2007 California Health and Safety Code Article 9. Hospital Owner Responsibilities

CA Codes (hsc:130050-130070)

130050.  (a) Within three years after the adoption of the standards
described in Section 130020, owners of all general acute care
hospitals shall:
   (1) Conduct seismic evaluations in accordance with procedures
developed by the office pursuant to subdivision (e) of Section 130005
and submit evaluations to the office for its review and approval.
   (2) Identify the most critical nonstructural systems that
represent the greatest risk of failure during an earthquake and
submit the timetables for upgrading those systems pursuant to
subdivision (f) of Section 130005 to the office for its review and
approval.
   (3) With respect to the nonstructural performance evaluation
required by this subdivision, the evaluation need not exceed those
required by the nonstructural performance category the hospital owner
has elected.  Additional evaluations shall be obtained if the
hospital owner elects to obtain a higher nonstructural performance
category at a future date.  A hospital owner shall report to the
office all deficiencies that are pertinent to the nonstructural
performance category the hospital owner has elected to attain.  A
complete nonstructural evaluation and list of nonstructural
deficiencies shall be submitted to the office prior to the hospital
owner selling or leasing the hospital to another party.
   (b) Within three years after the adoption of standards described
in Section 130020, owners of all general acute care hospitals shall
prepare a plan and compliance schedule for each building under the
office's jurisdiction that indicates the steps by which the hospital
intends to bring their hospital buildings into substantial compliance
with the regulations and standards developed by the office pursuant
to the Alfred E. Alquist Hospital Facilities Seismic Safety Act and
this act, identifies the phasing out of or retrofit of noncomplying
structures and systems, or outlines steps for relocation of acute
care services to facilities that comply with the regulations and
standards developed by the office pursuant to the Alfred E. Alquist
Hospital Facilities Seismic Safety Act and this act, and presents
comprehensive plans and compliance schedules to the office for its
review and approval, and integrates this schedule into the facility's
master plan.
   (c) Owners of all general acute care hospitals may be granted a
one year allowance from the requirements of subdivision (b) by the
office if they demonstrate a need for more time to prepare plans and
compliance schedules for their buildings.



130055.  Within 60 days following the office's approval of the
report submitted pursuant to subdivision (b) of Section 130050,
general acute hospital building owners shall do all of the following:

   (a) Inform the local office of emergency services or the
equivalent agency, the California Office of Emergency Services, and
the office, of each building's expected earthquake performance.
   (b) Include all pertinent information regarding the building's
expected earthquake performance in emergency training, response, and
recovery plans.
   (c) Include all pertinent information regarding the building's
expected earthquake performance in capital outlay plans.



130060.  (a) (1) After January 1, 2008, any general acute care
hospital building that is determined to be a potential risk of
collapse or pose significant loss of life shall only be used for
nonacute care hospital purposes. A delay in this deadline may be
granted by the office upon a demonstration by the owner that
compliance will result in a loss of health care capacity that may not
be provided by other general acute care hospitals within a
reasonable proximity. In its request for an extension of the
deadline, a hospital shall state why the hospital is unable to comply
with the January 1, 2008, deadline requirement.
   (2) Prior to granting an extension of the January 1, 2008,
deadline pursuant to this section, the office shall do all of the
following:
   (A) Provide public notice of a hospital's request for an extension
of the deadline. The notice, at a minimum, shall be posted on the
office's Internet Web site, and shall include the facility's name and
identification number, the status of the request, and the beginning
and ending dates of the comment period, and shall advise the public
of the opportunity to submit public comments pursuant to subparagraph
(C). The office shall also provide notice of all requests for the
deadline extension directly to interested parties upon request of the
interested parties.
   (B) Provide copies of extension requests to interested parties
within 10 working days to allow interested parties to review and
provide comment within the 45-day comment period. The copies shall
include those records that are available to the public pursuant to
the Public Records Act, Chapter 3.5 (commencing with Section 6250) of
Division 7 of Title 1 of the Government Code.
   (C) Allow the public to submit written comments on the extension
proposal for a period of not less than 45 days from the date of the
public notice.
   (b) (1)  It is the intent of the Legislature, in enacting this
subdivision, to facilitate the process of having more hospital
buildings in substantial compliance with this chapter and to take
nonconforming general acute care hospital inpatient buildings out of
service more quickly.
   (2) The functional contiguous grouping of hospital buildings of a
general acute care hospital, each of which provides, as the primary
source, one or more of the hospital's eight basic services as
specified in subdivision (a) of Section 1250, may receive a five-year
extension of the January 1, 2008, deadline specified in subdivision
(a) of this section pursuant to this subdivision for both structural
and nonstructural requirements. A functional contiguous grouping
refers to buildings containing one or more basic hospital services
that are either attached or connected in a way that is acceptable to
the State Department of Health Services. These buildings may be
either on the existing site or a new site.
   (3) To receive the five-year extension, a single building
containing all of the basic services or at least one building within
the contiguous grouping of hospital buildings shall have obtained a
building permit prior to 1973 and this building shall be evaluated
and classified as a nonconforming, Structural Performance Category-1
(SPC-1) building.  The classification shall be submitted to and
accepted by the Office of Statewide Health Planning and Development.
The identified hospital building shall be exempt from the requirement
in subdivision (a) until January 1, 2013, if the hospital agrees
that the basic service or services that were provided in that
building shall be provided, on or before January 1, 2013, as follows:

   (A) Moved into an existing conforming Structural Performance
Category-3 (SPC-3), Structural Performance Category-4 (SPC-4), or
Structural Performance Category-5 (SPC-5) and Non-Structural
Performance Category-4 (NPC-4) or Non-Structural Performance
Category-5 (NPC-5) building.
   (B) Relocated to a newly built compliant SPC-5 and NPC-4 or NPC-5
building.
   (C) Continued in the building if the building is retrofitted to a
SPC-5 and NPC-4 or NPC-5 building.
   (4) A five-year extension is also provided to a post 1973 building
if the hospital owner informs the Office of Statewide Health
Planning and Development that the building is classified as a SPC-1,
SPC-3, or SPC-4 and will be closed to general acute care inpatient
service use by January 1, 2013. The basic services in the building
shall be relocated into a SPC-5 and NPC-4 or NPC-5 building by
January 1, 2013.
   (5) Any SPC-1 buildings, other than the building identified in
paragraph (3) or (4), in the contiguous grouping of hospital
buildings shall also be exempt from the requirement in subdivision
(a) until January 1, 2013. However, on or before January 1, 2013, at
a minimum, each of these buildings shall be retrofitted to a SPC-2
and NPC-3 building, or no longer be used for general acute care
hospital inpatient services.
   (c) On or before March 1, 2001, the office shall establish a
schedule of interim work progress deadlines that hospitals shall be
required to meet to be eligible for the extension specified in
subdivision (b). To receive this extension, the hospital building or
buildings shall meet the year 2002 nonstructural requirements.
   (d) A hospital building that is eligible for an extension pursuant
to this section shall meet the January 1, 2030, nonstructural and
structural deadline requirements if the building is to be used for
general acute care inpatient services after January 1, 2030.
   (e) Upon compliance with subdivision (b), the hospital shall be
issued a written notice of compliance by the office. The office shall
send a written notice of violation to hospital owners that fail to
comply with this section.  The office shall make copies of these
notices available on its Web site.
   (f) (1) A hospital that has received an extension of the January
1, 2008, deadline pursuant to subdivisions (a) or (b) may request an
additional extension of up to two years for a hospital building that
it owns or operates.
   (2) The office may grant the additional extension if the hospital
building subject to the extension meets all of the following
criteria:
   (A) The hospital building is under construction at the time of the
request for extension under this subdivision and the purpose of the
construction is to meet the requirements of subdivision (a) to allow
the use of the building as a general acute care hospital building
after the extension deadline granted by the office pursuant to
subdivision (a) or (b).
   (B) The hospital building plans were submitted to the office and
were deemed ready for review by the office at least four years prior
to the applicable deadline for the building. The hospital shall
indicate, upon submission of its plans, the SPC-1 building or
buildings that will be retrofitted or replaced to meet the
requirements of this section as a result of the project.
   (C) The hospital received a building permit for the construction
described in subparagraph (A) at least two years prior to the
applicable deadline for the building.
   (D) The hospital submitted a construction timeline at least two
years prior to the applicable deadline for the building demonstrating
the hospital's intent to meet the applicable deadline. The timeline
shall include all of the following:
   (i) The projected construction start date.
   (ii) The projected construction completion date.
   (iii) Identification of the contractor.
   (E) The hospital is making reasonable progress toward meeting the
timeline set forth in subparagraph (D), but factors beyond the
hospital's control make it impossible for the hospital to meet the
deadline.
   (3) A hospital denied an extension pursuant to this subdivision
may appeal the denial to the Hospital Building Safety Board.
   (4) The office may revoke an extension granted pursuant to this
subdivision for any hospital building where the work of construction
is abandoned or suspended for a period of at least one year, unless
the hospital demonstrates in a public document that the abandonment
or suspension was caused by factors beyond its control.




130061.  (a) An owner of a general acute care hospital building that
is classified as a nonconforming Structural Performance Category-1
(SPC-1) building, who has not requested an extension of the deadline
described in subdivision (a) or (b) of Section 130060, shall submit a
report to the office no later than April 15, 2007, describing the
status of each building in complying with the requirements of Section
130060. The report shall identify at least all of the following:
   (1) Each building that is subject to subdivision (a) of Section
130060.
   (2) The project number or numbers for retrofit or replacement of
each building.
   (3) The projected construction start date or dates and projected
construction completion date or dates.
   (4) The building or buildings to be removed from acute care
service and the projected date or dates of this action.
   (b) An owner of a general acute care hospital building that is
classified as a nonconforming, Structural Performance Category-1
(SPC-1) building, who has requested an extension of the deadline
described in subdivision (a) or (b) of Section 130060, shall submit a
report to the office no later than June 30, 2009, describing the
status of each building in complying with the requirements of Section
130060. The report shall identify, at a minimum, all of the
following:
   (1) Each building that is subject to subdivision (a) of Section
130060.
   (2) The project number or numbers for retrofit or replacement of
each building.
   (3) The projected construction start date or dates and projected
construction completion date or dates.
   (4) The building or buildings to be removed from acute care
service and the projected date or dates of that action.
   (c) An owner of a general acute care hospital building that is
classified as a nonconforming, Structural Performance Category-1
(SPC-1) building, who has requested an extension of the deadline
described in subdivision (a) or (b) of Section 130060, shall submit a
report to the office no later than June 30, 2011, describing the
status of each building in complying with the requirements of Section
130060. The report shall identify at least all of the following:
   (1) Each building that is subject to subdivision (a) of Section
130060.
   (2) The project number or numbers for retrofit or replacement of
each building.
   (3) The projected construction start date or dates and projected
construction completion date or dates.
   (4) The building or buildings to be removed from acute care
service and the projected date or dates of that action.
   (d) The office shall make the information required by subdivisions
(a), (b), and (c) available on its Web site within 90 days of
receipt of this information.
   (e) Hospitals that have not reported pursuant to this section are
not eligible for the extension provided in subdivision (f) of Section
130060.



130061.5.  (a) The Legislature finds and declares the following:
   (1) By enacting this section, the Legislature reinforces its
commitment to ensuring the seismic safety of hospitals in California.
In order to meet that commitment, this section provides a mechanism
for hospitals that lack the financial capacity to retrofit Structural
Performance Category-1 (SPC-1) buildings by 2013 to, instead,
redirect available capital and borrowing capacity to replace those
building by 2020. The mechanism is intended to allow these hospitals
to meet the seismic requirements, and provide state agencies and the
public with more timely and detailed information about the progress
these hospitals are making toward seismic safety compliance.
   (2) This section requires hospitals seeking this assistance to
demonstrate that their financial condition does not allow them to
retrofit these buildings by 2013, and requires them to meet specified
benchmarks in order to be eligible for the extended timelines set
forth in this section.  Failure to meet any of these benchmarks shall
result in the hospital being noncompliant and subject the hospital
to loss of licensure.
   (3) It is the intent of the Legislature to ensure the continuation
of services in medically underserved communities in which the
closure of the hospital would have significant negative impacts on
access to health care services in the community.
   (4) It is also the intent of the Legislature that this section be
implemented very narrowly to target only facilities that are
essential providers in underserved communities and that lack the
financial capacity to retrofit SPC-1 buildings by 2013.
   (b) A hospital owner may meet the requirements of subdivision (a)
of Section 130060 by replacing all of its buildings subject to that
subdivision by January 1, 2020, if it meets all of the following
conditions:
   (1) The hospital owner has requested an extension of the deadline
described in subdivision (a) or (b) of Section 130060.
   (2) (A) The office certifies that the hospital owner lacks the
financial capacity to meet the requirements of subdivision (a) of
Section 130060 for that building. In order to receive the
certification, the hospital owner shall file with the office by
January 1, 2009, financial information as required by the office.
This information shall include a schedule demonstrating that, as of
the end of the hospital owner's most recent fiscal year for which the
hospital owner has filed its annual financial data with the office
by July 1, 2007, the hospital owner's annual financial data for that
fiscal year show that the hospital owner meets all of the following
financial conditions:
   (i) The owner's net long-term debt to capitalization ratio, as
measured by the ratio of net long-term debt to net long-term debt
plus equity, was above 60 percent.
   (ii) The owner's debt service coverage, as measured by the ratio
of net income plus depreciation expense plus interest expense to
current maturities on long-term debt plus interest expense, was below
4.5.
   (iii) The owner's cash-to-debt ratio, as measured by the ratio of
cash plus marketable securities plus limited use cash plus limited
use investments to current maturities on long-term debt plus net
long-term debt, was below 90 percent.
   (B) The office shall certify that a hospital owner applying for
relief under this subdivision meets each of these financial
conditions.  For the purposes of this subdivision, a hospital owner
shall be eligible for certification only if the annual financial data
required by this paragraph for the hospital owners and all of its
hospital affiliates, considered in total, meets all of these
financial conditions. For purposes of this section, "hospital
affiliate" means any hospital owned by an entity that controls, is
controlled by, or is under the common control of, directly or through
intermediate entity, the entity that owns the specified hospital.
The applicant hospital owner shall bear all costs for review, but not
to exceed the costs of review, of its financial information.
   (3) The hospital owner files with the office, by January 1, 2009,
a declaration that the hospital for which the hospital owner is
seeking relief under this subdivision shall satisfy all of the
following conditions:
   (A) The hospital shall maintain a contract with the California
Medical Assistance Commission (CMAC) under the selective provider
contracting program, unless in an open area as established by CMAC.
   (B) The hospital shall maintain at least basic emergency medical
services if the hospital provided emergency medical services at the
basic or higher level as of July 1, 2007.
   (C) The hospital meets any of the following criteria:
   (i) The hospital is located within a Medically Underserved Area or
a Health Professions Shortage Area designated by the federal
government pursuant to Sections 330 and 332 of the federal Public
Health Service Act (42 U.S.C. Secs. 254b and 254e).
   (ii) The office determines, by means of a health impact
assessment, that removal of the building or buildings from service
may diminish significantly the availability or accessibility of
health care services to an underserved community.
   (iii) The CMAC determines that the hospital is essential to
providing and maintaining Medi-Cal services in the hospital's service
area.
   (iv) The hospital demonstrates that, based on annual utilization
data submitted to the office for 2006 or later, the hospital had in
one year over 30 percent of all discharges for either Medi-Cal or
indigent patients in the county in which the hospital is located.
   (4) The hospital owner submits, by January 1, 2010, a facility
master plan for all the buildings that are subject to subdivision (a)
of Section 130060 that the hospital intends to replace by January 1,
2020.  The facility master plan shall identify at least all of the
following:
   (A) Each building that is subject to subdivision (a) of Section
130060.
   (B) The plan to replace each building with buildings that would be
in compliance with subdivision (a) of Section 130065.
   (C) The building or buildings to be removed from acute care
service and the projected date or dates of that action.
   (D) The location for any new building or buildings, including, but
not limited to, whether the owner has received a permit for that
location.  The replacement buildings shall be planned within the same
service area as the buildings to be removed from service.
   (E) A copy of the preliminary design for the new building or
buildings.
   (F) The number of beds available for acute care use in each new
building.
   (G) The timeline for completed plan submission.
   (H) The proposed construction timeline.
   (I) The proposed cost at the time of submission.
   (J) A copy of any records indicating the hospital governing board'
s approval of the facility plan.
   (5) By January 1, 2013, the hospital owner submits to the office a
building plan that is deemed ready for review by the office, for
each building.
   (6) By January 1, 2015, the hospital owner receives a building
permit to begin construction, for each building that the owner
intends to replace pursuant to the master plan.
   (7) Within six months of receipt of the building permit, the
hospital owner submits a construction timeline that identifies at
least all of the following:
   (A) Each building that is subject to subdivision (a) of Section
130060.
   (B) The project number or numbers for replacement of each
building.
   (C) The projected construction start date or dates and projected
construction completion date or dates.
   (D) The building or buildings to be removed from acute care.
   (E) The estimated cost of construction.
   (F) The name of the contractor.
   (8) Every six months thereafter, the hospital owner reports to the
office on the status of the project, including any delays or
circumstances that could materially affect the estimated completion
date.
   (9) The hospital owner pays to the office an additional fee, to be
determined by the office, sufficient to cover the additional cost
incurred by the office for maintaining all reporting requirements
established under this section, including, but not limited to, the
costs of reviewing and verifying the financial information submitted
pursuant to paragraph (2).  This additional fee shall not include any
cost for review of the plans or other duties related to receiving a
building or occupancy permit.
   (c) The office may also approve an extension of the deadline
described in subdivision (a) or (b) of Section 130060 for a general
acute care hospital building that is classified as a nonconforming
SPC-1 building and is owned or operated by a county, city, or county
and city that has requested an extension of this deadline by June 30,
2009, if the owner files a declaration with the office stating that
as of the date of that filing the owner lacks the ability to meet the
requirements of subdivision (a) of Section 130060 for that building
pursuant to subdivision (b) of that section. The declaration shall
state the commitment of the hospital to replace those buildings by
January 1, 2020, with other buildings that meet the requirements of
Section 130065 and shall meet the requirements of paragraphs (4) to
(9), inclusive, of subdivision (b).
   (d) A hospital filing a declaration pursuant to this section but
failing to meet any of the deadlines set forth in this section shall
be deemed in violation of this section and Section 130060, and shall
be subject to loss of licensure.



130063.  (a) With regard to a general acute care hospital building
located in Seismic Zone 3 as indicated in the 1995 edition of the
California Building Standards Code, any hospital may request an
exemption from Non-Structural Performance Category-3 requirements in
Title 24 of the California Code of Regulations if the hospital
building complies with the year 2002 nonstructural requirements.
   (b) The office shall determine the maximum allowable level of
earthquake ground shaking potential for purposes of this section.
   (c) To qualify for an exemption under this section, a hospital
shall provide a site-specific engineering geologic report that
demonstrates an earthquake ground shaking potential below the maximum
allowable level of earthquake ground shaking potential determined by
the office pursuant to subdivision (b).
   (d) (1) To demonstrate an earthquake ground shaking potential as
provided in subdivision (c), a hospital shall submit a site-specific
engineering geologic report to the office.
   (2) The office shall forward the report received from a hospital
to the Division of Mines and Geology in the Department of
Conservation for purposes of a review.
   (3) If, after review of the analysis, the Division of Mines and
Geology concurs with the findings of the report, it shall return the
report with a statement of concurrence to the office.  Upon the
receipt of the statement, if the ground shaking potential is below
that established pursuant to subdivision (b), the office shall grant
the exemption requested.
   (e) A hospital building that is eligible for an exemption under
this section shall meet the January 1, 2030, nonstructural
requirement deadline if the building is to be used for general acute
care inpatient services after January 1, 2030.
   (f) A hospital requesting an exemption pursuant to this section
shall pay the actual expenses incurred by the office and the Division
of Mines and Geology.
   (g) All regulatory submissions to the California Building
Standards Commission made by the office for purposes of this section
shall be deemed to be emergency regulations and shall be adopted as
emergency regulations.  This emergency regulation authority shall
remain in effect until January 1, 2004.



130063.1.  Notwithstanding Section 130063, a county-owned general
acute care hospital building is allowed an extension of the
Non-structural Performance Category-2 requirements of Title 24 of the
California Code of Regulations if all of the following conditions
are met:
   (a) The county submitted the compliance plan on or before January
1, 2001.
   (b) The county submitted the Non-structural Performance Category-2
building plans to the Office of Statewide Health Planning and
Development on or before September 1, 2001.
   (c) The county complies with the year 2002 nonstructural
requirements established by regulation 12 months after receipt of the
building permit approval letter from the Office of Statewide Health
Planning and Development.



130063.2.  Notwithstanding Section 130063, an existing county-owned
general acute care hospital building may receive a one-year extension
of the January 1, 2002, deadline for the Non-structural Performance
Category-2 requirements in Title 24 of the California Code of
Regulations if all of the following conditions are met:
   (a) The existing hospital building is removed from general acute
care service on or before January 1, 2003.
   (b) Construction of the replacement building that will meet the
2030 nonstructural and structural deadline requirements, which
commenced before January 1, 2001, is completed by January 1, 2003.



130065.  In accordance with the compliance schedule approved by the
office, but in any case no later than January 1, 2030, owners of all
acute care inpatient hospitals shall either:
   (a) Demolish, replace, or change to nonacute care use all hospital
buildings not in substantial compliance with the regulations and
standards developed by the office pursuant to the Alfred E. Alquist
Hospital Facilities Seismic Safety Act and this act.
   (b) Seismically retrofit all acute care inpatient hospital
buildings so that they are in substantial compliance with the
regulations and standards developed by the office pursuant to the
Alfred E. Alquist Hospital Facilities Seismic Safety Act and this
act.
   Upon compliance with this section, the hospital shall be issued a
written notice of compliance by the office.  The office shall send a
written notice of violation to hospital owners that fail to comply
with this section.



130070.  The office shall notify the State Department of Health
Services of the hospital owners that have received a written notice
of violation for failure to comply with either Section 130060 or
130065.  Unless the hospital places its license in voluntary
suspense, the state department shall suspend or refuse to renew the
license of a hospital that has received a notice of violation from
the office because of its failure to comply with either Section
130060 or 130065.  The license shall be reinstated or renewed upon
presentation to the state department of a written notice of
compliance issued by the office.