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faulty assumption of the original 1953 law: that hospitals would pay to retrofit by 2008 and then also to replace by 2030. Retrofitting was the earnest and responsible but decidedly unsexy route. "Retrofit is viable in many cases," said John Gillengerten, the deputy director of OSHPD's Facilities Development Division. "For many buildings that is a lowercost alternative. They don't get any new services and the buildings are not nicer, but they're stronger and safer." In reality, though, hospitals planning to dish out money for a retrofit would rather spend it on building a fancy new facility with all kinds of bells and whistles that offer opportunities for generating more revenue: private patient rooms, more space to accommodate the latest technology and equipment, designs for specialty units. And until they are prepared to build a grand new campus, they want to eke every last penny of revenue out of their existing structures. "Hospitals have a strong desire to build updated facilities that will maximize their strategic and marketing goals," wrote RAND in its 2007 report. In another area, the group noted that "the policy problem is that hospitals clearly favor extended service lives for their buildings in the current financial and business environment." But while hospitals owners wait to undertake a big new replacement project on their terms, public safety is compromised, say proponents of taking a tougher stance with hospitals to meet seismic deadlines. A s evidenced by the multiple deadline extensions and the HAZUS reevaluation, however, policymakers so far have not aggressively required that hospitals shape up. And OSHPD, the agency implementing the seismic laws, has not enforced compliance because it views itself as the state's building department, not the police. In fact, it's unclear how far along or how behind many of the hospitals are in meeting the deadlines because hospitals have not been required to make progress reports or provide that kind of ISYOURHOSPITALGOINGTOSTAYSTANDING? Rank 1 1 2 2 2 3 4 4 5 5 5 5 5 5 5 5 data to the state. OSHPD only knows whether a building is in compliance or not in compliance. The hospital industry and some owners have proposed that the state help hospitals rebuild, but others cry foul at the prospect of using public money to bail out for profit (or profitable) corporations. In fact, some systems have already leveraged state-backed tax exempt bonds for capital projects but, instead of using the money for seismic upgrades, have built infrastructure that generates more dollars for the hospital. San Diego-based Scripps Health, for example, in 2005 received $300 million in bonds from the state. It used $200 million to refinance debt and the remaining $100 million to build three parking garages, a new imaging pavilion, catheterization labs, picture archiving and communication systems for imaging, and lots of new equipment. "Because we looked and saw that kind of behavior, we find it difficult to believe it is primarily a financial issue," said Gerber. "Most hospitals have huge amounts of money. I think it's a matter of priorities. Hospitals think the Legislature will change the deadline so they haven't taken it seriously." Indeed, RAND study coauthor Charles Meade noted that many observers even question whether OSHPD would actually close a hospital that didn't meet the seismic deadline. "A lot of hospitals have felt they wouldn't," said Meade, a senior scientist at RAND. "It's problematic that only OSHPD and hospitals are at the table because it's exactly that face off going on." What will it take for hospitals and policymakers to treat the seismic requirements more seriously? For one thing, Meade suggested, the public and medical employees such as nurses need to speak up and get involved in the debate because important issues of patient, worker, and community safety are at stake. "Historically, the discussion has largely been between hospital owners, CHA, and OSHPD," said Meade. "And that's too limited a discussion." I Lucia Hwang is editor of Registered Nurse. Bonnie Ho contributed to this story. Facilities with most buildings in danger of collapse during a quake Hospital Rancho Los Amigos National Rehabilitation Center UCLA Medical Center Kaiser Foundation Hospital Oakland Peninsula Medical Center Southern Inyo Hospital Biggs Gridley Memorial Hospital USC Medical Center Sharp Memorial Hospital Centinela Freeman Regional Medical Center, Centinela Campus City Downey Los Angeles Oakland Burlingame Lone Pine Gridley Los Angeles San Diego Inglewood County Los Angeles Los Angeles Alameda San Mateo Inyo Butte Los Angeles San Diego Los Angeles Children's Hospital San Diego Community Hospital of Long Beach El Camino Hospital Frank R. Howard Memorial Hospital Kaiser Foundation Hospital Fontana Stanford Hospital White Memorial Medical Center San Diego Long Beach Mountain View Willits Fontana Palo Alto Los Angeles San Diego Los Angeles Santa Clara Mendocino San Bernardino Santa Clara Los Angeles Number of SPC-1 buildings 15 15 12 12 12 11 10 10 9 9 9 9 9 9 9 9 Source: Most current 2007 data from California Office of Statewide Health Planning and Development. Note that some facilities may be undergoing construction but remain on the state's lists until projects are completed. DECEMBER 2007 W W W. C A L N U R S E S . O R G REGISTERED NURSE 13

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