BILL ANALYSIS                                                                                                                                                                                                    



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          Date of Hearing:   August 25, 2010

                            ASSEMBLY COMMITTEE ON HEALTH
                              William W. Monning, Chair
                   SB 289 (Ducheny) - As Amended:  August 24, 2010

           SENATE VOTE  :   36-0
           
          SUBJECT  :  Hospitals: seismic safety.

           SUMMARY  :  Provides extensions to the hospital seismic mandate  
          for general acute care hospitals (GAC) that are reclassified  
          using a regulatory option or have encountered local planning  
          delays.  Establishes additional posting and reporting  
          requirements for GACs with a building at risk of structural  
          damage during a major earthquake.  Specifically,  this bill  :    

          1)Requires any person, political subdivision of the state, or  
            governmental agency seeking licensure for a GAC, as defined,  
            to file with the Department of Public Health (DPH) a statement  
            that it has complied with the Alfred E. Alquist Hospital  
            Facilities Seismic Safety Act of 1983 (Alquist Act) and has  
            received approval from the Office of Statewide Health Planning  
            and Development (OSHPD).  Prohibits DPH from issuing a license  
            until these requirements are met.

          2)Requires an individual or entity that seeks initial approval  
            to operate or manage a GAC, as defined, to file with DPH a  
            statement that describes the plan for the GAC to comply with  
            the Alfred y Act.  Requires the plan to include a description  
            of the financial capacity that the proposed owner or operator  
            anticipates to be sufficient to ensure timely compliance and a  
            projected timeline for this compliance. 

          3)Requires the GAC applicant to provide the statement described  
            in 2) above to all of the following:

             a)   The Facility Development Division of OSHPD.  Requires  
               OSHPD to post the statement on OSHPD's Internet Web site;

             b)   Any investor or entity holding more than 5% of the value  
               of the GAC;

             c)   Any real estate investment trust which holds an interest  
               in the property on which the GAC is located;








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             d)   The entity responsible for providing property and  
               casualty insurance coverage for the GAC;

             e)   The entity responsible for the directors and the owner's  
               liability insurance for the management of the GAC;

             f)   The medical staff of the GAC;

             g)   The collective bargaining agent, if any, that has a  
               contract with the existing licenseholder;

             h)   The local planning departments within the local  
               jurisdiction of the GAC;

             i)   Any health care service plans or health insurers that  
               have had contracts with the GAC within the prior year; and,

             j)   Any contractor that employs workers at the GAC and, if  
               applicable, the collective bargaining agent representing  
               the subcontracted workers.

          4)Requires DPH to consider whether the GAC applicant has  
            demonstrated a history of substantial compliance with seismic  
            safety requirements, based on information provided by OSHPD  
            regarding the record of compliance with respect to any other  
            facilities owned by the same applicant.

          5)Prohibits failure to comply with 2) through 4) above from  
            being subject to criminal penalty, as specified.

          6)Adds the following additional conditions for OSHPD to grant an  
            extension of up to two years to eligible GACs that have  
            received an extension of the January 1, 2008 seismic deadline,  
            as specified, for a hospital building that the GAC owns or  
            operates:

             a)   The GAC owner provides documentation to OSHPD by January  
               20, 2011, stating the GAC owner's intent to comply with the  
               January 1, 2013, seismic deadline requirements, as  
               specified, by using computer modeling utilized by OSHPD  
               pursuant to regulations adopted after June 30, 2009, but  
               before December 30, 2010, and based upon Hazards US  
               (HAZUS).









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             b)   The GAC owner submits to OSHPD by July 1, 2011, a  
               request for review using computer modeling utilized by  
               OSHPD pursuant to regulations adopted after June 30, 2009,  
               but before December 30, 2010, and based upon Hazards US,  
               and the GAC plans to construct a building to meet the  
               structural performance category 2 (SPC-2) requirement.

             c)   The GAC building plans for the building are submitted to  
               OSHPD and deemed ready for review by OSHPD prior to January  
               1, 2012.  Requires the GAC to indicate, upon submission of  
               its plans, the SPC-1 building or buildings that are  
               required to be retrofitted or replaced to meet the  
               requirements of this bill as a result of the project.   
               Requires the GAC to also provide a proposed construction  
               timeframe to complete the project once the permit is  
               issued.  Requires the construction timeframe to be approved  
               by OSHPD and only include the amount of time that is  
               reasonably necessary to complete the construction required  
               to meet the SPC-2 requirement.

             d)   The GAC receives a building permit from OSHPD for the  
               construction described in 6) b) above, prior to January 1,  
               2013.

             e)   The GAC provides documentation upon application stating  
               that the purpose of the construction is to meet seismic  
               requirements, as specified, to allow the use of the  
               building as a GAC building after the extension deadline  
               granted by OSHPD, as specified, and to make reasonable  
               progress toward meeting the timeline set forth in 6) c)  
               above.

             f)   The additional extension granted by OSHPD, as specified,  
               may not exceed the lesser of two years or the amount of  
               time that is reasonably necessary to complete the  
               construction that is required for the building to meet the  
               SPC-2 requirement, as adjusted for delays in construction  
               that are beyond the control of the GAC.

             g)   The GAC owner completes construction in order for the  
               GAC to meet all of the criteria to enable OSHPD to issue a  
               certificate of occupancy by the applicable deadline for the  
               building.

          7)Permits OSHPD to revoke an extension granted for any GAC  








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            building where the work of construction is abandoned or  
            suspended for a period of at least six months, unless the  
            hospital demonstrates in a public document that the  
            abandonment or suspension was caused by factors beyond its  
            control.

          8)Requires all submissions to OSHPD to obtain an extension of  
            the January 1, 2008 seismic deadline, as specified, to comply  
            with the requirements for the extension to be complete and  
            accurate.  Requires OSHPD to deny or revoke an extension of  
            the January 1, 2008, seismic deadline, as specified, if OSHPD  
            determines that the information submitted did not meet this  
            standard.

          9)Permits OSHPD, in lieu of the extension to the January 1, 2008  
            seismic deadline, as specified, to grant an extension to a  
            GAC, in accordance with 11) and 14) below, if the GAC building  
            will not be able to meet the seismic safety standards, as  
            specified, by January 1, 2013. 

          10)Requires the owner of the GAC, when applying for an extension  
            under the provisions of this bill, to submit to OSHPD  
            documentation that includes at least all of the following:

             a)   The schedule of the project or projects, as had been  
               originally anticipated;

             b)   The schedule of the project or projects, as currently  
               projected;

             c)   Documentation that the timeline submitted to the local  
               planning authority or jurisdiction;

             d)   The local planning authority for the project and for the  
               enabling phases of the project does not grant approvals  
               prior to November 1, 2010, where the GAC had filed the  
               local application prior to January 1, 2009; and,

             e)   A proposed construction timeframe demonstrating the  
               completion of the project once the permit is issued.   
               Requires the construction timeframe to be approved by OSHPD  
               and to only include the amount of time that is reasonably  
               necessary to complete construction required to meet the  
               seismic requirements.









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          11)Permits OSHPD to grant an extension, in full one-year  
            increments, but no longer than three consecutive years, which  
            compensates for delays determined pursuant to 12) below.

          12)Requires OSHPD to conduct a comprehensive review of the  
            schedule for the project and necessary enabling phases  
            according to criteria specified in this bill.  Requires this  
            review to encompass the project under jurisdiction of OSHPD,  
            as well as enabling project phases not under the jurisdiction  
            of OSHPD.  Requires OSHPD to consider the cumulative effect of  
            local approval timelines for all elements of the project and  
            necessary enabling phases, inclusive of changes in scope or  
            sequence of the project or its enabling phases.  Permits OSHPD  
            to grant extensions based on evaluation of each of the  
            following circumstances:

             a)   Where the local planning authority approvals have  
               delayed or will delay the construction start date of the  
               project, or of an enabling phase of this project;

             b)   Where the local conditions of approval on a project or  
               on its enabling phases extend duration beyond the  
               originally anticipated construction completion date;

             c)   Where changes in sequence or processes the GAC deems  
               necessary to mitigate local concerns on the project or its  
               enabling phases delay the construction completion date;

             d)   Where the cumulative effect of delays on the project or  
               on enabling phases create additional construction delays  
               due to local seasonal weather impacts;

             e)   Construction related to the seismic retrofit or  
               replacement project has begun by January 1, 2013;

             f)   The project was submitted for review by DPH no later  
               than January 1, 2009; and,

             g)   The project has received a building permit from DPH no  
               later than January 1, 2012, to complete construction on the  
               entire project.

          13)Requires the GAC owner, every six months after the approval  
            of the extension, to report to OSHPD on the status of the  
            project, demonstrating that it is making reasonable progress  








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            toward meeting the construction timeline.  Requires the GAC to  
            also report any delays or circumstances that could materially  
            affect the estimated completion date.

          14)Permits OSHPD to grant an additional extension of up to two  
            years in addition to the extension granted pursuant to 11) and  
            12) above, if the project meets the following criteria:

             a)   A matrix of buildings at the facility that identifies  
               compliance of each building to the standards required in  
               existing law at the completion of the project; and,

             b)   The construction timelines submitted pursuant to 9)  
               above were determined to go beyond three years from the  
               date the building permit was issued.

          15)Permits OSHPD to revoke an extension granted pursuant to the  
            provisions of this bill for any GAC building where the work of  
            construction is abandoned or suspended for a period of at  
            least six months, unless the hospital demonstrates in a public  
            document that the abandonment or suspension was caused by  
            factors beyond its control.

          16)Permits OSHPD to revoke an extension provided pursuant to the  
            provisions in this bill if it is determined the documentation  
            provided under 10) above was falsified in any manner by the  
            GAC.

          17)Requires regulatory submissions made by OSHPD to the  
            California Building Standards Commission pursuant to  
            provisions in this bill to be deemed and to be adopted as,  
            emergency regulations.

          18)Permits a GAC denied an extension pursuant to the provisions  
            in this bill to appeal the assessment to the Hospital Building  
            Safety Board.

          19)Requires a GAC, on or before January 1, 2017, to report all  
            of the following to OSHPD:

             a)   Current configuration of all buildings on its campus,  
               including each structural performance category;

             b)   The number of acute care beds and the basic and  
               supplemental services provided in each building; and,








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             c)   Identification of each building that needs to meet the  
               structural and nonstructural requirements established in  
               existing law;

          20)Requires a GAC, before January 1, 2020, to submit a master  
            plan for all the buildings that the GAC intends to rebuild or  
            replace by January 1, 2030.  Requires the master plan to  
            identify at least all of the following:

             a)   Each building that is subject to be demolished, replaced  
               or changed to nonacute care use because it is not in  
               compliance with existing seismic law;

             b)   The current plan to rebuild or replace each building  
               with buildings that would be in compliance with existing  
               seismic law, including all structural and nonstructural  
               requirements;

             c)   The building or buildings to be removed from acute care  
               service and the projected date or dates of that action;

             d)   The location for any new building or buildings,  
               including, but not limited to, whether the owner has  
               received a permit for that location;

             e)   A copy of the preliminary design for the new building or  
               buildings;

             f)   The number of beds available for acute care use in each  
               new building;

             g)   The timeline for completed plan submission;

             h)   The proposed construction timeline;

             i)   The proposed cost at the time of submission; and,

             j)   A copy of any records indicating the hospital governing  
               board's approval of the hospital master plan.

          21)Requires on or before January 1, 2023, the GAC owner to  
            submit to OSHPD a building plan for each building that is  
            deemed ready for review by OSHPD.









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          22)Requires, on or before January 1, 2025, the GAC owner to  
            receive a building permit to begin construction for each  
            building that the owner intends to replace or retrofit  
            pursuant to the master plan.

          23)Requires, within six months of receipt of the building  
            permit, the GAC owner to submit a construction timeline that  
            identifies at least all of the following:

             a)   Each building that is subject to be demolished, replaced  
               or changed to nonacute care use because it is not in  
               compliance with existing seismic law;

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

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

             d)   The building or buildings to be removed from acute care;

             e)   The estimated cost of construction; and,

             f)   The name of the contractor.

          24)Requires the GAC owner, every six months thereafter, to  
            report to OSHPD on the status of the project, including any  
            delays or circumstances that could materially affect the  
            estimated completion date.

          25)Requires a hospital that has not submitted a report to be  
            assessed a civil penalty of $10 per licensed acute care bed  
            per day, but in no case to exceed $1,000 per day for each  
            SPC-1 building not in compliance until it has complied.   
            Requires these civil penalties to be deposited into the  
            Facilities Penalties Account established 32) below.  Permits a  
            GAC assessed a civil penalty to appeal the assessment to the  
            Hospital Building Safety Board.

          26)Requires OSHPD to make the information required by 19) and  
            20) above, available on its Internet Web site within 90 days  
            of receipt of this information.

          27)Permits a GAC that complies with seismic safety law to post a  
            sign at all public entrances to the GAC building that states:  








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            "THE STATE OF CALIFORNIA HAS DETERMINED THAT THIS HOSPITAL  
            FACILITY HAS COMPLIED WITH APPLICABLE STATE SEISMIC SAFETY  
            LAWS FOR HOSPITALS."

          28)Requires that a GAC that has a SPC-1 building to post a sign  
            at all public entrances to the building that states:  "THE  
            STATE OF CALIFORNIA HAS DETERMINED THAT THIS HOSPITAL HAS  
            BUILDING(S) THAT ARE AT RISK OF COLLAPSE IN A MAJOR  
            EARTHQUAKE.  The plan of compliance for this hospital is  
            available for your review at the hospital's Internet Web site  
            (insert Web site address).  To receive additional information  
            regarding hospital seismic safety, go to www.oshpd.ca.gov."

          29)Requires all signs posted pursuant to 27) or 28) above to be  
            posted in a conspicuous place at all public entrances of the  
            building, and not to be less than five inches by seven inches  
            in size and be printed in no less than 30-point bold-type.

          30)Clarifies that the plan of compliance to be publicly  
            available in 28) above is the November 1, 2010 reporting  
            requirement, in existing law, for SPC-1 buildings.  

          31)Requires, by February 1, 2011, each GAC that has an SPC-1  
            building to certify in writing to OSHPD that it has complied  
            with subdivision 28), 29), and 30) above.  Requires failure to  
            post the sign required in subdivision 29) to result in the GAC  
            being assessed a civil penalty of $10 per licensed acute care  
            bed per each day that the GAC fails to post the sign, but in  
            no case to exceed $1,000 per day for each SPC-1 building.

          32)Requires these fines to be deposited into the Facilities  
            Penalties Account which is hereby established within the  
            Hospital Building Fund established pursuant to existing law.  

          33)Permits a GAC assessed a civil penalty to appeal the  
            assessment to the Hospital Building Safety Board.  

          34)Prohibits moneys in the account from continuously  
            appropriated pursuant to this section, and are required to be  
            available for expenditure only upon appropriation by the  
            Legislature in the annual Budget Act or other measure.

          35)Makes other technical and clarifying changes.

           EXISTING LAW  :  








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          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 Alquist Act, and its amendments, with the  
            following deadlines for seismic safety compliance:

             a)   After January 1, 2008, requires any GAC 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:

               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 GAC 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  
                 Non-Structural Performance Category (NPC-3) standards, or  
                 not used for GAC 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  








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               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  
               substantial compliance.

          3)Requires an owner of a GAC 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, 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  








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            receipt.


           FISCAL EFFECT  :   This bill as amended has not been analyzed by a  
          fiscal committee.

           COMMENTS  :    

           1)PURPOSE OF THIS BILL  .  According to the author, current law  
            requires GACs to ensure buildings will not collapse from a  
            major earthquake by 2013.  The author maintains that, if they  
            do not meet this standard by then, GACs will be required to  
            close.  In order to assist with moving as many hospitals along  
            the path to compliance, while addressing the very real  
            barriers, such as access to capital, the author maintains that  
            this bill provides limited extensions for a very narrow set of  
            circumstances.

           2)BACKGROUND  .  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 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 GAC buildings and requiring every GAC building to comply  
            with the standards and to meet specific deadlines.  By January  
            1, 2008 (or 2013/2015 if extensions have been granted), every  
            GAC 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 GAC 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, with SPC-1 used to designate  
            buildings at potential risk of collapse or significant loss of  
            life in a major earthquake.  Because SPC-1 buildings are  








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            considered hazardous and at risk of collapse in the event of  
            an earthquake they are required under current law to be  
            retrofitted, replaced or removed from providing acute care  
            services by 2013.

           3)HAZUS 2010  .  The Multi-Hazard Loss Estimation Methodology,  
            Earthquake Module (known as Hazards US, or HAZUS) was  
            developed by the Federal Emergency Management Agency (FEMA)  
            and is a standardized methodology that estimates potential  
            losses from earthquakes, hurricanes, winds and floods.  Due to  
            strides in earthquake-risk engineering that have occurred in  
            the years since SB 1953 passed, the California Building  
            Standards Commission in November 2007 and again this year in  
            February 2010 approved the implementation of HAZUS, to  
            reexamine the collapse risk of SPC-1 GAC buildings.  This bill  
            provides GACs using HAZUS 2010 up to an additional two years  
            to mitigate through construction the structural deficiencies  
            that put the building at risk of collapse in a major  
            earthquake.  Currently, GACs using the previous regulatory  
            model (HAZUS 2007) are provided up to two additional years to  
            complete their work and become seismically compliant.  The  
            HAZUS 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.  According to the author,  
            as many as 400 GAC buildings could be re-classified and/or  
            perform construction mitigation to be re-evaluated to  
            withstand a major earthquake.  The author maintains that this  
            new evaluation will save hospitals up to $10 billion in  
            construction costs.

           4)LOCAL PLANNING DELAYS  . This bill provides a set of  
            circumstances that permit GACs to request from OSHPD an up to  
            three year extension to comply with state seismic safety  
            requirements if the GAC has run into local planning delays.   
            GACs report that there are instances where the local planning  
            review and approval process for GAC construction projects have  
            taken longer than originally anticipated.  This bill attempts  
            to address the issue of local planning delays and timing by  
            providing an opportunity for a limited number of hospitals  
            that are structurally rated as not having any patients or  
            employees in a SPC-1 building to achieve full seismic  
            compliance.

           5)POSTINGS  .  This bill requires each GAC with a building  








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            designated SPC-1 to post a sign at each entrance stating its  
            risk of collapse, and directs the public to a website to view  
            the GACs  plan to meet the seismic mandate.

           6)REPORTING REQUIREMENTS  .  Most of the current reporting  
            requirements for GAC seismic safety compliance were enacted in  
            SB 1661 (Cox), Chapter 679, Statutes of 2006.  Among other  
            provisions, SB 1661 requires all hospitals with SPC-1  
            buildings to report information on buildings to be  
            retrofitted, replaced, or removed from acute care service and  
            to provide the projected dates of those actions.  The most  
            recent report was due in June of 2009 and while the data  
            gather from these reports provided a broad picture of GACs'  
            progress toward seismic compliance, there was insufficient  
            information to develop a detailed status report on compliance,  
            as well as to assess the impact of the deadlines on GAC  
            services and capacity.  The next report is due November 1,  
            2010.

          This bill contains two additional reporting requirements for  
            GACs working to meet the 2030 deadline, mandating them to  
            begin reporting their status and progress toward the deadline  
            in 2016.  Besides identifying which SPC-1 buildings will be  
            retrofitted, replaced, or removed from acute care service, the  
            reports will provide such building-specific information as  
            planned SPC levels, applicable deadlines, project status, and  
            current and planned inpatient beds and services.  The reports  
            will also show the final configuration of all buildings on a  
            GAC campus, as well as net changes in a GAC's overall  
            inpatient capacity if buildings are to be removed from acute  
            care service.

           7)CHANGE OF OWNERSHIP  .  This bill will require an entity  
            purchasing a GAC that does not meet the seismic mandate at the  
            time of purchase to submit a report on how they plan to meet  
            the mandate, including information relating to their financial  
            capacity to build to the required standard.

           8)SUPPORT  .  The California Hospital Association, Catholic  
            Healthcare West, Tahoe Forest Health System, Association of  
            California Healthcare Districts and Providence Health &  
            Services California all write in support that this bill will  
            allow hospitals to continue working toward meeting the seismic  
            mandate, ensuring their buildings will withstand a major  
            earthquake, by recognizing the limits on capital while  








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            maintaining the structural integrity of the seismic mandates.   
            Supporter assert that this bill provides hospitals the time  
            needed to meet the seismic mandate without risk of closure  
            preserving access to care for communities throughout the  
            state.


          The California Children's Hospital Association (CCHA) writes  
            that safety is the number one concern of children's hospitals  
            and that all eight California hospitals are working diligently  
            to meet the seismic mandate and or move services from the  
            affected buildings.  CCHA maintains that if hospitals do not  
            met the specified deadline, they are required to close, and in  
            the case of children's hospitals, there is no other option for  
            providing these highly specialized tertiary and quaternary  
            services to California's children.

           9)OPPOSITION  .  According to the California Nurses Association  
            (CNA), California nurses know first hand the devastation that  
            an earthquake can bring.  CNA argues that the experience in  
            Haiti especially proved that the one building that  
            Californians will most need standing following a serious  
            earthquake is their community's acute care hospital.  CNA  
            maintains that for nearly four decades California hospitals  
            have been on notice regarding  seismic safety since the 1971  
            earthquake in Sylmar caused two big hospitals to collapse,  
            with 45 people alone dying in the ruins of a Veteran's  
            Hospital.  CNA asserts that hospitals have come begging to the  
            Legislature virtually every year seeking extension after  
            extension which has resulted in the deadlines being repeatedly  
            delayed.  According to CNA, in a seismically active state such  
            as California, the time for compliance is now and the reward  
            for non-compliance should not be more extensions.  CNA argues  
            the continually moving goal post of seismic extensions must  
            stop.

          The Children's Advocacy Institute (CAI) writes in opposition to  
            this bill that children are uniquely imperiled by hospitals  
            that remain seismically unsafe and believe that children's  
            hospitals can not be treated in an identical methodological  
            fashion as other hospitals with regard to the urgency of a  
            retrofitting timetable.  CAI also states that the reason for  
            instituting legislative deadlines in the first place is that  
            the Legislature sensibly believed that achieving seismic  
            safety for hospitals was a priority.  However, the legislative  








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            approach of setting a deadline and then offering an extension,  
            CAI further maintains, appears to be undermining the policy of  
            insisting on seismic safety by a hard accountable deadline.

           10)PREVIOUS AND RELATED LEGISLATION  :

             a)   SB 608 (Alquist) permits OSHPD to grant two separate  
               extensions to a GAC for a total of five years, under  
               specified circumstances related to local planning delays,  
               to comply with state seismic safety requirements.  SB 608  
               is currently in the Assembly Health Committee.

             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.  

             d)   SB 306 (Ducheny), Chapter 642, Statutes of 2008, amends  
               the Alquist 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 by 2013 and meets other specified  
               conditions.

             e)   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 Website of OSHPD.

             f)   SB 167 (Speier), of 2005, would have permitted delays of  








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               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.

             g)   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.

             h)   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.

             i)   SB 1953 (Alquist), Chapter 740, Statutes of 1994,  
               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  
               hospital buildings to comply with standards intended to  
               keep these buildings operational following a severe quake.

           11)CHAPTERING OUT  .  This bill and SB 608 (Alquist) both amend  
            the same code sections.  Language has been included in this  
            bill to avoid chaptering out the other, should both bills be  
            enacted.

           REGISTERED SUPPORT / OPPOSITION  :

           Support 
           
          California Hospital Association (sponsor)
          Catholic Healthcare West
          Association of California Healthcare Districts
          California Children's Hospital Association








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          Providence Health & Services California
          Tahoe Forest Health System
           Opposition 
           
          California Nurses Association
          Children's Advocacy Institute

           Analysis Prepared by  :    Tanya Robinson-Taylor / HEALTH / (916)  
          319-2097