 1, 2025, by which time they should be 2030 compliant in terms of SPC status.

In order to receive the extension to July 1, 2022 for a retrofit or replacement plan, the hospital and HCAI were required to identify at least two major milestones relating to the compliance plan to be used as a basis for determining whether the hospital is making adequate progress toward meeting the new seismic compliance deadline. The hospital needed to start construction by April 1, 2020, and meet any agreed upon milestone, or be subject to a $5,000 fine per calendar day until the requirements or milestones are met. Similarly, hospitals seeking an extension to January 1, 2025 for a rebuild plan had to work with HCAI to identify major milestones, begin construction by January 1, 2022, and are also subject to the daily $5,000 fine for failure to meet requirements or agreed upon milestones. AB 2190 permitted HCAI to grant adjustments to the deadlines to meet milestones or other requirements as necessary to deal with specified delays, but HCAI was prohibited from extending the final seismic compliance dates of July 1, 2022 for replacement or retrofit plans, and January 1, 2025 for rebuild plans. Hospitals granted extensions under AB 2190 are required to provide a quarterly status report to HCAI until seismic compliance is achieved. However, since that time, there has been legislation granting additional extensions for specific hospitals.

1. Background on the Providence hospitals affected by this bill and their seismic compliance status.
2. Providence Cedars-Sinai Tarzana Medical Center. Providence Cedars-Sinai in Tarzana is licensed for 204 beds. According to HCAI, one building is under an AB 2190 rebuild extension, and the facility has been under three ownerships during the full extension period: Tenet, Providence, and Providence/Cedars-Sinai Joint Venture. The compliance plan anticipated new construction to replace this building. The building decanted of known acute care functions following occupancy of the new patient wing in October of 2023 and relocation of the Neonatal Intensive Care Unit in December 2023. The work remaining to convert the SPC-1 building to a non-acute care building is disconnection of utilities and life safety systems from the conforming buildings, and HCAI deems this remaining work achievable by the end of the current extension. According to Providence, constructing the new patient wing took longer than anticipated, and they need additional time to complete the utility and building separation work associated with removing the old building from acute care services. The design team is engaged and they are working toward the first HCAI-issue milestone.
3. Providence St. Joseph Hospital in the City of Eureka. Providence St. Joseph in Eureka is licensed for 138 beds. According to HCAI, the hospital currently has one SPC-1 building under an AB 2190 rebuild extension and has missed mutually agreed upon milestones. The compliance plan began with one new building approved and built. When nearing completion, HCAI discovered that general acute care services remained in the nonconforming building. Providence then commenced working with HCAI on a series of amendments to their AB 2190 milestones, none of which have been met. Providence has not submitted plans to resolve the non-conforming conditions. Compliance work has not progressed since January 2020.

According to Providence, planning has been underway for years and make ready projects have been completed to move several impacted departments out of the non-compliant space, and noted that utility separation work had started and was paused due to COVID. Providence states a design team and general contractor have been engaged.

1. Providence Eureka The General Hospital. The General Hospital is a 15-bed rehabilitation center, and is operating under a consolidated license with its parent facility, Providence St. Joseph in Eureka. According to HCAI, there are five SPC-1 buildings at The General Hospital under an AB 2190 rebuild extension. The buildings house acute rehabilitation nursing. The extension was originally approved to relocate services to the St. Joseph campus. Current plans reflect relocation of services to a new construction at Providence Redwood Memorial Hospital in Fortuna, approximately 20 miles away. Construction of the new facility has not progressed since July 2019, with environmental damage requiring mitigation due to lack of building protection.

According to Providence, the new location for the acute rehabilitation unit project at Redwood Memorial in Fortuna was started in approximately 2017-2019, and HCAI temporarily paused the project to validate construction plans and schedules. COVID further paused the relocation work. Providence states that a design team and general contractor have been engaged.

1. Providence St. Jude Medical Center in the City of Fullerton. Providence St. Jude is licensed for 320 beds. According to HCAI, there are three SPC-1 buildings left unresolved following completion of a replacement tower in 2014. All three SPC-1 buildings are adjacent to SPC-conforming buildings, whose operations could be impacted by the nonconforming buildings in the case of a major seismic event.

According to Providence, pre-COVID, the healthcare industry projected increased outpatient utilization and decreased inpatient utilization, which led to the determination to remove acute care services from these buildings. However, those outpatient projections were not realized across the industry, and a strategy shift was needed to address the increasing inpatient needs at St. Jude, which resulted in the seismic requirements now becoming applicable. A design team has been engaged, and a general contractor was contracted in March for preconstruction scoping.

1. Letter of concern. The Service Employees International Union California (SEIU) submitted a letter of concern, stating that this bill grants an extension to certain hospitals that have already received an extension under AB 2190. SEIU states that it is time that these hospitals meet these standards and not continue to delay these important safety updates. SEIU states they look forward to continued dialogue and discussion on compliance with California’s 2030 seismic standards.

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

According to the Assembly Appropriations Committee: HCAI estimates annual costs of $199,000 for fiscal years (FYs) 2025-26, 2026-27, and 2027-28 (Hospital Building Fund) for staff to oversee hospital compliance with 2020 seismic safety requirements for another extension period. FY 2027-28 costs are based on the last compliance report of January 1, 2027, and when HCAI can reasonably confirm compliance. If confirmed, the Seismic Compliance Unit along with the field staff team must continue to monitor compliance with seismic safety requirements for the extension period.

SUPPORT: (Verified 8/19/24)

Providence (source)

Alliance of Catholic Health Care

Calabasas Councilmember Ed Albrecht

Calabasas Councilmember David Shapiro

California Hospital Association

Cedars-Sinai

City of Eureka

City of Fullerton

Fullerton Fire Department

Humboldt County Board of Supervisors

Humboldt County Sherriff’s Office

North Orange County Chamber of Commerce

Orange County Supervisor Doug Chaffee

Orange County United Way

South Orange County Economic Coalition

Valley Industry & Commerce Association

West Valley-Warner Center Chamber of Commerce

OPPOSITION: (Verified 8/19/24)

California Nurses Association

ARGUMENTS IN SUPPORT: This bill is sponsored by Providence, which states that this bill would authorize narrow, case-specific extensions of the seismic compliance deadlines of AB 2190 for three Providence hospitals. Specifically, this bill would authorize two additional years for Providence St. Jude Medical Center in Fullerton and Providence St. Joseph in Eureka, and an extension of one additional year for Providence Cedars-Sinai Tarzana Medical Center. Providence states that failure to meet current seismic deadlines would result in the revocation of a hospital license, and this bill is needed so that these hospitals can maintain critical access to care while making progress toward their respective deadlines. Cedars-Sinai writes in support that it is critical to maintaining access to care, especially as Providence serves significant Medicare and Medi-Cal populations. Cedars-Sinai states that the COVID-19 pandemic led to shifting financial priorities and conditions, requiring many hospitals to focus on ensuring adequate capacity and patient care at the expense of progress toward seismic compliance mandates. The Fullerton Fire Department writes in support that it has been local partners with Providence St. Jude Medical Center for decades, and the majority of their incident volume is transported to that hospital. The Fullerton Fire Department states it is important that beds remain available for patient care while hospital leadership continues to work deliberately toward meeting the state seismic safety requirement.

ARGUMENTS IN OPPOSITION: The California Nurses Association (CNA) is opposed to this bill, stating that this bill would delay seismic compliance requirements for four Providence hospitals spread out across California. Such preferential treatment for one hospital owner is arbitrary and unduly endangers patients as well as health care providers and workers in the event of an earthquake. CNA states that Providence’s delay is part of the hospital industry’s decades-long fight against seismic safety compliance ever since the passage of a law that required hospitals to be operational after an earthquake. CNA states that Providence has had plenty of opportunities over the past 30 years to develop compliance plans, and they have plenty of resources to meet the requirements.

ASSEMBLY FLOOR: 73-0, 8/26/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Robert Rivas

NO VOTE RECORDED: Cervantes, Lee, Ortega, Rendon, Rodriguez, Zbur

Click here to enter text.

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

8/27/24 13:23:08

**** END ****

SENATE THIRD READING

STR Bill Id:SB 1119

Author:(Newman)

As Amended Ver:August 19, 2024

2/3 vote. Urgency

SUMMARY

Authorizes the Department of Health Care Access and Information (HCAI) to extend the dates by which four hospitals owned by Providence are required to comply with specified (pre-2030) seismic safety standards: two hospitals on a consolidated license in Eureka, one hospital in Fullerton, and one hospital in Tarzana. Specifies dates for the hospitals to report to HCAI on their progress, and authorizes HCAI to grant no more time than is necessary for a hospital to fully comply with the standards. Imposes a fine of $5,000 per day if a hospital fails to demonstrate adequate progress. Contains an urgency clause to ensure that the provisions of this bill go into immediate effect upon enactment.

Major Provisions

COMMENTS

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 HCAI 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.

HCAI 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 multiple times. 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 more 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 original five-year extension to January 1, 2013, the Legislature has passed additional bills allowing hospitals to extend the deadlines for retrofitting SPC-1 buildings beyond the 2013 deadline. SB 306 (Ducheny), Chapter 642, Statutes of 2007, permitted a hospital owner to comply with seismic safety deadlines and requirements in current law by replacing all of its buildings subject to seismic retrofit by January 1, 2020, rather than retrofitting by 2013 and replacing them by 2030, if the hospital meets several conditions and HCAI certifies that the hospital owner lacks the financial capacity to meet seismic standards, as defined. SB 90 (Steinberg), Chapter 19, Statutes of 2011, allowed a hospital to seek an extension for seismic compliance for its SPC-1 buildings of up to seven years (no later than January 1, 2020) 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.

2018 seismic deadline extension. The Providence hospitals affected by this bill are operating under a seismic deadline extension passed in 2018. At that time, the Legislature passed AB 2190 (Reyes), Chapter 673, Statutes of 2018, which was intended to allow the last remaining hospitals that had not yet met the SPC- 2 standard, to meet the mandate without fear of closure should they have a construction or financing delay. AB 2190 provided two paths: a 30 month extension (to July 1, 2022) for hospitals that submitted a retrofit plan or a "replacement plan" (relocating acute care services or beds from nonconforming buildings into a conforming building); or alternatively, a five year extension (to January 1, 2025) for hospitals that submitted a rebuild plan to construct a new building that would meet the 2030 standard. The Providence hospitals affected by this bill were all granted extensions to January 1, 2025, by which time they should be 2030 compliant in terms of SPC status.

In order to receive the extension to July 1, 2022 for a retrofit or replacement plan, the hospital and HCAI were required to identify at least two major milestones relating to the compliance plan to be used as a basis for determining whether the hospital is making adequate progress toward meeting the new seismic compliance deadline. The hospital needed to start construction by April 1, 2020, and meet any agreed upon milestone, or be subject to a $5,000 fine per calendar day until the requirements or milestones are met. Similarly, hospitals seeking an extension to January 1, 2025 for a rebuild plan had to work with HCAI to identify major milestones, begin construction by January 1, 2022, and are also subject to the daily $5,000 fine for failure to meet requirements or agreed upon milestones. AB 2190 permitted HCAI to grant adjustments to the deadlines to meet milestones or other requirements as necessary to deal with specified delays, but HCAI was prohibited from extending the final seismic compliance dates of July 1, 2022 for replacement or retrofit plans, and January 1, 2025 for rebuild plans. Hospitals granted extensions under AB 2190 are required to provide a quarterly status report to HCAI until seismic compliance is achieved. However, since that time, there has been legislation granting additional extensions for specific hospitals.

Providence hospitals affected by this bill and their seismic compliance status.

1. Providence Cedars-Sinai Tarzana Medical Center. Providence Cedars-Sinai in Tarzana is licensed for 204 beds. According to HCAI, one building is under an AB 2190 rebuild extension, and the facility has been under three ownerships during the full extension period: Tenet, Providence, and Providence/Cedars-Sinai Joint Venture. The compliance plan anticipated new construction to replace this building. The building decanted of known acute care functions following occupancy of the new patient wing in October of 2023 and relocation of the Neonatal Intensive Care Unit in December 2023. The work remaining to convert the SPC-1 building to a non-acute care building is disconnection of utilities and life safety systems from the conforming buildings, and HCAI deems this remaining work achievable by the end of the current extension.
2. According to Providence, constructing the new patient wing took longer than anticipated, and they need additional time to complete the utility and building separation work associated with removing the old building from acute care services. The design team is engaged and they are working toward the first HCAI-issued milestone. Providence met the first HCAI issued milestone in April 2024.
3. Providence St. Joseph Hospital in the City of Eureka. Providence St. Joseph in Eureka is licensed for 138 beds. According to HCAI, the hospital currently has one SPC-1 building under an AB 2190 rebuild extension and has missed mutually agreed upon milestones. The compliance plan began with one new building approved and built. When nearing completion, HCAI discovered that general acute care services remained in the nonconforming building. Providence then commenced working with HCAI on a series of amendments to their AB 2190 milestones, none of which have been met. Providence has not submitted plans to resolve the remaining non-conforming conditions. Compliance work has not progressed since January 2020. According to Providence, planning has been underway for years and make ready projects have been completed to move several impacted departments out of the non-compliant space, and noted that utility separation work had started and was paused due to COVID. Providence states that a design team and general contractor have been engaged. Pre-construction work began in late May 2024.
4. Providence Eureka The General Hospital. The General Hospital is a 15-bed rehabilitation center, and is operating under a consolidated license with its parent facility, Providence St. Joseph in Eureka. According to HCAI, there are five SPC-1 buildings at The General Hospital under an AB 2190 rebuild extension. The buildings house acute rehabilitation nursing. The extension was originally approved to relocate services to the St. Joseph campus. Current plans reflect relocation of services to a new construction at Providence Redwood Memorial Hospital in Fortuna, approximately 20 miles away. Construction of the new facility has not progressed since July 2019, with environmental damage requiring mitigation due to lack of building protection. According to Providence, the new location for the acute rehabilitation unit project at Redwood Memorial in Fortuna was started in approximately 2017-2019, and HCAI temporarily paused the project to validate construction plans and schedules. COVID further paused the relocation work. Providence states that a design team and general contractor have been engaged. Providence states that due to escalating construction costs (in excess of 30%), for the proposed new acute rehabilitation project, Providence paused the re-location (May), and is actively working to maintain access to this critical service line. HCAI is aware of the project status. Once a pathway is identified, which Providence anticipates to occur within the next month, Providence will work with HCAI to determine new milestones in accordance with the required removal of acute care services for the non-compliant buildings in Eureka. In the interim, Providence continues to make required project progress at the Fortuna site.
5. Providence St. Jude Medical Center in the City of Fullerton. Providence St. Jude is licensed for 320 beds. According to HCAI, there are three SPC-1 buildings left unresolved following completion of a replacement tower in 2014. All three SPC-1 buildings are adjacent to SPC-conforming buildings, whose operations could be impacted by the nonconforming buildings in the case of a major seismic event. According to Providence, pre-COVID, the healthcare industry projected increased outpatient utilization and decreased inpatient utilization, which led to the determination to remove acute care services from these buildings. However, those outpatient projections were not realized across the industry, and a strategy shift was needed to address the increasing inpatient needs at St. Jude, which resulted in the seismic requirements now becoming applicable. A design team has been engaged, and a general contractor was contracted in March for preconstruction scoping. Providence states that this work is still underway as it is typically a six to eight month process, and that adding this campus to the AB 2190 program increases transparency by requiring milestones to be established.

According to the Author

The COVID-19 pandemic created a cascade of challenges requiring hospitals to focus on ensuring adequate capacity and critical patient care. The Providence hospital organization currently has three hospitals in California-- St. Jude Medical Center in Fullerton; St. Joseph Hospital in Eureka; and Providence Cedars-Sinai Tarzana Medical Center in Los Angeles—which are in the midst of rebuild plans. While Providence has endeavored to meet the seismic deadlines for California hospitals established in statute for each campus, due to a variety of circumstances beyond its control, particularly the impacts of the pandemic, these three hospitals will not be able to fully achieve seismic compliance in time to avoid significant financial penalties. The author concludes that without the deadline extension proposed in this bill, the hospitals will be faced with the reality of being unable to renew their licensure under DPH, leading to a loss of vital patient care in their communities.

Arguments in Support

Providence is the sponsor of this bill and states that it is critical to ensuring access to care, especially as Providence serves significant Medicare and Medi-Cal populations. Providence notes that the COVID-19 pandemic led to shifting financial priorities and conditions, requiring many hospitals to focus on ensuring adequate capacity and patient care, at the expense of progress toward the unfunded seismic compliance mandates. Providence states that failure to meet current seismic deadlines would result in the revocation of a hospital license, negatively impacting access to care. This legislation is needed so that Providence St. Jude Medical Center in Fullerton, Providence St. Joseph Hospital – Eureka, and Providence Cedars-Sinai Tarzana Medical Center in Tarzana can maintain critical access to care while making progress toward the respective deadlines outlined in the legislation.

Arguments in Opposition

The California Nurses Association (CNA) is opposed to this bill and states that delaying seismic compliance plan requirements for four Providence hospitals is arbitrary and unduly endangers patients, as well as health care providers and workers in the event of an earthquake. CNA notes that this bill would allow four Providence hospitals – Providence St. Joseph Hospital Eureka, Providence Eureka General Hospital, Providence St. Jude Medical Center, and Providence Cedars-Sinai Tarzana Medical Center – to further delay compliance in seismic safety by waiving existing requirements for hospitals to submit compliance plans for seismic rebuilds by 2025. CNA contends that Providence's delay is part of the hospital industry's decades-long fight against seismic safety compliance ever since the passage of law that required hospitals to be operational after an earthquake. In response to the 1994 Northridge earthquake that severely damaged 11 hospitals, the law requires hospitals to submit seismic compliance plans for both retrofits and rebuilds. These reporting requirements on seismic compliances plans help ensure that hospitals are adequately taking steps to meet seismic retrofit requirements by the 2030 statutory deadline. CNA states that Providence seeks to delay seismic safety in its buildings after 30 years of opportunity to submit compliance plans.

FISCAL COMMENTS

According to the Senate Appropriations Committee, HCAI estimates annual costs of $199,000 for fiscal years (FYs) 2025-26, 2026-27, and 2027-28 (Hospital Building Fund) for staff to oversee hospital compliance with 2020 seismic safety requirements for another extension period. FY 2027-28 costs are based on the last compliance report of January 1, 2027, and when HCAI can reasonably confirm compliance. If confirmed, the Seismic Compliance Unit along with the field staff team must continue to monitor compliance with seismic safety requirements for the extension period.

VOTES

SENATE FLOOR: 39-0-1

YES: Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

ABS, ABST OR NV: Allen

ASM HEALTH: 15-0-1

YES: Bonta, Waldron, Aguiar-Curry, Arambula, Wendy Carrillo, Flora, Haney, Jones-Sawyer, Maienschein, McCarty, Joe Patterson, Sanchez, Santiago, Lowenthal, Pellerin

ABS, ABST OR NV: Rodriguez

ASM APPROPRIATIONS: 11-0-4

YES: Wicks, Arambula, Bryan, Calderon, Wendy Carrillo, Mike Fong, Grayson, Haney, Hart, Pellerin, Villapudua

ABS, ABST OR NV: Sanchez, Dixon, Jim Patterson, Ta

UPDATED

VERSION: August 19, 2024

CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0004120

Date of Hearing: July 2, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

SBPCA Bill Id:SB 1119

Author:(Newman) – As Introduced Ver:February 13, 2024

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

SUMMARY:

This bill authorizes the Department of Health Care Access and Information (HCAI) to extend the dates by which specified buildings of four hospitals owned by Providence must comply with specified seismic safety standards.

Specifically, this bill:

1. Authorizes HCAI to extend the dates by which specified buildings of Providence St. Joseph Hospital and Providence Eureka General Hospital in Eureka, Providence St. Jude Medical Center in Fullerton, and Providence Cedars-Sinai Tarzana Medical Center in Tarzana, must meet the 2030 standard, which, under current law, is January 1, 2025, under the following conditions:
   
   1. The hospital or medical center submits to HCAI, within 30 days following the effective date of this bill, a plan for compliance with the applicable seismic safety standards.
      
   2. HCAI accepts the plan submitted by the hospital or medical center based on feasibility and public safety. HCAI may not unreasonably reject, or withhold or delay acceptance of the plan, or unreasonably impose conditions on the acceptance of the plan.
      
2. Specifies the hospital plans and compliance dates as follows:
   1. For Providence St. Joseph Hospital, original hospital and central plant: removal of acute care services or demolition, to January 1, 2027.
      
   2. For Providence Eureka General Hospital, various buildings: removal of acute care services or demolition, to January 1, 2027.
      
   3. For Providence St. Joseph Hospital, main building, canopies, and boiler room: removal of acute care services or demolition, to January 1, 2027.
      
   4. For Providence Cedars-Sinai Tarzana Medical Center, patient tower: removal of acute care services or demolition, to January 1, 2026.
      
3. Adds dates by which a hospital or medical center must provide a progress report to HCAI. Permits HCAI to revoke a seismic compliance waiver if a hospital fails to timely report progress that HCAI deems sufficient to complete the hospital’s plans, unless due to unforeseen circumstances outside of the control of the hospital, and the hospital has been given at least 90 days’ written notice with an opportunity to cure the noncompliance.
   
4. Allows HCAI to revoke the seismic compliance waiver if a hospital fails to timely report progress that HCAI deems sufficient to complete its plans, unless due to unforeseen circumstances outside the control of the hospital, and the hospital has been given at least 90 days written notice with an opportunity to cure the noncompliance.
   
5. Declares the bill is an urgency statute.

FISCAL EFFECT:

HCAI estimates annual costs of $199,000 for fiscal years (FYs) 2025-26, 2026-27, and 2027-28 (Hospital Building Fund) for staff to oversee hospital compliance with 2020 seismic safety requirements for another extension period. FY 2027-28 costs are based on the last compliance report of January 1, 2027, and when HCAI can reasonably confirm compliance. If confirmed, the Seismic Compliance Unit along with the field staff team must continue to monitor compliance with seismic safety requirements for the extension period.

COMMENTS:

1. Purpose. This bill is sponsored by Providence. According to the author:

The COVID-19 pandemic created a cascade of challenges requiring hospitals to focus on ensuring adequate capacity and critical patient care. The Providence hospital organization currently has three hospitals in California -- St. Jude Medical Center in Fullerton; St. Joseph Hospital in Eureka; and Providence Cedars-Sinai Tarzana Medical Center in Los Angeles—which are in the midst of rebuild plans. While Providence has endeavored to meet the seismic deadlines for California hospitals established in statute for each campus, due to a variety of circumstances beyond its control, particularly the impacts of the pandemic, these three hospitals will not be able to fully achieve seismic compliance in time to avoid significant financial penalties. Without the deadline extension proposed in SB 1119, the hospitals will be faced with the reality of being unable to renew their licensure under the State Department of Health, leading to a loss of vital patient care in their communities.

1. Background. In 1994, after the Northridge earthquake, SB 1953 (Alquist), Chapter 740, Statutes of 1994, required HCAI 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 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.
   
   HCAI categorizes hospitals into five structural performance categories (SPCs). SPC-1 is the category of buildings at most risk of collapse in an earthquake; these hospitals were originally required to be taken out of service or retrofitted by January 1, 2008, which has since been extended multiple times. 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 until January 1, 2030, at which time they must either meet SPC-5 requirements, or under more recently adopted regulations, the new category of SPC-4D, which allows for some more recently constructed buildings to be retrofitted and still be compliant with January 1, 2030 standards.
   
   The Providence hospitals affected by this bill are operating under a seismic deadline extension authorized by AB 2190 (Reyes), Chapter 673, Statutes of 2018. AB 2190 was to allow the last remaining hospitals that had not yet met the SPC- 2 standard to meet the mandate without fear of closure should they have a construction or financing delay. AB 2190 allowed a five-year extension (to January 1, 2025) to a hospital that submitted a rebuild plan to construct a new building that would meet the 2030 standard. The Providence hospitals in this bill were all granted extensions to January 1, 2025, by which time they were expected to achieve 2030 SPC compliance. AB 2190 allowed HCAI to grant adjustments to the deadlines to meet milestones or other requirements as necessary to deal with specified delays, but prohibited HCAI from extending the final seismic compliance dates of July 1, 2022 for replacement or retrofit plans, and January 1, 2025 for rebuild plans.
2. Related Legislation.
   1. AB 869 (Wood) creates a grant program for small and rural hospitals to fund assessments for complying with 2030 seismic safety requirements, and allows qualifying small, rural, or financially distressed district hospitals to apply for grants for complying with the 2030 seismic safety deadline, to January 1, 2035. AB 869 is pending in Senate Health Committee.
   2. SB 1432 (Caballero) extends, from January 1, 2030 to January 1, 2033, the deadline by which a hospital is to be capable of continued operations following a major earthquake, if the hospital submits a seismic compliance plan by January 1, 2026. The bill also permits HCAI to grant a hospital an additional extension up to January 1, 2038, based on an application and demonstration by the hospital that it meets specified criteria. SB 1432 is pending in Assembly Health Committee.
   3. SB 1447 (Durazo) extends, from January 1, 2030, to January 1, 2040, the seismic compliance deadline for Children’s Hospital Los Angeles to be capable of continued operations. SB 1447 is pending in this committee.
   4. SB 759 (Grove) extends the seismic safety deadline for a hospital to be capable of continued operations following an earthquake, from January 1, 2030, to January 1, 2040. SB 759 was referred to, but not heard in, Senate Health Committee.
3. Prior Legislation. Since the passage of the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983, numerous bills have provided seismic safety compliance extensions to hospitals throughout the state.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: June 11, 2024

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

SBPCA Bill Id:SB 1119

Author:(Newman) – As Introduced Ver:February 13, 2024

SENATE VOTE: 39-0

SUBJECT: Hospitals: seismic compliance.

SUMMARY: Extends the dates by which four hospitals owned by Providence are required to comply with specified seismic safety standards: two hospitals on a consolidated license in Eureka, one hospital in Fullerton, and one hospital in Tarzana. Contains an urgency clause to ensure that the provisions of this bill go into immediate effect upon enactment. Specifically, this bill:

1. Extends the dates by which specified buildings at four hospitals owned by Providence are required to comply with seismic safety standards, which under current law are required to meet the 2030 standard by January 1, 2025, as follows:
   
   1. For Providence St. Joseph Hospital in the City of Eureka, Original Hospital and Central Plant, removal of acute care services or demolition, to January 1, 2027;
      
   2. For Providence Eureka General Hospital in the City of Eureka, Original Hospital, 1950 Addition Building, 1955 Addition Building, 1957 Addition Center Building, and 1957 Addition West Side Building, removal of acute care services or demolition, to January 1, 2027;
      
   3. For Providence St. Joseph Hospital in the City of Fullerton, Main Building, Canopies and Boiler Room, removal of acute care services or demolition, to January 1, 2027; and,
      
   4. For Providence Cedars-Sinai Tarzana Medical Center Patient Tower, removal of acute care services or demolition, to January 1, 2026;
      
2. Adds additional quarterly reporting dates to the list of required quarterly reports that certain hospitals with a seismic extension are required to submit to the Department of Health Care Access and Information (HCAI) to update their progress toward compliance to accommodate the length of extensions in this bill.
   
3. Permits HCAI to revoke the seismic compliance waiver for these hospitals if a hospital fails to timely report progress that HCAI deems sufficient to complete their plans, unless due to unforeseen circumstances outside of the control of the hospital, and the hospital has been given at least 90 days written notice with an opportunity to cure the noncompliance.
   

EXISTING LAW:

1. Licenses and regulates health facilities, including general acute care hospitals, by the California Department of Public Health (DPH). [Health and Safety Code (HSC) §1250, et seq.]
2. 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 HCAI to propose building standards for earthquake resistance and to provide independent review of the design and construction of hospital buildings. [HSC §129675, et seq.]
3. 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 (SPC)-1 buildings) be rebuilt or retrofitted to be capable of withstanding an earthquake, or removed from acute care service, by January 1, 2008 (this has since been extended for various hospitals to various dates). Requires hospitals to be capable of continued operation by January 1, 2030. [HSC §130060, §130065]
4. Permits HCAI 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 HCAI 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]
5. Permits HCAI (under legislation enacted in 2018) to provide for an extension of the January 1, 2020 deadline described in 4) above, for up to 30 months (until July 1, 2022) for hospitals that plan to replace or retrofit a building to meet the 2020 standard, and up to five years (until January 1, 2025) for hospitals that plan to rebuild to a standard that meets the 2030 continued operation requirement. [HSC §130062]
6. Provides for penalties of $5,000 per calendar day for failure to comply, or failure to meet any agreed upon milestone toward complying, with the provisions in 5) above. [HSC §130062(d)(3) and (e)(3)]
7. Requires the owner of an acute care inpatient hospital whose building does not substantially comply with the January 1, 2030 seismic safety requirement described in 3) above, to submit to HCAI, by January 1, 2020, an attestation that the board of directors of that hospital is aware that the hospital building is required to meet this requirement. [HSC §130066]
   

FISCAL EFFECT: According to the Senate Appropriations Committee, HCAI estimates costs of $198,667 in 2025-26, $198,667 in 2026-27, and $198,667 in 2027-28 (Hospital Building Fund) for state administration due to the continued need to oversee the hospitals’ compliance with seismic safety requirements for another extension period.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, the COVID-19 pandemic created a cascade of challenges requiring hospitals to focus on ensuring adequate capacity and critical patient care. The Providence hospital organization currently has three hospitals in California-- St. Jude Medical Center in Fullerton; St. Joseph Hospital in Eureka; and Providence Cedars-Sinai Tarzana Medical Center in Los Angeles—which are in the midst of rebuild plans. While Providence has endeavored to meet the seismic deadlines for California hospitals established in statute for each campus, due to a variety of circumstances beyond its control, particularly the impacts of the pandemic, these three hospitals will not be able to fully achieve seismic compliance in time to avoid significant financial penalties. The author concludes that without the deadline extension proposed in this bill, the hospitals will be faced with the reality of being unable to renew their licensure under DPH, leading to a loss of vital patient care in their communities
2. BACKGROUND. 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 HCAI 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.
   
   HCAI 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 multiple times. 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 more 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 original five-year extension to January 1, 2013, the Legislature has passed additional bills allowing hospitals to extend the deadlines for retrofitting SPC-1 buildings beyond the 2013 deadline. SB 306 (Ducheny), Chapter 642, Statutes of 2007, permitted a hospital owner to comply with seismic safety deadlines and requirements in current law by replacing all of its buildings subject to seismic retrofit by January 1, 2020, rather than retrofitting by 2013 and replacing them by 2030, if the hospital meets several conditions and HCAI certifies that the hospital owner lacks the financial capacity to meet seismic standards, as defined. SB 90 (Steinberg), Chapter 19, Statutes of 2011, allowed a hospital to seek an extension for seismic compliance for its SPC-1 buildings of up to seven years (no later than January 1, 2020) 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.
   1. 2018 seismic deadline extension. The Providence hospitals affected by this bill are operating under a seismic deadline extension passed in 2018. At that time, the Legislature passed AB 2190 (Reyes), Chapter 673, Statutes of 2018, which was intended to allow the last remaining hospitals that had not yet met the SPC- 2 standard, to meet the mandate without fear of closure should they have a construction or financing delay. AB 2190 provided two paths: a 30 month extension (to July 1, 2022) for hospitals that submitted a retrofit plan or a “replacement plan” (relocating acute care services or beds from nonconforming buildings into a conforming building); or alternatively, a five year extension (to January 1, 2025) for hospitals that submitted a rebuild plan to construct a new building that would meet the 2030 standard. The Providence hospitals affected by this bill were all granted extensions to January 1, 2025, by which time they should be 2030 compliant in terms of SPC status.
      
      In order to receive the extension to July 1, 2022 for a retrofit or replacement plan, the hospital and HCAI were required to identify at least two major milestones relating to the compliance plan to be used as a basis for determining whether the hospital is making adequate progress toward meeting the new seismic compliance deadline. The hospital needed to start construction by April 1, 2020, and meet any agreed upon milestone, or be subject to a $5,000 fine per calendar day until the requirements or milestones are met. Similarly, hospitals seeking an extension to January 1, 2025 for a rebuild plan had to work with HCAI to identify major milestones, begin construction by January 1, 2022, and are also subject to the daily $5,000 fine for failure to meet requirements or agreed upon milestones. AB 2190 permitted HCAI to grant adjustments to the deadlines to meet milestones or other requirements as necessary to deal with specified delays, but HCAI was prohibited from extending the final seismic compliance dates of July 1, 2022 for replacement or retrofit plans, and January 1, 2025 for rebuild plans. Hospitals granted extensions under AB 2190 are required to provide a quarterly status report to HCAI until seismic compliance is achieved. However, since that time, there has been legislation granting additional extensions for specific hospitals.
   2. Status of hospital seismic safety compliance. According to HCAI, as of February 22, 2024, there are a total of 3,248 buildings at 410 licensed hospital facilities that are subject to the seismic safety standards. All have achieved at least the SPC-2 standard that allows them to remain in service until 2030 except for 41 buildings spread across 20 hospital facilities. In some cases, there are no plans to retrofit or rebuild, and the hospital has either already taken them out of service but it is not reflected in the data yet, or there are plans to take them out of service prior to the January 1, 2025 deadline. It is unclear how many of the remaining out-of-compliance buildings are expected to remain in service, but are in jeopardy of missing the January 1, 2025 deadline for retrofit or replacement projects.
      
      Regarding the 2030 deadline for buildings to achieve SPC-3, 4, 4D or 5, there are still 658 buildings, spread across 251 licensed hospitals, that have an SPC-2 rating and will need to either be retrofitted to SPC-4D, replaced with an SPC-5 building, or removed from acute care service.
   3. Providence hospitals affected by this bill and their seismic compliance status.
      1. Providence Cedars-Sinai Tarzana Medical Center. Providence Cedars-Sinai in Tarzana is licensed for 204 beds. According to HCAI, one building is under an AB 2190 rebuild extension, and the facility has been under three ownerships during the full extension period: Tenet, Providence, and Providence/Cedars-Sinai Joint Venture. The compliance plan anticipated new construction to replace this building. The building decanted of known acute care functions following occupancy of the new patient wing in October of 2023 and relocation of the Neonatal Intensive Care Unit in December 2023. The work remaining to convert the SPC-1 building to a non-acute care building is disconnection of utilities and life safety systems from the conforming buildings, and HCAI deems this remaining work achievable by the end of the current extension.
         According to Providence, constructing the new patient wing took longer than anticipated, and they need additional time to complete the utility and building separation work associated with removing the old building from acute care services. The design team is engaged and they are working toward the first HCAI-issued milestone. Providence met the first HCAI issued milestone in April 2024.
      2. Providence St. Joseph Hospital in the City of Eureka. Providence St. Joseph in Eureka is licensed for 138 beds. According to HCAI, the hospital currently has one SPC-1 building under an AB 2190 rebuild extension and has missed mutually agreed upon milestones. The compliance plan began with one new building approved and built. When nearing completion, HCAI discovered that general acute care services remained in the nonconforming building. Providence then commenced working with HCAI on a series of amendments to their AB 2190 milestones, none of which have been met. Providence has not submitted plans to resolve the remaining non-conforming conditions. Compliance work has not progressed since January 2020.
         
         According to Providence, planning has been underway for years and make ready projects have been completed to move several impacted departments out of the non-compliant space, and noted that utility separation work had started and was paused due to COVID. Providence states that a design team and general contractor have been engaged. Pre-construction work began in late May 2024.
      3. Providence Eureka The General Hospital. The General Hospital is a 15-bed rehabilitation center, and is operating under a consolidated license with its parent facility, Providence St. Joseph in Eureka. According to HCAI, there are five SPC-1 buildings at The General Hospital under an AB 2190 rebuild extension. The buildings house acute rehabilitation nursing. The extension was originally approved to relocate services to the St. Joseph campus. Current plans reflect relocation of services to a new construction at Providence Redwood Memorial Hospital in Fortuna, approximately 20 miles away. Construction of the new facility has not progressed since July 2019, with environmental damage requiring mitigation due to lack of building protection.
         
         According to Providence, the new location for the acute rehabilitation unit project at Redwood Memorial in Fortuna was started in approximately 2017-2019, and HCAI temporarily paused the project to validate construction plans and schedules. COVID further paused the relocation work. Providence states that a design team and general contractor have been engaged. Providence states that due to escalating construction costs (in excess of 30%), for the proposed new acute rehabilitation project, Providence paused the re-location (May), and is actively working to maintain access to this critical service line. HCAI is aware of the project status. Once a pathway is identified, which Providence anticipates to occur within the next month, Providence will work with HCAI to determine new milestones in accordance with the required removal of acute care services for the non-compliant buildings in Eureka. In the interim, Providence continues to make required project progress at the Fortuna site.
         
      4. Providence St. Jude Medical Center in the City of Fullerton. Providence St. Jude is licensed for 320 beds. According to HCAI, there are three SPC-1 buildings left unresolved following completion of a replacement tower in 2014. All three SPC-1 buildings are adjacent to SPC-conforming buildings, whose operations could be impacted by the nonconforming buildings in the case of a major seismic event.
         
         According to Providence, pre-COVID, the healthcare industry projected increased outpatient utilization and decreased inpatient utilization, which led to the determination to remove acute care services from these buildings. However, those outpatient projections were not realized across the industry, and a strategy shift was needed to address the increasing inpatient needs at St. Jude, which resulted in the seismic requirements now becoming applicable. A design team has been engaged, and a general contractor was contracted in March for preconstruction scoping. Providence states that this work is still underway as it is typically a six to eight month process, and that adding this campus to the AB 2190 program increases transparency by requiring milestones to be established.
   4. Other hospitals under AB 2190 extensions to January 1, 2025 at risk of not meeting the deadline. According to HCAI, these Providence hospitals are among 43 hospitals, involving 93 buildings, that applied for extensions under AB 2190 of 2018. Of these, 12 facilities with 28 buildings remain in the program. Aside from the Providence hospitals affected by this bill, HCAI has identified the following facilities as at risk of noncompliance with the deadlines associated with AB 2190, with each affected building being at risk for fines of $5,000 per day for missing milestones or completion:
      1. El Centro Regional Medical Center (Imperial Valley), with five buildings affected. City-owned, considered a distressed hospital, with a work stoppage due to financial constraints;
      2. Hollywood Presbyterian Medical Center (Los Angeles), with two buildings affected. This is an investor-owned facility, and a contractor dispute caused work to halt in May of 2023;
      3. Pacifica Hospital of the Valley (Los Angeles), with three buildings affected. It is investor-owned, and the contractor stopped work in August of 2023 for nonpayment;
      4. Southern California Hospital at Culver City, with one building affected. Investor-owned facility. Work halted in December of 2023 due to financial constraints;
      5. UC Davis Medical Center (Sacramento), with one building affected. Pace of work not on track to meet deadline; and,
      6. Central Valley Specialty Hospital (Modesto) has missed its completion deadline due to failure to start work and make progress through the approved extension period, and is being subject to fines for failure to make progress.
3. CONCERNS. The Service Employees International Union California (SEIU) submitted a letter of concern, stating that this bill grants an extension to certain hospitals that have already received an extension under AB 2190. SEIU states that it is time that these hospitals meet these standards and not continue to delay these important safety updates. SEIU states they look forward to continued dialogue and discussion on compliance with California’s 2030 seismic standards.
   
4. SUPPORT. Providence is the sponsor of this bill and states that it is critical to ensuring access to care, especially as Providence serves significant Medicare and Medi-Cal populations. Providence notes that the COVID-19 pandemic led to shifting financial priorities and conditions, requiring many hospitals to focus on ensuring adequate capacity and patient care, at the expense of progress toward the unfunded seismic compliance mandates. Providence states that failure to meet current seismic deadlines would result in the revocation of a hospital license, negatively impacting access to care. This legislation is needed so that Providence St. Jude Medical Center in Fullerton, Providence St. Joseph Hospital – Eureka, and Providence Cedars-Sinai Tarzana Medical Center in Tarzana can maintain critical access to care while making progress toward the respective deadlines outlined in the legislation.
   
5. OPPOSITION. The California Nurses Association (CNA) is opposed to this bill and states that delaying seismic compliance plan requirements for four Providence hospitals is arbitrary and unduly endangers patients, as well as health care providers and workers in the event of an earthquake. CNA notes that this bill would allow four Providence hospitals – Providence St. Joseph Hospital Eureka, Providence Eureka General Hospital, Providence St. Jude Medical Center, and Providence Cedars-Sinai Tarzana Medical Center – to further delay compliance in seismic safety by waiving existing requirements for hospitals to submit compliance plans for seismic rebuilds by 2025. CNA contends that Providence’s delay is part of the hospital industry’s decades-long fight against seismic safety compliance ever since the passage of law that required hospitals to be operational after an earthquake. In response to the 1994 Northridge earthquake that severely damaged 11 hospitals, the law requires hospitals to submit seismic compliance plans for both retrofits and rebuilds. These reporting requirements on seismic compliances plans help ensure that hospitals are adequately taking steps to meet seismic retrofit requirements by the 2030 statutory deadline. CNA states that Providence seeks to delay seismic safety in its buildings after 30 years of opportunity to submit compliance plans. Providence, like much of the hospital industry, seeks to avoid meeting its long overdue obligation to ensure its buildings are structurally safe during earthquakes. Providence has had plenty of opportunities over the past 30 years to develop compliance plans. CNA notes that Providence has plenty of resources to meet the requirement of timely submitting seismic compliance plans—all facilities subject to this bill have enjoyed net inpatient and outpatient revenues. CNA concludes that Providence’s delay would disproportionately impact Medi-Cal patients, as well as rural and marginalized communities, given that Providence seeks extensions for hospitals in rural areas, such as two of its hospitals in Eureka.
   
6. RELATED LEGISLATION.
   1. AB 869 (Wood) creates a grant program for small and rural hospitals to fund assessments for complying with 2030 seismic safety requirements, including estimating the costs of compliance. Additionally permits qualifying small and rural, as well as financially distressed district hospitals, as defined, to apply for grants for complying with the 2030 seismic safety deadline. AB 869 extends the January 1, 2030 deadline for seismic compliance to January 1, 2035, for hospitals that apply, and qualify for, seismic compliance grants under this bill. AB 869 exempts eligible small and rural and financially distressed district hospitals from the January 1, 2030 seismic safety requirements if the estimated cost of compliance is more than $1 million or 2% of the hospital’s revenue, whichever is greater, if HCAI determines that the cost of compliance results in a financial hardship for the hospital, and state or grant funding is not available to assist with the cost of compliance. AB 869 is pending a hearing in the Senate Health Committee.
   2. SB 1432 (Caballero) extends the January 1, 2030 deadline which requires hospitals to be capable of continued operations following a major earthquake, until January 1, 2033 if hospitals submit a seismic compliance plan by January 1, 2026. Permits HCAI to grant hospitals an additional extension up to January 1, 2038 based on an application and demonstration by the hospital that it meets specified criteria. SB 1432 is pending hearing in the Assembly Health Committee.
   3. SB 1447 (Durazo) extends the seismic compliance deadline for hospitals to be capable of continued operations, for Children Hospital Los Angeles, from January 1, 2030 to January 1, 2040. SB 1447 is pending hearing in the Assembly Health Committee.
   4. SB 759 (Grove) of 2023 would have extended the seismic safety deadline for hospitals to be capable of continued operations following an earthquake, from January 1, 2030 to January 1, 2040. SB 759 was never heard in Senate Health Committee.

7) PREVIOUS LEGISLATION.

• 1. AB 1471 (Pellerin), Chapter 304, Statutes of 2023, extended the dates for compliance with seismic safety requirements for three buildings on the campus of Santa Clara Valley Medical Center, with the latest deadline being July 1, 2026.
  2. AB 1882 (Robert Rivas), Chapter 584, Statutes of 2022, requires owners of general acute care hospital buildings that are not compliant with the January 1, 2030 seismic safety requirement to remain operational following a major earthquake, to submit annual status updates to various entities, including the county board of supervisors, any labor union that represents workers in a building that is not January 1, 2030 compliant, the local office of emergency services, and the medical health operational area coordinator; and, requires hospitals to post in any lobby or waiting area of a hospital building that is not compliant with the January 1, 2030 seismic requirement a notice that the hospital is not in compliance.
  3. AB 2404 (Luz Rivas), Chapter 592, Statutes of 2022, permits HCAI to waive the requirements of the Seismic Safety Act for Pacifica Hospital of the Valley in Los Angeles County if the hospital submits a plan that proposes compliance by January 1, 2025, HCAI accepts the plan based on it being feasible, and the hospital reports to HCAI on a quarterly basis on its progress to timely complete the plan.
  4. AB 2904 (Bonta) of 2022 would have extended the January 1, 2030 seismic safety requirement for Alameda Hospital until January 1, 2032. AB 2904 was vetoed by the Governor, who stated that any consideration of an extension must be contemplated across all communities and across all types of facilities in a holistic manner.
  5. SB 564 (Cortese), Chapter 388, Statutes of 2021, permits HCAI to grant an extension of the seismic safety requirement that hospitals be capable of remaining standing following a major earthquake, until a maximum of December 31, 2024, for two hospitals owned by the County of Santa Clara.
  6. AB 1527 (Ting), Chapter 1527, Statutes of 2021, permits HCAI to extend the seismic requirements for Seton Medical Center in Daly City until July 1, 2023.
  7. SB 758 (Portantino) of 2020, among other provisions, would have extended the 2030 hospital seismic compliance deadline to January 1, 2037. SB 758 was amended in the Assembly Appropriations Committee when it came off the Suspense File, to reduce the extension to January 1, 2032. SB 758 was not taken up on the Assembly Floor.
  8. AB 2190 (Reyes), Chapter 673, Statutes of 2018, provided 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.
  9. AB 908 (Dababneh), Chapter 350, Statutes of 2017, permitted 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.
  10. 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 was required to meet by January 1, 2015, so that this hospital could have until September 1, 2015.
  11. 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 HCAI.
  12. SB 90 (Steinberg), Chapter 19, Statutes of 2011, 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.
  13. SB 499 (Ducheny), Chapter 601, Statutes of 2009, required all general acute care hospitals that have SPC-1 buildings to report to HCAI by November 1, 2010, and annually thereafter, on the status of their compliance with the seismic safety deadlines.
  14. SB 306 (Ducheny), Chapter 642, Statutes of 2007, amended the Alquist Act to permit hospitals to delay compliance with the July 1, 2008 seismic retrofit deadline, and the 2013 extension, to the year 2020, by filing a declaration with HCAI that the owner lacks financial capacity to comply with the law.
  15. 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 HCAI website.

REGISTERED SUPPORT / OPPOSITION:

Support

Los Angeles County Supervisor Lindsey P. Horvath
Orange County Supervisor Doug Chaffee
Alliance of Catholic Health Care, INC.
California Hospital Association
Cedars Sinai
Cedars-Sinai Medical Center
City of Calabasas
City of Eureka
County of Humboldt
Fullerton Fire Department
Fullerton; City of
Humboldt County Sheriff's Office
North Orange County Chamber of Commerce
Orange County Business Council
Orange County United Way
Providence
South Orange County Economic Coalition
Valley Industry and Commerce Association (VICA)
West Valley Warner Center Chamber of Commerce

Opposition

California Nurses Association

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

 THIRD READING  

Bill No: SB 1119

Author: Newman (D), et al.

Introduced: 2/13/24

Vote: 27 - Urgency

SENATE HEALTH COMMITTEE: 9-0, 4/3/24

AYES: Roth, Nguyen, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Wiener

NO VOTE RECORDED: Glazer, Smallwood-Cuevas

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/16/24

AYES: Caballero, Jones, Ashby, Becker, Bradford, Seyarto, Wahab

SUBJECT: Hospitals: seismic compliance

SOURCE: Providence

DIGEST:

This bill extends the dates by which four hospitals owned by Providence are required to comply with seismic safety standards, including two hospitals on a consolidated license in Eureka, one hospital in Fullerton, and one hospital in Tarzana.

ANALYSIS:

Existing law:

1. Licenses and regulates health facilities, including general acute care hospitals, by the California Department of Public Health (CDPH). [HSC §1250, et seq.]
2. 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 Department of Health Care Access and Information (HCAI) to propose building standards for earthquake resistance and to provide independent review of the design and construction of hospital buildings. [HSC §129675, et seq.]
3. 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 (which has since been extended for various hospitals to various dates), and a requirement that hospitals must also be capable of continued operation by January 1, 2030. [HSC §130060, §130065]
4. Permits HCAI 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 HCAI 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]
5. Permits HCAI, under legislation enacted in 2018, to provide for an extension of the January 1, 2020 deadline in 4) above, for up to 30 months (until July 1, 2022) for hospitals that plan to replace or retrofit a building to meet the 2020 standard, and up to five years (January 1, 2025) for hospitals that plan to rebuild to a standard that meets the 2030 requirement. [HSC §130062]
6. Provides for penalties of $5,000 per calendar day for failure to comply, or failure to meet any agreed upon milestone toward complying, with the provisions in 5) above. [HSC §130062(d)(3) and (e)(3)]
7. Requires the owner of an acute care inpatient hospital whose building does not substantially comply with the January 1, 2030 seismic safety requirement described in 3) above, to submit to HCAI, by January 1, 2020, an attestation that the board of directors of that hospital is aware that the hospital building is required to meet this requirement. [HSC §130066]

This bill:

1. Extends the dates by which specified buildings at four hospitals owned by Providence are required to comply with seismic safety standards, which under current law are required to meet the 2030 standard by January 1, 2025, as follows:
2. For Providence Cedars-Sinai Tarzana Medical Center Patient Tower,

removal of acute care services or demolition, to January 1, 2026;

1. For Providence St. Joseph Hospital in the City of Eureka, Original Hospital

and Central Plant, removal of acute care services or demolition, to January 1, 2027;

1. For Providence Eureka General Hospital in the City of Eureka, Original

Hospital, 1950 Addition Building, 1955 Addition Building, 1957 Addition Center Building, and 1957 Addition West Side Building, removal of acute care services or demolition, to January 1, 2027; and,

1. For Providence St. Jude Medical Center in the City of Fullerton, Main

Building, Canopies, and Boiler Room, Basement Expansion, and West Building, removal from acute care service or demolition, to January 1, 2027.

1. Adds additional quarterly reporting dates to the list of required quarterly reports that certain hospitals with a seismic extension are required to submit to HCAI to update their progress toward compliance to accommodate the length of extensions in this bill.
2. Permits HCAI to revoke the seismic compliance waiver for these Providence hospitals if a hospital fails to timely report progress that HCAI deems sufficient to complete their plans, unless due to unforeseen circumstances outside of the control of the hospital, and the hospital has been given at least 90 days written notice with an opportunity to cure the noncompliance.
3. Contains an urgency clause that will make this bill effective upon enactment.

Comments

1. Author’s statement. According to the author, the COVID-19 pandemic created a cascade of challenges requiring hospitals to focus on ensuring adequate capacity and critical patient care. The Providence hospital organization currently has three hospitals in California—St. Jude Medical Center in Fullerton; St. Joseph Hospital in Eureka; and Providence Cedars-Sinai Tarzana Medical Center in Los Angeles—which are in the midst of rebuild plans. While Providence has endeavored to meet the seismic deadlines for California hospitals established in statute for each campus, due to a variety of circumstances beyond its control, particularly the impacts of the pandemic, these three hospitals will not be able to fully achieve seismic compliance in time to avoid significant financial penalties. Without the deadline extension proposed in this bill, the hospitals will be faced with the reality of being unable to renew their licensure under CDPH, leading to a loss of vital patient care in their communities.
2. Background on 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 HCAI 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.

HCAI 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 multiple times. 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 more 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 original five-year extension to January 1, 2013, the Legislature has passed additional bills allowing hospitals to extend the deadlines for retrofitting SPC-1 buildings beyond the 2013 deadline. SB 306 (Ducheny, Chapter 642, Statutes of 2007) permitted a hospital owner to comply with seismic safety deadlines and requirements in current law by replacing all of its buildings subject to seismic retrofit by January 1, 2020, rather than retrofitting by 2013 and replacing them by 2030, if the hospital meets several conditions and HCAI certifies that the hospital owner lacks the financial capacity to meet seismic standards, as defined. SB 90 (Steinberg, Chapter 19, Statutes of 2011) allowed a hospital to seek an extension for seismic compliance for its SPC-1 buildings of up to seven years (no later than January 1, 2020) 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.

1. Providence hospitals affected by this bill are operating under a seismic deadline extension passed in 2018. In 2018, the Legislature passed AB 2190 (Reyes, Chapter 673, Statutes of 2018) which was intended to allow the last remaining hospitals that had not yet met the

SPC- 2 standard, to meet the mandate without fear of closure should they have a construction or financing delay. AB 2190 provided two paths: a 30 month extension (to July 1, 2022) for hospitals that submitted a retrofit plan or a “replacement plan” (relocating acute care services or beds from nonconforming buildings into a conforming building); or alternatively, a five year extension (to January 1, 2025) for hospitals that submitted a rebuild plan to construct a new building that would meet the 2030 standard. The Providence hospitals affected by this bill were all granted extensions to January 1, 2025, by which time they should be 2030 compliant in terms of SPC status.

In order to receive the extension to July 1, 2022 for a retrofit or replacement plan, the hospital and HCAI were required to identify at least two major milestones relating to the compliance plan to be used as a basis for determining whether the hospital is making adequate progress toward meeting the new seismic compliance deadline. The hospital needed to start construction by April 1, 2020, and meet any agreed upon milestone, or be subject to a $5,000 fine per calendar day until the requirements or milestones are met. Similarly, hospitals seeking an extension to January 1, 2025 for a rebuild plan had to work with HCAI to identify major milestones, begin construction by January 1, 2022, and are also subject to the daily $5,000 fine for failure to meet requirements or agreed upon milestones. AB 2190 permitted HCAI to grant adjustments to the deadlines to meet milestones or other requirements as necessary to deal with specified delays, but HCAI was prohibited from extending the final seismic compliance dates of July 1, 2022 for replacement or retrofit plans, and January 1, 2025 for rebuild plans. Hospitals granted extensions under AB 2190 are required to provide a quarterly status report to HCAI until seismic compliance is achieved. However, since that time, there has been legislation granting additional extensions for specific hospitals.

1. Background on the Providence hospitals affected by this bill and their seismic compliance status.
2. Providence Cedars-Sinai Tarzana Medical Center. Providence Cedars-Sinai in Tarzana is licensed for 204 beds. According to HCAI, one building is under an AB 2190 rebuild extension, and the facility has been under three ownerships during the full extension period: Tenet, Providence, and Providence/Cedars-Sinai Joint Venture. The compliance plan anticipated new construction to replace this building. The building decanted of known acute care functions following occupancy of the new patient wing in October of 2023 and relocation of the Neonatal Intensive Care Unit in December 2023. The work remaining to convert the SPC-1 building to a non-acute care building is disconnection of utilities and life safety systems from the conforming buildings, and HCAI deems this remaining work achievable by the end of the current extension.

According to Providence, constructing the new patient wing took longer than anticipated, and they need additional time to complete the utility and building separation work associated with removing the old building from acute care services. The design team is engaged and they are working toward the first HCAI-issue milestone.

1. Providence St. Joseph Hospital in the City of Eureka. Providence St. Joseph in Eureka is licensed for 138 beds. According to HCAI, the hospital currently has one SPC-1 building under an AB 2190 rebuild extension and has missed mutually agreed upon milestones. The compliance plan began with one new building approved and built. When nearing completion, HCAI discovered that general acute care services remained in the nonconforming building. Providence then commenced working with HCAI on a series of amendments to their AB 2190 milestones, none of which have been met. Providence has not submitted plans to resolve the non-conforming conditions. Compliance work has not progressed since January 2020.

According to Providence, planning has been underway for years and make ready projects have been completed to move several impacted departments out of the non-compliant space, and noted that utility separation work had started and was paused due to COVID. Providence states a design team and general contractor have been engaged.

1. Providence Eureka The General Hospital. The General Hospital is a 15-bed rehabilitation center, and is operating under a consolidated license with its parent facility, Providence St. Joseph in Eureka. According to HCAI, there are five SPC-1 buildings at The General Hospital under an AB 2190 rebuild extension. The buildings house acute rehabilitation nursing. The extension was originally approved to relocate services to the St. Joseph campus. Current plans reflect relocation of services to a new construction at Providence Redwood Memorial Hospital in Fortuna, approximately 20 miles away. Construction of the new facility has not progressed since July 2019, with environmental damage requiring mitigation due to lack of building protection.

According to Providence, the new location for the acute rehabilitation unit project at Redwood Memorial in Fortuna was started in approximately 2017-2019, and HCAI temporarily paused the project to validate construction plans and schedules. COVID further paused the relocation work. Providence states that a design team and general contractor have been engaged.

1. Providence St. Jude Medical Center in the City of Fullerton. Providence St. Jude is licensed for 320 beds. According to HCAI, there are three SPC-1 buildings left unresolved following completion of a replacement tower in 2014. All three SPC-1 buildings are adjacent to SPC-conforming buildings, whose operations could be impacted by the nonconforming buildings in the case of a major seismic event.

According to Providence, pre-COVID, the healthcare industry projected increased outpatient utilization and decreased inpatient utilization, which led to the determination to remove acute care services from these buildings. However, those outpatient projections were not realized across the industry, and a strategy shift was needed to address the increasing inpatient needs at St. Jude, which resulted in the seismic requirements now becoming applicable. A design team has been engaged, and a general contractor was contracted in March for preconstruction scoping.

1. Letter of concern. The Service Employees International Union California (SEIU) submitted a letter of concern, stating that this bill grants an extension to certain hospitals that have already received an extension under AB 2190. SEIU states that it is time that these hospitals meet these standards and not continue to delay these important safety updates. SEIU states they look forward to continued dialogue and discussion on compliance with California’s 2030 seismic standards.

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

According to the Senate Appropriations Committee: The Department of Health Care Access and Information (HCAI) estimates costs of $198,667 in 2025-26, $198,667 in 2026-27, and $198,667 in 2027-28 (Hospital Building Fund) for state administration due to the continued need to oversee the hospitals’ compliance with seismic safety requirements for another extension period.

SUPPORT: (Verified 5/1/24)

Providence (source)

Calabasas Councilmember Ed Albrecht

Calabasas Councilmember David Shapiro

Cedars-Sinai

City of Eureka

City of Fullerton

Fullerton Fire Department

Humboldt County Board of Supervisors

Humboldt County Sherriff’s Office

North Orange County Chamber of Commerce

Orange County Supervisor Doug Chaffee

Orange County United Way

South Orange County Economic Coalition

Valley Industry & Commerce Association

West Valley-Warner Center Chamber of Commerce

OPPOSITION: (Verified 5/1/24)

California Nurses Association

ARGUMENTS IN SUPPORT: This bill is sponsored by Providence, which states that this bill would authorize narrow, case-specific extensions of the seismic compliance deadlines of AB 2190 for three Providence hospitals. Specifically, this bill would authorize two additional years for Providence St. Jude Medical Center in Fullerton and Providence St. Joseph in Eureka, and an extension of one additional year for Providence Cedars-Sinai Tarzana Medical Center. Providence states that failure to meet current seismic deadlines would result in the revocation of a hospital license, and this bill is needed so that these hospitals can maintain critical access to care while making progress toward their respective deadlines. Cedars-Sinai writes in support that it is critical to maintaining access to care, especially as Providence serves significant Medicare and Medi-Cal populations. Cedars-Sinai states that the COVID-19 pandemic led to shifting financial priorities and conditions, requiring many hospitals to focus on ensuring adequate capacity and patient care at the expense of progress toward seismic compliance mandates. The Fullerton Fire Department writes in support that it has been local partners with Providence St. Jude Medical Center for decades, and the majority of their incident volume is transported to that hospital. The Fullerton Fire Department states it is important that beds remain available for patient care while hospital leadership continues to work deliberately toward meeting the state seismic safety requirement.

ARGUMENTS IN OPPOSITION: The California Nurses Association (CNA) is opposed to this bill, stating that this bill would delay seismic compliance requirements for four Providence hospitals spread out across California. Such preferential treatment for one hospital owner is arbitrary and unduly endangers patients as well as health care providers and workers in the event of an earthquake. CNA states that Providence’s delay is part of the hospital industry’s decades-long fight against seismic safety compliance ever since the passage of a law that required hospitals to be operational after an earthquake. CNA states that Providence has had plenty of opportunities over the past 30 years to develop compliance plans, and they have plenty of resources to meet the requirements.

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

5/17/24 17:19:20

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SENATE COMMITTEE ON APPROPRIATIONS

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

SB 1119 (Newman) - Hospitals: seismic compliance

Bill Summary:

SB 1119, an urgency measure, would extend the dates by which four hospitals owned by Providence are required to comply with seismic safety standards, including two hospitals on a consolidated license in Eureka, one hospital in Fullerton, and one hospital in Tarzana.

Fiscal Impact:

The Department of Health Care Access and Information (HCAI) estimates costs of $198,667 in 2025-26, $198,667 in 2026-27, and $198,667 in 2027-28 (Hospital Building Fund) for state administration due to the continued need to oversee the hospitals’ compliance with seismic safety requirements for another extension period.

Background:

Current law requires the HCAI to propose building standards for earthquake resistance and to provide independent review of the design and construction of hospital buildings. State law 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 has allowed most hospitals to qualify for various extensions of the January 1, 2008 deadline.

The Providence hospitals affected by this bill were all granted extensions to January 1, 2025, with the requirement that their rebuild plans would also meet the 2030 standards. Hospitals seeking an extension to January 1, 2025 for a rebuild plan had to work with HCAI to identify major milestones, begin construction by January 1, 2022, and are subject to a daily $5,000 fine for failure to meet requirements or agreed upon milestones.

Proposed Law:

SB 1119, an urgency measure, would extend the dates by which specified buildings at four hospitals owned by Providence are required to comply with seismic safety standards, which under current law are required to meet the 2030 standard by January 1, 2025, as follows:

• For Providence Cedars-Sinai Tarzana Medical Center Patient Tower, as specified, to January 1, 2026;
• For Providence St. Joseph Hospital in the City of Eureka, as specified, to January 1, 2027;
• For Providence Eureka General Hospital in the City of Eureka, as specified, to January 1, 2027; and,
• For Providence St. Jude Medical Center in the City of Fullerton, as specified, to January 1, 2027.

Related Legislation:

SB 1432 (Caballero) would extend the January 1, 2030 seismic compliance deadline for hospitals. The bill is currently in the Senate Health Committee.

SB 1447 (Durazo) would extend the January 1, 2030 seismic compliance deadline for Children’s Hospital Los Angeles. The bill is currently in the Senate Health Committee.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Richard Roth, Chair

BILL NO: SB 1119

SUBJECT: Hospitals: seismic compliance

SUMMARY:

Extends the dates by which four hospitals owned by Providence are required to comply with seismic safety standards, including two hospitals on a consolidated license in Eureka, one hospital in Fullerton, and one hospital in Tarzana.

Existing law:

1. Licenses and regulates health facilities, including general acute care hospitals, by the California Department of Public Health (CDPH). [HSC §1250, et seq.]
2. 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 Department of Health Care Access and Information (HCAI) to propose building standards for earthquake resistance and to provide independent review of the design and construction of hospital buildings. [HSC §129675, et seq.]
   
3. 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 (which has since been extended for various hospitals to various dates), and a requirement that hospitals must also be capable of continued operation by January 1, 2030. [HSC §130060, §130065]
4. Permits HCAI 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 HCAI 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]
5. Permits HCAI, under legislation enacted in 2018, to provide for an extension of the January 1, 2020 deadline in 4) above, for up to 30 months (until July 1, 2022) for hospitals that plan to replace or retrofit a building to meet the 2020 standard, and up to five years (January 1, 2025) for hospitals that plan to rebuild to a standard that meets the 2030 requirement. [HSC §130062]
6. Provides for penalties of $5,000 per calendar day for failure to comply, or failure to meet any agreed upon milestone toward complying, with the provisions in 5) above. [HSC §130062(d)(3) and (e)(3)]
7. Requires the owner of an acute care inpatient hospital whose building does not substantially comply with the January 1, 2030 seismic safety requirement described in 3) above, to submit to HCAI, by January 1, 2020, an attestation that the board of directors of that hospital is aware that the hospital building is required to meet this requirement. [HSC §130066]

This bill:

1. Extends the dates by which specified buildings at four hospitals owned by Providence are required to comply with seismic safety standards, which under current law are required to meet the 2030 standard by January 1, 2025, as follows:
   1. For Providence Cedars-Sinai Tarzana Medical Center Patient Tower, removal of acute care services or demolition, to January 1, 2026;
   2. For Providence St. Joseph Hospital in the City of Eureka, Original Hospital and Central Plant, removal of acute care services or demolition, to January 1, 2027;
   3. For Providence Eureka General Hospital in the City of Eureka, Original Hospital, 1950 Addition Building, 1955 Addition Building, 1957 Addition Center Building, and 1957 Addition West Side Building, removal of acute care services or demolition, to January 1, 2027; and,
   4. For Providence St. Jude Medical Center in the City of Fullerton, Main Building, Canopies, and Boiler Room, Basement Expansion, and West Building, removal from acute care service or demolition, to January 1, 2027.
2. Adds additional quarterly reporting dates to the list of required quarterly reports that certain hospitals with a seismic extension are required to submit to HCAI to update their progress toward compliance to accommodate the length of extensions in this bill.
3. Permits HCAI to revoke the seismic compliance waiver for these Providence hospitals if a hospital fails to timely report progress that HCAI deems sufficient to complete their plans, unless due to unforeseen circumstances outside of the control of the hospital, and the hospital has been given at least 90 days written notice with an opportunity to cure the noncompliance.
4. Contains an urgency clause that will make this bill effective upon enactment.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, the COVID-19 pandemic created a cascade of challenges requiring hospitals to focus on ensuring adequate capacity and critical patient care. The Providence hospital organization currently has three hospitals in California—St. Jude Medical Center in Fullerton; St. Joseph Hospital in Eureka; and Providence Cedars-Sinai Tarzana Medical Center in Los Angeles—which are in the midst of rebuild plans. While Providence has endeavored to meet the seismic deadlines for California hospitals established in statute for each campus, due to a variety of circumstances beyond its control, particularly the impacts of the pandemic, these three hospitals will not be able to fully achieve seismic compliance in time to avoid significant financial penalties. Without the deadline extension proposed in this bill, the hospitals will be faced with the reality of being unable to renew their licensure under CDPH, leading to a loss of vital patient care in their communities.
2. Background on 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 HCAI 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.
   
   HCAI 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 multiple times. 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 more 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 original five-year extension to January 1, 2013, the Legislature has passed additional bills allowing hospitals to extend the deadlines for retrofitting SPC-1 buildings beyond the 2013 deadline. SB 306 (Ducheny, Chapter 642, Statutes of 2007) permitted a hospital owner to comply with seismic safety deadlines and requirements in current law by replacing all of its buildings subject to seismic retrofit by January 1, 2020, rather than retrofitting by 2013 and replacing them by 2030, if the hospital meets several conditions and HCAI certifies that the hospital owner lacks the financial capacity to meet seismic standards, as defined. SB 90 (Steinberg, Chapter 19, Statutes of 2011) allowed a hospital to seek an extension for seismic compliance for its SPC-1 buildings of up to seven years (no later than January 1, 2020) 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.
3. Providence hospitals affected by this bill are operating under a seismic deadline extension passed in 2018. In 2018, the Legislature passed AB 2190 (Reyes, Chapter 673, Statutes of 2018) which was intended to allow the last remaining hospitals that had not yet met the

SPC- 2 standard, to meet the mandate without fear of closure should they have a construction or financing delay. AB 2190 provided two paths: a 30 month extension (to July 1, 2022) for hospitals that submitted a retrofit plan or a “replacement plan” (relocating acute care services or beds from nonconforming buildings into a conforming building); or alternatively, a five year extension (to January 1, 2025) for hospitals that submitted a rebuild plan to construct a new building that would meet the 2030 standard. The Providence hospitals affected by this bill were all granted extensions to January 1, 2025, by which time they should be 2030 compliant in terms of SPC status.

In order to receive the extension to July 1, 2022 for a retrofit or replacement plan, the hospital and HCAI were required to identify at least two major milestones relating to the compliance plan to be used as a basis for determining whether the hospital is making adequate progress toward meeting the new seismic compliance deadline. The hospital needed to start construction by April 1, 2020, and meet any agreed upon milestone, or be subject to a $5,000 fine per calendar day until the requirements or milestones are met. Similarly, hospitals seeking an extension to January 1, 2025 for a rebuild plan had to work with HCAI to identify major milestones, begin construction by January 1, 2022, and are also subject to the daily $5,000 fine for failure to meet requirements or agreed upon milestones. AB 2190 permitted HCAI to grant adjustments to the deadlines to meet milestones or other requirements as necessary to deal with specified delays, but HCAI was prohibited from extending the final seismic compliance dates of July 1, 2022 for replacement or retrofit plans, and January 1, 2025 for rebuild plans. Hospitals granted extensions under AB 2190 are required to provide a quarterly status report to HCAI until seismic compliance is achieved. However, since that time, there has been legislation granting additional extensions for specific hospitals.

1. Status of hospital seismic safety compliance. According to HCAI, as of February 22, 2024, there are a total of 3,248 buildings at 410 licensed hospital facilities that are subject to the seismic safety standards. All have achieved at least the SPC-2 standard that allows them to remain in service until 2030 except for 41 buildings spread across 20 hospital facilities. In some cases, there are no plans to retrofit or rebuild, and the hospital has either already taken them out of service but it is not reflected in the data yet, or there are plans to take them out of service prior to the January 1, 2025 deadline. It is unclear how many of the remaining out-of-compliance buildings are expected to remain in service, but are in jeopardy of missing the January 1, 2025 deadline for retrofit or replacement projects.
   
   Regarding the 2030 deadline for buildings to achieve SPC-3, 4, 4D or 5, there are still 658 buildings, spread across 251 licensed hospitals, that have an SPC-2 rating and will need to either be retrofitted to SPC-4D, replaced with an SPC-5 building, or removed from acute care service.
2. Background on the Providence hospitals affected by this bill and their seismic compliance status.
   1. Providence Cedars-Sinai Tarzana Medical Center. Providence Cedars-Sinai in Tarzana is licensed for 204 beds. According to HCAI, one building is under an AB 2190 rebuild extension, and the facility has been under three ownerships during the full extension period: Tenet, Providence, and Providence/Cedars-Sinai Joint Venture. The compliance plan anticipated new construction to replace this building. The building decanted of known acute care functions following occupancy of the new patient wing in October of 2023 and relocation of the Neonatal Intensive Care Unit in December 2023. The work remaining to convert the SPC-1 building to a non-acute care building is disconnection of utilities and life safety systems from the conforming buildings, and HCAI deems this remaining work achievable by the end of the current extension.
      
      According to Providence, constructing the new patient wing took longer than anticipated, and they need additional time to complete the utility and building separation work associated with removing the old building from acute care services. The design team is engaged and they are working toward the first HCAI-issue milestone.
   2. Providence St. Joseph Hospital in the City of Eureka. Providence St. Joseph in Eureka is licensed for 138 beds. According to HCAI, the hospital currently has one SPC-1 building under an AB 2190 rebuild extension and has missed mutually agreed upon milestones. The compliance plan began with one new building approved and built. When nearing completion, HCAI discovered that general acute care services remained in the nonconforming building. Providence then commenced working with HCAI on a series of amendments to their AB 2190 milestones, none of which have been met. Providence has not submitted plans to resolve the remaining non-conforming conditions. Compliance work has not progressed since January 2020.
      
      According to Providence, planning has been underway for years and make ready projects have been completed to move several impacted departments out of the non-compliant space, and noted that utility separation work had started and was paused due to COVID. Providence states a design team and general contractor have been engaged.
   3. Providence Eureka The General Hospital. The General Hospital is a 15-bed rehabilitation center, and is operating under a consolidated license with its parent facility, Providence St. Joseph in Eureka. According to HCAI, there are five SPC-1 buildings at The General Hospital under an AB 2190 rebuild extension. The buildings house acute rehabilitation nursing. The extension was originally approved to relocate services to the St. Joseph campus. Current plans reflect relocation of services to a new construction at Providence Redwood Memorial Hospital in Fortuna, approximately 20 miles away. Construction of the new facility has not progressed since July 2019, with environmental damage requiring mitigation due to lack of building protection.
      
      According to Providence, the new location for the acute rehabilitation unit project at Redwood Memorial in Fortuna was started in approximately 2017-2019, and HCAI temporarily paused the project to validate construction plans and schedules. COVID further paused the relocation work. Again, Providence states that a design team and general contractor have been engaged.
   4. Providence St. Jude Medical Center in the City of Fullerton. Providence St. Jude is licensed for 320 beds. According to HCAI, there are three SPC-1 buildings left unresolved following completion of a replacement tower in 2014. All three SPC-1 buildings are adjacent to SPC-conforming buildings, whose operations could be impacted by the nonconforming buildings in the case of a major seismic event.
      
      According to Providence, pre-COVID, the healthcare industry projected increased outpatient utilization and decreased inpatient utilization, which led to the determination to remove acute care services from these buildings. However, those outpatient projections were not realized across the industry, and a strategy shift was needed to address the increasing inpatient needs at St. Jude, which resulted in the seismic requirements now becoming applicable. A design team has been engaged, and a general contractor was contracted in March for preconstruction scoping.
3. Other hospitals operating under AB 2190 extensions to January 1, 2025 that are at risk of not meeting the deadline. According to HCAI, these Providence hospitals are among 43 hospitals, involving 93 buildings, that applied for extensions under AB 2190 of 2018. Of these, 12 facilities with 28 buildings remain in the program. Aside from the Providence hospitals affected by this bill, HCAI has identified the following facilities as at risk of noncompliance with the deadlines associated with AB 2190, with each affected building being at risk for fines of $5,000 per day for missing milestones or completion:
   1. El Centro Regional Medical Center (Imperial Valley), with five buildings affected. City-owned, considered a distressed hospital, with a work stoppage due to financial constraints;
   2. Hollywood Presbyterian Medical Center (Los Angeles), with two buildings affected. This is an investor-owned facility, and a contractor dispute caused work to halt in May of 2023;
   3. Pacifica Hospital of the Valley (Los Angeles), with three buildings affected. It is investor-owned, and the contractor stopped work in August of 2023 for nonpayment;
   4. Southern California Hospital at Culver City, with one building affected. Investor-owned facility. Work halted in December of 2023 due to financial constraints;
   5. UC Davis Medical Center (Sacramento), with one building affected. Pace of work not on track to meet deadline; and,
   6. Central Valley Specialty Hospital (Modesto) has missed its completion deadline due to failure to start work and make progress through the approved extension period, and is being subject to fines for failure to make progress.
4. Related legislation. SB 1432 (Caballero) extends the seismic compliance deadline for hospitals to be capable of continued operations from January 1, 2030 to January 1, 2038, creates an abeyance by which a rural hospital or critical access hospital will not be required to meet these requirements until adequate funding is made available to the hospital, and requires hospital to submit a seismic compliance master plan by January 1, 2027, among other provisions. SB 1432 is pending referral in Senate Rules Committee.
   
   SB 1447 (Durazo) extends the seismic compliance deadline for hospitals to be capable of continued operations, for Children Hospital Los Angeles, from January 1, 2030 to January 1, 2040. SB 1447 is pending referral in Senate Rules Committee.
   
   SB 759 (Grove of 2023) would have extended the seismic safety deadline for hospitals to be capable of continued operations following an earthquake, from January 1, 2030 to January 1, 2040. SB 759 was never heard in Senate Health Committee.
   
   AB 869 (Wood) creates a grant program for small and rural hospitals to fund assessments for complying with 2030 seismic safety requirements, including estimating the costs of compliance. Additionally permits qualifying small and rural, as well as financially distressed district hospitals, as defined, to apply for grants for complying with the 2030 seismic safety deadline. AB 869 extends the January 1, 2030 deadline for seismic compliance to January 1, 2035, for hospitals that apply, and qualify for, seismic compliance grants under this bill. AB 869 exempts eligible small and rural and financially distressed district hospitals from the January 1, 2030 seismic safety requirements if the estimated cost of compliance is more than $1 million or 2% of the hospital’s revenue, whichever is greater, if HCAI determines that the cost of compliance results in a financial hardship for the hospital, and state or grant funding is not available to assist with the cost of compliance. AB 869 is pending in this Committee.
5. Prior legislation. AB 1471 (Pellerin, Chapter 304, Statutes of 2023) extended the dates for compliance with seismic safety requirements for three buildings on the campus of Santa Clara Valley Medical Center, with the latest deadline being July 1, 2026.
   
   AB 1882 (Robert Rivas, Chapter 584, Statutes of 2022) requires owners of general acute care hospital buildings that are not compliant with the January 1, 2030 seismic safety requirement to remain operational following a major earthquake, to submit annual status updates to various entities, including the county board of supervisors, any labor union that represents workers in a building that is not January 1, 2030 compliant, the local office of emergency services, and the medical health operational area coordinator; and, requires hospitals to post in any lobby or waiting area of a hospital building that is not compliant with the January 1, 2030 seismic requirement a notice that the hospital is not in compliance.
   
   AB 2404 (Luz Rivas, Chapter 592, Statutes of 2022), permits HCAI to waive the requirements of the Seismic Safety Act for Pacifica Hospital of the Valley in Los Angeles County if the hospital submits a plan that proposes compliance by January 1, 2025, HCAI accepts the plan based on it being feasible, and the hospital reports to HCAI on a quarterly basis on its progress to timely complete the plan.
   
   AB 2904 (Bonta of 2022) would have extended the January 1, 2030 seismic safety requirement for Alameda Hospital until January 1, 2032. AB 2904 was vetoed by the Governor, who stated that any consideration of an extension must be contemplated across all communities and across all types of facilities in a holistic manner.
   
   SB 564 (Cortese, Chapter 388, Statutes of 2021) permits HCAI to grant an extension of the seismic safety requirement that hospitals be capable of remaining standing following a major earthquake, until a maximum of December 31, 2024, for two hospitals owned by the County of Santa Clara.
   
   AB 1527 (Ting, Chapter 1527, Statutes of 2021) permits HCAI to extend the seismic requirements for Seton Medical Center in Daly City until July 1, 2023.
   
   SB 758 (Portantino of 2020), among other provisions, would have extended the 2030 hospital seismic compliance deadline to January 1, 2037. SB 758 was amended in the Assembly Appropriations Committee when it came off the Suspense File, to reduce the extension to January 1, 2032. SB 758 was not taken up on the Assembly Floor.
   
   AB 2190 (Reyes, Chapter 673, Statutes of 2018) provided 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.
   
   AB 908 (Dababneh, Chapter 350, Statutes of 2017) permitted 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) 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 was required to meet by January 1, 2015, so that this hospital could have until September 1, 2015.
   
   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 HCAI.
   

SB 90 (Steinberg, Chapter 19, Statutes of 2011) 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.

SB 499 (Ducheny, Chapter 601, Statutes of 2009) required all general acute care hospitals that have SPC-1 buildings to report to HCAI 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) amended the Alquist Act to permit hospitals to delay compliance with the July 1, 2008 seismic retrofit deadline, and the 2013 extension, to the year 2020, by filing a declaration with HCAI that the owner lacks financial capacity to comply with the law.

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 HCAI website.

1. Letter of concern. The Service Employees International Union California (SEIU) submitted a letter of concern, stating that this bill grants an extension to certain hospitals that have already received an extension under AB 2190. SEIU states that it is time that these hospitals meet these standards and not continue to delay these important safety updates. SEIU states they look forward to continued dialogue and discussion on compliance with California’s 2030 seismic standards.
2. Support. This bill is sponsored by Providence, which states that this bill would authorize narrow, case-specific extensions of the seismic compliance deadlines of AB 2190 for three Providence hospitals. Specifically, this bill would authorize two additional years for Providence St. Jude Medical Center in Fullerton and Providence St. Joseph in Eureka, and an extension of one additional year for Providence Cedars-Sinai Tarzana Medical Center. Providence states that failure to meet current seismic deadlines would result in the revocation of a hospital license, and this bill is needed so that these hospitals can maintain critical access to care while making progress toward their respective deadlines. Cedars-Sinai writes in support that it is critical to maintaining access to care, especially as Providence serves significant Medicare and Medi-Cal populations. Cedars-Sinai states that the COVID-19 pandemic led to shifting financial priorities and conditions, requiring many hospitals to focus on ensuring adequate capacity and patient care at the expense of progress toward seismic compliance mandates. The Fullerton Fire Department writes in support that it has been local partners with Providence St. Jude Medical Center for decades, and the majority of their incident volume is transported to that hospital. The Fullerton Fire Department states it is important that beds remain available for patient care while hospital leadership continues to work deliberately toward meeting the state seismic safety requirement.
3. Opposition. The California Nurses Association (CNA) is opposed to this bill, stating that this bill would delay seismic compliance requirements for four Providence hospitals spread out across California. Such preferential treatment for one hospital owner is arbitrary and unduly endangers patients as well as health care providers and workers in the event of an earthquake. CNA states that Providence’s delay is part of the hospital industry’s decades-long fight against seismic safety compliance ever since the passage of a law that required hospitals to be operational after an earthquake. CNA states that Providence has had plenty of opportunities over the past 30 years to develop compliance plans, and they have plenty of resources to meet the requirements.

SUPPORT AND OPPOSITION:

Support: Providence (sponsor)

Calabasas Councilmember Ed Albrecht

Calabasas Councilmember David Shapiro

Cedars-Sinai

City of Fullerton

Fullerton Fire Department

North Orange County Chamber of Commerce

Orange County Supervisor Doug Chaffee

South Orange County Economic Coalition

Valley Industry & Commerce Association

West Valley-Warner Center Chamber of Commerce

Oppose: California Nurses Association

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