GOOD AFTERNOON WOULD LIKE TO GO
AHEAD BRING TO BRING TO ORDER
THE JOINT. ASSEMBLY SO AT THE
SOME INTO COMMITTEE
INFORMATIONAL ON SEISMIC SAFETY.
HEARING WILL PROVIDE ENOUGH ON
WHERE HOSPITALS AREWITH
RESPECT TO COMPLIANCE OF THE
TWENTY TWENTY DEADLINE. BUT IF
YOUR MEMBER THERE HAVE BEEN
SEVERAL OF THE LAST FEW YEARS
ON THIS ISSUE THE TWIN. DIED
NINE IS A REQUIRED HOSPITAL
TREES REMAIN STANDING IN THE AN
EARTHQUAKE. I ALSO HEAR ABOUT.
WHERE WE ARE WITH. THIRTY
DEADLINE RECORD PRESENT MAIN
OPERATION SP SO FIFTY EIGHT SO
PORTANTINO CURRENTLY PENDING IN
THE HOW COMMITTEE PROPOSES SICK.
CHANGE TO THE TWENTY THIRTY
SEISMIC SAFETY REQUIREMENTS
WHILE NOT PER SE IT ENDED IN A
IS TAKEN DEPTH MORE IN DEPTH
LOOK AT SEISMIC CITY. MORE THAN
BE POSSIBLE TO THE BILL HEARING.
BIRDS IN THE STATE ON A SIMPLE
ISSUE BUT FIRST LIKE TO TURN
THIS OVER TO MY COACH OF SO PAN
FOR HIS REMARKS. THANK VERY
MUCH. BUT AND I TO THANK YOU
AND STAFF. WORKING OTHER WITH
THE SENATE HEALTH STAFF ON THIS
HERE AND ON THE MANY OTHER
JOINT THINGS WERE HOLD TOGETHER.
AND CERTAINLY ON BIG ISSUES.
THIS ONE THINK IT'S IMPORTANT
FOR OUR TO WORK. TOGETHER AND
TRYING TO THE PROP BASIC FIRST.
NOW THAT. THE HOW SIZE MAKES.
BEEN A LEGISLATIVE ISSUE FOR A
LONG TIME BUT IN TOLD NOW IS
MUCH BEEN FOCUSED ON THE STATE
FOR HOSPITAL REMAINS. NOW THAT
ALL ALL AND I DONE LOOKS BILL
USUALLY BUT NOW THAT ALMOST ALL
POSSIBLE TO MET THE STAND WE
NOW START TURNING ATTENTION
THEN UNDER THE HOUSE MOST.
REMAIN OP CHANNEL A FOLLOWING
IN. IT'S WHAT WE ARE FORTUNATE
IN I'M ALWAYS WELL WE'VE HAD
STILL HAD SOME EARTHQUAKES
INSERT PARTS OF STATE HAVE
BECAUSE US SERIOUS THE- REPORTS
OF. SOME EVER TODAY'S THE POPE
BEING FOR ZACH IN THE PORT ROLE
HOSPITAL PLAY IN THE NBA OF
KNOWLEDGE COURSE WILL BE GET
BUT AS A PLACES WHERE CAN
COORDINATE. RESPONSES BUT WELL
WE HAVEN'T FOCUSES ON THE NEXT
IT IS MY THIS IS. A TO HEAR
FROM PADA OTHERS A EGGS WHAT IT
TO REQUIRE HAAS TO RE OPERATION
I WILL HEAR FROM SO LOCAL ABOUT
WHAT HAPPENS FOLLOW NATURAL
DISASTER TO THE GUARD ARE ABLE
TO BE FOUND IN THE IMPACT
EMERGENCY RESPONSE WHEN A
HOSPITAL NEEDS TO ACT YOU.
LOOKING EFFECTIVE THE HOUSE OF
THOSE WHO IN THE SKILLED TRADES
PEOPLE THAT ACTUALLY DO THE TO
MAKE HOSPO EARTHQUAKE SAFE NOT
MAKE NOTE TO I GUESS ONE OF
CONFLICT POTENTIAL CONFLICTS OF
IN IS THAT IS A I DO IT ASIAN
WORK IN HOUSE SO. IN MY- IN
WATER IS NEED TO. IS RUNNING
ARE HALF THE FOR BE SO WITH
THAT LIKE TO BACK OVER TO THE
CHAIR WOULD AND I FOR ROOM FROM
OTHER MEMBERS SALUTE LASER ARE
TO HAVE OTHER MAY WHO LIKE MAKE
ANY ROOM THE ROOM. SEEING NONE
NUMBER I THINK WE LET. WHICH
PAUL COLEMAN WITH THE OFFICE OF
STATE HEALTH AND DEVELOPMENT
WHICH OVERSEES HOUSE SO BECOME
TO GIVE US AN OVERVIEW OF THE
TO REQUIRE AND COMPLY SO YOUR
CALL. THANK YOU GOOD AFTERNOON.
LIKE TO TALK ABOUT. THE STATUS
OF HOSTILE SIZING SAFETY TODAY
AND THE REQUIREMENTS GOING
FORWARD FIRST OF ALL MY NAME IS
PAUL COLEMAN OF THE DEPUTY
DIRECTOR OF THE OFFICE OF
STATEWIDE HEALTH PLANNING AND-
ARE THE OPPOSITE. MIGHT HELP.
OF IS THE BUILDING. OF CALLED
BUILDING APART. FOR HOSPITALS
AND SKILLED NURSING FACILITIES.
AND SO WE START WITH WHY IS IT
WISE HOSPITAL SEISMIC SAFETY
IMPORTANT. AND THE
LEGISLATURE'S FOUND THE PASSES
IMPORTANT FOR THE SAFETY OF THE
PATIENTS THE STAFF. AND THE
VISITORS THAT ARE IN THOSE
BUILDINGS. THIS ALSO PART HIGH
RISK OF. PATIENT HARM WITH
EVACUATION. OF THE MOST
CRITICALLY KILL. ESPECIALLY
THOSE THAT ARE DEPEND ON LIFE
SUPPORT. THOSE ARE NEEDED TO
PROVIDE ME ASSIST TO EARTH A
TONES TIME WHEN THEY'RE NEEDED
MOSTLY TO BE BE THERE FOR THEM.
ZERO PLANS PROVIDE TERM SALUTE.
THE ADDRESS IMMEDIATE. WHEN
CARE FOR THOSE AFFECTED BY
EVENT. IS IN THE HOSPITAL
BUILDING UP AS A DISK CAN TAKE
A DAY OR- THE DIGITAL STUFF SO
REQUIRED- OF. REMOVAL BUT THEM
AND DESTROYED BUILDING BEFORE
CONSTRUCTION NO ONE. POSSIBLE
POSSIBLE DELAYS INSURANCE OF
FUNDING AND OTHER INSURANCES.
PROLONGED OR EARTH RECOVERY IF
IN EVERY LONG TERM ECONOMIC
WELL BEING AS WELL AS ACCESS
FOR THE COMMUNITY ONE SO MORE
EARTHQUAKE ANOTHER. ALSO
COLLAPSED. IN FIFTH DEATHS.
THERE TWO ROWS OF THE ACT
FINISH ACT AND THOSE WERE TO
PREVENT LOSS OF LIFE. THE
HOSPITALS WERE TO OPERATE AFTER
AND- THE ONLY THE SUBSEQUENT TO
THE ACT REQUIRED HOSPITAL
BUILDING TO BE EXPLICITLY TIME
AND REVIEWED FOR SIDE. AND
WHILE 24% OR ALMOST A QUARTER
OF THE TOP LEAGUES IN AFFECTED
AREA A RED TAG IS A THE HE
THANK THE POSTER WHEREAS BACK
TO SHOWS THAT THE ACT WAS
AFFECT. IN ORDER THE QUAKE
WHICH AND SEND TWO OF THEM THE
TO FACILITY OF PATEL'S. FOR
COUNTIES RIGHT THANK YOU FOR
TELLING. AND BILLIONS OF
DOLLARS OF ECONOMIC LOSS THE
ACT WAS AMENDED. SO THIS IS
WHAT'S KNOWN AS SENATE BILL
NINE TWO FIFTY THREE WHICH ALSO
HAD. TO PHASES PHASE ONE. ACUTE
CARE SERVICES FROM BUILDINGS
THAT ARE RISK OF COLLAPSE.
INITIALLY THERE WAS A TWO
THOUSAND EIGHT DEADLINE- FOR
THAT TO OCCUR. AND THEN THERE
WAS EXTENSIONS TWENTY THIRTEEN
AND SO WHEN EXTENSION OF AS WAS
MENTIONED EARLIER UP TO THE
CURRENTLY WE HAVE EXTENSIONS
ALL THE WAY UP THROUGH TWENTY
TWENTY FIVE FOR THAT FIRST
PHASE. FOR THESE MEMBERS ARE
OBLIGATED REGULATIONS THAT
BECAME EFFECTIVE IN NINETEEN
NINETY EIGHT. UPON APPROVAL THE
BUILDING STANDARDS COMMISSION.
UNDER THESE REGULATIONS OFFER
CREATED STRUCTURAL AND
NONSTRUCTURAL PERFORMANCE
CATEGORIES. AS WITH THE ACT SO
ALTURAS HOOKER BUILDINGS ARE
SIGNED BOTH A STRUCTURAL AND A
NON STRUCTURAL PERFORMANCE
CATEGORY. THE STRUCTURE
CATEGORIES RANGE FROM VERY- MAY
BE AT RISK OF COLLAPSE IN A
STRONG EARTHQUAKE. THE HIGHEST
LEVEL THAT INDICATES BUILDINGS
ARE REASONABLY CAPABLE OF
PROVIDING SERVICES TO THE
PUBLIC FOLLOWING A STRONG
EARTHQUAKE. THERE ARE SIX
STRUCTURAL PERFORMANCE
CATEGORIES FOR HOSPITAL
BUILDINGS AS PC ONE BUILDINGS
ARE THOSE AT RISK OF COLLAPSE
IN A STRONG EARTHQUAKE. AS WE
SEE TO BILLINGS DO NOT
SIGNIFICANT JEOPARDIZE LIFE BUT
MAY NOT BE REPAIRABLE OR
FUNCTIONAL. FOLLOWING A STRONG
EARTHQUAKE. AS WE EE THREE
FOUR FORTY AND FIVE BUILDINGS.
ARE REASONABLY CAPABLE OF
PROVIDING SERVICES TO THE
PUBLIC AFTER NOTS EARTHQUAKE.
AS OF DECEMBER TWENTY FOUR
TWENTY NINETEEN THERE WERE
THREE THOUSAND ONE HUNDRED AND
THIRTY EIGHT ACUTE CARE
BUILDINGS ON FOUR HUNDRED AND
EIGHTEEN CAMPUSES. THAT WERE
SUBJECT TO THE ACT HOSTILE
CAMPUS THE TYPICALLY COMPRISED
OF MULTIPLE BUILDINGS. SO EVERY
BUILDING ON THE CAMPUS THAT
PROVIDES A TO CARE SERVICES
MUST COMPLY WITH THE SEISMIC
SAFETY ACT. UNDER FORTY SEVEN
BUILDINGS OR FOUR POINT SEVEN
OF THE TOTAL BUILDINGS. ARE
CURRENTLY RATED AT SPC ONE OR
COLLAPSE HAZARD. CONVERSELY
THAT MEANS THAT MORE THAN 95%
OF THE BUILDINGS HAVE BEEN
CHANGED FROM THAT
CLASSIFICATION TWO SPC TWO OR
TWO OR HIGHER CLASSIFICATION-
INDICATING THAT THE HOSPITAL
INDUSTRY HAS DONE A GOOD JOB AT
MOVING THOSE BUILDINGS. OUT OF
THAT CATEGORY. THE DEADLINE TO
THE NEXT LEVEL WHEREAS PC TWO
WAS ORIGINALLY TO A TWO
THOUSAND EIGHT. AND LATER WITH
SIX INCHES ALSO SET UP TO
TWENTY TWENTY FIVE THERE ARE
SIX HUNDRED AND FORTY SIX
BUILDINGS CURRENTLY THAT ARE
RATED. AS PC TO. THAT IS A
TWENTY POINT 6% OF THE HOSPITAL
BILLING INVENTORY. THESE
BUILDINGS MAY OFFER TO CARE
SERVICES UP TO TWENTY THIRD BUT
OUR NOTE AND NO LONGER PROVIDE
ACUTE CARE SERVICES GOING
BEYOND TWENTY THIRTY. FINALLY
THERE ARE TWO THOUSAND THREE
HUNDRED AND FORTY FIVE
BUILDINGS OR SEVENTY FOUR POINT
SEVEN ALMOST THREE QUARTERS OF
THE HOSPITAL BUILDINGS. ARE
RATED SPC THREE FOUR FORTY OR
FIVE. AND THEY ARE STRUCTURE
COMPLIANT BUILDINGS THAT OFFER
KIDS. IT WAS THE TWENTY THIRD.
IN ADDITION TO THE STRUCTURE
STANDARDS ARE FIVE
NONSTRUCTURAL STANDARDS. THESE
ARE CALLED NON STRUCTURE
PERFORMANCE CATEGORY
CLASSIFICATIONS. AND WHAT
NONSTRUCTURAL NEEDS ARE THOSE
SYSTEMS THAT ARE CRITICAL TO
PATIENT CARE. AND THAT WOULD
INCLUDE SUCH AS THE HVAC OR THE
MECHANICAL HEATING AND COOLING
IN VIOLATION SYSTEMS- MEDICAL
GAS THE STORAGE SO IT. IS THE
POWER. FUEL STORAGE. TEMPLES
WILL OF WHAT WOULD BE NON
STRUCTURAL ISSUES. IN ALL
BUILDINGS MOSTLY IN PC FOUR OR
FORTY AND FIVE BY TWENTY THIRTY.
ABOUT A 30% OF THE GENERAL TO
CARE BUILDINGS MEET THE TWENTY
THIRTY STANDARD FOR MPC FOUR OR
FIVE TODAY. I WAS ALSO ASKED TO
BRIEFLY DESCRIBE OFFERS
EMERGENCY EVENT RESPONSE.
ARSENAL FACILITIES DEVELOPMENT
VISION PROVIDE SUPPORT AND
EXPERTISE IN THE EVENT OF AN
EARTHQUAKE FAULT OR OTHER
DISASTER. UNDER THE CALIFORNIA
STATE MERCY PLAN OUR SPOT
PROVIDES RAPIDLY MUCH THE
STRUCTURAL FIRE LIFE SAFETY AND
CRITICAL BUILDING SYSTEMS
INSPECTIONS OF HOSPITALS AND
SKILLED NURSING FACILITIES.
OFTEN STAFF CONDUCT POST
DISASTER BUILDING INSPECTIONS
THE TERM CARE WHETHER BUILDING
SAFE FOR CONTINUED- FUNCTIONAL-
OPERATION SERVICES. AND
CRITICAL BUILDING SYSTEMS THE
FUNCTIONALITY. ARE WE ALSO
POSED VISIBLE TAGS RED YELLOW
OR GREEN ON THE BUILDINGS AFTER
OUR INSPECTION TO INDICATE
WHERE THE BUILDING THE FOR
OCCUPANCY OR HAS LIMITED USE OR
IS UNSUITABLE FOR USE OR
OPERATION AT ALL. SURE HAVE TO
HEALTH THAT IS UNDER OUR
FUNDERS BE. IT BECAUSE OF A OR
HAS JUST. THE BILL MUST BE
INSPECTED BY OUR FRAUD PRIOR.
TO THE BILLING BEING USED OR
REOCCUPIED. ALL FOUR CORNERS
INSPECTIONS WITH THE CALIFORNIA
OFFICE OF EMERGENCY SERVICES.
THE CALIFORNIA DEPARTMENT OF
PUBLIC HEALTH AND THE AFFECTED
FACILITIES. POST IS ASTER OFF
OUR PRODUCT CAUSES THE APPROVAL
AND PERMITTING OF REPAIR AND
RECONSTRUCTION PROJECTS FOR
HOSPITAL FACILITIES AFFECTED BY
THE DISASTER TO EXPEDITE THE
RESTORATION. OF THE SERVICES
AND SERVICE TO THE LOCAL
COMMUNITIES. OSWALD RESPONDED
TO TEN DISASTERS IN TWENTY
NINETEEN. INCLUDING WILD FIRES
EARTHQUAKES IN POWER SHUT OFFS.
THE BASIC OPERATING PRINCIPLE
FOR ALZHEIMER'S RESPONSE IS TO
SHELTER IN PLACE IF IT IS SAFE
TO DO SO. TERRESTRES ALL STATES
IN THE COMMAND STRUCTURE.
EVAPORATION SO UNSAFE OR HOUSES
HOSPITAL KILL NURSING RED
TAGGED BUILDINGS REQUIRE
RESOURCES FROM THE CALIFORNIA
EMERGENCY MEDICAL SERVICES
AUTHORITY THE CALIFORNIA OFFICE
OF EMERGENCY SERVICES SERVICES.
SUCH AS AMBULANCES AIR
TRANSPORT MEDICAL PERSONNEL
MEDICATIONS AND EQUIPMENT AND
WILL JUST DROP ACCESS TO HEALTH
CARE IN ACTED AREAS. THAT
CONCLUDES MY- I'M HAPPY TO
ANSWER ANY QUESTIONS. I THINK
THIS COLEMAN. I THINK VERY
MUCH- HAD SEVERAL QUESTIONS-
BUT- AND APPRECIATE YOUR
PRESENTATION- SO FIRST OF ALL
BUT OKAY SO FIRST OF ALL AND IN
YOUR CHARTS AND THE- DO YOU
PROVIDE. I PRESUME THAT THE
PERCENTAGES ARE BASED ON THE
NUMBER FACILITY NOT TERMS OF
NUMBER AND SO WITH DOLLARS IN.
IN TERMS. THESE ARE STATEWIDE-
IN TERMS OF ACTUAL TOTAL BED
COMPOUND THE THAT'S TIED IT
THAT'S IN EACH OF THESE
DIFFERENT. CATEGORIES IS. THAT
IS THE INFORMATION THAT WE'RE
NOT ABLE TO PROVIDE AT THIS
TIME BECAUSE HOSPITALS ARE NOT
REQUIRED TO REPORT TO US TO
WHAT'S HIS ARE IN EACH BILL
EACH OF THE PHONES OKAY. NOT
NECESSARILY NO SERVICE LEARNING
GOING OR THOSE REMOTE EACH OF
THESE BUILDING AS FAR AS
CLASSIC. AND OKAY SO I WOULD
THINK AND- PERHAPS MAYBE. WE
CAN HAVE A CONVERSATION THE
HOSPITAL TO SEE ABOUT HOW IT SO
YOU SAY YOU DON'T WE GET THAT
AT ALL. WE WILL. NOT A- ONE
LIMITED BUILDING THERE WAS A
BILL SENATE BILL FOR NINETY
NINE. THAT REQUIRED HOSPITALS
THAT WERE STILL OF SPC ONE
BUILDINGS AT THAT TIME.
INDICATE WAS SERVICES WHEN
THEIR BUILDINGS BUT IT WAS A
FAIRLY SMALL SUBSET OF TOTAL
BUILDINGS. OF ALL OF. THIS SO
I. I WOULD BE PARTICULARLY. PER
GEOGRAPHIC AREA SO YOU ONE YES
SENSE OF. IN A PARTICULAR
GEOGRAPHIC AREA OF THOSE AN
EARTHQUAKE EXACTLY WHAT
PERCENTAGE OF THE ACTUAL
CLINICAL CAPACITY WOULD BE
AFFECTED BECAUSE- BILL YEARS
DEPENDING ON WHAT'S UNDER DAY
ARE THEY ARE AT AT THE TIME- SO
I'M HOPING WE CAN ACCESS. AND
INFORMATION WE CAN GET THAT OUT
AND THEN THE OTHER QUESTION I
HAVE IS THAT. MAKING NOTE THAT
A 20% OF HOSPITAL BUILDINGS ARE
SPC TWO AND WILL PRIME NEED
EITHER RETROFIT TO S. B. C.
FOUR D. OR BE REPLACED BY NEW
BUILDING CAN YOU MAYBE TALK A
LITTLE BIT ABOUT WHAT'S
INVOLVED RETROFITTING OF
BUILDING FROM S. P. TWO TWO
FORTY- DO YOU HAVE TO HAVE IS
WHAT. IS REPLACE THE BUT IF YOU
WERE TO IT I NEED YOU HAVE. A
BUILDING TO GET TO BECAUSE-
ACTUAL THING HOW HOW MUCH OF IS
A TO GET A BUILDING FOR ESPYS
TO SB C. FORTY. WELL THAT WAS
VERY BUILDING SPECIFIC- FOR
NUMBER REASONS. WE HAVE SPC TWO
BUILDINGS THAT WERE BUILT- BACK
IN THE EARLY NINETEEN HUNDREDS
WE HAVE ONE THAT'S BUILT IN
NINETEEN OH TWO FOR EXAMPLE- SO
THESE ARE HAVE A QUITE A- OF
TIME THAT THESE. BUILDINGS WERE
CONSTRUCTED UNDER ALL OF THE
BUILDINGS CONCERT TO. ACT I
HAVE TO DIFFERENT PLEASE WELL
IT DEPENDS ON HOW MANY
STRUCTURE DEFICIENCIES A
PARTICULAR BUILDING HAS. KIND
AS HOW MUCH NEED TO BE MADE
THOSE BUILDINGS GOVIA TWENTY AT
THIS TIME THE- SOME OF THE MAY
ACTUALLY SOME OF SOME BUILDINGS
THAT HAVE BEEN TO BECOME SPC
FORTY WITH ANY STRUCTURAL WORK
AT ALL JUST SHARPENING THEIR
PENCILS AND SHOWING THAT THE
BUILDING I WORK AS IS- THAT IS
NOT THE CASE FOR THE MEN IN THE
PUBLIC MOST OLDER IT CHOOSE
THE BILL. OPPOSED TO THE- ORDER
TO MOVE THE SERVICES TO
DIFFERENT BILL. THAN THEIR OWN
MOST LIKELY BE SOME WORK
INVOLVED BUT WHAT WE'RE ALSO
FINDING OUT IS THAT IS
HOSPITALS DO THIS WORK. THEY
REALIZE THAT IS IT'S A GOOD
TIME TO START REPLACING
INFRASTRUCTURE THOSE ARE AGING-
UGH I'M THE IT ALSO REALLY
FALL. IN BRING THE POSSIBLE UP
TO MORE MODERN HEALTHCARE
CAPABILITIES- NEWER EQUIPMENT-
BECAUSE OF THAT NATURE SO.
SOMETIMES TO PARSE HOW MUCH OF
THAT. IS I SEISMIC RELATED AND
HOW MUCH IS BECAUSE THE
HOSPITAL HAS OTHER. REASONS FOR
DOING THE DIGITAL WORKS WITH
THE FORM AT THE SAME TIME. ALSO
THERE IS A QUORUM THAT AS A DO
THIS WORK. IF THE BUILDING DOES
NOT CURLY MEET ALL OF THE
STATE'S ACCESSIBILITY STANDARDS
FOR WHAT THE BUILDINGS. MUST
ALSO CORPORATE THE WORK. WITH
THE COST. SO IT'S DIFFICULT-
IT'S LIKE A SEA TO GIVE US AN
ACTUAL COSTS ON A PER BASS
BECAUSE EVERY. I WILL BE HAVE
NOT REQUIREMENTS. PLEASE BE ON
THE WHOLE LIFE LOCATION THE
BUILDING SINCE I ARE MORE
SEISMICALLY PRONE OTHER LOW.
ALSO IF YOU'RE RIGHT ON SENATOR
THIS FALL YOU'RE GONNA HAVE A
MUCH HIGHER STANDARD TO MEET
THEN IF YOU'RE IN A VERY LOW
SEISMIC SONG OKAY SO JUST TO
CLEAR THANKS THAT'D YOUR LAST
REMARK. YOU MAY NOTICE.
DIFFERENT DO HAVE- DIFFERENT
SEISMIC RISK SELL FOR EXAMPLE
BEING HERE IN SACRAMENTO. I'LL
BE A FAULT SON YOU KNOW TO THE
EAST TO THE WEST BUT NO OVER
MORE WITH A FLOOD HERE VERSES
WITH THE BUILDING THE EFFORTS
TO GO AREN'T OTHER. ISMS SO IN
TERMS OF THE- DEANDRE SINCE THE
SEISMIC REQUIREMENTS TODAY
ACTUALLY TAKE ACCOUNT OF THE
SEISMIC RISK SO IT'S THIS SO
IT'S A LITTLE DIFFERENT IF YOU
BUILT A HOSPITAL ONE LOCATION
VERSUS ANOTHER LOCATION YES SIR
PART OF THE- OF. THE VALUATION
THAT MUST BE MADE BY THE
HOSPITAL STRUCTURE ENGINEER IS
BASED ON. THE ACTUAL LOCATION
THE SEISMICITY OF THE LOCATION
SO A BUILDINGS THAT'S IN A
LOWER SEISMIC ZONE OR OR
LOCATION THEN WILL HAVE A LOWER
BASE YOUR- REQUIREMENT OR LOW
REQUIREMENT THAT THEY WOULD
HAVE TO DEAL WITH. THAT A
BUILDING THAT IS LOCATED AND
THEY ARE HIGHER SEISMIC ZONE. I
SAW THE AD STANDARD TO WHAT HE
DOES BILL I CHANGE VICE
LOCATION OKAY. ALL RIGHT. AND
THEN. YOU HOSPITAL BUILDINGS
ARE ONLY S. PC THREE INSTEAD OF
FOUR FIVE HAVE A GREATER
CHALLENGE IN MEETING THE HIGHER
LEVELS OF THE NPC REQUIREMENTS
SO YET STRUCTURE REQUIREMENTS
NONSTRUCTURAL CRIMES STAR
NEEDED BY TWENTY THIRTY. WELL
IS IT OKAY WE ONE OF THE THINGS
THAT THE OFFICE DID WAS IN THE
TWENTY. SIXTEEN CODE WE
INTRODUCED A NEW. CATEGORY OF
NONSTRUCTURAL PERFORMANCE
CALLED IN PC FORTY RIGHT AND
THAT ONE IS VERY SIMILAR TO PC
THREE WITH WITH ACTUALLY SOME
ITEMS MOVED. SAMPLE UNDER IN
THE PC PREVIOUSLY- THERE IS A
REQUIREMENT THAT CABINETS IN
CERTAIN LOCATIONS HAD TO BE.
ANCHORED SUCH MATTER TO THE
WALLS WHICH WOULD REQUIRE
REMOVING THESE CABINETRY-
DURING OPEN. PUTTING FRAMING
AND INPUT LET'S BACK AND SO-
WHAT WE CONCLUDED WAS THAT. IF
THE CAT IS BUILT ON THE WALL
NOW FIFTY OR SIXTY YEARS IS.
AND THAT THAT WAS COSTS THAT
MAY NOT NEED TO BE SPENT. SO
THAT'S WHAT KIND OF PRODUCT IN
PC FORTY- BECAUSE WE HAD A
NUMBER OF YEARS BEHIND US NOW
TO SEE WHAT WAS PRACTICAL
BECAUSE LOSSES WHATEVER'S
PRACTICAL SOCKS. WE HAD A SENSE
OF SOMETIME TO DETERMINE WHAT
WE'RE IT'S REALLY PRACTICAL TO
BE DONE SO WE SAID IF. I'M NOT.
ALL IN. IN A PATIENT WITH. BILL
WOULD BLOCK A RE. EXCEPT THEN
WE NEED TO MAKE SURE IT'S AN
COULD PROPERLY OTHERWISE.
BECOME IT'S GOOD TO GO. THAT'S
EXAMPLE OKAY AND SO- WE HAVE
MADE SOME. LIKE SEE SUBSTANTIAL
CHANGES. TO MAKE THOSE TO THOSE
MORE COST EFFECTIVE FOR ALL SPC
CATEGORIES ACROSS THE BOARD.
OKAY PRECIADO AND THEN FINALLY-
WE'RE TALKING ABOUT THE- THE-
NBC REQUIREMENTS. AS WE KNOW AS
WITH MY- YOUR HOSPITAL EIGHT
AND IT'S CONNECT. TO ELECTRICAL
LINES SEWER LINES WATER LINES
BECAUSE AFTER ALL HOSPITALS
NOT. AN ISLAND RIGHT AT. THE
EXIT RIGHT. TO WHAT HERMANCE
NOW IF YOU AN EARTHQUAKE THOSE
THE COULD BE DISRUPT THEMSELF
SO IT'S NOT WITHIN THE HOSPITAL
IT'S THE CONNECTIONS TO THE
HOSPITAL'S SO HE JUST SPEAK TO
GIVEN THE STANDARDS OF A
HOSPITAL OF YOU HAVE THAT
EARTHQUAKE THAT HAPPENS NOW THE
SEWER LINES IS DISRUPTED WATER
LINES ARE DISRUPTED COLLINES
OTHER THINGS. IT'LL IS STILL
EXPECT TO OPERATE ON ITS OWN
LIKE INDEPENDENTLY WITHOUT
THOSE CONNECTIONS ARE WE CAN
CAN YOU SPEAK TO WHAT THE
REQUIREMENTS. ALL FOR THE
HOSPITAL TO BE ABLE TO DO AN
EVENT THAT THERE'S DAMAGE I
MEAN OF THE INFRASTRUCTURE THAT
LEADS TO THE HOSPITAL PROVIDING
SERVICES. YES SIR. OF NBC FIVE
ADDRESSES THAT ISSUE AND THAT'S
WHY SO BY TWENTY THIRTY ALL
HOSPITALS HAVE TO BE IN PC
FIVE. M. WHAT IS REQUIRED IS
FOR EXAMPLE FOR FUEL FOR THE
GENERATORS- THEY MUST HAVE SOME
OF THE TWO HOURS A FEW ON HAND-
THEY MUST HAVE STORAGE OF
WATER- FOR PATIENTS STAFF AND
VISITORS LIMITS HAVE STORED
CAPABILITY. OF DEALING WITH THE
BOYS STORY. BECAUSE THE SEWER
LINES AS YOU SAID MAY BE BROKEN
OR OR AND NOT USABLE- SO THE A
TEN AS TO THE EXTENT POSSIBLE
AND WHATEVER'S PRACTICAL IT TO
MAKE SURE THE HOSPITAL CANNOT
RATE- BEYOND THE- THE EVENT- IF
THOSE OTHER SERVICES THEY
BECOME. DISABLED OR NOT
AVAILABLE OKAY SO THE EIGHT SO
THE CONCEPT IS THE HIGHEST
LEVEL THAT A HOSPITAL SHOULD BE
OF THE OPERATIONAL FOR
SOMETHING SOME TWO. IN ICE. AND
SORT YES. WITH THE I. THAT I
TWO THE NAFTA. IT'S REACHED.
OTHER MEMBERS HAVE QUESTIONS.
I'M I DO SO I DON'T KNOW PLEASE
ADVICE ONE GIVE. TO RUN AWAY
YET PLEASE- SO A COUPLE
QUESTIONS A PERSONAL THANK YOU
VERY MUCH FOR YOUR PRESENTATION
AND APPRECIATE- DOCTOR PANTS
QUESTIONS AS WELL- SO HOW DOES
THE UPDATE HAS BUILDING CODE
UPDATES THAT HAPPEN EVERY THREE
YEARS A FACT- THIS PROCESS AND
IN SEISMIC SAFETY FOR HOSPITALS.
WELL AS I MENTIONED WE LOOK AT-
WHAT APPROACHES CAN BE TAKEN.
TO BE MORE COST EFFECTIVE FOR
HOSPITALS TO COMPLY AND THROUGH
THIS APPROACH- THERE WE HAVE
HAD- HAS THIS INTRODUCED. WHICH
IS A PROGRAM THAT WAS- CREATED
INITIALLY BY FEMA. AND WE'VE
ALSO- INTRODUCED AS PC FORTY-
IN PC FORTY AND OTHERS AND WE
DO THOSE THROUGH REGULATIONS-
THROUGH THE BILLING CENTERS
COMMISSION AND THERE IS A LIKE
YOU SAID A THREE YEAR CYCLE
THEN THERE'S AN INTRO EIGHTEEN
MONTH CYCLE THAT WE CAN CATCH
UP ON THINGS BUT- HOUSE AS-
BILLS HAVE BEEN PASSED
REGARDING HOSPITAL CITING
SAFETY- SOMETIMES. THERE'S BEEN
AN URGENCY AD THAT SUCH THAT
THE BILL HAS. ALLOWED US ARE
PROVIDED- US TO PROVIDE
EMERGENCY REGULATIONS WHICH CAN
BE DONE OUTSIDE OF THE NORMAL.
THREE YEAR CYCLE. BUT WE WOULD
LOOK AT THE- EVENTS THAT
HAPPENED FOR EXAMPLE AND
KATRINA. THEY HAD ISSUES WITH
GENERATORS BECAUSE THEY WERE IN
THE FLOOD PLAIN. SO IS RESULT
THAT WE PUT IN OUR BUILDING
ABOUT. THAT ELEVATOR. DOLLARS
I'M SORRY GENERATOR SO. HAVE
YOU CANNOT BE IN THE FLOOD
PLAIN THAT THEY HAD TO BE ABOVE
THE FLOOD PLAIN. SO THAT IS ON
THE BUILDING CODE- THE FIRE AND
ALL THAT. THE BILL IS A HUNDRED
OUTSIDE ERROR NOT HAVE THE
PEOPLE OF SHUTTING SMALL FROM
COMING THE BUILDINGS. SO WE'VE
DOES ALLOW THAT AND THE CODE
GOING FORWARD SO AS THESE-
EMERGENCIES AND THESE-
DISASTERS OCCUR. THERE WE DO
LOOK AT ARE THE CODES- ADEQUATE
TO COVER. THOSE EVENTS AND IF
SO IF NOT THEN WE WILL- PUBLIC-
CODE CHANGES TO THE BILLING
CENTERS COMMISSION. SO WHEN
HOSPITALS RETROFITTING AS
OPPOSED TO A REBUILDING. OUR
THE SEISMIC- COMPLIANCE
STANDARDS DIFFERENT- BASED ON
THE CONSTRUCTION OF THE
HOSPITAL OR WHAT'S BEEN
RETROFITTED FOR EXAMPLE. MY
DISTRICT IS RURAL. A LOT OF ONE
IN TWO STORY WOODEN STRUCTURES-
WITH THE RETROFIT REQUIREMENTS
BASED ON. CURRENT CONSTRUCTION
IN WHAT WHAT WHAT IS THAT WHAT
IS THAT LOOK LIKE FOR. THE
DIFFERENCE AND WE'RE NOT WE'RE
NOT WE'RE NOT A LOT OF
SKYSCRAPERS IN MY DISTRICT. YES
YOUR CORRECT THAT NEVER
BUILDINGS HAVE DIFFERENT BILL.
AND DIFFERENT STRUCTURE
DEFICIENCIES AND I THINK THAT
WOULD BE. A SIX ESPECIALLY
SINGLE STORY WOOD FRAME
STRUCTURES HAVE FARED A FAIRLY
WELL DURING EARTQUAKES AND NOT
THAT MANY KNOWS THE THOSE- HAVE
COLLAPSED- IN AND SO TO THAT
EXTENT OF WHAT THE OFFICE IS
PROPOSING TO DO. IS TO LOOK AT
THOSE KINDS OF STRUCTURES THE
AND SEE IF THERE ARE THINGS
THAT WE CAN DO SOME OF LIKE-
RESIDENTIAL THERE ARE SOME
PRESCRIPTIVE STANDARD
RESIDENCES RESIDENTIAL
CONSTRUCTION TO MEET. THE
STANDARDS COULD WE COME UP WITH
SOME PRESCRIPTIVE STANDARDS FOR
THESE KIND OF BUILDINGS SO THAT
THEY CAN- DO IT ON A LESS
COSTLY. MORE COST EFFECTIVE
MANNER. TAKE INTO CONSIDERATION
THE FACT THAT THESE BUILDINGS
MAKE SURE. FOR BETTER AND
THERE'S SOME. SUPPOSED TO A-
NON DOCTOR CON THE OLD OF.
MULTI STOREY BUILDING OR OTHER
BILL THAT APPEARED BE MORE
FRAGILE DURING AN EARTHQUAKE
AND HAVE MORE STRUCTURAL DAMAGE.
WELL THE X. I. BREAK BRING THAT
UP BUT WHAT WHAT OUR PANELISTS
TODAY'S FROM MAD RIVER HOSPITAL
IN IN HUMBOLDT COUNTY AND- THAT
AREA OF THE HUMBLE COAST IS
EXPERIENCE TO THE TOP TEN.
EARTHQUAKES IN THE LAST TWENTY
THIRTY FIFTY YEARS WHATEVER I'M
ACTUALLY SINCE PROBABLY SINCE
THE BUILDING OF A HOSPITAL. IN
THEAT THE HOSPITAL REMAIN
STANDING FIFTY PLUS YEARS LATER
IT MADE ME THINK ABOUT YOUR
CABINET ON THE WALL. AND
WONDERING YOU KNOW WITH WITH
WITH HISTORIES LIKE THAT IN
CERTAIN AREAS WE ALSO KNOW
SEISMIC EVENTS OR OR HAPPEN IN
MULTIPLE WAYS IT COULD BE A
SPECIALTY COULD BE SLOW ROLLING
THERE'S ALL SORTS OF THESE
THINGS. AND SO YOU KNOW WE
LOOKING AT YOUR RURAL
COMMUNITIES AND THE POSSIBILITY
THAT YOU MAY NOT HAVE A
HOSPITAL BECAUSE YOU'RE
POSSIBLE CAN OF. RETRO WE- YEAH
I'M NOT ASKING YOU TO SAY
ANYTHING ON THIS BUT I DO
WONDER SOMETIMES A WEEK. REMAKE
A JOB AT THAT. THAT THAT THAT
CAN MAY NOT HAVE A HA. IN
BECAUSE THEY COULDN'T POSSIBLY
AFFORD IT- IS AND THAT'S THAT'S
OBVIOUSLY SOMETHING WILL HAVE
TO. GRAPPLE WITH AND IN OUR
WORLD BUT I KNOW IN MY
DISTRICT- THERE ARE A NUMBER OF
SINGLE STORY WOODEN STRUCTURES
AND I KNOW THEY ALL FAIR
DIFFERENTLY. IN SEISMIC EVENTS
AND SO I JUST MY HOPE IS THAT
THAT THERE IS SOME- REALISTIC
LOOK AT THAT TIME. TECH IS A
NICE GUY. HE IS. IT IN SOME
PLACES WE DON'T EVEN HAVE
ELEVATORS AND CITIES BECAUSE-
THEY DON'T WORK. YEAH THEY WORK
BUT- WE DON'T NEEDED SOME OKAY
THANK YOU BUT I THINK THE
PRESSURE. ANY ANY OTHER
QUESTIONS. OKAY THANK YOU
MISTER COMPETITION OKAY SO
WE'RE GONNA BE UP OUR NEXT
PANEL ON STATE LOCAL AGENCY
RESPONSIBILITIES- SO PLEASED TO
HAVE HEIDI'S US NINE NINE ACRE
THAT'S CORRECTLY A DEFEAT
DIRECTOR CENTER FOR HEALTH CARE
QUALITY CALVET APART PUBLIC
HEALTH WELCOME AND BRIAN
HENDRIX AND PRESIDENT OF THE U.
S. IN STRAIGHT SETS XIN
CALIFORNIA. WELL LOOK FOR TO
YUR PRESENTATIONS. AND IF YOU
CAN AND WILL I'M SURE PEOPLE
HAVE QUESTIONS SO WE ASK IF YOU
CAN TRY TO KEEP YOUR
PRESENTATIONS OF THREE MINUTES
APPRECIATED. GOOD AFTERNOON. MY
NAME IS HEIDI STEIN OCCUR AND
THE DEPUTY DIRECTOR FOR THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH. AND I WAS ASKED TO
SPEAK HERE ON AN OVERVIEW OF
WHAT OUR RESPONSE IS INTIMATE
AND EVENTS OF EMERGENCY FROM C.
PH. SO CITY PH WORKS IN
PARTNERSHIP WITH- YES IN OUR
SPOT IN THE HOSPITAL PROVIDERS
DURING EMERGENCY EVENTS TO
DETERMINE THE SAFE OPTION FOR
THE FACILITIES STAFF PATIENTS
AND COMMUNITY. FIRST AND
FOREMOST OUR PRIMARY GOAL IS TO
MAINTAIN AS MUCH ACCESS TO SAVE
HEALTHCARE AS POSSIBLE. AXIS IS
CRITICAL BOTH DURING THE EVENT
AND AFTER THE EVENT. SO THE
OPTIONS WE CONSIDER IN THIS
ORDER. ARE ONE FIRST AND
FOREMOST SHELTER IN PLACE TO
REMAIN ACCESS AND SERVICES TO
THE COMMUNITY. TO A PARTIAL
EVACUATION TO SPECIFIC LINES OF
HEALTH CARE SERVICES- THIS LAST
SUMMER- FOR THE JULY IF YOU
REMEMBER WE HAD A HOSPITAL
RIDGECREST. WAS AFFECTED BY
THE- EARTHQUAKE AND THAT IS A
PERFECT EXAMPLE OF A PARTIAL
EVACUATION WHERE THE EMERGENCY
ROOM WAS PRONE TO VERSION THE
HOSPITAL'S EVENTUALLY EVACUATED
BUT THE DISTINCT PARTS NET FOR
SKILLED NURSING FACILITY.
REMAINED TRAIN AND PLACE IN
PART TO MAKE SURE THAT THOSE
PATIENTS WERE NOT TRANSFERRED
SOMETIMES TRANSPLANT PATIENTS
ACTUALLY CAUSES MORE HARM. AND
THE LAST BUT NOT LEAST OUR LAST
OPTION TO TAKE IS A FULL
DIVERSION AND OR EVACUATION OF
THE FACILITY. THE FACTORS THAT
WE TAKE INTO CONSIDERATION ARE
ONE THE ACUITY LEVEL OR THE
LEVEL OF- TYPES OF PATIENTS THE
AMOUNT OF PATIENTS IN THE
HOSPITAL OR AT THE TIME OF THE
EVENT. I MEAN ARE THEY AMPLE
TORY- SELF CAPABLE OF SELF
PRESERVATION- OR NON AMBULATORY
THIS OR DURABLE MEDICAL
EQUIPMENT THAT NEEDS TO FOLLOW
THEM OTHER CORPSMAN QUORUM
ABILITIES OR THINGS THAT COULD
HARM THEM. IN TRANSFERRING. YOU
LOOK AT THE DEMOGRAPHIC REGION
RURAL VERSUS URBAN WE'RE
LOOKING AT DISTANCE TO OTHER
FACILITIES TAKES STELLAR. WE'RE
LOOKING AT A- IN ALL FOR
TRANSPORT AND HOW THIS AFFECTS
SINCE THE SERVICES IN THE AREA.
THE NEXT THING WE REVIEW IS A
FACTOR TYPE OF EVENT AND THE
RISK LEVEL OF IF THERE COULD BE
MORE FURTHER FOR THREATS TO THE
FACILITY OF THE COMMUNITY. IN
THE CASE OF AN EARTHQUAKE YOU
HAVE THE POTENTIAL OF EXTRA
AFTERSHOCKS RIGHT NOW WE ARE
DEALING WITH INFECTIOUS
OUTBREAKS WE ALSO OF COURSE
DEAL OF FIRES FLOODS ACTIVE
SHOOTERS ALL OF THESE ARE
HANDLED CASE CASE BECAUSE OF
THE TO IT. WE THEN. IN TO AYE
NORMALLY REACH OUT DIRECTLY THE
CEO OF A FACILITY. AND DISCUSS
WITH THE FACILITY SITUATION IS.
WHAT TYPES OF DAMAGE HAVE A
SUSTAINED. AND I WORK WITH US
PUT IN THE DESERT IN
DETERMINING. THE ABILITY TO BE
THERE QUICKLY FIX THE DAMAGE OR
FIND OTHER ALTERNATE SPACES
THAT CAN BE COMPLIANCE. WE I
TALK ABOUT STAFFING SUPPLIES
AND WHAT IS THE EMOTIONAL TENER
OF THEIR ENVIRONMENT MEANING.
ARE THERE STAFF AFRAID TO COME
IN OTHER STAFF TWENTY TO BE
WITH THEIR FAMILIES AT THIS
TIME. UP WITH THE COMMUNITY
SITUATION HOW CATASTROPHIC WAS
THE EVENT DID IT HIT SEVERAL
FACILITIES ALL AT ONCE AND IF
SO WE NEED A TRIAGE THE
FACILITIES TO WHICH ONES CAN
REMAIN STANDING OPEN. TO YOUR
QUESTION EARLIER YOU ASKED
ABOUT WATER IF EVERYONE LOST
WATER BUT THESE TWO HOSPITALS
HAVE ENOUGH WATER TO BE ABLE
TO- COME UP WITH OTHER OPTIONS
THEN WE WORK WITH THAT. SAID
DEPENDS ON THE SITUATION OF HOW
WIDESPREAD- THIS EVENT CAUSES-
THINGS TO BE DISABLED. WE LOOK
AT HOW MANY AVAILABLE
FACILITIES AND OUR COMMUNITY
SPACES SHELTERS CAN BE CREATED
OR USED. ACCESS TO CARE OPTIONS
FOR PATIENTS IN NEARBY
COMMUNITIES THE EVENT OF- THE
RECENT FIRES WE OFFER WILL COME
UP WITH MAKESHIFT SHELTERS IN
THE COMMUNITY AND WE'RE WITH
THE LOCAL HEALTH DEPARTMENTS-
AND THE PROVIDERS TO TRANSPORT.
THIS PATIENT SAFELY. SEE THE
PAGE FOR THE FACILITY ON ANY
SUPPLY STAFFING OR ASSESSMENT
NEEDS AND SEND A TEAM OF
TRAINED STAFF TO THE LOCATION
AS SOON AS POSSIBLE. IF AT ANY
POINT PARTIAL OR FULL DIVERSION
AND OR EVACUATION OCCURS CD
PEACH WORKS IN CONCERT WITH THE
FACILITY EMSA AND LOCAL COUNTY
HEALTH OFFICERS AND SPECIFIC
NEEDS TRANSPORT PLANTS AND
COMMUNICATES CONSTANTLY THE C.
PH MEDICAL HEALTH COORDINATION
CENTER. WAS WITHOUT THE AND
EIGHT CC. THE MAC'S HE PLAYS A
COORDINATING ROLE IN EMERGENCY
EVENTS WITH THOSE DEPARTMENTS
THAT ARE ADDRESSING THE MEDICAL
NEEDS OF THE IMPACTED
COMMUNITIES. AND THE CENTER
CLOSELY WITH THE STATE. AGENCY
OPERATIONS WITH A LOW MARGINS
PERSONNEL. AGAIN MAINTAINING
ACCESS- AND PRESERVING SERVICES.
WORKS CREATIVELY WITH
FACILITIES AN ARCH PART IN
FINDING UNIQUE SOLUTIONS TO
EACH SITUATION IN SOME CASES
THIS RESULT IN CRAFTING AND
APPROVING TEMPORARY TITLE
TWENTY TWO REGULATION PROGRAM
FLEXES TO FIND ALTERNATE MEANS
OF SAFETY COMPLIANCE. CAJUN OUR
SPOT STAFF WORK TOGETHER ON
SITE AND RE POPULATING AFTER AN
EVENT FOR THE HEALTH CARE
FACILITIES TO ENSURE SERVICES
CAN BE CONTINUED AS SOON AS
POSSIBLE. CONSIDERATIONS AGAIN
FOR FULL PARTIAL ARE PHASED IN
RE POPULATION INCLUDE REMOVING
THE TO EAT DIVERSION- WORKING
UP STAFFING LEVELS AGAIN
INTERNAL SYSTEMS UTILITIES. AND
FACILITY SPACES SUPPLIES
COMMUNITY NEED AND DISTANCE TO
NEXT FACILITY TYPE. THANK YOU
VERY MUCH THAT'S WHAT THIS. A
GOOD AFTERNOON CHAIRS AND
MEMBERS MY NAME IS BRIAN
HENDRIX AND I AM THE EMERGENCY
MEDICAL SERVICES ADMINISTRATOR
AND NAPA COUNTY AND THE
PRESIDENT OF THE EMERGENCY
MEDICAL SERVICES ADMINISTRATORS
ASSOCIATION OF CALIFORNIA.
REPRESENTING THE THIRTY THREE
LOCAL EMS AGENCIES FROM AROUND
THE STATE. LIKE MANY OF MY EMS
ADMINISTRATOR COLLEAGUES AYE
AYE SIR IS THE MEDICAL HEALTH
OPERATIONAL AREA COORDINATOR
FOR NAPA COUNTY WILL LOCAL
STATUTORY RESPONSE FOR PLANNING
AND READ. TO AND HEALTH RELATED
AMONG THESE DISASTERS WITHIN
OUR COUNTIES OR OPERATIONAL
AREAS. THIS RESPONSIBILITY
INCLUDES PLANNING FOR IN
RESPONSE TO CATASTROPHIC
EARTHQUAKES. MY GOAL IS TO
SHARE OF RULE COUNTIES
EXPERIENCE AS IT RELATES TO
DISASTER RESPONSE. THE SOUTH
NAPA EARTHQUAKE STRUCK. MY
COMMUNITY IN AUGUST OF TWENTY
FOURTEEN. AND WHILE THE
EARTHQUAKE DID COST MEXICAN
DAMAGE IN OUR COMMUNITY WE WERE
FORTUNATE THAT THE EVENT DID
NOT CAUSE MAJOR DAMAGE TO
EITHER. OF OUR LOCAL HOSPITAL
AGAIN IN A RURAL COUNTY.
THROUGHOUT THE AND OUR
HOSPITALS WERE ABLE TO CONTAIN
THE SERVICES THAT THEY WERE
ALREADY PROVIDING AND WE'RE
ALSO ABLE TO QUICKLY RAMP.
THEIR SERVICE AND PROVIDE CARE
TO KLAY IT'LL END IN THE HOURS
THAT ALLOWED THAT EVENT. HOUSE
AND LOCAL MASS EIGHT ARE KEY
PARTNER AND- FOR. INCLUDING
SEISMIC EVENTS. THIS
COORDINATION INCLUDES
PARTICIPATION AND LOCAL HEALTH
CARE COALITIONS THROUGH THE
FEDERAL AND STATE HOSPITAL
PREPAREDNESS PROGRAM AND PUBLIC
HEALTH EMERGENCY PREPAREDNESS
PROGRAMS. THE MEDICAL AND
HEALTH RESPONSE TO LARGE
EARTHQUAKES IS COMPLEX AND
REQUIRES SIGNIFICANT RISK
RESPONSE RESOURCES. FOR THIS
REASON OUR DISASTER PLANNING
RELIES ON OUR HOSPITALS
SURVIVING EARTHQUAKES
EARTHQUAKE OF BANDS AND BEING
ABLE TO MAINTAIN ALL OF THEIR
DAY TO DAY FUNCTIONS. HI BILLS
THAT EXPERIENCE SIGNIFICANT. OR
WE ARE TO SHUT DOWN SERVICE
LINES ARE LIKELY REQUIRE IT
WILL ALSO LIKELY REQUIRE
EVACUATION OF SOME OR ALL OF
THEIR PATIENTS. BECOME PART OF
SERIES. POSSIBLE EVACUATIONS
RICK SIGNIFICANT PATIENT
PLANNING RESOURCES REDUCING THE
AVAILABILITY OF THOSE SOURCE
AND THE COMMUNITY AND ALSO
TACTIC. THE MURDER THE THAT
THANK YOU. OUTSIDE OF THE IN
AREA. NO FOR. THE PEOPLE OF
TRANCE TO LOCAL FOLLOWING
EARTHQUAKE FOR THIS REASON IT
IS CRITICAL THAT HOUSE CERVI
SIZED EVENTS AND ALSO TO BE PAY.
THAT SO PRESENT AT FIRST FOR
CARE. EMERGENCY MEDICAL
SERVICES PLANNING FOR DISASTER
CENTERS ON TRANSPORTING
PATIENTS IN THE AFFECTED AREA
TO HOSPITALS OUTSIDE OF THE
AFFECTED AREA USING BOTH GROUND
AND AIR AMBULANCE RESEARCH IS.
DREADED HELPS TO REDUCE THE
ACUTE IMPACT HOSPITAL
FACILITIES ALLOWS THE HOSPITALS
TO FOCUS ON THEIR EXISTING
PATIENT AND THE PATIENT'S
ITSELF PRESENT FOLLOWING THE
EVENT. A KEY ASSUMPTION AND
MEDICAL AND HEALTH AFTER
PLANNING ALSO RELIES ON
HOSPITALS WORKING WITH THEIR
EMPLOYEES KEEP THEM ON THE JOB
UNTIL THEY ARE RELIEVED BY
OTHER PERSONNEL. STAFF
AVAILABILITY AND IT'S CRITICAL
TO MAINTAINING THE SERVICES
THEY PROVIDE THE RIVER
THROUGHOUT THE ACUTE IMPACTS OF
A SEISMIC EVENT OR OTHER
DISASTER. HOSPITALS ARE
REQUIRED TO HAVE CREDENTIALING
PROGRAMS TO HELP AUGMENT
STAFFING SHORTAGES RELATED
DISASTER EVENTS AND THIS MAY
INCLUDE USING THEIR NORMAL
STAFFING PROCESS BRINGING IN
STAFF FROM- WITHIN IN HOSPITAL
SYSTEMS OF THE APPLY TO DIGNITY
KAISER TENANT AT CETERA- FROM
AFFILIATED HOSPITALS OUTSIDE OF
THE AFFECTED AREA THROUGH THE
USE OF THE CALIFORNIA OR
FEDERAL MEDICAL. ASSISTANCE
TEAMS. HI THE MESSAGE THESE
ANOTHER PART TYPICAL PLAN FOR
THE STAFFING CONTINGENCIES
THROUGH THEIR LOCAL HEALTH CARE
COALITIONS. IN THE PLANNING FOR
DISASTER WE MUST ALSO CONSIDER
DAMAGE TO OTHER INFRASTRUCTURE
THAT MADE LIMIT ADDITIONAL
EMERGENCY RESOURCES THAT WOULD
TRANSPORT PATIENTS OUTSIDE OF
OUR COMMUNITIES. FOR EXAMPLE IN
A COMMUNITY LIKE NAPA WE MAY
QUICKLY BECOME ISOLATED IF
THERE IS DAMAGE TO OUR ROADS OR
BRIDGES IF THE DISASTER
EARTHQUAKE IMPACTS A LARGER
REGIONAL AREA LIKE THE GREATER
BAY AREA EMERGENCY
TRANSPORTATION AND THE
DESTINATION WHERE PATIENTS ARE
TRANSPORTED TO WILL BE EVEN
FURTHER AWAY FROM PAPPA FOR
THESE REASONS. THE RAPID
ARRIVAL OF ADDITIONAL MEDICAL
TRANSPORT RESOURCES IS NOT AN
OPTION THAT WE CAN RELY ON IN
THESE EVENTS. THANK YOU FOR THE
OPPORTUNITY PROVIDE TESTING CAN
BE HAPPY TO ANSWER ANY
QUESTIONS HAVE. THANK YOU OF
COURSE. FIRST IT IT SURE WOULD
pIN NAPA- THE EARTHQUAKE AND
FOURTEEN IS IT WHAT'S THE
CONSTRUCTION WHAT DOES IT LOOK
LIKE HOW TALL IS IT. YEAH SO-
AT DIFFERENT BUILDINGS THERE
ARE DIFFERENT SIZES I THINK WE
TALK ABOUT IT FIVE STORIES
RIGHT SO SMALL COMMUNITY- AND-
THE DIFFERENT BUILDINGS IN
DIFFERENT PHASES THAT MEET
DIFFERENT PARTS OF THE
REQUIREMENTS BECAUSE- AS WE
HEARD THERE'S MULTIPLE
BUILDINGS THAT EACH ONE OF
THESE SITES AND THEY- THEY WERE
ALL IN VARYING STAGES. OF
COMPLIANCE WITH- THE VERY
REQUIREMENTS AT THE TIME OF THE
TWENTY FOURTEEN EARTHQUAKE AND
TODAY. IN THE MAGNET TO THE
QUICK QUICK WAS WHAT OF THE-
HEY WE WITH SIX I CAN'T
REMEMBER. WHAT IT WAS- AFTER
THE DECIMAL OKAY OKAY THANK YOU
THANK YOU. IN THE QUESTIONS
OKAY AT THAT A COUPLE QUESTIONS
SO. AS YOU KNOW THE LEGISLATIVE
PROPOSAL- THAT WOULD CHANGE
TWENTY THIRTY STANDARDS- ONLY
REQUIRE HOSPITAL'S EMERGENCY
DEPARTMENT SURGICAL SUITE AND
POST SURGICAL SERVICES TO BE
CONTINUOUSLY OPERATE. AND FOR
ONLY SEVENTY TWO HOURS. CAN YOU
TALK ABOUT WHAT. THAT WOULD
MEAN FOR EMERGENCY MEDICAL
SERVICES EVENT OF A MAJOR
EARTHQUAKE SO IN TERMS OF YOU
KNOW WHAT. WHAT KIND OF
SERVICES NEED TO DEVELOP A
DOCTOR PEOPLE SELF
TRANSPORTING- ALSO I THINK THE
OTHER THING I MIGHT WANT TO
JUST TOUCH ON TO IS THAT. I
DON'T BELIEVE CAN CORRECT ME IF
I'M WRONG WITH- OTHERS
BUILDING- HAVE THE SAME
REQUIREMENTS AS WE'RE PUTTING
OUT HOSPITALS SO IT COULD BE
THAT. OF ALL THE PUBLIC
FACILITIES ARE AVAILABLE IN THE-
IN THE HOSPITAL MAY BE THE ONLY
ONE THAT IS STANDING STABLE
OPERATIONAL LIKE CITY HALL
MIGHT BE COMING DOWN THE FIRE
TO. THE OFFICE OR THE POLICE
STATION MIGHT BE COMING DOWN
SO- AND I DON'T KNOW IN YOUR
EXPERIENCE NAPA SO WHAT THAT
MEANS FOR A HOSPITAL. OPERATOR
THIS BOOK BUT ALL THOSE WERE
THE FEW MAJOR POP. THESE THAT
NAY. HOPEFUL UNDER THE
STANDARDS WITH BE OP. IN
EMERGENCY. SO I THINK IT'S YOU
KNOW IT'S A GREAT QUESTION
HOSPITAL'S END UP BEING THESE
PLACES WHERE PEOPLE COLLECT
AFTER DISASTERS ACTUALLY AND SO
THE FACT THAT THAT DID THE
HOSPITALS HAVE DONE SO MUCH TO-
MAKE SURE THAT THEY'RE SAFE FOR
THE SEISMIC EVENTS AS- IS
REALLY INTERESTING BECAUSE IT'S
NOT JUST CITY HALL OF THE FIVE.
NATIONS WHERE PEOPLE COLLECT
HOSPITALS AND UPPING THE CATION
I- I WOULD I WOULD OFFER THE
TWENTY THIRTY REQUIREMENTS THAT
REQUIRE EMERGENCY SERVICES- TO
CONTINUE CONTINUE TO BE
PROVIDED- IS HELP AT IT'S A
SEVENTY TWO HOUR WINDOW WRAPPED
IN IT AND THAT THAT. UP WHICH
IS. US TO RESOURCES TO COME
FROM FURTHER AWAY TO HELP- THEN
MEET THAT AND GAP- IF A
HOSPITAL DOES HAVE TO FULLY
BACKED UP BEING ABLE TO CARE
FOR. IT IS THE MOST EMERGENT IT
IS UP SELF BORDER AREA I THINK.
THAT'S OUR NUMBER ONE PRIORITY
WE- WE TRY TO WORK WITH THE
FACILITIES TO AT LEAST REMAIN
PARTIALLY OPEN OR HAVE CERTAIN
SERVICE LINES OPEN. IN TO
REMOVE DIVERSION AS AS QUICK AS
POSSIBLE I BELIEVE IN THE RIDGE
CREST EARTHQUAKE LAST SUMMER-
THE EARTHQUAKE HIT ON FOR THE
JULY. WITH THIS THURSDAY FROM
SERVING RIGHT. AND WE WERE
ALREADY TRYING TO COME UP TO
SPEED TO BE POPPED BY SATURDAY
SUNDAY- THE TIME FRAME IT
REALLY. HE STOPPED AND
EVACUATION FOR. THE CEO
THEMSELVES SELF BACKING THEY
CHOSE TO AND AGAIN IT WENT BACK
TO DO THAT FEAR OR THE- STAFF
COMING BACK. AND WASHED WAS
THAT SIDE TEAM IS THERE SIGHTS
ON WORKING THEM. TO MAKE THAT
THEY HAD THEY TO AT LEAST RE
OPEN. OKAY AND JUST TO CLARIFY.
IN REGARDS TO USE YOU MENTIONED
DEAL THE DIFFERENT OPTIONS
CHILDREN PLACE PARTIAL FULL
EVACUATION- AT AND UPS ECT AGES
INVOLVED BUT WHO ACTUALLY MAKES
THAT DECISION FOR THE HOSPITAL
IS THAT THE HOSPITAL. SHIP IT'S-
COURTESY IT SHOULD. COME IN WHO
MAKES THE DECISION TO SAY WELL
YOU KNOW WE'RE GOING TO DO A
PARTIAL EVACUATION WE EVACUATE
THE WHOLE. IT'S OUR STATE BUT
IT HAS TO ANY THE HOSPITAL
LEADER CAN STATE NO WE'RE GOING
TO- WE'RE GOING TO EVACUATE WE
CAN SAY- YOUR GREEN TAX BY ARCH
POD. YOUR PERFECTLY FINE AT
LEAST FROM OUR STANDPOINT FOR
OPERATIONS BUT IF THEY FEEL
LIKE THEY STILL WANT A TO A TO
WAIT. FOR OTHER REASONS THEN
THEY MAY CHOOSE THAT OPTION AND
THAT'S WHAT HAPPENED IN THAT
CASE- THERE'S OTHER
CONVERSATIONS THAT HAPPENED
ALONG THE WAY WHERE IT'S A
JOINT. DECISION LAST WEDNESDAY.
THANK YOU WE HI AND WHAT. THEY
HAD A UP WHY MAIN FOR OVER
SEVENTY TWO HOURS AND THEY WERE
WORKING ON CREATIVE SOLUTIONS
TO BE ABLE TO STILL KEEP
OPERATIONS OPEN BUT AFTER
HAVING A PHONE CALL WITH THEM
SAYING HEY LOOK THIS IS NO
LONGER SAFE THEY AGREED AND
BECAUSE OF SEVENTY TWO HOURS
THE CAT THEY HAD ALL THE
TRANSFERRED MOST OF THEIR AND
SAFELY OTHER STERN. SO WITHOUT.
JUST REMAINING ENTRANCE FOR
SIX. MOST THE TIME CONVERSATION
THAT WERE IN AGREEMENT ITS RARE
EARTH IT WOULD HAVE TO COME
DOWN TO THE STATE SAYING NO
THIS IS ABSOLUTELY NOT SAFE BUT
THERE ARE CASES IN HISTORY
WHERE THAT HAS HAPPENED. SO I
MEAN I GUESS IT BE HELPFUL TO
THINK ABOUT- CERTAINLY
APPRECIATE THAT IT'S A
CONVERSATION SOMEONE HAS TO
MAKE A DECISION AND WHAT KIND
OF FACTORSGO IN THAT DECISION
I CERTAINLY. UNDERSTAND THAT-
EVERYONE'S TRY TO DO THE RIGHT
THING BUT IT'S POSSIBLE THAT
SOMEONE MAY. BE NERVOUS LIKE
WELL I'M CONCERNED ABOUT
LIABILITY YEAH SO EVEN THOUGH
YOU MAY SAY YOU KNOW WHAT AND
THAT'S THE THINGS THAT DON'T
SEEM TO. VERSUS THE VISUAL
SPOTS IN THE INSTITUTION OF.
THE COMMUNITIES THEY WILL WE
NEED THIS IS TO OPERATE YOU
KNOW THINGS ARE NOW SOME PEOPLE
ARE STILL COMING ETCETERA AND
THEY'RE LIKE WELL I'M WORRIED
THAT I'M GOING TO GET. DEL
SOMETHING ELSE IS HAPPEN AND
HOW WE- ADDRESS SOME OF THOSE
BARRIERS. DOES TO BE SURE AT
THE HEART. CAN PLAY. ROLE IN
NEEDS AS A SITE FOR- FOR
RECOVERY AND CARE FOR PEOPLE
DURING DURING A DISASTER. OKAY
OCEANS HI. NINETY THREE WEEKS
PANEL THANK YOU VERY MUCH
APPRECIATE. A MUCH WE'RE GOING
TO MOVE ON TO OUR NEXT PANEL
WHICH IS- ON THE HOSPITAL
PERSPECTIVE SO- TOM- BUT TO RAT
CATHERINE AUSTIN SCOTT. KELLY
MAY THIRD JED RIDING CRAIG
WAGONER PLEASE COME ON UP. IT
WILL HAVE YOU GUYS SELF
INTRODUCES YOU- AS YOU SPEAK IF
YOU DON'T MIND.
THREE AS WITH
THE PREVIOUS PANEL- WILL ASK IF
YOU CAN KEEP YOUR COMMENT OR
YOUR- PRESENTATION TO ROUGHLY
THREE MINUTES AND THEN WE'LL
WE'LL HAVE QUESTIONS FOR YOU
TO. OKAY MR WATER AT I HOPE I
SAID THAT RIGHT I APOLOGIZE IN
ADVANCE IF I DO YOU NO PROBLEM
THANK YOU FOR THE OPPORTUNITY
TO SPEAK TODAY MY NAME'S TOM
MUCH READ. I'M A SENIOR
PHYSICAL SCIENTIST WITH THE
RAND CORPORATION. AND OVER THE
PAST TWENTY YEARS I'VE BEEN
RESEARCHING DIFFERENT ASPECTS
OF DISASTER PREPAREDNESS AND
RESPONSE- RAN THE NONPROFIT
NONPARTISAN RESEARCH
ORGANIZATION HEADQUARTERED IN
SANTA MONICA. CALIFORNIA IT'S
IMPORTANT FOR ME TO EMPHASIZE
NOT A WE'RE AN INDEPENDENT
RESEARCH ORGANIZATION WE'RE NOT
HERE REPRESENTING ANY HOSPITAL
OR- ASSOCIATION I'M GONNA BE
RISING RESULTS OF A STUDY I
COULD LEAD RAND WAS SPONSORED
BY THE CALIFORNIA HOSPITAL
ASSOCIATION THE PRIMARY
OBJECTIVE OF THE STUDY WAS TO
PROVIDE AN UPDATE TO RANT
PREVIOUS. HI OF COMPLYING.
THIRTY THAT. SB NINETY FIFTY
TWO. OUR STUDY ALSO EXAMINE THE
AFFORDABILITY THE HOSPITALS OF
THIS ANTICIPATED SPENDING AS
WELL AS OPPORTUNITY FOR AN
CHALLENGES TO COMPLIANCE. I'M
AS WE'VE SEEN OF NINETEEN FIFTY
THREE REQUIRES A BY TWENTY
THIRTY. HOSPITAL BUILDINGS THE
PROVIDED TO CARE SERVICES MUST
BE ABLE TO REMAIN OPERATIONAL
AFTER AN EARTHQUAKE. I CAN SKIP
A LOT OF THIS ABOUT WHAT THEY
EED TO DO- I'LL JUST ADD IT WE
ASSUME THAT ALL SPC ONE
BUILDINGS WOULD BE REMOVED FROM
ACUTE CARE SERVICES AND DO NOT
INCLUDE THEM IN OUR PROCESS. SO
WE PRODUCE TO COST ESTIMATES
THAT WERE DESIGNED TO REPRESENT
THE UPPER AND LOWER BOUND TO
FUTURE COSTS THE LOW END
ESTIMATE IS FOR UPGRADING
ENTIRELY THROUGH RETROFITTING
OF EXISTING. BUILDINGS
INVESTMENT FOR STRUCTURAL
UPGRADING IS ENTIRELY THROUGH
NEW CONSTRUCTION OF REPLACEMENT
REPLACEMENT BUILDINGS ALONG
WITH NONSTRUCTURAL UPGRADING
THROUGH RETROFITTING OF ALL
BUILDINGS THAT REQUIRE ONLY
NONSTRUCTURAL SO IN OTHER WORDS
BE FACING STRUCTURAL AND
UPGRADING WAS IT ONLY NEED
NONSTRUCTURAL WE USE THIS
BRACKETING APPROACH BECAUSE
MOST. AS WE WITH IN THAT THEY
DID NOT YET KNOW WHETHER THEY
WOULD PURSUE RETROFITTING
REPLACEMENT OR SOME COMBINATION
AS OF SEPTEMBER TWENTY EIGHTEEN
TWO THOUSAND SEVEN HUNDRED AND
SEVENTEEN BUILDINGS AND THREE
HUNDRED NINETY FIVE HOSPITALS.
STATEWIDE REQUIRED- SEISMIC
UPGRADING. WE ESTIMATED THAT
THE STATE WIDE COST FOR
COMPLYING WITH SB NINETEEN
FIFTY THREE RANGES FROM THIRTY
TWO BILLION FOR THE
RETROFITTING OF APPROACH AND A
HUNDRED AND FORTY THREE BILLION
FOR REPLACEMENT. WE INDEPENDENT
VALIDATED A REPLACEMENT COST
ESTIMATE USING DIFFERENT DATA
SOURCES IN JANUARY RESULTS THAT
WERE CONSISTENT WITH OUR
ORIGINAL ESTIMATE. REINFORCING
OUR CONFIDENCE IN OUR COST
ESTIMATES. OUR IN OUR ANALYSIS
ALSO ESTIMATE EXAMINE HOW WELL
HOSPITALS COULD AFFORD THIS
ESTIMATED SPENDING WE RATED
EACH HOSPITAL ACCORDING TO
FINANCIAL HEALTH INDEX THE
CONSIDER SEVERAL FINANCIAL
INDICATORS THEN THRESHOLD
VALUES ARE DEFINED TO SIGN
INDEX SCORES TO ONE OF THREE
CATEGORIES- NO INDICATION OF
FINANCIAL DISTRESS POTENTIAL
FOR FINANCIAL DISTRESS AND
SEVERE- FINANCIAL DISTRESS. AND
APPLYING THE SCORING SYSTEM WE
FOUND THAT 22% OF CALIFORNIA
HOSPITALS ARE CURRENTLY IN
SEVERE FINANCIAL DISTRESS AND
12% HAVE THE POTENTIAL FOR
FINANCIAL DISTRESS. GREATER
FINANCIAL DISTRESS OCCURS
DISPROPORTIONATELY AMONG PUBLIC
AND ACADEMIC HOSPITALS AND
AMONG HOSPITALS THAT SERVE
HIGHER PROPORTIONS OF MEDI CAL
PATIENTS. TO ASSESS THE IMPACT
OF SEISMIC UPGRADING COSTS ON
THE HOSPITAL FINANCIAL HEALTH
WE COMPUTER HOSPITAL'S
FINANCIAL HEALTH INDEX SCORES
TO INCLUDE RETROFITTING COSTS
AS A LIABILITY. AFTER RE
COMPUTING THE PERCENT OF
HOSPITALS IN SEVERE FINANCIAL
DISTRESS INCREASE FROM 22% 240%
AND THIS INCREASE IS
DISPROPORTIONATELY BORNE BY
INDEPENDENT PRIVATE HOSPITALS.
COMMUNITY ACCESS BILLS AND
PUBLIC HEALTH CARE DISTRICT
HOSPITALS. IN ADDITION TO BEING
PUT INTO FINANCIAL DISTRESS
THESE HOSPITAL OWNERSHIP TYPES
ARE COMPARATIVELY LESS
COMPARATIVELY LESS CAPABLE. OF
ABSORBING FINANCIAL DISTRESS
WHICH MAGNIFIES THE IMPACT OF
THE INCREASE IN DISTRESS ON
OVERALL AFFORDABILITY. AND THIS
REPRESENTS AND ANY INEQUITABLE
IMPACTS OF DEFECTIVE SB
NINETEEN FIFTY THREE COMPLIANCE
ON CERTAIN GEOGRAPHIC AREAS AND
I'M LOWER SOCIO ECONOMIC STATUS
POPULATIONS SERVED BY THESE
KINDS HOSPITALS. OUR ANALYSIS
ALSO EXAMS AND EXAMINE SOME
ALTERNATIVE APPROACHES TO
MEETING THE GOALS OF SB
NINETEEN FIFTY THREE. SUCH AS
ALTERNATIVE FINANCING MODELS
REGIONALIZATION AND REVISED
SCHEDULING AND I'D BE HAPPY TO
DISCUSS THIS FURTHER THERE'S
INTERESTS. ARE THANK YOU VERY
MUCH FOR THE OPPORTUNITY TO
TESTIFY RIGHT THANK YOU VERY
MUCH THE SCOTT. AFTERNOON
CAPTAIN SCOTT I KNOW HOW TO
PUSH A BUTTON GOOD AFTERNOON
CAPTAIN SCOTT WITH CALIFORNIA
HOSPITAL ASSOCIATION I JUST A
COUPLE OF THINGS BEFORE- OUR
HOSPITALS HAVE AN OPPORTUNITY
TO TALK ABOUT THEIR EXPERIENCE
WITH THE SEISMIC MAN I'M FOR AS
YOU FROM OFF WE'VE GOT NINETY.
HOSPITALS THAT MEET IN STANDING
REQUIREMENTS SUCH ISSUE THAT
WHILE IT'S TAKEN A LONG TIME TO
GET THERE- AS YOU HEARD FROM
OFF FOR THEIR VARIOUS ROADS WE
HAD TO TAKE IN AND WE ARE
FINALLY THERE- INCOME XIN
COUPLE YEAR. NOT BE A TO AND
EMPLOYEES INCIDENT MANDATE
SECONDLY- WE'VE BEEN ASKED THE
QUESTION WHY ARE WE TALKING
ABOUT THIS TEN YEARS AWAY- IT'S
AN IMPORTANT QUESTION FOR NOW
BECAUSE IT TAKES AT LEAST TEN
YEARS TO DO THE KIND FOR
FITTING AND MORE IMPORTANTLY
REPLACING THAT WE'RE TALKING
ABOUT FOR TWENTY THIRTY THE
MAJORITY OF OUR HOSPITALS WILL
LIKELY BE A REPLACEMENT- IT
TAKES A COUPLE YEARS TO WORK
THROUGH THE PLAN A COUPLE YEARS
TO WORK THROUGH THE LOCAL
PLANNING PROCESS. PLAYERS TO
WORK THROUGH THE OFF PROCESS ON
A COMPLEX PROJECT LIKE THIS AND
THEN AT LEAST FOUR YEARS TO
BUILD SO FOR US TO CUT TWENTY
THIRTY MANDATE OUR HOSPITALS
ARE CONTEMPLATING THIS NOW
WHICH IS WHY THE HOSPITALS ARE-
AND WILLING TO TALK ABOUT IT
I'M AND LASTLY I. WE WILL TO
TALK ABOUT. I'M THANKS FOR A
HOUSE THERE AND IS WITH US ON
THEIR VARIOUS WAYS WHICH WE MAY
OUR DOES PLAN BUT WE ARE
PLANNING SEISMIC TODAY OUR
HOSPITALS PLAN- AND TO
OPERATIONAL PROCEDURES RELATED
TO A BIG EARTHQUAKE TODAY
THEY'RE NOT WAITING FOR TWENTY
THIRD PLANNING AN EXERCISE IN
THESE TODAY AS WAS POINTED OUT
BY THE SECOND PANEL SO I THINK
IT'S IMPORTANT TO REMEMBER THAT
I'M MORE HOT. ARE WORKING YOU
READY. FOR THE BIG EARTHQUAKE
AT ANY GIVEN TIME SO I'D LIKE
TO- IF I COULD DO A QUICK
INTRODUCTION I'M TODAY YOU'LL
HEAR FROM THE THREE HOSPITALS
WE HAVE CRAIG WAGONER FROM.
COMMUNITY COMMUNITY REGIONAL IN
CLOVIS REGIONAL MEDICAL CENTER
WILL TALK ABOUT THE MULTIPLE
BILLIONS OF THEY WILL FACE-
FROM CINEMA VALLEY- MULTIPLE
BILLIONS I APOLOGIZE FOR THE BE.
HI KELLY MY OTHER- CO CINEMA
VALLEY- WHO ALSO TALK ABOUT-
FUNDING ISSUES AND THEN THE
EFFORTS THEY HAD TO REBUILD
THEIR KEY DE. AND THEN FROM MAD
RIVER CHAD BREAD BECAUSE A RULE
HOSPITAL AS YOU DISCUSSED UP
NORTH WHO HAS UNIQUE ISSUES
RELATED TO THE RETROFIT OF A
SINGLE STORY BUILDING. SO WHY
DON'T WE START WITH KELLY. GOOD
AFTERNOON I'M KELLY MOTHER CEO
AT CINEMA VALLEY HOSPITAL-
SNOWMOBILE HOSPITAL IS A
DISTRICT HOSPITAL TO SMALL
ACUTE CARE FACILITY
GEOGRAPHICALLY ISOLATED. THIRTY
MINUTES FROM THE LOCAL
EMERGENCY DEPARTMENT AND WE
HAVE DOUBLE THE SENIOR
POPULATION THAT MOST HAVE. WERE
THE LARGEST EMPLOYER WE HAVE A
HUNDRED MILLION DOLLAR ECONOMIC
IMPACT ON OUR COMMUNITY. WE
HAVE A SIXTY MILLION DOLLARS IN
REVENUE AND MOST OF THE
PHYSICIANS RELY ON US FOR
SUPPORT AT THE HOSPITAL WAS NOT
THERE. WE DON'T THINK MANY
PHYSICIANS WOULD BE ABLE TO
AFFORD TO STAY IN THE COMMUNITY.
RESOURCES HAVE ALREADY ALWAYS
BEEN LIMITED WE ARE ONE OF
THOSE HOSPITALS THAT IS IN
FINANCIAL DISTRESS AT TIMES BUT
ABOUT TWENTY YEARS AGO THE
COMMUNITY DECIDED TO INVEST IN
THE HOSPITAL. THEY PASSED A
PARCEL TAX WE WERE THEN EIGHT
TO FOUR THE OPERATE. IT CAN YOU
TO. IT'S FROM MEDICAID. AND
MEDICARE. ABOUT THAT SAME TIME
WE HAD TO WIN NOW KNEW WE WERE
GOING TO BE ALIVE NOW WE HAD TO
FACE THE SEISMIC. ISSUE WE
TRIED SEVERAL TIMES A BY THE
THIRD TIME WE PASSED AT THIRTY
FIVE MILLION DOLLAR. GEO BOND.
THAT WASN'T ENOUGH TO REPLACE
THE HOSPITAL BUT IT WAS
CERTAINLY ENOUGH TO GET US TO
AT LEAST BE SAFE FOR THE TWENTY
TWENTY REQUIREMENTS WOULD BE.
OUR FIRST PRIORITY AND THEN WE
CHOSE THE EMERGENCY IN SURGERY
DEPARTMENT TO REPLACE INPUT AND
IT TO A TWENTY THIRTY BUILDING.
SO WE BOTH MET THE INTENT OF
THE CODE TAKING THOSE ESSENTIAL
SERVICES THAT ARE NEEDED BY THE
COMMUNITY. AND IN THE TWENTY
THIRTY BILL. LOOK AT A FOR
TWENTY. WE HAVE IN TOWER THAT
HAS A NOW CENSUS TEN. WE KNOW
THAT IN EMERGENCIES WE'VE
SUFFERED THEM THROUGH THE FIRES
BEFORE THAT WE CAN EASILY
TRANSFER PATIENTS OUT THERE ARE
SURROUNDING HOSPITALS AND WE'VE
ESTIMATED THAT THE COST OF
REPLACING ARE IMPATIENT TOWER
IS OVER ONE HUNDRED MILLION
DOLLARS. THERE IS ABSOLUTELY NO
WAY THAT OUR UNITY IS GOING TO
BE ABLE TO SUPPORT ANOTHER BOND
IN ADDITION TO THE TAXES AND WE
WOULD HAVE TO CLOSE IF WE HAD
TO MEET THE TWENTY THIRTY
EXPECT. WE'RE A THING WHICH I
THINK AND IT ALL AS AN
ALTERNATIVE. IS EMERGENCY IN
SURGERY COMPLY WITH THE TWENTY
THIRTY GUIDELINES AND THEN WE
ARE ABLE TO OFFER THE ESSENTIAL
SERVICES THAT WE PROVIDE WHICH
IS MOSTLY OUTPATIENT. THANK YOU.
HI THERE I'M CHEN READ DIRECTOR
OF ANCILLARY SERVICES AND
SAFETY AT MAD RIVER COMMUNITY
HOSPITAL AND- I'M HERE
REPRESENTING MAD RIVER
COMMUNITY HOSPITAL I BROUGHT A
COUPLE OF PICTURES- I BELIEVE
SENATOR PAN HAD HAD ASKED A
QUESTION ABOUT- ONES THAT LOOK
LIKE IN SOME HOPEFULLY BE ABLE
TO COMMUNICATE WHAT IT MIGHT
LOOK LIKE AND FEEL LIKE FOR OUR
SINGLE STORY WOOD FRAME
HOSPITAL. WHICH IS IT A SEE TO
IT IF IT WERE ACTED SO WE'VE
ACTUALLY AS A ASSEMBLY MEMBER
WOULD POINT IT OUT FOR US WE'VE
ALREADY HAD THREE EARTHQUAKES I
THREE LARGE INTO HOSTILE NINETY
SEP TO THE FIRST NINETY EIGHTY
I WAS SEVEN POINT FOUR MEG AND
IN THE NIGHT SIXTY TWO WE HAD A
SEVEN WE WANT A MORE. WE HAD A
SIX EARTHQUAKE AND DOT BACK TO
THOSE. ALL HEADS BOB
INSTRUCTION NOT A BROKEN NINETY
A CRACK PIPE. SO AS A SINGLE
STORE RURAL WE SHOULDER A BIG
COST IF WE'RE TO PURSUE TWENTY
THIRTY COMPLIANCE AND ONE OF
THE ELEMENTS MANY ELEMENTS FOR
SEISMIC COMPLIANCE IS THE THING
CALLED MICRO PILES AND SO
THAT'S WHAT THIS IMAGES WHEN
MICHAEL PYLE LOOKS LIKE IN A
HOSPITAL. THE NEXT IMAGE. RIGHT
COULD BE THAT. ALL RIGHT I GOT
MULTIPLE SKILLS ALL THE BAD
EXES HERE THOSE ARE THE AREAS
WITHIN OUR HOSPITAL THAT
REQUIRE A MICRO PILE. IT'S NOT
SUPPOSED TO BE BEAUTIFUL BUT
YOU SEE THE MAGNITUDE OF THAT
THOSE KIND OF TWO THINGS
IMPACTING PATIENT CARE AND SO
WE'VE GOT HUGE DISTRACTIONS
GOING ON WHILE WE'RE TRYING TO
SHUFFLE PATIENTS AROUND WE HAVE
TO CLOSE CERTAIN SECTION OF THE
BUILDING. AND THEN. BILL MIKE
PYLE SO THIS IS JUST ONE SMALL
ELEMENT AND MEANWHILE AS WERE
CLOSING ON THIS PATIENT CARE
AREAS WERE ALSO LOSING REVENUE
FOR OUR- LITTLE. AS THE RURAL
HA. WE THIS YOU KNOW WHAT
MATTERS MOST WITH WHERE WE PUT
OUR MONEY AND WE BELIEVE THAT
EVERY DAY PATIENTS THERE WHAT
WE ACTUALLY IT IS NEW RADIOLOGY
EQUIPMENT WE NEED NEW ERROR
HANDLERS. WE NEED A VERY SIMPLE
THINGS LIKE RESTROOM UPGRADES
NEW FLOORING- GOING AFTER THIS-
THIS REGULATION AND TRYING TO
ACHIEVE IT- WE HAVE TO SHOW UP
BETWEEN TWENTY AND THIRTY
MILLION DOLLARS. F. REST TO
REALISTICALLY VETERAN MAKE IT
AHA. I'M THAT'S NOT SU. PLASTIC
FOR A HALF ARE SO NINE THE
CLOSE. AND THIS IS FOR A YOU
KNOW FOR A SINGLE STORY WOOD
FRAMED- A BUILDING THAT HAS
SUCCESSFULLY SURVIVED THREE OF
QUAKES MAJOR EARTHQUAKES UP TO
THIS POINT. WE'RE URGING YOU
ARE REQUESTING THAT YOU GIVE
SERIOUS CONSIDERATION FOR-
HOSPITALS LIKE OURS THAT- TO
NOT HOLD TO THAT TWENTY THIRTY
REQUIREMENT- ESPECIALLY FOR
SINGLE STORY WOOD FRAME
HOSPITAL LIKE OURS WITHOUT YOUR
HELP- WE'RE NOT SURE THAT WE
COULD STAY OPEN- WE WOULD HAVE
TO CLOSE THE HOSPITAL WE WORRY
THAT OTHER FOLKS OBVIOUSLY HERE
AT. WITH THIS NAPA CLOSER
HOSPITAL AS WELL. IT DOESN'T
SERVE OUR COMMUNITY IT DOESN'T
SERVE PATIENTS. WE NEED TO
INVEST MONEY IN PATIENT CARE
NOT NECESSARILY ELIMINATED IN
THIS CASE. THANK YOU. GOOD
AFTERNOON MY NAME'S CRAIG
WAGONER ON THE CEO OF COMMUNITY
REGIONAL MEDICAL CENTER LOCATED
IN- DOWNTOWN FRESNO AND JUST-
THREE THINGS I'D LIKE TO COVER
THIS AFTERNOON- ONE IS OUR-
UNIQUE REGION IN THE PATIENTS
WE SERVE OUR COMMITMENT TO
SAFETY IN RED READY MISS AND
ALSO OUR SEISMIC RISK IN
FRESNO- ARE FOR COUNTY REGION
WHICH INCLUDES- FRESNO KING
MADERA. TULARE COUNTIES-
SUFFERS OF COURSE AND
DISPROPORTIONATE HEALTH BURDENS
INCLUDING SOME OF THE HIGHEST
PART OF THE- IN THE STATE TO AT
TWENTY FIVE PER PAN AND
EMPLOYMENT AT EIGHT PERCENT.
AND HEALTH THIRTY SUCH AS
OBESITY DIABETES AND WE SERVICE
VERY DIVERSE- POPULATION- THIS
SPEAKS MORE THAN A HUNDRED
DIFFERENT LANGUAGES INCOMES FOR
FROM A VARIETY OF CULTURAL
BACKGROUNDS. AT SIX HUNDRED AND
EIGHTY FIVE ED. UP GRAPH FOR
THE. ALL UP IN FRONT OF YOU
COMMUNITY RIDGE MEDICAL. IS A
LOT SAFETY NET HAAS IN THE
STATE ONLY SO. TO LA COUNTY
USC- FOR MEDI CAL DISCHARGE- WE
RUN A COMPREHENSIVE LEVEL ONE
TRAUMA CENTER BURN CENTER
PEDIATRIC TRAUMA NEONATAL ICU.
WHICH SERVES THE REGION BETWEEN
LOS ANGELES AND- SACRAMENTO.
85% OF OUR PATIENTS ARE COVERED
BY GOVERNMENT INSURANCE 53% OF
THOSE PATIENTS- HAVE MEDI CAL
AND WE PROVIDE ACTUALLY A
HIGHER LEVEL OF CARE- THAN MOST
HOSPITAL REGION TAKEN REFERRALS
FOR CLINICS. OTHER OUTLETS IN
HOT WHEELS RECEIVING ABOUT SIX
HUNDRED PATIENTS MONTH- IT. IS
A HIGH LEVEL CARE TRANSFERS.
CAN YOU YOU REGIONAL IS ALL SO
HOME. TO UCS FOR AS GRAD
MEDICAL EDUCATION PROGRAM WHICH
WE TRAIN ABOUT THREE HUNDRED-
AND MEDICAL AND GRADUATE
MEDICAL STUDENTS A YEAR AND WE
GRADUATE ABOUT A HUNDRED
PHYSICIANS ANNUALLY FOR. A
PATIENT ANDEMPLOYEE SAFETY OF
COURSE IS EXTREMELY- IMPORTANT
TO US AND WE ARE IN COMPLIANCE
WITH THE TWO HUNDRED AND WITH
THE TWENTY TWENTY STANDARDS IN
COMPLETED CONSTRUCTION OF A
FIVE STOREY TRAUMA IN CRITICAL
CARE BUILDING IN TWO THOUSAND
OR- IS COMPLY. TWENTY STANDARDS
HOWEVER. A TWO OF OUR PATIENT
CARE BUILDINGS NOT MEET THE
TWENTY THIRD STANDARDS AND IS
PROJECTED ON THE SCREEN AND
YOU'LL SEE THE HASHED OUT-
AREAS THAT'S A SIX. SEVENTEEN
OUT OF OUR SIX EIGHT FIVE BEDS
OR 90% OF. WILL TO BE REPLACED
AT BECAUSE OF OVER TO BE.
DOLLAR AS ONE OF THE NINE
LICENSE COMPREHENSIVE HOSPITALS
IN OUR STATE OUR TRAUMA%
CRITICAL CARE BUILDING HOUSES
EMERGENCY SERVICES- WITH
SURGICAL SUITES POST SURGICAL
SERVICES AND WE CURRENTLY HAVE
NINETY SIX HOURS OF UTILITIES
AND SUPPLIES EXCEEDING THE
SEVENTY TWO HOUR- REQUIREMENT
IN BECAUSE OF OUR CRITICAL CARE
BUILDING IF A SEISMIC ACTUATION
OUR BASES. WE'RE DECISION TO
DESTINATION LOCATION FOR
EMERGENCIES AT TIMES OF
DISASTERS WE ARE REGULARLY
PLACED ON CALL TO RECEIVE
PATIENTS IF HOSPITAL
EVACUATIONS ARE NECESSARY AS
WITH THE SITUATION. FOR THE
RETURN RIDGECREST EARTHQUAKE IN
KINCAID FOR A FIRE AND
CALIFORNIA. OUR HOSPITAL IS
LOCATED IN THE VICINITY
TRADITIONALLY CHARACTERIZED BY
LOW TO MODERATE SEISMIC
ACTIVITY BUT WE HAVE BEEN
CORRELATED WITH HIGH SEISMIC
RISK IS WE ARE SITUATED BETWEEN
THE EASTERN SIERRA NEVADA FAULT
IN THE DISTANT. SAN ANDREAS
FAULT WHICH INCLUDES THE
WESTERN PORTION OF FRESNO
COUNTY SO UNFORTUNATELY WE
REPEAT THE SAME BROAD BRUSH- AS
OTHERS THAT MAY BE DIRECTLY
LOCATED NEXT TO A FAULT LINE SO
OUR REGION DEPENDS ON THIS
HOSPITAL THE SAFETY NET
HOSPITAL TO BE READY AT ALL
TIMES. BUT OUR SAFETY NET
STATUS MAKES IT CHALLENGING.
FUND TO BE IN DOLLARS OF COSTS
TO MEET THE TWENTY THIRTY
SEISMIC STANDARDS THANK YOU.
THANK YOU. QUESTIONS SENATOR
MONNING THANK YOU MISTER
CHAIRMAN JOINT CHAIRS AND STAFF
FOR ORGANIZING THIS- QUESTION
FOR THE LAST WITNESS- FROM
COMMUNITY REGIONAL YOU HAVE THE
REPLACEMENT COST IT TWO BILLION
DOLLARS IS THERE AN OPTION FOR
RETROFITTING REINFORCEMENT
SOMETHING SHORTER FOR PLACE
YES- THE RETROFIT THAT YOU JUST
A LITTLE OVER ONE BILL. ABOUT
HALF THE PROJECT ADDRESS MUCH
AND VERY INVASIVE AS WELL MMHM.
AND I KNOW WE HEARD FROM THE
PRIOR PANEL. EACH HOSPITAL SITE
IS DIFFERENT EACH CAMPUS IS
DIFFERENT THERE'S NOT. A
UNIFORM FIX I'M WONDERING IF-
ALLOWING ANY GREATER
FLEXIBILITY IN THE EVALUATION
OR RANKING- COULD. COULD ADAPT
BETTER TO THE UNIQUE NATURE OF
THE DIFFERENT HOSPITALS- MAYBE
FOR THE CJ REPRESENTED SURE- I
THINK I'D ACTUAL PROBABLY
DEFERRED OFF PUT MORE IS I'M
NOT A STRUCTURAL ENGINEER BUT I
THINK- AS WE HAVE- MATURE TO
SEISMIC MANDATE- PARTICULARLY
THE US STAY STANDING MANDATE-
SO HAVE THE REQUIREMENTS I
THINK WE ARE NOW DOWN TO A
PLACE WHERE. WE WHEN YOU TALK
FULLY OPERATIONAL- AND WHAT IS
OPERATIONAL EXCUSE ME REASON
WHAT FOR CATIA OPERATIONAL IT
NOW GETS DOWN TO- WHETHER THE
BUILDING WILL BE ABLE TO
OPERATE AFTER A DISASTER AND I
AND I ALWAYS STRUGGLE WITH.
FOLKS AT THE STATE AND I HOUSE
HOW OPERATED WITH THE BUILDINGS
WE HAVE TODAY AFTER DISASTERS.
SO I THINK THAT OUR SQUAD
STRUGGLING OR OUGHT NOT SHOWING
OFF BODS WORKING FOR STANDARD
THAT FROM AN ENGINEERING
STANDPOINT. I'M CAN ASSURE THAT
LEVEL OF SECURITY- AND I THINK
WE APPRECIATE THAT BUT AT THE
SAME TIME OUR HOSPITALS HAVE.
SCHOOL EXPERIENCE OF HAVING
SURVIVED VARIOUS DIFFERENT
DISASTERS WITH THE STRUCTURES
WE HAVE TODAY SO WE CAN
PROBABLY TAKE A LOOK BASS- THE-
MANDATE SHORED. I THINK WHAT
WE'RE TRYING TO FIND IS THE
BALANCE BETWEEN WHAT WE- WHAT
WE KNOW WE DO IN DISASTERS
ALREADY. WITH THE STRUCTURES
AND WE HAVE TODAY- KNOWING THAT
THEY'LL STAY STANDING- AND WHAT
IS ENGINEERING WISE THE RIGHT.
YOU KNOW OR THE- THE-
REQUIREMENTS RELATED TO
OPERATIONAL THANK YOU AND I
THINK NOT SO MUCH FOR THIS
PANEL BUT MAYBE MORE OF A
COMMENT I KNOW A LOT OF THE-
SAFETY PRECAUTIONS. FOLKS LINED
XIN BUT IT ALSO INCLUDES
EMPLOYEES AND STAFF- BUT
WHETHER THERE'S CALCULUS IN THE
TERMS. YOU FACILITY IS NOT
OPERATIONAL OR REQUIRES PATIENT
EVACUATION. IF THERE'S ANY
CALCULATION IN THE RAND REPORT
OR OTHERS. OF IMPACT YES LOST
JOBS ECONOMIC. TO MAYBE THE
REPRESENTATIVE IN THE RAND
REPORT. GREAT QUESTIONS BUT NO
WE DIDN'T LOOK AT THAT AT ALL
SO ON FOR SO I CAN'T REALLY
COMMENT. SO I THINK AS WE MOVE
FORWARD ONE OF THE BOUNCING
AXES. IN SAFETY WORKER SAFETY
IMMEDIATE RISK BUT THEN ALSO
CONSEQUENCES OF. THIS PLACE TO
NOT ONLY PATIENTS BUT THIS
PLACED. POLICE IN TIME OF
CRISIS SO DID YOU HAVE A
COMMENT ON IT WOULD ONLY ARGUE
THAT THE COMMUNITY AT LARGE IS
BEING HIT BY THIS EARTHQUAKE
REMEMBER TALKING ABOUT AN EIGHT
POINT NO SO TO THE EARLIER-
POINT I THINK IT WAS OF DOCTOR
PANS- THE HOSPITAL- MAY BE
OPERATIONAL BUT THERE MAY BE
NOTHING OR NOT MUCH AROUND IT
THAT'S OPERATIONAL. THROUGH
WHAT WHAT ARE WE RETURNING TO
OR SING SOME OF THAT IN
PARADISE UNFORTUNATELY AND
THERE'S OF THAT IN OTHER
COMMUNITIES IT TOOK NAPA
DOWNTOWN WILD THREE YOU KNOW TO
RE- GAIN THEIR STATURE I THINK
THERE ARE STILL SOME BUILDINGS
THAT MIGHT BE AT RISK SO I
THINK WE'RE TRYING TO ALSO
LEVELS AT OUR SCHOOLS IN THE-
UNITIES FARM UNDER. MAKE ME IN
WHAT LOOKS LIKE ALL. I'M NO
WATER NO POWER NO SEWAGE. AND
THERE CAN YOU. THERE ARE.
LESSONS LEARNED MEAN FROM THE-
WILD FIRE JUST ASK. I THINK DE
PAN EARLIER QUESTION TO THREE
AND FOR. IN REBOUND IT'S ONE
THING TO HAVE FUEL TO KEEP
GENERATORS GOING FOR SEVENTY
TWO HOURS. BUT IT'S- IT'S IN
ADDED CATASTROPHE OF THOSE
POWER LINES AREN'T RESTORED IF.
SEWERS OUT IF WATER SO TO THINK
THAT HAS TO BE PART OF THE-
CALCULUS OF. IN SPAIN DISASTERS
AS WELL BUT- THANK YOU FOR
CHAIRS WHO. THANK YOU SO MUCH
FOR YOUR PRESENTATION ACTUALLY
IS MISTER COLEMAN FOR MUCH BUT
THE MIND COMING BACK UP TO THE
PODIUM. THANK YOU. THE ****
YEAH I WANNA THANK THE
PRESENTERS FOR THEIR
PRESENTATIONS. SO. YOU KNOW I
APPRECIATE THE HOSPITAL'S
TALKING ABOUT THE CHALLENGES
BECAUSE OF CEDARS COMPETING
DEMANDS FOR RESOURCES- AND- YOU
KNOW ONE IS OF COURSE ASSURING
WE HAVE A- BOTH A SAFE FACILITY
FOR THE PATIENTS THAT ARE IN
THE FACILITY AT THE TOP AND THE
SIXERS STRIKES WELLS OF COURSE
THE WORKERS WHO ARE WORKING IN
THAT FACILITY AS WELL. JUST
CLARIFY I UNDERSTAND THAT THE
TWENTY THIRTY STANDARD IS
FOCUSED ON THE EMERGENCY
DEPARTMENT THE SURGICAL SUITES
AND POST SURGICAL SERVICES
BEING UP OPERATE FOR SEVENTY
TWO HOURS SO THAT'S THAT. AND
ACTUALLY FOR- MISTER- COLEMAN-
THAT DAY GET THAT CORRECTLY
THAT AND THAT IS THAT FOR THE
NONSTRUCTURAL SIDE OF THINGS.
CURRENTLY THE LAW REQUIRES ALL
ACUTE CARE SERVICES TO BE-
FUNCTIONAL INSOFAR AS
PRACTICAL. OKAY THAT NOT JUST
THOSE PARTICULAR SERVICES ALL
ACUTE CARE SERVICES ALL RIGHT
SO THAT MEANS THE ENTIRE-
HOSPITAL YOU ANY BUILDING THAT
IS PROVIDING A TWO CAR SERVICE
FOR EXAMPLE. IF YOU HAVE
EMERGENCY DEPARTMENTS AND
SURGICAL- THEY NEED CLINICAL
LABS THE PHARMACY IS THERE A
LOT OF OTHER. COMPONENTS OF A
HOSPITAL THAT STILL NEED TO
FUNCTION AND FOR THOSE TO BE
ABLE TO FUNCTION AS WELL SO FOR
ALL THOSE ANCILLARY. SERVICES
OKAY RIGHT NEXT. ONE FIVE SO IN
TERMS OF. WE'RE LOOKING AHEAD
THIRD NOW WE TALK ABOUT THE SPC
TO TWENTY OF ALL THE BUILDINGS
IS NOW WE HAVE TO WE HAVE
STRUCTURAL OF THE NONSTRUCTURAL
AND- SO IN TERMS OF. ISN'T WELL
MAYBE IT'S MORE QUESTION FOR
THE HOSPITALS AND HOSPITAL
ASSOCIATION IS AND I REALIZE
THAT IT'S A MUTUAL BURDEN BUT
AS THE MAIN BURDEN R. COSTA
MAYBE THE RIGHT PERSON TO TALK
ABOUT THIS- THE DOCTOR FOR A
TOUR AT IS THE MAIN BURDEN. TO
GET STRUCTURAL POINT- SO
BASICALLY BRING THE SPC TO IN
COMPLIANCE OR IS THE STARS AT
THE NONSTRUCTURAL THE NPC
REQUIRE THAT'S THE MAIN
CHALLENGE FOR A FINANCIALLY FOR
HOSPITALS THAT SHE'S. AT YEAH.
YEAH SO AS FAR AS- TOTAL
CHALLENGE I ANSWER FINE ARE
ESTIMATES WHAT OR IT WAS AROUND
HALF OF IN THE FITTING. AND
HALF THE STRUCTURAL AND HALF
WAS NONSTRUCTURAL OKAY- AS FAR
AS THE OTHER IMPACTS TO HAVE TO
TALK TO THE HOSPITAL'S. YEAH I
WOULD AGREE WITH THAT- I THINK
THE STRUCTURAL- PIECE
REPRESENTS- WHAT WE SEE IS THAT
LARGER FINANCIAL SORT OF STEEL
BEAMS AND CONSTRUCTION PIECE
AND THE NONSTRUCTURAL- CREATE
SOME CHALLENGES- OPERATIONALLY
AS WELL WE SORT OF PUT IT IN A
COUPLE OF BUCKETS SO WE HAVE
HOSPITALS THAT EVEN IF THEY-
ARE. BEING FOR THE INITIAL
PIECE- THEY HAVE SOME ISSUES
WITH THEIR OF BEING LANDLOCKED
AND MOVING SERVICES AROUND SO
IF HOSPITALS THAT MIGHT HAVE
SIX BUILDINGS AND YOU CAME OUT
AND IF YOU NEED TO RETROFIT FOR
OF THE BUILDING. LOOK AT THIS
PIC. NEED TO BE DIRECTOR OF.
CURRENTLY HAS SERVICES AND ITS
UNIT TO MOVE ONCOLOGY TO A
BUILDING THAT WILL MEET THE
REQUIREMENT- AND DOC OF WHAT.
IF YOU'RE NOT GOING TO TAKE
DOWN IN OFFICE BUILDING TO PUT
UP WITH IT TO MOVE DOC RETURN.
THE CAT EIGHT A FACT CAN BE
EQUALLY IS JUST TO SIR SO WE
HOSPITAL THE FIT AND BUCKET.
AND AS YOU HEARD TODAY WE HAVE
HOUSE THAT FOR IN THE BOX OF
JUST NOW BEING ABLE TO AFFORD
IT SERVE A COUPLE OF DIFFERENT
BOX OF ISSUES FOR HOSPITALS-
DEPENDING ON THE REGION IN THE
TYPE OF HOSPITAL. THE
NONSTRUCTURAL CREATES. RACIAL
CHALLENGES IT AND POP WOULD
KNOW THIS AS WELL BECAUSE SOME
OF THOSE ARE YOU TO TEAR OPEN A
WALL- AND IT'S THE PLUMBING
PAGES AND NOT I'M STOCK IN
TRADE OPERATIONAL CHALLENGES AS
WELL. I SORRY I JUST WANNA
CLEAR. THE NO FOR STATE. SURE
AT A GIVEN HOSPITAL IT'S A MUCH
MUCH MORE EXPENSIVE FOR AS PC
THE REASON IT'S ABOUT HALF
STATEWIDE AS FAR FAR MORE
BUILDINGS NEED ONLY
NONSTRUCTURAL- BRATCHER
UPGRADING. SO FOR THE ****
STATEWIDE IT'S ABOUT HALF AN
HAPPEN FOR A BUILDING IT'S FAR
MORE EXPENSIVE TO THE
STRUCTURAL ON THE OTHER ONES
ARE SPC TO THE NEED TO DO
STRUCTURE UPGRADES RIGHT. OKAY
AND THEN I GUESS THE QUESTION I
HAVE IS THAT- MISS COLEMAN I
KNOW AND WHEN YOU PRESENTED. WE
TALKED ABOUT INCORPORATING THE
SEISMIC RISKIN TERMS OF WHAT.
WE'RE HEARING STORIES VALLEY'S
FROM AT LEAST OF THE PEOPLE
PRESENTED HERE MY HOSPITAL
STILL STANDING IN OPERATION
WE'VE HAD THREE EARTHQUAKES
ETCETERA- SO CAN YOU. CAN SIGN
ALL THE STANDARD. THIS WILL
PRESENT THE FACT THAT THERE.
HOUSE ARE STILL STANDING. AFTER
EARTHQUAKES IN YOU'RE SAYING WE
STONE TO REST YOUR HOUSE. CAN
YOU. PERHAPS ADDRESS HOW ASH IS
A- THE ISSUE. THANK YOU FIRST
OF ALL MOST OF THESE BUILDINGS
HAVE NOT SEEN WHAT WE CALL THE
DESIGN EARTHQUAKE OKAY SO THEY
MAY HAVE SEEN SOME LARGE
EARTHQUAKES SIX POINT ALL UP IN
SOME IS SET UP TO SEVEN- BUT
MANY OF THESE LOCATIONS ARE
CAPABLE OR OUR FAULTS ARE
CAPABLE OF AN EIGHT HOUR. OR
LARGER EARTHQUAKE THAT THESE
HAVE NOT BEEN SUBJECTED. AND OF
COURSE THAT THE LIGHTER MEXICO.
RECKONS A MATTER OF WIND THAT
IS GOING TO HAPPEN NOT IF IT'S
GOING TO HAPPEN BASED ON. WHAT
GEOLOGISTS TELL US. AND SO-
THAT IS TAKE INTO CONSIDERATION
IN THE STRUCTURAL CAPACITY THE
BILLING SECONDLY AS I
MENTIONED- IN THESE BUILDINGS
ARE BUILT FOR THE ACT. OF THOSE
STRUCTURAL CODES. DID NOT HAVE
A COVER OF LATERAL RESISTANCE
OR SEISMIC SAFETY. AND SO MANY
OF THESE BUILDINGS HAVE
STRUCTURAL WEAKNESSES. THAT IF.
THEY ARE. EXPOSED TO THESE
DESIGNER QUAKES- COULD HAVE
CATASTROPHIC EVENT OF RESULTS.
OKAY AND PERHAPS MAYBE- THE
HOSPITAL'S MIGHT. AND IF YOU
WANT A RISK. TO THAT TERMS OF
FEAR CONVERSATIONS DAS POTTER
WITH OTHER PEOPLE CONSULTANTS
REGARDING. I MEAN I KNOW YOUR
HOSPITAL DID SURVIVE SEVERAL
EARTHQUAKES I. SEE GOT- WHICH
DOMINO'S TALKING THAT MS FROM
THE MAD RIVER MAYBE CAN ADD AND
I REALIZE YOU'RE COMPETING
DEMANDS BUT NO WHAT WE HEARING
IS THAT WEALTH FROM THE LARGER
ONE I MEAN I REALIZE YOU DON'T
KNOW WHEN THE LARGER ONES GOING
TO HIT AND HOW MANY YEARS THAT
WILL TAKE BUT TH SAME TIME.
GOD FORBID. SOMETHING HAPPENS-
WE'RE TRYING TO BALANCE THAT
RISK AGAINST. IMMEDIATE NEEDS
CAN YOU SPEAK TO THAT WHAT I
CONVERSATIONS YOU'VE HAD WITH
US FIVE OR OTHER CONSULTANTS
ABOUT THE RISKS THAT. THE YOUR
TOP STRUCTURE HAS TO A LARGE
EARTHQUAKE EVENT THAT MIGHT
HAPPEN IN YOUR COMMUNITY WHY NO
THEY WEREN'T ACTIVE CON ALL CAN
SPEAK TO IS THAT WE'RE NOT
CONVERSATION WITHOUT HOT AND
WE'VE BEEN COLLABORATING AND
GAVE GIVEN MEDIA FEEDBACK ON
THE RECENT CHANGES. HAS SOME OF
THE EXAMPLES HE MENTIONED IN
HIS IS TALK WE'RE WE'RE BECAUSE
WE WERE SEEING SEEN CABINETS IN
OUR BROOM CLOSETS THAT WE'RE
GONNA HAVE TO TEAR UP THE WALL
IN THE BROOM CLOSET. AND THEN
DO WHAT AND IT DIDN'T MAKE
SENSE SO WE'RE ACTED ABSOLUTELY
NEXT CONVERSATION. SPEAKING
ABOUT THE BIG. THE CALL ON THAT
SPECIFICALLY BUT IT SEEMS.
UNIQUE THAT THE HOT. BEING TO
BE ON KIND AT THE SAID OF THE
ENTIRE SO. RIGHT AS A VERY NEW
REQUIRED FOR HAAS. AND WE
ACTUALLY TO PLAY OUR- BUT PUT
ALL RESPOND. IN HOSPITALS DOES
HE LIKE A TREMENDOUS AMOUNT OF
RESPONSIBILITY PARTICULARLY
WHEN THERE'S NO- SUPPORT. AT IN
OUR CASE WE ARE A STANDALONE
PRIVATE HOSPITAL. WE DON'T HAVE
ANY DISTRICTS SUPPORT. SO THAT
PRESENTS A UNIQUE CHALLENGE
OKAY AND I THINK AND IF THEY
HAVE MADE SOME REMARKS EARLIER
OUT THE FACT THAT- THE
HOSPITAL'S PAY THE ONLY
BUILDINGS WERE PUTTING THIS
KIND OF STANDARD SO- SEEMS BUT
WE HAVEN'T. REALLY PUT IN A-
THAT THE HOSPITAL THE- DRIVING
STRUCTURE. AN EVENT A LARGE
EARTHQUAKE. SIMILAR TO OF THE
ACTUALLY OUT ALSO I THINK. IT'S
MAYOR WAGNER I REMEMBER YOUR
NAME CORRECTLY DO WANT TO SPEAK
TO THESE YOU TALK ABOUT YOU WE
HAVE THE PICTURE OF YOUR
HOSPITAL HERE. IN TERMS OF-
YOUR CONVERSATIONS WITH THE IN
OUR SPOT OR OTHER TYPES OF
CONSOLES REGARDING. SURELY THE
SAFETY OF YOUR PATIENTS AND
STAFF- IN THE EVENT OF A YOU
KNOW AT THAT THE- POSSIBLE
EARTHQUAKE IN YOUR COMMUNITY
THAT THE SIZE THAT. YES
CERTAINLY YES WE COMMISSIONED
A- INDEPENDENT THIRD PARTY TO
COME IN AND LOOK AT. THOSE
BUILDINGS THAT YOU SEE HASH
MARK OUT THERE NOW- TO COMPLETE
A SEISMIC STUDIES STRUCTURAL
STUDY FOR US. AND ACTUALLY THE-
WILL AND WE HAVE BEEN WORKING
WITH US BUT- ON THAT STUDY- IN
AND- ARE AWAITING COMMENTS BACK
SO. WE'RE IN THE MIDDLE THAT
CONVERT THATCONVERSATION AS
WELL- OUR- OUR BIG CONTENTION
IS OF COURSE IN FRESNO. WE
DON'T BELIEVE THERE WILL I KNOW
I'M PREDICTING THE TRYING TO
PREDICT THE FUTURE HERE BUT- WE
SOMEBODY HAS TO YEAH. WE DON'T
BELIEVE THERE WILL EVER BE AN
EIGHT POINT OH. EARTHQUAKE IN
FRESNO- WERE IT WE ARE AND WE
ALSO COMMISSION SOMEBODY TO DO.
A SEISMIC ZONE STUDY FOR IS-
THAT TELLS US WE ARE IN A VERY
LOW SEISMIC. AREA. WHICH MEANS
THAT- THE ENTIRE COUNTY IS
PAINTED AS THE YOU KNOW. HIGHER
RISK- SEISMIC AREA. IN THE
FRESNO IS KIND OF BALLING. OR
KIND ROLLED INTO THAT SAME
CATEGORY AS WELL WITH IT WHERE
IT'S NOT SO AND- MISTER
COLEMAN- DOES THE LAW GIVES YOU
SOME FLEXIBILITY IN REGARDS.
THE CANDY YOU KNOW THEY MAKE
THE CASE THAT LAST EYES BECAUSE
WE WERE A REAL RESPONSE MORE
AND- YEAH I KNOW SEVEN POINT
OVER SIX POINT OVERS AN EIGHT
POINT- BECAUSE OF GIVEN OUR
LOCATION DE THAT'S THAT. THE
FACT THAT. YOUR VALUE WITH NEED
TO THE YES SIR. OF WE HAVE WHAT
WE CALL HIS PC FORTY WHICH IS A
DAMAGE CONTROL RIGHT- CATEGORY
THE LAWS HOSPITAL BUILDINGS TO
GO BEYOND TWENTY THIRTY.
BECAUSE WE KNOW THAT EXISTING
BUILDINGS THAT WERE BUILT FOR
THE ACT. CANNOT BE MADE A
COMPLAINT WITH CURRENT CODE
IT'S JUST NOT FEASIBLE NOT
PRACTICAL. IN THIS- PARTICULAR
PROGRAM DOES TAKEN STEPS WITH
FEDERATION THE VERY SITE
SPECIFIC- GROUND MOTIONS. AND
THOSE ARE GIVEN TO US BY THE
USPS AND THE- CALIFORNIA
GEOLOGICAL SURVEY. AND THAT
ALSO AND THE BUILDING CODE SO
THOSE ARE THE NUMBERS THAT AND
THE STANDARDS THAT WE USE IN
DETERMINING. THE SEISMICITY OF
A LOCATION AND IT IS VERY-
SUBSPECIFIC NOW SO POSSIBLY IN
THE PAST AND LOOKING AT AS PC
TO ANOTHER'S WHERE. IT WAS MORE
OF A- A TRIAGE OR OR JUST
TRYING TO FIGURE OUT WHERE THIS
BUILDING FRONT IN THE OVERALL
SCHEME OF BUILDINGS OF THE
SIMILAR NATURE- WE DO START TO
DRILL IN TO GET A LOT. MORE
SPICES SITE PACIFIC. AND ALSO
WHEN I MENTION ABOUT A
DESIGNER'S QUICK I DON'T. GIVE
ME THAT EVERY FAULT. IT'S GOING
TO HAVE AN EIGHT POINT. THE
POINT WAS. SOFTBALL ARE ACTIVE
OTHERS AND ARE GOING TO BE
PRONE TO LARGER MAGNET. OF
QUAKES AND OTHERS AND SO WE DO
THINK THAT AND- AS HE TAKE INTO
CONSIDERATION OKAY APPRECIATE
THAT AND FIND. OUT JUST A
REALLY QUICK I WANT TO MAKE
SURE WE'RE CLEAR ABOUT WHAT
WE'RE TALKING ABOUT HERE. I'M
THE TWENTY TWENTY STANDARD
REQUIRES US REQUIRED HOSPITALS
TO REMAIN STANDING. IN IT IN A
DESIGNER OF QUICK SO IN AN
EIGHT POINT NO SO OR DESIGN
STANDARD. SO YOUR REMAIN
STANDING IN A LARGE EARTHQUAKE.
CORRECT RIGHT SO AHEAD WE TALK
ABOUT IS THE FULLY OPERATIONAL
HOUSES ONE THAT HAS US THAT'S
WHAT HAS THE COST EXPENSE FOR
THESE HOSPITALS BUT I DON'T
WANT THAT SO GET GOING THE
MYSTICAL WE CAN ANSWER THE SIZE
OF THE EARTHQUAKE YOU HAVE TO
DO RIGHT I THINK THERE'S SOME
CONFUSION AS TO WHAT IN THIS PC
TO BUILDING ACTUALLY MEANS OKAY
AS PC TO BUILDING 78% OF THE
SPC TO BILLING FOR RE
CATEGORIZE THROUGH FOR- HAS US.
IN HOUSES WAS A PROGRAM
DEVELOPED BY- FEMA ANGER OF
WHAT'S CALLED HAZARDS U. S. AND
THAT WAS INITIALLY AUTHORIZED
FOR USE BY THEN GOVERNOR
SCHWARZENEGGER AS A SCREENING
TOOL TO DETERMINE WHICH OF
THESE SPC ONE BUILDINGS WERE
THE WORST BUILDINGS THAT SHOULD
HAVE IMMEDIATE ACTION TAKEN
UPON THEM AND SO THAT SCREENING
TOOL- DID NOT DRILL DOWN IN THE
SITE SPECIFIC ASSIST FACILITY
THAT- WE DON'T READ DRILL DOWN
NOW ON WE HAD SOME DEALINGS FOR
EXAMPLE THAT BECAME TO SEE TO
BECAUSE THEY WERE ACTUALLY
EVALUATED CALL VALUE IT. AND
ALL ACTUALLY DRILL DOWN TO LOOK
AT AND EVALUATE THOSE
STRUCTURES DO THEY HAVE STRUCK
DEFICIENCIES THAT CAN STILL
REMAINING THAT COULD RESULT IN
A PARTIAL COLLAPSE OR A PAGE UP
FOR UP. FROM THE BEST WAY FOR
ME TO THIS TO READ. FROM FEMA
WHAT THIRD OF A OF A DUE TO BE
AS A I MAY. BRIEF. IN THE IN
THE HOUSE. PROBE THEY THE UNTIL
WAS TO CREATE THESE SEAT GO
INTO WHAT'S CALL A LIFE SAFETY
LAW AND THIS IS THE DEFINITION
OF LYE SAFETY BY FEMA LIFE
SAFETY MEANS THE POST
EARTHQUAKE DAMAGE STATE IN
WHICH SIGNIFICANT DAMAGE TO THE
STRUCTURE HAS OCCURRED BUT SOME
MARGIN AGAINST EITHER PARTIAL
OR TOTAL STRUCTURAL COLLAPSE
REMAINS SOME STRUCTURAL
ELEMENTS AND COMPONENTS MAY BE
SEVERELY DAMAGED BUT SHOULD NOT
RESULT IN LARGE FALLING DEBRIS
HAZARDS EITHER WITHIN OR
OUTSIDE THE BUILDING INJURIES
MAY OCCUR DURING THE EARTHQUAKE
HOWEVER IT IS EXPECTED THAT THE
OVERALL RISK OF LIFE
THREATENING INJURIES. AS A
RESULT OF STRUCTURAL DAMAGE IS
LAW COST TO REPAIR THE
STRUCTURE. HOWEVER FOR ECONOMIC
REASONS THIS MAY NOT BE
PRACTICAL WHY THE DAM
INSTRUCTOR IS NOT AN EMINENT
COPS RISK. IT WOULD BE PRUDENT
TO IMPLEMENT STRUCTURAL REPAIRS
OR INSTALL BRACING PRIOR TO RE
OCCUPANCY AND THAT'S FROM FEMA
TWO SEVENTY THREE THAT. THAT'S
A SPICY TOO RIGHT AND THE
OTHER. IT'S A YEAH THAT'S RISKY
SEE TO READ AND THEN WE NEED TO
MOVE PEOPLE SPC FOR OUR FOR A
FORTY RIGHT EXACTLY WHICH FORTY
THEM WOULD. REDUCE SOME OF
THESE RICH THAT I MENTIONED ARE
FINE- FOR STC TO BILLS. AND
THAT'S TO REMAIN OPERATIONAL.
AND I THINK WHAT WE'RE TRYING
TO UNDERSTAND IN BALANCE IS
WHAT IS IT AGAIN THE RISK TO
THE PATIENT AND THE EMPLOYEE
TO. SENATOR MY STANDARD VERSUS
WHAT IT IS FULLY OPERATIONAL OR
WHAT AN OPERATIONAL POST AN
EARTHQUAKE AND THAT'S WHERE
WE'RE TRYING TO FIND THAT
BALANCE IS WHAT WE BUILDING TO-
IS THE- BUILDING- SO GOING TO.
BE IN A SPACE WHERE AFTER AN
EARTHQUAKE IT'S NOT A- IT'S NOT
JEOPARDY TO AND CAN STILL
MANAGED SERVICES SO I THINK
WHEN I. TRY TO DRILL DOWN
THOUGH AND IT IS THAT I THINK
YOU KNOW AGAIN. TWENTY THIRTY
YEARS CAN BE OPERATION. SONNY
THAT TERMS OF THE- SIZE THE
AFTER WORRY ABOUT. YOU ARE LOW.
AT NOT ONE SIZE FITS ALL ACROSS
THE STATE YOU ARE TAKING
ACCOUNT OF THE AXE SIZE RISK IN
EACH INDIVIDUAL AREA. YES YOUR
LETTER CORRECT. OKAY THAT'S
THAT'S THE POINT I WAS TRYING
TO CLARIFY AND THEN FINALLY-
THAT- IS ALSO IS THAT WE TALKED
ABOUT HOW STRUCTURAL IS THE BIG
EXPENSE SO MOVING SB T. TO THE
FORTY OR FIVE- BUT IN TERMS OF
THE BURDEN OF ACTUALLY. BEYOND
STRUCTURAL TRYING TO BE
COMPLIANT WITH THE
NONSTRUCTURAL STANDARDS. ARE
THEIR MAJOR I MEAN I'M SURE
THERE ARE SOME CONCERNS THAT
SOME FINANCIAL BURDENS THAT HOW
MUCH OF THAT CONCERN IS THAT SO
ONCE YOU'VE GOT THE STRUCTURAL
POINT THERE. THAN TRYING TO
TRUSTS COME TO COMPLY TO
NONSTRUCTURAL STANDARDS HOW
MUCH OF A BURDEN IS THAT. IN
OTHER REQUIRE. DO IT THE SAME
TIME SO YOU DON'T REALLY
SEPARATE THEM SO IF YOU HAVE A
BUILDING SPC TO YOU DO THE
NONSTRUCTURAL AS WELL SO IF
YOU'RE REBUILDING YOU WOULD DO
THE NONSTRUCTURAL AS WELL SURE
RETROFITTING ANYONE OPENING. WE
HAVE A LOT OF MONEY BUT IF THE
I MEAN WE A LOT OF PEOPLE FOR A
FORTY YEAR RIGHT IT MIGHT BE A
20% SO IF YOU'RE READY THERE SO
NOW IT'S A PEOPLE READY AT FOR
THE ARE FIVE THEY'RE FINE ARE
AT THEIR DIVISIONAL INVESTMENTS
THEY NEED TO MAKE TO. THE NYSE
THEY MIGHT STILL HAVE BEEN PC
TO DO BUT MOST OF THE TIME YOU
DO IT TOGETHER OKAY WHAT ABOUT
THIS FOR AWHILE OKAY SOUNDS
THAT SOUNDS LIKE THE WELL
THERE'S A BURDEN THAT SEEMS TO
BE MANAGED. WELL WELL NOW THAT
THAT'S QUITE YEAH THEIR LOVE WE
TALKED OVER NON STROKE WRITING
IF THIS AGAIN THIS IS WHERE YOU
GET BY TO WHAT GOING ON WITH
EACH DIFFERENT HOSPITAL SO YOU
CAN HAVE A HOSPITAL THAT IS US
THREE OR FOUR THAT HAS
SIGNIFICANT NONSTRUCTURAL
ISSUES AND NEED TO OPEN UP
WALLS FOR THAT AND THIS IS
WHERE I'M LOOKING AT PAUL ONLY
BECAUSE I DON'T KNOW EVERY
HOSPITAL IT TOO NEARING WHAT
PULLS DO. ALSO OPERATIONAL
STANDARDS INCLUDE. THE IN THE
WATER YEAH THAT'S REQUIRED THAT
COULD BE DEPENDING ON HOW AND
WHEN THAT STORAGE IS REQUIRED
THAT COULD BE AN ISSUE FOR THE
HOSPITAL. I'M STORING THREE
DAYS F FUEL COULD COULD CREATE
SOME CHALLENGES AS WELL SO- I
DEFERRED UPON THE ON THE-
NONSTRUCTURAL BUT WE HAVE HEARD
FROM OUR HOSPITALS THAT STUFF.
CREATING SIGNIFICANT
OPERATIONAL ISSUES TO RETROFIT
TO THAT SPACE AS WELL OKAY.
THANK YOU I APPRECIATE THAT.
THINK THANK YOU THANK YOU
DOCTOR PAN. JUST A QUESTION.
HOW OFTEN ARE THIS SITE HOW HOW
FOR THE SEISMIC STUDIES DONE
AND HOW OFTEN DOES. IT LOOK AT
THE RAMIFICATIONS OF THAT
BECAUSE I'M HEARING ROM A
HOSPITAL CEO HERE THAT THEY
WENT OUT AND DID THEIR OWN
SEISMIC THAT APPEAL TO YOU SO
THAT DOESN'T. FEEL RIGHT
SOMEHOW WE'RE RECORD- SO HELLO.
STAND THAT. TYPICALLY THE
HOSPITALS WILL DO WILK-
CONTRACT WITH DESTRUCTION
DURING FIRM. TO DO SEISMIC
EVALUATIONS ON THEIR SITE. AND
A MAN INVOLVED YOUR TECHNICAL-
INVESTIGATIONS AS WELL. WITH
REGARDS TO SOIL IN SEISMICITY.
AND THEN THEY WILL SUBMIT THAT
TO US FOR OUR REVIEW. AND IN
SOME CASES- THE HOSTELS IN OR
NEAR MAY COME UP WITH. THE WORK
THAT WE FEEL IS- ABOVE AND
BEYOND WHAT'S ACTUALLY NEEDED-
HOWEVER IF THE HOSPITAL AS
WANTING TO DO THAT MUCH WORK
THAN THAT IT'S ALLOWED- FOR
EXAMPLE ON. ON THE. I WON WITH
BLUE. AND RIVER FOR EXAMPLE I.
YOU KNOW I'M I'M CURIOUS AS TO
THE PURPOSE OF THE MICHAEL
PILES IN A ONE STORY BUILDING
SO THAT'S SOMETHING I THINK WE
NEED HAS FOR THE DISCUSSION ON
SO- YEAH WE DO WE DO LOOK AT
THAT AND WE DO QUESTION IT AND
SOMETIMES WE WILL. BE ABLE TO
PROVIDE ALTERNATIVES TO
HOSPITALS AS TO MAYBE LESS
EXPENSIVE WAYS TO ACHIEVE
COMPLIANCE THEN WHAT- THEIR
INJURES MAY HAVE HAVE COME UP
WITH SO I GUESS I GUESS WHAT I
GUESS WHAT I'M STRUGGLING WITH
THEM IS A LITTLE BIT. IS THAT.
AND I AND I DON'T WANT TO GET.
IT YOU KNOW I JUST. THAT IS A
HOSPITAL PEOPLE YOU PROBABLY.
ARE PROBABLY A LITTLE.
RELUCTANT TO POKE AT THE PAIR-
QUITE FRANKLY. AND I THE I
WOULD BE- BUT BUT I'M TRYING TO.
WELL I'M YOU KNOW I'M SERIOUS I
AM BEING SERIOUS SO I'M NOT YOU
PERSONALLY MISTER COLEMAN- BUT-
BUT I DO BECAUSE OF REGULATORS
AND I AND I DO. SO I AM I AM. I
AM WONDERING IF. SO YOU. PRETTY
YOU GOT TO READ HOSPITALS TO
BILL DOLLARS THIS IS A SAFETY
NET HOSPITAL SO WE ALREADY KNOW
THE DISEASE ARE COMMUNITIES
THAT DON'T HAVE A LOT OF
RESOURCES- IF THEY DON'T HAVE
THE RESOURCES TO BUILD THAT
WHERE THE RESEARCH COMES FROM
AND THAT'S A BIG QUESTION ABOUT
ASKING FOR AN ANSWER BUT THAT
IS A BIG QUESTION HERE BUT I'M
ALSO A LITTLE YOU KNOW IF WE IS
THERE REQUIRE. THIS AND AT OUR
BY STATUTE IN AND LOS. THAT I
DO WONDER. ARE WE- ARE WE NOT-
WHITE WHERE WE NOT DO BEING A
LITTLE BIT MORE- SO WHAT I'M
LOOKING FOR- PROGRESSIVE IN THE
WAY WE LOOK AT- AS TIMES CHANGE
AND SCIENCE CHANGES AND THINGS
SO I'M NOT I'M NOT ENGINEERS NO
IN. A YOU KNOW I GOT LIKE I CAN
BOUNCE MY BOOK- AND I AND I. AM
LOOKING FOR BIG. THROUGH A BIG
PICTURE OF. SURVIVABILITY HERE
I THINK OF THE NATURAL
DISASTERS IN MY DISTRICT- AND
THERE HAVE BEEN SEVERAL- MOST
RECENTLY FIRES AND I THINK OF
THE PEOPLE THAT WERE EVACUATED.
AND THE HOSPITAL STAFF AND THE
AND THE DOCTORS AND EVERY DID
FABULOUS JOBS MEAN NO NO NO
REAL BAD OUTCOMES OF ANYTHING
THAT I'M AWARE OF AND WE'RE
TALKING ABOUT MAJOR
EVACUATIONS- I WONDER IF AT
SOME POINT. WE HAVE A HOSPICE.
THAT'S FIVE EIGHT POINT OH
EARTHQUAKE BUT BECAUSE OF
COMMUNITIES AND- YOU KNOW YOU
DON'T HAVE A DOCTOR TO GET
THERE. YOU DON'T HAVE STAFF WHO
CAN GET THAT IN MANY CASES OUR
CAN WITH THE FIRES BECAUSE OF
ELECTRICITY. LACK OF **** IN
CASES WATER BECAUSE OF RURAL
RURAL AREAS BIG RELY ON PUMPS-
THEIR WELLS. WE GO TO WORK AS
THAT SCHOOL IN SESSION AND SO I
FOR ME I'M LOOKING FOR THIS
BALLOT IS SAYS WE ABSOLUTELY
HOSPO SURVIVE IN A OVER BUT WE
ALSO KNOW TO KNOW THAT WE'RE
NOT CREE AS AT WE IT EVEN IF IT
SURVIVE THAT WE DON'T HAVE THE
CAPACITY TO RUN HOSPITAL
BECAUSE- UP. OF THE OF THE
PEACE NOW NOT A SKIN FOR AN
ANSWER I'M JUST I'M JUST KIND
OF KIND OF KIND MAKING A
STATEMENT THERE- I WOULD
IMAGINE THAT THE COMMUNITY
REGIONAL IS A HUGE ECONOMIC
DRIVER FOR THAT FOR THE FRESNO
REGION- WHERE HE NOTED THAT
SIXTY MILLION IN REVENUE FROM
CINEMA VALLEY WITH A MAP IN
THAT RIVER- CLOSE. FIVE THIS IS
A RECALL. SEVENTY EIGHT SEC.
BECAUSE ADDED UP UP BUT I GUESS
FOR ME A PART OF THIS IS AT THE
KNOW IS THERE ARE PRACTICAL
APPLICATION OF THIS OR IS
EVERYTHING HOW IS EVERYTHING
GOING TO BE. YOU KNOW EXACTLY
AS AS ENGINEERS AND EVERYONE TO
CREATE WHAT WE WOULD
POTENTIALLY LOOK AT AREAS WHERE
IN A HOSPITAL CEASE TO EXIST
BECAUSE THERE IS NO ABILITY TO
FINANCE THEM SO WITH THREE
EXAMPLES HERE I WONDER HOW MANY
OF THEM ARE GOING TO- BE ABLE
TO SEE I'VE AND WHAT'S THAT
MEAN FOR A COMMUNITY. WHAT DOES
THAT MEAN FOR CAN WHEN YOU LOSE
A HOSPITAL- IN ONE COMMUNITY
I'M NOT ONE OF THESE- SMALL
COAST HOSPITAL- THREE HUNDRED
EMPLOY THREE AND PEOPLE WORK
FOR THE HOSPITAL TO THE THREE
HUNDRED PEOPLE WORK FOR THE
HOSPITAL- IN A SMALL SMALL
TOWN- WHEN PEOPLE AYE POSSIBLE
SERVICES IS. THERE THEY'RE
REMOVE CLOSER TO SERVICES SUB.
I'M NOT I'M NOT AND WITH THIS
BE CRITICAL AND NOT AND NOT
POKING IT. AT THINGS. BUT I'M
WE'RE KIND OF LOOKING FOR A BIG
SOLUTION HERE THAT THAT
BALANCES THE SAFETY AND
EVERYTHING. BUT DOESN'T PUT
ESPECIALLY SOME OF OUR SAFETY
NET HOSPITALS AND RURAL
HOSPITALS OUT OF BUSINESS-
SOMETIMES WITH I FEEL LIKE A
PART I JUST REALLY FEEL LIKE A
THIRD WORLD COUNTRY- I DON'T
NEED. TO WHISPER THAT IT YES.
AND SO THAT'S THE THAT'S A
CONCERN WE HAVE SO. SHE THAT
SORRY THAT WAS A BIT OF A SOAP
BOX. BUT A MORE STATEMENT AND
THEN. SO QUESTION SO ANY
QUESTIONS THIS WELL A QUESTION.
OKAY OKAY THANK YOU VERY MUCH
FOR YOUR PERSPECTIVE REALLY
PROJECT UP. BUT OKAY AND
ACTUALLY IS THIS- PANELS
LEAVING AYE I WOULD I WOULD
ALSO JUST MAKE NOTE TO AND I
APPRECIATE- CHAIR WOODS
COMMENTS- WE ARE TALKING ABOUT
THE IMPORTANCE OF HOSPITALS AND
THE COMMUNITY AND DURING
DISASTERS BUT I THINK BECAUSE I
THINK- MY THINGS ALSO WE NEED
TO RECOGNIZE IS THAT- WE HAVE
THE STANDS WE NEED TO HOSPITALS
THERE AND SOME OF THE
HOSPITAL'S DISAPPEAR EVEN
BEFORE DISASTER WE HAVE LOST
SOMETHING- JOBS ACCESSTO
HEALTH CARE CENTER. ALL RIGHT
SO OUR NEXT PANEL IS. ON HEALTH
CARE PROVIDER CONSUMER
PERSPECTIVE AND I WANT TO
WELCOME UP STEPHANIE ROBERSON
DIRECTOR OF GOVERNMENT
RELATIONS FOR THE CALIFORNIA
NURSES ASSOCIATION. JIM ONES-
MEMBER AT AT- FROM TARZANA
MEDICAL CENTER AND MEMBER OF S.
YEAH YOU AND ALSO SAYS ARE DIAZ
LEGISLATIVE DIRECTOR OF STATE
BUILDING CONSTRUCTION TRADES
COUNCIL WELCOME AND APPRECIATE
YOU BEING HERE AND ASK THAT IF
YOU COULD AND- LIKE THE OTHER
WITNESSES IF YOU TRY TO KEEP
YOUR REMARKS TO THREE MINUTES
FOR YOUR PRESENTATION OF SURE
WILL HAVE MORE OPPORTUNITIES-
AFTERWARDS WITH QUESTIONS.
THANK YOU WELCOME. THANK OU
FOR THE INTRODUCTION- OF A
GERMAN. GERMAN WOOD TRIM AND
PAN. MEMBERS OF THE COMMITTEE-
AND STAFF STEPHANIE ROBERSON ON
BEHALF OF THE CNA- I WANT TO
APOLOGIZE BECAUSE I WANT TO
BRING UP THE NUMBER OF MINE
WHO- WORKS AND- QUEEN OF THE
VALLEY HOSPITAL IN NAPA. WHERE
THE SEISMIC EVENT HIT VARGAS OF
LAST YEAR WITH EXPERIENCE
FLOODING DOORS COMING OFF ITS
HINGES ON HOW THEY LOST ONE
LIFE AND OVER TWO HUNDRED
PEOPLE SUSTAIN INJURIES AND I
BET BECAUSE ABOUT A BILLION
DOLLARS IN DAMAGE THAT
COMMUNITY CELS AS YOU KNOW-
CHAIRMAN THAT WAS A QUITE A
DEVASTATING EVENT. BUT BEFORE
SHE CAN BE THERE TODAY AND
OFFERS HER APOLOGIES- AS YOU
KNOW FROM THE GOOD BACKGROUND
MATERIALS THAT YOU ALL HAVE
BEEN HAVE REPAIR THE HOSPITAL
INDUSTRY IN CALIFORNIA FIRST
BECAME AWARE OF THE DIRE
CONSEQUENCES OF ALLOW. MOST
TIES WITH BEEN SICK SINCE THE
SEVENTIES. QUICKLY SEVENTY
FOUR. THE ALFORD ALQUIST
SEISMIC WAS IN INTO TO PLAY.
SAFETY ON THE INDUSTRY'S TOP
PRIORITY LIST FOR CAPITAL
IMPROVEMENTS. AND REQUIRE THEM
TO PLAN ACCORDINGLY. ON THIS
LAW WAS IN RESPONSE TO SILMAR
QUAKE THATKILLED OVER SIXTY
PEOPLE AND CLAPS ONE HOSPITAL.
THE INDUSTRY ESSENTIALLY
IGNORED THOSE REQUIREMENTS AND
HOW HAVE THEY- BECAUSE WE KNOW
THAT THEIR BEEN SCORES OF
SEISMIC SAFETY BILLS- PASSED ON
THE BOOKS CA SEVEN. BIG MAJOR
BILLS BETWEEN NINETEEN NINETY
NINE TWO THOUSAND ELEVEN AND
MANY OTHER SMALLER EXTENSION
BILLS PASSED BY THE LEGISLATURE
THAT GIVEN THE INDUSTRY. THESE
EXTENSIONS EVEN THOUGH WE KNOW
HOW SIZE AND KLAY ACTIVE THIS
STATE IS THE FIRST ACTUAL EVENT
WAS RECORDED IN SEVENTEEN SIXTY
NINE. BETWEEN EIGHTEEN FIFTY
TWO THOUSAND FOR A DAMAGING
SEISMIC EVENT. OCCURRED AVERAGE
AT LEAST SPUR GEAR. CREST AS
YOU KNOW HOW LAST JULY. AROUND
THE SAME TIME THIS IS. COUNT AT
A SEISMIC RELIEF BILL WAS
PROPOSED. IT'S ABOUT A FEW DAYS
ON BAR SO CALIFORNIA. PLEASE X.
EARTHQUAKE HIT. SO I WANT ABOUT
SOME THINGS ARE ALL IF YOU WILL
IS AT YOU DON'T KNOW THE ACCESS
TO TAX EXEMPT FIND A BY TAX
DOLLARS HOSPITAL FEES WHICH SEE
MORE FROM OUR HOUSE. IT IS THE
SAME HOSPITALS THAT USE THESE
FUNDS AREN'T RETURNING
SUFFICIENT AMOUNT OF CHARITY
CARE DOLLARS BACK TO THE
COMMUNITIES THAT THEY SERVE.
THESE ARE SOME OF THE SAME
HOSPITALS THAT RECEIVE TAX
EXEMPT BONDS. AND IN THE PAST
DIDN'T USE A PENNY FOR SEISMIC
RETROFIT. WE ARE IN TWENTY
TWENTY AND WE FINALLY ARE
CLOSING IN ON RETROFITTING SOME
OF THE MOST DANGEROUS BUILDINGS
LIKELY THE PANCAKE AND
EXCITEMENT IN THAT WE'VE SEEN
IT HAPPEN. NURSES ARE IN THE
STREETS AT THESE INANCING
MEETINGS AND AT LOCAL CITY
COUNCIL MEETINGS. I DON'T WANT.
A TREMENDOUS IMPACT ON SEISMIC
COMPLIANT. WHEN AN ENTITY
ACQUIRES A HOSPITAL USUALLY
THESE DAYS AS A HEDGE FUND.
THEY HAVE NO PLANS TO RUN THESE
HOSPITALS AS HOSPITALS. THE
FIRST TELL THE ATTORNEY GENERAL
THAT THEY CAN'T MEET THE
REQUIREMENTS OF THE SALE THAT
MEANS SEISMIC THAT MEANS
WOMEN'S HEALTH- KEEPING CERTAIN
DEPARTMENTS OPEN STAFF
OBLIGATIONS ALL OF THAT. IN THE
G. IS DONE A TREMENDOUS JOB
PUSHING VERY HARD TO MAKE THESE
NEW BUYERS PONY UP ON
CONDITIONS- RECENT DEALS THAT
YOU MAY HAVE HEARD IN THE NEWS
AYE KPCC WHICH WAS PREVIOUSLY
OWNED BY VERITY WHICH WAS
PREVIOUSLY OWNED BY DAUGHTERS
OF CHARITY. FELL THROUGH WHEN
BANKRUPTCY COURT THIS DYNAMIC
MEMBERS WE FEEL IS A HUGE
PROBLEM AND IT HAS RESULTED IN
THE OLDEST HOSPITAL AND LOS
ANGELES CLOSING ST VINCENT'S
HOSPITAL. I DON'T THINK A
REBUILD WILL HAPPEN- AND WE
HAVE HIGHLY TRAINED TRADESMAN
READY TO DO THE WORK. THIS FULL
SERVICE HOSPITAL WILL BE LIKELY
REPAIR PLACE BY PSYCH SERVICES
MUCH NEEDED DEFINITELY BUT WE
LOSE YET ANOTHER FULL SERVICE
HOSPITAL. ALSO WERE FIGHTING IN
HOSPITALS WANT TO CONTINUE TO
COME TO THE LEGISLATURE AND ASK
FOR RELEASED WE HAVE TO
SCRUTINIZE MORE I THINK YOU'RE
DOING THAT. DEFINITELY DOING
THAT'S NOT A CRITICISM BUT WE
NEED TO DO MUCH MORE ANOTHER
REAL IMPACT AND SEISMIC
COMPLIANCE IS EVIDENCED BY
WHAT'S HAPPENING IN SOUTHERN
CALIFORNIA WILL NAME THE
FACILITIES BUT- STRUGGLING
AUSTAL AA IS SEEKING A BONTA
PAY FOR SEISMIC. FINANCING
MEANWHILE UP STRUGGLING
HOSPITAL WAY IS SEEKING THIS
BOND MEANWHILE I FINANCIALLY
SOLVENT HOSPITAL BE IS RUNNING
AN ACTIVE CAMPAIGN TODAY TO
HAVE VOTERS WORK AGAINST THE
MEASURE BECAUSE HOSPITAL BE
ONCE ALL THE PATIENTS. THUS
STRUGGLING HOSPITAL A THAT IS A
PROBLEM. I THINK THAT HI THAT
ACTIVITY SHOULD BE DENOUNCED
AND I THINK IT NEEDS TO BE PUT
TO STOP IMMEDIATELY.
COMMUNITIES DESERVE MORE WE
TALK ABOUT WORK FORCE IN THIS
BUILDING AND WHAT HAPPENS THE
NEXT TIME THE HOSPITAL CLOSES
OR GETS ACQUIRED BY HEDGE FUND
WHAT HAPPENS TO THOSE PATIENTS.
WHAT HAPPENS ARE HIGHLY TRAINED
WORKFORCE WHAT'S THE RIVER
RESULT. AND WE BELIEVE A
REPUTABLE DEVASTATION TO THE
FABRIC AND THE HEALTH OF OUR
COMMUNITIES. ARE WITH RESPECT
TO THE TWENTY THIRTY STANDARD
AND ALL CLOSE- IN THE
POSSIBILITY FOR CHANGES TO THE
INTEGRITY OF THE SEISMIC SAFETY
LAW WE BELIEVE SHOULD NEVER BE
EXPLORED. TO MUCH DIFFERENT
STANDARD THAN EXTENSION CURRENT
PROPOSALS BY THE HOSPITAL
ASSOCIATION SEEK TO UNDERMINE
ALIVE BY ENSURING WHICH YOU'VE
ALREADY HEARD- IN CERTAIN
SITUATIONS CERTAIN PARTS OF THE
HOSPITAL. TO REMAIN STANDING
AFTER AND THE EXCITEMENT THAT.
HOSPITALS ARE ENTIRELY
DIFFERENT WE'RE NOT TALKING
ABOUT YOU KNOW MALL STRIP MALLS
WE BELIEVE ALL THE STRUCTURAL
INTEGRITY NEEDS TO OBVIOUSLY
HAPPEN. BUT THIS IS WHERE.
PATIENTS WORKERS THE PUBLIC
VISITORS COME IN. AND WE NEED
THE ABILITY TO CONTINUE
PROVIDING THE TREATMENT THAT'S
LINKED TO ALL THE ESSENTIAL
SERVICES YOU CAN'T HAVE A FEW
ESSENTIAL SERVICES NOT. TO THE
REST AND MAKES NO SENSE TO US.
SO DO TO THAT IN DUE TO
PATIENTS WHO MAY NOT BE ABLE TO
GET OUT DOING DUE TO THEIR
MOBILITY WE BELIEVE THAT THIS
IS A NO GO ON POLICY- PLEASE
CONSIDER. THESE THOUGHTS AS YOU
MOVE FORWARD ON THIS AND WE
HAVE STRONG CONCERNS THIS BILL
THIS TO. A SIZE SIX TEAMS FOR
THANK YOU FOR YOUR. THANK YOU.
X. WITNESSED. VETERANS MY NAME
IS JIM I'M GONNA READ NURSE FOR
FOUR YEARS I IN SO FERNANDO IN
I WORK AT TARZANA HOSPITAL I'VE
WORKED IN ALMOST EVERY
DEPARTMENT IN THE HOSPITAL
EXCEPT FOR LABOR AND DELIVERY
AND WOMEN'S. WOMEN'S HEALTH
SERVICES SO THE ONLY ONES I
COULDN'T GO TO I'VE LIVED MY
ENTIRE LIFE IN THE SAN FERNANDO
VALLEY AND I REMEMBER WHEN THE
EARTHQUAKE OF SEVENTY ONE HIT
IT WAS MY SENIOR YEAR IN HIGH
SCHOOL WE SAW THE GROUND COMING
IN WAYS HOW IT LIFTED UP OUR
HOME AND DROPPED IT ON. WE LIVE
IN EARTHQUAKE WERE YOU TO IT.
IN NINETEEN. THERE WAS FILLED
WITH THE SOUNDS OF. GLASS
CRACKLING IN EXPLODING MY
WIFE'S- PINK GLASS COLLECTION
TOTALLY WENT INTO THE KITCHEN.
I TRIED TO CALL THE HOSPITAL
BUT I COULDN'T GET THROUGH
THERE WAS NO TELEPHONE LINE AT
THAT TIME AND THERE WAS NO
CELLPHONES BACK THEN. PEOPLE
WERE PANICKING MY WIFE TOLD ME
GO GET SOME WATER I WENT OUT
AND PEOPLE WERE DRIVING.
THROUGH THE INTERSECTION WITH
NO LIGHTS AND COMPLETELY. AT
FULL SPEED SERVE THE
NEIGHBORHOOD WAS PANICKED. ONCE
I FINALLY DID GET. INTO THE
HOSPITAL ALL ELECTIVE SURGERIES
HAVE BEEN CANCELED THE
EMERGENCY ROOM. WAS COMPLETELY
PACKED WITH PATIENTS AND
INJURED AND PEOPLE WERE COMING
IN TO BE TREATED. ON MY WAY
INTO THE HOSPITAL THERE WAS
APARTMENTS THAT HAVE BEEN
COLLAPSED. AT THAT YOU CAN SEE
RIGHT OFF OF THE FREEWAY AT
RECEIVABLE OF ART. OUR HOSPITAL
UNLIKE MANY OF THE OTHERS WERE
STANDING WE TREAT US TO
PATIENTS AND AS THE AFTERSHOCKS
WARM WE COULD WATCH THE IV POLE
SWAY. AND WE COULD PICK HOW HOW
HEAVY THAT EARTHQUAKE ACTUALLY
WAS FOLLOWING AT. AND EACH ONE
CAME IN THE EMERGENCY IN AN
EMERGENCY OF THIS MAGNITUDE
HOSPITALS PLAY A CRITICAL ROLE
IN THE COMMUNITY. WE ARE THE
ONLY LIFE LINE OF OUR COMMUNITY
AN EMERGENCY SITUATION.
HOSPITALS IN THE PLACE WITH THE
INJURED WHO TRADED WHERE PEOPLE
IN DISTRESS CAN RECEIVE COMFORT
AND WHERE THOSE WERE SEPARATED
FROM EACH OTHER COME TO. WE HAD
MANY PEOPLE COME IN THE AND
DONE ONLY HAD PHYSICAL INJURIES
BUT WERE PURE PANICKED. AND SO
THAT WAS REALLY IMPORTANT FOR
IT. BABY STILL NEED TO BE BORN
THERE'S STILL COMING IN FOR
LABOR AND DELIVERY STROKES
HEART ATTACKS BURST APPENDIX
CONTINUE TO HAPPEN WE STILL HAD
EMERGENCY SURGERY. YESTERDAY
BEFORE I LEFT THE HOSPITAL I
HAD SIX EMERGENCY SURGERIES
THAT I HAD TO RECOVER. THOSE
WITH THINGS THAT COULDN'T GO
AWAY THAT HAD TO BE DONE AND
THEY WOULD HAVE SHOWN UP IF WE
HAD AN EARTHQUAKE THAT DAY. A
GROUP THAT. CRITICAL CARE
WORKING NEVER PULSE. I HAVE
FRIENDS WHO WORK AT NORTHRIDGE
HOSPITAL WHEN THE TRIAGE WAS
SET UP IN THE PARKING LOT THE
PATIENTS WERE ALL TAKEN OUT OF
THE HOSPITAL NORTHRIDGE'S A
LARGER HOSPITAL IN TARZANA. AND
THE PATIENTS WERE OUT IN THE
PARKING LOT FOR IT THIS IS NOT
WHAT YOU WANT TO DO AND IF YOU
CAN POSSIBLY AVOID IT YOU DO
NOT WANT TO ALL OF A SUDDEN
HAVE TRAUMATIZED PEOPLE OUT IN
AN AREA WHERE YOU'RE LITERALLY
GOING YOU'RE GOOD YOU'RE BAD
YOU'RE GONE. THAT'S IT. LIVES
ARE LOST WHEN A HOSPITAL CANNOT
BE FULLY FUNCTIONAL. IT WAS
THIS EVENT THE MOTIVATED
CALIFORNIA TO ASSESS THIS
SAFETY OF ITS COMMUNITIES IN AN
EMERGENCY REQUIRE THAT MOST AT
RISK HOSPTALS BE RETROFITTED
AND UPGRADED TO WITHSTAND THE
DAMAGE. IT IS A HARD WON WISDOM
ALLOW BORN A PAINFUL EXPERIENCE
AND WE CANNOT WE CAN A- SUMMER
PROPOSAL WE YOU CAN READ TRIPIT
PART OF A HOSPITAL EXPOSE
RESTED CATASTROPHES. A COMPLEX
SYSTEM LIKE A HOSPITAL WORKS IN
MANY WAYS HOW CAN AN EMERGENCY
ROOM FUNCTION IF THE SUPPLY
ROOM IS COLLAPSED IT'S
IMPOSSIBLE. HOW CAN THE
RECOVERY ROOM IF YOU CANNOT
PICK AND CHOOSE WHICH PART IN
WORK TOGETHER OUR PARTS ALL
WORK TOGETHER IF I DO NOT HAVE
THE LAB TO TAKE IN TELL ME WHAT
THE PATIENT'S HEMOGLOBIN AS I
DON'T KNOW IF I HAVE TO TRY TO
GET SOME BLOOD TO GIVE THAT
PATIENT THAT COMES TO ME IN THE
RECOVERY. ALL OF THOSE THINGS
HAVE TO TUNE IN WHEN. SURGERY
HAS PATIENTS IF AT THE
EARTHQUAKE TIME. AND THEY WE-
HAVE THE STRUCTURE IN PLACE FOR
THE E. R. TO GET THE PATIENT.
THE PATIENT COMES TO SURGERY
AND COMES TO US. I GET HIM IN
RECOVERY ROOM AND I FILL UP TO.
THE SPACES THAT WE HAVE IN THE
RECOVERY ROOM YET. THE FLOORS
ARE NOT CAPABLE OF TAKING THEM.
THEN EVERYTHING STOPS. WE
CANNOT TAKE IN ANOTHER PATIENT
SO THE FLOW OF THOSE STRUCTURES
WITH IN THE HOSPITAL AND I DO
UNDERSTAND. THAT EACH HOSPITALS
A LITTLE BIT DIFFERENT IN THAT
FLOW IN EACH COMMUNITY. BUT IN
ORDER TO BE ABLE TO COMPLETELY
FUNCTION WITHIN THAT WE HAVE TO
HAVE IT. HOSPITALS HAVE HAD A
QUARTER OF A CENTURY TO COMPLY
WITH THIS LAW. SOME HAVE SUMMER
THRIVING BUT OTHERS HAVE EVEN
AS THEY'VE BEEN REWARDED FOR
THEIR PAYOFFS TO SEE CEOS I
WORK FOR TENET HEALTHCARE. AND
THAT OKAY THANK YOU AND WE WILL
ENSURE TO BE MORE IT'S JUST
OPPORTUNITIES WHEN YOU IN A-
SERBIAN SO EACH EACH WITNESSES
TEND TO GO MORE OUT FIVE
MINUTES YOU CAN. STEP THANK YOU
I'LL I'LL I'LL TRY TO KEEP IT
BRIEF- HARD TO FOLLOW UP WITH
THE- PREVIOUS TESTIMONY-
STRUCTURE- BUT WE ARE THANKFUL
TO HAVE THE OPPORTUNITY HERE TO
ADDRESS- OF THE JOINT-
COMMITTEE- AND TO DISCUSS THE
MANY ISSUES AND POSSIBLE
SOLUTIONS TO THOSE ISSUES
PRESENTED BY HOSPITALS
ORGANIZED LABOR. AND OF COURSE
STAKEHOLDERS- I SHOULD BEGIN UP
FRONT BY SITTING THAT WE ARE IN
STRONG SUPPORT OF MAINTAINING
CALIFORNIA'S REQUIREMENT TO
BUILD AND OPERATE HOSPITALS TO
MEET THE SEISMIC STANDARDS. OF
COURSE SUCH COMPLIANCE OF
COMING FROM THE STABLE INJURIES
IS THE SECRET WE DOWANNA.
BUILD THOSE BUILDINGS AND
REPRESENT A LOT OF
OPPORTUNITIES FOR A LOT OF MEN
WOMEN AND APPRENTICES ACROSS
THE ENTIRE STATE OF CALIFORNIA.
BUT THAT'S NOT ALL OUR ENTIRE
INVOLVED IN AS WELL- MUCH OF
THE WORK INVOLVED IN HOSPITAL
CONSTRUCTION IS SIMILAR TO ANY
OTHER LARGE SCALE CONSTRUCTION
PROJECTS. THESE PROJECTS
HOWEVER ARE ALSO COMPLEX AND
REQUIRE HIGH LEVELS OF POSITION
AND SKILLS FROM VARIOUS
CONSTRUCTION CROPS. AS YOU'VE
HEARD CONSTRUCTION STANDARDS
AND ACCESS TO FINANCING FOR
HOSPITAL MEDICAL FACILITIES
PRESENT UNIQUE CHALLENGES. TO
DESIGN AND CONSTRUCTION TEAMS.
IN ADDITION TO SEISMIC
REQUIREMENTS NEW PROJECTS ARE
ALSO BUILDING TO LEAD STANDARDS
FOR ENERGY EFFICIENCY USING
HEALTHY BUILDING MATERIALS
INSTALLING WATER CONSERVATION
SYSTEMS INCORPORATING FILTERED
OUTSIDE AIR SYSTEMS ARE RESULT.
IN A SETTING THAT PROMOTES THE
HEALTH OF SAFETY A HEALTH AND
SAFETY OF PATIENTS STAFF AND
VISITORS. CREATIVE CONTRACTING
INCLUDING INTEGRATED PROJECT
DELIVERY TEAMS THE USE OF
BUILDING INFORMATION MODEL OR
BAM. MEDICAL GAS PURITY PIPING
SEISMIC BRACING AN AWESOME BED
SPECIALTY TRADE TEAMS ARE ALL
ASPECTS OF TODAY'S HOSPITAL
CONSTRUCTION. HOWEVER NO ONE
DISPUTES THAT A HOSPITAL
PROJECT THAT IT HERE'S TO LOCAL
STATE AND BUILDING CODE
REQUIREMENTS IS MORE LIKELY TO
WITHSTAND AN EMERGENCY.
SITUATION AND HAVING AND HAVING
THE BEST TRAINED WORKERS
BUILDING THE FACILITY WILL HELP
INSURE QUALITY AND STABILITY.
WE DID ALL- HAVE SOME
EXPERIENCE IN THIS AND A GERMAN
MENTIONED ON TWO THOUSAND AND
EIGHT OR SO WHEN WOMEN ARE SORE
TEENAGER CONVENED- A SERIES OF
MEETINGS ACROSS THE STATE. WE
WERE PART OF THOSE MEETINGS
BACK WE PARTNER WITH THE LABOR
WORKFORCE DEVELOPMENT AGENCY.
VERY STAKEHOLDERS TO ORGANIZE
WHAT WE CALL THE CALIFORNIA
HEALTHCARE CONSTRUCTION SUMMIT.
THE PURPOSE OF THE SUMMIT WAS
TO BRING HOSPITAL OWNERS
GENERAL CONTRACTORS
SUBCONTRACTORS AND BUILDING
TRADES WRAPS. TOGETHER TO
IDENTIFY AND FIND SOLUTIONS THE
MAIN ISSUES AND CHALLENGES AT
THE TIME THAT INVOLVED HOSPITAL
HEALTH CARE FACILITY
CONSTRUCTION. I MENTION THIS AS
AN OTION TO ESTABLISH A
SIMILAR CONVENING AIMED AT
ADDRESSING THE ISSUES RAISED
TODAY. WE SHOULD EXPLORE
STREAMLINING FOR PROJECT
DELIVERY THAT SAVES TIME AND
HOSPITAL RESOURCES. AND THE
RESULTING COMPLIANCE WITH
SEISMIC REQUIREMENTS. WE'RE
LOOKING TO LIKE SITUATIONS LIKE
AB NINE HUNDRED THE
ENVIRONMENTAL OF PROJECTS
LEADERSHIP PROJECTS WHERE
THERE'S- JUDICIAL REVIEW THAT
SHORTEN- WE'RE LOOKING AT THE
CALIFORNIA HEALTHCARE FINANCING
AUTHORITY IN SEEING HOW YOU CAN
EXPAND ACCESS TO THOSE
RESOURCES- WE SUGGEST THE STATE
WIDE BOND- WE'VE ALL KIND OF
KNOWN ABOUT THE STATE
ALLOCATION BOARD AND WHAT IT
DOES FOR SCHOOLS IN TERMS OF
MATCHING FUNDS. WHY NOT EXPAND
THOSE OPPORTUNITIES TO A LOT OF
THESE HOSPITALS THAT ARE TRYING
TO MEET THESE REQUIREMENTS ARE
HAVING OR STRUGGLING WITH
FINANCING AT THE LOCAL LEVEL. I
THINK THERE'S A LOT OF
OPPORTUNITY HEROES OF MENTIONED
BY SOME OF MY COLLEAGUES-
CREATIVE SOLUTIONS TO ADDRESS
BOTH THE FINANCING BUT ALSO
NOT- SACRIFICE HEALTH AND
SAFETY IS ALSO CRITICAL HERE SO
WE URGE- THAT CONVENING TO TAKE
PLACE. THANK YOU. THANK YOU
VERY MUCH. THANK YOU FOR YOUR
PRESENTATIONS QUESTIONS. OF A
CHURCH. THANK YOU VERY MUCH FOR
YOUR YOUR PERSPECTIVES AND
INFORMATION I APPRECIATE MISTER
DE AS A- BOB MY QUESTION WAS
GOING TO BE OKAY. WHAT DO WE
DO- WE HAVE MANY HOT WE HAVE
MANY HOSPITALS NOT NOT ALL
HOSPICE WE HAVE WE HAVE MANY
HOSPITAL CERTAINLY SO MANY IN
MY DISTRICT THAT ARE STRUGGLING
JUST TO REMAIN VIABLE AND OPEN
AS THEY ARE. LET ALONE MEETING
THE SAFETY STANDARDS- THAT ARE
COMING- AND- IF FOR SOME OF
THEM THIS MAY BE THE STRAW THAT
BREAKS THE CAMEL'S BACK AND SO-
APPRECIATE THAT YOU'VE OFFERED-
SOME SOLUTIONS THERE AT. A
STATEWIDE BOND- COULD BE THE
MOTHER OF ALL STATEWIDE BONDS-
IF THE NUMBERS BETWEEN THIRTY
TWO BILLION AND A HUNDRED AND
WHATEVER. GOT THE THAT NUMBER-
OUT THERE WOULD BE PRETTY
PRETTY. PRETTY BIG BOND- MAYBE
BEYOND OUR CAPACITY AS A STATE
QUITE FRANKLY- I DON'T KNOW.
I'M NOT BE QUESTION FOR OTHER
PEOPLE BUT I IN THAT THERE ARE
OTHER RESOURCES AS WELL SO. I
WOULD JUST SAY THAT- NOT THAT
OF COURSE LOOKING AT SCHOOL
FACILITY BONDING IS IT IS THE
ONLY OPTION AGO BUT- SINCE LIKE
EARLY TWO THOUSAND MAYBE
NINETEEN NINETY EIGHT THERE
HAVE BEEN SEVERAL SCHOOL BONDS-
A YEAR YOU ARE LOOKING AT A- A
CONSTRUCTION- TO A PROGRAM THAT
HAS MATCHING FUNDS THAT HAS.
SORT RAGED. THIRTY BILLION
DOLLARS HERSELF IN STATE
FINANCING WITH MATCHING FUNDS
AND OTHER FEDERAL RESOURCES.
THAT CAN ACTUALLY INCREASE THAT
AMOUNT- TAX EXEMPT FINANCING
AND CONDUIT FINANCING IS ALSO
SOMETHING THAT COULD BE LOOKED
AT IN EXPANDED. AS WELL AS YOU
KNOW SOME STREAMLINING FROM
SOME OF THE LOCAL APPROVAL
PROCESSES AS ENVIRONMENTAL
STANDARDS AS YOU. YOU KNOW WE
KNOW WE FULL WELL WHAT IT MEANS
FOR STADIUMS WHAT IT COULD MEAN
FOR SPECIFIC HOSPITAL PROJECT
WITHOUT SACRIFICING ACTUAL
SEQUEL BUT- HELPING COMPLIANCE-
AND STREAMLINING MOVE THE
PROJECT FASTER. DO EITHER WOULD
EITHER YOU HAVE ANYTHING YOU'D
LIKE TO ADD TO THAT. THANK YOU
MISTER DE AS A CHRISTIAN. THANK
YOU MISTER CHAIRMAN I WOULD
ECHO THE COMMENTS OF MY BROTHER
AND SISTER DE IS OVER HERE I'M
IN PART OF MY COMMENTS I
MENTION CHAFF THAT CALIFORNIA
HEALTH FACILITIES FINANCING
AUTHORITY I MEAN THESE BONDS
HAVE BEEN DETECTED THEM BONTA
BEEN USE NUMEROUS TIMES. IN
FACT I THINK CHILDREN'S
HOSPITALS AND SOME OTHERS THEY
RELEASE SEVERAL BONDS OVER TIME
I THINK THE NEXT PHASE OF THEIR
FUNDING IS MOVING SO THAT IS
DEFINITELY A VIABLE OPTION TO
EXPLORE SO I WOULD JUST ECHO
THOSE COMMENTS AND THEN
OBVIOUSLY KEEPING THE
OPPORTUNITIES OPEN FOR THE
LOCALS TO. HIM TAX THE LOCALS
WITHOUT INTERRUPTION WOULD BE
HELPFUL TO KEEP THESE HOSPITALS
OPEN WHAT I TO DO YOU KNOW I'VE
BEEN I APPRECIATE THAT TOO I DO
WONDER I MEAN SOME OF MY RURAL
COMMUNITIES THAT ARE POOR- TAX.
IT'S HARD TO SQUEEZE MONEY OUT
OF WHERE THERE IS A MONEY AND
SO WHEN I START THINKING ABOUT
SAFETY NET HOSPITALS AND RURAL
HOSPITALS THAT. I'M ALREADY
STRUGGLING THE BONDS AND THOSE
ARE THAT'S GREAT BUT I'M NOT
I'M NOT SURE HOW IF THEY'RE
STRUGGLING WITH THAT AND THEN
YOU ADD BOND PAYMENTS ON TOP OF
THAT I'M SURE THAT HOW WE HOW
WE GET THERE AND SO I
APPRECIATE APPRECIATE WHERE
YOU'RE COMING FROM BUT I. NOT
ALL HOSPITALS ARE CREATED
EQUAL- NOT ALL OF SEISMIC ZONES
ARE CREATED EQUAL AND- AND- YOU
KNOW I'M I'M NOT AN ADVOCATE
FOR ONE SIZE FITS ALL APPROACH
IS TO- COMPLEX PROBLEMS AND SO-
I THAT I THINK WE NEED TO BE
LOOKING REALLY HOLISTICALLY AND
EVERYTHING AS WE DO THIS. THANK
YOU FOR. HAVE QUESTIONS YES A
SUMMER. LIKE JUST SAVE THOUGHTS
IT IS FROM. AND I JUST I JUST
FOR. AND MAYBE YOUR INPUT TO
THAT WHEN I TO THE HOSPITAL'S
MY JUST I'VE ONE HOSPITAL THAT
WAS GOING TO THE SEISMIC YOU
KNOW UPGRADES AND THEN THEY
HAVE DIFFERENT TYPES OF PLANS
AND IT ENDED UP THEY DID A BOND
AND BUILT A BRAND NEW HOSPITAL
RATHER THAN TRY. DO WITH OLD
TOWER AND EVERYTHING ELSE THAT
THEY HAD- SO WE'RE STILL
WORKING ON THAT. WHAT'S GOING
TO HAPPEN WITH THE OLD FACILITY
BUT I HAVE ANOTHER HOSPITAL
THAT IS NEW. THAT ACTUALLY WHEN
WE TOURED IT- THEY HAVE
DIFFERENT AREAS OF THE HOSPITAL
THAT THE KIND OF SWITCH OFF AND
USE IN A DIFFERENT WAY. SO WHEN
YOU KNOW WE TALK ABOUT. MAYBE
PRIORITIZING CERTAIN AREAS TO
BE YOU KNOW SEISMICALLY
RETROFIT IN LEAVING THE OTHERS.
IN A WAITING THEM YOU KNOW
WHEN- YOU MENTIONED ABOUT THE
SUPPLY ROOM THAT'S A THOUGHT
PROVOKING THING BECAUSE IT MADE
ME THINK ABOUT THE FACT THAT
THIS ONE THE HOSPITAL. USES
THIS AREA FOR- A RECOVERY ROOM
SOMETIMES AND AS YOU KNOW SOME
TYPES OF OTHER SERVICE I CAN'T
REMEMBER EXACTLY ALL THE
DIFFERENT THINGS- OTHER TIMES
SO. IT'S NOT LIKE A ONE SIZE
FITS ALL AND I DON'T KNOW HOW
YOU COULD ISOLATED TO CERTAIN
AREAS THAT NEED TO BE. YOU KNOW
THE RETRO FITTED VERSUS OTHERS.
AND I DON'T KNOW IF YOU SEE
THAT ANOTHER BUT THAT THE-
THOUGHT OF THE SUPPLY ROOM
BEING THAT WOULD PROBABLY BE
SOMETHING THAT WOULDN'T BE
PRIORITIZED GENERALLY I DON'T
KNOW. WE'VE DONE THAT AT OUR
FACILITY WHERE. DURING THE DAY
THE CATH LAB THE- CARDIO
VASCULAR LAB HAS THE RECOVERY
AREA AND THEN AT NIGHT THEY OF
CONVERTED THAT OVER TO AN
URGENT CARE AREAS SO THAT THEY
TOOK PRESSURE OFF OF THE
EMERGENCY ROOM. YEAH THAT'S
WHAT I THINK THE IS THE ONE
AREAS A TRIAGE OR- THE OVER
FLOW FROM THE EMERGENCY ROOM
SOMETIMES AND AS WE COVER ROOM
OTHER TIMES. SO THAT AREA MIGHT
BE NOT NECESSARILY PRIORITIZED
IF YOU LOOK AT IT IN ONE USE
THE COULD BE IN ANOTHER. SOME.
NINE THANK YOU- AND I ALSO
THINK THE- OUR PRESENTERS HERE
I MEAN I THINK WE'VE REFERENCED
EARLIER IN THE HEARING- THE
IMPORTANT ROLE- HOSPO OFTEN
PLAYS IN THE COMMUNITY. DURING
A DISASTER BEYOND WHAT THE
NORMALLY VERY IMPORTANT ROLE IN
A HOSPITAL PLYS IN- JUST IN
EVERYDAY LIFE AND THEN THE ROLE
AND CERTAINLY STAFF THAT WORK
IN THE HOSPITAL AND- AND IN A
NO THERE LAW HOSPITALS AND
THERE ARE MANY OF THEM IN
VARIOUS STATE SOMEWHERE DOING
VERY WELL OTHERS. AREN'T SO BE
SO WELL- AND I THINK THAT IS-
BUT- WHEN A DISASTER STRIKES-
pTHEY DON'T GO AND SAY IS A
PUBLIC IS A PRIVATE IS IT
WHATEVER ELSE AND- AND I THINK
YEAH I APPRECIATE YOU SHARING
YOUR STORIES. ABOUT WHAT
HAPPENED IN NORTHRIDGE WE ALSO
HEARD FROM THE OTHER HOSPITALS
THE MAN'S PEOPLE COME TO THE
HOSPITAL RIGHT THEY MAY COME TO
THE HOSPITAL BECAUSE THEY ARE
INJURED OR SOMEONE- FAMILIES
INJURED BUT THEY MAY BE COMING
THE HOSPITAL JUST FOR NEWS
WHAT'S GOING ON. RIGHT IT'S-
IT'S A IT'S CONVENIENT PLACE
FOR PEOPLE AS WELL AND IT'S NOT
JUST FOR PEOPLE WHO MAY BE
RESIGNING NEIGHBORHOOD IT'S US.
ALSO THAT FOR THE FOR SPONSORS
COME RAZOR PEOPLE TO ADDRESS
HELP I THINK THERE'S A VERY
IMPORTANT ROLE FOR THE HOSPITAL
TO BE ABLE TO ACT IN THAT
FUNCTION WE CAN HAVE A DEBATE
WHETHER YOU KNOW HOW. THE
HOSPITAL SHOULD BE THE CENTER
FOR THAT- EVER IS IT'S A CITY
HALL OR SOMETHING LIKE THAT BUT
I THINK WITH THIS WAY. RIGHT
NOW. PERMIT ME GOOD. THE ROLE
THAT OUR HOSPITALS DO PLAY. AND
SHOULD PLAY A THIS ASK. GIVE
THE- THIS TYPE TO SERVE THERE.
AND SO WITH THAT I THINK THERE
IS AN ARGUMENT TO BE MADE THAT-
SOME OF PARTICULAR HOSPITALS OR
STRUGGLING THAT THERE MAY BE
SOME NEED FOR PUBLIC SUPPORT
BECAUSE AFTER ALL THEY'RE
SERVING A FUNCTION. THAT GOES
BEYOND SIMPLY. A ORG EMAIL AN
INSTITUTION THAT'S PROVIDING
HEALTH CARE RIGHT- DURING AN
EMERGENCY AND- SO THERE'S THAT
SORT OF PUBLIC SPHERE OF. OF
THAT. SAME TIME. I WOULD ALSO
MAKE NOTE AS I WAS LISTENING
CAREFULLY TO OUR- FROM OUR
PERSON FROM OSHKOSH IT IS THAT.
I THINK WELL WE MIGHT THINK
ABOUT VARIOUS PUBLIC FINANCING
OPPORTUNITIES WHETHER IT'S
BONDS ARE THE TYPES OF THINGS
TO HELP HOSPITALS THAT
STRUGGLING. I THINK WE ALSO
NEED TO RECOGNIZE THAT- THE ANY
SORT OF PUBLIC FUNDS THAT WE
USE LET THOR COULD BE ARGUED IT
CIVILLY TO ORDER. SERVICE
FUNCTION ERIC TO MEET THE.
THIRTY GOT THE IDEA OF HAVING A
BILL TO. BUILD SOME LITTLE
EXTRA ARE SOME NICER PERSON
LIKE THAT. THAT'S BUT- LET I
THINK WE ALSO NEED TO KEEP IN
MY THAT LEAST WE'RE LEVERAGE.
PUBLIC RESOURCES THE THEY CAN
ARE THAT WITH THEIR OWN FRIED
FINANCE BUT WE NEED TO THE I
THINK IN TERMS OF- TRYING TO
FIGURE OUT EXACTLY HOW MUCH OF
THE THIRTY TWO HUNDRED FORTY
THREE BILLION IS REALLY
DIRECTLY RELATED TO. THE TWENTY
THIRTY STANDARDS VERSES- OTHER
THINGS AND I RECOGNIZE WHEN
YOU'RE BUILDING SOMETHING NEW
RIGHT THERE'S A LOT OF THINGS
THAT. UBM MAKES SENSE IT'S
CHEAPER TO ADD ON TO THAT- BUT
I THINK WE NEED TO. THAT'S
SOMETHING WE NEED TO- FIGURE
OUT AS WELL AND THEN. THEN WHEN
IT COMES TO- SO EXACTLY HOW
MUCH THAT WOULD BE YOU KNOW
WHAT ROLE THAT A PUBLIC
FINANCING. WOULD WOULD BE
INVOLVED I THINK IT'S SOMETHING
THAT WE MGHT WANNA LOOK AT
AGAIN IS THAT THERE'S
HOSPITAL'S EARNED DIFFERENT
RANGES RIGHT SO WE HAVE SOME
THAT ARE DOING BETTER THAN
OTHERS BUT I THINK PARTICULAR
SAFETY NET. HOSPITALS THE OTHER
PART THAT I ALSO MIGHT WANT TO
MENTION IS THAT WE TALK ABOUT
FINANCING AND HOW THE HOSPITAL
PAYS BACK ANY SORT OF LOAN.
THAT THEY MAY HAVE- OUR SAFETY
NET HOSPITALS ARE OFTEN MORE
DEPENDENT ON. STATE XIN
REIMBURSEMENT FUNDING HAS THEIR
FUNDING STREAM LIKE MEDI CAL.
SO WE MIGHT WANT TO HAVE TO
LOOK AT. WHAT'S MEDI CAL'S
ROLE- AND WE DO GET A FEDERAL
MATCH FOR SOME OF THE MEDICAL
SPENDING. NOW IS THERE IN TERMS
OF FROM ENSURING THAT WE
PROVIDE AN ADEQUATE FINANCING
STREAM. FROM THE PATIENT CARE
RECOGNIZES AN ESSENTIAL PART OF
PATIENT CARE I MEAN WHAT WE ARE
TRYING TO DO IS TRYING TO
PROTECT. THE PATIENTS FIRST AND
THEN THE STAFF FOR TAKING CARE
OF THEM. DURING A DISASTER AND
THAT STAFF IS ALSO NEEDED SO WE
WILL KEEP THOSE PATIENTS SAFE
AND THAT'S THAT'S ALSO NEED
TAKE CARE OF OTHER PATIENTS MAY
BE COMING AND SO WE- NEED
HOSPITAL. GETTING CAN TAKE
PEOPLE GETTING INJURED WITHIN
THE HOSPITAL- AND- OR NOT BE
ABLE TO DELIVER THE HELP THEY
NEED BECAUSE OF SLOW. IN IT
UNABLE TO. RIGHT SO I THINK
THAT PART OF THE GOAL OF THE
TWENTY THIRTY STANDARDS SO
THAT. WE ACTUALLY CAN MAKE USE
OF ALL THE PROFESSIONAL. SO
THAT'S AVAIL. ON SITE BE ABLE
TO CONTINUE DELIVER SERVICES.
SO IN MY MIND AT LEAST SOME. I
DON'T I DON'T THINK WE WANT THE
CONVERSATION SHOULD BE ABOUT.
GIVE UP ON THE THIRTY STANDARD
I THINK THE- BEES. THAT THERE.
AND CAN WE- TO HELP. PLEASE AND
THE P. WORKED WELL TO GET TO
THAT. ARE USING YOU KNOW
PRUDENTLY. FOR SOME A PUBLIC TO
TRY TO HELP THEM IS TO YOU NEED
SYSTEM I THINK MANY OF THE
HOSPITALS AND PARTICULARLY
RURAL COMMUNITIES OR BEGAN
OFTENTIMES DEPENDENT ON PUBLIC
FOR. REIMBURSEMENTS ANYWAY IN
LOW INCOME COMMUNITIES. OF THE
WORD TIME ON DIFFERENT SIDES
YEAH AS AS AS ITS STATE AND
ALSO WHAT COUNTIES AND THEY'LL
PLAYING MULTIPLE ROLES IN TERMS
OF- HOW THAT HOW THAT WORKS-
SO- SO I THINK THERE'S A LOT
OF. YOU KNOW I THINK THIS IS A
CONVERSATION WE NEED TO
CONTINUE BUT- I DO WE WANT TO
CAUTION AND THAT- WE WE'VE
DECIDED AS A LEGISLATURE WE
ESTABLISH THESE I MEAN THIS IS
EXISTING LAW TWENTY THIRTY
STANDARDS AND I ALSO
APPRECIATE. HEARING FROM. I WAS
COMMON FROM AJ BUT THAT WE WANT
YOU KNOW WE WANNA TRY TO. BIG
SURE THAT WERE FOCUSING ON- YOU
KNOW WHAT THE ACTUAL RISK IS
RIGHT WHEN NOT USING A ONE SIZE
FITS ALL BUT- ULTIMATELY FOR
THAT COMMUNITY WE NEED TO BE
SURE TO HOSPITALS ABLE TO
FUNCTION. THE OTHER THING I
ALSO PERHAPS THEY CAN ALSO SAY
AND- AND PERHAPS MAYBE COMING
ON AND I KNOW YOU MADE SOME
REMARKS IS THAT. HOW DO WE AS
FOR HOSPITALS ARE TRYING TO
ACHIEVE THAT GOAL. WHAT ARE WE
TRYING TO DO TO TRY TO MINIMIZE
THE COST OF THEM GETTING THERE
SO- LITTLE YOU KNOW. TO ASK
FIGHT A LITTLE BIT LIKE CAN WE
YOU KNOW WHAT. I MEAN I WAS
INVOLVED IN SOME HOSPITAL AYE
AYE WITH WASN'T DIRECTLY
INVOLVED BY WITNESS SOME
HOSPITAL CONSTRUCTION WHEN I
WAS AT UC DAVIS AND SO WE WANT
TO BE SURE WE MAINTAIN THE
HIGHEST SAFETY STANDARDS- BUT-
CAN WE'D- LIKE. FACILITATE THAT
NOW I'M NOT TAKING S
CISIONS AND THINGS THAT OFTEN
CAN CAUSE DELAYS THAT AND
INCREASED COSTS- SPECIALLY- IF.
COME OUT YEAH. AT LEAST ONE OF
THE PRICE OF THE METALS GATHERS
YOU KNOW THE VARIOUS PARTS WAS
GOING UP DAY BY DAY AND YOU'RE
SITTING THERE WAITING FOR
DECISION AND NOW IT'S TWO
MONTHS LATER NOW. IT'S GOT A
BIT MORE EXPENSIVE TO BUILD IT
THAN IT WAS BEFORE HIM FOR THE
SAME DESIGN- MAYBE WE CAN TRY
TO DO SOMETHING ALONG THOSE
LINES AS WELL TO TRY TO HELP
REDUCE. THE COST WHAT TRAIN
CHIEF THE GOALS SO- I KNOW IT
KIND OF GAVE MORE OF A SPEECH
THAT QUESTION BUT- I AM CAN YOU
MAYBE- PERHAPS- OUR WITNESSES
CAN. REFLECT IS THAT APPROACH
THAT YOU THINK THAT- FROM YOUR
PERSPECTIVE THAT WE CAN WE CAN
ACHIEVE. AND YOUR ORGANIZATIONS
SUPPORT FOR THAT. THEN THE IS
IN THE- REBUILDING. THE
HOSPITAL. CAN DOWN AND THEY PUT
IT OFF THEY PUT IT OFF THEY PUT
IT OFF. THEY FINALLY SOLD THE
HOSPITAL N TWO THOUSAND EIGHT
TO PROVIDENCE PROVIDENCE SAID
THEY WERE GOING TO REBUILD IT.
AND BACK AT THE TIME WE WERE
TOLD THAT IT WAS GOING TO BE
ROUGHLY A HUNDRED MILLION
DOLLARS TO REBUILD THE HOSPITAL.
WELL JUST RECENTLY. PROVIDENCE
TOOK IT THEY FINALLY BROKE
GROUND THEY PUT ARE DOING THE
RETROFIT THEY'RE TEARING DOWN.
THE FRONT HALF OF THE HOSPITAL
THIS WEEK. AND CEDARS SINAI HAD
TO COME IN WITH A OVER THREE
HUNDRED MILLION DOLLAR BY AND
4409% OF THAT HOSPITAL TO TAKE
IN O IT SO THAT DELAY IN THAT
WHOLE PROCESS IS EXACTLY WHAT
YOU JUST SAID. THE CONSTRUCTION
COSTS EVERYTHING THEN IT WOULD
HAVE COST TO REPAIR IT BACK AT
THAT TIME. WAS HAS TRIPLED. AND
YET FOR ALL THAT PERIOD OF TIME
WE'VE BEEN SITTING WITH THE
HOSPITAL THE DOESN'T DOESN'T
COMPLY WE HAVE AREAS IN THE
HOSPITAL THAT I CAN SHOW YOU
WHERE THE STAIRCASE WAS
TWISTED. DURING THE INITIAL
EARTHQUAKE BUT IT'S STILL THERE
IS ONE CHANGE. IT SO IT IS
IMPORTANT THAT IT IS DONE IN A
TIMELY MANNER TO PROTECT OUR
PATIENTS. YEAH I THINK THE
SHORT ANSWER WHAT YOU'RE SAYING
IS YOU KNOW YEAH YOU DELAY
PROJECTS IT'S GOING TO COST
MORE LATER WE'VE BEEN SAYING
THAT FOR YEARS AS WE HAVE THESE
DEBATES- IT CERTAINLY DOESN'T
HIM. MAKE THINGS CHEAPER AND
THEN YOU GET TO A CERTAIN POINT
WHERE YOU JUST DO JUST A FOR
JUST A FULL NEW HOSPITAL
BECAUSE IT'S ACTUALLY CHEAPER
THAT WAY THEN TO- RETROFIT THE
PART- AND I THINK ALSO AND IN
SOME OF MY COMMENTS I WAS
TALKING ABOUT YOU KNOW. IN
INSTANCES WHERE THERE'S A HAND
OFF FOR SALE FROM HOSPITAL TO
HOSPITAL I THINK IT KIND OF WHO
WAS TO LOOK AT THOSE
TRANSACTIONS TO WE'VE BEEN
TALKING INTERNALLY IS THERE
ANYTHING THAT WE CAN DO WITH.
DEPARTMENT OF- MY DD PH KINDA
STREAMLINED LICENSING WHERE-
THE PREVIOUS BUYER IS BUYING
THE HOSPITAL THAT HAS RETROFIT
ISSUES CAN QUICKLY DO THIS THEY
CALL ONE HAND OFF. AT DOT COM
THIS WOMAN LATE THE HOSPITAL.
DOES LITTLE NEW ONES THINGS ARE.
IN OF OFF BOOK IF YOU WILL
ISSUES WERE FINE. OUR PROBLEM
THAT ALSO LEAD TO DELAYS SO
THINGS OF THAT NATURE WITH.
SOME THAT WILL BE HELPFUL TO US.
THERE IS ANOTHER THING THAT
CAME TO MIND BUT- THOSE TYPES
OF THINGS WOULD BE IT WOULD BE
INTERESTING I DON'T KNOW IF
THERE'S ANOTHER HOOK- I KNOW
THAT WE- KIND OF WALK CAREFULLY
WHEN WE TALK ABOUT EXPANDING
ANY OF THE ATTORNEY GENERAL'S
KIND OF POWERS AROUND THE
STUFF- BUT ALSO. TO YOUR POINT
ABOUT YOU KNOW THESE DIFFERENT
TRANSACTIONS YOU KNOW THE
PREVIOUS THE THAT WOULD BE
PERSPECTIVE BUYER HAS TO PONY
UP A LOT OF CASH TO STAY YES
DO. YOU KNOW EACH WITH A HOT
WEATHER SEISMIC OBLIGATIONS
PENSION OBLIGATIONS ALL THAT
SOME OF THAT STUFF FALL THROUGH
THE CRACKS AND HOW. DOES THAT-
YOU KNOW KIND OF FLOW A LITTLE
BIT MORE SMOOTHLY WITH THESE
THESE LEAST DIFFERENT
TRANSACTIONS WE'RE LOOKING AT
DIFFERENT WAYS WE CAN PROVIDE.
ON HIS. YOU MIGHT BY ONE DAY
AND THEN. THE NEXT THING FALLS
APART AND THEN YOU HAVE THAT
HOSPITAL THAT NOT ONLY NEEDS TO
BE ACQUIRED BUT HAS SAID SO
SIZE RETROFIT ON THE BOOKS HAS
TO BE MET SO HOW COULD WE WORK
WITHIN THAT FRAMEWORK TO MAKE
THINGS MORE STREAMLINED TO
WE'VE BEEN JUST WRESTLING WITH
THOSE GUYS IDEAS SO THIS
TRANSACTION ISSUES YEAH. YEAH
I'LL JUST SAY THAT WE WOULD UPS
PARTICIPATE IN LOOKING AT
WHATEVER SOLUTIONS AND SECOND-
COME OUT OF WORKING TOGETHER
WITH OF COURSE LABOR AND
BUSINESS AT THE TABLE TO YOU
KNOW TALK ABOUT THE SITUATION
YEARS MENTION WHICH IS
COMPLIANCE BUT ALSO EASING HOW
THEY GET THERE SO WE HAVE OUR
COMMITMENT THAT WE WOULD BE AT
THAT TABLE TO TRY TO COME UP
WITH A SOLUTION. THANK YOU.
RIGHT NOW ANY OTHER QUESTIONS-
THANK YOU VERY MUCH FOR YOUR
PRESENTATIONS. IT THE END OF.
OKAY SO I'M GONNA SO NOW I
THINK- WE'RE MOVING ON TO
PUBLIC COMMENT SO LEAVE THE
TURN IT GAVEL THAT YOU'RE WITH
YEAH THANK YOU SO WE'D LIKE A
PUBLIC COMMENT IF YOU CAN KEEP
YOUR COMMENTS TO A MINUTE THAT
WOULD BE GREAT I KNOW THAT'S
NOT WE WON'T I'M NOT GONNA BE
HARD ON YOU. BUT BUT IF PLEASE
FEEL FREE TO COME. HELLO MY
NAME IS THE OVERSEAS. WE ALWAYS
ALREADY FOR AND PEOPLE NORTH
CALIFORNIA WORK AT NORTHRIDGE
HIGH. OF I WAS THERE FOR THE
NINETY FOUR EARTHQUAKE I SAW
WHEN I WALK WHEN I DROVE INTO
THE HOSPITAL THE G. TOWER BY
THIS PARKING STRUCTURE WHERE I
PARK AT THE WHOLE FACADE WAS
GONE THE ONLY THING THAT
SEPARATED THE PATIENTS IN THE
OUTSIDE WORLD WAS THE SHEET
ROCK. THOSE PATIENTS WERE MOVED
OUT OF THAT BUILDING THE
OPERATING ROOM WHERE I WORK WAS
OUT OF SERVICE BECAUSE A WATER
BREAK IN THE OPERATING ROOM WE
MOVE SUPPLIES DOWN TO OUR
AMBULATORY SURGERY CENTER IN
ORDER TO BE ABLE TO TAKE CARE
OF PATIENTS. BUT BECAUSE- OF
THE- OF DAMAGE THAT WAS DONE TO
THE HOSPITAL INTO THE OPERATING
ROOM WE COULDN'T DO IT UNTIL
LIKE THE NEXT DAY BUT WE WERE
ALL READY TO DO IT TO TAKE CARE
FOR PATIENTS THAT WERE COMING
IN. AND TRUST ME THE PATIENTS
WERE COMING IN AND DROPS ARE
NICK YOU BABIES OUT- NEONATAL
INTENSIVE CARE PATIENTS THEY
WERE TAKEN DOWN FIVE FLIGHTS OF
STAIRS TO THE EMERGENCY ROOM.
AND THEY WERE ALL SHELTERED ON
THE FLOOR ON BLANKETS UNDER
SHELVES IN OUR EMERGENCY ROOM
BECAUSE THE DAY ARE THEY ABLE
CENTER WAS DAMAGED. THE
HOSPITAL. HAD OUR HOSPITAL NOT
BEEN RETRO FOR IT PRIOR TO THAT
EARTHQUAKE. THAT HOSPITAL WOULD
NOT BE STANDING TODAY. SO I
URGE YOU TO PLEASE DO NOT GIVE
UP ON THE STANDARDS THE SEISMIC
STANDARDS FOR THE EARTHQUAKE
BECAUSE IT DOES SAY BUILDINGS
BUT MOST IMPORTANTLY IT SAVES
LIVES PATIENTS EMPLOYEES THAT
ARE THERE TO CARE FOR THOSE
PATIENTS SO PLEASE I URGE YOU.
TO WHATEVER WHAT EVER IT MEANS
YOU HAVE TO WORK BUT THE
HOSPITALS THAT NEED THE FUNDS.
WORK WITH THEM. BUT WE DO NAY
SEISMIC RETROFITTING OUR
REPLACEMENT OF HOSPITALS. THANK
YOU THANK YOU. IS THERE ANYONE
ELSE. IT'S A LITTLE BRING IT
BACK- WHICH I TO CLOSE SO. I
JUST WANT TO THANK ALL OF THE
WITNESSES WHO CAME 2% TODAY AND
I REALLY APPRECIATED- THE VERY
IMPORTANT PERSPECTIVES AND
INFORMATION YOU'VE SHARED WITH-
ARE- JOINT- ASSEMBLY HEALTH
THE- COMMITTEES- AND- I THINK
THERE'S A LOT OF ISSUES FOR US
TO- TO WORK ON. IN RELATION TO
THIS ISSUE OF SEISMIC SAFETY
BUT I THINK ULTIMATELY THIS IS
ABOUT HOW O WE KEEP OUR
PATIENTS SAFE HOW DO WE KEEP
THE STAFF WHO WORK IN THE
HOSPITAL SAFE. AND HOW DO WE
KEEP OUR COMMUNITY SAFE
ESPECIALLY IN THE DISASTER- TO
SURE THAT THERE IS- THERE AT
THAT THE FACILITIES THERE IN
THE COMMUNITY OR ABLE TO
CONTINUE TO SERVE THE
COMMUNITIES- AND DURING THAT AS
ASTOR AND I WILL- I. CERTAINLY
UNDERSTAND THAT BY THE WAY JUST
BECAUSE YOU HAVE A DISASTER
DOESN'T MEAN ALL THE NORMAL
THINGS IN LIFE. IMMEDIATELY
STOP EITHER PEOPLE STILL
DELIVER BABIES DAHLE STUFF
HEART ATTACKS AND STROKES IN
ADDITION TO ALL ANY INJURIES OR
OTHER EVENTS THAT HAPPENS
RESULT DISASTER SO I THINK IT
IS IMPORTANT THAT- WE HAVE OUR-
HOSPITALS BE ABLE TO CONTINUE
TO FUNCTION. THE SAME TIME I
ALSO RECOGNIZE THAT- IN DOING
SO THE HOSPITAL IS A SERVING A
BROADER COMMUNITY FONG AND- AND
THAT- PERHAPS WILL BE AS STATE
NEED TO THINK OF SOME DIFFERENT
OP. WE CAN'T PARTICULARLY
SUPPORT- SAFETY NET HOSPITALS
HOSPITALS THAT- ARE STRUGGLING
FINANCIALLY TO BE SURE THEY CAN
BE THESE VERY IMPORTANT
STANDARD. I GUESS I THINK
EVERYONE ARE PRESENTED AND THIS
IS UP IN A VERY POOR HEARING TO
HEAR FROM ALL OF YOU. THANK YOU
VERY MUCH DOCTOR PAN FOR
WORKING WITH US ON THE AND- ANY
PARTICIPATION IN. AND YOUR
FIRST AS A PROVIDER WHICH I
THINK IS REALLY REALLY
IMPORTANT- APPRECIATE THANK YOU
EVERYBODY WHO CAME IN PRESENTED
TODAY THIS IS A COMPLEX
PROBLEM- AND- WE- THIS THE OVER-HERE THIS IS A HEARING TO. TO
LOOK AT- THE COMPLEXITY OF THE
THIS IS NOT ABOUT A SPECIFIC
BILL THIS POINT ALTHOUGH THERE
IS A BILL OUT THERE IS PENDING
IN. AND I THINK SOME OF THE
COMMENTS HERE MAY HAVE SOME
INFLUENCE OVER OVER HOW THAT
HOW THAT ULTIMATELY PLAYS OUT.
FOR ME- AND I AND I DON'T MEAN
TO BEAT A DEAD HORSE COULD-
WHICH IS STILL VERY MUCH ALIVE.
BUT YOU KNOW I THINK THE
CHALLENGES THAT WE FACE IN SOME
OF OUR OUR MORE RURAL AREAS
AREN'T ARE LITTLE DIFFERENT.
AND SO THE SIZE FITS ALL
APPROACH IS REALLY ARE A
STRUGGLE FOR ME- SOMEONE
HOSPITALS ARE STRUGGLING-
THEY'RE NOT LIKELY TO BE
ACQUIRED. MORE LIKELY TO CALL
THOSE. THEN IS THAT WOULD MEAN
FOR COMMUTE WHAT IS IT FOR THE
PEOPLE WHO WORK THERE. WAS THAT
MEAN FOR THE PEOPLE WHO- GO
THERE. WE KNOW THAT. IN OTHER
AREAS OF THE- WHERE HA. CLOSE
IT LIVE. IN CASES THE OF THE
UNIT. THE DOES. WELL WITH THAT
IN THE LONG RUN SO. GOAL WE
WANT TO SAY FOSTER. THE CAN WE-
THESE. OF AT THE DAY WE ALL
WILL. IT'LL. WE. WE'LL SEE YOU
NEXT TIME FOR.