BILL ANALYSIS                                                                                                                                                                                                    



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          Date of Hearing:   April 20, 2010

                            ASSEMBLY COMMITTEE ON HEALTH
                              William W. Monning, Chair
                 AB 2512 (Blumenfield) - As Amended:  April 12, 2010
           
          SUBJECT  :  Seismic safety: Office of Statewide Health Planning  
          and Development and health facilities.

           SUMMARY  :  Provides for extensions to interim seismic safety  
          requirements for the Shriner's Children's Hospital in Los  
          Angeles (SCH-LA) to allow more time for SCH-LA to complete  
          negotiations with the County of Los Angeles for donated land to  
          build a new pediatric hospital that meets the state's seismic  
          safety requirements.  Specifically,  this bill  :   

          1)Establishes that it is the intent of the Legislature to create  
            a mechanism that will allow a general acute care hospital to  
            meet seismic safety requirements in new facilities and provide  
            state agencies and the public with more timely and detailed  
            information about the progress the hospital is making toward  
            seismic safety compliance.

          2)Permits Office of Statewide Health Planning and Development  
            (OSHPD) to approve an extension of the January 1, 2013  
            deadline for a hospital building that is classified as a  
            nonconforming Structural Performance Category-1 (SPC-1)  
            building and is owned or operated by a nonprofit organization  
            that exclusively provides pediatric care at no cost to the  
            patient and is located in a city with a population greater  
            than three million persons that has requested an extension of  
            this deadline by June 30, 2011, if the owner or operator files  
            a declaration with OSHPD stating that as of the date of the  
            filing, the owner lacks the ability to meet the requirements,  
            as specified, the owner or operator is negotiating an  
            agreement with a city or county to purchase or lease public  
            land that meets the requirements to relocate to a compliant  
            SPC-5 and Non-Structural Performance Category-4 (NPC-4) or  
            NPC-3 building that is constructed on or after January 1,  
            2011, and that the owner is committed to replacing that  
            building by January 1, 2020, with other buildings on the  
            public land that meet the requirements 

          3)Requires the approval of the extension to be subject to  
            compliance with all of the following conditions:








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             a)   The hospital owner submits by January 1, 2012, a  
               facility master plan for all buildings that have been  
               determined to be a potential risk of collapse or pose  
               significant loss of life during an earthquake, that the  
               hospital intends to replace by January 1, 2020.  Requires  
               the facility master plan to identify at least all of the  
               following:

                i)      A description of each building that is determined  
                  to be a potential risk of collapse or pose significant  
                  loss of life during an earthquake; 
                ii)    The plan to replace the building with one or more  
                  buildings that comply with the January 1, 2030 seismic  
                  requirement;
                iii)   The building to be removed from acute care service  
                  and the projected date of that action;
                iv)    The location of any new building or buildings to  
                  replace the building described in 3) a) iii) above;
                v)      A copy of the preliminary design for the new  
                  building or buildings;
                vi)    The number of beds available for acute care use in  
                  each new building;
                vii)   The timeline for completed plan submission;
                viii)  The proposed construction timeline;
                ix)    The proposed cost at the time of submission; and,
                x)      A copy of any record of the hospital governing  
                  board's approval of the master plan.

             b)   By January 1, 2015, the hospital owner submits to OSHPD  
               a building plan that is deemed ready for review by OSHPD,  
               for each building or for review by a qualified inspector  
               retained by the applicant at its own cost;
             c)   By January 1, 2016, the hospital owner receives a  
               building permit to begin construction for each building  
               that the owner intends to replace pursuant to the master  
               plan;
             d)   Within six months of receipt of the building permit, the  
               hospital owner provides OSHPD with a construction timeline  
               that identifies at least all of the following:

               i)     A description of each building that is determined to  
                 be a potential risk of collapse or pose significant loss  
                 of life during an earthquake;
               ii)    The project number or numbers for replacement of  








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                 each building;
               iii)   The projected construction start date or dates and  
                 projected construction completion date or dates;
               iv)    The building or buildings to be removed from acute  
                 care;
               v)     The estimated cost of construction; and,
               vi)    The name of the contractor.

             e)   By January 1, 2017, and every six months thereafter, the  
               hospital owner reports to OSHPD on the status of the  
               project, including any delays or circumstances that could  
               materially affect the estimated completion date; and,

             f)   The hospital owner pays to OSHPD an additional fee, to  
               be determined by OSHPD, sufficient to cover the additional  
               cost incurred by OSHPD for maintaining all reporting  
               requirements established under this bill, including, but  
               not limited to, the costs of reviewing and verifying the  
               financial information submitted.  Prohibits this additional  
               fee from including any cost for review of the plans or  
               other duties related to receiving a building or occupancy  
               permit.

           EXISTING LAW  :

          1)Establishes and grants OSHPD authority and responsibility for  
            reviewing and approving all plans relating to construction,  
            additions to, reconstruction, or alteration of, health care  
            facilities, as defined.  Before adopting any such plans,  
            requires hospitals to submit the plans to OSHPD for approval  
            and to pay an application filing fee, as determined by OSHPD,  
            based on the project's estimated construction cost.

          2)Establishes the Alfred E. Alquist Hospital Facilities Seismic  
            Safety Act of 1983 (Alquist Act), and its amendments, with the  
            following deadlines for seismic safety compliance:

             a)   After January 1, 2008, requires any general acute care  
               hospital building that is determined to be a potential risk  
               for collapse or significant loss of life in a major  
               earthquake (i.e., designated as SPC-1) to be used only for  
               non-acute care purposes;

             b)   Authorizes OSHPD to extend the 2008 deadline by five  
               years, to January 1, 2013, if:








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               i)     The hospital demonstrates that compliance with the  
                 2008 deadline will result in a loss of health care  
                 capacity that may not be provided by other hospitals  
                 within a reasonable proximity, and other conditions are  
                 met;

               ii)    The hospital agrees that by January 1, 2013,  
                 designated services will be provided by moving into an  
                 existing conforming building, relocating to a newly-built  
                 building, or continuing in the retrofitted building, as  
                 specified; or,

               iii)   The building is either retrofitted to SPC-2 and  
                 NPC-3 standards, or not used for hospital inpatient  
                 services, by January 1, 2013.

             c)   Authorizes OSHPD to extend the 2013 deadline by up to  
               two additional years, up to January 1, 2015, if the  
               hospital meets specified interim deadlines and is making  
               reasonable progress toward meeting its timeline to retrofit  
               or replace an SPC-1 building but is delayed due to factors  
               beyond its control;

             d)   Permits a hospital owner, in lieu of retrofitting or  
               rebuilding SPC-1 buildings by 2013, to instead replace them  
               by January 1, 2020, if:

               i)     The hospital meets specified conditions, including  
                 serving Medi-Cal or indigent patients and underserved  
                 areas, and OSHPD certifies that the hospital owner lacks  
                 the financial capacity to meet seismic standards, as  
                 defined; or,

               ii)    The nonconforming building is owned or operated by a  
                 county, city, or county and city that lacks the ability  
                 to meet the 2013 deadline but commits to replace the  
                 buildings by January 1, 2020.

             e)   Requires, by January 1, 2030, all hospital buildings to  
               be capable of remaining intact after an earthquake, and  
               capable of continued operation and provision of acute care  
               medical services (designated as SPC-5), and requires owners  
               of all acute care inpatient hospitals to demolish, replace,  
               or change to non-acute care all hospital buildings not in  








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               substantial compliance.

          3)Requires an owner of a hospital building classified as SPC-1,  
            who has not requested an extension of the 2008 deadline, to  
            submit a report to OSHPD no later than April 15, 2007,  
            describing the status of each building in complying with the  
            deadline, and to identify the following:

             a)   Each building that is subject to the deadline;

             b)   The project number or numbers for retrofit or  
               replacement of each building;

             c)   The projected construction start date or dates and  
               projected construction completion date or dates; and,

             d)   The building or buildings to be removed from acute care  
               service and the projected date or dates of this action.
          4)Requires owners of SPC-1 hospital buildings who have requested  
            an extension of the 2008 deadline to submit similar reports by  
            June 30, 2009, June 30, 2011 and November 1, 2010.

          5)Requires OSHPD to make the information reported pursuant to 3)  
            and 4) above available on its Web site within 90 days of  
            receipt.

           FISCAL EFFECT  :   This bill has not been analyzes by a fiscal  
          committee.

           COMMENTS  :    

           1)PURPOSE OF THIS BILL  .  According to the author, this bill  
            would allow more time for SCH-LA to complete negotiations with  
            the County of Los Angeles for the donation of a parcel of land  
            as a potential cite for a new SCH-LA pediatric care hospital  
            that meets California seismic safety requirements.  The author  
            maintains that completion of the complex land deal with the  
            County of Los Angeles would allow SCH-LA to build a new  
            pediatric care hospital in the Lincoln Heights area of the  
            city of Los Angeles adjacent to the newly built LA County +  
            University of Southern California (USC) Medical Complex.   
            According to the author, a portion of the SCH-LA's current  
            hospital does not meet seismic requirements.  In order to  
            become seismically compliant, the author asserts that it would  
            be most cost-effective to build a replacement facility, as  








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            opposed to retrofitting.  The author is requesting the seismic  
            safety deadline extensions in this bill to accomplish that  
            goal.  

          2)BACKGROUND  .  SCH-LA is a nonprofit corporation that provides  
            no-cost acute and ongoing care for approximately 6,000  
            children annually from birth to 18 years of age with  
            neuromuscular disorders, limb deficiencies, burn deformities,  
            or craniofacial disorders.  At its current cite, SCH-LA has  
            six buildings.  In a letter dated June 24, 2009 from OSHPD to  
            SCH-LA, five of the six buildings have been approved as either  
            SPC-3 or SPC-5 buildings, meaning these buildings are capable  
            of providing services to the public after a major earthquake.   
            The acute care uses for these five buildings are: in-patient  
            beds; outpatient beds; radiology; and, food service.  In a  
            separate letter, OSHPD indicated to SCH-LA that one of its  
            buildings had been designated a SPC-1 as a result of the HAZUS  
            (Hazards U.S. Multi-Hazard) analysis.  This SPC-1 designation  
            means that the building is at a significant risk of collapse  
            in a major earthquake and must be removed from service by  
            2013.  The building designated as SPC-1 houses: surgery rooms;  
            some food service; and, the main supply room.  According to  
            SCH-LA they have determined that it would be more  
            cost-effective to build a replacement hospital rather than  
            retrofit the SPC-1 designated building.  Currently, SCH-LA  
            maintains that the County of Los Angeles and SCH-LA are in  
            exclusive negotiations regarding a lease for new land on which  
            SCH-LA plans to build a 250,000 square foot, 60-bed acute care  
            replacement facility.  SCH-LA further maintains that they  
            have, to-date, negotiated a term sheet and are awaiting a  
            decision from the County of Los Angeles on whether California  
            Environmental Quality Act compliance must occur prior to the  
            Los Angeles Board of Supervisors' approval of a Ground Lease  
            for the new land.  According to SCH-LA, once the Ground Lease  
            is approved by the Los Angeles County Board of Supervisors,  
            SCH-LA can submit their entitlement application to the County  
            of Los Angeles and the Los Angeles City Planning Department.   
            SCH-LA anticipates the negotiations for the new land to be  
            completed by the end of 2010.

           3)SEISMIC SAFETY REQUIREMENT OVERVIEW  .  In 2008, a  
            multidisciplinary working group of scientists and engineers  
            predicted that, within the next 30 years, California has more  
            than a 99% chance of having an earthquake equal to or greater  
            than the magnitude 6.7 Northridge earthquake of 1994.  The  








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            probability of a magnitude 6.7 or stronger earthquake striking  
            the Los Angeles area over the next 30 years is 67%, and 63%  
            for the San Francisco Bay Area.

          The Northridge earthquake resulted in enactment later that year  
            of SB 1953 (Alquist), Chapter 740, Statutes of 1994.  SB 1953  
            expands the 1983 Alquist Act by establishing seismic standards  
            for hospital buildings and requiring every hospital building  
            to comply with the standards and to meet specific deadlines.   
            By January 1, 2008 (or 2013/2015 if extensions have been  
            granted), every hospital building must meet specific  
            construction standards established to keep these structures  
            standing after a major earthquake or be removed from acute  
            care.  By January 1, 2030, all hospital buildings must comply  
            with standards intended to keep these buildings standing and  
            operational following a severe earthquake.

          SPC classifications, ranging from SPC-1 to SPC-5, are used to  
            indicate the structural seismic risk of a hospital building in  
            the event of a major earthquake.  Due to major strides in  
            earthquake risk engineering that have occurred in the years  
            since SB 1953 passed, the California Building Standards  
            Commission in November 2007 approved the implementation of a  
            state-of-the-art risk assessment technology, HAZUS, to  
            reexamine the collapse risk of SPC-1 hospital buildings.  This  
            reassessment allows OSHPD to move SPC-1 hospital buildings  
            that meet specified criteria to SPC-2 category.  If  
            reclassified, these hospital buildings would move from a 2013  
            seismic deadline to a 2030 deadline.

          In addition, SB 306 (Ducheny), Chapter 642, Statutes of 2008  
            permits a hospital owner to comply with seismic safety  
            deadlines and requirements in current law by replacing its  
            buildings subject to seismic retrofit by January 1, 2020,  
            rather than retrofitting by 2013, and then replacing them by  
            2030, if the hospital meets several conditions and OSHPD  
            certifies that the hospital owner lacks the financial capacity  
            to meet seismic standards, as defined.  Among the conditions a  
            hospital must meet to be eligible for this extension are that  
            it maintains a contract to provide Medi-Cal services,  
            maintains a basic emergency room, and is either in an  
            underserved area, serves an underserved community, is an  
            essential provider of Medi-Cal services, or is a heavy  
            provider of services to Medi-Cal and indigent patients.   
            Twenty-seven hospitals have qualified for extensions to 2020  








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            under this authority.

           4)OPPOSITION  .  According to the Service Employees International  
            Union (SEIU), hospitals should be safe - for workers, for  
            patients, and for the community which relies on the hospital  
            to be there when a major disaster strikes.  SEIU argues that  
            hospitals have been given numerous extensions to date and SEIU  
            is generally opposed to the notion that hospitals should be  
            excused from the seismic requirements.  While SEIU maintains  
            that they recognize that capital costs are a major burden for  
            many hospitals, they argue that hospitals can face practical  
            barriers in completing construction in a timely manner.  

           5)PREVIOUS AND RELATED LEGISLATION  .

             a)   SB 499 (Ducheny) Chapter 601, Statutes of 2009, revises  
               and extends, under specified conditions, hospital seismic  
               safety construction and reporting requirements.

             b)   AB 303 (Beall),Chapter 428, Statutes of 2009, allows  
               specified county and University of California  
               disproportionate share hospitals that serve Medi-Cal  
               patients to receive supplemental Medi-Cal reimbursement  
               from the Construction and Renovation Reimbursement Program  
               for debt service on new capital projects to meet seismic  
               safety deadlines if plans are submitted to the state after  
               January 1, 2007 and before December 31, 2011.

             c)   AB 523 (Huffman), Chapter 243, Statutes of 2009, allows  
               OSHPD to grant a two-year extension of the 2013 seismic  
               deadline for a hospital building that is owned by Marin  
               Healthcare District.  Establishes interim deadlines and  
               requirements the hospital must meet in order to qualify for  
               the extension, as specified.  Contains an urgency clause.

             d)   SB 289 (Ducheny), a two-year bill currently on the  
               Assembly floor, expands the reporting requirements for  
               SPC-1 buildings in a manner similar to this bill.

             e)   SB 306 (Ducheny) amends the Act to permit a hospital  
               that has received an extension of the 2008 seismic retrofit  
               deadline to January 1, 2013, to instead replace a SPC-1  
               building by January 1, 2020, if the hospital demonstrates  
               it lacks financial capacity to retrofit and meets other  
               specified conditions.








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              f)   SB 1661 (Cox), Chapter 693, Statutes of 2006, authorizes  
               up to two additional two years for hospitals that have  
               already received an extension to January 1, 2013 of the  
               2008 seismic safety compliance deadline if specified  
               criteria are met, and requires hospitals with SPC-1  
               buildings to submit reports with specified information, to  
               be posted on the Web site of OSHPD.  
           
             g)   SB 167 (Speier), of 2005, would have permitted delays of  
               the 2008 seismic safety deadline for specified hospitals  
               that do not exceed maximum allowable seismic risk, as  
               determined by OSHPD, and expedited the final compliance  
               deadline to 2020 for hospitals granted the delay.  SB 167  
               failed passage in the Assembly Health Committee.  
           
             h)   AB 1978 (Walters), of 2005, would have extended, from  
               January 1, 2008 to January 1, 2015, the deadline for any  
               SPC-1 building to only be used for nonacute care purposes,  
               and permitted hospitals subject to the 2015 deadline to  
               request additional extensions to 2020, as specified.  AB  
               1978 failed passage in the Assembly Health Committee.  
           
             i)   AB 1673 (Nation and Richman), of 2005, would have  
               repealed provisions of the Alquist Act that require  
               specified hospitals to meet seismic retrofitting  
               requirements by 2008, revised the final 2030 deadline  
               requirement to 2020, and made the bill contingent upon the  
               enactment of AB 1672 (Nation) relating to electronic  
               medical recordkeeping.  AB 1673 failed passage in the  
               Assembly Health Committee.  

              j)   SB 1953 (Alquist) requires every hospital building to  
               comply with two deadlines.  By January 1, 2008 (or no later  
               than January 1, 2013, if an extension has been granted),  
               every hospital building must meet specific construction  
               standards established to keep these structures standing  
               after a major earthquake.  By January 1, 2030, the law  
               requires all buildings to comply with standards intended to  
               keep these buildings operational following a severe quake.  



          REGISTERED SUPPORT / OPPOSITION  :   









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           Support 
           
          None on file.

           Opposition 
           
          Service Employees International Union
           
          Analysis Prepared by  :    Tanya Robinson-Taylor / HEALTH / (916)  
          319-2097